The devastation of Bam: an overview of health issues 1 month after the earthquake

Communicable diseases in northwest Syria in the context of protracted armed conflict and earthquakes

The earthquakes in Türkiye and Syria in February, 2023, have caused further devastation in northwest Syria-an area already affected by protracted armed conflict, mass forced displacement, and inadequate health and humanitarian provision. The earthquake damaged infrastructure supporting water, sanitation, and hygiene, and health-care facilities. The disruptions to epidemiological surveillance and ongoing disease control measures resulting from the earthquake will accelerate and expand ongoing and new outbreaks of many communicable diseases including measles, cholera, tuberculosis, and leishmaniasis. Investing in existing early warning and response network activities in the area is essential. Antimicrobial resistance, which had already been an increasing concern in Syria before the earthquake, will also be exacerbated given the high number of traumatic injuries and breakdown of antimicrobial stewardship, and the collapse of infection prevention and control measures. Tackling communicable diseases in this setting requires multisectoral collaboration at the human-animal-environment nexus given the effect of the earthquakes on all these sectors. Without this collaboration, communicable disease outbreaks will further strain the already overburdened health system and cause further harm to the population.

The Impact of Earthquakes on Public Health: A Narrative Review of Infectious Diseases in the Post-Disaster Period Aiming to Disaster Risk Reduction

Earthquakes are among the most impressive natural phenomena with very high potential to set off a chain of effects that significantly affects public health through casualties and injuries. Related disasters are attributed not only to the strong ground motion and coseismic phenomena but also to secondary effects, comprising mainly landslides and tsunamis, among others. All these can create harsh conditions favorable for the emergence of infectious diseases that are capable of causing additional human and economic losses and disruption of the emergency and recovery process. The present study comprises an extensive narrative review of the existing literature on the earthquake-triggered infectious diseases recorded worldwide, along with their symptoms, causative pathogens, associated risk factors, most vulnerable population groups, and prevention strategies. Respiratory, gastrointestinal, and vector-borne diseases, as well as wound and skin infections, are mainly recorded among the earthquake-affected population. Measures for effectively preventing earthquake-triggered infectious diseases are also proposed. One of the widely proposed measures is the establishment of a proper disease surveillance system in order to immediately and effectively identify the pre- and post-disaster occurrence of infectious diseases. This approach significantly contributes to disease trends monitoring, validation of early warning, and support of the emergency response and recovery actions.

Rescue Robots for the Urban Earthquake Environment

Robotics have important applications in the field of disaster medical rescue. The deployment of urban rescue robots at the earthquake site can help shorten response time, improve rescue efficiency and keep rescue personnel away from danger. This discussion introduces the performance of some robots in actual rescue scenarios, focuses on the current research status of robots that can provide medical assistance, and analyzes the merits and shortcomings of each system. Based on existing studies, the limitations and development directions of urban rescue robots are also discussed.

Civil-Military Coordination (CIMIC) Model in Natural Disasters in Iran

Objective:

The present study aimed at codifying a native model of civil-military coordination (CIMIC) in natural disasters in Iran.

Methods:

This manuscript is a part of a larger study. The present cross-sectional study was conducted in 2019 using a two-stage Delphi technique. The factors confirmed by the technique were prioritized via a pairwise questionnaire. In doing so, 24 elites and experts in civil-military coordination were presented with the indicators in the course of classic Delphi technique and pairwise comparison. At the end, the nationalized model was finalized by sending the model to ten experts and asking their ideas.

Results:

The results obtained from the two rounds of Delphi indicated that 36 coordination factors could be classified into three primary classes of staff, stuff, and system. All factors were confirmed by the experts. Considering the weight of each class, “staff” and “stuff” classes were considered to be the highest and lowest priorities, respectively.

Conclusion:

Application of the coordination factors in the context of military and civil organizations leads to a better response to natural disasters. The organizations in charge of responding to disasters should be obliged to apply this model in the highest organizational commitment level as the final goals of disaster management. The results of the present study can be applied for codification of a comprehensive plan for assessing the civil-military coordination in natural disasters.

Quality management in humanitarian operations and disaster relief management: a review and future research directions

Quality management has been widely discussed in the literature, and recent special issues on humanitarian supply chains and relief operations have emphasized the increasing importance of quality management in this key emerging area. In this paper, we provide an extensive literature review in the field of quality management in humanitarian operations and disaster relief management. Our comprehensive review, comprising 61 articles published from 2009 to 2018, leads to the identification of enablers (e.g., transparency, policy framework), challenges (e.g., financial services, identity protection), and theory development approaches, as well as numerous research gaps that must be addressed.

A multi-hazards earth science perspective on the COVID-19 pandemic: the potential for concurrent and cascading crises

Meteorological and geophysical hazards will concur and interact with coronavirus disease (COVID-19) impacts in many regions on Earth. These interactions will challenge the resilience of societies and systems. A comparison of plausible COVID-19 epidemic trajectories with multi-hazard time-series curves enables delineation of multi-hazard scenarios for selected countries (United States, China, Australia, Bangladesh) and regions (Texas). In multi-hazard crises, governments and other responding agents may be required to make complex, highly compromised, hierarchical decisions aimed to balance COVID-19 risks and protocols with disaster response and recovery operations. Contemporary socioeconomic changes (e.g. reducing risk mitigation measures, lowering restrictions on human activity to stimulate economic recovery) may alter COVID-19 epidemiological dynamics and increase future risks relating to natural hazards and COVID-19 interactions. For example, the aggregation of evacuees into communal environments and increased demand on medical, economic, and infrastructural capacity associated with natural hazard impacts may increase COVID-19 exposure risks and vulnerabilities. COVID-19 epidemiologic conditions at the time of a natural hazard event might also influence the characteristics of emergency and humanitarian responses (e.g. evacuation and sheltering procedures, resource availability, implementation modalities, and assistance types). A simple epidemic phenomenological model with a concurrent disaster event predicts a greater infection rate following events during the pre-infection rate peak period compared with post-peak events, highlighting the need for enacting COVID-19 counter measures in advance of seasonal increases in natural hazards. Inclusion of natural hazard inputs into COVID-19 epidemiological models could enhance the evidence base for informing contemporary policy across diverse multi-hazard scenarios, defining and addressing gaps in disaster preparedness strategies and resourcing, and implementing a future-planning systems approach into contemporary COVID-19 mitigation strategies. Our recommendations may assist governments and their advisors to develop risk reduction strategies for natural and cascading hazards during the COVID-19 pandemic.

Subacute Phase After an Earthquake: An Even More Important Period

An earthquake is a very common natural disaster. Numerous studies have focused on the acute phase, but studies concerning the subacute phase after an earthquake were very limited. This aroused more attention being paid to medical relief in the subacute phase, and this study elaborated on the division of the medical relief period and the definition of medical relief targets. More importantly, major types of disease were analyzed by reviewing the relevant published studies, which were identified by searching electronic databases. Findings suggested that the clear division of medical relief stage is vital for determining the priority of medical aid and allocating medical resources scientifically, and all concerned populations should be targeted for medical assistance. The focus of acute phase is injury (64.2%), and the subacute phase is disease (27.8% respiratory disease, 22.9% common disease, 12.5% wound/injury, 10.5% skin disease, 8.7% gynecological and pediatric disease, 8.5% digestive disease). However, due to the limited available studies, the included articles perhaps did not reflect the actual proportion of each type of disease. More studies are needed to better understand the proportion of different diseases in each phase of an earthquake.

A Rapid Public Health Needs Assessment Framework for after Major Earthquakes Using High-Resolution Satellite Imagery

Background: Earthquakes causing significant damage have occurred frequently in China, producing enormous health losses, damage to the environment and public health issues. Timely public health response is crucial to reduce mortality and morbidity and promote overall effectiveness of rescue efforts after a major earthquake. Methods: A rapid assessment framework was established based on GIS technology and high-resolution remote sensing images. A two-step casualties and injures estimation method was developed to evaluate health loss with great rapidity. Historical data and health resources information was reviewed to evaluate the damage condition of medical resources and public health issues. Results: The casualties and injures are estimated within a few hours after an earthquake. For the Wenchuan earthquake, which killed about 96,000 people and injured about 288,000, the estimation accuracy is about 77%. 242/294 (82.3%) of the medical existing institutions were severely damaged. About 40,000 tons of safe drinking water was needed every day to ensure basic living needs. The risk of water-borne and foodborne disease, respiratory and close contact transmission disease is high. For natural foci diseases, the high-risk area of schistosomiasis was mapped in Lushan County as an example. Finally, temporary settlements for victims of earthquake were mapped. Conclusions: High resolution Earth observation technology can provide a scientific basis for public health emergency management in the major disasters field, which will be of great significance in helping policy makers effectively improve health service ability and public health emergency management in prevention and control of infectious diseases and risk assessment.

Natural Disasters and Injuries: What Does a Surgeon Need to Know?

PURPOSE OF REVIEW

Natural disasters have injured more than 2 million people in the last 10 years and led to significant international medical relief deployment. Knowledge of expected injury patterns following these disasters is an important part of planning for type and size of outside surgical assistance. This review aims to summarize what is known about injury patterns following natural sudden-onset disasters (SODs).

RECENT FINDINGS

Several systematic reviews have concluded that data on injury patterns and surgical needs following natural SODs is scarce. Studies on earthquakes indicate that earthquakes generate large numbers of injured, out of which limb injuries are most common. Tsunamis, floods, storms, and wildfires do not generate a significant burden of injuries in relation to numbers affected.

SUMMARY

Earthquake may require surgical assistance, especially for limb injuries; therefore, mainly orthopedic and plastic surgeries are priority specialist areas. Major injuries seem to be few in other natural disasters. However, more detailed data is needed on specific injury patterns to determine if additional surgical assistance is needed and to what extent it is needed to cater for normal surgical conditions if existing health care has seized to function.

Examination of previously published data to identify patterns in the social representation of "Loud music" in young adults across countries

Purpose:

The current study was aimed at understanding the patterns in the social representation of loud music reported by young adults in different countries.

Materials and Methods:

The study included a sample of 534 young adults (18–25 years) from India, Iran, Portugal, United Kingdom, and United States. Participants were recruited using a convince sampling, and data were collected using the free association task. Participants were asked to provide up to five words or phrases that come to mind when thinking about “loud music.” The data were first analyzed using the qualitative content analysis. This was followed by quantitative cluster analysis and chi-square analysis.

Results:

The content analysis suggested 19 main categories of responses related to loud music. The cluster analysis resulted in for main clusters, namely: (1) emotional oriented perception; (2) problem oriented perception; (3) music and enjoyment oriented perception; and (4) positive emotional and recreation-oriented perception. Country of origin was associated with the likelihood of participants being in each of these clusters.

Conclusion:

The current study highlights the differences and similarities in young adults’ perception of loud music. These results may have implications to hearing health education to facilitate healthy listening habits.

Toward a Better Nutritional Aiding in Disasters: Relying on Lessons Learned during the Bam Earthquake

Introduction Examining various problems in the aftermath of disasters is very important to the disaster victims. Managing and coordinating food supply and its distribution among the victims is one of the most important problems after an earthquake. Therefore, the purpose of this study was to recognize problems and experiences in the field of nutritional aiding during an earthquake.

METHODS

This qualitative study was of phenomenological type. Using the purposive sampling method, 10 people who had experienced nutritional aiding during the Bam Earthquake (Iran; 2003) were interviewed. Colaizzi's method of analysis was used to analyze interview data.

RESULTS

The findings of this study identified four main categories and 19 sub-categories concerning challenges in the nutritional aiding during the Bam Earthquake. The main topics included managerial, aiding, infrastructural, and administrative problems.

CONCLUSIONS

The major problems in nutritional aiding include lack of prediction and development of a specific program of suitable nutritional pattern and nutritional assessment of the victims in critical conditions. Forming specialized teams, educating team members about nutrition, and making use of experts' knowledge are the most important steps to resolve these problems in the critical conditions; these measures are the duties of the relevant authorities. Nekouie Moghadam M , Amiresmaieli M , Hassibi M , Doostan F , Khosravi S . Toward a better nutritional aiding in disasters: relying on lessons learned during the Bam Earthquake. Prehosp Disaster Med. 2017;32(4):382-386.

Disaster response under One Health in the aftermath of Nepal earthquake, 2015

Until now, an estimate quotes that 1100 healthcare facilities were damaged and over 100,000 livestock lost in the two earthquakes that occurred in April and May of 2015 in Nepal. Threats of infectious diseases, mostly zoonoses, could affect Nepal's economy, trade, and tourism, and reaching the targets of the United Nations Millennium Development Goals. Historically, outbreaks of infectious diseases, including zoonoses, were largely associated with the aftereffects of the earthquakes. It has been documented that zoonoses constitute 61% of all known infectious diseases. Therefore, the purpose of this communication was to examine the infectious disease outbreaks after earthquakes around the world and explore the risk assessment of the zoonoses threats reported in Nepal and highlight adopting One Health. Our summaries on reported zoonoses in Nepal have shown that parasitic zoonoses were predominant, but other infectious disease outbreaks can occur. The fragile public health infrastructure and inadequately trained public health personnel can accelerate the transmission of infections, mostly zoonoses, in the post impact phase of the earthquake in Nepal. Therefore, we believe that with the support of aid agencies, veterinarians and health professionals can team up to resolve the crisis under One Health.

Public perceptions and attitudes to biological risks: Saudi Arabia and regional perspectives

Saudi Arabia has experienced frequent occurrences of biological disasters due to a wide range of generator factors, including natural disasters and epidemics. A national survey (n=1,164) was conducted across 13 regions of Saudi Arabia to examine public perceptions to the risk of a biological disaster. The primary results reveal: (a) a degree of knowledge about biological threats such as SARS and H5N1 flu, despite the lack of individual experience with disasters; (b) age, gender, education and faith are positively related to the perception of biological risk; and (c) a number of important community resilience factors exist, including faith, education and willingness. This study concludes that the development of adapted resilience strategies in disaster management can be achieved through public education and training involving cooperation with official organisations and religious authorities in the country to increase public awareness, knowledge and skills in mitigating biological threats.

Vaccine-preventable disease and the under-utilization of immunizations in complex humanitarian emergencies

Complex humanitarian emergencies affect 40-60 million people annually and are a growing public health concern worldwide. Despite efforts to provide medical and public health services to populations affected by complex emergencies, significant morbidity and mortality persist. Measles is a major communicable disease threat, but through vaccination of broader target age groups beyond the traditional immunization schedule, measles-related mortality has been significantly reduced during crises. Yet, a limited number of vaccine-preventable diseases continue to contribute disproportionately to morbidity and mortality in complex emergencies. The literature suggests that Streptococcus pneumoniae, Rotavirus, and Haemophilus influenzae type-b should be key targets for vaccination programs. Because of the significant contribution of these three pathogens to complex humanitarian emergencies in low and middle-income countries regardless of disaster type, geography, or population, their vaccines should be considered essential components of the standard emergency response effort. We discuss the barriers to vaccine distribution and provide evidence for strategies to improve distribution, including expanded target age-range and reduced dose schedules. Our review includes specific recommendations for the expanded use of these three vaccines in complex emergencies in low and middle-income countries as a way to guide future policy discussions.

Shelter crowding and increased incidence of acute respiratory infection in evacuees following the Great Eastern Japan Earthquake and tsunami

Although outbreaks of acute respiratory infection (ARI) at shelters are hypothesized to be associated with shelter crowding, no studies have examined this relationship. We conducted a retrospective study by reviewing medical records of evacuees presenting to one of the 37 clinics at the shelters in Ishinomaki city, Japan, during the 3-week period after the Great Eastern Japan Earthquake and tsunami in 2011. On the basis of a locally weighted scatter-plot smoothing technique, we categorized 37 shelters into crowded (mean space <5·5 m2/per person) and non-crowded (⩾5·5 m2) shelters. Outcomes of interest were the cumulative and daily incidence rate of ARI/10 000 evacuees at each shelter. We found that the crowded shelters had a higher median cumulative incidence rate of ARI [5·4/10 000 person-days, interquartile range (IQR) 0–24·6,P= 0·04] compared to the non-crowded shelters (3·5/10 000 person-days, IQR 0–8·7) using Mann–WhitneyUtest. Similarly, the crowded shelters had an increased daily incidence rate of ARI of 19·1/10 000 person-days (95% confidence interval 5·9–32·4,P< 0·01) compared to the non-crowded shelters using quasi-least squares method. In sum, shelter crowding was associated with an increased incidence rate of ARI after the natural disaster.

Natural disasters and nontuberculous mycobacteria: a recipe for increased disease?

Infectious diseases acquired by survivors of large-scale natural disasters complicate the recovery process. During events such as tsunamis, hurricanes, earthquakes, and tornados and well into the recovery period, victims often are exposed to water-soil mixtures that have relocated with indigenous microbes. Because nontuberculous mycobacteria (NTM) are ubiquitous in water and soil, there is potential for increased exposure to these organisms during natural disasters. In this hypothesis-driven commentary, we discuss the rise in NTM lung disease and natural disasters and examine the geographic overlap of NTM infections and disaster frequencies in the United States. Moreover, we show an increased number of positive NTM cultures from Louisiana residents in the years following three of the relatively recent epic hurricanes and posit that such natural disasters may help to drive the increased number of NTM infections. Finally, we advocate for increased environmental studies and surveillance of NTM infections before and after natural disasters.

Crisis management aspects of bam catastrophic earthquake: review article

BACKGROUND

Bam earthquake was the most catastrophic natural disasters in recent years. The aim of this study was to review different aspects of crisis management during and after the catastrophic earthquake in Bam City, Iran.

METHODS

Data needed for this systematic review were collected through searching PubMed, EMBASE and SID databases, for the period from 2003 to 2011. Keywords included earthquake, Iran and Bam earthquake. The data were summarized and were analyzed using Content Analysis.

RESULTS

Out of 422 articles, 25 articles were included in the study. Crisis Management aspects and existing pitfalls were classified into seven categories including planning and organization, human resource management, management of logistics, international humanitarian aids, field performance of the military and security forces, health and medical service provision, and information management. Positive aspects and major pitfalls of crisis management have been introduced in all the mentioned categories.

CONCLUSION

The available evidence indicated poor crisis management during Bam earthquake that resulted in aggravating the losses as well as diminishing the effect of interventions. Thus, concerning the importance of different aspects of the crisis management and the high prevalence of disasters in Iran, the observed vulnerability in disaster management process should be addressed.

Communicable diseases surveillance system in East azerbaijan earthquake: strengths and weaknesses

Background: A Surveillance System was established for 19 diseases/syndromes in order to prevent and control communicable diseases after 2012 East Azerbaijan earthquakes. This study was conducted to investigate the strengths and weaknesses of the established SS. Methods: This study was carried out on an interview-based qualitative study using content analysis in 2012. Data was collected by semi-structured deep interviews and surveillance data. Fifteen interviews were conducted with experts and health system managers who were engaged in implementing the communicable disease surveillance system in the affected areas. The selection of participants was purposeful. Data saturation supported the sample size. The collected data was analyzed using the principles suggested by Strauss and Corbin. Results: Establishment of the disease surveillance system was rapid and inexpensive. It collected the required data fast. It also increased confidence in health authorities that the diseases would be under control in earthquake-stricken regions. Non estimated denominator for calculating the rates (incidence & prevalence), non-participation of the private sector and hospitals, rapid turnover of health staff and unfamiliarity with the definitions of the diseases were the weak points of the established disease SS. Conclusion: During the time when surveillance system was active, no significant outbreak of communicable diseases was reported. However, the surveillance system had some weaknesses. Thus, considering Iran’s susceptibility to various natural hazards, repeated exercises should be conducted in the preparedness phase to decrease the weaknesses. In addition, other types of surveillance system such as web-based or mobile-based systems should be piloted in disaster situations for future.

Major incident experience and preparedness in a developing country

BACKGROUND

Research shows that having previous experience of major incidents has a positive impact on awareness and preparedness of organizations. We investigated the effects of major incident experience on preparedness of health organizations on future disasters in Iran.

METHODS

A qualitative study using a semistructured interview technique was conducted with 65 public health and therapeutic affairs managers. Analysis of the data was performed used the framework analysis technique, which was supported by qualitative research software.

RESULTS

The study found that prior experience of major incidents results in better performance, coordination, and cooperation in response to future events. There was a positive effect on policy making and resource distribution and an increase in (1) preparedness activities, (2) raising population awareness, and (3) improving knowledge. However, the preparedness actions were predominantly individual-dependent.

CONCLUSIONS

Our findings showed that to increase system efficiency and effectiveness within health organizations, an appropriate major incident management system is needed. The new system can use lessons learned from previous major incidents to better equip health organizations to cope with similar events in the future.

Geological hazards: from early warning systems to public health toolkits

Extreme geological events, such as earthquakes, are a significant global concern and sometimes their consequences can be devastating. Geographic information plays a critical role in health protection regarding hazards, and there are a range of initiatives using geographic information to communicate risk as well as to support early warning systems operated by geologists. Nevertheless we consider there to remain shortfalls in translating information on extreme geological events into health protection tools, and suggest that social scientists have an important role to play in aiding the development of a new generation of toolkits aimed at public health practitioners. This viewpoint piece reviews the state of the art in this domain and proposes potential contributions different stakeholder groups, including social scientists, could bring to the development of new toolkits.

Rapid health needs assessment experience in 11 august 2012 East azerbaijan earthquakes: a qualitative study

INTRODUCTION

In disasters, health care providers need to find out the essential needs of the affected populations through Rapid Health Needs Assessment (RHNA). In East Azerbaijan earthquakes, a rapid assessment was performed by the provincial health system. The main purpose of this study was to explore the RHNA challenges.

METHODS

In this qualitative study (Grounded theory), data was collected through semi-structured interviews with purposely selected health care workers. The data collection process continued until data saturation. All interviews were recorded and then transcribed. The Colaizzi's descriptive method was used to analyze the data.

RESULTS

The themes emerged from the analysis of the interviews were: 1) Logistic problems 2) Lack of RHNA tools 3) Inherent difficulty of RHNA in disaster situations 4) Lack of preparedness and 5) Lack of coordination between different organizations. These challenges result in inapplicable use of RHNA results.

CONCLUSION

The most important challenge in this RHNA process was the lack of East Azerbaijan health center preparedness. Although they were familiar with the importance of RHNA, they did not have any plans for conducting RHNA.

Methanol mass poisoning in Iran: role of case finding in outbreak management

BACKGROUND

There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources according to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013.

METHODS

A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims.

RESULTS

A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to other cities. Seventy-five and 100 patients underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available.

CONCLUSION

In developing countries, where diagnostic resources are limited, use of active case finding and developing national guidelines can help in the management of large outbreaks of methanol poisonings.

Infectious Disease Frequency Among Evacuees at Shelters After the Great Eastern Japan Earthquake and Tsunami: A Retrospective Study

Objective

After the Great Eastern Japan Earthquake and tsunami, the World Health Organization cautioned that evacuees at shelters would be at increased risk of infectious disease transmission; however, the frequency that occurred in this population was not known.

Methods

We reviewed medical charts of evacuees who visited medical clinics at 6 shelters from March 19, to April 8, 2011. Excluded were patients who did not reside within the shelters or whose medical records lacked a name or date. We investigated the frequency of and cumulative incidences of acute respiratory infection [ARI], acute gastroenteritis, acute jaundice syndrome, scabies, measles, pertussis, and tetanus.

Results

Of 1364 patients who visited 6 shelter clinics, 1167 patients (86.1%) were eligible for the study. The median total number of evacuees was 2545 (interquartile range [IQR], 2277-3009). ARI was the most common infectious disease; the median number of patients with ARI was 168.8 per week per 1000 evacuees (IQR, 64.5-186.1). Acute gastroenteritis was the second most common; the median number of patients was 23.7 per week per 1000 evacuees (IQR, 5.1-24.3). No other infectious diseases were observed. The median cumulative incidence of ARI per 1000 evacuees in each shelter was 13.1 person-days (IQR, 8.5–18.8). The median cumulative incidence of gastroenteritis was 1.6 person-days (IQR, 0.3–3.4).

Conclusion

After the Great Eastern Japan Earthquake and tsunami, outbreaks of ARI and acute gastroenteritis occurred in evacuation shelters. (Disaster Med Public Health Preparedness. 2014;0:1-7)

Surveillance and epidemiology in natural disasters: a novel framework and assessment of reliability

OBJECTIVE

To create a framework and methodology for organizing relevant disaster epidemiology literature. The target audience for the framework is local public health practitioners conducting emergency surveillance in the setting of preparedness or response to natural disasters.

METHODS

The approach to developing the framework involved utilizing the public health and emergency management literature. It was created along four axes. The first was the type of natural disaster; second was according to phase of disaster cycle; third was the impact of the disaster (health, infrastructure, economic); and fourth was related to the main outcome of the study (ie. injuries or infectious diseases). A literature review was conducted and subsequently the current literature was utilized to perform a reliability test of the established framework, using two independent reviewers.

RESULTS

Using existing disaster classification systems and risk analysis tools, a framework was developed along the four axes. The final literature search resulted in 85 articles on surveillance in natural disaster settings. The majority of studies are on the subject of hurricanes with a catastrophic impact rating. The phase of testing reliability of the framework resulted in percent agreement of 74%.

CONCLUSIONS

A reliable framework was developed that enables local public health practitioners to easily access appropriate and previously utilized surveillance methods for a natural disaster emergency. This framework contributes to an evidence-informed approach to surveillance in natural disasters with public health impacts.

Incidence of Japanese encephalitis, visceral leishmaniasis and malaria before and after the Wenchuan earthquake, in China

The objective of this study was to investigate the incidence of insect-borne diseases from 2005 to 2011, before and after the 2008 Wenchuan earthquake in Longnan City, Gansu Province, China. The data include Japanese encephalitis, Kala-azar and malaria cases from 2005 to 2011 that occurred in Longnan City. We calculated the incidence rates and analyzed the epidemiological characteristics of the diseases before and after the Wenchuan earthquake. During 2005-2011, 212 Japanese encephalitis cases were reported in Longnan City, and the average incidence was 1.11/100,000. Compared with any year from 2005 to 2010 the incidence of Japanese encephalitis in Longnan City in 2011 was not significantly different (P≥0.05). From 2005 to 2011, there were 719 Kala-azar cases in Longnan City, the annual incidence was 3.77/100,000, and the incidence in males was higher than females (P<0.001). Compared with 2011, there was no significant difference in incidence of Kala-azar in 2009 or 2010 (P≥0.05). There were seven total cases of malaria from 2005 to 2011, and the annual incidence was 0.07/100,000. Wudu District and Wen County were the main endemic areas of insect-borne diseases in Longnan City. The results showed that Japanese encephalitis and Kala-azar were common insect-borne infectious diseases in Longnan City, and that the incidence of insect-borne disease did not increase after the Wenchuan earthquake. It is possible that vector control measures implemented after the earthquake prevented an increase in such diseases.

The perspective of psychosocial support a decade after Bam earthquake: achievements and challenges

The 2003 Bam earthquake was one of the most catastrophic disasters to have struck Iran. This article summarizes the short-term and long-term psychological, social, and economic impacts of the Bam earthquake on survivors across a decade since its occurrence. Identification and definition of capability as well as recognizing the nature and extent of personal and social capabilities in a community are priceless in preventing disasters and reducing their consequent destruction.

Impact of the Tohoku earthquake and tsunami on pneumonia hospitalisations and mortality among adults in northern Miyagi, Japan: a multicentre observational study

Background

On 11 March 2011, the Tohoku earthquake and tsunami struck off the coast of northeastern Japan. Within 3 weeks, an increased number of pneumonia admissions and deaths occurred in local hospitals.

Methods

A multicentre survey was conducted at three hospitals in Kesennuma City (population 74 000), northern Miyagi Prefecture. All adults aged ≥18 years hospitalised between March 2010 and June 2011 with community-acquired pneumonia were identified using hospital databases and medical records. Segmented regression analyses were used to quantify changes in the incidence of pneumonia.

Results

A total of 550 pneumonia hospitalisations were identified, including 325 during the pre-disaster period and 225 cases during the post-disaster period. The majority (90%) of the post-disaster pneumonia patients were aged ≥65 years, and only eight cases (3.6%) were associated with near-drowning in the tsunami waters. The clinical pattern and causative pathogens were almost identical among the pre-disaster and post-disaster pneumonia patients. A marked increase in the incidence of pneumonia was observed during the 3-month period following the disaster; the weekly incidence rates of pneumonia hospitalisations and pneumonia-associated deaths increased by 5.7 times (95% CI 3.9 to 8.4) and 8.9 times (95% CI 4.4 to 17.8), respectively. The increases were largest among residents in nursing homes followed by those in evacuation shelters.

Conclusions

A substantial increase in the pneumonia burden was observed among adults after the Tohoku earthquake and tsunami. Although the exact cause remains unresolved, multiple factors including population aging and stressful living conditions likely contributed to this pneumonia outbreak.

Infectious diseases following natural disasters: prevention and control measures

Natural disasters may lead to infectious disease outbreaks when they result in substantial population displacement and exacerbate synergic risk factors (change in the environment, in human conditions and in the vulnerability to existing pathogens) for disease transmission. We reviewed risk factors and potential infectious diseases resulting from prolonged secondary effects of major natural disasters that occurred from 2000 to 2011. Natural disasters including floods, tsunamis, earthquakes, tropical cyclones (e.g., hurricanes and typhoons) and tornadoes have been secondarily described with the following infectious diseases including diarrheal diseases, acute respiratory infections, malaria, leptospirosis, measles, dengue fever, viral hepatitis, typhoid fever, meningitis, as well as tetanus and cutaneous mucormycosis. Risk assessment is essential in post-disaster situations and the rapid implementation of control measures through re-establishment and improvement of primary healthcare delivery should be given high priority, especially in the absence of pre-disaster surveillance data.

Effects of the Bam earthquake on employment: a shift-share analysis

Disasters have potential short-term and long-term impacts on employment and employment structures in affected regions. While measuring the full economic impact of a disaster requires sophisticated econometrics and mathematical simulations, conventional regional economic models such as shift-share analysis can be used to assess some of these effects. This paper applies shift-share analysis to understand potential long-term impacts of disasters on employment using the December 2003 Bam earthquake as a case study. The results provide further evidence that disasters could have significant long-term effects on the employment structure of affected regions.

The 2003 Bam Earthquake: Overview of First Aid and Transport of Victims

Introduction:

In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city.

Problem:

The purpose of this study was to assess the status of the rescue, evacuation, and transportation of the casualties during the early stages following the earthquake.

Methods:

A cross-sectional study of 185 casualties who were transferred to and hospitalized in the university hospital during the first week period following the earthquake was conducted. Information regarding different places of settlement after being removed from the rubble, initial medical care, and the means of transportation was obtained by reviewing medical records and interviewing the victims.

Results:

The mean value of the duration of times taken for the first rescuers to reach the scene and remove the casualties from the rubble was 1.7 ±2.7 and 0.9 ±1.1 hours, respectively. Sixty-nine (37.7%) of the patients stayed within the area immediately surrounding their home for average times of 8 ±10 hours. The majority of casualties (57.6%) were transferred manually to a first place of settlement; 45.8% were taken to a second place of settlement using blankets. Of the patients studied, 159 (85.9%) did not receive any basic medical care at the first place and intravenous fluid therapy was the most common treatment provided for 24 (13%) patients at the second place of settlement. Patients received medical care at the first place of settlement for a mean time of 16.8 ±13.5 hours after escaping the rubble.

Conclusions:

These findings indicate that the emergency medical service system in Bam was destroyed and not able to respond adequately. In order to reduce the negative effects of such disasters in the future, there is an essential need for a comprehensive disaster management plan and improvement of hospital structures, healthcare facilities, and communication between the different governmental departments for better coordination and planning.

Strategies in Evaluation and Management of Bam Earthquake Victims

Background:

On 26 December 2003, an earthquake measuring 6.5 on the Richter scale occurred in the city of Bam in southeastern Iran. Bam was destroyed completely, >43,000 people were killed, and 30,000 were injured. The national and international responses were quick and considerable. Many field hospitals werecreated and large numbers of patients were evacuated from their homes and transported to hospitals throughoutIran. Nearly 700 patients were transferred to Chamran hospital in Shiraz within the first 48 hours after the earthquake.

Methods:

This is a retrospective study based on the medical records of earthquake casualties dispatched to Chamran Hospital. A screening tunnel composed of multiple stations was prepared before patients entered to facilitate the large influx of patients. Each of the victims was passed through this screening tunnel and assigned into one of three groups: (1) those needing emergency surgical intervention; (2) those needing less urgent surgery; and (3) those needing elective operations, supportive care, observation, and/or rehabilitation.

Results:

Among the 708 patients, 392 were male (male/female ratio: 1.24) with a mean value of their ages of 30.5 years. (range: 1.5 months–70 years). Extremity fractures (136, 19%) were more common than were axial skeleton fractures (28, 4%). Out of the total 708 patients, 152 (21.5%) patients needed emergency operations, 26 (4%) needed less urgent surgery, and 530 (74.5%) required wound care or antibiotic therapy and other forms of supportive care. Some complications occurred, such as two patients with compartment syndromes of theleg, three required below-the-knee amputation, eight suffered acute renal failure, two developed fat emboli syndrome, and one had a brain injury that resulted in death.

Conclusion:

A comprehensive disaster plan is required to ensure a prompt disaster response and coordinated management of a multi-casualty incident. This can influence the outcomes of patients directly. A patient screening tunnel has advantages in rapid and effective evaluation and management of victims in any multi-casualty incident.

Earthquake Related Injuries: Assessment of 854 Victims of the 2003 Bam Disaster Transported to Tertiary Referral Hospitals

Background:

In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed >90% of the city. After the assessment and initial treatment of injuries at national and international field hospitals, a considerable number of victims (approximately 12,000) were transferred to tertiary referral hospitals around the country. Objective: This report evaluated the injuries of 854 victims transferred to 12 referral hospitals in Tehran.

Methods:

The demographic data, injury patterns, injury severity score (ISS), diagnosis, treatment, and outcome data of 854 Bam earthquake victims were assessed.

Results:

There were 467 (54.7%) males and 387 (45.3%) females. The mean age of the patients was 29.0 years. Transportation by aircraft was the most common method used for evacuation, which was used to evacuate 555 patients (65%). Fifty-four percent of the victims required initial medical aid at field hospitals before transportation to Tehran. There were 1,322 patients with injuries, of which, fractures of the lower extremities were the most common (331; 25%). Limb fixation was the most commonly performed primary procedure in emergency wards (389 cases, 39.9%). The mean value ±SD for ISS was 6.7 ±5.2. Orthopedic operations were the most frequent surgical procedures performed (195/260 operations, 75%) and the overall mortality rate was 1.6% (n = 14).

Conclusions:

Along with the crucial importance of aid provided by national and international field hospitals in disasters, suitable triage of casualties and preparedness of tertiary referral centers in unaffected regions also play an important role in providing medical care to disaster victims. During these situations, the number of victims cannot be predicted accurately, and sufficient medical care, particularly for orthopedic problems, can be provided by referral centers.

Emergency medical rescue efforts after a major earthquake: lessons from the 2008 Wenchuan earthquake

Major earthquakes often result in incalculable environmental damage, loss of life, and threats to health. Tremendous progress has been made in response to many medical challenges resulting from earthquakes. However, emergency medical rescue is complicated, and great emphasis should be placed on its organisation to achieve the best results. The 2008 Wenchuan earthquake was one of the most devastating disasters in the past 10 years and caused more than 370,000 casualties. The lessons learnt from the medical disaster relief effort and the subsequent knowledge gained about the regulation and capabilities of medical and military back-up teams should be widely disseminated. In this Review we summarise and analyse the emergency medical rescue efforts after the Wenchuan earthquake. Establishment of a national disaster medical response system, an active and effective commanding system, successful coordination between rescue forces and government agencies, effective treatment, a moderate, timely and correct public health response, and long-term psychological support are all crucial to reduce mortality and morbidity and promote overall effectiveness of rescue efforts after a major earthquake.

Disaster health-related challenges and requirements: a grounded theory study in Iran

BACKGROUND

Despite frequent disasters caused by natural hazards, concern has been raised regarding the effectiveness of disaster health services in disaster-prone countries such as Iran. The purpose of this study was to explore, in relation to health disaster management, the experiences and perceptions of individuals who responded or were affected by a recent Iranian earthquake disaster.

METHODS

This study was conducted using grounded theory. Study participants included members of a multidisciplinary disaster response team as well as residents of the community affected by the earthquake (n = 29). Data collection included semi-structured interviews, field notes, and reviews of narratives.

RESULTS

The findings of this study indicate that the lack of planning, inadequate organizational management of resources, insufficient coordination in the provision of health services during the disaster, and the manner of participation of international relief efforts were the most important barriers to adequate disaster healthcare services delivery during the 2003 Bam Iranian earthquake.

CONCLUSIONS

This study supports the value of health service managers coordinating the appropriate use of international aid in advance. It is suggested that this can be done by better communication with local and foreign constituents. Further, this study indicates that public education and proper pre-event planning help to bring about an effective response to providing healthcare services during a disaster.

Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

Background

Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days.

Methods

The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation.

Results

The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators.

Conclusions

The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

A reassessment and review of the Bam earthquake five years onward: what was done wrong?

INTRODUCTION

An earthquake measuring 6.6 on the Richter scale on 23 December 2003 devastated the city of Bam in southeastern Iran. During the response and recovery phases, considerable shortcomings were discovered. The dire situation in the affected area, a variety of urgently required interventions, and the large number of aid organizations involved brought about difficulties in management, coordination, and communication among authorities and aid organizations. This article highlights flaws in management in the various aspects of this disaster in order to assess what was done, and what should be done to overcome these shortcomings in future disasters.

METHODS

A retrospective review of the various aspects of management related to the Bam disaster was done via the assessment of files, multi-center studies, governmental data, and available literature from 2003-2008.

RESULTS

A review of the available data relevant to search and rescue operations and short-term aid provision revealed flaws in different aspects of disaster management including personnel, the transfer of the injured, availability medical supplies, treatment planning, problems concerning the composition of treatment forces dispatched to the region, distribution of tasks among treatment workers, transferring of equipment, availability of facilities, and lack of coordination among the organizations responsible for the management of the disaster. Most of the aforementioned issues have been addressed.

CONCLUSIONS

A comprehensive disaster management plan must not be limited only to the response phase, but rather must include: preparedness, recovery with optimal legislation and budgeting, improvement of healthcare facilities, and organized communication channels between the different governmental departments. This important issue has been addressed, and a disaster management organization under the supervision of the President has been established, developing a national search and rescue strategy and protocol for unified managerial organization, an alert system, an international disaster command system (under which search and rescue and emergency medical service teams can be deployed, increasing the efficacy and coordination of the arrival of foreign teams and the construction field hospitals), and developing a flowchart to coordinate international agencies and the domestic authorities in charge. Continuous education, training of the general population, conducting periodic exercise drills, and provision for prepared task force mobilization in disaster management all are important aspects of the management of disasters due to natural hazards.

The role of non-governmental organisations in the management of separated and unaccompanied children, following disasters in Iran

BACKGROUND

Following disasters, separated and unaccompanied children are among the most vulnerable, therefore international organisations have formed guidelines regarding the management of these children. Guidelines include recommendations for identifying and registering children, tracing family members, reunification and arrangements for interim and durable care. There is a lack of experiential evidence on how these principles are put into practice at operational levels, and whether existing policies were useful. There is a particular lack of empirical evidence from the disaster prone country of Iran. The aim of this study was to describe the role of Non- Governmental Organisations (NGOs) in the management of separated and unaccompanied children, following disasters in Iran in order to plan for and provision of future disasters.

FINDINGS

The Iranian Red Crescent Organisation, Committee Emdad Imam Khomeini (a national organisation unique to Iran that is protected by the government and supported by public contributions) and Behzisti (the government welfare organisation in Iran) are the main figures involved in the management of separated and unaccompanied children, following disasters in Iran. NGOs are rarely responsible for caring for unaccompanied children, however they provide valuable support including financial assistance, arrangement of educational and extra-curricular activities and psychosocial support. Following the initial chaos after the Bam earthquake, international guidelines on separated and unaccompanied children were largely followed.

CONCLUSIONS

Systems for managing separated and unaccompanied children following disasters in Iran, involving NGOs, are emerging. However, most are yet to be formalised.

Disaster relief and recovery after a landslide at a small, rural hospital in Guatemala

INTRODUCTION

Though many reports have assessed hospital emergency responses during a disaster that affected the facility's operations, relatively little work has been dedicated to identifying factors that aid or impede the recovery of such hospitals.

PROBLEM

On 05 October 2005, Hurricane Stan triggered landslides that buried an impoverished Mayan community in Santiago Atitlán, Guatemala. The six-bed Hospitalito Atitlán also was in the landslide's path. Though opened just months earlier, the institution maintained 24-hour services until reopening in a new facility only 15 days after the landslides.

METHODS

This qualitative study examined the Hospitalito Atitlán's disaster recovery using unstructured interviews with key hospital personnel and community members. Participant observation provided information about institutional and cultural dynamics affecting the hospital's recovery. Data were collected retrospectively during June-September 2006 and June 2007.

RESULTS

The Hospitalito's emergency responses and recovery were distinct endeavors that nonetheless overlapped in time. The initial 12 hours of disorganized emergency relief work was quickly succeeded by an organized effort by the institution to provide inpatient and clinic-based care to the few severely injured and many worried-well patients. As international aid started arriving 2-3 days post-landslide, the Hospitalito's 24-hour clinical services made it an integral organization in the comprehensive health response. Meanwhile, a subset of the Hospitalito's non-clinical staff initiated rebuilding efforts by Day 2 after the event, joined later by medical staff as outside aid allowed them to hand off clinical duties. Effective use of the Internet and conventional media promoted donations of money and supplies, which provided the raw materials used by a group determined to reopen their hospital.

CONCLUSIONS

Early work by a recovery-focused team coupled with a shared understanding of the Hospitalito as an institution that transcended its damaged building drove the hospital's rapid post-emergency revival. Encouraging a similar sense of mission, emulating the Hospitalito's handling of funding and material procurement, and conducting rebuilding and relief efforts in parallel may aid recovery at other health facilities.

Pattern of drug prescription and utilization among Bam residents during the first six months after the 2003 Bam earthquake

INTRODUCTION

It is important to identify what kinds of drugs are required by disaster-affected populations so that appropriate donations are allocated. On 26 December 2003, an earthquake with an amplitude of 6.3 on the Richter scale struck southeastern Iran, decimating the city of Bam. In this study, the most frequently utilized and prescribed drugs for Bam outpatients during the first six months after the Bam Earthquake were investigated.

METHODS

In this descriptive, cross-sectional study, the data were collected randomly from 3,000 prescriptions of Bam outpatients who were examined by general practitioners from Emergency Medical Assistance Teams in 12 healthcare centers during the first six months after the Bam Earthquake. The data were analyzed for: (1) patient sex; (2) number of drugs/prescriptions; (3) drug category; (4) drug name (generic or brand); (5) route of administration; (6) percent of visits where the most frequent drug categories were prescribed; and (7) the 25 most frequently prescribed drugs, using World Health Organization (WHO) indicators of drug use in health facilities.

RESULTS

Male patients represented 47.4% and females 52.6% of the total number of outpatients. The mean number of drugs/prescriptions was 3.5 per outpatient. Oral administration was the most frequent method of administration (81.7%), followed by injections (10.9%). Respiratory drugs were the most frequently used drugs (14.2%), followed by analgesics/non-steroidal anti-inflammatory drugs (NSAIDs) (11.3%), antibacterials (11.2%), gastrointestinal (GI) drugs (9.6%), and central nervous system drugs (7%). Penicillins (6.8%), cold preparations (8%), and systemic anti-acids (ranitidine and omeprazole) were among the 25 most frequently used drugs by outpatients and inhabitants of Bam during the first six months after the Bam Earthquake.

CONCLUSION

Respiratory, analgesic, antibacterial, GI, and psychiatric medications were among the most commonly prescribed pharmaceuticals after the catastrophic Bam Earthquake. The results of this study may help to predict the needs of patients during future disasters and prevent unnecessary donations of medicine.

Negligible risk for epidemics after geophysical disasters

After geophysical disasters (i.e., earthquakes, volcanic eruptions, tsunamis), media reports almost always stress the risk for epidemics; whether this risk is genuine has been debated. We analyzed the medical literature and data from humanitarian agencies and the World Health Organization from 1985 to 2004. Of >600 geophysical disasters recorded, we found only 3 reported outbreaks related to these disasters: 1 of measles after the eruption of Pinatubo in Philippines, 1 of coccidioidomycosis after an earthquake in California, and 1 of Plasmodium vivax malaria in Costa Rica related to an earthquake and heavy rainfall. Even though the humanitarian response may play a role in preventing epidemics, our results lend support to the epidemiologic evidence that short-term risk for epidemics after a geophysical disaster is very low.

Health needs assessment tools: Progress and potential

Objectives:Health needs has attracted the interest of policy-makers, health economists, and health professionals as modern health services try to satisfy individual and population health needs to optimize resource utilization. Health needs can be assessed by administering various types of survey or interview-based instruments. If health needs are to be satisfied in changing health agendas in developed and developing countries, it is essential to employ valid and reliable tools. Despite the importance of needs assessment, no comprehensive review of tools is currently available. We carried out a literature search to define and categorize existing health needs assessment tools.

Methods:We reviewed medical and social search engines for items containing specific health needs–related words to identify needs tools across a range of specialties. Papers were reviewed in terms of design, subject matter, psychometric features, and method of administration method.

Results:Thirty-one employed in 52 studies including cancer, mental health, palliative care, multiple sclerosis, and cardiovascular disease tools were identified.

Conclusions:This report summarizes available health needs instruments in a range of diseases to assist researchers in accessing health needs resources more easily and to encourage further research in this field.