Evaluating an equity-focused approach to assess climate resilience and disaster priorities through a community survey.

As the Duwamish Valley community in Seattle, Washington, U.S.A. and other environmental justice communities nationally contend with growing risks from climate change, there have been calls for a more community-centered approach to understanding impacts and priorities to inform resilience planning. To engage community members and identify climate justice and resilience priorities, a partnership of community leaders, government-based practitioners, and academics co-produced a survey instrument and collected data from the community using the Seattle Assessment for Public Health Emergency Response (SASPER), an approach adapted from the Centers for Disease Control and Prevention's Community Assessment for Public Health Emergency Response (CASPER). In addition, we conducted a process and outcome project evaluation using quantitative survey data collected from volunteers and qualitative semi-structured interviews with project team members. In October and November 2022, teams of volunteers from partner organizations collected 162 surveys from households in the Duwamish Valley. Poor air quality, extreme heat, and wildfires were among the highest reported hazards of concern. Most Duwamish Valley households agreed or strongly agreed that their neighborhood has a strong sense of community (64%) and that they have people nearby to call when they need help (69%). Forty-seven percent of households indicated willingness to get involved with resilience planning, and 62% of households said that they would use a Resilience Hub during an emergency. Survey volunteers evaluated their participation positively, with over 85% agreeing or strongly agreeing that they learned new skills, were prepared for the survey, and would participate in future assessments. The evaluation interviews underscored that while the SASPER may have demonstrated feasibility in a pre-disaster phase, CASPER may not meet all community/partner needs in the immediate disaster response phase because of its lack of focus on equity and logistical requirements. Future research should focus on identifying less resource intensive data collection approaches that maintain the rigor and reputation of CASPER while enabling a focus on equity.

Assessment of Disaster Preparedness at the Household Level in a Pediatric Cardiology Clinic Population.

Natural and human-provoked disasters pose serious health risks to children, particularly children and youth with special healthcare needs, including many cardiology patients. The American Academy of Pediatrics (AAP) provides preparedness recommendations for families, but little is known about recommendation adherence. Caregivers of children seen in a pediatric cardiology clinic network were recruited to complete an electronic survey. Participants self-reported child medical history and their household's implementation of AAP recommended disaster preparedness items. Families received a link to AAP resources and a child ID card. Data were analyzed using descriptive statistics with Fisher's exact and Wilcoxon rank sum tests. 320 caregivers participated in the study, of whom 124 (38.8%) indicated that their child has a diagnosed cardiac condition, and 150 (46.9%) indicated that their child had special healthcare needs. The average preparedness item completion rate was 70.7% for household preparedness, 40.1% for reunification preparedness, and 26.3% for community preparedness. Households of children with medical needs had similar rates of preparedness compared to overall rates. Of all respondents, 27.8% previously received disaster preparedness resources, 67.7% would like resources on discussing disaster preparedness, and 93.0% intend to talk with their household about disaster preparedness after completing the survey. These results demonstrate a gap between AAP recommendations and household-level disaster preparedness, including patients with cardiac conditions and those with special healthcare needs. Families expressed that they were interested in getting resources for disaster preparedness. Pediatric cardiologists may consider asking about disaster preparedness and providing disaster preparedness resources tailored to the needs of their patients.

Weighing structural damage and social susceptibility: A decision-making tool to perform longitudinal studies of geographically large hazard events.

Geographically large climatic hazard events are occurring more frequently, and with this increase, more research emphasis is being placed on their impact. However, a metrology for selecting which communities to survey following an event is not frequently discussed and as a result does not effectively incorporate all relevant disciplines in disaster research. This article provides a method for selecting communities for inclusion in field studies not only based on anticipated damage but also community-level social factors that show predictive power in long-term analyses. Due to the perishable nature of disaster data, this social metric and the field study decision tool were developed with the intent of being as rapidly implementable as possible while still providing insight regarding long-term post-event community trends. The community-level social metric was developed using a hindcasting technique for hazard events in the years 2011, 2012, and 2013. Thresholds for stability and decline were established for both the predicted and the actual community outcomes. Of the communities that the model predicted would recover, 73% recovered using the definition provided. Meanwhile 74% of the communities predicted to decline did indeed decline, again using the definition provided. To enhance operability of this social metric, a decision-making tool for community selection was also formalized and implemented in a field study conducted following the December 2021 quad-state tornado outbreak in the United States. The lessons learned from this first implementation were used to inform a refined version of the decision-making tool that is presented herein.

Community resilience across Australia towards natural hazards: an application of the Conjoint Community Resiliency Assessment Measurement.

Natural hazards can turn into disasters when not managed well. An important part of disaster risk reduction is to understand how well communities are prepared for natural hazards and how well they can cope with and recover from shocks in the long term. This research assesses self-reported community resilience and asks what makes a community resilient, using Australia as a case study. It reports on an Australian-wide online survey which included questions related to the Conjoint Community Resiliency Assessment Measurement, a subjective indicator, as well as questions about risk perception, well-being, and self-efficacy. Community resilience was found to be moderately high but scores for community leadership and preparedness were low. Perceived community resilience was positively correlated with age and those with high scores for self-efficacy and well-being. There was, as expected, an inverse relationship between reliance on external support during natural hazards and self-efficacy. The results complement previous studies which used different measures of community resilience.

Economic Evaluation Approaches in the Field of Disaster Health Management.

BACKGROUND: Economic evaluation approaches are needed to establish useful interventions for saving lives, preventing economic damage, and saving recovery costs at the time of disasters. Thus, the present study is aimed to identify the studies that applied economic evaluation approaches/methods for evaluating the economic costs of disasters. METHODS: A scoping review was conducted to find the eligible studies and perform a comprehensive data analysis. RESULTS: Based on the findings, cost-effectiveness analysis, economic loss assessment, modeling, or mapping, as well as behavioral economic analysis were used as the economic evaluation approaches/methods. CONCLUSIONS: Applying economic evaluation approaches to illustrate the economic costs of disasters is highly recommended. Managing competing priorities and optimizing resources allocations to the most cost-effective interventions can be achieved by cost-effectiveness analysis. The results of economic loss assessment can be used as the basis of disaster preparedness and response planning. Economic modeling can be applied to compare different interventions and anticipate socio-economic effects of disasters. A behavioral economic approach can be effective for decision-making in the field of disaster health management. Further research is needed to identify the advantages and limitations of each economic evaluation method/approach in the field of health in disasters. Such research can preferably be designed as the systematic review and meta-analysis.

Investigating the impact of a community disaster awareness training on subjective disaster preparedness: the case of Myanmar's Ayeyarwaddy region.

This paper investigates the impact of a community disaster awareness training on subjective disaster preparedness, focusing on the case of a Republic of Korean aid-supported disaster risk reduction project in the Ayeyarwaddy region of Myanmar. A subsequent survey by the authors of a total of 182 households, an equal number of project participating and control households, produced encouraging results regarding the endeavour. Although both ordinal logistic regression and ordinary least squares models support overall robust effectiveness of participating in the project, the results also reveal different effects of specific activities. Disaster risk reduction (DRR) awareness meetings and trainings, and personal visits to share knowledge and/or to distribute informative flyers, are important. In contrast, the significance of drills or community activities, in mass, is lost in a combined model. Consequently, 'personalising risk' should be prioritised in any DRR undertaking, as well as, and in particular, development cooperation aimed at increasing confidence in disaster preparedness.

Quantitative risk assessment of typhoon storm surge for multi-risk sources.

Typhoon storm surge (TSS) is a complex marine disaster affected by multi-risk sources. Quantitative risk assessment is an important prerequisite for identifying risk areas and designing risk reduction strategies. This paper aims to propose a rapid, accurate, and comprehensive quantitative risk assessment method for TSS under multi-risk sources, including disaster occurrence probability and severity. First, identify the primary risk sources according to the disaster-causing mechanism of TSS. Then, based on the official public data from 1989 to 2020, the dependence structure among multi-risk sources is constructed using Copulas to calculate the probability of each superposition scenario. Meanwhile, build visual scenario databases employing Geographical Information System (GIS) techniques. Subsequently, the extent and depth of inundation are translated into economic risk and population risk using GIS and depth-damage functions. Finally, taking the "Mangkhut" as a case study, the method's feasibility and accuracy are verified. The results show that the primary risk sources of TSS are storm tide, astronomical tide and coastal waves. The Gumbel Copula is optimal, with OLS (ordinary least squares) and D of 0.0186 and 0.1831, respectively. The probability assessment under different superposition scenarios indicates that the greatest threat of TSS in Guangzhou comes from the storm tide and the astronomical tide. As for the "Mangkhut" case study in Jiangmen City, the assesses occurrence probability is 0.0355%, the accuracy of economic risk assessment (except mariculture) is 95.28%, and the accuracy of population risk assessment is 98.60%. Residences and the disaster-bearing bodies in 0-3 m inundation depth are most severely affected by TSS disasters. Measures such as locating residential and important buildings away from the shoreline (at least 10 km) and ground (above 3 m), formulating disaster emergency plans, and developing the forecast and prevention of storm tides and astronomical tides will help ensure the safety of residents' life and property. This paper provides an efficient and accurate method, which is of great significance for disaster control, sustainable development, and decision-making.

Factors Influencing Public Participation in Community Disaster Mitigation Activities: A Comparison of Model and Nonmodel Disaster Mitigation Communities.

Public participation in community-organized disaster mitigation activities is important for improving disaster mitigation capacity. With data from 260 questionnaires, this study compared the current status of public participation in model disaster mitigation communities and nonmodel communities in a geological-disaster-prone area. Three community-organized disaster mitigation education activities were compared cross-sectionally. A binary logistic regression was used to analyze the effects of attitude, perceived behavioral control, disaster experience, and other key factors on the public's choice to participate in community disaster mitigation activities. The analysis results indicated that model communities had higher public participation in two efforts, evacuation drills and self-help skills training, and lower participation in activities that invited them to express their feedback than nonmodel communities. The influence of attitudinal factors on the decision to participate in disaster mitigation activities had a high similarity across community types. The public participation in model disaster mitigation communities is influenced by factors such as subjective norms and participation cognition; the behavior of people in nonmodel communities is influenced by factors such as previous experience with disasters, perceived behavioral control, risk perception, and participation cognition and has a greater potential for disaster mitigation community construction. This study provides practical evidence and theoretical support for strengthening the sustainable development of disaster mitigation community building.

Multiobjective Emergency Resource Allocation under the Natural Disaster Chain with Path Planning.

Public safety and health cannot be secured without the comprehensive recognition of characteristics and reliable emergency response schemes under the disaster chain. Distinct from emergency resource allocation that focuses primarily on a single disaster, dynamic response, periodic supply, and assisted decision-making are necessary. Therefore, we propose a multiobjective emergency resource allocation model considering uncertainty under the natural disaster chain. Resource allocation was creatively combined with path planning through the proposed multiobjective cellular genetic algorithm (MOCGA) and the improved A* algorithm with avoidance of unexpected road elements. Furthermore, timeliness, efficiency, and fairness in actual rescue were optimized by MOCGA. The visualization of emergency trips and intelligent avoidance of risk areas were achieved by the improved A* algorithm. The effects of logistics performance, coupling of disaster factors, and government regulation on emergency resource allocation were discussed based on different disaster chain scenarios. The results show that disruption in infrastructure support, cascading effect of disasters, and time urgency are additional environmental challenges. The proposed model and algorithm work in obtaining the optimal solution for potential regional coordination and resilient supply, with a 22.2% increase in the total supply rate. Cooperative allocation complemented by political regulation can be a positive action for successfully responding to disaster chains.

Operationalizing Community Assessment Results to Enhance Preparedness for a Radiological Emergency.

OBJECTIVE: A radiological emergency such as the detonation of a radiological dispersal device would have catastrophic health, environmental, and economic consequences. Community assessments can provide useful information about radiological and other emergency preparedness at the household level. Tools such as logic models can be applied to link data collected in a community assessment to planned activities and targeted outcomes. This study sought to answer how public health departments can use the results of a community assessment to improve preparedness for radiological and other types of emergencies and to present a sample logic model demonstrating how questions asked in a community assessment can be used to drive intended outcomes. DESIGN: Surveys were fielded in 2019 to professionals with experience in radiological emergency preparedness, state and local health and emergency management, and journalism. Questions included the role of health departments in radiological emergency preparedness, the operationalization of results from a community assessment for preparedness, and information sharing in a radiological emergency. Descriptive statistics and a modified framework approach were used for open-ended questions. RESULTS: Nearly three-fourths of state/local officials reported that it would be at least somewhat difficult (73%; 11 of 15 state/local officials) for a local health department to operationalize the results of a community health assessment for radiological emergency preparedness. Potential barriers included competing priorities, lack of funds, and limited staff. Resources such as pretested communication materials, tailored messaging, and technical tools and training can assist health departments and emergency management agencies in using the information collected from a community assessment. CONCLUSIONS: To address implementation challenges in operationalizing the results of a community assessment, officials can use tools such as logic models to illustrate how the information gathered from a community health assessment will create an intended preparedness outcome and to advocate for funds for this type of assessment.

On the resilience of health systems: A methodological exploration across countries in the WHO African Region.

The need for resilient health systems is recognized as important for the attainment of health outcomes, given the current shocks to health services. Resilience has been defined as the capacity to "prepare and effectively respond to crises; maintain core functions; and, informed by lessons learnt, reorganize if conditions require it". There is however a recognized dichotomy between its conceptualization in literature, and its application in practice. We propose two mutually reinforcing categories of resilience, representing resilience targeted at potentially known shocks, and the inherent health system resilience, needed to respond to unpredictable shock events. We determined capacities for each of these categories, and explored this methodological proposition by computing country-specific scores against each capacity, for the 47 Member States of the WHO African Region. We assessed face validity of the computed index, to ensure derived values were representative of the different elements of resilience, and were predictive of health outcomes, and computed bias-corrected non-parametric confidence intervals of the emergency preparedness and response (EPR) and inherent system resilience (ISR) sub-indices, as well as the overall resilience index, using 1000 bootstrap replicates. We also explored the internal consistency and scale reliability of the index, by calculating Cronbach alphas for the various proposed capacities and their corresponding attributes. We computed overall resilience to be 48.4 out of a possible 100 in the 47 assessed countries, with generally lower levels of ISR. For ISR, the capacities were weakest for transformation capacity, followed by mobilization of resources, awareness of own capacities, self-regulation and finally diversity of services respectively. This paper aims to contribute to the growing body of empirical evidence on health systems and service resilience, which is of great importance to the functionality and performance of health systems, particularly in the context of COVID-19. It provides a methodological reflection for monitoring health system resilience, revealing areas of improvement in the provision of essential health services during shock events, and builds a case for the need for mechanisms, at country level, that address both specific and non-specific shocks to the health system, ultimately for the attainment of improved health outcomes.

Mass casualty medicine: time for a 21st century refresh.

Mass casualty events are on the rise globally, as we face increasing pressures from scarcity of resources, population growth, systemic inequalities, geopolitical instabilities, and polarised discourse. Although they are rare events for an individual practitioner, they are going to happen to someone, somewhere, this week, this month, this year. And whilst they are often the last consideration for healthcare systems under constant pressures from daily routine work, individuals, departments, hospitals, and systems have to step up effectively in times of crisis. Failure to do so can lead to suboptimal outcomes for casualties, and even perceived failures can have crippling consequences on staff, families, and communities for years.

Disaster Response to a Mass Casualty Incident in a Hospital Fire by Regional Disaster Medical Assistance Team: Characteristics of Hospital Fire.

OBJECTIVE: A disaster in the hospital is particularly serious and quite different from other ordinary disasters. This study aimed at analyzing the activity outcomes of a disaster medical assistance team (DMAT) for a fire disaster at the hospital. METHODS: The data which was documented by a DMAT and emergent medical technicians of a fire department contained information about the patient's characteristics, medical records, triage results, and the hospital which the patient was transferred from. Patients were categorized into four groups according to results of field triage using the simple triage and rapid treatment method. RESULTS: DMAT arrived on the scene in 37 minutes. One hundred and thirty eight (138) patients were evacuated from the disaster scene. There were 25 patients (18.1%) in the Red group, 96 patients (69.6%) in the Yellow group, and 1 patient (0.7%) in the Green group. One patient died. There were 16 (11.6%) medical staff and hospital employees. The injury of the caregiver or the medical staff was more severe compared to the family protector. CONCLUSIONS: For an effective disaster-response system in hospital disasters, it is important to secure the safety of medical staff, to utilize available medical resources, to secure patients' medical records, and to reorganize the DMAT dispatch system.

A Markov Decision Process Approach for Cost-Benefit Analysis of Infrastructure Resilience Upgrades.

As climate change threatens to cause increasingly frequent and severe natural disasters, decisionmakers must consider costly investments to enhance the resilience of critical infrastructures. Evaluating these potential resilience improvements using traditional cost-benefit analysis (CBA) approaches is often problematic because disasters are stochastic and can destroy even hardened infrastructure, meaning that the lifetimes of investments are themselves uncertain. In this article, we develop a novel Markov decision process (MDP) model for CBA of infrastructure resilience upgrades that offer prevention (reduce the probability of a disaster) and/or protection (mitigate the cost of a disaster) benefits. Stochastic features of the model include disaster occurrences and whether or not a disaster terminates the effective life of an earlier resilience upgrade. From our MDP model, we derive analytical expressions for the decisionmaker's willingness to pay (WTP) to enhance infrastructure resilience, and conduct a comparative static analysis to investigate how the WTP varies with the fundamental parameters of the problem. Following this theoretical portion of the article, we demonstrate the applicability of our MDP framework to real-world decision making by applying it to two case studies of electric utility infrastructure hardening. The first case study considers elevating a flood-prone substation and the second assesses upgrading transmission structures to withstand high winds. Results from these two case studies show that assumptions about the value of lost load during power outages and the distribution of customer types significantly influence the WTP for the resilience upgrades and are material to the decisions of whether or not to implement them.

"That's the price of living in paradise:" coastal retirement and hurricanes.

Coastal Carolina is a popular retirement destination. Ten individuals, previously interviewed regarding their decision to retire here, were re-interviewed after Hurricane Florence. This sample of eight women and two men, mean age 74.4 (range = 68-88), provided a unique opportunity to learn about their hurricane experiences and to compare their pre- and post-responses about their choice to move to the coast. Nine evacuated, including one to a local shelter. Respondents reported a lack of preparations, but neighbors played an important supportive role. Issues about the shelter and for single women were identified. Results have implications for future disaster preparations.

Developing a Context-Bound Model for Hospital Triage in Disasters and Mass Casualty Incidents in the Health System of Iran.

OBJECTIVE: The aim of this study was to develop a context-bound model of hospital triage in disasters and mass casualty incidents in the health system of Iran. METHODS: This study was done using a sequential mixed method. Data were analyzed using Expert Choice software program. RESULTS: In the qualitative phase, 27 specialists were interviewed. Walking and purposeful movement, airway and respiration, circulatory status, and mental indices were included in the finalized model. In the quantitative phase, 21 participants responded to a questionnaire for weighting and ranking the final indices based on 3 competing options, including clinical importance of the index, lack of complexity and simplicity in implementation, and speed of implementation. The index of walking and purposeful movements weighing 0.300 and ranking 1, airway and respiration weighing 0.276 and ranking 2, blood circulatory status weighing 0.245 and ranking 3, and finally mental status weighing 0.179 and ranking 4 were obtained. CONCLUSIONS: This is the first attempt to design and develop a new context-bound model of hospital triage in disasters and mass casualties in Iran. The development of new triage models is a dynamic and continuous process, and changes will be applied to them, in case further developments and improvements are required.

Adapting a Federal Disaster Medical Assistance Team to Operate During a Pandemic.

After Hurricane Laura struck the southeast coast of Louisiana in August 2020, the National Disaster Medical System (NDMS), a component of the US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, deployed several 35-person disaster medical assistance teams in response to requests for medical support at 3 hospital locations that had been severely damaged in the storm. This was the first natural disaster medical deployment for NDMS during the coronavirus disease (COVID-19) pandemic. This article describes the modifications to the standard operating procedures that were made at 1 site to reduce the risk of infection to our patients and NDMS responders, including changes to the physical layout of the tenting, and alterations to the triage and treatment process.

Disaster Risk Management Plans in Colombia: General Guidelines for Their Development.

Over the years, Colombia has faced disaster situations that have generated changes in risk management models. These situations have brought suffering, destruction, and loss of human life, but have also served as lessons to develop procedures aimed at minimizing the risks caused by the presence of hazards. The objective of this article is to provide general evidence-based guidelines for formulating disaster risk management plans for each of the 3 action processes: risk awareness, risk reduction, and disaster management in Colombia. These plans can be achieved by preparing responses to different emergencies, which arise from threats in each of the possible scenarios, and are adverse events that alter the normal functioning of entities and communities. The implementation of these prevention strategies will allow communities to respond effectively to emergencies and recover rapidly in the face of adversity.