Objective:

  Fatalities and injuries during an earthquake can be reduced by taking preemptive measures beforehand, and furniture anchoring is an important safety measure for all residents. This study sought to clarify the factors associated with furniture anchoring within the home.

Methods:

  A self-administered mail survey was completed from July to August 2010 by 3500 men and women between the ages of 20 and 69 years who were chosen at random from an official government resident registry of 2 cities in Japan.

Results:

  Of the 1729 valid responses, 37.1% reported furniture anchoring. An association with furniture anchoring was observed for having viewed earthquake intensity maps or damage predictions (odds ratio [OR] 1.92, 95% CI 1.54-2.39), expressing concern about a future earthquake (OR 2.07, 95% CI 1.36-3.15), feelings of urgency (OR 1.90, 95% CI 1.47-2.45), accuracy of the government disaster preparedness information (OR 1.68, 95% CI 1.17-2.42), knowledge of the meaning of emergency earthquake warnings (OR 1.67, 95% CI 1.12-2.48), and participation in voluntary disaster preparedness activities (OR 1.40, 95% CI 1.12-1.75).

Conclusions:

  Furniture anchoring was found to be associated with risk awareness, risk perception, disaster preparedness information provided by government to residents, knowledge of earthquakes, participation in voluntary disaster preparedness activities, nonwooden structures, and marital status. An increase in furniture anchoring is important and can be achieved through education and training in daily life.

Collapsed structures, typically as a result of earthquakes, may result in individuals entrapped by their limbs under heavy structural elements. In addition, access to living persons may be blocked by the deceased. Individuals are often critically ill by the time they are found, and rapid extrication is warranted. This and other factors may necessitate field amputation of an extremity on a living person or dismemberment of the deceased to achieve a rescue. Although case reports have described industrial, mining, and transportation accidents, few discuss this potential in collapsed structures. Also, few specifically outline the indications or the decision process and associated administrative procedures that should be addressed before conducting these procedures. This report presents a review of the literature along with a limited case series. A discussion regarding relevant decision making is provided to encourage the development of protocols. An international consensus statement on these procedures is provided.

Almost 2 million Americans rely on nursing homes for care, and many require daily or near daily contact with the health care system to remain alive and functional. In October 2007, Southern California experienced a series of wildfires that burned over 500, 000 acres and caused 14 nursing homes to evacuate more than 1200 residents. In response to this event, nursing home administrators and officials from various health care and emergency management agencies in San Diego County collaborated to form a model for nursing home emergency preparedness. This report describes the model, known as the area coordinator system, and discusses its strengths and limitations, and whether it ought to be replicated in other areas of the country.

The user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use ("dual utility") and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. The medical facilities store a sufficient cache to meet part of the surge needs but not so much that the resources expire before they would be used in the normal course of business. In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement.

In 2009, a monovalent H1N1 influenza (H1N1) vaccine was manufactured in response to the pandemic of 2009 influenza A (H1N1) virus infection that emerged earlier in the year. The overall allocation of the H1N1 vaccine to the states was the purview of the federal government; thereafter, the states were accountable for distributing and reporting the number of doses of H1N1 vaccine administered weekly. This report describes how the Wisconsin Immunization Registry (WIR) was updated and used during the H1N1 immunization campaign and its role in meeting the federal H1N1 immunization reporting requirements. Activities to enhance the registry's functionality included the creation of a rapid data entry screen for providers to facilitate the entry of data into the WIR, and enhancing the reporting capabilities of the WIR to generate H1N1-related reports at the local level. Results of these activities included an increase in the number of WIR users, higher reported numbers of seasonal influenza doses administered, and the establishment of data streams from new users. Data completeness, the ability to accurately forecast doses needed, and validating administered doses were challenges in the changing environment.

One of the most striking features of the ongoing conflict in the Democratic Republic of Congo (DRC) is the use of sexual violence. In spite of the brutality of these crimes, the experiences of women affected by sexual violence in Eastern DRC remain poorly characterized. This analysis aimed to (1) provide detailed demographics of sexual violence survivors presenting to Panzi Hospital; (2) examine how demographic factors might impact patterns of sexual violence; and (3) describe care-seeking behavior among sexual violence survivors.The demographics and care-seeking behavior of sexual violence survivors in South Kivu Province were described from a retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital (2004-2008).A total of 4311 records were reviewed. The mean age of survivors was 35 years. Most women (53%) were married, self-identified with the Bashi tribe (65%), and reported agriculture as their livelihood (74%). The mean time delay between sexual assault and seeking care was 10.4 months. Five reasons were identified to help explain the lengthy delays to seeking care: waiting for physical symptoms to develop or worsen before seeking medical attention, lack of means to access medical care, concerns that family would find out about the sexual assault, stigma surrounding sexual violence, and being abducted into sexual slavery for prolonged periods of time.Many sexual assault survivors have very delayed presentations to medical attention. Promoting timely access of medical care may best be facilitated by reducing stigma and by educating women about the benefits of early medical care, even in the absence of injuries or symptoms.

Older persons have levels of frailty and disability that place them at far greater risk of harm in disasters than younger adults, making it crucial for all agency planners, public health workers, and health care providers to be aware of age-appropriate considerations of preparedness and response. This research evaluated the knowledge and utilization intentions of participants of a geriatric emergency preparedness and response (GEPR) continuing education program that was designed to provide this training.A qualitative training evaluation was conducted using course evaluation questionnaires from GEPR workshops offered in 2009 in 7 nationwide cities through a partnership of the University of Texas Center for Biosecurity and Public Health Preparedness with the Texas Consortium Geriatric Education Center at Baylor College of Medicine, Houston.Evaluations were completed by 292 participants. Respondents were able to name specific information learned, give examples of applications of the material, and devise plans for further action. Participants believed that their ability to do their jobs had increased, and they provided insightful suggestions instructive to both trainers and to leaders of health care organizations.The results of the evaluation suggest that GEPR workshops are effective in increasing the knowledge of participants and their intentions to use it. There is both a need and a demand for this training. Developers and trainers should provide participants with sufficient time for absorbing the information, consider tailoring the training to the local context, and provide opportunity for practical application, particularly planning exercises.

Nonpharmacologic interventions such as limiting nosocomial spread have been suggested for mitigation of respiratory epidemics at health care facilities. This observational study tested the efficacy of a mass screening, isolation, and triage protocol in correctly identifying and placing in a cohort exercise subjects according to case status in the emergency departments at 3 acute care hospitals in Brooklyn, New York, during a simulated pandemic influenza outbreak.During a 1-day, full-scale exercise using 354 volunteer victims, variables assessing adherence to the mass screening protocol and infection control recommendations were evaluated using standardized forms.While all hospitals were able to apply the suggested mass screening protocol for separation based on case status, significant differences were observed in several infection control variables among participating hospitals and different hospital areas.Implementation of mass screening and other infection control interventions during a hospital full-scale exercise was feasible and resulted in measurable outcomes. Hospital drills may be an effective way of detecting and addressing variability in following infection control recommendations.

The Haitian earthquake of January 12, 2010, was a disaster essentially unprecedented in the Western Hemisphere's recorded history. The USNS Comfort departed from Baltimore, Maryland, within 72 hours of the earthquake and arrived in Port-au-Prince harbor on January 19. During the subsequent 40 days, the ship provided one of the largest relief efforts in the US Navy's history.The data analyzed included all patients evaluated and treated by the USNS Comfort between January 19 and February 27, 2010. A medical chart with a unique identifier was created for each patient on admission. A patient database was created from these records and used for this analysis.A total of 872 patients and 185 patient escorts were processed aboard the ship. Ages ranged from younger than 1 day to 89 years: 635 were adults and 237 were children. Of those admitted, 817 of the patients were admitted for longer than 24 hours; the average length of stay was 8.0 days. The need for surgery was substantial: 454 patients went to the operating room (OR) 843 times for 927 cumulative procedures. A total of 58 patients underwent amputations.Haiti was almost completely reliant on foreign medical teams for trauma care. Analysis of the data illustrates the challenges of triage and treatment in a humanitarian mass-casualty response. The remarkable coordination and cooperation among the Haitian Ministry of Health, nongovernmental humanitarian aid organizations, and the US military highlighted the responders' respective capabilities and demonstrated the importance of collaboration in future disaster response efforts.

The incidence, types, and influencing factors of injuries due to snow-ice disasters are essential for public health preparedness. This study was designed to assess such factors of injuries during the 22-day snowstorm in Ningbo, Zhejiang Province, China, in 2008.A multistage cluster probability sampling method was applied to select the study population in urban, rural, and mountainous areas. Data including sociodemographic characteristics, frequency, and types of injuries during the snowstorm between January 20 and February 10, 2008, were obtained by face-to-face interviews using a structured questionnaire and by checking the participants' medical records. Univariate and multivariate regression analyses were used to determine the factors significantly associated with the risk of injuries.A total of 3169 residents of 1416 families took part in this survey. In 581 residents, 602 injuries were identified. Incidences of frostbite, falling injury, and traffic accident-related injury were 12.78%, 5.30%, and 0.50%, respectively. Injury occurred more frequently in women than in men (odds ratio [OR], 1.42; 95% CI, 1.19-1.70). Frostbite occurred more frequently in women than in men (adjusted OR, 1.86; 95% CI, 1.43-2.41) and more frequently in urban areas than in other areas (adjusted OR, 1.65; 95% CI, 1.24-2.20). Travel by bus or car, wearing a scarf, wearing gloves, wearing a raincoat, reducing outdoor activity, and performing regular physical exercise were independent protective factors of frostbite, with an adjusted OR (95% CI) of 0.35 (0.20-0.61), 0.45 (0.33-0.62), 0.35 (0.26-0.48), 0.45 (0.33-0.61), 0.36 (0.27-0.48), and 0.18 (0.13-0.24), respectively. Falling injury occurred more often in mountainous areas than in other areas (adjusted OR, 1.74; 95% CI, 1.27-2.42). Age 45 years or older, working outside more than 15 days, and wearing a raincoat were independent risk factors of falling injury, with an adjusted OR (95% CI) of 2.30 (1.60-3.32), 1.92 (1.36-2.72), and 2.21 (1.56-3.11), respectively. Falling and traffic accident-related injuries were mainly due to slippery roads.Frostbite and falling injury were the major injuries caused by an unprecedented snow-ice disaster. Keeping warm and maintaining regular physical exercise appeared to reduce frostbite risk. Public health intervention also reduced the risk of falling and traffic accident-related injuries.