To examine systemic challenges to health system resilience in Puerto Rico following Hurricane Maria, focusing on resource, management, and policy domains.

Semi-structured interviews (n = 62) were conducted from January to April 2023 with health care professionals, patients, community leaders, nonprofits, and government stakeholders using purposive sampling. Interviews were conducted in Spanish, transcribed, translated, and thematically analyzed.

Resource failures centered on prolonged power outages (mean 62.7 days; up to 300 days), which cascaded into water, transport, and communication breakdowns. These disruptions endangered patients through interrupted surgeries, inoperable imaging, oxygen shortages, and infection control failures. Management challenges included depleted stockpiles, staff burnout, and workforce migration, which extended wait times to 6-8 months. Coordination was inconsistent, with duplication of aid in some areas and neglect in others, while top-down governance slowed response. Policy constraints compounded vulnerabilities: health insurance pre-authorizations delayed urgent care, capped Medicaid funds, and lack of federal parity, limited preparedness, and centralized aid distribution left rural communities underserved.

Puerto Rico’s health system resilience was undermined by interdependent failures across infrastructure, management, and policy. Building resilience will require investment in decentralized power, reforms to emergency insurance protocols, stronger inter-agency coordination, and equitable federal financing to ensure preparedness for future climate-related disasters.

This study examined the behavioral characteristics of psychiatric inpatients following disasters.

Data were collected from 2 psychiatric hospitals in Japan, 1 affected by the Northern Osaka Earthquake (magnitude 6.1, seismic intensity 6) on June 18, 2018, and the other impacted by torrential rainstorms (total rainfall reaching 1800 mm; 224 fatalities, 8 missing) between June 28 and July 8, 2018. Focus group interviews were conducted with 24 nursing staff members from each hospital, divided into 8 groups.

A total of 158 inpatient behaviors were identified and organized into 19 themes. To delineate behavioral patterns, these behaviors were interpreted as adaptive (53.1%), maladaptive (22.2%), or unclassifiable (24.7%). Among maladaptive behaviors requiring prioritized care, 56.8% were associated with psychiatric disorders, while 43.2% reflected general disaster-related reactions.

Psychiatric inpatients demonstrated adaptive responses alongside typical disaster-related behaviors, with some behaviors attributable to underlying psychiatric conditions. Post-disaster care for psychiatric inpatients should emphasize strategies that support adaptability and protection. Additionally, targeted care for maladaptive behaviors specific to psychiatric conditions and vigilant observation of patients who do not display overtly agitated behaviors are critical.

This study qualitatively examines community experiences related to housing following natural disasters, focusing on damage to home infrastructure, barriers to completing repairs, and the resources needed for recovery and rebuilding.

Participants included members from 3 historically underserved Houston communities (Kashmere Gardens, Fifth Ward, and Third Ward) with Social Vulnerability Index (SVI) rankings in the 80th percentile. Town hall–style conversations were held within each community; small focus groups were completed within the town halls. Reflexive thematic analysis was used to identify themes, supported by researcher triangulation, reflexivity, and member checking to establish trustworthiness.

Analysis identified 7 key themes :1) Successive Disasters Exacerbate Problems Driven by Gentrification, 2)Insufficient and Unequal Post-Disaster Resources Drive Dependence on Community Support Networks, 3) Systemic Delays in Relief Services to Underserved Communities Underscore The Need for Government Accountability, 4) Growing Distrust in Local Government to Address Evolving Post-Disaster Needs, 5) Navigating Complex Insurance Policies While Being Drained by a Disaster, 6) Trickle-Down Unpreparedness Starts at a City Level, and 7) Steps to Prepare for Future Disasters.

Systemic inequities in disaster preparedness and response affecting low-income Black and Hispanic communities are evident. Addressing these disparities requires prioritizing resource distribution, infrastructure investments, and community-driven planning and resilience building.

As natural disasters become more frequent and severe, examining their impact on health care access is increasingly important. This study was a community-level assessment of the effects of flooding and COVID-19 on access to health care services.

This study utilized a self-administered survey in flood-prone Houston communities. Bivariable associations of having experienced flooding damage, as well as having a history of COVID-19 diagnoses, were examined by demographics and health care access using chi-square analyses, t-tests, and both unadjusted and adjusted logistic and Poisson regression models.

Among 206 surveys, 20.39% reported homes or vehicles lost to flooding, and 33.5% had been diagnosed with COVID-19. Those who experienced flooding were 3 times more likely to report their closest hospital closed, their doctor’s office closed, delays filling prescriptions, not getting needed medical care, and delayed medical care access. Experiencing both COVID-19 and flooding was even more strongly associated with the frequency of health care services lost.

These findings highlight the need for expanded health care access and support services that accommodate localized damages in communities susceptible to adverse events. Future planning for disasters should include plans for expanded access to health care resources for those with comorbidities and low-socioeconomic groups.

Mass casualty incidents (MCI) are a challenge for prehospital response. The global response may include primary health care teams (PHCT), even more in remote and rural areas. As training in MCI response is complex, it is essential to simplify it when focused in PHCT as it is a low frequency phenomenon in their context. Our objective is to measure self-perception and the impact of a brief training experience using a mass casualty incident tabletop game with primary care doctors and nurses.

Descriptive study of the impact of a training intervention on 27 primary care physicians and nurses in the Principality of Asturias. A 2-h training experience was carried out using a tabletop game. Self-perception was measured using a Likert’s scale on methodology, knowledge and skills, as well as a multiple-choice knowledge test after two months. Strengths and weaknesses of the methodology were also identified using open-ended questions, as well as attitudes towards incidents with mass casualty incidents.

85% of participants improved their level of knowledge without providing them study material. Self-perception measured 27 items in 3 dimensions: methodology (Median = 9; interquartile range (IQR) = 2), knowledge (Median = 10; IQR = 1), and skills (Median = 9; IQR = 1). All items except one had a median greater than or equal to 9.

Gamification using the MassCas tabletop game for mass casualty incidents is perceived by primary care doctors and nurses as a useful tool in their training for mass casualty incidents, as well as for acquiring specific knowledge and skills in this area.

This study examined the relationship between food safety, food access, and nutritional status among earthquake victims in Kahramanmaraş and Hatay, Türkiye.

This descriptive, cross-sectional study was conducted face-to-face with 209 earthquake victims in 2023.

The median age was 42 years, and 52.6% were female. Among women, the perception of unhealthy food, inadequate mass feeding services, and dissatisfaction with meals increased the risk of food safety concerns. In men, those with an associate degree or higher were 20.7 times more likely to perceive food safety as inadequate, while the perception of unhealthy food raised this risk by 12.4 times. Lack of access to sufficient drinking water increased the risk of food inaccessibility by 2.6 times among women. In men, employment and dissatisfaction with meals increased this risk by 2.7 and 2.8 times, respectively. Both genders exhibited inadequate intake of water, energy, protein, polyunsaturated fats, fiber, folate, potassium, calcium, magnesium, iron, zinc, and several vitamins (P <0.05), while phosphorus and sodium levels were elevated (P <0.01).

Food safety and access issues were critical among earthquake victims, significantly impacting nutritional status. Findings emphasize the need for improved emergency food aid and distribution systems to mitigate post-disaster nutritional risks.

In March 2019, flooding of the Missouri River and its tributaries destroyed infrastructure and farmland and affected communities, including those in the state of Nebraska. The objective of this study was to assess emergency preparedness and satisfaction with flood response, recovery, and relief efforts 5 years following the 2019 floods in rural eastern Nebraska.

Using stratified simple random sampling, this study surveyed 13 Nebraska communities to assess emergency preparedness and satisfaction with flood response, recovery, and relief efforts 5 years following the 2019 Missouri River Flood. Descriptive statistics are reported.

Households impacted by the 2019 Nebraska flood reported worsening physical and mental health symptoms and identified major gaps in communication, long-term mental health support, and infrastructure resilience. Self-reported preparedness improved post-flood. Inadequate early warnings and poor information dissemination eroded trust.

There are persistent mental and physical health impacts resulting from exposure to the 2019 Missouri River floods that can impact communities’ ability to respond and recover from subsequent hazards. Evaluating the impacts of previous disasters is a critical component of increasing community resiliency and local public health and emergency preparedness capacity to serve these populations.

To prevent power lines from igniting wildfires, utility companies in California are authorized to conduct Public Safety Power Shutoffs (PSPS), de-energizing, or shutting off power to equipment during periods of high wildfire risk. This study assessed the association between PSPS and emergency department visits.

The study quantified the extent to which counties in California experienced PSPS each day between September 15 and November 30, 2019. Linear mixed models were used to estimate the rate of emergency department encounters per 100,000 county residents based on quartiles of PSPS exposure, compared to no PSPS exposure at the county-day level. Analyses examined all emergency department encounters as well as age- and diagnosis-specific visits.

There was an increase of 15 emergency department visits per 100,000 persons aged 65 years and older on days with the highest levels of PSPS exposure compared to days without PSPS. The highest level of PSPS exposure was associated with increased rates of emergency department visits for respiratory, cardiovascular, injury, and mental or behavioral diagnoses.

Despite advanced notification, PSPS events are associated with negative health consequences. Older adults are particularly vulnerable to the unintended adverse health effects of PSPS and should be prioritized in mitigation efforts.

The aim of this research is to explore the experience of allocating scarce health resources in humanitarian response settings, specifically in relation to decision-making.

This research utilized an exploratory qualitative design. Participants were identified as clinicians with relevant first-hand experiences with scarce health resource allocation in humanitarian response settings. Participants were purposively recruited to include the broadest perspectives possible. Semi-structured interviews were hosted remotely. Transcripts capturing participant narratives were analyzed using inductive thematic analysis to allow themes to emerge.

Seventeen participants were recruited and interviewed as part of the Scarce Health Resource Allocation in Humanitarian Response Settings (SHARE-HRS) project. Inductive thematic analysis related to decision making revealed 5 key themes: devices; priorities; ideals; context-specific decision making; and weight of decision making. These themes informed the development of the SHARE-HRS Decision Making Model.

While health resource allocation decision-making is not unique to humanitarian settings, there are unique situational challenges faced by humanitarian health care workers. The SHARE-HRS Decision Making Model provides a new insight into how these challenges may be addressed or impact decision-making, and thus offers a structure and common nomenclature for future humanitarian health response operations and research.

Triage is an essential process used to adequately allocate resources and thus increase chances of survival in case of mass-casualty incidents (MCIs). Several triage scales are currently used, but data regarding their performance remain scarce. The objective was to compare the performance of two prehospital triage algorithms (Sieve versus SwissPre) using a validated physiological simulator.

This was a web-based, randomized open-label study. A real-time evolutive simulator based on a heart-lung-brain interaction model embedding functional blocks was used to simulate the evolution of vital parameters. Participants, who were randomly allocated to either algorithm, were asked to triage 30 patients in random order. The primary outcome was the triage score (each correct decision was awarded one point). The “Immediate patients” were defined as those who would die within the first hour according to the physiological model. The secondary outcome was the duration of patient triage.

Out of 71 participants, 67 (94.4%) were included in the final analysis. The Sieve group achieved a mean score of 17.1 out of 30 (95%CI, 16.3 to 17.8). The SwissPre group scored 15.5 out of 30 (95%CI, 14.5 to 16.5). The mean difference between groups was 1.6 points (95%CI, 0.4 to 2.8; P = .011) in favor of the Sieve algorithm. Triage duration did not differ significantly between the Sieve (mean 43 minutes, SD = 10) and SwissPre (mean 46 minutes, SD = 23) groups, with a mean difference of three minutes (95%CI, −12 to 6; P = .507).

The simpler Sieve algorithm may slightly outperform the more complex SwissPre in accurately categorizing critically injured patients who would likely die within 60 minutes if left untreated. No significant difference was observed in triage speed. However, these exploratory findings should be interpreted cautiously, considering the mean difference was modest and the controlled simulated setting, limiting generalizability.

To comprehensively investigate the factors associated with tsunami evacuation after the 2011 Great East Japan Earthquake (GEJE).

This cross-sectional study conducted a baseline survey between 2013 and 2016 and included 15,935 participants. The participants were asked to self-report whether they had evacuated after the GEJE and their basic characteristics, as well as their socio-behavioral, physical, lifestyle, and mental factors. The objective variable was the presence or absence of tsunami evacuation after the GEJE, and the explanatory variables were comprehensively explored with reference to previous studies.

Factors associated with the promotion of tsunami evacuation included being a woman, age 30-39 years, working, damage to houses, and participation in tsunami or earthquake evacuation drills before the GEJE. Factors associated with the inhibition of tsunami evacuation were over 60 years of age, higher education, living in areas unaffected by the GEJE, having a spouse, living with many cohabitants, having pets such as dogs or cats, and a high level of physical activity.

This study demonstrates the necessity of enhancing the evacuation processes of older adults, cohabitants, and households with pets. It is important to conduct evacuation drills and hold discussions about disasters within families and households.

The increasing frequency and severity of unexpected events in recent years underscore the need for more effective disaster management strategies. This study aimed to identify obstacles and solutions for serving affected groups, providing practical strategies for improved disaster response.

This qualitative content analysis study of the conventional type, conducted in 2024, involved semi-structured face-to-face interviews and a focused group discussion with 17 participants, including university experts, executive bodies, and affected individuals. The method of “Granheim and Lundman” was used to analyze the data, and “Lincoln and Guba’s” four criteria were used to establish the reliability of the data.

A total of 348 themes were identified, ultimately refined to 245 themes after repetition analysis. These themes were categorized into eight main categories: “Management, Financial and Non-Financial Resources, Programs, Educational Affairs, Organizational Matters, Community Affairs, Participation, and Spiritual Affairs.” Additionally, 29 subcategories were extracted.

This study reveals key obstacles in disaster service delivery, including inadequate management, resources, and coordination. Solutions such as enhancing communication, clarifying roles, and promoting community participation can address these challenges. Strengthening public education, updating regulations, and integrating local cultural and spiritual support systems are essential for improving crisis response.

Pharmacies play a critical role in healthcare systems, especially during emergencies. Disruptions in the supply of medicines and consumables pose significant challenges in disaster response and recovery. Given the complexity and socio-political sensitivity of the resilient medicine supply chain, this study aimed to assess the resilience of the supply chain of medicines and consumables during disasters in Iran based on the World Economic Forum framework.

A cross-sectional, descriptive-analytical study was conducted using a validated questionnaire. Data were collected from 224 pharmacies in Shiraz city using the census method for hospital-based pharmacies and cluster and simple random sampling methods for city-level pharmacies. The collected data were analyzed and modeled using SPSS v.21 and Smart PLS v.3 software.

The results confirmed the validity and reliability of the questionnaire developed for assessing the resilience of the supply chain of medicines and consumables during disasters based on the World Economic Forum framework. The results also demonstrated that participation (41.04), policy (30.22), information technology (26.72), and strategy (23.46) directly and positively contributed, respectively, to enhancing the resilience of the medicines and consumables supply chain during disasters.

According to the results, the medicines and consumables supply chain resilience in Iran can be improved by facilitating international partnerships, developing better relationships with suppliers, moving toward digital and information technology-based supply chains, having a strategic plan for the medicines and consumables supply chain in disasters, and developing coordinating policies and effective strategies.