Note: Many of the concepts and some of the text and content provided in this paper were developed in association with Knut Ole Sundnes, MD and evolved from the Health Disaster Management: Guidelines for Evaluation and Research in the Utstein Style.* Initial and partial support for this project was provided by the Task Force for Quality Control of Disaster Management. This Project is under the auspices of the World Association for Disaster and Emergency Medicine.
The goals of conducting disaster research are to obtain information to: (1) decrease the human, environmental, and economic losses; (2) decrease morbidity; (3) decrease pain and suffering; and (4) enhance the recovery of the affected population. Two principal, but inter-related, branches of disaster research are: (1) Epidemiological; and (2) Interventional. In response to the need for the discipline of disaster health to build its science on data that are generalizable and comparable, a set of five Frameworks have been developed to structure the information and research of the health aspects of disasters: (1) Conceptual; (2) Longitudinal; (3) Transectional Societal; (4) Relief-Recovery; and (5) Risk-Reduction. These Frameworks provide a standardized format for studying and comparing the epidemiology of disasters as well as evaluating the interventions (responses) provided prior to, during, and following a disaster, especially as they relate to the health status of the people affected or at-risk. Critical to all five Frameworks is the inclusion of standardized definitions of the terms used to describe factors that lead to and affect the occurrence and severity of a disaster. The Conceptual Framework describes the progression of a hazard that becomes an event, which causes structural damage and a decrease or loss of function (functional damage), that, in turn, produces needs that lead to a disaster. The Longitudinal Framework describes this chronological progression as phases in order of their appearance in time, even though some of them occur concurrently. In order to study and compare the effects of an event on the complex amalgam that constitutes a society, the essential functions of a society have been deconstructed into 13 Basic Societal Systems that comprise the Transectional Societal Framework. These diverse, but inter-related Basic Societal Systems interface with each other through a 14th system called Coordination and Control. Epidemiological research studies the relationships and occurrences that influence and result from a disaster. Interventional research involves the evaluation of interventions, whether they are directed at relief, recovery, hazard mitigation, capacity building, or performance. The Relief-Recovery and Risk-Reduction Frameworks are based on a Disaster Logic Model. The Relief-Recovery Framework provides the structure necessary to systematically evaluate specific interventions provided during the Relief and Recovery phases of a disaster. The Risk-Reduction Framework details the processes involved in mitigating the risk that a hazard will produce a destructive event and/or that capacity building will augment the resilience of a community to the consequences of such an event. It incorporates a cascade of risks that lead from the presence of a hazard to the development of a disaster. Risk is described as the likelihood that each of the steps leading from a hazard to a disaster will take place; it also includes the probable consequences of the occurrence of each of the elements in the Conceptual Framework. The Conceptual, Longitudinal, and Transectional Societal Frameworks are useful in epidemiological research, i.e., the study of the incidence of, and factors influencing events and disasters. The Relief-Recovery and Risk-Reduction Frameworks are added to the Conceptual, Longitudinal, and Transectional Societal Frameworks for conducting and reporting of interventional research/evaluations. Examples of the application of these Frameworks are provided.
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