Critically insufficient pediatric hospital capacity may develop during a disaster or surge event. Research is lacking on the creation of pediatric surge capacity. A system of “reverse triage,” with early discharge of hospitalized patients, has been developed for adults and shows great potential but is unexplored in pediatrics.

We conducted an evidence-based modified-Delphi consensus process with 25 expert panelists to derive a disposition classification system for pediatric inpatients on the basis of risk tolerance for a consequential medical event (CME). For potential validation, critical interventions (CIs) were derived and ranked by using a Likert scale to indicate CME risk should the CI be withdrawn or withheld for early disposition.

Panelists unanimously agreed on a 5-category risk-based disposition classification system. The panelists established upper limit (mean) CME risk for each category as <2% (interquartile range [IQR]: 1–2%); 7% (5–10%), 18% (10–20%), 46% (20–65%), and 72% (50–90%), respectively. Panelists identified 25 CIs with varying degrees of CME likelihood if withdrawn or withheld. Of these, 40% were ranked high risk (Likert scale mean ≥7) and 32% were ranked modest risk (≤3).

The classification system has potential for an ethically acceptable risk-based taxonomy for pediatric inpatient reverse triage, including identification of those deemed safe for early discharge during surge events. (Disaster Med Public Health Preparedness. 2015;9:283-290)

The most effective way to reduce the number of expected victims and amount of damage from earthquakes is by effective preparedness. The Israeli government launched a national campaign to change its citizens’ behavior. This study assessed the effectiveness of the campaign on the Israeli population.

The survey was conducted 2 weeks after the campaign ended. It was based on a randomly selected representative sample of the adult Israeli population.

Of the 42% of the Israeli public exposed to the campaign, 37% estimated that a strong earthquake might occur in Israel during the coming years. Only 23% of those who were exposed to the campaign (9% of the Israeli public) said that the campaign improved their awareness; 76% reported that after their exposure to the campaign they did nothing to prepare. However, exposure to the campaign significantly increased the knowledge of dealing with earthquakes (30% vs 21% among those not exposed).

Although the campaign increased knowledge and awareness, it did not achieve the goal of improving public preparedness. The campaign was not effective by itself, and it should be part of a multiyear activity. (Disaster Med Public Health Preparedness. 2015;9:138-144)

Hospitals are expected to serve the medical needs of casualties in the face of a disaster or other crisis, including man-made conflicts. The aim of this study was to evaluate the impact of the 2011 Yemeni revolution on hospital disaster preparedness in the capital city of Sana’a.

The study was conducted in September 2011 and 2013. For evaluation purposes, the hospital emergency response checklist published by the World Health Organization (WHO) was used. Additional information was also obtained to determine what steps were being taken by hospital authorities to improve hospital preparedness.

The study selected 11 hospitals. At the time of the first evaluation, 7 hospitals were rated “unacceptable” for level of preparedness and 4 were rated “insufficient,” receiving a WHO checklist rating of 10 to 98. At the second evaluation, 5 hospitals were rated “unacceptable,” 3 “insufficient,” and 1 “effective,” receiving a rating of 9 to 134.

Unfortunately, this study shows that between 2011 and 2013, no significant progress was made in hospital disaster preparedness in Sana’a. In a disaster-prone country like Yemen, the current situation calls for drastic improvement. Health system authorities must take responsibility for issuing strategic plans as well as standards, guidelines, and procedures to improve hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2015;9:396–402)

The aims of this study were to assess the awareness of risk for suicidal behaviors and perspectives of Project Recovery counselors who provided crisis counseling services to hurricane survivors.

The Short Posttraumatic Stress Disorder Rating Interview–Extended, a quantitative disaster mental health measure, was used to assess distress and dysfunction to the recent hurricanes. Project Recovery counselor data were collected through a 22-item qualitative interview.

Seven out of 207 clients (3.4%) endorsed the quantitative item measuring suicidal ideation. Clients who reported suicidal ideation had significantly higher scores on items indicating a loss of enjoyment, feelings of depression, feeling less able to handle stress, and other mental health items. Counselor responses fell into 5 major themes: Assessment and Action, Client Characteristics, Services, Counselor Training and Preparedness, and Future Directions.

Suicidal behavior is a serious mental health emergency, yet it remains a challenging issue as suicidal behaviors are complex and disaster survivors with suicidal ideation may experience intense psychological reactions to the event. In order to provide competent care to survivors experiencing suicidal thoughts or behaviors, the need for counselors to receive adequate training in suicide assessment and management is essential. (Disaster Med Public Health Preparedness. 2015;9:291–300)

This study examines the public perception of the 2009 H1N1 influenza risk and its association with flu-related knowledge, social contexts, and preventive behaviors during the second wave of the influenza outbreak in Arizona.

Statistical analyses were conducted on survey data, which were collected from a random-digit telephone survey of the general public in Arizona in October 2009.

The public perceived different levels of risk regarding the likelihood and their concern about contracting the 2009 H1N1 flu. These measures of risk perception were primarily correlated with people of Hispanic ethnicity, having children in the household, and recent seasonal flu experience in the previous year. The perceived likelihood was not strongly associated with preventive behaviors, whereas the perceived concern was significantly associated with precautionary and preparatory behaviors. The association between perceived concern and precautionary behavior persisted after controlling for demographic characteristics.

Pandemic preparedness and response efforts need to incorporate these findings to help develop effective risk communication strategies that properly induce preventive behaviors among the public. (Disaster Med Public Health Preparedness. 2015;9:145-154)

New theoretical and practical approaches were used to determine the outcome of complex interorganizational networks during the 2009 H1N1 outbreak in Australia.

Seventy health professionals from different skill sets and organizational positions who participated in the 2009 swine influenza H1N1 outbreak in Australia were surveyed. Interviews were designed to collect both qualitative and quantitative data to build a comprehensive and in-depth understanding of the dynamics of interorganizational networks that evolve during the coordinated response to the H1N1 outbreak. Three main components of network theory, ie, degree centrality, connectedness, and tie strength, were used to construct a performance model for assessing networks of preparedness and response.

We observed that increasing communication frequency and diversifying the tiers of the interorganizational links enhanced the overall network’s performance in the case of formal coordination. Network measures such as centrality, connectedness, and tie strength were relevant and resulted in improving the entire network’s performance during the outbreak.

In the context of a disease outbreak in a complex environment and a large geographical area, this investigation has provided a new perspective for understanding how the structure of a collaborative network of personnel affects the performance of the overall network. (Disaster Med Public Health Preparedness. 2015;9:155-165)

Recent disasters within the United States, such as Hurricanes Katrina and Sandy, have highlighted the vulnerability of older adults, and recent litigation has upheld the responsibility of government in assisting the public during mandatory evacuations. Older adults designated as homebound due to their disabilities are at greatest risk of poor outcomes in disasters. This study aimed at assessing the willingness and ability of homebound older adults to evacuate, as well as categorizing their medical needs in the event they are relocated to an emergency shelter.

Fifty-six homebound older adults and medical decision surrogates from 1 homebound primary care practice in Philadelphia were assessed with a novel structured interview.

Respondents reported limitations in both their ability and their willingness to evacuate their neighborhoods. Medical needs of homebound older adults were on par with those of nursing home residents.

Many homebound older adults are unable or unwilling to evacuate in a mandatory evacuation situation, highlighting a need for public assistance. Their complex medical needs will require significant preparation by special needs shelters. (Disaster Med Public Health Preparedness. 2015;9:301-306)

This study aimed to explore the correlation between the 2011 Great East Japan Earthquake and postpartum depression among perinatal subjects in the Miyako region of Iwate, an area damaged by earthquakes and tsunamis.

We retrospectively compared the percentages of women with scores ≥9 on the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) among 3 groups of women who gave birth prior to the disaster (before-disaster group: n=141), within 3 months after the disaster (within-3-months group: n=70), and 4-6 months after the disaster (4-6-months group: n=89) at the Iwate Prefectural Miyako Hospital. The risk factors for EPDS scores ≥9 were estimated with multivariate logistic regression analyses.

Compared with the before-disaster group, a significantly greater number of women in the within-3-months group had EPDS scores ≥9 at hospital discharge (31.4% versus 9.9%, P<.0001), whereas women in the 4-6-months group did not (10.1% versus 9.9%, P=.96). In both the after-disaster groups, the destruction of their home (adjusted odds ratio [AOR], 3.68; 95% confidence interval [CI], 1.46-9.26) and dissatisfaction with their living conditions (AOR, 3.02; 95% CI, 1.20-7.59) were significantly associated with EPDS scores ≥9.

An increase in postpartum depression was observed after the Great East Japan Earthquake among perinatal women. (Disaster Med Public Health Preparedness. 2015;9:307-312)