Utilization of the Disaster Medical Assistance Team (DMAT) in an Inner-City Emergency Department During the COVID-19 Pandemic.

OBJECTIVE: To evaluate the effect of the Disaster Medical Assistance Team (DMAT) in an inner-city emergency department during the coronavirus disease (COVID-19) pandemic. METHODS: Data were abstracted from individual emergency department encounters over 6 weeks. The study compared left without being seen (LWBS) percentage, door-to-provider, and door-to-disposition times for 2 weeks before, during, and after the DMAT. RESULTS: The LWBS percentages for the 2 weeks before and after the DMAT were 16.2% and 11.6%, respectively. The LWBS percentage during the DMAT was 8.1%. Door-to-disposition times for the 2 weeks before and after the DMAT were 7.36 hours and 8.53 hours, respectively. The door-to-disposition during the DMAT was 7.33 hours. Door-to-disposition was statistically significant during the 2 weeks of the DMAT compared to the 2 weeks after the DMAT (7.33 vs 8.53, P < 0.05) but not statistically significant when compared to the period before the DMAT (7.36 vs 7.33, P = 1.00). Door-to-provider time was the longest during the DMAT (122.5 minutes [2.04 hours]) when compared to the time frame before the DMAT (114.54 minutes [1.91 hours]) and after the DMAT (102.84 minutes [1.71 hours]). CONCLUSION: The DMAT had the most positive impact on LWBS percentages. The DMAT showed no improvement in door-to-provider times in the study and only in door-to-disposition times when comparing the time the DMAT was present to after the DMAT departed.

Investigating Factors Influencing Disaster Preparedness Perception of Nurses in Turkey:A Meta-Analytic Approach.

AIM AND BACKGROUND: In contemporary healthcare, the crucial importance of disaster preparedness and response within the nursing profession has gained recognition. Considering the elevated probability of encountering numerous disasters in Türkiye, it is noteworthy that limited research has been conducted in this domain. This study, therefore, aims to investigate the related factors to nurses' disaster preparedness Türkiye through a meta-analysis method. METHODS: The study was conducted based on PRISMA guidelines. We searched the national databases in Türkiye and Web of Science Core Collection. Descriptive studies published in Turkish or English between 01.01.2000-31.12.2021 in Türkiye were included in the study to derive the pooled outputs. RESULTS: A total of nine studies, encompassing a sample size of 3222 nurses, met the inclusion criteria. The meta-analysis' results revealed that gender and prior experience with disasters did not exhibit a statistically significant impact on nurses' disaster preparedness (p>0.05). Conversely, engaging in disaster education programs, familiarizing oneself with disaster plans, and actively participating in disaster drills were found to have a significant positive effect on nurses' preparedness for disasters (p<0.05). However, it is worth noting that the analysis of disaster experience exhibited substantial heterogeneity (I2=85.6%), indicating variations among the included studies. Similarly, the analysis related to reading disaster plans also demonstrated high heterogeneity (I2=77.7%). CONCLUSION: Based on the available evidence from the meta-analysis, it can be concluded that receiving disaster education, reading disaster plans, and participating in disaster drills have a positive and significant impact on nurses' perception of disaster preparedness.

Women's reproductive health in the aftermath of natural disasters in Bangladesh: Prospects for empowerment.

In this study, the authors examine the effect of Cyclone Sidr in 2007 on selected aspects of women's reproductive decision-making in Bangladesh. We used Person in Environment theories to model the effect of cyclone Sidr on the reasons for non-contraception among women who did not want a child. The difference-in-difference approach was used as a research design using Bangladesh Demographic and Health Surveys of 2004 and 2011 to test a model of reasons for non-contraception among a subsample of women who did not want a child. Our results indicated that women experienced fewer social controls on contraceptive use decision-making in the aftermath of a natural disaster.

Coral geochemical response to uplift in the aftermath of the 2005 Nias-Simeulue earthquake.

On 28 March 2005, the Indonesian islands of Nias and Simeulue experienced a powerful Mw 8.6 earthquake and coseismic uplift and subsidence. In areas of coastal uplift (up to ~ 2.8 m), fringing reef coral communities were killed by exposure, while deeper corals that survived were subjected to habitats with altered runoff, sediment and nutrient regimes. Here we present time-series (2000-2009) of Mn/Ca, Y/Ca and Ba/Ca variability in massive Porites corals from Nias to assess the environmental impact of a wide range of vertical displacement (+ 2.5 m to - 0.4 m). High-resolution LA-ICP-MS measurements show that skeletal Mn/Ca increased at uplifted sites, regardless of reef type, indicating a post-earthquake increase in suspended sediment delivery. Transient and/or long-term increases in skeletal Y/Ca at all uplift sites support the idea of increased sediment delivery. Coral Mn/Ca and Ba/Ca in lagoonal environments highlight the additional influences of reef bathymetry, wind-driven sediment resuspension, and phytoplankton blooms on coral geochemistry. Together, the results show that the Nias reefs adapted to fundamentally altered hydrographic conditions. We show how centuries of repeated subsidence and uplift during great-earthquake cycles along the Sunda megathrust may have shaped the modern-day predominance of massive scleractinian corals on the West Sumatran reefs.

Use of virtual reality exercises in disaster preparedness training: A scoping review.

Background: The scope and number of disasters have increased over the years. This has called for more robust disaster preparedness training and plans. The use of virtual reality exercises in addition to tabletop exercises is considered a new approach to the preparation of disaster preparedness plans. Virtual reality exercises are being developed to either replace or complement current traditional approaches to disaster preparedness training. Objectives: To review and summarize the current existing literature regarding the effectiveness, advantages and limitations of using virtual reality exercises in disaster preparedness as a complementary/replacement mechanism for real-time drills and tabletop exercises. Methods: In this scoping review, we searched PubMed, Cochrane, EMBASE, PLOS, and Google Scholar for research publications involving virtual reality exercises in disaster training from 2008 to 2022 using "AND" and "OR" operators for the keywords "disaster," "preparedness," "virtual reality," and "tabletop." From a total of 333 articles that resulted in our search and were then evaluated by the authors, 55 articles were finally included in this review. Results: Virtual reality exercises are found to be better in the formulation of disaster preparedness plans compared to tabletop exercises. Virtual reality exercises can be used as the primary means of creating a real-life-like experience in disaster preparedness training and proved at least as better complementary to tabletop exercises. Virtual reality exercises have many advantages over traditional real-life or tabletop exercises and are more cost-effective, but some drawbacks are still identified. Conclusion: The advantages of virtual reality exercises are remarkable and underline their benefits and uses versus costs. We highly encourage decision-makers and institutions dealing in disaster preparedness to adopt using virtual reality exercises in training for disaster preparedness.

Ethical-legal dilemmas of nursing practice in emergencies and disasters: a scoping review.

OBJECTIVE: To map the ethical-legal dilemmas related to nursing practice in emergency and disaster situations. METHOD: A scoping review developed in accordance with the JBI method, whose information sources were accessed in databases, in addition to gray literature. The selection was made by reading the titles, abstracts and descriptors, observing eligibility criteria, including two reviewers and a third in case of discrepancies. After reading, data extraction and content analysis of 17 selected studies were carried out. RESULTS: Thirteen ethical-legal dilemmas were mapped related to professional/functional duty towards the family, lack of personal protective equipment and unsafe conditions at work, preparation and availability for action, skills, limits imposed by victims' religion, obligation to provide care. CONCLUSION: Professionals, researchers and representatives of the category need to resolve demands that involve acting in emergencies and disasters, (re)cognizing the ethical-legal dilemma, and seeking (re)legal frameworks and observance of the fundamental/ethical principles that govern the profession, in the sense to support decision-making and the development of legally safe practices.

The impact of coping strategies and positive resources on post-traumatic stress symptoms among bereaved families of the Sewol ferry disaster.

Introduction: This study investigated the long-term prevalence of, and factors associated with, post-traumatic stress disorder (PTSD) among the bereaved families of the Sewol ferry disaster, in which 250 students lost their lives during a school excursion. Methods: Eight years after the disaster, 181 family members were surveyed, and the prevalence of clinical PTSD symptoms was estimated. The Positive Resources Test (POREST), the Duke-UNC Functional Social Support Questionnaire, and the Brief COPE were evaluated using self-report measures. The multivariable binomial logistic regression was used to identify protective and risk factors for PTSD. Results: PTSD symptoms were present in 49.7% of the family members 8 years after the incident. A one-point increase in the score on the optimism subscale of the POREST was associated with a 20.1% decreased likelihood of having clinical PTSD symptoms (OR = 0.799; p = 0.027; 95% CI = 0.655-0.975). Conversely, a one-point increase in the score on the avoidant subscale of Brief COPE was associated with a 13.2% increased likelihood of having clinical PTSD symptoms (OR = 1.132; p = 0.041; 95% CI = 1.005-1.274). Discussion: Our results provide evidence of the need for long-term mental health monitoring of bereaved families of disaster victims, along with valuable insights for the development of mental health intervention programs.

Cyclone Jasper's rains in the context of climate change.

Cyclone Jasper struck northern Queensland in mid-December, 2023, causing extensive flooding stemming from torrential rain. Many stations reported rainfall totals exceeding 1 m, and a few surpassed 2 m, possibly making Jasper the wettest tropical cyclone in Australian history. To be better prepared for events like Jasper, it is useful to estimate the probability of rainfall events of Jasper's magnitude and how that probability is likely to evolve as climate warms. To make such estimates, we apply an advanced tropical cyclone downscaling technique to nine global climate models, generating a total of 27,000 synthetic tropical cyclones each for the climate of the recent past and that of the end of this century. We estimate that the annual probability of 1 m of rain from tropical cyclones at Cairns increases from about 0.8% at the end of the 20th century to about 2.3% at the end of the 21st, a factor of almost three. Interpolating frequency to the year 2023 suggests that the current annual probability of Jasper's rainfall is about 1.2%, about a 50% increase over that of the year 2000. Further analysis suggests that the primary causes of increasing rainfall are stronger cyclones and a moister atmosphere.

Influence of climate change on emerging pathogens and human immunity.

Global warming can be defined as the detectable increase in average global temperature in the last ten years regarding frequency and intensity. Climate change represents a long-term detectable climatic variability. The climatic system of the earth is disrupted because of the continuous production of greenhouse gases, which raises the risk of the emergence and re-emergence of human pathogens. In this review, we aimed to present the different mechanisms of climate change that increase human/pathogen exposure, introduce the recent concept of disaster microbiology, and discuss the effects of climate change on zoonoses as well as the effects of climate change on antibiotic resistance and human health.

Post-earthquake dizziness and its psychiatric comorbidities among adolescents following the 2023 Kahramanmaras earthquakes in Turkey.

OBJECTIVE: Natural disasters, such as earthquakes, have detrimental effects on mental health. The occurrence of dizziness following earthquakes, termed post-earthquake dizziness syndrome (PEDS), has been noted in the epicenter and surrounding areas. The current study aimed to explore the prevalence of PEDS and its association with psychiatric disorders among adolescents. METHODS: The sample consisted of 100 adolescents, aged 10-17 years, who had no history of vertigo or dizziness and were treated at a child and adolescent psychiatry outpatient clinic. RESULTS: In the aftermath of the earthquake, 68.0% of the adolescents reported experiencing PEDS. A higher prevalence of PEDS was found among female adolescents compared to males. The most frequently reported symptom of PEDS was a sensation of ground shaking, typically experienced indoors within a week following the earthquake. Unpaired t-test analysis revealed that adolescents with PEDS had significantly higher scores on scales measuring panic disorder, generalized anxiety disorder, and post-traumatic stress disorder compared to those without PEDS. CONCLUSIONS: In summary, the findings highlight the potential association between PEDS and psychiatric disorders in adolescents. However, the underlying mechanisms remain elusive, necessitating further research to elucidate the connections between PEDS and psychiatric conditions for more effective treatment strategies.

Exploring Cascading Disaster Risk During Complex Emergencies: Chemical Industry Disaster Risk Assessment in the Aftermath of the Kakhovka Dam Bombing in Ukraine.

OBJECTIVE: This risk assessment aims to investigate the analysis of cascading disaster risks from the perspective of the chemical industry and public health subsequent to the Kakhovka dam bombing in Ukraine. METHOD: The study utilized a modified observational cross-sectional risk assessment method to assess disaster risk. The method involved identifying the location of chemical factories, determining flooded or at-risk factories, analyzing the type and frequency of chemical hazards, assessing population exposure, and plotting a disaster risk metric. Data on chemical industries and flood extent were collected from open-source secondary data. RESULTS: The destruction of the Kakhovka dam in June 2023 led to severe flooding, placing 42 000 individuals at risk. The analysis identified four chemical factories, with 1 affected by flooding and 3 at risk. The overall risk assessment indicated a high likelihood and severe consequences, including loss of life, environmental contamination, and property damage. CONCLUSION: The combination of complex emergencies and high-risk chemical facilities in Kherson Oblast poses a significant risk of a chemical industry disaster. The interplay between compound and cascading risks during complex emergencies amid the current war further exacerbates the situation, leading to the devastation and destruction of the environment to the detriment of life, and aligns with the characterization of ecocide.

Effectiveness of a Fire Disaster PFA Simulation Game: A Single-Blinded Trial.

OBJECTIVE: As societies become more complex, disasters are increasing in frequency and magnitude. To respond to the psychological problems that may arise in such situations, it is necessary to develop the psychological first aid (PFA) training program that is more engaging for disaster relief workers and less limited in time and space. This study aimed to investigate the effectiveness of a web-based PFA simulation game for disaster relief workers to provide to fire disaster victims. METHODS: This was a non-randomized controlled experimental study with 30 participants in the experimental and control groups. The experimental group learned through the web-based PFA simulation game developed in this study, and the control group was provided with written educational materials regarding general disaster. The effects of time between groups and interaction between groups were tested. RESULTS: Compared to the control group, the experimental group showed significant effects on core competencies in disaster response, self-efficacy, and problem-solving process, and the persistence of the effects was also significantly different. CONCLUSION: The web-based PFA simulation game was found to be effective in improving core competencies in disaster response, self-efficacy, and problem-solving process of disaster relief workers. These results suggest that simulation games can be an effective learning method for learning PFA for disaster relief workers. Since it is difficult to learn through direct participation in disaster situations, a web-based simulation game may be a more effective way to improve and maintain the competence of PFA.

Next Generation Computing and Communication Hub for First Responders in Smart Cities.

This paper contributes to the development of a Next Generation First Responder (NGFR) communication platform with the key goal of embedding it into a smart city technology infrastructure. The framework of this approach is a concept known as SmartHub, developed by the US Department of Homeland Security. The proposed embedding methodology complies with the standard categories and indicators of smart city performance. This paper offers two practice-centered extensions of the NGFR hub, which are also the main results: first, a cognitive workload monitoring of first responders as a basis for their performance assessment, monitoring, and improvement; and second, a highly sensitive problem of human society, the emergency assistance tools for individuals with disabilities. Both extensions explore various technological-societal dimensions of smart cities, including interoperability, standardization, and accessibility to assistive technologies for people with disabilities. Regarding cognitive workload monitoring, the core result is a novel AI formalism, an ensemble of machine learning processes aggregated using machine reasoning. This ensemble enables predictive situation assessment and self-aware computing, which is the basis of the digital twin concept. We experimentally demonstrate a specific component of a digital twin of an NGFR, a near-real-time monitoring of the NGFR cognitive workload. Regarding our second result, a problem of emergency assistance for individuals with disabilities that originated as accessibility to assistive technologies to promote disability inclusion, we provide the NGFR specification focusing on interactions based on AI formalism and using a unified hub platform. This paper also discusses a technology roadmap using the notion of the Emergency Management Cycle (EMC), a commonly accepted doctrine for managing disasters through the steps of mitigation, preparedness, response, and recovery. It positions the NGFR hub as a benchmark of the smart city emergency service.

Long-term mental health and resilience of the first responders in Japanese ground self-defense forces engaging body recovery after the great east Japan earthquake.

Handling human remains is extremely difficult and stressful task, and it can contribute to the development of stress-related mental health problems. To prevent disaster from the development of mental disorders in first responders, it will be important to elucidate factors sustaining psychological well-being following the events requiring handling of human remains. Japanese Ground Self-Defense Forces (JGSDF) first responders (n = 146), involved in human remains recovery after the Great East Japan Earthquake (GEJE) participated. We examined the psychological resilience (S-H Resilience Test), depressive symptoms (SDS), and psychological distress (GHQ-28) 6 years after GEJE, in three groups; Group A: no contact no view of human remains, B: view only of human remains, and C: direct handling of human remains. S-H Resilience test evaluated the 3 subclasses of resilience; Social Support, Self Efficacy, Sociality. One-way ANOVA revealed the significant difference in resilience scores between Group B and C without any differences in depressive symptoms or psychological distress among the 3 groups. Multiple regression analyses revealed that depressive symptoms and resilience were associated with psychological distress in all participants. Path analyses showed that whereas one subtype of resilience indirectly reduced psychological distress through lower depressive symptoms in Group A (Social Support) and Group B (Sociality), both subtypes of resilience indirectly reduced psychological distress by lowering depressive symptoms in Group C. These findings suggest that exposure to higher stressful situation may decrease the psychological resilience based on the S-H Resilience test, and two subtypes of resilience may be necessary to sustain the psychological well-being.

From Tragedy to Resilience in a University Hospital: Characteristics of Patients in the Aftermath of the 2023 Turkey Earthquake.

OBJECTIVE: This study focuses on adults affected by the February 2023 Turkey earthquakes, aiming to uncover demographic and clinical traits. METHODS: A retrospective analysis of data from adult patients who sought emergency care between February 6 and February 21, 2023, following the earthquakes, was conducted. RESULTS: Among 3072 patients, 1544 (50.3%) of whom were women, trauma (31.1%) was the most prevalent cause of emergency department presentations. The median age of all patients was 44 y (interquartile range [IQR] 31-61 y). Hatay province accounted for 65.2% of trauma patients as origin. Most of the patients (66.8%) presented to the emergency department by their own means, while this was opposite for trauma patients, of whom 54.5% was transferred by means of Ambulance Service. Half of the total trauma patients were rescued from the debris, and 75.9% sustained limb injuries. Crush syndrome affected 24.7%, and emergency hemodialysis was performed on 9.1%, whereas emergency surgery was performed on 22.8% of all trauma cases. Overall, 10.2% of trauma patients lacked any identification. The rate of emergency department admittions due to respiratory and cardiovascular diseases was higher at the time of the earthquake compared with the previous year (P < 0.001). CONCLUSIONS: The insights gained from this study hold valuable implications for disaster response strategies, emphasizing the importance of preparedness, timely intervention, and comprehensive patient care.

Investigation of innovative designs of high-velocity channels for damping kinetic energy of flows.

In our contemporary world, demanding sustainable resource management, the study focuses on innovative fast flow channel designs. It investigates their efficacy in reducing flow kinetic energy, aiming to optimize water and energy management and diminish flood risks. Employing diverse methodologies, it analyzes and develops these designs, proving their substantial impact on stream energy management. These innovations not only enhance energy efficiency but also mitigate risks associated with excess kinetic energy, promoting safer stream management. This research significantly contributes to fluid dynamics and engineering, deepening the understanding of kinetic energy control in flows and offering potential solutions for water supply, environmental sustainability, and infrastructure safety challenges.