The Annual Global Incidence Rate of Extreme Weather Event Disasters Appears Positively Correlated with World GDP, 1961-2020.

OBJECTIVE: This study compared the per capita annual global incidence rate of disasters caused by natural hazards with the annual world real gross domestic product, GDP (per global capita), as reported during 1961 through 2020. METHODS: Sixty (60) values for the world real GDP per global capita (in constant 2015 $USD) were compared to corresponding annual values for global incidence rates for five natural disaster subgroups and then for a total of twelve individual disaster types that comprise the subgroups; each expressed as an annual global incidence rate (in terms of annual incidence per 100,000 persons). Calculations of multiple linear regression, ANOVA, and Pearson's correlation coefficient were performed for comparing population-adjusted values for GDP to corresponding values. RESULTS: Four out of five hydrological and meteorological disasters were found to have a positive correlation with GDP. Results of the analysis revealed a relatively high degree of correlation between world GDP and the annual incidence of flood and storm disasters (P = 6.21 × 10-10 and P = 4.23 × 10-4, respectively). The annual incidence of heat waves and cold weather disasters also appeared to correlate with GDP (P = .002 and P = .019, respectively). In comparison, wet landslides indicated no such correlation (P = .862). No significant associations were found among the seven other individual biological, climatological, and geophysical disasters and GDP. CONCLUSION: The global incidence of four extreme weather (hydrometeorological) disasters appear to be positively associated with world real GDP during 1961-2020. These findings contradict previous postulates that the risk of disaster incidence is inversely associated with the capacity of the population.

Validity of the National Health Security Preparedness Index as a Predictor of Excess COVID-19 Mortality.

OBJECTIVE: This study compared 2019 values for the National Health Security Preparedness Index (NHSPI) with 2020 rates of coronavirus disease 2019 (COVID-19)-related mortality as reported by the 50 US states and Puerto Rico during the first six months of the US pandemic (March 1 - August 31, 2020). METHODS: Data regarding provisional death counts and estimates of excess deaths for COVID-19 according to state and territory were downloaded from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website. Reporting included the six-month-long period of March 1 - August 31, 2020. Excess mortality rates were calculated as the number of excess deaths per 100,000 persons in each state population using 2019 US Census Bureau data. Mean values for state and territorial NHSPI domain indices were compared to state and territorial rates of COVID-19-related excess mortality using multiple linear regression, including analysis of variance. Correlations between the 51 state and territorial NHSPI values and corresponding COVID-19 excess mortality rates were calculated using Pearson's correlation coefficient. RESULTS: These calculations revealed a high degree of variance (adjusted r square = 0.02 and 0.25) and poor correlation (P = .16 and .08) among values for the overall NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.There was also a high degree of variance (adjusted r square = 0.001 and 0.03) and poor correlation (P values ranging from .09 to .94) for values for the six individual domains of the NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico. CONCLUSION: The NHSPI does not appear to be a valid predictor of excess COVID-19 mortality rates for 50 US states and Puerto Rico during the first six months of the pandemic.

Measuring the Efficacy of a Pilot Public Health Intervention for Engaging Communities of Puerto Rico to Rapidly Write Hurricane Protection Plans.

OBJECTIVE: The efficacy is measured for a public health intervention related to community-based planning for population protection measures (PPMs; ie, shelter-in-place and evacuation). DESIGN: This is a mixed (qualitative and quantitative) prospective study of intervention efficacy, measured in terms of usability related to effectiveness, efficiency, satisfaction, and degree of community engagement. SETTING: Two municipalities in the Commonwealth of Puerto Rico are included. PARTICIPANTS: Community members consisting of individuals; traditional leaders; federal, territorial, and municipal emergency managers; municipal mayors; National Guard; territorial departments of education, health, housing, public works, and transportation; health care; police; Emergency Medical Services; faith-based organizations; nongovernmental organizations (NGOs); and the private sector. INTERVENTION: The intervention included four community convenings: one for risk communication; two for plan-writing; and one tabletop exercise (TTX). This study analyzed data collected from the project work plan; participant rosters; participant surveys; workshop outputs; and focus group interviews. MAIN OUTCOME MEASURES: Efficacy was measured in terms of ISO 9241-11, an international standard for usability that includes effectiveness, efficiency, user satisfaction, and "freedom from risk" among users. Degree of engagement was considered an indicator of "freedom from risk," measurable through workshop attendance. RESULTS: Two separate communities drafted and exercised ~60-page-long population protection plans, each within 14.5 hours. Plan-writing workshops completed 100% of plan objectives and activities. Efficiency rates were nearly the same in both communities. Interviews and surveys indicated high degrees of community satisfaction. Engagement was consistent among community members and variable among governmental officials. CONCLUSIONS: Frontline communities have successfully demonstrated the ability to understand the environmental health hazards in their own community; rapidly write consensus-based plans for PPMs; participate in an objective-based TTX; and perform these activities in a bi-lingual setting. This intervention appears to be efficacious for public use in the rapid development of community-based PPMs.

The Epidemiology of Extreme Weather Event Disasters (1969-2018).

INTRODUCTION: This manuscript summarizes the global incidence, exposures, mortality, and morbidity associated with extreme weather event (EWE) disasters over the past 50 years (1969-2018). METHODS: A historical database (1969-2018) was created from the Emergency Events Database (EM-DAT) to include all disasters caused by seven EWE hazards (ie, cyclones, droughts, floods, heatwaves, landslides, cold weather, and storms). The annual incidence of EWE hazards and rates of exposure, morbidity, and mortality were calculated. Regression analysis and analysis of variance (ANOVA) calculations were performed to evaluate the association between the exposure rate and the hazard incidence rate, as well as the association between morbidity and mortality incidence rates and rates of human exposure and annual EWE incidence. RESULTS: From 1969-2018, 10,009 EWE disasters caused 2,037,415 deaths and 3,998,466 cases of disease. A reported 7,350,276,440 persons required immediate assistance. Floods and storms were the most common. Most (89%) of EWE-related disaster mortality was caused by storms, droughts, and floods. Nearly all (96%) of EWE-related disaster morbidity was caused by cold weather, floods, and storms. Regression analysis revealed strong evidence (R2 = 0.88) that the annual incidence of EWE disasters is increasing world-wide, and ANOVA calculations identified an association between human exposure rates and hazard incidence (P value = .01). No significant trends were noted for rates of exposure, morbidity, or mortality. CONCLUSIONS: The annual incidence of EWEs appears to be increasing. The incidence of EWEs also appears to be associated with rates of human exposure. However, there is insufficient evidence of an associated increase in health risk or human exposures to EWEs over time.

An innovative approach to capability-based emergency operations planning.

This paper describes the innovative use information technology for assisting disaster planners with an easily-accessible method for writing and improving evidence-based emergency operations plans. This process is used to identify all key objectives of the emergency response according to capabilities of the institution, community or society. The approach then uses a standardized, objective-based format, along with a consensus-based method for drafting capability-based operational-level plans. This information is then integrated within a relational database to allow for ease of access and enhanced functionality to search, sort and filter and emergency operations plan according to user need and technological capacity. This integrated approach is offered as an effective option for integrating best practices of planning with the efficiency, scalability and flexibility of modern information and communication technology.

Challenges and strategies for climate change adaptation among Pacific Island nations.

Few regions of the world are at higher risk for environmental disasters than the Pacific Island countries and territories. During 2004 and 2005, the top public health leadership from 19 of 22 Pacific Island countries and territories convened 2 health summits with the goal of developing the world's first comprehensive regional strategy for sustainable disaster risk management as applied to public health emergencies. These summits followed on the objectives of the 1994 Barbados Plan of Action for the Sustainable Development of Small Island Developing States and those of the subsequent Yokohama Strategy and Plan of Action for a Safer World. The outputs of the 2004 and 2005 Pacific Health Summits for Sustainable Disaster Risk Management provide a detailed description of challenges and accomplishments of the Pacific Island health ministries, establish a Pacific plan of action based upon the principles of disaster risk management, and provide a locally derived, evidence-based approach for many climate change adaptation measures related to extreme weather events in the Pacific region. The declaration and outputs from these summits are offered here as a guide for developmental and humanitarian assistance in the region (and for other small-island developing states) and as a means for reducing the risk of adverse health effects resulting from climate change.

Organizational and command aspects for coordinating the public health response to an outbreak of acute renal failure, Republic of Panama, 2006.

The Ministry of Health of Panama (MINSA) received several reports of ill persons who had clinical presentations of acute renal insufficiency or failure during September and October 2006. On 01 October 2006, the MINSA formally asked the Pan-American Health Organization (PAHO) and the US Centers for Disease Control and Prevention (CDC) to assist with the investigation. Additional agencies involved in the response included the US Food and Drug Administration (FDA), the Gorgas Institute for Health Studies (GIHS), and the Social Security Health System (SSHS) of Panama. Through a joint effort, the MINSA, CDC, FDA, GIHS, SSHS, and PAHO were able to characterize the illness, identify the etiological agent, identify the population-at-risk, and launch an unprecedented media and social mobilization effort to prevent additional cases.International outbreak responses may require familiarity with basic emergency management principles beyond technical or scientific considerations. The management, logistical capabilities, team interaction, and efficiency of outbreak investigations can be enhanced substantially by having staff already familiar with common operational frameworks for incident responses. This report describes the inter-agency coordination and organizational structure implemented during an international response to identify the cause of an outbreak of acute renal failure in Panama.

Emergent use of social media: a new age of opportunity for disaster resilience.

Social media are forms of information and communication technology disseminated through social interaction. Social media rely on peer-to-peer (P2P) networks that are collaborative, decentralized, and community driven. They transform people from content consumers into content producers. Popular networking sites such as MySpace, Facebook, Twitter, and Google are versions of social media that are most commonly used for connecting with friends, relatives, and employees. The role of social media in disaster management became galvanized during the world response to the 2010 Haiti earthquake. During the immediate aftermath, much of what people around the world were learning about the earthquake originated from social media sources. Social media became the new forum for collective intelligence, social convergence, and community activism. During the first 2 days following the earthquake, "texting" mobile phone users donated more than $5 million to the American Red Cross. Both public and private response agencies used Google Maps. Millions joined MySpace and Facebook discussion groups to share information, donate money, and offer comfort and support. Social media has also been described as "remarkably well organized, self correcting, accurate, and concentrated," calling into question the ingrained view of unidirectional, official-to-public information broadcasts. Social media may also offer potential psychological benefit for vulnerable populations gained through participation as stakeholders in the response. Disaster victims report a psychological need to contribute, and by doing so, they are better able to cope with their situation. Affected populations may gain resilience by replacing their helplessness with dignity, control, as well as personal and collective responsibility. However, widespread use of social media also involves several important challenges for disaster management. Although social media is growing rapidly, it remains less widespread and accessible than traditional media. Also, public officials often view P2P communications as "backchannels" with potential to spread misinformation and rumor. In addition, in absence of the normal checks and balances that regulate traditional media, privacy rights violations can occur as people use social media to describe personal events and circumstances.

Preventing disasters: public health vulnerability reduction as a sustainable adaptation to climate change.

Global warming could increase the number and severity of extreme weather events. These events are often known to result in public health disasters, but we can lessen the effects of these disasters. By addressing the factors that cause changes in climate, we can mitigate the effects of climate change. By addressing the factors that make society vulnerable to the effects of climate, we can adapt to climate change. To adapt to climate change, a comprehensive approach to disaster risk reduction has been proposed. By reducing human vulnerability to disasters, we can lessen--and at times even prevent--their impact. Human vulnerability is a complex phenomenon that comprises social, economic, health, and cultural factors. Because public health is uniquely placed at the community level, it has the opportunity to lessen human vulnerability to climate-related disasters. At the national and international level, a supportive policy environment can enable local adaptation to disaster events. The purpose of this article is to introduce the basic concept of disaster risk reduction so that it can be applied to preventing and mitigating the negative effects of climate change and to examine the role of community-focused public health as a means for lessening human vulnerability and, as a result, the overall risk of climate-related disasters.

The public health impact of tsunami disasters.

Tsunamis have the potential to cause an enormous impact on the health of millions of people. During the last half of the twentieth century, more people were killed by tsunamis than by earthquakes. Most recently, a major emergency response operation has been underway in northeast Japan following a devastating tsunami triggered by the biggest earthquake on record in Japan. This natural disaster has been described as the most expensive in world history. There are few resources in the public health literature that describe the characteristics and epidemiology of tsunami-related disasters, as a whole. This article reviews the phenomenology and impact of tsunamis as a significant public health hazard.

The public health impact of industrial disasters.

The recent Deepwater Horizon oil spill and Japanese earthquake/tsunami radiation disaster have increased public concerns regarding the public health impact of industrial disasters. Industrial disasters are known to impose a unique set of challenges for public health emergency response. There are critical gaps in scientific knowledge regarding assessment and control of public health disasters related to industrial releases of hazardous materials. There is also a fundamental lack of familiarity regarding industrial disasters among the public health and medical communities, in general. There are few sources in the current public health literature that review this disaster phenomenon in a comprehensive manner. This article offers a review of the public health impact and unique considerations related to industrial disasters.

O2C3: A unified model for emergency operations planning.

The leadership in each jurisdiction of the world has been described as legally, morally, and politically responsible for ensuring that necessary and appropriate actions are taken to protect people and property from the consequences of emergencies and disasters. As emergencies often evolve rapidly and become too complex for effective improvisation, a government can successfully discharge its emergency management responsibilities only by taking action beforehand. This requires preparedness in advance of the disaster event. Accordingly, preparedness measures should not be improvised or handled on an ad hoc basis.

Sea-level-rise disaster in Micronesia: sentinel event for climate change?

OBJECTIVES: To describe the impact of an acute-onset sea-level-rise disaster in 2 coral atoll populations and to generate hypotheses for further investigation of the association between climate change and public health. METHODS: Households of Lukunoch and Oneop islands, Micronesia, were assessed for demographics, asset damage, food availability, water quantity and quality, hygiene and sanitation, and health status. Every fourth household on Lukunoch was randomly selected (n = 40). All Oneop households were surveyed (n = 72). Heads of each household were interviewed in the local language using a standard survey tool. Prevalence data were analyzed, and 95% confidence intervals were calculated. RESULTS: A total of 112 total households were respondents representing 974 inhabitants. On Lukunoch, roughly half of all households surveyed reported at least a partial loss of their primary dietary staple and source of calories (taro and breadfruit). Six (15%) of 40 Lukunoch households surveyed (95% CI, 6%-30%) reported a complete loss of taro and four (10%) of the 40 households (95% CI, 3%-24%) reported a complete loss of breadfruit. On Oneop, nearly all households reported at least a partial loss of these same food staples. Twenty four (31%) of all 76 Oneop households reported a complete loss of taro and another 24 (31%) households reported a complete loss of breadfruit. One third of all households surveyed reported a complete loss. On Lukunoch 11 (28%) of 40 households, (95% CI, 15%-43%) reported damage from salination, but none were damaged to the point of a complete loss. Forty-nine (64%) of 76 Oneop households reported salination and five (6%) reported complete loss of their well. CONCLUSION: On March 5, 2007, an acute-onset, sea level rise event resulting in coastal erosion, shoreline inundation, and saltwater intrusion occurred in two coral atoll islands of Micronesia. The findings of this study suggest that highly vulnerable populations of both islands experienced disastrous losses involving crop productivity and freshwater sources. These findings reveal the need for effective public health research and sustainable interventions that will monitor and shape the health of small island populations predicted to be at high risk for adverse health effects due to climate change.

Building human resilience: the role of public health preparedness and response as an adaptation to climate change.

Global climate change will increase the probability of extreme weather events, including heatwaves, drought, wildfire, cyclones, and heavy precipitation that could cause floods and landslides. Such events create significant public health needs that can exceed local capacity to respond, resulting in excess morbidity or mortality and in the declaration of disasters. Human vulnerability to any disaster is a complex phenomenon with social, economic, health, and cultural dimensions. Vulnerability to natural disasters has two sides: the degree of exposure to dangerous hazards (susceptibility) and the capacity to cope with or recover from disaster consequences (resilience). Vulnerability reduction programs reduce susceptibility and increase resilience. Susceptibility to disasters is reduced largely by prevention and mitigation of emergencies. Emergency preparedness and response and recovery activities--including those that address climate change--increase disaster resilience. Because adaptation must occur at the community level, local public health agencies are uniquely placed to build human resilience to climate-related disasters. This article discusses the role of public health in reducing human vulnerability to climate change within the context of select examples for emergency preparedness and response.

Terrorism involving cyanide: the prospect of improving preparedness in the prehospital setting.

The potential for domestic or international terrorism involving cyanide has not diminished and in fact may have increased in recent years. This paper discusses cyanide as a terrorist weapon and the current state of readiness for a cyanide attack in the United States. Many of the factors that render cyanide appealing to terrorists are difficult to modify sufficiently to decrease the probability of a cyanide attack. For example, the relative ease with which cyanide can be used as a weapon without special training, its versatile means of delivery to intended victims, and to a large degree, its ready availability cannot be significantly modified through preparedness efforts. On the other hand, the impact of an attack can be mitigated through preparedness measures designed to minimize the physical, psychological, and social consequences of cyanide exposure. Although the nation remains ill-equipped to manage a cyanide disaster, significant progress is being realized in some aspects of preparedness. Hydroxocobalamin-a cyanide antidote that may be appropriate for use in the prehospital setting for presumptive cases of cyanide poisoning-currently is under development for potential introduction in the US. If it becomes available in the US, hydroxocobalamin could enhance the role of the prehospital emergency responder in providing care to victims of a cyanide disaster. Additional progress is required in the areas of ensuring local and regional availability of antidotal treatment and supportive interventions, educating emergency healthcare providers about cyanide poisoning and its management, and raising public awareness of the potential for a cyanide attack and how to respond.

Lack of hospital preparedness for chemical terrorism in a major US city: 1996-2000.

INTRODUCTION: The [US] Nunn-Lugar-Domenici Defense Against Weapons of Mass Destruction (WMD) Act (the WMD Act of 1996) heralded a new wave of spending by the federal government on counter-terrorism efforts. Between 1996 and 2000, the United States of America (US) federal government allocated large sums of funding to the States for bioterrorism preparedness. Distribution of these funds between institutions involved in first-responder care (e.g., fire and safety departments) and hospitals was uneven. It is unknown whether these additional funds had an impact on the level of hospital preparedness for managing mass casualties involving hazardous materials at the local level, including potential terrorist attacks with chemical agents. OBJECTIVES: (1) To compare 1996 and 2000 measures of preparedness among hospitals of a major US metropolitan area for dealing with hazardous material casualties, including terrorism that involved the use of weapons of mass destruction; and (2) To provide guidance for the improvement of emergency preparedness and response in US hospitals. METHODS: In July 1996 and again in July 2000,21 hospitals in one major US city were surveyed by questionnaire. A survey was used to assess the amounts of antidote stocks held available for treatment of casualties caused by toxic chemical agents and institutional response capabilities including the number of showers for decontaminating patients, the level of worker protection, and the number of staff trained to decontaminate patients. RESULTS: Hospital preparedness for treating and decontaminating patients exposed to toxic chemical agents was inadequate in 1996 and in 2000. From 1996 to 2000, there was no statistically significant change in the lack of hospital preparedness for stocking of nerve agent and cyanide antidotes. Capacity for decontamination of patients, which included appropriate hazardous material infrastructure and trained staff, generally was unimproved from 1996 to 2000 with the exception of an increase of nearly 30% in hospitals with at least one decontamination shower facility. CONCLUSION: Hospitals surveyed in this study were poorly prepared to manage chemical emergency incidents, including terrorism. This lack of hospital preparedness did not change significantly between 1996 and 2000 despite increased funds allocated to bioterrorism preparedness at the local level.

Emergency health and risk management in sub-saharan Africa: a lesson from the embassy bombings in Tanzania and Kenya.

In 1998, terrorists simultaneously bombed United States Embassies in Dar es Salaam, Tanzania and Nairobi, Kenya. The local response to these bombings was unorganized and ad hoc, indicating the need for basic disaster preparedness and improvement of emergency management capabilities in both countries. In this context, risk and risk management are defined and are related to the health hazards affecting Tanzanians and Kenyans. In addition, the growing number of injuries in Tanzania is addressed and the relationship between risk management and injury is explored. Also, an emergency medicine-based strategy for injury control and prevention is proposed. Implications of implementing such a protocol in developing nations also are discussed.