Journal of Emergency Management

Volume 23, Number 1

Journal of Emergency Management — Sat, 01 Feb 2025 00:00:00 -0500

January/February 2025

The psychological impact of mass shootings on emergency physician mental health

Mary McDonough, Anne Weisman, PhD, Andrew Hanson, PhD, Stephen D. Benning, PhD — Sat, 01 Feb 2025 00:00:00 -0500

On October 1, 2017 in Las Vegas, Nevada, the largest mass shooting in US history was committed by a shooter high above the Route 91 Harvest Festival. In light of this tragedy and the increasing incidence and prevalence of mass shootings in America, it is important to examine how exposure to traumatic events (specifically mass shootings) affects the mental health of hospital physicians through the treatment of victims. This study sought to examine how witnessing mass shootings through the treatment of shooting victims psychologically affects physicians. Nine physicians who had direct contact with the victims were interviewed, and the data were analyzed for common themes using phenomenology. From the interviews, five central themes emerged: normalization of the event, denial, feelings of guilt, the positive outcomes associated with the event, and the magnitude of the patient volume. These themes show specifically how physicians are impacted by traumatic events and can be used to implement strategies to promote physician mental health.

Logic of crisis management practice in handling the COVID-19 pandemic: Experiences from two Swedish public-sector organizations

Sat, 01 Feb 2025 00:00:00 -0500

This study aims to examine the ambiguity and uncertainty surrounding crisis management and the implementation of national recommendations in two public-sector organizations during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic. This study is based on two case studies: a municipality and a county administrative board in Sweden. Data were collected through interviews, surveys, and participation in meetings, and they were analyzed using a practice theory lens. The results demonstrate a lack of knowledge and uncertainty regarding the crisis management structure, leading to conflicting interpretations of rules, recommendations, and decision-making procedures. The somewhat uncoordinated response from central authorities had a significant impact on local handling of the crisis, requiring higher management to spend considerable time interpreting the regulations and adjusting them to the local situation. The lack of clear decision procedures and support from higher management creates frustration and anxiety among operational managers. Organizations struggle to keep up with fast-changing guidelines and implement them effectively, resulting in an increased workload and challenges in prioritizing resources. The study also reveals concerns about the long-term consequences and ability to maintain quality in core activities during a wide-ranging crisis as the COVID-19 pandemic.

Software simulation of emergency evacuation and providing corrective measures in hospital buildings

Sat, 01 Feb 2025 00:00:00 -0500

Introduction: Emergency evacuation from hospitals is a complicated process. This is on account of multiple categories of occupants of hospitals at any given time. This study was conducted using simulation, which simulated emergency evacuation in a teaching hospital. The aim was to identify defects in stairways and exit doors to propose design modifications to facilitate emergency evacuation.

Methods: This cross-sectional study was conducted using Pathfinder software. The stages of the study included (1) map and model preparation, (2) field study, (3) simulation of evacuation, and (4) making feasible changes in the dimension of the hospital stairways and exit doors and examining its impact on the efficiency of evacuation processes.

Results and discussion: In the case where all people can move on their own, the evacuation time was 129.7 seconds. If the occupants of the beds and wheelchairs needed assisted evacuation, the evacuation time was 733.3 seconds, which increased by more than five times. If there were impediments in the building corridors, the evacuation was not complete, and 36 percent of the people could not be evacuated. By considering modification of around 58.6 percent in width and/or area of exit dimensions based on the field visit and its feasibility without making major structural changes, there was a reduction in the evacuation time by 46 percent.

Conclusion: The results showed that the modifications of passages could make significant improvements in the evacuation process. This would also lead to the reduction of evacuation time in emergencies.

Factors influencing successful planning, implementation, and improvement of emergency exercises

Sat, 01 Feb 2025 00:00:00 -0500

Despite the critical importance of emergency exercises for emergency preparedness, there are major deficiencies in some organizations in managing their exercises. Lack of a comprehensive and systematic approach to emergency exercises can waste organizational resources and diminish the response confidence. The present study was conducted to identify and prioritize influencing success factors for planning, implementing, and improving the exercise process. In this study, a pattern for exercise management process was established based on relevant standards and guidelines. Then, the success and failure factors for each step of a typical exercise were identified based on previous studies. Finally, Fuzzy analytic hierarchy process was used to prioritize the identified influencing factors. Based on literature review and experts’ opinions, 28 factors influence the success of emergency exercises. Although relative importance of all factors was close to each other, findings showed that “establishing the base of support for an exercise program,” “designing the scenario,” “presentations/briefings,” “using expert evaluators,” and “defining appropriate corrective actions plan” had the greatest impacts on the success of an emergency exercise.

Hospital cybersecurity: Emergency planning response and preparedness to mitigate the effects of a potential cyberattack on French hospitals in Paris, France

Ali Ghanchi, PhD, MPH, RM, Charles Barthe, MSc, Didier Perret, MSc — Sat, 01 Feb 2025 00:00:00 -0500

Over the last few years, numerous hospitals in France have been subject to increasingly frequent and severe cyberattacks that have disrupted healthcare provision to varying degrees. To mitigate this threat, especially in light of the forthcoming 2024 Olympic Games, Assistance Publique–Hôpitaux de Paris in Paris has been developing contingency plans that have been tested in simulated exercises called CRYPTolocker EXercice since May 2021. The latest simulated ransomware cyberattack that involved more than 200 participants took place on July 5, 2023, and lasted for 24 hours. Although cybersecurity contingency plans are confidential for obvious reasons, this article presents the multidisciplinary organization of the simulated attack based on previous experiences from other hospitals and general findings that are in the public domain. It was found that the procedures in place worked well overall, and countermeasures were quickly implemented to limit the severity of this simulated cyberattack. However, failings were observed in intra- and extra-hospital communication, and conflicting priorities between different categories of personnel (administrative, managerial, and clinical) hampered the information technology team in resolving various issues. Furthermore, it was found that mental fatigue, task saturation, and information overload may have overwhelmed senior managers at sporadic intervals. This often resulted in an action–reaction approach being used to find temporary solutions to immediate problems. Consequently, senior managers who participated in this simulated cyberattack were unable to think strategically and anticipate demands for middle- and long-term issues. This unprecedented exercise was an important learning experience for all participants, and the lessons learned will help further improve contingency planning and cyber resilience. It advised that all hospitals worldwide adopt and develop a similar multidisciplinary approach (taking into account their local contexts) to limit the deleterious effects of a potential cyberattack that undoubtedly will become more prevalent in the future.

Active shooter preparedness for special education classrooms

Linda Suarez, EdD, Erica C. Pinket, MPS-EDM — Sat, 01 Feb 2025 00:00:00 -0500

Active shooter planning for special education classrooms requires considerations commensurate to the needs of students with mobility, cognitive, auditory, visual, and communicative limitations. The federally established Run, Hide, Fight response methodology has no modified alternative for students who are not able to meet the criteria to run, hide, or fight. School districts that implement Run, Hide, Fight plans without any modified alternatives for special education students expose a compliance lapse of the American Disabilities Act, the Department of Education’s Individuals with Disabilities Education Act, and the National Preparedness Goal. To address this gap in planning, a qualitative analysis of primary source documents determined that there is insufficient active shooter planning guidance requisite to students with Access and Functional Need limitations.

Communication preferences during the recovery phase of a hurricane disaster: Rural residents prefer face-to-face interaction

C. Suzanne Lea, MPH, PhD, Hanna Beers, MSW — Sat, 01 Feb 2025 00:00:00 -0500

Objective: The recovery phase of the emergency management cycle is understudied. This research aimed to understand the communication preferences of rural residents with low literacy during the recovery phase of a hurricane and flooding disaster.

Methods: During October and November 2019, three focus groups (n = 32) were conducted with members of church congregations in three small townships in eastern North Carolina. Audio recordings were transcribed and coded for communication preferences and themes.

Results: Participants were primarily non-White (62 percent), over age 55 (78 percent), and a majority (70 percent) had completed high school or less education. The primary communication preference for the recovery phase was face-to-face. Television (TV) was seen as an approach to disseminate dates and times for local in-person meetings and provide phone numbers to speak with a “live” person. Social media was not a dominant communication preference. Themes that emerged included the following: (1) governmental response related to repairs and buyout following past hurricanes has been too slow; (2) the elderly and those with low literacy seek in-person attention in their towns; (3) residents feel “forgotten” because resources are concentrated in the county seat.

Conclusions: Rural residents prefer face-to-face communication in the recovery phase. Multiple approaches to communication may be most effective to distribute recovery phase opportunities.

Helene: The whole community approach—North Carolina pulls together in the face of disaster

DC Linton — Sat, 01 Feb 2025 00:00:00 -0500

In the wake of Hurricane Helene, North Carolina has seen its people come together in extraordinary ways, embodying the spirit of the “whole community” approach. This approach emphasizes the collaboration of various stakeholders, including local residents, businesses, government agencies, and nonprofits, to enhance disaster response and recovery efforts. By involving everyone, it ensures that the diverse needs of the community are met efficiently. This collective effort fosters resilience and strengthens the community’s ability to bounce back from adversity. This disaster, of biblical proportions, has tested the state’s resilience, but the response has been nothing short of inspiring. This approach not only expedites immediate recovery but also builds long-term resilience by fostering stronger relationships and trust among community members. By continuously involving all stakeholders, it ensures better preparedness for future disasters. Additionally, it promotes sustainable development practices that can mitigate the impact of future emergencies. Faith-based organizations, nongovernmental organizations, and everyday citizens have all united, pulling together to support their fellow neighbors and meet immediate needs long before federal aid could arrive.

National health care security and the dentist and dental hygienist compact: A call to action

Sat, 01 Feb 2025 00:00:00 -0500

There appears to be some confusion, misunderstanding, and unfounded concern about state governments being asked to adopt the recent initiative from the United States (US) Department of Defense regarding a dental health provider’s compact for US states and territories. Yet, there needs to be a realization of the significance and priority for joining the Dentist and Dental Hygienist Compact, since it directly incorporates into health care security as a strategy component. While there is a gross lack of research and information shared in this area, this editorial serves to offer such research, information, insight, and clarification to emergency management professionals on the value and necessity to openly support dental compact agreements for all US states and territories.

Appendix: Hospital cybersecurity: Emergency planning response and preparedness to mitigate the effects of a potential cyberattack on French hospitals in Paris, France

Ali Ghanchi, PhD, MPH, RM, Charles Barthe, MSc, Didier Perret, MSc — Sat, 01 Feb 2025 00:00:00 -0500

Volume 22, Number 6

Journal of Emergency Management — Sun, 01 Dec 2024 00:00:00 -0500

November/December 2024

The impact of COVID-19 public health and social measures on years of potential life lost

Sun, 01 Dec 2024 00:00:00 -0500

Background: To determine the impacts of statewide coronavirus disease 2019 (COVID-19)-related public health and social measures (PHSMs) and attempted pandemic mitigation measures on years of potential life lost (YPLL).

Methods: The “openness score” of each state during the COVID-19 pandemic was obtained using two open-source sites, the Multistate openness score and the Wallethub openness score. These scores combined various PHSMs, such as restrictions on gatherings and closing various types of businesses. Using data from the Centers for Disease Control and Prevention (CDC) Wonder database, the differences in prepandemic (2017-2019) and pandemic excess mortality were calculated in terms of YPLL and then compared to the openness scores using univariate regression modeling.

Results: States that instituted more restrictive PHSMs as measured by openness scores failed to experience reductions in YPLL. On the contrary, there were trends toward statistical significance associating greater YPLL with the institution of more stringent PHSMs (p = 0.109 and p = 0.080 for Multistate and Wallethub, respectively).

Discussion: This study suggests restrictive PHSMs were ineffective for improving mortality in this pandemic and trended toward increasing mortality in the younger population, presumably from other, non-COVID-19 causes.

Evaluation and comparison of hospital preparedness levels against mass-casualty disasters and the COVID-19 pandemic

Sun, 01 Dec 2024 00:00:00 -0500

Background: Inadequate preparedness of hospitals is associated with negative outcomes in the treatment procedure. During the coronavirus disease 2019 (COVID-19) pandemic, healthcare systems faced many problems due to the widespread prevalence of the disease. This study was designed and conducted with the aim of investigating and comparing the preparedness levels of hospitals against mass-casualty disasters and the COVID-19 pandemic.

Method: This research was a cross-sectional, descriptive-analytical study conducted in January 2022 in five educational hospitals affiliated with Qom University of Medical Sciences, Qom, Iran, admitting COVID-19 patients. The National Hospital Preparedness Checklist and the Hospital Preparedness Checklist for the COVID-19 pandemic were used to collect the required data.

Results: The total preparedness level against mass-casualty disasters was estimated to be 79.81 percent. The lowest and highest average preparedness scores were related to the dimensions of “Logistic and management of supplies” (74 percent) and “command and control” (96.66 percent), respectively. In addition, the overall preparedness level against COVID-19 was estimated to be 87.20 percent. The lowest and highest average percentage of preparedness scores were related to the fields of “supply management” (71.81 percent) and “laboratory services” (97.14 percent), respectively.

Conclusion: The duration of exposure to emergency situations and managerial perspectives are among the factors affecting the preparedness of medical systems against disasters. It is assumed that some kind of adaptation exists in healthcare systems, which leads to an improvement in their preparedness level. In order to deal with crises, it is suggested to set up specialized hospitals (such as trauma centers), train crisis managers, and use them in the management of medical centers.

Skills for Psychological Recovery train-the-trainer program: For care providers of children with special healthcare needs and disabilities during COVID-19 recovery

Sun, 01 Dec 2024 00:00:00 -0500

Care providers, including both professional and family caregivers, were negatively impacted by the pandemic. In partnership with the Minnesota (MN) Pediatric Care Coordination Community of Practice, the MN Department of Health Regional Behavioral Health Coordinator team provided a 7-week training of trainers in Skills for Psychological Recovery (SPR) to care providers of adults and children with special healthcare, mental health needs, and disabilities. The goal of SPR training was to protect the mental health of disaster survivors, enhance their abilities to address needs and concerns, teach skills to promote recovery, and prevent maladaptive behaviors while identifying and supporting adaptive behaviors. Weekly sessions presented skills to gather information and prioritize assistance, build problem-solving capacity, promote positive activity, manage reactions, promote helpful thinking, and rebuild healthy social connections. Data were collected during registration on the community challenges they are dealing with due to coronavirus disease 2019 (COVID-19), how COVID-19 has impacted them personally and/or professionally, and what they hoped to gain from this training. Data were also collected during the training regarding the quality of the training and the skills that they were learning through weekly feedback forms. Post-training data were collected on how they plan to use the SPR. This case study article will discuss collected data and outcomes and provide information on how to conduct the SPR training for replication. The article will also discuss limitations and future research possibilities.

Capturing human response to Winter Storm Frankie based on X (formerly known as Twitter) data

Seungil Yum, PhD — Sun, 01 Dec 2024 00:00:00 -0500

This study delves into how people responded to Winter Storm Frankie in the United States based on X (formerly known as Twitter^®) data according to a multitude of regions, periods, sociodemographic characteristics, census regions, and geographical scales. This study finds that people actively respond to natural disasters on X during the winter storm week. Specifically, the highest number of keywords during the winter storm week is 1.6 times greater than the second-highest number of keywords during the prewinter storm week. Second, the spatial distribution of tweets exhibits significant fluctuations across different periods. For instance, in the prewinter storm week, more tweets are posted in the West region, while in the winter storm week, the Northeast region experiences a higher volume of uploads. Third, regional variables exert a substantial influence on the number of tweets. For instance, Ohio and Montana demonstrate higher elasticity than Pennsylvania. Fourth, many sociodemographic variables, such as gender, age, education, and income, are associated with individual responses. For example, a 1 percent increase in males corresponds to a 0.01 percent increase in tweets.

Social media and disaster management by the National Emergency Management in Nigeria: What it is and what it should be

Oluwasinaayomi Faith Kasim, PhD, Ismail Adedapo Oyerinde, MSc — Sun, 01 Dec 2024 00:00:00 -0500

The environment for communicating about emergencies and disasters has changed as a result of the development of mobile technologies and social media applications. The public expects emergency management agencies to monitor, respond to, and report disasters via mobile applications due to this shift. This study, using the retrospective approach, analyzes the posts by the National Emergency Management Agency (NEMA) on social media in Nigeria. Activities reported via the agency’s verified social media handles (Facebook^®) between 2015 and 2021 serve as the data source. Findings revealed that social media is a useful tool in disaster management, as disaster-related activities and events across the management cycle were posted by NEMA’s national and zonal offices. Most posts (45.0 percent) focused on response activities, while the recovery phase (2.0 percent) had the least posts. There was a significant variation in the reporting across the disaster management cycle (F(4,30) = 9.746). Attention should be placed on shifting NEMA from post-disaster activities to a predisaster-focused agency. Therefore, the agency should develop a social media policy and train its information officers to use the medium to engage actively with the public, especially regarding information on predisaster management activities.

Tornado sheltering: Challenges and solutions including public storm shelters

Craig D. Croskery, PhD, Kathleen Sherman-Morris, PhD — Sun, 01 Dec 2024 00:00:00 -0500

Tornadoes are a considerable threat across the United States, occurring in many regions of the country on a frequent basis throughout the year. Finding a safe place to go during a tornado can be a challenge for many individuals, and, in some situations, there is no safe place available. Increasing the number of tornado shelters and establishing them in regions where they are not currently present can greatly improve the safety of local residents and visitors, especially for those who are unable to afford retrofitting a shelter into their own home or business. Research is lacking regarding the use of such public shelters. To better understand tornado sheltering behavior, an online survey was conducted with about 1,450 people. The survey examined current tornado sheltering behavior in locations with and without public shelters available, as well as hypothetical behavior if the respondent’s location acquired a public shelter. A majority of respondents in the Deep South and Great Plains reported living in a county or community with a public shelter. While a majority of respondents have never used a public tornado shelter, the majority of those surveyed mentioned that they would utilize such shelters, at least during extreme threats. Actual use is also higher among mobile home residents. Consistent wayfinding and policies (such as pet accommodation) should also be implemented to ensure their use and promotion, and mobile applications should identify their locations.

Areas in conflict and emergency response: Navigating complex challenges

Thad Hicks, PhD, CEM — Sun, 01 Dec 2024 00:00:00 -0500

This article explores the intricate relationship between conflict and emergency response. It emphasizes the need for understanding the nexus between these two challenges and the pivotal role of conflict analysis in effective humanitarian efforts. This article highlights real-world examples and the importance of conflict-sensitive approaches while addressing the challenges and ethical dilemmas in conflict-affected emergency response. It concludes with policy recommendations aimed at improving coordination and strengthening conflict analysis capacities to provide more effective and safer assistance in complex crisis situations.

Volume 22, Number 5

Journal of Emergency Management — Tue, 15 Oct 2024 00:00:00 -0400

September/October 2024