Long-term Recovery From Hurricane Sandy: Evidence From a Survey in New York City.

OBJECTIVES: This study aimed to examine a range of factors influencing the long-term recovery of New York City residents affected by Hurricane Sandy. METHODS: In a series of logistic regressions, we analyzed data from a survey of New York City residents to assess self-reported recovery status from Hurricane Sandy. RESULTS: General health, displacement from home, and household income had substantial influences on recovery. Individuals with excellent or fair health were more likely to have recovered than were individuals with poor health. Those with high and middle income were more likely to have recovered than were those with low income. Also, individuals who had not experienced a decrease in household income following Hurricane Sandy had higher odds of recovery than the odds for those with decreased income. Additionally, displacement from the home decreased the odds of recovery. Individuals who applied for assistance from the Build it Back program and the Federal Emergency Management Agency had lower odds of recovering than did those who did not apply. CONCLUSIONS: The study outlines the critical importance of health and socioeconomic factors in long-term disaster recovery and highlights the need for increased consideration of those factors in post-disaster interventions and recovery monitoring. More research is needed to assess the effectiveness of state and federal assistance programs, particularly among disadvantaged populations. (Disaster Med Public Health Preparedness. 2018;12:172-175).

Hospital referral patterns: how emergency medical care is accessed in a disaster.

BACKGROUND: A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning. METHODS: We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data. RESULTS: Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care. CONCLUSIONS: Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major incident.

Public health department training of emergency medical technicians for bioterrorism and public health emergencies: results of a national assessment.

HYPOTHESIS: The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers. METHODS: A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided. RESULTS: Local health departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%-14.9%). State health departments provided even less training (6.3%-17.3%) on all topics to emergency medical services providers. Training that was provided by the health department in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81). CONCLUSIONS: Local and state public health agencies should work with the emergency medical services systems to develop and deliver training with an all-hazards approach to disasters and other public health emergencies.