American Journal of Disaster Medicine

Australasian Journal of Disaster and Trauma Studies

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science at www.liebertonline.com/loi/bsp/

Disaster Medicine and Public Health Preparedness (from American Medical Association)

Disasters: The Journal of Disaster Studies, Policy and Management

Emergency Medicine Clinics of North America

Also see

the Bioterrorism Issue Volume 20, Issue 2, Pages 255-536

International Journal of Disaster Medicine

Journal of Prehospital And Disaster Medicine (The Official Medical Journal of the World Association for Disaster and Emergency Medicine)

Medicine, Conflict & Survival

The Internet Journal of Rescue and Disaster Medicine

Journal Articles (abstracts where available)

Arnold, JL. Disaster Medicine in the 21st Century: Future Hazards, Vulnerabilities, and Risk. Prehosp Disast Med 2002;17(1):3–11.

Abstract:The prediction of future disasters drives the priorities, urgencies, and perceived adequacies of disaster management, public policy, and government funding. Disasters always arise from some fundamental disequilibrium between hazards in the environment and the vulnerabilities of human communities. Understanding the major factors that will tend to produce hazards and vulnerabilities in the future plays a key role in disaster risk assessment. The factors tending to produce hazards in the 21st Century include population growth, environmental degradation, infectious agents (including biological warfare agents), hazardous materials (industrial chemicals, chemical warfare agents, nuclear materials, and hazardous waste), economic imbalance (usually within countries), and cultural tribalism. The factors tending to generate vulnerabilities to hazardous events include population growth, aging populations, poverty, maldistribution of populations to disaster-prone areas, urbanization, marginalization of populations to informal settlements within urban areas, and structural vulnerability. An increasing global interconnectedness also will bring hazards and vulnerabilities together in unique ways to produce familiar disasters in unfamiliar forms and unfamiliar disasters in forms not yet imagined. Despite concerns about novel disasters, many of the disasters common today also will be common tomorrow. The risk of any given disaster is modifiable through its manageability. Effective disaster management has the potential to counter many of the factors tending to produce future hazards and vulnerabilities. Hazard mitigation and vulnerability reduction based on a clear understanding of the complex causal chains that comprise disasters will be critical in the complex world of the 21st Century.Auf der Heide, E. DISASTER PLANNING, PART II: Disaster Problems, Issues, and Challenges Identified in the Research Literature. Emergency Medicine Clinics of North America, Volume 14, Issue 2, Pages 453-480
Borio L, Inglesby T, Peters CJ, Schmaljohn AL, Hughes JM, Jahrling PB, Ksiazek T, Johnson KM, Meyerhoff A, O'Toole T, Ascher MS, Bartlett J, Breman JG, Eitzen EM Jr, Hamburg M, Hauer J, Henderson DA, Johnson RT, Kwik G, Layton M, Lillibridge S, Nabel GJ, Osterholm MT, Perl TM, Russell P, Tonat K; Working Group on Civilian Biodefense. Hemorrhagic fever viruses as biological weapons: medical and public health management. JAMA. 2002 May 8;287(18):2391-405.

Brandenburg MA, Arneson WL. Pediatric disaster response in developed countries: ten guiding principles. Am J Disaster Med. 2007 May-Jun;2(3):151-62.

Abstract: Mass casualty incidents and large-scale disasters involving children are likely to overwhelm a regional disaster response system. Children have unique vulnerabilities that require special considerations when developing pediatric response systems. Although medical and trauma strategies exist for the evaluation and treatment of children on a daily basis, the application of these strategies under conditions of resource-constrained triage and treatment have rarely been evaluated. A recent report, however, by the Institute of Medicine did conclude that on a day-to-day basis the U.S. healthcare system does not adequately provide emergency medical services for children. The variability, scale, and uncertainty of disasters call for a set of guiding principles rather than rigid protocols when developing pediatric response plans. The authors propose the following guiding principles in addressing the well-recognized, unique vulnerabilities of children: (1) terrorism prevention and preparedness, (2) all-hazards preparedness, (3) postdisaster disease and injury prevention, (4) nutrition and hydration, (5) equipment and supplies, (6) pharmacology, (7) mental health, (8) identification and reunification of displaced children, (9) day care and school, and (10) perinatology. It is hoped that the 10 guiding principles discussed in this article will serve as a basic framework for developing pediatric response plans and teams in developed countries.
Challen K, Bentley A, Bright J, Walter D. Clinical review: mass casualty triage--pandemic influenza and critical care. Crit Care. 2007;11(2):212. http://ccforum.com/content/11/2/212
Christian MD, Hawryluck L, Wax RS, Cook T, Lazar NM, Herridge MS, Muller MP, Gowans DR, Fortier W, Burkle FM. Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006 Nov 21;175(11):1393. http://www.cmaj.ca/cgi/content/abstract/175/11/1377
Dalsey, W. Community Medical Disaster Planning and Evaluation Guide. Annals of Emergency Medicine. Volume 28, Issue 6, Pages 737-738

Dara, Saqib I; Ashton, Rendell W; Farmer, J Christopher; Carlton, Paul K. Worldwide disaster medical response: An historical perspective. Critical Care Medicine. 33(1) Supplement:S2-S6, January 2005.

Abstract: Objective: Disaster medicine and disaster medical response is a complex and evolving field that has existed for millennia. The objective of this article is to provide a brief review of significant milestones in the history of disaster medicine with emphasis on applicability to present and future structures for disaster medical response. Results: Disaster medical response is an historically necessary function in any society. These range from response to natural disasters, to the ravages of warfare, and most recently, to medical response after terrorist acts. Our current disaster response systems are largely predicated on military models derived over the last 200 yrs. Their hallmark is a structured and graded response system based on numbers of casualties. In general, all of these assume that there is an identifiable "ground zero" and then proceed with echelons of casualty retrieval and care that proceeds rearward to a hospital(s). In a civil response setting, most civilian models of disaster medical response similarly follow this military model. This historical approach may not be applicable to some threats such as bioterrorism. A "new" model of disaster medical response for this type of threat is still evolving. Using history to guide our future education and planning efforts is discussed. Conclusion: We can learn much from an historical perspective that is still applicable to many current disaster medical threats. However, a new response model may be needed to address the threats of bioterrorism.
De Ville de Goyet, C. (2007). Epidemics after natural disasters: A highly contagious myth. Natural Hazards Observer, XXXI(3), 15/11/2007.
De Ville de Goyet, C. (2000). Stop propagating disaster myths. The Lancet, 356(9231), 762.
Einav S, Feigenberg Z, Weissman C, Zaichik D, Caspi G, Kotler D, Freund HR. Evacuation priorities in mass casualty terror-related events: implications for contingency planning. Ann Surg. 2004 Mar;239(3):304-10. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15075645

Freyberg CW, Arquilla B, Fertel BS, Tunik MG, Cooper A, Heon D, Kohlhoff SA, Uraneck KI, Foltin GL. Disaster preparedness: hospital decontamination and the pediatric patient--guidelines for hospitals and emergency planners. Prehosp Disaster Med. 2008 Mar-Apr;23(2):166-73.

Abstract: In recent years, attention has been given to disaster preparedness for first responders and first receivers (hospitals). One such focus involves the decontamination of individuals who have fallen victim to a chemical agent from an attack or an accident involving hazardous materials. Children often are overlooked in disaster planning. Children are vulnerable and have specific medical and psychological requirements. There is a need to develop specific protocols to address pediatric patients who require decontamination at the entrance of hospital emergency departments. Currently, there are no published resources that meet this need. An expert panel convened by the New York City Department of Health and Mental Hygiene developed policies and procedures for the decontamination of pediatric patients. The panel was comprised of experts from a variety of medical and psychosocial areas. Using an iterative process, the panel created guidelines that were approved by the stakeholders and are presented in this paper. These guidelines must be utilized, studied, and modified to increase the likelihood that they will work during an emergency situation.

Goddard NL, Delpech VC, Watson JM, Regan M, Nicoll A. Lessons learned from SARS: the experience of the Health Protection Agency, England. Public Health. 2006 Jan;120(1):27-32. Epub 2005 Nov 16.

Abstract: The United Kingdom was assessed as a low risk country throughout the 2003 global SARS outbreaks. Despite this, 368 reports of potential SARS cases were made to the Health Protection Agency (HPA) between March and July 2003. The public health actions undertaken in response to these reports, the establishment of reporting mechanisms and the development of guidance documents were substantial. Lessons learned from mounting a UK response to SARS included: the importance of international collaboration; formation of a UK-wide, multidisciplinary Task Force; flexible case reporting mechanisms; integration of surveillance and laboratory data; generation of prompt and web-accessible guidance and advice; availability of surge capacity; and contingency planning. Lessons learned are being incorporated into the HPA's preparedness to prevent and control future newly emerging infectious disease threats.
Han SZ, Alfano MC, Psoter WJ, Rekow ED. Bioterrorism and catastrophe response: a quick-reference guide to resources. J Am Dent Assoc. 2003 Jun;134(6):745-52. http://jada.ada.org/cgi/content/full/134/6/745

Iserson KV, Heine CE, Larkin GL, Moskop JC, Baruch J, Aswegan AL.Fight or flight: the ethics of emergency physician disaster response. Ann Emerg Med. 2008 Apr;51(4):345-53.

Abstract: Most disaster plans depend on using emergency physicians, nurses, emergency department support staff, and out-of-hospital personnel to maintain the health care system's front line during crises that involve personal risk to themselves or their families. Planners automatically assume that emergency health care workers will respond. However, we need to ask: Should they, and will they, work rather than flee? The answer involves basic moral and personal issues. This article identifies and examines the factors that influence health care workers' decisions in these situations. After reviewing physicians' response to past disasters and epidemics, we evaluate how much danger they actually faced. Next, we examine guidelines from medical professional organizations about physicians' duty to provide care despite personal risks, although we acknowledge that individuals will interpret and apply professional expectations and norms according to their own situation and values. The article goes on to articulate moral arguments for a duty to treat during disasters and social crises, as well as moral reasons that may limit or override such a duty. How fear influences behavior is examined, as are the institutional and social measures that can be taken to control fear and to encourage health professionals to provide treatment in crisis situations. Finally, the article emphasizes the importance of effective risk communication in enabling health care professionals and the public to make informed and defensible decisions during disasters. We conclude that the decision to stay or leave will ultimately depend on individuals' risk assessment and their value systems. Preparations for the next pandemic or disaster should include policies that encourage emergency physicians, who are inevitably among those at highest risk, to "stay and fight."
Kelen G, Sauer LM. Trend analysis of disaster health articles in peer-reviewed publications pre- and post-9/11. Am J Disaster Med. 2008 Nov-Dec;3(6):369-76.

Kirkis, E. J. (2006). A myth too tough to die: The dead of disasters cause epidemics of disease. Am J Infect Control;34:331-4.
Levitin, HW. Hazardous materials. Disaster medical planning and response. Emerg Med Clin North Am - 01-MAY-1996; 14(2): 327-48

Abstract: Hazardous materials offer a variety of unique challenges to emergency personnel. These agents have immense economic impact, but when mishandled, they become notorious for turning contained accidents into disasters involving the entire community. During a hazmat accident, the victims often ignore the rules of the disaster plan by seeking out the nearest hospital for medical care, regardless of that institution's capabilities. Health care workers rushing to the aid of contaminated individuals, without taking appropriate precautions (i.e., donning PPE), potentially make themselves victims. Disaster preparedness requires planning, policy, and procedure development, hazard analysis, training, and the availability of personal protective equipment for all responding personnel. Presently, the level of hazmat preparedness varies greatly among different hospitals, EMS and fire services, and disaster response teams. These differences in hazmat preparedness can be linked to a variety of factors (lack of awareness, funding, and support) and controversies (types of PPE and level of training required) which have prevented the establishment of a national hazmat policy for most of these organizations. Despite these difficulties, emergency departments continue to be the primary provider of care to contaminated individuals. As a result, emergency physicians must work with their hospital to implement a hazmat decontamination program in order to appropriately care for these individuals. The appendix to this article presents a list of recommendations for hospital hazmat preparedness. It is modeled after existing CDC and OSHA guidelines.
McMillan R. The South Asian earthquake: an emergency physician's perspective. CJEM. 2006 May;8(3):174-6 http://caep.ca/template.asp?id=167825AF3810406EABF3BAF5DF8ED21E

Morgan O, de Ville de Goyet C. Dispelling disaster myths about dead bodies and disease: the role of scientific evidence and the media. Rev Panam Salud Publica. 2005 Jul;18(1):33-6.

Abstract: For decades, after nearly every natural disaster, fear of disease has encouraged communities, local authorities, and governments to rapidly dispose of the bodies of the victims without first identifying them. In May 2004 this journal published the first-ever review article to comprehensively assess the scientific evidence on the infectious disease risks of dead bodies following natural disasters, along with an editorial commenting on the persistence of myths concerning the dangers allegedly posed by dead bodies. This paper assesses the impact that the review article and the editorial have had on the way that health risks from dead bodies have been reported by the media over the following year, especially focusing on the South Asian tsunami disaster of December 2004. While some media outlets have reported erroneous information, hundreds of other news stories have accurately reported that dead bodies pose no public health risk, and have explained the priority for properly identifying the deceased. Nevertheless, publication of scientific evidence alone is insufficient to bring about public health action. International agencies need to continue their work on producing standards, guidelines, and practical guidance on managing dead bodies. There needs to be a community-centered approach to informing communities about the management of the dead following disasters and the rights of individuals to be treated respectfully after death. Nongovernmental organizations should be encouraged to provide expertise and technical support in identifying and burying large numbers of dead. There also needs to be ongoing assessment of the technical processes involved in the recovery, identification, and disposal of dead bodies, as well as the effectiveness of disaster preparedness plans and communication with the affected population.
Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a systematic review. Psychol Med. 2008 Apr;38(4):467-80.
Oshitani H, Kamigaki T, Suzuki A. Major issues and challenges of influenza pandemic preparedness in developing countries. Emerg Infect Dis. 2008 Jun;14(6):875-80. http://www.cdc.gov/eid/content/14/6/875.htm

Perera C, Briggs C. Guidelines for the effective conduct of mass burials following mass disasters: post-Asian tsunami disaster experience in retrospect.Forensic Sci Med Pathol. 2008;4(1):1-8.

Abstract: The frequency of mass disasters is increasing, demanding actions that deal with these promptly and effectively to secure human interests. An undeniable and inevitable reality of any mass disaster is the massive number of fatalities, which will give rise to a further chain of events ranging from the recovery of the deceased, to their transport, storage, identification and, finally, disposal. Past experience has shown that traditional human disposal methods should be redesigned according to the requisites of mass fatality scenarios, and it has been proven that a proper mass burial is by far the most appropriate and standard method for disposal of the dead due to mass disasters as it takes all its practical issues into consideration. A mass burial can be defined as burying more than one deceased of a single or related incident in a single grave or multiple graves simultaneously or separately within a restricted time period in a single or multiple burial sites located within an identified geographical area. In the present context, it is an utmost necessity that we develop uniform detailed guidelines for the proper conduct of mass burials that provide the deceased with all due respect to human dignity, as this will enable these guidelines to be incorporated into future national mass disaster management schemes as an integral component.
Rosenberg DB. Unmasking procedures following a chemical attack: a critical review with recommendations. Mil Med. 2005 Jul;170(7):599-601.
Talmor D, Jones AE, Rubinson L, Howell MD, Shapiro NI. Simple triage scoring system predicting death and the need for critical care resources for use during epidemics. Crit Care Med. 2007 May;35(5):1251-6.
Tice AD, Kishimoto M, Dinh CH, Lam GT, Marineau M.Knowledge of severe acute respiratory syndrome among community physicians, nurses, and emergency medical responders. Prehosp Disaster Med. 2006 May-Jun;21(3):183-9.

Williams J, Nocera M, Casteel C. The effectiveness of disaster training for health care workers: a systematic review. Ann Emerg Med. 2008 Sep;52(3):211-22, 222.e1-2.

Abstract: STUDY OBJECTIVE: Evidence-based medical literature is lacking about the best methods to train health care providers in disaster response. We systematically review the recent literature to report whether training interventions in disaster preparedness improve knowledge and skills in disaster response. METHODS: We searched MEDLINE through PubMed, ISI Web of Science, BIOSIS, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library, ClinicalTrials.gov, the Public Affairs Information Service, and Education Full Text. Selected journals, articles, and other comprehensive reports were also reviewed for relevant citations. Subjects of eligible articles were hospital-based and out-of-hospital health care providers. Articles meeting inclusion criteria were published in English between January 2000 and December 2005, described a training exercise undertaken to further knowledge or skills in disaster response, measured a quantitative and objective outcome, and used a control group. Included studies were independently reviewed by 2 researchers, and study quality was assessed with criteria adapted from the US Preventive Services Task Force and the Centre for Reviews and Dissemination. RESULTS: We identified 258 studies. Nine studies are included in this review. Computer- and lecture-based training interventions may be effective in increasing disaster-related knowledge for out-of-hospital providers, though questions about study design and quality may cast doubt on the results. Evidence about effectiveness of training for inhospital providers is inconclusive. Comparison across studies is difficult because of diversity in study subjects, designs, and interventions. Results are likely biased by contamination from outside events. CONCLUSION: The available evidence is insufficient to determine whether training interventions for health care providers are effective in improving knowledge and skills in disaster response.