Following humanitarian crises (e.g. armed conflict), reliable population health metrics are vital to establish health needs and priorities. However, the challenges associated with accurate health information and research in conflict zones are well documented. Often working within conflict settings are authorities and non-government organizations (NGOs) who frequently collect data under the context of operations. This operational data is a potentially untapped source of hard-to-reach data that could be utilized to provide a better insight into conflict affected populations. The Hard to Reach Data (HaRD) framework highlights the process of identifying and engaging with these stakeholders collaboratively to develop research capacity.

The HaRD framework was developed from literature searches of health and social sciences databases. The framework which provides a structure to gain access to data in hard-to-reach settings was applied to humanitarian mine action to identify and collect existing but underutilized data.

Guided by the HaRD framework we compiled the world’s first global casualty dataset for casualties of landmines and explosive remnants of war. The framework provided a structured approach to identify and engage with key stakeholders. An adaptive approach was needed for stakeholder engagement with trust building and transparency important factors in developing a collaborative partnership. Appropriate communication of research findings is important to ensure reciprocity.

The HaRD framework can identify potential data sources and guide access in hard-to-reach data settings. Operational data is often available but hidden; a systematic approach to identifying and engaging with stakeholders can assist in developing successful research partnerships between academia and humanitarian organizations.

Disasters have adversely affected human life since the beginning of our existence. In response, societies have attempted to improve disaster response & reduce the consequences of disasters by developing standardized organizational arrangements, often known as Incident Command Systems (ICS). These ICS response systems have a military heritage in hierarchical organizational command & control (C2) that is authoritative by nature and fits well with bureaucratic organization. While emergency service agencies have embraced ICS, other agencies often involved in community-level disaster response, such as public health, non-government organizations and community groups, have not. Although ICS have become the backbone of disaster management (DM) policy in Australia and overseas, worldwide debate over the effectiveness of ICS continues. Therefore, this study investigated ICS systems used worldwide to aid in the development of an improved conceptual framework for managing the response to modern-day disasters, for all agencies, at all levels and across all hazard types.

Phase one involved a review and critical analysis of the literature. Phase two used inductive research methods to gain a better understanding of the barriers & facilitators of ICS to the multi-agency disaster response. Two studies were conducted in this phase: Study one used semi-structured interviews with key informants involved in the 2018 Central Queensland Bushfire & 2019 North & Far North Queensland Monsoon Trough Flood & Study two participants from any disaster. Phase three undertook a policy analysis of recent disaster reviews and inquiries. This was triangulated with previous findings and presented to an expert panel by way of a 2-round modified Delphi.

The most significant outcome of this research was the improved understanding of the strengths and weaknesses of ICS within the context of multi-agency engagement in disaster management.

Development of conceptual framework based on modifications to the ICS principles and includes other phases of the DM continuum with psychological aspects taken into consideration.

Explosive hazards like landmines are known to contaminate over sixty countries and continue to threaten the health of affected communities across generations. The current study is the first to consider the impact of landmines and explosive remnants of war by drawing on global casualty data to determine mortality patterns.

This study is a retrospective analysis of secondary multi-source data on over 100,000 explosive hazard casualties from 17 low and middle income conflict-affected countries. This data was collected from mine action centers, international non-governmental organizations, and international bodies (e.g., United Nations), and include surveillance data, retrospective and prospective survey, and data collected through organizational operations.

The global case fatality rate was 38.8 deaths per 100 casualties. Males represented 87.4% (n = 34,642) of those killed, however females had higher odds of death when involved in an explosive incident (OR = 1.29, 95% CI: 1.24 – 1.34, p < 0.01). Adults experienced higher odds of death compared to children (OR = 1.60 95% CI: 1.55 – 1.64, p < 0.01). Case fatality ranged between countries with Lao PDR, Angola and Ukraine the countries with the highest proportion of deaths. Improvised explosive devices (IEDs) and ERW had higher odds of death compared to antipersonnel landmines (OR = 1.78, 95% CI: 1.67 – 1.91, p < 0.01; OR = 1.55, 95% CI: 1.50 – 1.60, p < 0.01).

Mortality from landmines and other explosive hazards remains a public health issue in conflict impacted countries. This study addresses the lacunae of global data for explosive hazard casualties and provides an understanding of how fatal injury is endured. Adult males represent the most deaths globally, however case fatality ranges across conflicts. ERW and IED had the highest risk of death. These findings underscore the need for a global health response and strengthen advocacy measures for conflict affected communities as well as weapons prohibition campaigns.

The differential impact and needs of women during disasters are highlighted in contemporary research, there is limited understanding of the distinctive contribution they make and the ways they cope. Women are the key drivers of livelihood, therefore, the economic losses resulting from natural hazards may have massive impacts on their mental health. This study examines how the self-help women's groups in rural Nepalese communities provide economic, social, socio-political, and public-health support to build safer, sustainable, and resilient communities.

In-depth open-ended interviews were conducted between January 2021–April 2021 with grassroots women leaders(n=8) representing their (women’s/mother’s) group inquiring about their activities related to risk reduction and perspectives on how they cope during natural hazards. The findings were analyzed and discussed using two analytical frameworks namely, the Sustainable Livelihood Approach (SLA) and Bronfenbrenner’s Socio-Ecological Model (SEM) as scaffolds. Data analysis followed the thematic analysis technique.

Two major themes emerged from the in-depth interviews: 1) Women are doing their part and 2) Help-seeking behavior as a barrier and facilitator. The traditional female household roles such as cooking, feeding, and caring during pre-disaster states are extended to rescuing, protecting, laborious cleaning, and providing physical and emotional support during disasters. The pre-and post-disaster care responsibility and help-seeking behavior have implications for health, safety, well-being and sustainability. The findings also suggest the inevitability of self-care for women during and post-disasters.

The care roles of women involve both livelihood and health benefits for the family and the entire community. To mitigate the physical and mental health burden for women amplified during natural hazards, self-care should be a critical component of advocacy in disaster awareness campaigns and help-seeking behavior should be promoted as a strength rather than insufficiency.

In a disaster aftermath, pharmacists have the potential to provide essential health services and contribute to the maintenance of the health and well-being of their community. Despite their importance in the health care system, little is known about the factors that affect pharmacists’ disaster preparedness and associated behaviors.

The goal of this study was to determine the factors that influence disaster preparedness behaviors and disaster preparedness of Australian pharmacists.

A 70-question survey was developed from previous research findings. This survey was released online and registered Australian pharmacists were invited to participate. Multiple linear regression was used to determine the factors that influenced preparedness and preparedness behaviors among pharmacists.

The final model of disaster preparedness indicated that 86.0% of variation in preparedness was explained by disaster experience, perceived knowledge and skills, colleague preparedness, perceived self-efficacy, previous preparedness behaviors, perceived potential disaster severity, and trust of external information sources. The final model of preparedness behaviors indicated that 71.1% of variation in previous preparedness behaviors can be explained by disaster experience, perceived institution responsibility, colleague preparedness, perceived likelihood of disaster, perceived professional responsibility, and years of practice as a pharmacist.

This research is the first to explore the significant factors affecting preparedness behaviors and preparedness of Australian pharmacists for disasters. It begins to provide insight into potential critical gaps in current disaster preparedness behaviors and preparedness among pharmacists.

Paramedics are tasked with providing 24/7 prehospital emergency care to the community. As part of this role, they are also responsible for providing emergency care in the event of a major incident or disaster. They play a major role in the response stage of such events, both domestic and international. Despite this, specific standardized training in disaster management appears to be variable and inconsistent throughout the profession. A suggested method of building disaster response capacities is through competency-based education (CBE). Core competencies can provide the fundamental basis of collective learning and help ensure consistent application and translation of knowledge into practice. These competencies are often organized into domains, or categories of learning outcomes, as defined by Blooms taxonomy of learning domains. It is these domains of competency, as they relate to paramedic disaster response, that are the subject of this review.

The methodology for this paper to identify existing paramedic disaster response competency domains was adapted from the guidance for the development of systematic scoping reviews, using a methodology developed by members of the Joanna Briggs Institute (JBI; Adelaide, South Australia) and members of five Joanna Briggs Collaborating Centres.

The literature search identified six articles for review that reported on paramedic disaster response competency domains. The results were divided into two groups: (1) General Core Competency Domains, which are suitable for all paramedics (both Advanced Life Support [ALS] and Basic Life Support [BLS]) who respond to any disaster or major incident; and (2) Specialist Core Competencies, which are deemed necessary competencies to enable a response to certain types of disaster. Further review then showed that three separate and discrete types of competency domains exits in the literature: (1) Core Competencies, (2) Technical/Clinical Competencies, and (3) Specialist Technical/Clinical Competencies.

The most common domains of core competencies for paramedic first responders to manage major incidents and disasters described in the literature were identified. If it’s accepted that training paramedics in disaster response is an essential part of preparedness within the disaster management cycle, then by including these competency domains into the curriculum development of localized disaster training programs, it will better prepare the paramedic workforce’s competence and ability to effectively respond to disasters and major incidents.

Emergency services are not the only source of information that the public uses when considering taking action during an event. There are also environmental cues, information from the media, or actions by peers that can influence perceptions and actions. When cues from different information sources are in conflict, it can cause uncertainty about the right protective action to take.

Our research responds to concerns that conflicting cues exacerbate community non-compliance with emergency warnings.

The sample consisted of 2,649 participants who completed one of 32 surveys.

The findings from this project confirmed emergency services agencies’ suspicions that conflicting cues can affect information processing and risk perceptions, and therefore prevent people from taking appropriate protective action. The results were reasonably consistent across fire and flood scenarios, suggesting the problem of conflicting cues is not hazard-specific. When presented with consistent cues, participants were more likely to evacuate, perceive risk about the event, share information with friends, family, and peers, find emergency warnings to be effective, and comprehend information. When faced with conflicting cues, participants were more likely to seek out additional information. It affected their information processing and self-efficacy. The results did not change for people of different ages, native language, country of birth, or post-hazard experience. This is contrary to most emergency literature research findings, which show that individual differences play a role in impacting propensity to take protective action. However, there does appear to be a significant gender effect. These results require further exploration.

These findings may be used to assist emergency services agencies to tailor community warnings during time-critical situations, and develop ways to mitigate ambiguity caused by conflicting cues to encourage protective action in order to save lives and properties.

The pharmacist’s role in disasters is just as important as in everyday practice. Lack of access to health care services and interruptions to continuity of medication care are the major concerns for chronic disease patients during disasters. Pharmacists’ responsibilities during crises is undefined and their skills and knowledge are underutilized.

To convene an expert panel to discuss the role of pharmacists in disasters and the specific roles they could be undertaking in a disaster, prioritizing the roles in order of importance.

There were 15 key opinion leaders identified as experts in their knowledge of pharmacists’ roles and the disaster health management field who agreed to participate in the three rounds of surveys. The first round provided the panelists with a list of 46 roles identified from previous research conducted and the literature. The panelists were asked to rank their opinion of pharmacist’s capability of undertaking each role on a 5-point Likert scale and consensus was set at 80%. There were three rounds of surveys with the final round presenting the results for the panel to provide qualitative comments on the results and roles. The roles were broken up into the four phases of disaster management – prevention, preparedness, response, and recovery (PPRR).

Out of the 46 roles provided to the panelists, consensus was reached on 43 roles with 80% of panelists being in agreement. The experts identified pharmacists had roles across the entire PPRR cycle. The roles included pharmacists being further integrated into disaster teams and managing low-acuity patients requiring chronic disease medications.

This Delphi study begins the process of defining roles for pharmacists in disasters. It can assist policymakers in providing changes to legislative frameworks to allow pharmacists to undertake the roles identified as being beneficial to a community in a disaster.

Evidence-based training and curriculum are seen as vital in order to be successful in preparing paramedics for an effective disaster response. The creation of broadly recognized standard core competencies to support the development of disaster response education and training courses for general health care providers and specific health care professionals will help to ensure that medical personnel are truly prepared to care for victims of mass casualty events.

To identify current Australian operational paramedic’s specific disaster management education and knowledge as it relates to disaster management core competencies identified throughout the literature and the frequency of measures/techniques which these paramedics use to maintain competency and currency.

Paramedics from all states of Australia were invited to complete an anonymous online survey. Two professional bodies distributed the survey via social media and a major ambulance service was surveyed via email.

The study population includes 130 respondents who self-identified as a currently practicing Australian paramedic. Paramedics from all states except South Australia responded, with the majority coming from Queensland Ambulance Service (N= 81%). In terms of experience, 81.54% of respondents report being qualified for greater than 5 years. Initial analysis shows that despite the extensive experience of the practitioners surveyed when asked to rate from high to low their level of knowledge of specific disaster management core competencies a number of gaps exist.

Core competencies are a defined level of expertise that is essential or fundamental to a particular job, and serve to form the foundation of education, training, and practice for operational service delivery. While more research is needed, these results may help inform industry, government, and education providers to better understand and to more efficiently provide education and ongoing training to paramedics who are responsible for the management of disaster within the Australian community.

Weather-related natural disasters are increasing in frequency and intensity, severely impacting communities. The patient demographic requiring assistance in a disaster is changing from acute traumas to chronic disease exacerbations. Adequate management requires a multidisciplinary healthcare approach. Pharmacists have been recorded in various disaster roles in literature. However, their roles within these disaster health teams are not well-established and do not fully utilize their skill sets.

To identify where pharmacists roles are within the four phases of a disaster – prevention, preparedness, response, and recovery (PPRR), and to determine the barriers to pharmacists being better integrated into disaster teams.

Semi-structured interviews were conducted with 28 international key stakeholders and pharmacists. Interviews were transcribed and analyzed using both open and axial manual coding, as well as the text-analytics software Leximancer®. The use of these two methods provided triangulation of methods for reliability of results. This research project was covered by QUT ethics approval number 1700000106.

The themes identified were community, government, "disaster management," "pharmacy," and "barriers and facilitators." The Leximancer® analysis compared the different disaster perspective and experience levels of the participants. The more experienced disaster health professionals who had worked closely with pharmacists believed they were capable of undertaking more roles in a disaster.

Pharmacists have been placed in the logistics "silo" for their role in disaster management supply chain operations. However, pharmacists have the expertise, knowledge, and skills which transcend this "silo" to work across the multiple health roles in disasters. Pharmacists are identified as a critical piece to the puzzle in the disaster management throughout the PPRR cycle. They are capable of undertaking more roles in disasters in addition to the established logistics role. The barriers identified need to be addressed for the better integration of pharmacists into disaster teams.

Current literature suggests that a large percentage of the health workforce may be unwilling to work during a disaster. The willingness of pharmacists to work during a disaster is under-researched internationally and non-existent in Australia.

To determine if Australian pharmacists are willing to work in a disaster and the factors that affect the willingness to work.

A 13-question survey was developed from the current literature and released nationally through professional organizations and social media.

Sixty Australian pharmacists completed the survey. Most participants believed their pharmacy was an essential service for their community. Pharmacists reported they would be likely to report to work during a pandemic or biological disaster (73%) or natural disaster (78%). The two major factors likely to prevent pharmacists from working in a disaster are family and safety concerns. Pharmacists perceived that their duty of care to their patients would make them likely to work during a disaster. Most pharmacists noted they would work even if they were expected to work outside their scope of practice, or if their place of work lacked electricity or was damaged.

Depending on the disaster, up to 27% of the pharmacy workforce may be unwilling to work in a disaster. Family and safety concerns were the primary barriers to pharmacists reporting to work in the aftermath of a disaster. Providing guidelines on how pharmacists can prepare their family for a disaster may assist in ensuring pharmacists are willing to work. The pharmacists surveyed demonstrated a strong commitment to their duty of care with the majority stating they would be likely to work in austere work environments. This research raises questions of the safety of pharmacists working outside their scope and in austere environments and whether it is safe for them, their patients, and the broader community.

The acute care of stroke involves the administration of a clot-dissolving drug (thrombolysis) and/or its removal using endovascular clot retrieval. Earlier intervention results in significantly improved patient outcomes. Clinical assessment scores have limitations, and studies have shown that even the most robust scores have a reported false-negative rate of >20% for large vessel occlusive strokes that may be eligible for clot retrieval, while inappropriate bypass may delay delivery of thrombolysis.1 Quantitative Electroencephalography (QEEG) has been shown to have a very high sensitivity and specificity in the identification of acute stroke versus matched controls in an in-hospital setting.(2,3)

The SPIDER study commenced in Brisbane, Queensland on September 3, 2018, and is investigating the use of an EEG recorder to gather data on acute stroke patients presenting to a metropolitan ambulance service.

The data collected will guide the development of a simple numerical output reference to guide decision making. The data may aid in identifying large vessel occlusive stroke and patients eligible for endovascular intervention. The QEEG will provide a more accurate and cost-effective tool for the prehospital clinician over other imaging technologies and can guide early destination decisions. This presentation discusses the implementation of a pre-hospital research platform, integration with the clinical dispatch matrix, staff engagement, patient recruitment, and the success of the project so far.

In addition to the traditional logistics role, pharmacists are undertaking important new roles in disasters. Despite this, little is known about the level of acceptance of these activities by other providers.

The aim of this study was to determine the international opinion of disaster and health professionals regarding the emerging roles of pharmacists in disasters.

Delegates at the World Association for Disaster and Emergency Medicine’s (WADEM; Madison, Wisconsin USA) 20th Congress in Toronto, Canada (April 2017) were invited to complete an anonymous survey posing eight questions regarding attitudes towards pharmacists’ roles in disasters. Quantitative data were analyzed using IBM (IBM Corp.; Armonk, New York USA) SPSS statistical software version 23, and qualitative data were manually coded.

Of the 222 surveys handed out, 126 surveys were completed yielding a 56.8% response rate. Of the respondents, 96.8% (122/126) believed pharmacists had a role in disasters additional to logistics. Out of 11 potential roles pharmacists could perform in a disaster, provided on a 5-point Likert scale, eight roles were given a rating of “Agree” or “Strongly Agree” by 72.4% or more of the participants. Lack of understanding of a pharmacist’s roles and capabilities was the highest described barrier to pharmacists’ roles in disaster management.

This multi-disciplinary disaster health “community” agreed pharmacists have roles in disasters in addition to the established role in supply chain logistics. Participants accepted that pharmacists could possibly undertake numerous clinical roles in a disaster. Several barriers were identified that may be preventing pharmacists from being further included in disaster health management planning and response.

WatsonKE, TippettV, SingletonJA, NissenLM. Disaster Health Management: Do Pharmacists Fit in the Team?Prehosp Disaster Med. 2019;34(1):30–37.