Objectives: It has been estimated that up to 90% of the US population is exposed to at least 1 traumatic event during their lifetime. Although there is growing evidence that most people are resilient, meaning that they have the ability to adapt to or rebound from adversity, between 5% and 10% of individuals exposed to traumatic events meet criteria for posttraumatic stress disorder. Therefore, identifying the elements of resilience could lead to interventions or training programs designed to enhance resilience. In this article, we test the hypothesis that the effects of stressor conditions on outcomes such as job-related variables may be mediated through the cognitive and affective registrations of those events, conceptualized as subjective stress arousal.

Methods: The subjects were 491 individuals employed in public accounting, who were sampled from a mailing list provided by the American Institute of Certified Public Accountants. The stressors used in this study were role ambiguity, role conflict, and role overload and the outcome measures were performance, turnover intentions, job satisfaction, and burnout. Stress arousal was measured using a previously developed stress arousal scale. We conducted a series of 2 EQS structural modeling analyses to assess the impact of stress arousal. The first model examined only the direct effects from the role stressors to the outcome constructs. The second model inserted stress arousal as a mediator in the relations between the role stressors and the outcomes.

Results: The results of our investigation supported the notion that subjective stress arousal provides greater explanatory clarity by mediating the effects of stressors upon job-related outcome. Including stress arousal in the model provided a much more comprehensive understanding of the relation between stressor and outcomes, and the contribution of role ambiguity and role conflict were better explained.

Conclusions: By understanding these relations, anticipatory guidance and crisis intervention programs can be designed and implemented to enhance human resilience. These data could serve to improve training programs for these “at risk” professional groups or even the population as a whole.

(Disaster Med Public Health Preparedness. 2011;5:98–105)

Objectives: The primary objective of the study was to understand the public's perception of the effectiveness of Rhode Island's public health emergency response plans by using municipal H1N1 vaccination clinics conducted in Rhode Island in January and February 2010 as a basis for public reaction. The effect of previous exercises on public perception was also examined.

Method: A survey of 926 H1N1 vaccination clinic attendees was conducted via mail during the period between March 18 and May 1, 2010.

Results: A total of 579 surveys were returned, rendering a response rate of 62.5%. The majority of clinic attendees traveled ≤10 mi to the vaccination clinic (90.48%). The average self-reported wait time inside the clinic was 19.16 minutes, and 69.84% of respondents expected to have waited longer before attending the clinic. The self-reported wait time was negatively correlated with patient-reported overall clinic satisfaction. A total of 98.08% of respondents believed that the signage used at the clinics was easy to follow, 100% of respondents believed that the clinic staff was courteous and respectful, and 82.35% of respondents reported that they would rate the clinic they attended as excellent.

Conclusions: Rhode Islanders prefer local public health service sites. There was a minor difference in the overall satisfaction of respondents who attended municipal clinics that had exercised emergency plans before activation for H1N1 vaccinations and those municipalities that had not previously exercised. The lack of difference between the practicing and nonpracticing points-of-dispensing may be caused by the standardization of municipal emergency plans, uniformity in the guidance and support of each clinic provided by the Rhode Island Department of Health, and municipalities that had not previously exercised had the opportunity to observe those that had exercised. Having thorough mass dispensing plans in place in advance of a public health emergency is as important as having exercised a point-of-dispensing before a real-world activation.

(Disaster Med Public Health Preparedness. 2011;5:106–111)

Objectives: The technology and resource-rich solutions of the developed world may not be completely applicable to or replicable in disasters occurring in the developing world. With the current looming hazards of pandemics, climate change, global terrorism and conflicts around the world, policy makers and governments will need high-quality scientific data to make informed decisions for preparedness and mitigation. The evidence on disasters in peer-reviewed journals about the developing world was examined for quality and quantity in this systematic review.

Methods: PubMed was searched using the Medical Subject Heading (MeSH) terms disasters, disaster medicine, rescue work, relief work, and conflict and then refined using the MeSH term developing country. The final list of selected manuscripts were analyzed by type of article, level of evidence, theme of the manuscript and topic, author affiliation, and region of the study.

Results: After searching and refining, <1% of the citations in PubMed addressed disasters in developing countries. The majority was original research articles or reviews, and most of the original research articles were level IV or V evidence. Less than 25% of the authors were from the developing world. The predominant themes were missions, health care provision, and humanitarian aid during the acute phase of disasters in the developing world.

Conclusions: Considering that 85% of disasters and 95% of disaster-related deaths occur in the developing world, the overwhelming number of casualties has contributed insignificantly to the world's peer-reviewed literature. Less than 1% of all disaster-related publications are about disasters in the developing world. This may be a publication bias, or it may be a genuine lack of submissions dealing with these disasters. Authors in this part of the world need to contribute to future disaster research through better-quality systematic research and better funding priorities. Aid for sustaining long-term disaster research may be a more useful investment in mitigating future disasters than short-term humanitarian aid missions to the developing world.

(Disaster Med Public Health Preparedness. 2011;5:112–116)

Objectives: Hospital surge capacity in multiple casualty events (MCE) is the core of hospital medical response, and an integral part of the total medical capacity of the community affected. To date, however, there has been no consensus regarding the definition or quantification of hospital surge capacity. The first objective of this study was to quantitatively benchmark the various components of hospital surge capacity pertaining to the care of critically and moderately injured patients in trauma-related MCE. The second objective was to illustrate the applications of those quantitative parameters in local, regional, national, and international disaster planning; in the distribution of patients to various hospitals by prehospital medical services; and in the decision-making process for ambulance diversion.

Methods: A 2-step approach was adopted in the methodology of this study. First, an extensive literature search was performed, followed by mathematical modeling. Quantitative studies on hospital surge capacity for trauma injuries were used as the framework for our model. The North Atlantic Treaty Organization triage categories (T1-T4) were used in the modeling process for simplicity purposes.

Results: Hospital Acute Care Surge Capacity (HACSC) was defined as the maximum number of critical (T1) and moderate (T2) casualties a hospital can adequately care for per hour, after recruiting all possible additional medical assets. HACSC was modeled to be equal to the number of emergency department beds (#EDB), divided by the emergency department time (EDT); HACSC = #EDB/EDT. In trauma-related MCE, the EDT was quantitatively benchmarked to be 2.5 (hours). Because most of the critical and moderate casualties arrive at hospitals within a 6-hour period requiring admission (by definition), the hospital bed surge capacity must match the HACSC at 6 hours to ensure coordinated care, and it was mathematically benchmarked to be 18% of the staffed hospital bed capacity.

Conclusions: Defining and quantitatively benchmarking the different components of hospital surge capacity is vital to hospital preparedness in MCE. Prospective studies of our mathematical model are needed to verify its applicability, generalizability, and validity.

(Disaster Med Public Health Preparedness. 2011;5:117–124)

There is a need for model uniform core criteria for mass casualty triage because disasters frequently cross jurisdictional lines and involve responders from multiple agencies who may be using different triage tools. These criteria (Tables 1-4) reflect the available science, but it is acknowledged that there are significant research gaps. When no science was available, decisions were formed by expert consensus derived from the available triage systems. The intent is to ensure that providers at a mass-casualty incident use triage methodologies that incorporate these core principles in an effort to promote interoperability and standardization. At a minimum, each triage system must incorporate the criteria that are listed below. Mass casualty triage systems in use can be modified using these criteria to ensure interoperability. The criteria include general considerations, global sorting, lifesaving interventions, and assignment of triage categories. The criteria apply only to providers who are organizing multiple victims in a discrete geographic location or locations, regardless of the size of the incident. They are classified by whether they were derived through available direct scientific evidence, indirect scientific evidence, expert consensus, and/or are used in multiple existing triage systems. These criteria address only primary triage and do not consider secondary triage. For the purposes of this document the term triage refers to mass-casualty triage and provider refers to any person who assigns primary triage categories to victims of a mass-casualty incident.

(Disaster Med Public Health Preparedness. 2011;5:125–128)

Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.

(Disaster Med Public Health Preparedness. 2011;5:129-137)

Global warming could increase the number and severity of extreme weather events. These events are often known to result in public health disasters, but we can lessen the effects of these disasters. By addressing the factors that cause changes in climate, we can mitigate the effects of climate change. By addressing the factors that make society vulnerable to the effects of climate, we can adapt to climate change. To adapt to climate change, a comprehensive approach to disaster risk reduction has been proposed. By reducing human vulnerability to disasters, we can lessen—and at times even prevent—their impact.

Human vulnerability is a complex phenomenon that comprises social, economic, health, and cultural factors. Because public health is uniquely placed at the community level, it has the opportunity to lessen human vulnerability to climate-related disasters. At the national and international level, a supportive policy environment can enable local adaptation to disaster events. The purpose of this article is to introduce the basic concept of disaster risk reduction so that it can be applied to preventing and mitigating the negative effects of climate change and to examine the role of community-focused public health as a means for lessening human vulnerability and, as a result, the overall risk of climate-related disasters.

(Disaster Med Public Health Preparedness. 2011;5:140–148)

As cases of 2009 novel H1N1 influenza became prevalent in Cincinnati, Ohio, Hamilton County Public Health called upon the University of Cincinnati College of Medicine to enhance its surge capacity in vaccination administration. Although the collaboration was well organized, it became evident that a system should exist for medical students' involvement in disaster response and recovery efforts in advance of a disaster. Therefore, 5 policy alternatives for effective utilization of medical students in disaster-response efforts have been examined: maintaining the status quo, enhancing the Medical Reserve Corps, creating medical school–based disaster-response units, using students within another selected disaster-response organization, or devising an entirely new plan for medical students' utilization. The intent of presenting these policy alternatives is to foster a policy dialogue around creating a more formalized approach for integrating medical students into disaster surge capacity–enhancement strategies. Using medical students to supplement the current and future workforce may help substantially in achieving goals related to workforce requirements. Discussions will be necessary to translate policy into practice.

(Disaster Med Public Health Preparedness. 2011;5:150–153)

Mental health is an important aspect of public health after a disaster. This article describes what is known and what remains to be learned regarding the mental health impact of the January 12, 2010, earthquake in Haiti. Public health surveillance efforts in Haiti and the United States in the first 2 months after the earthquake are described. Challenges in clinical assessment and public health surveillance are explored. Potential implications for survivors and public health officials are considered.

(Disaster Med Public Health Preparedness. 2011;5:154–157)

Health care providers face multiple difficulties in providing care to a disaster-stricken community. Training, preparation, and a good attitude are important, as is adequate logistical support. An often-ignored issue is the difficulty encountered with language barriers during a response, and how using interpreters affects the quality and impact of the health care provided. This article reviews the use of interpreters and focuses on how they may affect an international health care response.

(Disaster Med Public Health Preparedness. 2011;5:159–163)