The Great East Japan Earthquake on 11 March 2011 caused considerable loss of life, destruction of livelihood and infrastructure. Linked to this event but not its cause, was the meltdown and radioactive contamination of the environment from Fukishima Dai-ichi power plant. This disaster, in turn, led to the enforced evacuation of populations at risk. Japanese nurses, physicians, paramedical staff and faculty from nearby universities all volunteered to staff decontamination centres for evacuees and survivors.This commentary critically reflects on the insights provided in this issue by Noto, Kitamiya, Itaki, Urushizaka & Yamabe (pp. 196-200) on the role of nurses in the Fukishima Dai-ichi disaster, extending that critique to evidence that has emerged through official and unofficial sources.Disaster planning is not a popular subject for societies in general nor is it a finite art or process. Civil authorities often work under restricted or reducing budgets and resources while serving increasing demands. Disaster planning requires multidisciplinary skills sets to be able to work across the many different departments, agencies, interest groups and budgets. Planners need to think outside the box, allocate resources and training to a level that justifies known and/or projected threats in preparing first responders with the correct tools, training and time to practise skills they may never be called upon to use.Disasters will always happen be they natural or man-made. To rely on the courage and selflessness of professionals is not enough. Training and learning from previous disasters can help in responsible planning.

This article presents governance and institutional strategies for climate-induced community relocations. In Alaska, repeated extreme weather events coupled with climate change-induced coastal erosion impact the habitability of entire communities. Community residents and government agencies concur that relocation is the only adaptation strategy that can protect lives and infrastructure. Community relocation stretches the financial and institutional capacity of existing governance institutions. Based on a comparative analysis of three Alaskan communities, Kivalina, Newtok, and Shishmaref, which have chosen to relocate, we examine the institutional constraints to relocation in the United States. We identify policy changes and components of a toolkit that can facilitate community-based adaptation when environmental events threaten people's lives and protection in place is not possible. Policy changes include amendment of the Stafford Act to include gradual geophysical processes, such as erosion, in the statutory definition of disaster and the creation of an adaptive governance framework to allow communities a continuum of responses from protection in place to community relocation. Key components of the toolkit are local leadership and integration of social and ecological well-being into adaptation planning.

Introduction The 2005 Gulf Coast hurricane season was one of the most costly and deadly in US history. Hurricane Rita stressed hospitals and led to multiple, simultaneous evacuations. This study systematically identified community factors associated with patient movement out of seven hospitals evacuated during Hurricane Rita.This study represents the second of two systematic, observational, and retrospective investigations of seven acute care hospitals that reported off-site evacuations due to Hurricane Rita. Participants from each hospital included decision makers that comprised the Incident Management Team (IMT). Investigators applied a standardized interview process designed to assess evacuation factors related to external situational awareness of community activities during facility evacuation due to hurricanes. The measured outcomes were responses to 95 questions within six sections of the survey instrument.Investigators identified two factors that significantly impacted hospital IMT decision making: (1) incident characteristics affecting a facility's internal resources and challenges; and (2) incident characteristics affecting a facility's external evacuation activities. This article summarizes the latter and reports the following critical decision making points: (1) Emergency Operations Plans (EOP) were activated an average of 85 hours (3 days, 13 hours) prior to Hurricane Rita's landfall; (2) the decision to evacuate the hospital was made an average of 30 hours (1 day, 6 hours) from activation of the EOP; and (3) the implementation of the evacuation process took an average of 22 hours. Coordination of patient evacuations was most complicated by transportation deficits (the most significant of the 11 identified problem areas) and a lack of situational awareness of community response activities. All evacuation activities and subsequent evacuation times were negatively impacted by an overall lack of understanding on the part of hospital staff and the IMT regarding how to identify and coordinate with community resources.Hospital evacuation requires coordinated processes and resources, including situational awareness that reflects the condition of the community as a result of the incident. Successful hospital evacuation decision making is influenced by community-wide situational awareness and transportation deficits. Planning with the community to create realistic EOPs that accurately reflect available resources and protocols is critical to informing hospital decision making during a crisis. Knowledge of these factors could improve decision making and evacuation practices, potentially reducing evacuation times in future hurricanes. Downey EL , Andress K , Schultz CH . External factors impacting hospital evacuations caused by Hurricane Rita: the role of situational awareness. Prehosp Disaster Med. 2013;28(3):1-8 .

Abstract

Purpose:

This article describes the roles and experiences of rehabilitation therapists involved in disaster relief work (DRW) in Haiti after the 2010 earthquake. The results of a pilot study and phenomenological study are presented. Method: A phenomenological study of rehabilitation providers' experiences in post-disaster relief care is presented along with preliminary pilot study results. The phenomenological study explored the experiences of therapists from a lived experience perspective through the roles they played in DRW.

Results:

Participants provided disaster relief through direct patient care, adaptive equipment sourcing and allocation, education and training, community outreach and logistic or administrative duties. Barriers and challenges included: (1) emotions: ups and downs; (2) challenges: working at the edge of practice; (3) education: key to success and sustainability; (4) lessons learned: social responsibility is why we go; and (5) difficulty coming home: no one understands.

Conclusions:

Therapists play a key role in disaster relief situations. Data presented should encourage organizations to include therapists from early planning to implementation of relief services. Further studies are needed to evaluate the impact of rehabilitation interventions in disaster settings. Implications for Rehabilitation Understanding the roles and experiences of therapists in disaster relief setting is important Certain barriers to providing care in post-disaster settings exist Those participating in disaster response should be well prepared and aware of that they might be asked to do.

This article describes Australia's broad disaster recovery planning and management approach, adopting a social and community recovery perspective. The role of social work in Australian disaster recovery management is discussed, and its increasing assertion and maturation of practice. Theoretical underpinnings include trauma, grief, and crisis intervention. Strengths-based, solution-focused approaches to intervention, and a sound understanding of community development principles, are essential to facilitating community recovery. Two examples (flood and bushfire) illustrate the full spectrum of planning, immediate psychosocial response, and longer term community and individual recovery. Issues such as effective multiagency practice, individual case management, and consideration of vulnerable groups are highlighted.

An emerging approach to public health emergency preparedness and response, community resilience encompasses individual preparedness as well as establishing a supportive social context in communities to withstand and recover from disasters. We examine why building community resilience has become a key component of national policy across multiple federal agencies and discuss the core principles embodied in community resilience theory-specifically, the focus on incorporating equity and social justice considerations in preparedness planning and response. We also examine the challenges of integrating community resilience with traditional public health practices and the importance of developing metrics for evaluation and strategic planning purposes. Using the example of the Los Angeles County Community Disaster Resilience Project, we discuss our experience and perspective from a large urban county to better understand how to implement a community resilience framework in public health practice. (Am J Public Health. Published online ahead of print May 16, 2013: e1-e8. doi:10.2105/AJPH.2013.301268).

Community resilience (CR) is a priority for preparedness, but few models exist. A steering council used community-partnered participatory research to support workgroups in developing CR action plans and hosted forums for input to design a pilot demonstration of implementing CR versus enhanced individual preparedness toolkits. Qualitative data describe how stakeholders viewed CR, how toolkits were developed, and demonstration design evolution. Stakeholders viewed community engagement as facilitating partnerships to implement CR programs when appropriately supported by policy and CR resources. Community engagement exercises clarified motivations and informed action plans (e.g., including vulnerable populations). Community input identified barriers (e.g., trust in government) and CR-building strategies. A CR toolkit and demonstration comparing its implementation with individual preparedness were codeveloped. Community-partnered participatory research was a useful framework to plan a CR initiative through knowledge exchange. (Am J Public Health. Published online ahead of print May 16, 2013: e1-e9. doi:10.2105/AJPH.2013.301407).

The Southern Region of the American Burn Association began to craft a regional plan to address a surge of burn-injured patients after a mass casualty event in 2004. Published in 2006, this plan has been tested through modeling, exercise, and actual events. This article focuses on the process of how the plan was created, how it was tested, and how it interfaces with other ongoing efforts on preparedness. One key to success regarding how people respond to a disaster can be traced to preexisting relationships and collaborations. These activities would include training or working together and building trust long before the crisis. Knowing who you can call and rely on when you need help, within the context of your plan, can be pivotal in successfully managing a disaster. This article describes how a coalition of burn center leaders came together. Their ongoing personal association has facilitated the development of planning activities and has kept the process dynamic. This article also includes several of the building blocks for developing a plan from creation to composition, implementation, and testing. The plan discussed here is an example of linking leadership, relationships, process, and documentation together. On the basis of these experiences, the authors believe these elements are present in other regions. The intent of this work is to share an experience and to offer it as a guide to aid others in their regional burn disaster planning efforts.

This paper examines a city and a natural disaster, specifically New Orleans, Louisiana, after Hurricane Katrina of August 2005. Recovery here is ongoing and the process of return is incomplete, with long-term dislocation to other cities in the United States, such as Houston, Texas. The question arises as to how planning and stratification influence evacuation and return/dislocation and how they result in a particular practice of adaptation. This interrelated process is conceptually integrated and termed 'schismo-urbanism' and is analysed within a multidimensional theoretical framework to evaluate aspects of urban sociology and natural disasters. Empirical research is based on a quantitative and qualitative mixed-method case study. Data were collected during two rounds of field research in New Orleans and Houston in 2007 and 2009. As a comparative sociospatial study of affected and receptor communities, it makes a novel theoretical and methodological contribution to research on urban disasters in the context of continuing and rapid social change, and is targeted at disaster researchers, planning theorists and practitioners, and urbanists.