American Journal of Disaster Medicine

Interventions to improve the psychological well-being of healthcare workers in disasters, pandemics, and mass casualty events

Romeo Fairley, MD, MPH — 2022-09-01

Objectives: This information paper will describe the current research and recommendations for improving healthcare worker’s (HCW) mental health. Individual and organizational goals will be outlined with items broken up into the time frames of predisaster, during a disaster, and post-disaster.

Methods: A team of subject matter experts reviewed the current literature utilizing a search of PubMed, Google Scholar, relevant article reference lists, and subject matter interviews.

Results: Thirty-six distinct recommendations were identified and distributed into the time frames of predisaster, during a disaster, and post-disaster. Twenty-one of these are pertaining to organizational goals and factors. Fifteen recommendations are identified for individual HCWs.

Conclusions: Additional institutional and government policies supporting the protection of HCW’s mental health are required to reduce the stigma and fear, preventing frontline workers from seeking help with the psychological effects of disasters, mass casualty incidents, and pandemics. Further research dealing with ways to ameliorate the negative effects of the stress related to the duties and responsibilities of HCWs, which are exacerbated by disasters, is needed.

Health systems’ resilience during the COVID-19 pandemic public health emergency: The role of existing community health structures in rural Malawi

Juliet Charity Yauka Nyasulu, PhD — 2022-09-01

The emergence of the COVID-19 pandemic has put health systems under enormous pressure, pushing for health systems’ resilience. Malawi, mostly rural with hard-to-reach areas, had their first case in April 2020, amidst political turmoil. So far, much has been documented on how health systems contained the COVID-19 pandemic. This paper describes the role of community health system structures in ensuring health systems’ resilience during the COVID-19 pandemic in rural Malawi.

To highlight the role of community health structures in the Malawian health system, we developed and applied a framework on health systems’ resilience through the community health system structures in a rural district in Malawi. Our data collection and analysis were informed by a desk review of government documents and other publications. We drew on authors’ expertise and experience in Malawi community health, and joint reflections on the role played by community health structures in ensuring access to essential health services during the COVID-19 pandemic in Malawi.

The desk review and experts’ reflections have highlighted the strong Malawi community health strategy with a clear chain of command from national to community levels. The community health surveillance assistants and volunteers have shown to be the backbone of community health structures and positive service delivery, contributing to health systems resilience during the COVID-19 pandemic.

Countries’ existing health system structures are a key determinant of response to pandemics regardless of the available resources. Even though Malawi’s health system is under-resourced, the existing community-based health structures have shown to contribute to the health systems’ resilience during the COVID-19 pandemic. The proposed framework in this paper is a great tool in allowing countries to reflect on having pre-existing health system structures to strengthen the health systems’ resilience during such pandemics. Therefore, having independent disease prevention and control structures from national to community levels, as done in Malawi, can help countries to absorb the shocks of health system emergencies and maintain essential health services, the core business of the health system.

The lingering impact of Hurricane Katrina: Examining the physical health, mental health, and racial equity impacts of disaster response

Christine Crudo Blackburn, PhD — 2022-09-01

Purpose: The purpose of the research discussed in this paper is to better understand the negative health outcomes resulting from Hurricane Katrina and the disaster response that followed. This understanding can inform future disaster response.

Design: We conducted 10 in-depth interviews with individuals who lived in New Orleans at the time of Hurricane Katrina. We conducted thematic analysis on the interview content and identified patterns across all 10 interviews.

Findings: Four primary patterns emerged across all interviews. These were: (1) Federal Emergency Management Agency’s (FEMA) response to the crisis created greater physical and mental health hazards for interviewees; (2) Hurricane Katrina led to long-term mental health issues for interviewees, even those who evacuated before the storm; (3) displacement from homes following the storm typically resulted in overcrowded living conditions, which increased interviewees’ risk of infectious disease; and (4) the discrimination faced by interviewees in the months and years following Hurricane Katrina had a profound and lasting impact on their well-being.

Originality: Numerous studies have been conducted to understand the mental health impacts of disaster and a limited number have looked at the physical health impacts or the threat of infectious disease. This study is unique because it incorporates both mental and physical health impacts, but also examines how disaster response itself plays a role in health outcomes for survivors. Additionally, this paper also incorporates the role of racial inequities in disaster response and how those inequities impact survivor health.

Lessons from the first wave of COVID-19 in Italy: A collection of design strategies to face pandemic situations in healthcare facilities

Andrea Brambilla, PhD — 2022-09-01

Objectives: This study aims to provide metadesign indications for the improvement of healthcare facilities, emphasizing the role of spatial design in the management of epidemic health emergencies.

Study design: A parallel mixed-method study including literature reviews, survey creation, and survey distribution was performed.

Methods: Data were collected between August and October 2020 capturing information related to the first wave of the COVID-19 pandemic, utilizing a review of existing literature, a comparison of existing hospital planning guidelines and assessment tools, and distribution of a survey to analyze design changes within selected Italian hospitals.

Results: Among the changes identified, the most frequently identified included the conversion of space into intensive care units, space expansion, and the usage of wayfinding strategies for the reduction of cross-contamination risks. There was limited attention given to solutions with a human-centered approach, and those that addressed physical and psychological well-being of all users, including healthcare staff. The solutions were collected and systematized into a list of metadesign guidelines.

Conclusions: The resulting indications represent a starting point for developing design solutions to aid healthcare facilities in facing future epidemics.

Displacement after disaster: Challenges and opportunities responding to Puerto Rican evacuees in Central Florida after Hurricane Maria

Tanya Buhler Corbin, PhD — 2022-09-01

Major disasters often displace populations, requiring coordinated response efforts from governmental and voluntary organizations to support and assist an influx of evacuees. Despite the frequency and significance of this occurrence, this aspect of disaster management has received limited scholarly attention, with research predominantly focusing on response and recovery at the impacted disaster sites. This study investigates disaster management and support offered to Puerto Rican evacuees arriving in Central Florida after Hurricane Maria. A multiagency resource center (MARC) was established at the Orlando Airport to support evacuees, facilitating a network of agencies to coordinate response efforts. The analysis uses data obtained through in-depth, semistructured interviews from members of the Orlando metropolitan area disaster response community who worked at the MARC center, and content analysis of state and local government documents. The results identify challenges and successes and common themes in disaster support for displaced evacuees after disasters. Results confirm some conventional wisdom about disaster response, such as persistent significant challenges related to shelter and housing, and offer new insights about how to successfully support displaced evacuees, particularly using MARCs. This study provides foundational knowledge to inform future research and contributes to the development of successful support for those who are displaced after disaster.

Characteristics of chemical attacks

Emel Altıntaş, MD — 2022-09-01

Background: The use and storage of chemical weapons in war was banned. However, chemical weapons continue to be used in wars. Therefore, in this study, we tried to identify the chemical agents used by defining the characteristics of chemical attacks.

Method: We designed our study using the international dataset that can be accessed from www.start.umd.edu/gtd/. Chemical attacks between 1970 and 2020 were recorded in terms of decade, type of attack, success, suicidal purpose, property damage, number of deaths and injuries, and agents used.

Results: A total of 347 attacks were reported. The highest number of attacks was 162 (46.7 percent), which occurred between 2010 and 2020. Among the chemical agents used, acidic substances (39, 11.2 percent), chlorine gas (32, 9.2 percent), and tearing agents (24, 6.9 percent) were found to be the most common. When the distribution of the five most common chemical agents by years was examined, it was found that the use of chlorine gas gradually increased in the last three decades. In the last decade, it was found that the use of mustard gas increased, whereas cyanide was not used.

Conclusion: In the last decade, we found that chemical attacks have increased more, especially chlorine and mustard gas were predominantly used.

Field hospitals’ diagnostic radiology standards in low-resource settings

Hisham Ali Dinar, MBBS, MSc, EMDM — 2022-09-01

Objective: To review the current standards being followed for diagnostic radiology at low-resource settings.

Design: A systematic review was conducted.

Setting: Low-resource field hospitals were reviewed.

Patients and participants: All patients who were diagnosed using imaging in field hospitals were included in this review.

Interventions: Only standard care diagnostic imaging was reviewed.

Results: Scanty evidence on the standard quality control for mobile health unit (MHU) in low-resource settings is observed. The lack of evidence makes it inconclusive to decide if suboptimal quality of care is being provided to patients at the MHUs or if the quality is optimal. Multiple international societies such as the Radiological Society of North America and European Society of Radiology do provide extensive guidelines and algorithms for radiologists under normal conditions in the hospital. However, no such guidelines were found for MHUs. The most significant contributions that have been done in the guidance and quality control of the MHUs have been done by the World Health Organization with their emergency medical team guidelines and publications.

Conclusions: MHUs are critical interventions introduced to mitigate crises and manage health campaigns. Diagnostic imaging also plays a pivotal role in ensuring successful patient management in the MHUs. No international or local diagnostic imaging standard for quality control was found in the evidence. Investigations to access the feasibility of different quality control standards in the MHUs are warranted.

An overview of a successful COVID-19 vaccination campaign at a prominent Connecticut healthcare system

Jane Keating, MD — 2022-09-01

The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems to adapt, innovate, and collaborate to protect public health through treatment, testing, and vaccination initiatives related to the virus. As the pandemic evolved, lessons learned early on through testing and treatment were applied to vaccination efforts. Hartford HealthCare (HHC) is one of the largest healthcare systems in New England and took an integral role in vaccinating patients throughout the region, thus providing one of the largest vaccination campaigns in Connecticut. Early planning for equipment and personnel, in addition to effective communication between providers and patients, was critical in accomplishing HHC’s goal of rapidly providing access to COVID-19 vaccines. The efficient and effective response to the pandemic at HHC was led by the Office of Emergency Management, which worked to ensure continuity of patient care and physician excellence in the face of disaster. Initially, resources were directed to testing and treatment of the disease; as vaccine clinical trials announced successful outcomes, these efforts shifted to preparing for the storage and distribution of a mass number of vaccines. This manuscript details the factors that enabled success in HHC’s vaccination campaign and serves to provide a useful template for similar healthcare systems for future pandemic response.

Volume 17, Number 3

American Journal of Disaster Medicine — 2022-09-01