As the cornerstone of any health system, hospitals have a crucial role in response to disasters. Because hospital experiences in disaster response can be instructive, this study examined the challenges of hospital response to the twin earthquakes of 2012 in East Azerbaijan, Iran.

In this qualitative study, the challenges of hospital response in the East Azerbaijan earthquakes were examined through focus group discussions. Participants were selected purposefully, and focus group discussions continued until data saturation. The data were manually analyzed by using Strauss and Corbin’s recommended method.

Hospitals were faced with 6 major challenges: lack of preparedness, lack of coordination, logistic deficiencies, patient/injured management, communication management, and other smaller challenges that were categorized in the “other challenges” category. The main theme was the lack of preparedness for disasters.

Although hospital preparedness is emphasized in credible references, this study showed that lack of preparedness is a major challenge for hospitals during disasters. Thus, it seems that hospital officials’ disaster risk perception and hospital preparedness should be improved. In addition, hospital preparedness assessment indexes should be included in the hospital accreditation process. (Disaster Med Public Health Preparedness. 2017;11:422–430)

Personal protective equipment (PPE) use is frequently construed as inconvenient and disturbing by health care professionals (HCPs). We hypothesized that new-onset symptoms among HCPs may be associated with extended use of PPE and aimed to investigate risk factors related with new-onset symptoms. In addition, the effects of new-onset symptoms on working performance were evaluated.

In this cross-sectional study, 315 participants filled out a questionnaire that contains 4 main parts: (1) demographics, (2) new-onset symptoms with PPE use, (3) PPE usage hours, and (4) personal opinion about the effect of sensed symptoms on working performance.

The mean age was 31.58 ± 4.6 years, and 50.5% (n = 159) were female. New-onset symptom rate was 66% (n = 208). The most common new-onset symptom was headache (n = 115, 36.5%) followed by breathing difficulty-palpitation (n = 79, 25.1%), and dermatitis (n = 64, 20.3%). Extended use of PPE, smoking, and overweight were independently associated with developing new-onset symptoms. A clear majority of symptomatic participants pointed out the impact on working performance (193/208, 92.7%).

Hospitals should take the necessary precautions (eg, shorter shifts and more frequent breaks) to prevent symptoms associated with PPE and ensure that HCPs comply with these precautions.

To determine the ability of a novel responder mental health self-triage system to predict post-traumatic stress disorder (PTSD) in emergency medical responders after a disaster.

Participants in this study responded to Typhoon Haiyan, which struck the Philippines in November 2013. They completed the Psychological Simple Triage and Rapid Treatment (PsySTART) responder triage tool, the PTSD Checklist (PCL-5) and the Patient Health Questionnaire-8 (PHQ-8) shortly after responding to this disaster. The relationships between these 3 tools were compared to determine the association between different risk exposures while providing disaster medical care and subsequent levels of PTSD or depression.

The total number of PsySTART responder risk factors was closely related to PCL-5 scores ≥38, the threshold for clinical PTSD. Several of the PsySTART risk factors were predictive of clinical levels of PTSD as measured by the PCL-5 in this sample of deployed emergency medical responders.

The presence of a critical number and type of PsySTART responder self-triage risk factors predicted clinical levels of PTSD and subclinical depression in this sample of emergency medical workers. The ability to identify these disorders early can help categorize an at-risk subset for further timely “stepped care” interventions with the goals of both mitigating the long-term consequences and maximizing the return to resilience. (Disaster Med Public Health Preparedness. 2018;12:19–22)

We aimed to compare access to gynecologic oncology care at a private and a city hospital, both of which closed for a period of time because of Hurricane Sandy.

This was a cross-sectional study of gynecologic oncology chemotherapy, radiotherapy, and surgical patients from October 29, 2012 (the eve of the storm), to February 7, 2013 (the reopening of the city hospital). New referrals during this time were excluded. Delays in chemotherapy, radiotherapy, and surgery were compared.

Analysis included 113 patients: 59 private patients (52.2%) and 54 city patients (47.8%). Of the private patients, 33/59 received chemotherapy (55.9%), 1/59 received radiotherapy (1.7%), and 28/59 had planned surgery (47.5%). Of the city patients, 40/54 received chemotherapy (74.1%), 7/54 received radiotherapy (12.3%), and 18/54 had planned surgery (33.3%). The mean delay in chemotherapy was 7.6 days at the private hospital and 21.7 days at the city hospital (P=0.0004). The mean delay in scheduled surgery was 14.2 days at the private hospital and 22.7 days at the city hospital (P=0.3979). The mean delay in radiotherapy was 0.0 days at the private hospital and 25.0 days at the city hospital (P=0.0046). Loss to follow-up rates were 3/59 of the private patients (5.1%) and 3/54 of the city patients (5.6%).

Gynecologic oncology care was maintained during a natural disaster despite temporary closure and relocation of services. Disparity in care was in access to chemotherapy. (Disaster Med Public Health Preparedness. 2015;9:605–608)

Public education and training that focus on appropriate knowledge, attitudes, and practices have had a crucial role in preparedness. The aim of this study was to assess knowledge, attitudes, and practices of households regarding natural disasters in Shiraz, Iran.

In this cross-sectional descriptive study, we used a stratified random sampling technique. The data collection tool was a self-administered questionnaire, which was completed in through face-to-face interviews. The data were analyzed with the SPSS statistical software package (version 16).

The overall mean scores were 7.3±2.0 for knowledge, 26.3±6.5 for attitudes, and 5.2±2.2 for practices. Mean scores for all 3 factors were higher in women and married participants. In other comparisons, the differences were statistically significant only for the associations between gender and the score for practices. The mean knowledge score was lower in illiterate participants than in other categories of educational status.

Our findings showed that the knowledge of households regarding disaster preparedness was encouraging, but that of attitudes and practices might be improved through a greater focus on motivational educational programs and cooperation among the organizations involved in public awareness. (Disaster Med Public Health Preparedness. 2014;0:1–4)

It is unclear which pediatric disaster triage (PDT) strategy yields the best accuracy or best patient outcomes.

We conducted a cross-sectional analysis on a sample of emergency medical services providers from a prospective cohort study comparing the accuracy and triage outcomes for 2 PDT strategies (Smart and JumpSTART) and clinical decision-making (CDM) with no algorithm. Participants were divided into cohorts by triage strategy. We presented 10-victim, multi-modal disaster simulations. A Delphi method determined patients’ expected triage levels. We compared triage accuracy overall and for each triage level (RED/Immediate, YELLOW/Delayed, GREEN/Ambulatory, BLACK/Deceased).

There were 273 participants (71 JumpSTART, 122 Smart, and 81 CDM). There was no significant difference between Smart triage and CDM. When JumpSTART triage was used, there was greater accuracy than with either Smart (P<0.001; OR [odds ratio]: 2.03; interquartile range [IQR]: 1.30, 3.17) or CDM (P=0.02; OR: 1.76; IQR: 1.10, 2.82). JumpSTART outperformed Smart for RED patients (P=0.05; OR: 1.48; IQR: 1.01,2.17), and outperformed both Smart (P<0.001; OR: 3.22; IQR: 1.78,5.88) and CDM (P<0.001; OR: 2.86; IQR: 1.53,5.26) for YELLOW patients. Furthermore, JumpSTART outperformed CDM for BLACK patients (P=0.01; OR: 5.55; IQR: 1.47, 20.0).

Our simulation-based comparison suggested that JumpSTART triage outperforms both Smart and CDM. JumpSTART outperformed Smart for RED patients and CDM for BLACK patients. For YELLOW patients, JumpSTART yielded more accurate triage results than did Smart triage or CDM. (Disaster Med Public Health Preparedness. 2016;10:253–260)

This study explored the influence of satisfaction with economic and social rights (ESR) on the quality of life (QOL) of people in post-disaster zones in Sichuan, China.

Data from a survey conducted in 2013 in the 5 hardest hit counties in the earthquake-prone area of Sichuan were used. QOL was measured by use of the brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). Structural equation models were developed to determine the specific features of the influence of satisfaction with ESR on QOL.

The mean values of both the WHOQOL-BREF scale and the ESR satisfaction scale were lower than the midpoint of the scales. Satisfaction with ESR had a significant effect on psychological health, social relationships, and environment, apart from physical health. Satisfaction with the right to food had the greatest effect on QOL, followed by the rights to education, work, health, social security, and housing.

Satisfaction with ESR had a significant positive influence on the QOL of people in a post-disaster zone, particularly satisfaction with the right to food. Policies on food and education guarantees and mental health intervention are highlighted. (Disaster Med Public Health Preparedness. 2015;9:111-118)

Women and men might experience psychological distress differently during a disaster. This study investigated gender differences in the factors associated with psychological distress among working-age people 1 to 2 years after the Great East Japan Earthquake.

A cross-sectional household survey of victims who remained living in their homes was conducted between May and December 2012 in Ishinomaki City, Japan. Psychological distress was defined as a Kessler Psychological Distress Scale ≥5, and gender differences were examined using a logistic regression analysis.

Data were obtained from 2593 individuals, and 1537 participants were included in the analyses. Psychological distress was observed in 28.0% of the participants. Living in a household without a salaried income and a low frequency of leaving the house were associated with psychological distress among women. Young age, lack of occupation and no informational support were associated with psychological distress among men. Income change due to the disaster and health complaints were associated with psychological distress in both genders.

For women, stable household income and frequently leaving the house can be protective factors. For men, intervention focusing on young people, occupational support, and informational support may be useful. Income change after the disaster and health complaints may be risk factors in both genders. (Disaster Med Public Health Preparedness. 2019;13:487-496)

The coronavirus disease 2019 (COVID-19) outbreak has been declared a pandemic and has affected both patients and health-care workers. This study was conducted to explore the extent of posttraumatic stress disorder (PTSD) experiences among nurses because of the COVID-19 pandemic in Jordan.

This study used a cross-sectional study design with a convenience sampling approach. A sample of 259 participants completed the study questionnaires, including a socio-demographic questionnaire and the Posttraumatic Stress Disorder Checklist for DSM-5 between May and July 2020.

The prevalence of PTSD among the study participants was 37.1%. Most study participants who exhibited PTSD symptoms presented the lowest level of PTSD (17%). The results showed significant differences in overall COVID-19-related PTSD according to the participant’s age (F = 14.750; P = 0.000), gender (F = 30.340; P = 0.000), level of education (F = 51.983; P = 0.000), years of experience (F = 52.33, P = 0.000), place of work (F = 19.593; P = 0.000), and working position (F = 11.597; P = 0.000), as determined by 1-way ANOVA.

Nurses must be qualified and accredited to cope with reported PTSD cases and their consequences in relation to COVID-19 outbreaks. A close collaboration with a multidisciplinary team is required to recognize, manage, and encourage safety literacy among health-care professionals and individuals diagnosed with or suspected of PTSD due to COVID-19 outbreaks or any other viral outbreaks.

We sought to elucidate news article reporting of adverse public psychosocial behaviors, in particular, rumor-related coverage (eg, panic, demagoguery) and exclusive behavior coverage (negative behaviors, eg, discrimination, bullying) during the 2009 influenza A (H1N1) influenza pandemic in Japan.

We examined 154 Internet news-site articles reporting adverse public psychosocial responses in the first 60 days of the outbreak. Rumor-related coverage and exclusive behavior coverage were dichotomously coded as included or not. Moreover, we assessed whether or not health information (eg, coping methods, virus toxicity information) or emphasis on information quality (eg, importance of information, cautions about overreactions) were simultaneously reported.

Rumor-related coverage (n=120, 77.9%) was less likely to simultaneously report public health information (eg, toxicity information, health support information, and cautions about overreactions; P<.05). Conversely, exclusive behavior coverage (n=41, 26.6%) was more likely to report public health information (P<.05).

Rumor-related coverage was less likely to have accompanying public health information, whereas exclusive behavior coverage was more likely to include it. During public health crises, it is essential to understand that rumors and exclusive behaviors have adverse effects on the public and that accompanying public health information may help people take proactive coping actions. (Disaster Med Public Health Preparedness. 2015;9:459–463)