American Journal of Disaster Medicine

The aim of this study was to determine which journals publish medical disaster-related work, their individual focus, and publication volume pre- and post-9/11. PubMed and Google Scholar were searched using key words to identify peer-review journals (print or electronic) publishing medical and public health disaster-related manuscripts. All medical journals with an average volume of at least five disaster-related publications per year over the 11-year study period (1996-2006) were selected. Identified journals were categorized as either general or specialty medical, or disaster health dedicated. All disaster-related articles in each journal were identified and classified according to 11 subtopics. Of 16 journals meeting entry criteria, 10 were disaster dedicated. Of these, only six existed pre-9/ 11. Only six general journals (JAMA, American Journal of Public Health, The Lancet, New England Journal of Medicine, Annals of Emergency Medicine, Academic Emergency Medicine) had sufficient publications for analysis. Of the 2899 disaster articles identified, 1769 (61 percent) were from the dedicated journals. Publications increased by 320 percent in the general/subspecialty journals and 145 percent for disaster-specific journals in the 5-year period post-9/11 (2002-2006) versus the previous 5-year period (1996-2000). Among the dedicated journals, Journal of Prehospital and Disaster Medicine published the most (21 percent), followed by Disaster Prevention and Management: An International Journal (18 percent). Among the general/subspecialty journals, The Lancet published the most (33 percent), followed by JAMA (28 percent) and Annals of Emergency Medicine (18 percent). These journals published the most pre- and post-9/11. Bioterrorism (36 percent) and Preparedness (18 percent) were the most frequent topic areas for the general/subspecialty journals, while General Disasters (38 percent) and Preparedness (27 percent) were of the highest interest for the dedicated journals. The greatest increase in the proportion of publications pre- and post-9/11 was by the New England Journal of Medicine (2340 percent) and Academic Emergency Medicine (1275 percent). Individual journals appear to emphasize particular subtopic areas. Interest in publishing medical disaster-related articles has increased tremendously since 9/11 in both general/subspecialty journals as well as disaster-dedicated medical journals. Some journals focus on certain topics. Details of this study should help authors identify appropriate journals for their manuscript submissions.

The US continues to be a target for terrorist activities that threaten the lives of the populace. Training on preparedness and response for emergency medical technicians (EMTs) and paramedics is critical to the success of an early response to any such attack. Previous surveys have suggested that terrorism-specific training has been modest at best since September 11. In order to gain further insight into emergency personnel's level of training and competence, we sent surveys to 4,000 EMTs and paramedics in the state of Florida in late 2005 and early 2006. Results show a much higher level of training than previously reported from other states and suggest a direct correlation between the amount and type of training and self-reported competence. Our results suggest that most emergency personnel are receiving terrorism-specific training, but gaps in competencies exist and require the attention of educators and policymakers.

Natural disasters disproportionately injure women and children. Disaster teams need intensive training in the management of obstetrics and women's healthcare at the disaster site. This article summarizes the obstetrical experience for the International Medical Surgical Response Team (IMSuRT) stationed at Gheskio in Port Au Prince during the first 2 weeks after the 2010 Haitian earthquake. The world's literature on the impact of disasters on women is reviewed. Sixty-three members of the IMSuRT and Disaster Medical Assistance Team set up a mobile surgical field hospital after the 2010 Haitian earthquake. One member (AG) managed all the obstetrical care and taught the other team members essentials of labor management and assessment in pregnancy. Six hundred patients were treated in the first 14 days. Ten percent of these patients were pregnant.There were 12 deliveries. All pregnant patients were evaluated by a Sonosite ultrasound device. Pregnant patients with earthquake-related injuries were treated for their injuries.Women in labor were managed by active management in labor. No cesarean sections were needed. Well-being of mother and babies. Sixty pregnant women presented to the mobile hospital for evaluation from January 17, 2010, through January 28, 2012. Twelve women in labor delivered healthy infants by vaginal delivery. Gestational ages ranges from 34 to 40 weeks. Active management of labor included the use of intravenous Pitocin, which was titrated to contractions. Duration of labor ranged from 2 to 12 hours. Three team members participated in each delivery. Two women were discharged on the same day as their deliveries. Eight women were discharged on the first postpartum day and two on the second postpartum day. Pregnant women suffered severe injuries. Additionally, pregnant women with pre-existing medical conditions were treated after the earthquake. Active management of labor allowed all women to deliver vaginally. The labor management required tremendous team resources to facilitate vaginal deliveries and avoid cesarean sections. Cesarean sections in an austere environment have the potential for devastating consequences such as sepsis, wound dehiscence, and the long-term risks of uterine rupture with subsequent pregnancies. Our experience highlights the need to include trained obstetrical providers on the first response team. Data from this article were included in the presentation, "An urgent need for women's health specialists in disaster response," at the Disaster Response Workshop, Annual Meeting Society Maternal Fetal Medicine, Dallas, 2012.

The authors review the preparation, implementation, and management of the US Airways Flight 1549 Hudson River crash. This is a review of the experience of NJ. The state planning that created the ability to execute the treatment of patients from time of impact in the river until debriefing is reviewed.

Background: In-hospital triage is the key factor for successful management of an overwhelming number of patients in lack of treatment capacity. The main goal of in-hospital triage is to identify casualties with life-threatening injuries and to allocate immediate medical aid. For the first time, we evaluate the quality of in-hospital triage in the German capital Berlin. Methods: In this prospective observational study of 17 unheralded external mass casualty trainings for Berlin disaster hospitals in 2010/2011, we analyzed the in-hospital triage of 601 rouged casualty actors. Evaluation was performed by structured external survey and interview of the casualty actors after the disaster training. In 93 percent (n = 558), complete data were available and suitable for statistical analysis. Results: The primary triage category was allocated correctly to 61 percent (n = 338) of the simulated injury severity. The following measurements were performed: anamnesis in 77 percent, physical examination 71 percent, blood pressure in 68 percent, heart rate in 61 percent, and oxygen saturation in 25 percent. Additive radiological diagnostics were used: 38 percent X-ray, 16 percent computer tomography, and 7 percent ultrasound. On an average, 1.6 ± 1.2 diagnostic tools were used to allocate injury severity to rouged casualties. Of all the rouged casualties, 24 percent overtriage and 16 percent undertriage were observed. Overtriage was significantly infrequent in level I trauma centers (p = 0.03). Of the patients with life-threatening injuries, 18 percent was undertriaged. Of the 62 percent with secondary right allocation to triage category, re-triage was only used in 4 percent. Conclusion: The accuracy of in-hospital triage is low (61 percent). Predominately, the problem of overtriage (24 percent) due to insufficient triage training in contrast to undertriage (16 percent) occurs. The diagnostic triage adjuncts, ultrasound and re-triage, should be routinely used to lower the rate of undetected life threat in mass casualty incidents. Furthermore, a standardized training program and triage algorithm for in-hospital triage should be established.

When pandemic influenza arrived from the United States in 1918-1920 to strike Canada with devastating force, the health system was overwhelmed. Although emergency hospitals were established in public buildings including schools and universities, many sick remained in their homes. Because of the war, many physicians and nurses were overseas. Many of those who were in Canada became flu victims. The result was a massive call for volunteers. Although a few men responded, most volunteers were women. These women, many of whom had little or no training, risked their lives by acting as nurses in existing and emergency hospitals and by assisting sick families in their homes. Many became ill and some died. The result is an incredible portrait of volunteer response to a major medical emergency.

The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo is one of the first Ebola outbreaks to be treated in a hospital setting and is one of the most well-studied Ebola epidemics to have occurred to date. Many of the lessons learned from identifying, containing, and treating the epidemic are applicable to future viral outbreaks. This article looks at the characteristics of the Ebola virus and health system issues, which affected the healthcare providers' ability to contain and treat the virus. It specifically examines factors such as the disease characteristics, surge capacity, supply issues, press involvement, and the involvement of voluntary organizations.

The threat of suicide bombing attacks has become a worldwide problem. This special type of multiple casualty incidents (MCI) seriously challenges the most experienced medical facilities. The authors concluded a retrospective analysis of the medical management of victims from the six suicide bombing attacks that occurred in Metropolitan Haifa from 2000 to 2006. The six terrorist suicide bombing attacks resulted in 411 victims with 69 dead (16.8 percent) and 342 injured. Of the 342 injured, there were 31 (9.1 percent) severely injured, seven (2.4 percent) moderately severely injured, and 304 (88.9 percent) mildly injured patients. Twenty four (77 percent) of the 31 severely injured victims were evacuated to the level I trauma center at Rambam Medical Center (RMC). Of the seven severely injured victims who were evacuated to the level II trauma centers (Bnai-Zion Medical Center and Carmel Medical Center) because of proximity to the detonation site, three were secondarily transferred to RMC after initial resuscitation. Eight of the 24 severely injured casualties, admitted to RMC, eventually died of their wounds. There was no in-hospital mortality in the level II trauma centers. A predetermined metropolitan triage system which directs trauma victims of a MCI to the appropriate medical center and prevents overcrowding of the level I facility with less severe injured patients will assure that critically injured patients of a suicide bombing attack will receive a level of care that is comparable with the care given to similar patients under normal circumstances. Severe blast injury victims without penetrating injuries but with significant pulmonary damage can be effectively managed in ICUs of level II trauma centers.

A statistical relationship exists between state per capita smallpox vaccination rates of healthcare workers in 2003 and state presidential election results in 2004. The potential implications of political influence on national biosecurity decision making are discussed.

The purpose of this study was to determine the prevalence of acute distress-that is, clinically significant posttraumatic stress symptoms (PTSS) and depression-and to identify predictors of each in a sample of people who witnessed a fatal aircraft collision at the 2005 Saskatchewan Centennial Air Show. Air Show attendees (N = 157) were recruited by advertisements in the local media and completed an Internet-administered battery of questionnaires. Based on previously established cut-offs, 22 percent respondents had clinically significant PTSS and 24 percent had clinically significant depressive symptoms. Clinically significant symptoms were associated with posttrauma impairment in social and occupational functioning. Acute distress was associated with several variables, including aspects of Air Show trauma exposure, severity of prior trauma exposure, low posttrauma social support (ie, negative responses by others), indices of poor coping (eg, intolerance of uncertainty, rumination about the trauma), and elevated scores on anxiety sensitivity, the personality trait of absorption, and dissociative tendencies. Results suggest that clinically significant acute distress is common in the aftermath of witnessed trauma. The statistical predictors (correlates) of acute distress were generally consistent with the results of studies of other forms of trauma. People with elevated scores on theoretical vulnerability factors (eg, elevated anxiety sensitivity) were particularly likely to develop acute distress.

Although older people may be recognized as a vulnerable group post-natural disasters, their particular needs are rarely met by the providers of emergency services. Studies about older people's health needs post disasters in the South East Asia Tsunami, Kashmir, Pakistan, China, and United States has revealed the lack of concern for older people's health needs. Recent study of older people's health needs post the Kashmir Pakistan earthquake (2005) found older peoples' health needs were masked within the general population. This survey study examines the providers' perceptions of older people's vulnerabilities post-2005 Pakistan earthquake. It aims to understand the awareness of geriatric issues and issues related to current service provision/planning for older people's health needs post disasters. Specifically, service delivery patterns will be compared among different relief agencies. Cross-sectional, structured stakeholder interviews were conducted within a 2 weeks period in February 2006, 4 months post-earthquake in Pakistan-administrated Kashmir. Health/medical relief agencies of three different types of organizational nature: international nongovernmental organization (INGO), national organization, and local/community group were solicited to participate in the study. Descriptive analysis was conducted. Important issues identified include the need to sensitize relief and health workers about older people's health needs post disaster the development of relevant clinical guidelines for chronic disease management postdisaster in developing countries and the advocacy of building in geriatric related components in natural disaster medical relief programs. To effectively address the vulnerability of older people, it is important for governments, relief agencies, and local partners to include and address these issues during their relief operations and policy planning.

To examine patterns of visits by residents of northern Israel displaced during the Israel-Lebanon War of 2006 to an urgent care system in central Israel and to compare these patterns with those of local patients. Retrospective analysis of electronic medical records. Urgent care clinic system in and around Jerusalem, Israel. Patients residing in northern Israel who presented from July 12 to August 21, 2006. Local patients who presented during the same time period were used for comparison. None. Chief complaints, discharge diagnoses, demographics, and visit characteristics. There were a total of 1,175 visits for 938 northern patients, reflecting 6.7 percent of total visits to this system. Overall age distribution of northerners was generally similar. As a proportion of visits, adult northerners were less likely to visit for chief complaints of injury or laceration and more likely to visit for complaint of back pain. They were more likely to have a discharge diagnosis of chest pain, anxiety, or hypertension. Northern children and adolescents were less likely to visit due to injury or fall or to have a discharge diagnosis of fracture. They were more likely to have a discharge diagnosis of gastroenteritis or tonsillitis. Patterns of common discharge diagnoses were generally similar between northern and local residents, with the exception of fewer injury-related visits and more anxiety-related visits. Urgent care appears to have served an important function for displaced individuals during this war, mostly for routine medical needs.

The 2007 southern California wildfires resulted in over 500,000 residents being displaced. A team from Johns Hopkins University and the American Red Cross surveyed 163 families at shelters and local assistance centers during the disaster. The responses were used to evaluate the needs and movement patterns of a displaced population. The data were also used to determine the risk factors associated with needing sheltering. There is a lower than expected reliance on public shelters, and displaced persons move frequently.

Children have unique needs and are at risk of being exposed to hazardous materials and necessitating decontamination. A drill was conducted to identify problems that arise in the decontamination of children and develop recommendations for effective age appropriate decontamination. In a prospective, observational, multicenter, simulation exercise (drill), the authors assessed the management of patients (actors) ages 0.25-15 years and their adult guardians, who self-presented for treatment at two hospital emergency departments (EDs) (a tertiary care university hospital and an urban, municipal, level 1 trauma center) after a radiation exposure. The drill and responses of the participants were evaluated by trained observers using standardized forms and focus group interviews. Twenty children (aged 0-15 years, mean 10.7, median 12.0) and five adults presented to two EDs. Eighty-five percent of the children were successfully decontaminated in showers. Reasons for noncompletion included medical (respiratory distress, n = 1) and behavioral (n = 2) limitations. Sixty-five percent of children shivered and none were provided with appropriate sized covering immediately after showering. Forty percent were reluctant to undress and all children < 5 years (n = 4) needed assistance undressing and showering. Eighty-four percent received postdecontamination radiation screening and all had their contaminated belongings secured. Moods were described as happy 25 percent, cooperative 80 percent, consolable 35 percent, fearful 15 percent, and crying 10 percent. There was an association between children younger than 12 years of age and fearful mood or crying (p < 0.05). This drill identified several key areas of concern; including the need to maintain children's warmth by using heaters and sufficient body coverings and to increase staffing to better focus on age-specific requirements such as psychosocial needs that included anxiety, modesty, and keeping families together. These needs may compromise effective decontamination. Pediatric decontamination protocols and interventions addressing all these concerns should be further studied and implemented.

To quantify earthquake injury and mortality from the 2007 Ica earthquake in Peru and to assess earthquake-related risk and vulnerability. A population-based cluster survey of households in the region most affected by the earthquake. A stratified cluster survey design was used to allow for comparison between urban, periurban, and rural areas, where different outcomes were anticipated as a result of variation in building practices and access to post-earthquake assistance. A total of 42 clusters of 16 households were planned to allow for comparison between the location types and to ensure adequate spatial coverage. The four affected provinces in Southern Peru: Ica, Pisco, Chincha, and Canete. A total of 672 randomly selected households with a combined population of 3,608 individuals, of which 3,484 (97 percent) were reported as household members on the day of the earthquake. Mortality and injury rates in the four most affected provinces were estimated at 1.4 deaths/ 1,000 exposed (95 CI: 0.5-3.3) and 29 injuries/1,000 exposed (95 CI: 6-52). Older adults and members of households of lower socioeconomic status faced increased risk of injury. No significant differences in injury rates were observed between rural, urban, and peri-urban residence areas. Populations of lower socioeconomic status faced increased risk of injury; however, no differences in injury rates were observed between rural, urban, and peri-urban communities. Study findings suggest that earthquake preparedness and mitigation efforts should focus on population subgroups of lower socioeconomic in both rural and urban areas of earthquake-prone regions.

Train crashes represent a devastating multicasualty event. The purpose of this study was to analyze the injury severity, specific organ injuries, and cause of death in the fatalities of the 2008 Chatsworth, Los Angeles train crash. This is a review of the medical examiner records of the 25 fatalities in the train crash. The Injury Severity (ISS) Score, body area with severe injuries (Abbreviated Injury Scale [AIS] > or = 4), specific organ injuries, and causes of death were recorded. The immediate cause of death was determined to be the most severe or most rapidly fatal injury in the opinion of the reviewers. A total of 25 fatalities occurred, including 24 victims who were pronounced dead at the accident scene and one who died 4 days later in the hospital. One victim did not undergo full autopsy. All of the decedents were located in the locomotive or in the passenger car immediately behind the locomotive. Overall, 15/24 decedents (63 percent) sustained unsurvivable injuries to at least one body region rendering an ISS of 75. The chest was the most severely injured body area (AIS > or = 4; 18/24, 75 percent), followed by the head (13/24, 54 percent), the extremities (11/24, 46 percent), and the abdomen (7/24, 29 percent). Spinal fractures were recorded in 17/24 (71 percent), and the cervical spine was the most commonly injured site. Thoracic aortic rupture was found in eight cases (33 percent) and cardiac ruptures in five cases (21 percent). The Metrolink train crash in 2008 in Chatsworth, Los Angeles, was the worst train crash in the history of California with 25 fatalities. The most common cause of death was due to chest injury (cardiac and aortic laceration) followed by head injury. This review could aid in improving passenger protection from head-on collision and in further development of head protection in train seats, as well as be useful in disaster planning and a benchmark for future rescue and triage operations.

This article traces the spread and route of the H1N1 pandemic in 2009 from its possible origin in La Gloria to Mexico City. A lack of health control measures or nonpharmaceutical interventions (NPIs) in La Gloria accounts for the unprecedented high basic reproductive number (R0) in that town and a higher incidence of H1N1 flu in Mexico City. We analyzed data collected from Mexican news articles, the Healthmaps dataset, the Google search engine, and telephone interviews with Mexican community physicians and residents. Our article uses a simple Susceptible Infected and Recovered model based on the data collected, to show the relationship between the disease curve and the implementation of NPI use. As a result of this study, we conclude that, with strict government measures to control the disease over an extended period of time, it is possible that many hundreds or even thousands of lives might be saved in the future.

The purpose of this study was to describe the impact of the 2009 H1N1 influenza pandemic on a pediatric emergency department (ED) at a freestanding children's hospital in the summer and fall of 2009. In July 2009, active prospective surveillance for influenza-like illness (ILI) was performed on a daily basis of patients presenting to the ED of Arkansas Children's Hospital. The Centers for Disease Control and Prevention definition of ILI was used. Records of daily ILI volume were kept. A retrospective review of admissions from the ED to the inpatient service was done for patients with ILI and non-ILI. In addition, comparisons of monthly patient census for the months involved were compared with historical census data. When public schools started in mid-August 2009, there was a rapid and dramatic increase in the number of patients with ILI seen in the pediatric ED. Within 3 weeks, as many as 120 patients with ILI per day were being seen in the ED. The month of September 2009 was the highest census month ever recorded in this ED. The admission rate of the patients with ILI was lower than patients with non-ILI between September and November 2009 (10.8 percent vs 14.8 percent). The 2009 H1N1 influenza pandemic resulted in unprecedented patient volumes in this pediatric ED; however, patient acuity (based on admission rate) for patients with ILI was lower than patients with non-ILI. Pandemic influenza can overwhelm emergency care resources, even when the overall severity of illness is relatively low.

After initial flu cases are reported, months elapse before vaccine becomes available. The authors report the experience of US states during the fall of 2009 on H1N1 vaccine availability in relation to the occurrence of disease. The authors used data from the Centers for Disease Control and prevention and state health departments to approximate second wave H1N1 epidemic curves. The authors compared these curves to two sources of vaccine distribution data-shipment and administration. Ten states received their first shipments of vaccine after the epidemic peaked, four states during the week of the peak, and 10 states only 1 week prior to the peak. In nearly half of all states, the epidemic had already begun to decline before any individuals could have been protected. A sensible approach would be to highlight the importance of diligent hygienic behavior and to reduce the rate of human-to-human contacts before vaccine is available.

To investigate the impact of excluding cases with alternative diagnoses on the sensitivity and specificity of the Centers for Disease Control and Prevention's (CDC) influenza-like illness (ILI) case definition in detecting the 2009 H1N1 influenza, using Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification, a disease surveillance system. Retrospective cross-sectional study design. Emergency department of an urban tertiary care academic medical center. 1,233 ED cases, which were tested for respiratory viruses from September 5, 2009 to May 5, 2010. The main outcome measures were positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of the ILI case definition (both including and excluding alternative diagnoses) to detect H1N1. There was a significant decrease in sensitivity (chi2 = 9.09, p < 0.001) and significant improvement in specificity (chi2 = 179, p < 0.001), after excluding cases with alternative diagnoses. When early detection of an influenza epidemic is of prime importance, pursuing alternative diagnoses as part of CDC's ILI case definition may not be warranted for public health reporting due to the significant decrease in sensitivity, in addition to the resources required for detecting these alternative diagnoses.

On January 12, 2010, a 7.0 magnitude Richter earthquake devastated Haiti, leading to the world's largest humanitarian effort in 60 years. The catastrophe led to massive destruction of homes and buildings, the loss of more than 200,000 lives, and overwhelmed the host nation response and its public health infrastructure. Among the many responders, the United States Government acted immediately by sending assistance to Haiti including a naval hospital ship as a tertiary care medical center, the USNS COMFORT. To adequately respond to the acute needs of patients, healthcare professionals on the USNS COMFORT relied on Haitian Creole-speaking volunteers who were recruited by the American Red Cross (ARC). These volunteers complemented full-time Creole-speaking military staff on board. The ARC provided 78 volunteers who were each able to serve up to 4 weeks on board. Volunteers' demographics, such as age and gender, as well as linguistic skills, work background, and prior humanitarian assistance experience varied. Volunteer efforts were critical in assisting with informed consent for surgery, family reunification processes, explanation of diagnosis and treatment, comfort to patients and families in various stages of grieving and death, and helping healthcare professionals to understand the cultural context and sensitivities unique to Haiti. This article explores key lessons learned in the use of volunteer interpreters in earthquake disaster relief in Haiti and highlights the approaches that optimize volunteer services in such a setting, and which may be applicable in similar future events.

To describe factors associated with inpatient mortality in a field hospital established following the 2010 Haiti earthquake. Data were abstracted from medical records of patients admitted to the University of Miami Global Institute/Project Medishare hospital. Decedents were compared to survivors in terms of age, sex, length of stay, admission ward, diagnosis, and where relevant, injury mechanism and surgical procedure. Three multivariate logistic regression models were constructed to determine predictors of death among all patients, injured patients, and noninjured patients. During the study period, 1,339 patients were admitted to the hospital with 100 inpatient deaths (7.5 percent). The highest proportion of deaths occurred among patients aged < or = 15 years. Among all patients, adult intensive care unit (ICU) admission (adjusted odds ratio [AOR] = 7.6 and 95% confidence interval [CI] = 3.4-16.8), neonatal ICU/pediatric ICU (NICU/PICU) admission (AOR = 7.8 and 95% CI = 2.7-22.9), and cardiac/respiratory diagnoses (AOR = 8.5 and 95% CI = 4.9-14.8) were significantly associated with death. Among injured patients, adult ICU admission (AOR = 7.4 and 95% CI = 1.7-33.3) and penetrating injury (AOR = 3.3 and 95% CI = 1.004-11.1) were significantly associated with death. Among noninjured patients, adult ICU admission (AOR = 6.6 and 95% CI = 2.7-16.4), NICU/PICU admission (AOR = 8.2 and 95% CI = 2.1-31.8), and cardiac/ respiratory diagnoses (AOR = 6.5 and 95% CI = 3.6-12.0) were significantly associated with death. Following earthquakes in resource-limited settings, survivors may require care in field hospitals for injuries or exacerbation of chronic medical conditions. Planning for sustained post-earthquake response should address these needs and include pediatric-specific preparation and long-term critical care requirements.

Recent evidence demonstrates that emergency department (ED) and inpatient hospital crowding contributes to unsafe patient care. The blizzards of 2010 produced conditions that prohibited the safe discharge of admitted inpatients and were identified as a major factor in crowding of the ED at Howard County General Hospital (HCGH). At one point, admitted patients occupied 35 of the 36 treatment beds in the ED. A novel intervention was conceived and created that used the resources of Howard County Fire and Rescue (HCFR) to transport discharged patients from the inpatient floors to their home, thereby decreasing ED boarding and crowding. Throughout the 12-hour operation, HCFR personnel transported 13 patients from hospital inpatient floors to their home, and two ED interfacility transports were performed. In addition, HCFR units conducted one rescue and successful resuscitation of a patient with a sudden cardiac arrest during a 911 emergency call. During this call, HCFR and HCGH also coordinated the emergency transport of an interventional cardiologist through the blizzard to HCGH to perform emergency cardiac catheterization. At the end of the operational period, the ED had regained all but four beds pending inpatient admission. These efforts fortified a strong partnership between a community hospital and local fire department to facilitate the expeditious discharge and disposition of inpatients during the blizzards of 2010 to decrease crowding.

Background: In disasters, hospitals play a crucial role in supplying essential medical care to the society but there is no standardized checklist for assessing hospital disaster preparedness. Objectives: The objective of this study was to recognize and compare almost all the components of disaster preparedness between teaching and private hospitals in Shiraz, Iran, focusing on incident command systems (ICS), communications, surge capacity, human resources, supply management, logistic service, case management, surveillance, laboratory and operating room management. Methods: From May to August 2011, we assessed the preparedness of teaching and private hospitals in Shiraz, using the 10-key component World Health Organization checklist. Results: Twenty four out of 31 hospitals responded. The scores for preparedness of ICS, communication, surge capacity and human resources was 73.9 percent, 67.3 percent, 49 percent, and 52.6 percent respectively. The preparedness scores for supply management and logistic services were 68.5 percent and 61.8 percent. While the levels of preparedness of laboratory and operating room management were low, preparedness of the surveillance system and case management were 66.7 percent and 70.8 percent, respectively. The average total preparedness of all hospitals was 59.5 percent, with scores of 62.2 percent in teaching hospitals and 55 percent in private hospitals. Conclusion: At the time of our study, the total preparedness among hospitals was at the intermediate level, but in some key components such as operating room management, surge capacity, and human resources, the total preparedness was very limited and at an early stage of development, therefore, requiring urgent attention and improvement.

The purpose of this article was to collect, examine, and report the data obtained in response to opening a 24/7 Call Center in response to the H1N1 influenza outbreak in the State of New Jersey in the Spring of 2009. Data log sheets were collected and analyzed based on phone calls received into the State of New Jersey H1N1 Call Center during the initial response to the H1N1 public health emergency from April to May 2009. Data were stratified to examine the types of calls received, where they originated, and the types of organizations/agencies that needed guidance/information during the initial response to the H1N1 public health emergency. Additionally, lessons learned from this operational response were documented. 3,855 calls were received and analyzed during the first 8 days of commencing the H1N1 Call Center. Signs and symptoms were the main category of questions asked, representing 31.2 percent of the call volume. Of the 3,855 calls, 216 (5.6 percent) were from agencies, such as healthcare institutions. Multiple lessons learned were documented from a planning and operations perspective. Communication to the general public is paramount to ensure accurate information is being conveyed during a public health response. The lessons learned from this operation are currently being utilized in response to the H1N1 influenza outbreak during the Fall of 2009.