Objectives: In this survey, we aimed to build consensus and gather opinions on ‘Kokoro-no care’ or mental health services and psychosocial support (MHSPSS) after a disaster, among mental health professionals who engaged in care after the Great East Japan Earthquake.

Methods: We recruited mental health professionals who engaged in support activities after the Great East Japan Earthquake, which included local health professionals in the affected areas and members of mental health care teams dispatched from outside (n = 131). Adopting the Delphi process, we proposed a definition of ‘Kokoro-no care’, and asked the participants to rate the appropriateness on a 5-point Likert scale. We also solicited free comments based on the participants’ experiences during the disaster. After Round 1, we presented the summary statistics and comments, and asked the participants to re-rate the definition that had been modified based on their comments. This process was repeated twice, until the consensus criterion of ≥ 80% of the participants scoring ≥ 4 on the statement was fulfilled.

Results: In Round 1, 68.7% of the respondents rated the proposed definition ≥ 4 for its appropriateness, and 88.4% did so in Round 2. The comments were grouped into categories (and subcategories) based on those related to the definition in general (Appropriate, Continuum of MHSPSS, Cautions in operation, Alternative categorisation of care components, Whether the care component should be categorised according to the professional involved, Ambiguous use of psychology, and Others), to mental health services (Appropriate, More specification within mental health services, More explicit remarks on mental health services, and Others), and to psychosocial support (Whether the care component should be categorised according to the professional involved, Raising concerns about the terms, and Others), and others.

Conclusion: We achieved a consensus on the definition of ‘Kokoro-no care’, and systematically obtained suggestions on the concept, and practical advice on operation, based on the participants’ experiences from the Great East Japan Earthquake. This collective knowledge will serve as reference to prepare and respond to future disasters.

Background: The management of large animals during disasters and emergencies creates difficult operational environments for responders. The aims of this study were to identify the exact challenges faced by Australian emergency response personnel in their interactions with large animals and their owners, and to determine the readiness for large animal rescue (LAR) in Australia.

Methods: A survey tool collected the views and experiences of a broad cross section of emergency services personnel operating across Australia and across all hazards. Data were collected from 156 responders including Australian emergency services personnel, emergency managers such as federal agricultural departments, and local government.

Results: Overall, many of the respondents had serious concerns, and felt that there were significant issues in relation to LAR in Australia. These included the coordination of emergency care for animals, physical management of large animals, inter-agency coordination, and dealing with animal owners. Very few respondents had received any formal training in LAR, with an overwhelming majority indicating they would attend formal training if it were made available.

Discussion: Results help to guide the development of evidence-informed support tools to assist operational response and community engagement, and the production of professional development resources.

Introduction: This paper describes how American federal, state, and local organizations created, sourced, and disseminated emergency information via social media in preparation for several winter storms in one county in the state of New Jersey (USA).

Methods: Postings submitted to Twitter for three winter storm periods were collected from selected organizations, along with a purposeful sample of select private local users. Storm-related posts were analyzed for stylistic features (hashtags, retweet mentions, embedded URLs). Sharing and re-tweeting patterns were also mapped using NodeXL.

Results: Results indicate emergency management entities were active in providing preparedness and response information during the selected winter weather events. A large number of posts, however, did not include unique Twitter features that maximize dissemination and discovery by users. Visual representations of interactions illustrate opportunities for developing stronger relationships among agencies.

Discussion: Whereas previous research predominantly focuses on large-scale national or international disaster contexts, the current study instead provides needed analysis in a small-scale context. With practice during localized events like extreme weather, effective information dissemination in large events can be enhanced.

Introduction: Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries.

Method: A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient.

Results: Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%).

Conclusion: This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal.

Keywords: Disaster medicine; Disaster preparedness; Disaster epidemiology; Health systems; European Union

Introduction: Recovery from disasters is a critical function of federal, state, and local governments, yet measurable, validated indicators of community recovery remain unidentified. A list of potential recovery indicators was developed by the authors through a literature review, recovery plan review, and case study of two disaster impacted communities.

Methods: To validate the indicators, qualitative data was collected from experts on disaster recovery. Twenty-one key informant interviews and two focus groups were conducted between January and April of 2014 to solicit feedback from disaster recovery practitioners and academics.

Results: Five major themes emerged from the qualitative data. These included: the flexibility of the indicators to serve multiple purposes for communities and individuals both pre- and post- disaster; the focus areas are comprehensive, but content and organization can be improved; the importance of seeing the indicators as a self-assessment, rather than a tool for comparing communities; the potential challenges of collecting data for some indicators; and the identification of potential measurement issues with the indicators.

Discussion: The proposed recovery indicators can be utilized by both practitioners and researchers to effectively track post-disaster recovery. They capture many of the complexities of community disaster recovery and provide potential opportunities for linkages to the development of disaster recovery plans and other activities that could increase community resilience in the future.

Introduction: Older adults are vulnerable to disproportionately higher morbidity following disasters. Reasons for this vulnerability are multifaceted and vary by disaster type as well as patient comorbidities. Efforts to mitigate this increased morbidity require identification of at-risk older adults who can be targeted for intervention.

Methods: A PubMed search was performed using the search terms “geriatric, disaster” and “morbidity, disaster” to identify published articles that reported variables associated with increased morbidity of older adults during and after disasters. A review of article titles and abstracts was then conducted to identify those articles that contained evidence-based variables that render older adults vulnerable to poor health outcomes during disasters.

Results: A total of 233 studies was initially identified. After applying exclusion criteria, nine studies were chosen for the comprehensive review. Based on the synthesis of the literature, factors were identified that were repeatedly associated with morbidity and mortality among older adults during and shortly after disasters.

Conclusion: Older adults, especially those with multiple co-morbidities, are at risk of increased morbidity after disasters and catastrophic events. Factors such as the need for prescription medications, low social support, visual and hearing impairment, impaired mobility, and poor economic status are associated with an increased risk of morbidity.

Importance: Utilizing social media in an emergency can enhance abilities to locate and evacuate casualties more rapidly and effectively, and can contribute towards saving lives following a disaster, through better coordination and collaboration between search and rescue teams.

Objective: An exercise was conducted in order to test a standard operating procedure (SOP) designed to leverage social media use in response to an earthquake, and study whether social media can improve joint Israeli-Jordanian search and rescue operations following a regional earthquake.

Design: First responders from both Jordan and Israel were divided into two mixed groups of eight people each, representing joint (Israeli-Jordanian) EMS teams. Simulated patients were dispersed throughout the Ben-Gurion University Campus. The first search and rescue team used conventional methods, while the second team also used social media channels (Facebook and Twitter) to leverage search and rescue operations.

Participants: Eighteen EMS and medical professionals from Israel and Jordan, which are members of the Emergency Response Development and Strategy Forum working group, participated in the exercise.

Results: The social media team found significantly more mock casualties, 21 out of 22 (95.45%) while the no-media team found only 19 out of 22 (86.36%). Fourteen patients (63.63%) were found by the social media team earlier than the no-media team. The differences between the two groups were analyzed using the Mann-Whitney U-test, and evacuation proved to be significantly quicker in the group that had access to social media. The differences between the three injury severities groups’ extraction times in each group were analyzed using the Kruskal-Wallis test for variance. Injury severity influenced the evacuation times in the social media team but no such difference was noted in the no-media team.

Conclusions: Utilizing social media in an emergency situation enables to locate and evacuate casualties more rapidly and effectively. Social media can contribute towards saving lives during a disaster, in national and bi-national circumstances. Due to the small numbers in the groups, this finding requires further verification on a larger study cohort.

Background and objective:
Growing evidence is indicating that some of disaster affected people face challenges to resume normal life several months after an earthquake. However, there is no sufficient in-depth understanding of complex process of resuming normal life after an earthquake in Iran, as one of the most disaster-prone countries in the world, and in rural areas as a particular setting. This study aimed to explore challenges of return to normalcy in rural earthquake-stricken areas of Iran.

Methods:
The study was conducted using qualitative content analysis method (Graneheim approach). Twenty people from the earthquake-stricken areas and seven qualified experts were selected via purposeful sampling .Data was collected through semi-structured interviews, focus group discussions, and field notes from August 2013 to January 2014. Data collection continued to the point of data saturation (no new information was provided by interviewees). Data saturation supported the sample size. Data analysis was based on qualitative content analysis principles.

Results:
“Social uncertainty and confusion” was the most prominent challenge of return to the normal life after earthquake, which was categorized into six concepts of social vulnerability, lack of comprehensive rehabilitation plan, incomplete reconstruction, ignorance of local social capital, waste of assets, and psychological problems.

Conclusions:
Findings showed that social uncertainty and confusion occurs as a result of negligence of some important social aspects in process of returning to the normal life. This issue, in turn, can greatly interrupt the normal developmental processes. Understanding the challenges of life recovery after disasters will help policy makers consider social rehabilitation as a key factor in facilitation of return to normal life process after earthquakes.

Keywords: Disaster; earthquake; social rehabilitation; social uncertainty.

Aim – To explore GP perceptions of the impact of the 2010/2011 Canterbury earthquakes on primary care clinic patients.

Methods – Qualitative study using semi-structured interviews with eight GPs from the Christchurch area exploring GPs’ perceptions of the impact on patients.

Results – Patients experienced significant strain and anxiety following the earthquakes. The impact of this differed due to personal circumstances. Secondary stressors such as insurance and housing issues contributed to experiences of distress.

Conclusions – The GPs identified significant impacts on patients as a result of the earthquakes with significant levels of strain and anxiety being due to the on-going recovery process. It appears that a significant proportion of the affected population felt comfortable talking with the GPs about the earthquakes, secondary stressors and their effects upon them.