On May 22, 2011, The St Johns Mercy Medical Center in Joplin, MO, was destroyed by an F-5 tornado. There were 183 patients in the building at that time in this 367-bed Medical Center. The preparation and response were superbly done and resulted in many lives saved. This report is focused on the reconstitution phase of this disaster response, which includes how to restore business continuity. As 95 percent of our medical capacity resides in the private sector in the United States, we must have a proper plan for how to restore business continuity or face the reality of the medical business failing and not providing critical medical services to the community. A tornado in 2007 destroyed a medical center in Sumter County, GA, and it took more than 365 days to restore business continuity at a cost of $18M. The plan executed by the Mercy Medical System after the disaster in Joplin restored business continuity in 88 days and cost a total of $6.6M, with all assets being reusable. The recommendation from these lessons learned is that every county, state, and Federal Emergency Management Agency region has a plan on the shelf to restore business continuity and the means to be able to do so. The hard work that the State of Missouri and the Mercy Medical System did after this disaster can serve as a model for the nation in how to quickly recover from any loss of medical capability.

Despite anesthesiology personnel involvement in initial treatment of patients exposed to potentially lethal agents, less than 40 percent of US anesthesiology training programs conduct training to manage these patients.(1) No previous studies have evaluated performance of anesthesiologists wearing protective gear. The authors compared the performance of anesthesiologists intubating a high-fidelity mannequin while wearing either a powered air-purifying respirator (PAPR) or a negative pressure respirator (NPR).Twenty participants practiced intubations on a high-fidelity simulator until comfortable. Each subject performed 10 repetitions, initially without any gear, then while wearing a protective suit, gloves, and respirator. The order of gear use was randomized and all subjects used both devices. Time for task completion were recorded, and at the end of the trial, subjects were asked to rate their comfort with the equipment.After controlling for other variables, overall statistically slower total performance times were observed with use of the PAPR when compared to the control arm and use of the NPR (p 5 0.01 and p < 0.007, respectively). Of the total 90 intubations, only one proved to be esophageal and initially undetected.The use of an NPR or PAPR does not preclude an anesthesiologist from successfully intubating, but practice is necessary. The slightly better performance with the NPR is weighed against the improved comfort of the PAPR and the fact that PAPR users could wear eyeglasses. Neither type of gear allowed the users to auscultate the lung fields to confirm correct endotracheal tube placement.

Concerns have arisen over recent years about the absence of empirically derived evidence on which to base policy and practice in the public health system, in general, and to meet the challenge of public health emergency preparedness, in particular. Related issues include the challenge of disaster-caused, behavioral health surge, and the frequent exclusion of populations from studies that the research is meant to aid.To characterize the contributions of nonacademic collaborators to a series of projects validating a set of interventions to enhance capacity and competency of public mental health preparedness planning and response.Setting(s): Urban, suburban, and rural communities of the state of Maryland and rural communities of the state of Iowa. Participants: Study partners and participants (both of this project and the studies examined) were representatives of academic health centers (AHCs), local health departments (LHDs), and faith-based organizations (FBOs) and their communities. Procedures: A multiple-project, case study analysis was conducted, that is, four research projects implemented by the authors from 2005 through 2011 to determine the types and impact of contributions made by nonacademic collaborators to those projects. The analysis involved reviewing research records, conceptualizing contributions (and providing examples) for government, faith, and (nonacademic) institutional collaborators.Ten areas were identified where partners made valuable contributions to the study series; these "value-areas" were as follows: 1) leadership and management of the projects; 2) formulation and refinement of research topics, aims, etc; 3) recruitment and retention of participants; 4) design and enhancement of interventions; 5) delivery of interventions; 6) collection, analysis, and interpretation of data; 7) dissemination of findings; 8) ensuring sustainability of faith/government preparedness planning relationships; 9) optimizing scalability and portability of the model; and 10) facilitating translational impact of study findings.Systems-based partnerships among academic, faith, and government entities offer an especially promising infrastructure for conducting participatory public health systems research in domestic emergency preparedness and response.

Public health emergencies (disasters) are associated with mental health conditions ranging from mild to severe. When persons pose a danger to themselves or others, a brief emergency detention allows a mental health assessment to determine if a lengthier involuntary civil commitment is needed. Involuntary commitment requires participation of the civil justice system to provide constitutionally mandated due process protections. However, disasters may incapacitate the judicial system, forcing emergency detainees to be prematurely released if courts are unavailable. The authors review state laws regarding emergency detention of persons deemed a potential mental health-related danger. Although some states are well prepared for the dual impact of disasters on mental health and the court system, important gaps exist. The authors recommend that state laws anticipate the need for brief extensions of emergency detention periods without court participation. States should also include mental health considerations in their disaster preparedness plans for the court system.

Since 2004, the US Navy has provided ship-borne medical assistance during three earthquake disasters. Because Navy ship deployment for disaster relief (DR) is a recent development, formal guidelines for equipping and staffing medical operations do not yet exist. The goal of this study was to inform operational planning and resource allocation for future earthquake DR missions by 1) reporting the type and volume of patient presentations, medical staff, and surgical services and 2) providing a comparative analysis of the current medical and surgical capabilities of a hospital ship and a casualty receiving and treatment ship (CRTS).The following three earthquake DR operations were reviewed retrospectively: 1) USNS Mercy to Indonesia in 2004, 2) USNS Mercy to Indonesia in 2005, and 3) USNS Comfort/USS Bataan to Haiti in 2010. (The USS Bataan was a CRTS.) Mission records and surgical logs were analyzed. Descriptive and statistical analysis was performed. Comparative analysis of hospital ship and CRTS platforms was made based on firsthand observations.For the three missions, 986 patient encounters were documented. Of 1,204 diagnoses, 80 percent were disaster-related injuries, more than half of which were extremity trauma. Aboard hospital ships, healthcare staff provided advanced (Echelon III) care for disaster-related injuries and various nondisaster-related conditions. Aboard the CRTS, staff provided basic (Echelon II) care for disaster-related injuries.Our data indicate that musculoskeletal extremity injuries in sex- and age-diverse populations comprised the majority of clinical diagnoses. Current capabilities and surgical staffing of hospital ships and CRTS platforms influenced their respective DR operations, including the volume and types of surgical care delivered.

Prior to the devastating earthquake in Haiti, January 12, 2010, a group of Haitian physicians, leaders and members of Project Medishare for Haiti, a Non-governmental Organization, had developed plans for a Trauma Critical Care Network for Haiti.One year after the earthquake stands a 50-bed trauma critical care and rehab hospital that employs more than 165 Haitian doctors, nurses and allied healthcare professionals, and administrative and support staff in Port-Au-Prince. Hospital Bernard Mevs Project Medishare (HBMPM) has been operating with the following two primary goals: 1) to provide critical-care- and trauma-related medical and rehabilitation services and 2) to provide clinical education and training to Haitian healthcare professionals.(1)These goals have been successfully accomplished, with more than 43,000 outpatients seen, 6,500 emergency room visits, and about 2,300 surgical procedures performed. Daily patient care has been managed by Haitian medical staff as well as more than 2,400 international volunteers including physicians, nurses, and allied healthcare professionals. With the continued assistance of weekly volunteers, many programs and services have been developed; however, many challenges remain.This article highlights the development and progress of HBMPM over the last year with emphasis on developing inpatient and outpatient services, which include surgical, clinical laboratory, wound care, radiology, rehabilitation, and prosthesis/orthotics programs. Some of the challenges faced and how they were managed will be discussed as well as future plans to conduct more training and education to increase the building of medical capacity for Haiti.

The objective of this study is to gain insight into the medical needs of disaster evacuees, through a review of experiential data collected in evacuation shelters in the days and weeks following Hurricanes Katrina and Rita in 2005, to better prepare for similar events in the future. Armed with the information and insights provided herein, it is hoped that meaningful precautions and decisive actions can be taken by individuals, families, institutions, communities, and officials should the Louisiana Gulf Coast-or any other area with well-known vulnerabilities-be faced with a future emergency.Demographic and clinical data that were recorded on paper documents during triage and treatment in evacuation shelters were later transcribed into a computerized database management system, with cooperation of the Department of Health Information Management at The University of Louisiana at Lafayette. Analysis of those contemporaneously collected data was undertaken later by the Louisiana Center for Health Informatics.Evacuation shelters, Parish Health Units, and other locations including churches and community centers were the venue for ad hoc clinics in the Acadiana region of Louisiana.The evacuee-patients-3,329 of them-whose information is reflected in the subject dataset were among two geographically distinct but similarly distressed groups: 1) evacuees from Hurricane Katrina that devastated New Orleans and other locales near Louisiana and neighboring states in late August 2005 and 2) evacuees from Hurricane Rita that devastated Southwest Louisiana and neighboring areas of Texas in September 2005. Patient data were collected by physicians, nurses, and other volunteers associated with the Operation Minnesota Lifeline (OML) deployment during the weeks following the events.Volunteer clinicians from OML provided triage and treatment services and documented those services as paper medical records. As the focus of the OML "mission of mercy" was entirely on direct individually specific evaluation and care, no population-based experimental hypothesis was framed nor was the effectiveness of any specific intervention researched at the time.This study reports experiential data collected without a particular preconceived hypothesis, because no specific outcome measures had been designed in advance.Data analysis revealed much about the origins and demographics of the evacuees, their hurricane-related risks and injuries, and the loss of continuity in their prior and ongoing healthcare.The authors believe that much can be learned from studying data collected in evacuee triage clinics, and that such insights may influence personal and official preparedness for future events. In the Katrina-Rita evacuations, only paper-based data collection mechanisms were used-and those with great inconsistency-and there was no predeployed mechanism for close-to-real-time collation of evacuee data. Deployment of simple electronic health record systems might well have allowed for a better real-time understanding of the unfolding of events, upon arrival of evacuees in shelters. Information and communication technologies have advanced since 2005, but predisaster staging and training on such technologies is still lacking.

"Pediatrics in Disasters" (PEDS) is a course designed by the American Academy of Pediatrics to provide disaster preparedness and response training to pediatricians worldwide. China has managed to sustain the course and adapt its content for local needs. China has also experienced several natural disasters since the course's inception, providing an opportunity to evaluate the impact of courses that took place in Beijing and Sichuan, in 2008-2010.We used pretesting/post-testing, participant surveys, and in-depth interviews to evaluate whether the course imparted cognitive knowledge, was perceived as useful, and fostered participation in relief efforts and disaster preparedness planning.In Beijing and Sichuan, post-test scores were 16 percent higher than pretest scores. On immediate postcourse surveys, 86 percent of Beijing and Sichuan respondents rated the course as very good or excellent. On 6-month surveys, participants identified emotional impact of disasters, planning/triage, and nutrition as the three most useful course modules. Twelve of 75 (16 percent) of Beijing respondents reported direct involvement in disaster response activities following the course; eight of 12 were first-time responders. Participant interviews revealed a need for more training in providing nutritional and psychological support to disaster victims and to train a more diverse group of individuals in disaster response.PEDS imparts cognitive knowledge and is highly valued by course participants. Emotional impact of disasters, planning/triage, and nutrition modules were perceived as the most relevant modules. Future versions of the course should include additional emphasis on emotional care for disaster victims and should be extended to a broader audience.

The provision of critical care in any environment is resource intensive. However, the provision of critical care in an austere environment/mass disaster zone is particularly challenging. While providers are well trained for care in a modern intensive care unit, they may be under-prepared for resource-poor environments where there are limited or unfamiliar equipment and fewer support personnel. Based primarily on our experiences at a field hospital in Haiti, we created a short guide to critical care in a mass disaster in an austere environment. This guide will be useful to the team of physicians, nurses, respiratory care, logistics, and other support personnel who volunteer in future critical care relief efforts in limited resource settings.

Enhancing the effectiveness, efficiency, and fairness of interventions is an increasing source of concern in the field of disaster response. As a result, the expansion of the disaster relief evidence base has been identified as a pressing need. There has been a corresponding increase in discussions of ethical standards and procedures for disaster research. In general, these discussions have focused on elucidating how traditional research ethics concerns can be operationalized in disaster settings. Less attention has been given to the exploration of the ethical implications of heterogeneity within the field of disaster research. Hence, while current efforts to discuss the ethics of disaster research in low-resource settings are very encouraging, it is clear that further initiatives will be crucial to promote the ethical conduct of disaster research. In this article, we explore how the ethical review of disaster research conducted in low-resource settings should account for this diversity. More specifically, we consider how the nature of the project (what?), sociopolitical and physical environment of research sites (where?), temporal proximity to the disaster event (when?), objectives motivating the research (why?), and identity of the stakeholders involved in the research process (who?) all relate to the ethics of disaster research.