Background: Research on healthcare delivery in zones of conflict requires sustained and systematic attention. In the context of the South Asian region, there has been an absence of research on the vulnerabilities of health care workers and institutions in areas affected by armed conflict. The paper presents a case study of the varied nature of security challenges faced by local healthcare providers in the state of Manipur in the North-eastern region of India, located in the Indo-Myanmar frontier region which has been experiencing armed violence and civil strife since the late 1960s. . The aim of this study was to assess longitudinal and spatial trends in incidents involving health care workers in Manipur during the period 2008 to 2009.

Methods: We conducted a retrospective database analysis of the Manipur Micro-level Insurgency Database 2008-2009, created by using local newspaper archives to measure the overall burden of violence experienced in the state over a two year period. Publicly available press releases of armed groups and local hospitals in the state were used to supplement the quantitative data. Simple linear regression was used to assess longitudinal trends. Data was visualized with GIS-software for spatial analysis.

Results: The mean proportion of incidents involving health care workers per month was 2.7% and ranged between 0 and 6.1% (table 2). There was a significant (P=0.037) month-to-month variation in the proportion of incidents involving health care workers, as well as a upward trend of about 0.11% per month. Spatial analysis revealed different patterns depending on whether absolute, population-adjusted, or incident-adjusted frequencies served as the basis of the analysis.

Conclusions: The paper shows a small but steady rise in violence against health workers and health institutions impeding health services in Manipur’s pervasive violence. More evidence-building backed by research along with institutional obligations and commitment is essential to protect the health-systems

Keywords: India, Manipur, insurgency, healthcare, security, ethnic strife

Objective: To identify and prioritize potential Emergency Department (ED) and hospital-based interventions which could mitigate the impact of crowding during patient surge from a widespread infectious respiratory disease outbreak and determine potential data sources that may be useful for triggering decisions to implement these high priority interventions.

Design: Expert panel utilizing Nominal Group Technique to identify and prioritize interventions, and in addition, determine appropriate “triggers” for implementation of the high priority interventions in the context of four different infectious respiratory disease scenarios that vary by patient volumes (high versus low) and illness severity (high versus low).

Setting: One day in-person conference held November, 2011.

Participants: Regional and national experts representing the fields of public health, disease surveillance, clinical medicine, ED operations, and hospital operations.

Main Outcome Measure: Prioritized list of potential interventions to reduce ED and hospital crowding, respectively. In addition, we created a prioritized list of potential data sources which could be useful to trigger interventions.

Results: High priority interventions to mitigate ED surge included standardizing admission and discharge criteria and instituting infection control measures. To mitigate hospital crowding, panelists prioritized mandatory vaccination and an algorithm for antiviral use. Data sources identified for triggering implementation of these interventions were most commonly ED and hospital utilization metrics.

Conclusions: We developed a prioritized list of potentially useful interventions to mitigate ED and hospital crowding in various outbreak scenarios. The data sources identified to “trigger” the implementation of these high priority interventions consist mainly of sources available at the local, institutional level.

Both ‘disasters’ and ‘global health in crisis’ research has dramatically grown due to the ever-increasing frequency and magnitude of crises around the world. Large volumes of peer-reviewed literature are not only a testament to the field’s value and evolution, but also present an unprecedented outpouring of seemingly unmanageable information across a wide array of crises and disciplines. Disaster medicine, health and humanitarian assistance, global health and public health disaster literature all lie within the disaster and global health in crisis literature spectrum and are increasingly accepted as multidisciplinary and transdisciplinary disciplines. Researchers, policy makers, and practitioners now face a new challenge; that of accessing this expansive literature for decision-making and exploring new areas of research. Individuals are also reaching beyond the peer-reviewed environment to grey literature using search engines like Google Scholar to access policy documents, consensus reports and conference proceedings. What is needed is a method and mechanism with which to search and retrieve relevant articles from this expansive body of literature. This manuscript presents both a framework and workable process for a diverse group of users to navigate the growing peer-reviewed and grey disaster and global health in crises literature.

Methods:
Disaster terms from textbooks, peer-reviewed and grey literature were used to design a framework of thematic clusters and subject matter ‘nodes’. A set of 84 terms, selected from 143 curated terms was organized within each node reflecting topics within the disaster and global health in crisis literature. Terms were crossed with one another and the term ‘disaster’. The results were formatted into tables and matrices. This process created a roadmap of search terms that could be applied to the PubMed database. Each search in the matrix or table results in a listed number of articles. This process was applied to literature from PubMed from 2005-2011. A complementary process was also applied to Google Scholar using the same framework of clusters, nodes, and terms expanding the search process to include the broader grey literature assets.

Results:
A framework of four thematic clusters and twelve subject matter nodes were designed to capture diverse disaster and global health in crisis-related content. From 2005-2011 there were 18,660 articles referring to the term [disaster]. Restricting the search to human research, MeSH, and English language there remained 7,736 identified articles representing an unmanageable number to adequately process for research, policy or best practices. However, using the crossed search and matrix process revealed further examples of robust realms of research in disasters, emergency medicine, EMS, public health and global health. Examples of potential gaps in current peer-reviewed disaster and global health in crisis literature were identified as mental health, elderly care, and alternate sites of care. The same framework and process was then applied to Google Scholar, specifically for topics that resulted in few PubMed search returns. When applying the same framework and process to the Google Scholar example searches retrieved unique peer-reviewed articles not identified in PubMed and documents including books, governmental documents and consensus papers.

Conclusions:
The proposed framework, methodology and process using four clusters, twelve nodes and a matrix and table process applied to PubMed and Google Scholar unlocks otherwise inaccessible opportunities to better navigate the massively growing body of peer-reviewed disaster and global health in crises literature. This approach will assist researchers, policy makers, and practitioners to generate future research questions, report on the overall evolution of the disaster and global health in crisis field and further guide disaster planning, prevention, preparedness, mitigation response and recovery.

Disaster recovery after the Indian Ocean tsunami in 2004 led to a number of challenges and raised issues concerning land rights and housing reconstruction in the affected countries. This paper discusses the resistance to relocation of fishing communities in Chennai, India. Qualitative research methods were used to describe complexities in the debate between the state and the community regarding relocation, and the paper draws attention to the dimensions of the state–community interface in the recovery process. The results of this study highlight the effects of differences in the values held by each of the stakeholders regarding relocation, the lack of community participation, and thereby the interfaces that emerge between the state and the community regarding relocation. The failure to establish a nexus between disaster recovery and the importance of a sustainable livelihood for fishing communities severely delayed housing reconstruction.

On 11 August 2012, twin earthquakes measured 6.3 and 6.4 on the Richter scale hit three towns (Ahar, Varzaqan, and Heris) in East Azerbaijan Province, Iran resulting in tragic loss of three hundred lives and leaving thousands of injured. The aim of the present study was to report the spinal injuries during recent earthquake in northwest Iran, its consequences and management. Of the 923 hospitalized patients, 26 (2.8%) had neurosurgical complications. The imaging and clinical data of the patients were retrospectively studied regarding the anatomical location of the injury, the severity of spinal injury and associated neurological deficit. To further analyze the findings, Magerl (AO) and Frankel’s classifications were used. The injuries without any fracture were considered as minor spinal injuries. The mean age of the patients was 44.54±22.52 (range: 5-88) years. We detected a total of 38 vertebral injuries including 24 major (63.15%) and 14 minor injuries (36.85%). The most common injuries were observed in the lumbar spine (19 injuries, 50%). The 24 major injuries chiefly included Magerl type A (14 injuries, 58.3%). According to the Frankel’s classification, majority of the patients (88.46%) had no neurological deficit. In this study, three patients had nerve injuries. In conclusion, the number and proportion of spinal fractures patients in the recent twin earthquakes, northwest Iran was limited and caused less nerve injuries compared to the previous similar disasters. This might be due to the milder earthquake consequences since the incident happened in the middle of the day when men were working their fields. Potential complications in patients traumatized in earthquake incidents should be monitored for and early assessment of the neurological function is required to prioritize care for the victims.

Objectives: This paper presents the initial data analysis for a survey to identify the attitudes towards systematic reviews and research of those involved in the humanitarian response to natural disasters and other crises; their priorities for evidence, and their preferences for accessing this information.

Methods: Snowballing sampling techniques were used to recruit participants who identified themselves as humanitarian aid workers, with or without experience in providing funding to aid agencies. An online questionnaire with both quantitative and qualitative questions was made available to participants using a variety of e-mail lists. Quantitative responses from 85 participants to a selection of questions were descriptively analysed using SPSS.

Results: Findings indicated that respondents had positive opinions about systematic reviews and using research evidence when planning and responding to disasters. Seventy participants answered the question on the usefulness of reviews before, during and after disasters and, of these, 83% said that systematic reviews are useful in disasters, and the remaining 17% said they did not know. No-one selected the option that systematic reviews are not useful. The most preferred format for access to systematic reviews was the whole reviews, supplemented by comments from experts in the humanitarian sector (61%), 33% choose access to the full review, 20% choose the summary of reviews and 50% choose summary of reviews plus context-specific information. Inadequate access was the most commonly reported barrier to the use of systematic reviews (70%). This was followed by the lack of time to use reviews (59%) and insufficient knowledge about reviews (49%). Respondents selected scientific evidence as the most preferred type of evidence for influencing their decisions (80%), 11% ranked personal experience highest, 6% said their organisation’s usual practice, 1% said anecdotal evidence and 1% said intuition would be their first choice. 69% of participants “strongly agreed” that evidence from systematic reviews could have a positive role in humanitarian interventions and a further 29% “agreed” with the same statement. 66% thought they would like to access them when a natural disaster is not known to be imminent, compared to 34% who said that they would not wish to access systematic reviews at such a time. 70% would like to access systematic reviews during the period of prediction that a disaster will happen

Conclusion: These preliminary findings from the Evidence Aid survey emphasise the need for “global” evidence but also the need that this be supplemented by local and context-specific knowledge. Systematic reviews could play a central role in improving the effectiveness of humanitarian aid in the planning, delivery and recovery phases of a disaster.

Keywords: Evidence base, humanitarian planning, delivery and recovery, systematic review

This paper presents the results of an analysis of data on mortality in the magnitude 6.3 earthquake that struck the central Italian city and province of L’Aquila during the night of 6 April 2009. The aim is to create a profile of the deaths in terms of age, gender, location, behaviour during the tremors, and other aspects. This could help predict the pattern of casualties and priorities for protection in future earthquakes. To establish a basis for analysis, the literature on seismic mortality is surveyed. The conclusions of previous studies are synthesised regarding patterns of mortality, entrapment, survival times, self-protective behaviour, gender and age. These factors are investigated for the data set covering the 308 fatalities in the L’Aquila earthquake, with help from interview data on behavioural factors obtained from 250 survivors. In this data set, there is a strong bias towards victimisation of young people, the elderly and women. Part of this can be explained by geographical factors regarding building performance: the rest of the explanation refers to the vulnerability of the elderly and the relationship between perception and action among female victims, who tend to be more fatalistic than men and thus did not abandon their homes between a major foreshock and the main shock of the earthquake, three hours later. In terms of casualties, earthquakes commonly discriminate against the elderly and women. Age and gender biases need further investigation and should be taken into account in seismic mitigation initiatives.

Background
In January 2010, Haiti was struck by a powerful earthquake, killing and wounding hundreds of thousands and leaving millions homeless. In order to better understand the severity of the crisis, and to provide early warning of epidemics or deteriorations in the health status of the population, Médecins Sans Frontières established surveillance for infections of epidemic potential and for death rates and malnutrition prevalence.

Methods
Trends in infections of epidemic potential were detected through passive surveillance at health facilities serving as sentinel sites. Active community surveillance of death rates and malnutrition prevalence was established through weekly home visits.

Results
There were 102,054 consultations at the 15 reporting sites during the 26 week period of operation. Acute respiratory infections, acute watery diarrhoea and malaria/fever of unknown origin accounted for the majority of proportional morbidity among the diseases under surveillance. Several alerts were triggered through the detection of immediately notifiable diseases and increasing trends in some conditions. Crude and under-5 death rates, and acute malnutrition prevalence, were below emergency thresholds.

Conclusion
Disease surveillance after disasters should include an alert and response component, requiring investment of resources in informal networks that improve sensitivity to alerts as well as on the more common systems of data collection, compilation and analysis. Information sharing between partners is necessary to strengthen early warning systems. Community-based surveillance of mortality and malnutrition is feasible but requires careful implementation and validation.

The Department of Veterans Affairs (VA) is a key player in emergency management for both veterans and civilians. Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of article characteristics include methodology, phase of emergency management addressed in the research, and study design. Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to generate suggestions for future research.

Keywords: Veterans Affairs, veterans, disaster, emergency

Introduction
Wildfires are common globally. Although there has been considerable work done on the health effects of wildfires in countries such as the USA where they occur frequently there has been relatively little work to investigate health effects in the United Kingdom. Climate change may increase the risk of increasing wildfire frequency, therefore there is an urgent need to further understand the health effects and public awareness of wildfires. This study was designed to review current evidence about the health effects of wildfires from the UK standpoint.

Methods
A comprehensive literature review of international evidence regarding wildfire related health effects was conducted in January 2012. Further information was gathered from authors’ focus groups.

Results
A review of the published evidence shows that human health can be severely affected by wildfires. Certain populations are particularly vulnerable. Wood smoke has high levels of particulate matter and toxins. Respiratory morbidity predominates, but cardiovascular, ophthalmic and psychiatric problems can also result. In addition severe burns resulting from direct contact with the fire require care in special units and carry a risk of multi – organ complications. The wider health implications from spreading air, water and land pollution are of concern. Access to affected areas and communication with populations living within them is crucial in mitigating risk.

Conclusion
This study has identified factors that may reduce public health risk from wildfires. However more research is needed to evaluate longer term health effects from wildfires. An understanding of such factors is vital to ensure preparedness within health care services for such events.

Introduction
Extreme events and disasters, such as earthquakes and floods, cause distress and are associated with some people developing mental disorders. Primary stressors inherent in many disasters can include injuries sustained or watching someone die. The literature recognises the distress which primary stressors cause and their association with mental disorders. Secondary stressors such as a lack of financial assistance, the gruelling process of submitting an insurance claim, parents’ worries about their children, and continued lack of infrastructure can manifest their effects shortly after a disaster and persist for extended periods of time. Secondary stressors, and their roles in affecting people’s longer-term mental health, should not be overlooked. We draw attention in this review to the nature of secondary stressors that are commonly identified in the literature, assess how they are measured, and develop a typology of these stressors that often affect people after extreme events.

Methods
We searched for relevant papers from 2010 and 2011 using MEDLINE®, Embase and PsycINFO®. We selected primary research papers that evaluated the associations between secondary stressors and distress or mental disorders following extreme events, and were published in English. We extracted information on which secondary stressors were assessed, and used thematic analysis to group the secondary stressors into a typology.

Results
Thirty-two relevant articles published in 2010 and 2011 were identified. Many secondary stressors were poorly defined and difficult to differentiate from primary stressors or other life events. We identified 11 categories of secondary stressors, though some extend over more than one category. The categories include: economic stressors such as problems with compensation, recovery of and rebuilding homes; loss of physical possessions and resources; health-related stressors; stress relating to education and schooling; stress arising from media reporting; family and social stressors; stress arising from loss of leisure and recreation; and stress related to changes in people’s views of the world or themselves. Limitations in this review include its focus on studies published in 2010 and 2011, which may have led to some secondary stressors being excluded. Assumptions have been made about whether certain items are secondary stressors, if unclear definitions made it difficult to differentiate them from primary stressors.

Conclusions
This is the first review, to our knowledge, that has developed a typology of secondary stressors that occur following extreme events. We discuss the differing natures of these stressors and the criteria that should be used to differentiate primary and secondary stressors. Some secondary stressors, for example, are entities in themselves, while others are persisting primary stressors that exert their effects through failure of societal responses to disasters to mitigate their immediate impacts. Future research should aim to define secondary stressors and investigate the interactions between stressors. This is essential if we are to identify which secondary stressors are amenable to interventions which might reduce their impacts on the psychosocial resilience and mental health of people who are affected by disasters.

Corresponding Author: Dr Sarah Lock, Extreme Events and Health Protection, London, 151 Buckingham Palace Road, London, SW1W 9SZ. E-mail: [email protected]

BACKGROUND
Psychosocial support is a widely accepted term referring to activities designed to promote social and psychological recovery in disasters, and is a crucial concept in the organisation and management of preparedness, response and recovery systems. The New Zealand Ministry of Health recognised the importance of a common framework of understanding this concept, and commissioned a series of workshops to promote the understanding and implementation of psychosocial support concepts in disasters.

METHODS
Two hundred and eighty-eight people participated in 9 educational workshops across New Zealand – before the recent Canterbury earthquakes – designed to educate people about the key concepts and delivery models of psychosocial support during and after emergency events. Participants were also asked to note down three key ideas concerning what psychosocial support meant to them both before and after participating in the workshop.

FINDINGS
The level of satisfaction reported both for the workshop presentations (4.5 out of 5) and the resources provided (4.6 out of 5) suggested that participants were highly engaged with the presented material, and that this may be a useful training resource tool for education about psychosocial support in emergency events. Although the general concepts of support and recovery remained important both before and after the workshops, there was a shift to expressing attitudes acknowledging the importance of the management and organisation of psychosocial support activities.

CONCLUSIONS
Overall, the findings suggest that participants’ attitudes about psychosocial support in disasters changed after attending the workshop, from a consideration of the experience of the individual in a disaster to more structured ideas about how supportive interventions might be organised and implemented. Although care should be taken to reinforce the core actions of psychosocial support for practitioners, the workshops seem to offer a promising approach for developing cross-agency understanding on managing psychosocial support interventions.

Citation: Johal S. Assessing the Impact Of Workshops Promoting Concepts of Psychosocial Support for Emergency Events. PLOS Currents Disasters. 2012 Sep 17. doi: 10.1371/4fd80324dd362.

BACKGROUND The World Health Organisation’s (WHO) sixty-fourth World Health Assembly in May 2011 adopted a resolution on ‘strengthening national health emergency and disaster management capacities and resilience of health systems’. Disaster management is a topical issue globally and countries are being encouraged to improve their disaster preparedness, along with growing international commitment to strengthening health systems. Lessons identified from disasters have not been effectively collated; essential experience is forgotten.

METHODS This paper describes the analysis of the worldwide experience of disasters through a health systems approach. A systematic search of the core literature from January 2000 to November 2011 was conducted. Components drawn from the WHO’s Global assessment of national health sector emergency preparedness and response baseline survey were combined with WHO’s six health system building blocks (or levers) to act as the initial analysis anchors, with a further grounded theory qualitative analysis of the literature allowing the identification of emerging themes and insights. The priority areas identified by this literature review were then compared with the topics covered by the new expert-consensus-derived Toolkit for assessing health-system capacity for crisis management developed by the WHO Regional Office for Europe.

FINDINGS 143 publications identified from a literature search were analysed and appraised. Themes and examples from the literature demonstrate how health system strengthening should contribute to disaster management. Priority areas under-represented in the WHO Toolkit and identified by the qualitative analysis are discussed.

INTERPRETATION Collation and analysis of the disaster management literature identifies how health system strengthening can promote resilience and efficient recovery in the face of disasters. These findings support and complement the WHO Toolkit. Countries can use the literature evidence with the WHO Toolkit to assess their disaster management capacities and identify priorities for strengthening their health system.

Citation: Bayntun C, Rockenschaub G, Murray V. Developing a health system approach to disaster management: A qualitative analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management. PLOS Currents Disasters. 2012 Aug 22. doi: 10.1371/5028b6037259a.

AIM This review aims to develop disaster management practice using a health system strengthening approach through two objectives. Firstly, to review the disaster management literature to test the hypothesis that a holistic health system approach has not been established in practice or evaluated in the core literature. Secondly, to collate the worldwide experience of disaster management found in the core literature according to the components of a health system.

METHOD A systematic review was conducted of the core literature published between January 2000 and November 2011 on the MEDLINE and Embase databases. Search terms combined the WHO’s descriptors for a health system with disaster terms. Non-restrictive inclusion criteria were applied. Papers were assessed using a quality appraisal tool. Content analysis identified the disaster management components discussed within the context of the health system.

RESULTS The search yielded 143 relevant disaster management documents for collation. The review found that none of these publications described a holistic health system approach to disaster management, and none evaluated such an approach.

CONCLUSION The findings of this review demonstrate that a holistic health system approach to disaster management has not been established in practice or evaluated in the core literature. Important lessons identified through the collation and analyses of isolated disaster-related experience require further research to incorporate them within a holistic health system approach. This approach, supported by the resolution passed at the World Health Assembly in 2011, aims to build health system resilience to protect immediate and long-term population health in the face of all-hazards disasters.

Citation: Bayntun C. A health system approach to all-hazards disaster management: A systematic review. PLOS Currents Disasters. 2012 Aug 22. doi: 10.1371/50081cad5861d.

Background
A major destructive earthquake is predicted to shake the Tehran city in the near future. To mitigate the damage from such earthquakes, it is necessary to assess the preparedness of people and find the related risk factors.

Methods
A cross-sectional study was conducted in Tehran city among people aged 15 years or older in 2009. 1195 of Tehran’s residents were interviewed using a questionnaire. Pearson chi-square test and binary logistic regression were used in order to evaluate the factors associated with preparedness against an earthquake.

Results
The analysis showed that 1076 (90.0%), 1160 (97.1%), and 490 (41.0%) of the participants achieved half of the possible scores for the knowledge, attitude, and practice components, respectively. Furthermore, in multivariate analysis low knowledge (p<0.001), having a high-school (p=0.033) or lower education (p<0.001) and living in Northern high-risk regions (p<0.001) of the Tehran were identified as risk factors for taking precautionary measures against earthquake. For low knowledge, lack of previous experience (p<0.001), and working as labor, businessman, employee (p=0.001) or being housewife (p=0.002) were related risk factors. In addition, people in the Southern high risk regions were significantly more knowledgeable (OR=0.618 compared to people in low risk regions) about earthquakes.

Conclusions
It is suggested that preparedness programs should target people with lower educational level and people in high risk regions especially the Northern districts of the city and aim at increasing public knowledge about earthquakes.

Address for correspondence: Ali Ardalan, No. 78, Italia Ave, Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Email: [email protected] or [email protected]

Citation: Ostad Taghizadeh A, Hosseini M, Navidi I, Mahaki AA, Ammari H, Ardalan A. Knowledge, Attitude and Practice of Tehran’s Inhabitants for an Earthquake and Related Determinants. PLOS Currents Disasters. 2012 Aug 6

Introduction
During disaster relief, personnel’s safety is very important. Mental well being is a part of this safety issue. There is however a lack of objective mental well being monitoring tools, usable on scene, during disaster relief. This study covers the use of validated tools towards detection of psychological distress and monitoring of mental well being of disaster relief workers, during the Belgian First Aid and Support Team deployment after the Haiti earthquake in 2010.
Methodology
The study was conducted using a demographic questionnaire combined with validated measuring instruments: Belbin Team Role, Compassion Fatigue and Satisfaction Self-Test for Helpers, DMAT PsySTART, K6+ Self Report. A baseline measurement was performed before departure on mission, and measurements were repeated at day 1 and day 7 of the mission, at the end of mission, and 7 days, 30 days and 90 days post mission.
Results
23 out of the 27 team members were included in the study.
Using the Compassion Fatigue and Satisfaction Self-Test for Helpers as a monitoring tool, a stable condition was monitored in 7 participants, a dip in 5 participants, an arousal in 10 participants and a double pattern in 1 participant.
Conclusions
The study proved the ability to monitor mental well being and detect psychological distress, by self administered validated tools, during a real disaster relief mission. However for practical reasons some tools should be adapted to the specific use in the field. This study opens a whole new research area within the mental well being and monitoring field.

Citation: Van der Auwera M, Debacker M, Hubloue I. Monitoring the mental well-being of caregivers during the Haiti-earthquake.. PLoS Currents Disasters. 2012 Jul 18

Background

On Friday March 11, 2011 a 9.0 magnitude earthquake triggered a tsunami off the eastern coast of Japan, resulting in thousands of lives lost and billions of dollars in damage around the Pacific Rim. The tsunami first reached the California coast on Friday, March 11th, causing more than $70 million in damage and at least one death. While the tsunami’s impact on California pales in comparison to the destruction caused in Japan and other areas of the Pacific, the event tested emergency responders’ ability to rapidly communicate and coordinate a response to a potential threat.

Methods

To evaluate the local public health system emergency response to the tsunami threat in California, we surveyed all local public health, emergency medical services (EMS), and emergency management agencies in coastal or floodplain counties about several domains related to the tsunami threat in California, including: (1) the extent to which their community was affected by the tsunami, (2) when and how they received notification of the event, (3) which public health response activities were carried out to address the tsunami threat in their community, and (4) which organizations contributed to the response. Public health activities were characterized using the Centers for Disease Control and Prevention (CDC) Public Health Preparedness Capabilities (PHEP) framework.

Findings

The tsunami’s impact on coastal communities in California ranged widely, both in terms of the economic consequences and the response activities. Based on estimates from the National Oceanic and Atmospheric Administration (NOAA), ten jurisdictions in California reported tsunami-related damage, which ranged from $15,000 to $35 million. Respondents first became aware of the tsunami threat in California between the hours of 10:00pm Pacific Standard Time (PST) on Thursday March 10th and 2:00pm PST on Friday March 11th, a range of 16 hours, with notification occurring through both formal and informal channels. In response to this threat, the activities most commonly reported by the local government agencies included in this study were: emergency public information and warning, emergency operations coordination, and inter-organizational information sharing, which were reported by 86%, 75%, and 65% of all respondents, respectively. When looking at the distribution of responsibility, emergency management agencies were the most likely to report assuming a lead role in these common activities as well as those related to evacuation and community recovery. While activated less frequently, public health agencies carried out emergency response functions related to surveillance and epidemiology, environmental health, and mental health/psychological support. Both local public health and EMS agencies took part in mass care and medical material management activities. A large network of organizations contributed to response activities, with emergency management, law enforcement, fire, public health, public works, EMS, and media cited by more than half of respondents.

Conclusions

In response to the tsunami threat in California, we found that emergency management agencies assumed a lead role in the local response efforts. While public health and medical agencies played a supporting role in the response, they uniquely contributed to a number of specific activities. If the response to the recent tsunami is any indication, these support activities can be anticipated in planning for future events with similar characteristics to the tsunami threat. Additionally, we found that many respondents first learned of the tsunami through the media, rather than through rapid notification systems, which suggests that government agencies must continue to develop and maintain the ability to rapidly aggregate and analyze information in order to provide accurate assessments and guidance to a potentially well-informed public.

Citation: Hunter JC, Crawley AW, Petrie M, Yang JE, Aragón TJ. Local Public Health System Response to the Tsunami Threat in Coastal California following the Tōhoku Earthquake. PLoS Currents Disasters. 2012 Jul 16

Introduction

The French warning system for heat waves is based on meteorological forecasts. Near real-time health indicators are used to support decision-making, e.g. to extend the warning period, or to choose the most appropriate preventive measures. They must be analysed rapidly to provide decision-makers useful and in-time information. The objective of the study was to evaluate such health indicators.

Methods

A literature review identified a range of possible mortality and morbidity indicators. A reduced number were selected, based on several criteria including sensitivity to heat, reactivity, representativity and data quality. Two methods were proposed to identify indicator-based statistical alarms: historical limits or control charts, depending on data availability. The use of the indicators was examined using the 2006 and 2009 heat waves.

Results

Out of 25 possible indicators, 5 were selected: total mortality, total emergency calls, total emergency visits, emergency visits for people aged 75 and over and emergency visits for causes linked to heat. In 2006 and 2009, no clear increases were observed during the heat waves. The analyses of real-time health indicators showed there was no need to modify warning proposals based on meteorological parameters.

Discussion

These findings suggest that forecasted temperatures can be used to anticipate heat waves and promote preventive actions. Health indicators may not be needed to issue a heat wave alert, but daily surveillance of health indicators may be useful for decision-makers to adapt prevention measures.

Objective: In line with Iran’s Comprehensive Health Sector Road Map, the National Institute of Health Research at the Tehran University of Medical Sciences developed the 2012-2025 road map of Disaster Health Management (DHM), including goals and objectives, strategies, activities and related prerequisites. This article presents the process and results of this road mapping project.
Methods: The project started with an expanded literature review followed by stakeholder analysis to assess level of interest and impact of related organizations to DHM; STEEP.V methodology to define determinants with a potential impact on Iran’s HDM for duration of 2012 to 2025; strength, weakness, opportunity and threat (SWOT) analysis and formulation of goals and objectives, strategies, activities, and prerequisites. Brainstorming, group discussion and interviews with key informants were used for data collection; nominal group technique was used whenever prioritization was necessary, and Delphi panel methodology was applied for consensus development.
Results: STEEP.V analysis revealed the most important Social, Technological, Environmental, Economic, Political and Value-based determinants. Iran’s DHM mission and vision were defined respectively as “Mitigation from, preparedness for, response to and recovery from consequences of natural and man-made hazards at the community level as well as to the health facilities and resources of I.R.Iran” and “In 2025, Iran’s DHM will be the most developed system in the region resulting in the least vulnerability, the highest readiness in health facilities and resources, and the highest and most effective contribution of the Iranian community to disaster resilience”, respectively. Sixteen strategies and related activities, along with the necessary prerequisites, were developed.
Conclusions: This was the first attempt at comprehensive strategic planning in the field of DHM in Iran. The current framework provides Iran’s health system with a list of strategies and activities to be considered in operational planning and actions. However, a dynamic process of evaluation and revision is required to ensure that Iran’s health system goals are met by 2025.

Address for correspondence: Ali Ardalan, No. 78, Italia Ave, Department of Disaster and Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. Email: [email protected] or [email protected]

Citation: Ardalan A, Rajaei MH, Masoumi G, Azin A, Zonoobi V, Sarvar M, Vaskoei Eshkevari K, Ahmadnezhad E, Jafari G. 2012-2025 Roadmap of I.R.Iran’s Disaster Health Management. PLoS Currents Disasters. 2012 Jul 16

Introduction
While most people who are involved in disasters recover with the support of their families, friends and colleagues, the effects on some people’s health, relationships and welfare can be extensive and sustained. Flooding can pose substantial social and mental health problems that may continue over extended periods of time. Flooding can challenge the psychosocial resilience of the hardiest of people who are affected.

Methods
The Health Protection Agency (HPA) undertook a review of the literature published from 2004 to 2010. It is intended to: assess and appraise the epidemiological evidence on flooding and mental health; assess the existing guidance on emergency planning for the impacts of flooding on psychosocial and mental health needs; provide a detailed report for policymakers and services on practical methods to reduce the impacts of flooding on the mental health of affected people; and identify where research can support future evidence-based guidance. The HPA identified 48 papers which met its criteria. The team also reviewed and discussed relevant government and non-government guidance documents. This paper presents a summary of the outcomes and recommendations from this review of the literature.

Results
The review indicates that flooding affects people of all ages, can exacerbate or provoke mental health problems, and highlights the importance of secondary stressors in prolonging the psychosocial impacts of flooding. The distressing experiences that the majority of people experience transiently or for longer periods after disasters can be difficult to distinguish from symptoms of common mental disorders. This emphasises the need to reduce the impact of primary and secondary stressors on people affected by flooding and the importance of narrative approaches to differentiate distress from mental disorder. Much of the literature focuses on post-traumatic stress disorder; diagnosable depressive and anxiety disorders and substance misuse are under-represented in the published data. Most people’s psychosocial needs are met through their close relationships with their families, friends and communities; smaller proportions of people are likely to require specialised mental healthcare. Finally, there are a number of methodological challenges that arise when conducting research and when analysing and comparing data on the psychosocial and mental health impacts of floods.

Conclusions
The HPA’s findings showed that a multi-sector approach that involves communities as well as agencies is the best way to promote wellbeing and recovery. Agreeing and using internationally understood definitions of and the thresholds that separate distress, mental health and mental ill health would improve the process of assessing, analysing and comparing research findings. Further research is needed on the longitudinal effects of flooding on people’s mental health, the effects of successive flooding on populations, and the effects of flooding on the mental health of children, young people and older people and people who respond to the needs of other persons in the aftermath of disasters.

Corresponding author: Carla Stanke
Address: Health Protection Agency
151 Buckingham Palace Road
London SW1W 9SZ
E-mail: [email protected]
Fax: 020 7811 7759
Telephone: 020 7811 7161

Background

To adequately plan relief, adequate information that describe and quantify the severity of a disaster, and estimate the number of affected population, is rapidly needed. However, needs assessments describing the severity of the disaster has been shown to be conducted too late in order to guide the first days relief interventions. The aim of this study was to assess availability of early disaster severity information on Internet during the first seven days following the 2010 Haiti earthquake and assess to which extent the information was consistent with later revelations.

Methods

We searched the well acknowledged web portal Relief Web for all Haiti postings during the first seven days (12 -18 January 2010) after the earthquake. A form was created to classify and quantify extracted severity variables found in the postings. The results were compiled, analysed and compared with CRED (Centre for Research on the Epidemiology of Disaster) official data made available later.

Findings

A total of 822 reports were posted where of 15 % provided a numerical estimate of the affected population, while 10% had an estimate on the number of dead. On day four 200 000 dead was reported, which is of the same magnitud compared to later official estimates (CRED data). Not a single report described the data collection method.

Conclusions

Within a few days of the 2010 Haiti earthquake it was possible to find surprisingly accurate information regarding severity of the earthquake but the available data must be questioned as no method was reported. More specialized and independent needs assessment agencies may improve availability of strategic information in the early onset of a disaster.

Background: In 2003, the Task Force on Quality Control of Disaster Management (WADEM) published guidelines for evaluation and research on health disaster management and recommended the development of a uniform data reporting tool. Standardized and complete reporting of data related to disaster medical response activities will facilitate the interpretation of results, comparisons between medical response systems and quality improvement in the management of disaster victims.

Methods: Over a two-year period, a group of 16 experts in the fields of research, education, ethics and operational aspects of disaster medical management from 8 countries carried out a consensus process based on a modified Delphi method and Utstein-style technique.

Results: The EMDM Academy Consensus Group produced an Utstein-style template for uniform data reporting of acute disaster medical response, including 15 data elements with indicators, that can be used for both research and quality improvement.

Conclusion: It is anticipated that the Utstein-style template will enable better and more accurate completion of reports on disaster medical response and contribute to further scientific evidence and knowledge related to disaster medical management in order to optimize medical response system interventions and to improve outcomes of disaster victims.

Cholera is an endemic disease in certain well-defined areas in the east of the Democratic Republic of Congo (DRC). The west of the country, including the mega-city Kinshasa, has been free of cases since mid 2001 when the last outbreak ended. Methods and Findings: We used routinely collected passive surveillance data to construct epidemic curves of the cholera cases and map the spatio-temporal progress of the disease during the first 47 weeks of 2011. We compared the spatial distribution of disease spread to that which occurred in the last cholera epidemic in Kinshasa between 1996 and 2001. To better understand previous determinants of cholera spread in this region, we conducted a correlation analysis to assess the impact of rainfall on weekly health zone cholera case counts between December 1998 and March 2001 and a Generalized Linear Model (GLM) regression analysis to identify factors that have been associated with the most vulnerable health zones within Kinshasa between October 1998 and June 1999. In February 2011, cholera reemerged in a region surrounding Kisangani and gradually spread westwards following the course of the Congo River to Kinshasa, home to 10 million people. Ten sampled isolates were confirmed to be Vibrio cholerae O1, biotype El Tor, serotype Inaba, resistant to trimethoprim-sulfa, furazolidone, nalidixic acid, sulfisoxaole, and streptomycin, and intermediate resistant to Chloramphenicol. An analysis of a previous outbreak in Kinshasa shows that rainfall was correlated with case counts and that health zone population densities as well as fishing and trade activities were predictors of case counts. Conclusion: Cholera is particularly difficult to tackle in the DRC. Given the duration of the rainy season and increased riverine traffic from the eastern provinces in late 2011, we expect further increases in cholera in the coming months and especially within the mega-city Kinshasa. We urge all partners involved in the response to remain alert.

Background: July 2006 was the first major heat wave in France after the creation of a heat prevention plan. Understanding its impacts on health will help improving the efficiency of this plan. We assessed the mortality impact of the heat wave, and investigated the influence of the heat prevention plan.

Methods: The study focused on nine French cities. A Poisson regression model was used to analyze the correlation between temperature, air quality and mortality. An additional spline of time was introduced to capture an additional heat wave effect. Heat-action days defined by the prevention plan were introduced as a dummy variable.

Results: 411 extra deaths were observed in the nine cities during the 2006 heat wave. Unlike the 2003 heat wave, no additional heat wave effect was observed in 2006. The maximum daily relative risk of mortality varied from 1.45 in Strasbourg (IC 95% [1.01-2.08]) to 1.04 in Lille (IC 95% [0.92-1.18]). The impact on mortality of the implementation of heat-action days was non-significant and highly variable depending on the cities, with a combined excess of relative risk of -3.3% (IC 95% [-10.3%; 4.4%]).

Conclusions: Although no specific heat wave effect was observed, warm temperatures and air pollution were still responsible for a significant excess mortality in France. The absence of a specific heat wave effect may be partly explained by the prevention plan. It may also indicate that higher temperatures are required to observe a mortality outburst.

Objective: To model the possible air pollution-related health impact of the 2005 oil depot fire at Buncefield, near London, UK, under alternative meteorological conditions to those experienced at the time.

Design: Atmospheric dispersion modelling of the smoke plume was conducted under the range of meteorological conditions occurring throughout 2005 assuming constant particle emission rates. Population exposure to particle concentrations (PM10) was calculated by linking the atmospheric dispersion modelling data (2 km resolution) and postcode population data. Health impacts were estimated using time-series-based exposure-response relationships for PM10 available from the epidemiological literature.

Main outcomes: Estimates of pollution-related deaths brought forward, emergency hospital admissions from respiratory problems and emergency hospital admissions from cardiovascular disease.

Findings: The highest four-day population exposure to PM10 for meteorological data from 2005 was predicted to occur between 5 and 8 August 2005, when northerly winds would have carried the plume towards London and surrounding areas of high population density. On these days, we estimated the additional PM10 exposure would have resulted in around 12 extra deaths brought forward, and around 13 additional emergency hospital admissions and a similar additional number of emergency admissions for cardiovascular disease. These numbers are slightly greater than estimated deaths and emergency admissions attributable to regular anthropogenic PM10 concentrations in south east England over the same four day period.

Conclusions: Although the particle pollution-related health impacts of the Buncefield fire could have been higher under different meteorological conditions, it is unlikely that the impacts would be substantially greater than those attributable to regular anthropogenic particle pollution over the similar period.

Keywords: oil depot fire; health impact; epidemiology; air pollution; explosion; atmospheric dispersion modelling; exposure