Journal of Emergency Management <h2>The Most Respected Name in Emergency Management</h2> <p>The <em><strong><span class="italic">Journal of Emergency Management</span> </strong></em>is edited, written, and peer-reviewed by an internationally recognized team of the foremost, hands-on EM experts. They include top professionals from the public and private sectors who offer real-world experience and practical solutions and leading academics who provide perspective and analysis on the latest research and studies. Together, they bring you the most thorough, relevant, and useful source of information on emergency management.</p> <h2><span class="bluetext">The Most Important Thing You Can Do for Yourself and Your EM Team</span></h2> <h4><strong>Published bi-monthly, every issue of the Journal of Emergency <span class="italic">Management</span> is peer-reviewed and packed with invaluable information and insight. Topics include:</strong></h4> <ul> <li>Emergency planning and response</li> <li>Disaster recovery and business continuity planning</li> <li>Emergency preparedness and response legislation</li> <li>Risk management</li> <li>Emergency management today, tomorrow, and in the future</li> <li>Severe weather, flood, and hurricane studies</li> <li>Emergency communications</li> <li>Continuity of operations and infrastructure protection</li> <li>Preparation and evacuation for the disabled</li> <li>Cross-training in emergency management</li> <li>And much more, including a special focus on EM training and higher education</li> </ul> en-US <p>Copyright 2007-2023, Weston Medical Publishing, LLC and Journal of Emergency Management. All Rights Reserved</p> (Richard A. DeVito, Jr.) (Richard A. DeVito, Jr.) Tue, 16 May 2023 16:05:26 -0400 OJS 60 Journal of Emergency Management <p>March/April 2023</p> Journal of Emergency Management Copyright (c) 2023 Journal of Emergency Management Tue, 16 May 2023 00:00:00 -0400 Method development for the evaluation of emergency decontamination protocol effectiveness using an ultraviolet fluorescent aerosol <p><em>After hazardous material incidents, it is important to perform emergency decontamination procedures to remove contamination from the body. As these emergency decontamination procedures are developed, it is important to understand the efficacy of a given protocol. This study discusses a method that was developed to evaluate the efficacy of decontamination procedures by using an ultraviolet fluorescent aerosol and an image analysis protocol. This method involves imaging a mannequin while both unclothed and clothed prior to exposure to the fluorescent aerosol. After exposure, it was imaged again, disrobed, and decontaminated following an unconscious patient wet decontamination method. This work describes in detail the materials and methods used to develop the final methodology. Two clothing types (black cotton and Tyvek) were used to simulate civilian and first responder casualties. Image analysis was used to measure the extent of contamination on the mannequin at each stage of the procedure. These measurements were then compared to determine decontamination efficacy for each step (disrobing, wet decontamination, and total removal). The exposure protocol was shown to provide repeatable deposition of aerosol onto the mannequin. Decontamination was also shown to be repeatable, with no trends toward efficacy changing over time.</em></p> Emily M. Spatz, Jeremy M. Slagley, PhD, Casey Cooper, PhD, Robert Eninger, PhD, Trevor Sleight, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 16 May 2023 00:00:00 -0400 Ready or not: Emergency preparedness in residential care facilities for the elderly (RCFE) in California <p><em>This study examined the results of an electronic survey of residential care facilities for the elderly (RCFE) in California in 2021 to provide insight on key elements of emergency plans and facility preparedness for the COVID-19 pandemic and future emergencies.</em></p> <p><em>Surveys were distributed to RCFE administrators using publicly available emails found on the California Health and Human Services Open Data Portal. Responses from 150 facility administrators included data on their perception of current and future facility preparedness for COVID-19 and other emergency scenarios, items included in facility evacuation</em>/<em>shelter-in-place plans, and hazard vulnerability analyses and training practices of facility staff. Descriptive analyses were performed on collected data.</em></p> <p><em>The majority of results were from small facilities serving less than seven residents (70.7 percent). Prior to COVID-19, more than 90 percent of respondents included disaster drills, evacuation plans, and emergency transportation in their emergency preparedness plan. The majority of facilities added pandemic planning, vaccine distribution, and quarantine guidelines elements into their plans during COVID-19. Approximately half of facilities reported conducting proactive hazard vulnerability analyses. Around 75 percent of RCFEs felt well prepared for fires and infectious disease outbreaks, had mixed preparedness levels for earthquakes and floods, and felt least prepared for landslides and active shooter emergencies. During the pandemic, perceptions of preparedness rose, with 92 percent stating they felt very prepared currently and almost 70 percent felt very prepared for future pandemics.</em></p> <p><em>Preparedness of these essential facilities and their residents can continue to improve by conducting regular proactive hazard vulnerability analyses, improving communication lines and mutual aid agreements with local and state organizations, and preparing for critical emergencies such as landslides and active shooter scenarios. This can help to ensure adequate resources and investments are provided to care for older adults during emergencies.</em></p> <p>&nbsp;</p> Kaitlin O. Bahr, PhD, MPH, Grishma P. Bhavsar, PhD, MPH, Vickent Ung, MPH, Eric Vargas, MPH Copyright (c) 2023 Journal of Emergency Management Tue, 16 May 2023 00:00:00 -0400 Individual emergency response and recovery: What people worried about during and after Hurricane Maria <p><em>Hurricane Maria was a disastrous weather event that devastated Puerto Rico (PR) in September 2017. Yet, little is known about people’s perceptions of this event. In this investigation, we offer insight about Hurricane Maria’s impact on PR’s inhabitants. More specifically, we study a sample (n = 542 responses) of individuals’ worry levels through four time points during the aftermath of Hurricane Maria: their variation through time, their relationship to decision making, and if and how certain demographic variables may influence them. For these purposes, we designed and implemented the Individual Emergency Response and Recovery Questionnaire, a web-based survey that measured several aspects of the objective and subjective experiences of individuals who underwent Hurricane Maria in PR. Results of a statistical analysis using nonparametric tests show that some of the demographic variables selected as factors of interest influence the worry levels reported by respondents. Most significant results coincide with conclusions drawn by literature: that time, age group, and the level of information influence worry levels. Another key finding is that the worry level may influence individual decision-making frequency. Understanding principal factors in people’s behavior and perceptions during hurricanes is crucial to help us learn how to better prepare for and respond to natural disasters in the future.</em></p> Verónica Díaz-Pacheco, MS, Angelie Nieves-Jiménez, BE, Robert Whalin, PhD, Thomas Richardson, MS, Cristina Pomales-García, PhD, Clara E. Isaza, PhD, Mauricio Cabrera-Ríos, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 16 May 2023 00:00:00 -0400 Human information processing under stress <p><em>This article is a review of literature focused on how human beings process information under stress. Three major theories on information processing are reviewed: cue utilization theory, attentional control theory, and working memory capacity theory. Different conditions that can cause an individual to feel stress are examined, how stress affects information processing, ways which stress may be beneficial, and different ways to mitigate stress, so they may process information more accurately and efficiently. Throughout the article, examples of how stress can affect incident commanders responding to a disaster situation are used to illustrate research findings.</em></p> Tracy Rogers, MPA Copyright (c) 2023 Journal of Emergency Management Tue, 16 May 2023 00:00:00 -0400 Using neurotechnology in the emergency and safety management for creating a safer work environment <p><em>Brain–computer interfaces are emerging neurotechnology conducting specific commands or outputs based on acquiring brain signals or inputs. This study examines the common hazards present in industries, which can be managed by neurotechnology, as well as compares two types of brain–computer interfaces in the neurotechnology area. The findings from this work suggest acknowledging current safety management practices and technology that can promote a safer work environment, in addition to increasing probable applications of use of the current research findings related to neurotechnology. This study advises understanding the risks associated between noninvasive and invasive neurotechnologies, whereas noninvasive technologies are safer that exhibit lesser degrees of accuracy or applications of use compared to its counterpart, which is invasive technology. This study proposes future development of this technology, which can integrate components based on common practices by industry.</em></p> James Adams, BS, Mahmud Hasan, PhD, PE, CSP, Jacob Thorp, BS Copyright (c) 2023 Journal of Emergency Management Tue, 16 May 2023 00:00:00 -0400 Mitigation insights from emergency managers on working with stakeholders <p><em>Emergency managers have the important responsibility of planning and implementing mitigation policies and programs to reduce losses to life and property. To accomplish these goals, they must use limited time and resources to ensure the communities they serve have adequately mitigated against potential disasters. As a result, it is common to collaborate and coordinate with a wide variety of partner agencies and community organizations. While it is well established that strengthening relationships and increasing familiarity improve coordination, this article advances that narrative by providing direct insights on the ways a select group of local, state, and federal emergency managers view relationships with other mitigation stakeholders. Using insights from a 1-day workshop hosted at the University of Delaware to gather information from mitigation stakeholders, this article provides a discussion of commonalities and challenges workshop participants identified with other stakeholder groups. These insights can inform other emergency managers about potential collaborators and coordination opportunities with similar stakeholders in their own communities. </em></p> Rachel Slotter, MS, Meghan Millea, PhD, Joseph Trainor, PhD, Rachel Davidson, PhD, Jamie Kruse, PhD, Linda Nozick, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 16 May 2023 00:00:00 -0400 Managing risk and information asymmetry in cross-sector networks: The case of the West, Texas fertilizer plant explosion <p><em>Technological hazards threaten public safety, and related risk cuts across jurisdictional boundaries, requiring a multiorganizational effort to mitigate. Yet, for those involved, ineffective risk recognition inhibits appropriate action. Using an embedded single-case study design, this article examines the 2013 West, Texas, fertilizer plant explosion and the networks of organizations responsible for disaster prevention, mitigation, preparedness, and response. Aspects of risk detection, communication, and interpretation and a series of self and collective mobilization efforts were analyzed. Findings demonstrate that information gaps between key actors, ie, information asymmetry—particularly the company, regulators, and local officials—hindered effective decision making. The case reveals the limitations of contemporary bureaucratic structures for the collective management of risk and the need for network governance that takes a more flexible and adaptive approach. The discussion section concludes with an outline of essential steps to improve the management of similar systems.</em></p> Clayton Wukich, PhD, Thomas W. Haase, PhD, Wenjiun Wang, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 16 May 2023 00:00:00 -0400 Volume 21, Number 7 COVID-19 Pandemic Response: Research and Applied Science Journal of Emergency Management Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 Emergency powers and the pandemic: Reflecting on state legislative reforms and the future of public health response <p><em>The first 2 years of combatting the COVID-19 pandemic necessitated an unprecedented use of emergency powers. States responded with an equally unprecedented flurry of legislative changes to the legal underpinnings of emergency response and public health authorities. In this article, we provide a brief background on the framework and use of governors and state health officials’ emergency powers. We then analyze several key themes, including both the enhancement and restriction of powers, emerging from emergency management and public health legislation introduced in state and territorial legislatures. During the 2020 and 2021 state and territorial legislative sessions, we tracked legislation related to the emergency powers of governors and state health officials. Legislators introduced hundreds of bills impacting these powers, some enhancing and others restricting emergency powers. Enhancements included increasing vaccine access and expanding the pool of eligible medical professions that could administer vaccinations, strengthening public health investigation and enforcement authority for state agencies, and preclusion of local orders by orders at the state level. Restrictions included establishing oversight mechanisms for executive actions, limits on the duration of the emergency, limiting the scope of emergency powers allowed during a declared emergency, and other restraints. By describing these legislative trends, we hope to inform governors, state health officials, policymakers, and emergency managers about how changes in the law may impact future public health and emergency response capabilities. Understanding this new legal landscape is critical to effectively preparing for future threats.</em></p><p><em> </em></p> Maggie Davis, JD, MA, PMP, Lauren Dedon, JD, Stacey Hoffman, MPH, Andy Baker-White, JD, MPH, David Engleman, JD, Gregory Sunshine, JD Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 Post-pandemic tourism strategies: A case of Himachal Pradesh <p><em>Tourism has always been a vulnerable industry. Minimal disturbances can halt or even destroy tourism and its associated economy. There is no dearth of research on vulnerability and resilience of the tourism industry for various tourism destinations,, and on post-disaster studies, but mainly these were limited to a city or tourist destination and focused on the destination image recovery. The primary purpose of this study is to identify different tourism stages and the local community’s issues and desires associated with each stage and to propose strategies that can be used during and after the COVID-19 pandemic. The district-wise monthly domestic and foreign tourist arrival data from 2008 to 2018 for Himachal Pradesh (HP) were observed. The observations reveal that HP experiences overtourism, balanced tourism, and undertourism. Two hundred seven telephonic interviews were conducted with different stakeholders such as tourism department officers, urban planners, hotel owners and managers, environmentalists, and state residents. Research themes were identified based on the interview responses, and these themes were further validated using a review of newspaper reports and court and local administration order. This study identified nine broad problems and patterns associated with tourism and proposes 17 sustainable tourism strategies that the post-COVID-19 crisis can follow. The proposed strategies give special attention to confidence-building of tourist and residents, image building of the location, and increasing tourism number sustainably and tourism earning of the state. This study investigates problems and suggests sustainable strategies for a state in India for the first time and may be used for policy decision and regional sustainable tourism development plan.</em></p><p><em> </em></p> Mahfuzuar Rahman Barbhuiya, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 Fear of COVID-19 among nonsmokers and smokers/former smokers: Implications for health promotion practice <p><em>Introduction: Fear of COVID-19 may differ for individuals with compromised health and those with unhealthy behaviors, placing them at greater risk. Based on previous analysis of academic medical center faculty and staff, the authors predicted that workers who were smokers</em>/<em>previous smokers would express the greater fear of COVID-19 relative to nonsmokers. </em></p><p><em>Methods: The present study used the Fear of COVID-19 Scale to assess fear among nonsmokers (n = 1,489) and smokers</em>/<em>previous smokers (n = 272) from a larger population of academic medical center members (N = 1,761). This study assessed nonsmokers’ and smokers</em>/<em>previous smokers’ demographic and background variables on Fear of COVID-19 scores. </em></p><p><em>Results: In this academic community, smokers</em>/<em>previous smokers had higher fear of COVID-19 scores than did nonsmokers (p &lt; 0.05). Smokers</em>/<em>previous smokers differed from nonsmokers on three Fear of COVID-19 scale items (most afraid of COVID-19, fear of losing life, and physiological fear of COVID-19). </em></p><p><em>Discussion</em>/<em>conclusions: These results provide a better understanding of how fear of COVID-19 can differ based on one’s smoking status. These findings inform public health smoking cessation efforts aimed at reducing morbidity and mortality, both in response and secondary to COVID-19 exposure.</em></p><p><em> </em></p> Blake T. Hilton, PsyD, Brandt J. Wiskur, PhD, Michael W. Brand, PhD, Julio I. Rojas, PhD, Raina D. Leckie, LCSW, Maria Trapp, PhD, Katrin Gaardbo Kuhn, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 Examining the effects of COVID-19 on logistics and supply chain networks in Oman <p><em>Our study analyzes the economic impact of COVID-19 and its subsequent border closure and the lockdown on the logistics, transportation services, and supply chain networks, most notably the closure of industrial complexes, commercial centers, and loss of jobs and businesses. As the pandemic disruption of the global supply chains reached its peak in the Middle East region, with approximately 22 percent decline in turnover of goods transport companies in 2020, we empirically assess the impact of this decline on the revenue, demand of services, operation, wages, and employments in the logistics companies in the Sultanate of Oman. Methodologically, we employ the Kolmogorov–Smirnov test, McNemar’s test, and Wilcoxon Signed- Ranks test to analyze the primary data collected from 61 survey questionnaire responses and 20 interviews of senior executives of these companies. Our results reveal unfavorable pandemic externalities on the surveyed companies’ balance sheet, demand for services, operational capacity, wage payments, and employee layoffs. We also observed strong correlations between the timely goods delivery and customs clearance and material shortages, and between customs clearance and material shortages. Our findings have practical implications for company executives to lessen the effects of the pandemic on the reduction of company income, service demand, operational capacity, salary payments, and employee layoffs. Policymakers must develop appropriate policy measures to enhance port competitiveness and improve customs procedures and service delivery.</em></p> Ashraf Mishrif, PhD, Asharul Khan, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 COVID-19 self-medication treatment: Media’s adverse effect based on people’s level of education <p><em>Objective: Self-medication has become a major concern among nonmedical professionals during the treatment of COVID-19. Such concerns have been attributed to the adverse effect of information shared via media outlets. Here, a survey was undertaken among nonhealthcare professionals to find out the adverse effect of media on self-medication for treating COVID-19.</em></p><p><em>Methods: A questionnaire-based survey was conducted electronically among nonmedical professionals (270 respondents). The questionnaire comprised three main components: demographic, education, and factor for self-medication. Statistical analysis of the data was made using analysis of variance to determine the degree of agreement between the response of participants with education below and above graduation. </em></p><p><em>Results and conclusion: Most of the respondents agreed that they get information about the COVID-19 medicines from different media. However, most of them do not visit the reliable source like World Health Organization (WHO) website to get information about COVID-19. The respondents were aware of the usage of medications such as Remdesvir, azithromycin, vitamins, herbal preparations, paracetamol, and cetirizine for COVID-19. The usage of herbal preparation may be due to their promotion in the media as over the counter drugs (OTC) products. It has been proposed to create more awareness and warning signs for the patients in and around pharmacy and hospital. Media campaign to create awareness for the prevention of COVID-19 spread should also be added with a caution line not to use any medication for treatment without prior consultation with physician. The matter of concern is that only a small fraction of the respondents follow WHO website to get information regarding COVID-19, which mandates to create awareness among the public regarding the role of WHO in healthcare. A significant agreement was noted between below graduates and post-graduates regarding questions such as visiting WHO website and the safety of taking medicine without consulting physician. Media is a contributing factor to self-medication, and measures of caution are highly imperative.</em></p><p><em> </em></p> Dibya Sundar Panda, PhD, Nasser Hadal Alotaibi, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 After action review of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, in 2020 <p><em>Surveillance is the backbone of any response to an infectious disease outbreak, and comprehensive evaluation of surveillance systems is crucial. However, structured evaluations of surveillance systems during the COVID-19 pandemic are scarce. We conducted a after action review (AAR) of the performance of the COVID-19 surveillance system in Quang Ninh Province, Vietnam, during 2020 using the COVID-19-specific AAR methodology developed by the World Health Organization in combination with guidance from the US Centers for Disease Control and Prevention (CDC). We conducted a stakeholder survey, document reviews, and key informant interviews with staff from Quang Ninh CDC’s COVID-19 surveillance system. The COVID-19 surveillance system was based on the pre-existing surveillance system in the province. The system’s strengths were early preparation for emergency response, strong governance and central coordination, and multidisciplinary collaboration. Stakeholders agreed that the system proved useful and adaptive to the fast-evolving COVID-19 situation but was weakened by overly complex systems, redundant administrative processes, unclear communication channels, and lack of resources. Overall, the surveillance systems in Quang Ninh province proved effective in containing COVID-19 and adaptive in a fast-changing epidemiological context. Several recommendations were made based on identified areas of concern that are of relevance for COVID-19 surveillance systems in Vietnam and similar settings.</em></p> Ha-Linh Quach, MPH, MAppEpid, Khanh Cong Nguyen, MD, MSc, Thai Quang Pham, MD, PhD, Ngoc-Anh Hoang, BSc, Hien Hong Thi Do, MD, PhD, Dung Thi Nguyen, MPH, Chu Van Ninh, MD, Emma Field, MAppEpid, DrPH, Anh Duc Dang, MD, PhD, Duong Nhu Tran, MD, PhD, Ha Cam Thi Pham, MSc, Anh Tu Tran, MD, MSc, Hien Tran Nguyen, MD, PhD, Nghia Duy Ngu, MD, PhD, Florian Vogt, MD, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 Perceptions regarding second wave of coronavirus disease 2019 (COVID-19) pandemic among Indian adults: A cross-sectional study <p><em>Background and aims: A massive surge in coronavirus disease 2019 (COVID-19) cases and deaths occurred in India during March–April 2021, and this was considered as second wave of the pandemic in the country. This study was conducted to find out the perceptions about second wave of the COVID-19 pandemic among Indian adults. </em></p><p><em>Methods: An online-survey-based cross-sectional study was conducted over 3 weeks from April 21, 2021 to May 11, 2021. Information regarding sociodemographic profile, perceptions about COVID-19 during second wave, perceptions and practices related to COVID-19 vaccination, COVID-19 appropriate behavior, and government’s response to the pandemic was collected. Descriptive analysis was performed.</em></p><p><em>Results: A total of 408 study participants were included. Mean age of the study participants was 29.2 ± 10.4 years. Around 92.6 percent (378) of respondents agreed that COVID-19 in 2021 is different from 2020. Perceived reasons for increased severity and cases were change in virus characteristics; social, religious, and political gatherings; and complacent behavior by people. Three-fourth (311, 76.2 percent) of the study participants agreed that vaccines have a positive role against COVID-19. Majority of the study participants (329, 80.6 percent) concurred that lockdown restrictions help in control of the pandemic. About 60.3 percent (246) of respondents had less trust on government post this pandemic compared to pre- COVID-19 times.</em></p><p><em>Conclusion: The public perception about reasons for second wave in India acknowledges both human and virus factors and highlights the importance of shared responsibility between citizens and government for controlling the pandemic.</em></p> Priyanka Sharma, MD, Anita Khokhar, MD, Shubham Mittal, MBBS Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 Individual and community preparedness to disasters and pandemics in Idaho Falls: A cross sectional analysis <p><em>Communities form an integral component of disaster and pandemic preparedness. This study aimed to explore disaster</em>/<em>pandemic preparedness—with a special focus on coronavirus disease 2019 (COVID-19)—at the household and community level among residents within 50 miles of Idaho Falls. A structured online survey questionnaire was distributed, resulting in 924 responses from participants over 18 years of age. The results highlighted that 29 and 10 percent of participants were not prepared to deal with disasters and pandemics, respectively. Most participants trusted healthcare professionals (61 percent) for information about COVID-19, followed by scientists (46 percent) and local health departments (26 percent). The overall preparedness to disasters</em>/<em>pandemics at the community level was 50 percent. Males, participants older than 35 years, and participants with paid employment had higher odds of being prepared for disasters, whereas higher education was associated with higher preparedness for pandemics. This study highlights the need for better household and community disaster and pandemic preparedness.</em></p> Meesha Iqbal, MD, MPH, FCPS, Ryan Lindsay, PhD, MPH, Megan Warnement Wrobel, PhD, Irene van Woerden, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 Anticipation or resilience in times of emergent crisis? COVID-19 responses in the United States, Taiwan, and South Korea <p><em>This research employs Wildavsky’s two strategies—anticipation and resilience—as our conceptual framework to compare COVID-19 policies in the United States, South Korea, and Taiwan. Also, following Handmer and Dovers’ three types of resilience, we develop theory-driven codes and then explain how governmental structures and cultural factors influenced governmental responses. We found that a key response to this pandemic is arguably correlated with how quick and flexible a government can adopt different types of resilient strategies. Our research provides a foundation for governmental emergency response discussions and management strategies to better cope with public health crises in the future.</em></p> Ray Hsienho Chang, PhD, Wen-Chi Shie, PhD, Yun-Hsiang Hsu, PhD, Hyungjo Hur, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 Management of emergency department diversion during the COVID-19 pandemic and disaster periods <p><em>Background: Recent news has shown the strain on hospital emergency departments (EDs) and emergency medical services agencies due to the surge of COVID-19; however, compared to all emergency medical service transports, is it true that the United States is seeing an increase in the frequency of diversions? In this quantitative research report, data were collected and analyzed from a national prehospital emergency medical services information system, which allowed for a comparison of the frequency of diverted ambulances, transport times, and final patient acuity of patients arriving by diverted ambulances before and during the COVID-19 pandemic. Statistical analysis was performed on data obtained from the National Emergency Medical Services Information System to compare the frequency of ambulance diversion prior to the COVID-19 disaster and during COVID-19.</em></p><p><em>Findings: Analysis of data obtained from the National Emergency Medical Services Information System found that there was not a significant increase in the percentage of ambulance transports that were diverted during the COVID-19 pandemic compared to before the pandemic. However, there were significant increases in the volume of all transports and diverted transports during the COVID-19 pandemic (p &lt; 0.01 for both measures).</em></p><p><em>Conclusion: The significant increases seen in the demand for services, combined with an overall downward trend in the number of healthcare facilities, have resulted in an increase in the volume of diversions, despite the overall demand increasing as well. The COVID-19 pandemic serves as a disaster</em>/<em>public health crisis that is subject to the same phases compared to other types of disasters. The significant findings of this report should provide the emergency services field a big picture, understanding that the problem at hand is multifaceted, with these findings shining light on the effects of current issues between emergency services and hospital EDs.</em></p> Michael Steflovich, MSFES, EMT, NREMT Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500 Exploration roles and responsibilities of trade unions in preventing and responding to emergencies against epidemics: The case of COVID-19 <p><em>Background and aim: The coronavirus disease 209 (COVID-19) pandemic has been affecting various strata of society including different guilds. Each of these segments has its role to play in controlling epidemics. Accordingly, this study aimed to explore trade unions’ roles and responsibilities in the prevention and emergency response to epidemic, including the COVID-19 pandemic.</em></p><p><em>Materials and methods: The present qualitative research was conducted using directed content analysis. Participants were selected by a purposeful sampling method. Data were collected through semi-structured interviews and field notes and validated through Lincoln and Guba’s (1985) evaluative criteria. Data were analyzed by MAXQDA software.</em></p><p><em>Results: Data analysis, constant comparison, and class integration provided a total of seven main themes, which were extracted into four domains of Plan, Implementation, Review, and Action. The main themes were categorized into the dimensions of each domain, so that the Plan domain included three dimensions of union</em>/<em>guild contexts, leadership and staff participation, and planning. The Implementation domain included two dimensions of support and operations. The Assessment domain had a performance evaluation dimension, and the Action domain was made up of an improvement dimension.</em></p><p><em>Conclusion: Relying on their organizational and social capacities, trade unions can facilitate the leadership and participation of employees and communities for appropriate policies and making resilient decisions to control epidemics and other roles and responsibilities related to health.</em></p><p><em> </em></p> Masoud Motalebi Gh, PhD, Elahe Ezati, PhD, Ali Asghar Farshad, PhD, Yahya Khosravi, PhD, Narmin Hassanzadeh-Rangi, PhD, Somayeh Karami, Mostafa Maleki, PhD Candidate, Mohammad Aligol, PhD Copyright (c) 2023 Journal of Emergency Management Tue, 28 Feb 2023 00:00:00 -0500