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Objective: The coronavirus disease 2019 (COVID-19) pandemic as well as other recent natural emergencies have put the spotlight on emergency planning. One important aspect is that natural disasters or emergencies often lead to indirect deaths, and studying the behavior of indirect deaths during emergencies can guide emergency planning. While many studies have suggested many indirect deaths in Puerto Rico due to Hurricane Maria; the specific causes of these deaths have not been carefully studied., Methods: In this study, we use a semiparametric model and mortality data to evaluate cause of death trends. Our model adjusts for cause of death effect potentially varying over time while also inferring on how long excess deaths occurred., Results: From September 2017 to March 2018, after adjusting for intra-annual variability and population displacement, we find evidence of significant excess deaths due to Alzheimer's/Parkinson, heart disease, sepsis, diabetes, renal failure, and pneumonia and influenza., Conclusions: In contrast, for the same time period we find no evidence of significant excess deaths due to cancer, hypertension, respiratory diseases, cerebrovascular disease, suicide, homicide, falling accidents, and traffic accidents.

Objectives: Ideally, mosquito control programs (MCPs) use surveillance to target control measures to potentially dangerous mosquito populations. In North Carolina (NC), where there is limited financial support for mosquito control, communities may suffer from mosquito-related issues post-hurricane due to lack of existing MCPs. Here, study objectives were to (1) investigate the emergency response of a subset of NC counties post-Hurricane Florence and (2) develop guidelines and policy recommendations to assist MCPs in post-hurricane mosquito control response., Methods: A survey was administered to a subset of eastern NC counties (an area previously impacted by hurricanes) with various levels of MCPs (from none to well-developed)., Results: All respondents indicated that having Federal Emergency Management Agency (FEMA) training would be helpful in developing a post-hurricane emergency response plan for mosquito control. There was concern related to a lack of knowledge of emergency control methods (eg, aerial/ground, adulticiding/larviciding) post-hurricane. MCP structure (eg, infrastructure, resources, operational plans/policies) could facilitate response activities and help ensure necessary emergency financial support from agencies such as FEMA., Conclusions: Mosquito control post-hurricane protects public health. Public health and other agencies can be networking resources for MCPs. Policy recommendations include implementation of routine FEMA assistance training workshops to improve an understanding of processes involved in assistance and reimbursement.

Objective: The aim of this study was to look at a cohort of adolescents who were already enrolled in a randomized controlled trial to see (1) how demographics were associated with hurricane impact, and (2) how hurricane impact was associated with reported asthma quality of life., Methods: One hundred fifty-one adolescents ages 11-17 and their parents enrolled in a randomized controlled trial at 2 sites in southeastern North Carolina completed questions about asthma quality of life, demographics, and the impact of Hurricane Matthew., Results: The most common effects of Hurricane Matthew were that the family's home was damaged or flooded (32.5%), the school was damaged or flooded (31.8%), and the home had mold or mildew as a result of flooding or damage (25.8%). Problems with access to care were more common for families whose adolescent was non-White ( P = 0.04), on Medicaid ( P = 0.05), or if the family spoke Spanish at home ( P < 0.001). Being affected by the hurricane was negatively associated with asthma quality of life., Conclusions: Hurricane Matthew had significant impact on the health of adolescents with asthma in the affected region, especially in the most vulnerable populations. Providers should ensure that families of adolescents with asthma have a hurricane plan to mitigate impact on their children's health.

Trends in 2-1-1 calls reflect evolving community needs during public health emergencies (PHEs). The study examined how changes in 2-1-1 call volume after 2 PHEs (Hurricane Irma and the coronavirus disease 2019 [COVID-19] pandemic declaration) in Broward County, Florida, varied by PHE type and whether variations differed by gender and over time. Examining 2-1-1 calls during June to December 2016, June to December 2017, and March 2019 to April 2021, this study measured changes in call volume post-PHEs using interrupted time series analysis. Hurricane Irma and the COVID-19 pandemic were associated with increases in call volume (+81 calls/d and +84 calls/d, respectively). Stratified by gender, these PHEs were associated with larger absolute increases for women (+66 and +57 calls/d vs +15 and +27 calls/d for men) but larger percent increases above their baseline for men (+143% and +174% vs +119% and +138% for women). Calls by women remained elevated longer after Hurricane Irma (5 wk vs 1 wk), but the opposite pattern was observed after the pandemic declaration (8 vs 21 wk). PHEs reduce gender differences in help-seeking around health-related social needs. Findings demonstrate the utility of 2-1-1 call data for monitoring and responding to evolving community needs in the PHE context.

Objectives: The objective of this study was to assess recovery of Aransas County, Texas households 2 years after Category 4 Hurricane Harvey made landfall., Methods: A 2-stage cluster sampling method used to conduct a Community Assessment for Public Health Emergency Response (CASPER) on May 3 - 4 and May 18 - 19, 2019. A household-based survey was administered through face-to-face interviews, selected through systematic random sampling using weighted analysis of the county population. Field teams collected 175 surveys (83.3% completion rate)., Results: Approximately 57% households experienced repairable damage, 23% had destroyed homes, and 19% had minimal damage. 38% stated having 'no need,' 18% needed financial assistance, 16% needed household repairs, and over 8% had behavioral health needs. 17% experiencing a behavioral health concern were seeking services. Of the 35% of households who did not seek services, 14% felt there was no need, and 4% were not aware of the resources available., Conclusions: Households reported high levels of preparedness, but gaps remain in evacuation intention and behavioral health care access. CASPERs are effective in assessing long-term recovery of communities impacted by major disasters.

The impact of hurricane-related flooding on infectious diseases in the US is not well understood. Using geocoded electronic health records for 62,762 veterans living in North Carolina counties impacted by Hurricane Matthew coupled with flood maps, we explore the impact of hurricane and flood exposure on infectious outcomes in outpatient settings and emergency departments as well as antimicrobial prescribing. Declines in outpatient visits and antimicrobial prescribing are observed in weeks 0-2 following the hurricane as compared with the baseline period and the year prior, while increases in antimicrobial prescribing are observed 3+ weeks following the hurricane. Taken together, hurricane and flood exposure appear to have had minor impacts on infectious outcomes in North Carolina veterans, not resulting in large increases in infections or antimicrobial prescribing.

Objectives: Hurricane Sandy made landfall across New York City (NYC) in October 2012, but the long-term consequences of the storm are still not fully understood. We analyzed NYC data to quantify the extent of Hurricane Sandy-related concerns over time., Methods: Data on NYC 311 Call Center inquiries were downloaded from the NYC Open Data website (October 29, 2012 to May 26, 2020) to provide information about Sandy-related calls using the keywords "Hurricane" and "Sandy"., Results: In the first 2 wk after Hurricane Sandy, 15.6% of 311 calls were related to the storm. From 2012 to 2020, the volume of inquiries decreased from 87,209 to 25. The majority of calls in 2012 (49,181; 56%) was requesting general Hurricane Sandy information, and in 2020 assistance with property restoration (20; 79%)., Conclusions: The long-term consequences of Hurricane Sandy in NYC persist into 2020, almost 8 y after the initial event. The needs of Hurricane Sandy victims have changed over time from requiring general information regarding closures, property destruction and immediate disaster relief to aid with legal, financial, and mental health consequences. Disaster response policy-makers must understand the changing needs of NYC residents to provide resources and prepare for future disasters.

Objective: In times of repeated disaster events, including natural disasters and pandemics, public health workers must recover rapidly to respond to subsequent events. Understanding predictors of time to recovery and developing predictive models of time to recovery can aid planning and management., Methods: We examined 681 public health workers (21-72 y, M(standard deviation [SD]) = 48.25(10.15); 79% female) 1 mo before (T1) and 9 mo after (T2) the 2005 hurricane season. Demographics, trauma history, social support, time to recover from previous hurricane season, and predisaster work productivity were assessed at T1. T2 assessed previous disaster work, initial emotional response, and personal hurricane injury/damage. The primary outcome was time to recover from the most recent hurricane event., Results: Multivariate analyses found that less support (T1; odds ratio [OR] = .74[95% confidence interval [CI] = .60-.92]), longer previous recovery time (T1; OR = 5.22[95%CI = 3.01-9.08]), lower predisaster work productivity (T1; OR = 1.98[95%CI = 1.08-3.61]), disaster-related personal injury/damage (T2; OR = 3.08[95%CI = 1.70-5.58]), and initial emotional response (T2; OR = 1.71[95%CI = 1.34-2.19]) were associated with longer recovery time (T2)., Conclusions: Recovery time was adversely affected in disaster responders with a history of longer recovery time, personal injury/damage, lower work productivity following prior hurricanes, and initial emotional response, whereas responders with social support had shorter recovery time. Predictors of recovery time should be a focus for disaster preparedness planners.

Objective: Hurricane evacuation is one of the strategies employed by emergency management and other agencies to reduce morbidity and mortality associated with hurricanes. However, factors associated with residents' evacuation decision-making have been inconsistent. In this study, we conducted a statistical meta-analysis to identify factors associated with hurricane evacuation as well as moderators of the evacuation decision., Methods: A systematic literature search identified 36 studies published between 1999 and 2018. Pooled estimates were calculated using random-effects models, and heterogeneity across studies was checked using both Q and I 2 statistics. Meta-regression methods were used to identify moderators. Publication bias was assessed using both visual (funnel plots) and statistical methods., Results: Mobile home residence, perception of risk, female sex, and Hispanic ethnicity were statistically associated with hurricane evacuation, while geographic region modified the relationship between Hispanic race and evacuation., Conclusions: Agencies responsible for preparedness may utilize these findings to identify specific population sub-groups for hurricane evacuation communication and other interventions. Future studies should consider statistical interactions and explore opportunities for research translation to emergency officials.

Objective: Community characteristics, such as collective efficacy, a measure of community strength, can affect behavioral responses following disasters. We measured collective efficacy 1 month before multiple hurricanes in 2005, and assessed its association to preparedness 9 months following the hurricane season., Methods: Participants were 631 Florida Department of Health workers who responded to multiple hurricanes in 2004 and 2005. They completed questionnaires that were distributed electronically approximately 1 month before (6.2005-T1) and 9 months after (6.2006-T2) several storms over the 2005 hurricane season. Collective efficacy, preparedness behaviors, and socio-demographics were assessed at T1, and preparedness behaviors and hurricane-related characteristics (injury, community-related damage) were assessed at T2. Participant ages ranged from 21-72 ( M ( SD ) = 48.50 (10.15)), and the majority were female (78%)., Results: In linear regression models, univariate analyses indicated that being older ( B = 0.01, SE = 0.003, P < 0.001), White ( B = 0.22, SE = 0.08, P < 0.01), and married ( B = 0.05, SE = 0.02, p < 0.001) was associated with preparedness following the 2005 hurricanes. Multivariate analyses, adjusting for socio-demographics, preparedness (T1), and hurricane-related characteristics (T2), found that higher collective efficacy (T1) was associated with preparedness after the hurricanes ( B = 0.10, SE = 0.03, P < 0.01; and B = 0.47, SE = 0.04, P < 0.001 respectively)., Conclusion: Programs enhancing collective efficacy may be a significant part of prevention practices and promote preparedness efforts before disasters.

Objective: With the advancement of technology, disaster preparedness related to hurricane hazards can be taught through an app. This study aimed to examine the effect of using an android-based disaster preparedness app on community knowledge and intentional behavior in hurricane risk areas., Methods: A quasi-experimental study was conducted from October to November, 2020 and a total of 80 respondents were recruited using cluster sampling. The treatment group was given the intervention in the form of the disaster preparedness app for 2 weeks. Meanwhile, the control group received home visits and conventional education about hurricane disasters twice throughout the same period. We then used a Wilcoxon Signed Rank test to analyze the pre-test and post-test and a Mann-Whitney U test to compare between treatment and control groups., Results: After the implementation of the SiBen app, we found a statistically significant difference in knowledge between treatment and control groups ( P < 0.003) and intentional behavior between treatment and control groups ( P < 0.001)., Conclusion: The findings indicate that the disaster preparedness app was an effective educational program able to improve the knowledge and intentional behavior among community members in a hurricane risk area.

Objective: Thea aim of this study was to explore the relationship between Florida nursing home and assisted living facility characteristics and their ability to comply with a new emergency power rule in the aftermath of Hurricane Irma., Methods: This study used characteristics data on Florida nursing homes (NHs) ( N = 680) and assisted living facilities (ALFs) ( N = 2940) in operation between September 2017 and January 2019. Logistic regressions were used to determine whether certain characteristics were associated with compliance with the emergency power rule by January 1, 2019., Results: A total of 219 (32.9%) NHs and 2219 (75.5%) ALFs had an emergency power plan implemented by January 1, 2019. Results suggest having a dementia care unit increased the odds of compliance for NHs, while chain membership, for-profit status, and a higher reliance on Medicaid decreased the odds. Additionally, smaller size, mental health specialty license, and higher reliance on supplemental state funding increased the odds of compliance for ALFs, while nursing care specialty license and for-profit status decreased the odds of compliance., Conclusions: Policy implications from these results include informing policy-makers on the barriers faced by NHs and ALFs to implement a new regulation that may cause financial difficulties and compromise quality care.

Objective: Hurricane Sandy made landfall in New Jersey on October 29, 2012, resulting in widespread power outages and gasoline shortages. These events led to potentially toxic exposures and the need for information related to poisons/toxins in the environment. This report characterizes the New Jersey Poison Information and Education System (NJPIES) call patterns in the days immediately preceding, during, and after Hurricane Sandy to identify areas in need of public health education and prevention., Methods: We examined NJPIES case data from October through December 2012. Most Sandy-related calls had been coded as such by NJPIES staff. Additional Sandy-related cases were identified by performing a case narrative review. Descriptive analyses were performed for timing, case frequencies, exposure substances, gender, caller site, type of information requests, and other data., Results: The most frequent Sandy-related exposures were gasoline and carbon monoxide (CO). Gasoline exposure cases were predominantly males and CO exposure cases, females (P < 0.0001). Other leading reasons for Sandy-related calls were poison information, food poisoning/spoilage information, and water contamination., Conclusions: This analysis identified the need for enhanced public health education and intervention to improve the handling of gasoline and encourage the proper use of gasoline-powered generators and cleaning and cooking equipment, thus reducing toxic exposures.

Background: In March 2020, the Louisiana Department of Health activated the Medical Monitoring Station (MMS) in downtown New Orleans. This alternative care site is designed to decompress hospitals and nursing homes overwhelmed by the coronavirus disease 2019 (COVID-19) pandemic. Given the city's historic vulnerability to hurricanes, planning for possible tropical weather events has been a priority for MMS leadership., Methods: The planning process incorporated input from all sectors/agencies working at the facility, to ensure consistency and cohesion. The MMS Shelter-in-Place Plan (MSIPP) was created, and a comprehensive tabletop exercise was conducted., Results: Six planning topics emerged as a result of the planning process and were used to create a comprehensive plan for sheltering-in-place. These topics address hurricane preparedness for patient care, interfacility coordination, wrap-around services, medical logistics, essential staffing, and incident command during a shelter-in-place scenario., Conclusions: The MSIPP created by the MMS helped to maximize patient safety and continuity of operations during a real-world event. Select pieces of the plan were activated to meet the needs and threat level of Tropical Storm Cristobal. This experience reinforced the need for originality, scalability, and flexibility in building emergency operations plans in the midst of an unprecedented pandemic.

Objective: Emergency departments (EDs) are critical sources of care after natural disasters such as hurricanes. Understanding the impact on ED utilization by subpopulation and proximity to the hurricane's path can inform emergency preparedness planning. This study examines changes in ED utilization for residents of 344 counties after the occurrence of 7 US hurricanes between 2005 and 2016., Methods: This retrospective observational study used ED data from the Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases. ED utilization rates for weeks during and after hurricanes were compared with pre-hurricane rates, stratified by the proximity of the patient county to the hurricane path, age, and disease category., Results: The overall population rate of weekly ED visits changed little post-hurricane, but rates by disease categories and age demonstrated varying results. Utilization rates for respiratory disorders exhibited the largest post-hurricane increase, particularly 2-3 weeks following the hurricane. The change in population rates by disease categories and age tended to be larger for people residing in counties closer to the hurricane path., Conclusions: Changes in ED utilization following hurricanes depend on disease categories, age, and proximity to the hurricane path. Emergency managers could incorporate these factors into their planning processes.

Objectives: In the Philippines, morbidity control of soil-transmitted helminth (STH) infections is done through mass drug administration (MDA) of anthelmintics to school-age children (SAC). In 2013, the Philippines was devastated by the deadliest cyclone ever recorded, Typhoon Haiyan. The study aimed to understand the impact of Typhoon Haiyan on the MDA of anthelmintics to SAC in the provinces of Capiz and Iloilo in the Philippines from the perspectives of local health and education officials., Methods: The study was conducted in the municipalities of Panay and Pilar in Capiz and the municipalities of Estancia and Sara in Iloilo, areas that were devastated by Typhoon Haiyan. Qualitative, semi-structured key informant interviews were conducted with 16 total participants, which included officials of the Department of Health, Department of Education, and concerned local government units. All interviews were transcribed verbatim and coded in an open, iterative manner. Codes were reviewed to identify patterns and themes., Results: Participants described the following themes: (1) their perception that the typhoon had no effect on the MDA program or on resources necessary to complete the program; (2) the program's simple design allowed for 1-time administration to a pre-assembled population; (3) the program allowed a sense of community cohesiveness; (4) the program served as a vehicle for altruism, particularly regarding helping needy children, in this time of calamity., Conclusions: Our informants perceived that the MDA program in Region VI was not affected by Typhoon Haiyan. They attributed the resilience to the program's simple procedure, attitudes of altruism, program importance, and community cohesiveness. Despite Typhoon Haiyan's mass destruction of infrastructure and livelihood leading to incredible challenges, mobilization of the community allowed for the continuation and successful implementation of the MDA program. The experience of Region VI may serve as a model for other low- and middle-income countries prone to natural disasters.

Objective: Previous research suggests that people with asthma may experience a worsening of symptoms following hurricanes due to changes in environmental exposures, discontinuity in chronic disease management, and stress. The objective of this study was to estimate changes in asthma-related emergency department (ED) visits in North Carolina following Hurricane Irene, which made landfall in August 2011., Methods: Changes in asthma-related ED visits in September to December of 2010 and 2011 were examined using data from the Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases. A Poisson generalized linear model was used to estimate the association between Federal Emergency Management Agency disaster declarations following Hurricane Irene and county-level asthma-related ED visits controlling for month, year, and county., Results: Following Hurricane Irene, disaster declarations were made for 38 of 100 counties in North Carolina. In September 2010, the rate of asthma-related ED visits for North Carolina was 6 per 10,000 person-months. In September 2011, rates of asthma-related ED visits were similar in counties with and without disaster declarations (7 and 5 per 10,000 person-months, respectively). When adjusting for covariates, there was little or no difference in the rate of asthma ED visits before and after the hurricane between counties with and without a disaster declaration (rate ratio {RR} [95% confidence interval {CI}] = 1.02[0.97, 1.08])., Conclusions: Although risk factors for asthma exacerbations increase following hurricanes, these results found little evidence of an increase in asthma-related ED visits in North Carolina following Hurricane Irene.

Objective: The aim of this study was to describe the results of food environment assessments completed after Hurricane Florence in North Carolina (2018) and Hurricane María in Puerto Rico (2017), and provide recommendations for assessing disaster food environments., Methods: Adapted structured observation protocols were used to conduct rapid assessments of the availability, price, and quality of specific foods in retail markets., Results: In both settings, unhealthful food items (soda, chips, fruit-flavored drinks) and milk were widely available and at lower prices than domestic averages. The adapted instrument in Puerto Rico allowed for documentation of greater availability of canned items compared with fresh or frozen foods. In both settings, researchers noted the inability of the instrument to document items that are important to assess postdisaster: ready-to-heat and ready-to-eat foods; food preparation facilities and supplies; hygiene supplies; and empty shelf-space., Conclusions: The instruments, despite their limitations, were able to capture food availability issues in postdisaster environments. Future instrument adaptation is necessary to capture availability of all major food groups, healthful and unhealthful options, shelf-stable, ready-to-eat, and ready-to-heat foods versus other formats (fresh, frozen), and cooking and hygiene supplies.

Objective: This study aimed to characterize ophthalmology consultations ordered after Hurricane Harvey compared to consultations ordered during the same time period of the prior year., Methods: A retrospective chart review was performed at an urban, level 1 trauma center of a county hospital. All patients were included who received an electronic health record, documented ophthalmology consultation order between September 2017 and October 2017 (the time period immediately following Hurricane Harvey) or September 2016 and October 2016. Patient demographic risk factors were collected. Patient ICD10 clinical diagnoses were categorized as extraocular, intraocular, infectious, physiological, or other, and then subcategorized as trauma or non-trauma-related. A geographical heat map was generated to compare the changes in diagnosis volume by zip code to the magnitude of rainfall in the county., Results: Following Hurricane Harvey, ophthalmology consultation volume decreased, number of infectious ophthalmology diagnoses increased ( P < 0.001), percentage of patients on immunosuppression increased ( P < 0.001), and the number of private insurance payers increased while the number of county-funded insurance payers decreased ( P = 0.003)., Conclusions: The risk of infectious eye diagnosis was double the risk of traumatic eye diagnosis from Hurricane Harvey flooding. During public disaster planning, different ophthalmological medical resources and responses should be considered for flooding versus high-wind events.

Objectives: This article aims to: (1) describe the 'Return to Open Pharmacy Operations' in Puerto Rico following the hurricanes Irma and Maria in the 2017 hurricane season, and (2) compare the recovery rate (Return to Open Pharmacy Operations) during the 2017 hurricane season between the US Commonwealth of Puerto Rico and the state of Florida., Methods: We performed a cross-sectional study of pharmacy operations in Puerto Rico utilizing Rx Open data for pharmacies in Puerto Rico during the 2017 hurricane season. To compare open rates of pharmacy operations over time in different contexts, we also analyzed Rx Open data for the state of Florida for Hurricane Irma., Results: Only 11.1% of pharmacies remained open in Puerto Rico 3 days after Hurricane Maria made landfall, and Puerto Rico pharmacy operations recovered slowly, at an average daily rate of 3.9% before reaching pre-landfall baseline operations. Puerto Rico pharmacy operations after Hurricane Maria recovered 10 times slower on average, compared to pharmacy operations in Florida after Hurricane Irma which reached baseline operations less than 1 week following Hurricane Irma's landfall., Conclusion: Our results demonstrate the unique severity of Hurricane Maria's impacts on Puerto Rico's health system.

Rice University's Culture of Care represents a commitment to ensuring that all are treated with respect, compassion, and deep care. Rice leveraged information technology (IT) to deliver its Culture of Care, in responding to Hurricane Harvey. IT tools were used to gather key information on Rice's over 12000 community members. These data were fused with structured university data, enabling data-driven disaster response, with actionable information pushed to local managers. Our successful communication and response programs were all driven by the data analyses.

The co-occurrence of the 2020 Atlantic hurricane season and the ongoing coronavirus disease 2019 (COVID-19) pandemic creates complex dilemmas for protecting populations from these intersecting threats. Climate change is likely contributing to stronger, wetter, slower-moving, and more dangerous hurricanes. Climate-driven hazards underscore the imperative for timely warning, evacuation, and sheltering of storm-threatened populations - proven life-saving protective measures that gather evacuees together inside durable, enclosed spaces when a hurricane approaches. Meanwhile, the rapid acquisition of scientific knowledge regarding how COVID-19 spreads has guided mass anti-contagion strategies, including lockdowns, sheltering at home, physical distancing, donning personal protective equipment, conscientious handwashing, and hygiene practices. These life-saving strategies, credited with preventing millions of COVID-19 cases, separate and move people apart. Enforcement coupled with fear of contracting COVID-19 have motivated high levels of adherence to these stringent regulations. How will populations react when warned to shelter from an oncoming Atlantic hurricane while COVID-19 is actively circulating in the community? Emergency managers, health care providers, and public health preparedness professionals must create viable solutions to confront these potential scenarios: elevated rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19, and the resurgence of COVID-19 cases among hurricane evacuees who shelter together.

Objectives: The hazardous environmental conditions hurricanes create might increase injury incidence almost 7 times. Therefore, a cohort study was performed at the Puerto Rico Trauma Hospital to compare morbidity and mortality patterns of patients after Hurricane Maria with a control period., Methods: Admissions from September 20, 2017, through January 20, 2018, constituted the post-Maria period (473 patients); the corresponding months of the previous year comprised the pre-Maria period (439 patients). Comparisons were done using Pearson's chi-square or Mann-Whitney U-tests, as appropriate. A logistic regression was performed to assess the association between mortality and the study period., Results: Postlandfall admissions among patients aged 40-64 y increased by 6.6%, while among subjects between ages 18 and 39 y dropped by 7.0% ( P = 0.03). Falls, gunshots, and burns were the injury mechanisms that varied the most across the exposure period. The median Injury Severity Score (13 vs 12; P = 0.05) and the frequency of Glasgow Coma Scale scores ≤8 (17.1% vs 10.9%; P = 0.03) were higher among poststorm patients. Moreover, a 2-fold (odds ratio = 1.93; 95% CI: 1.07-3.47) increase in mortality was observed after Maria, when adjusting for covariates., Conclusions: Following a hurricane, trauma centers might expect an older population, with more severe injuries and a 2-fold increased mortality risk.

Objective: Hurricanes can interrupt communication, exacerbate attrition, and disrupt participant engagement in research. We used text messaging and disaster preparedness protocols to re-establish communication, re-engage participants, and ensure retention in a human immunodeficiency virus (HIV) self-test study., Methods: Participants were given HIV home test kits to test themselves and/or their non-monogamous sexual partners before intercourse. A daily text message-based short message service computer-assisted self-interview (SMS-CASI) tool reminded them to report 3 variables: (1) anal sex without a condom, (2) knowledge of partners' testing history, and (3) proof of partners' testing history. A disaster preparedness protocol was put in place for hurricanes in Puerto Rico. We analyzed 6315 messages from participants (N = 12) active at the time of Hurricanes Irma and Maria. Disaster preparedness narratives were assessed., Results: All participants were able to communicate sexual behavior and HIV testing via SMS-CASI within 30 days following María. Some participants (n = 5, 42%) also communicated questions. Re-engagement within 30 days after the hurricane was 100% (second week/89%, third week/100%). Participant re-engagement ranged from 0-16 days (average = 6.4 days). Retention was 100%., Conclusions: Daily SMS-CASI and disaster preparedness protocols helped participant engagement and communication after 2 hurricanes. SMS-CASI responses indicated high participant re-engagement, retention, and well-being.

On September 20, 2017, Hurricane Maria made landfall on Puerto Rico as a category 4 storm, resulting in serious widespread impact across the island, including communication and power outages, water systems impairment, and damage to life-saving infrastructure. In collaboration with the Puerto Rico Department of Health, the Public Health Branch (PHB), operating under the Department of Health and Human Services Incident Response Coordination Team, was tasked with completing assessments of health-care facilities in Puerto Rico to determine infrastructure capabilities and post-hurricane capacity. Additionally, in response to significant data entry and presentation needs, the PHB leadership worked with the Puerto Rico Planning Board to develop and test a new app-based infrastructure capacity assessment tool. Assessments of hospitals were initiated September 28, 2017, and completed November 10, 2017 (n = 64 hospitals, 97%). Assessments of health-care centers were initiated on October 7, 2017, with 186 health-care centers (87%) assessed through November 18, 2017. All hospitals had working communications; however, 9% (n = 17) of health-care centers reported no communication capabilities. For the health-care centers, 114 (61%) reported they were operational but had sustainment needs. In conclusion, health-care facility assessments indicated structural damage issues and operational capacity decreases, while health-care centers reported loss of communication capabilities post-Hurricane Maria.

Objective: Survivors of natural disasters are at risk for mental health sequela, including deficits in neurocognitive functioning. This study explores links between hurricane exposure and resulting psychiatric symptoms and deficits in cognitive processing, attention, learning, and memory., Methods: Relocated Katrina survivors and demographically matched controls completed neurocognitive tests assessing processing speed (Trail Making Test, Part A), mental flexibility (Trail Making Test, Part B), sustained attention (Conner's Continuous Performance Test), and learning and memory (Rey Auditory-Verbal Learning Test). PTSD (Clinician-Administered PTSD Scale) and depressive symptoms (BDI- II) were also measured., Results: Survivors had more PTSD and depression symptoms and weaker performance in cognitive processing, mental flexibility, and sustained attention, but not memory and learning compared to controls. When controlling for depression and PTSD symptoms (analysis of covariances), only CPT-II response time remained significantly different for survivors, so that sustained attention deficits were independent of emotional symptoms., Conclusion: Survivors had more psychiatric symptoms and neurocognitive dysfunctions than controls in most assessed measures. Our study had mixed results in identifying cognitive deficits related to psychopathology. Results suggest that disaster survivors, even those without psychopathology, should be assessed for cognitive issues that may affect their ability to process post-disaster instructions and access assistance in recovery efforts.

Objective: When 2017 Hurricane Harvey struck the coastline of Texas on August 25, 2017, it resulted in 88 fatalities and more than US $125 billion in damage to infrastructure. The floods associated with the storm created a toxic mix of chemicals, sewage and other biohazards, and over 6 million cubic meters of garbage in Houston alone. The level of biohazard exposure and injuries from trauma among persons residing in affected areas was widespread and likely contributed to increases in emergency department (ED) visits in Houston and cities receiving hurricane evacuees. We investigated medical surge resulting from these evacuations in Dallas-Fort Worth (DFW) metroplex EDs., Methods: We used data sourced from the North Texas Syndromic Surveillance Region 2/3 in ESSENCE to investigate ED visit surge following the storm in DFW hospitals because this area received evacuees from the 60 counties with disaster declarations due to the storm. We used the interrupted time series (ITS) analysis to estimate the magnitude and duration of the ED surge. ITS was applied to all ED visits in DFW and visits made by patients residing in any of the 60 counties with disaster declarations due to the storm. The DFW metropolitan statistical area included 55 hospitals. Time series analyses examined data from March 1, 2017-January 6, 2018 with focus on the storm impact period, August 14-September 15, 2017. Data from before, during, and after the storm were visualized spatially and temporally to characterize magnitude, duration, and spatial variation of medical surge attributable to Hurricane Harvey., Results: During the study period overall, ED visits in the DFW area rose immediately by about 11% (95% CI: 9%, 13%), amounting to ~16 500 excess total visits before returning to the baseline on September 21, 2017. Visits by patients identified as residing in disaster declaration counties to DFW hospitals rose immediately by 127% (95% CI: 125%, 129%), amounting to 654 excess visits by September 29, 2017, when visits returned to the baseline. A spatial analysis revealed that evacuated patients were strongly clustered (Moran's I = 0.35, P < 0.0001) among 5 of the counties with disaster declarations in the 11-day window during the storm surge., Conclusions: The observed increase in ED visits in DFW due to Hurricane Harvey and ensuing evacuation was significant. Anticipating medical surge following large-scale hurricanes is critical for community preparedness planning. Coordinated planning across stakeholders is necessary to safeguard the population and for a skillful response to medical surge needs. Plans that address hurricane response, in particular, should have contingencies for support beyond the expected disaster areas.

Objective: The aim of this study was to describe individuals seeking care for injury at a major emergency department (ED) in southern Puerto Rico in the months after Hurricane Maria on September 20, 2017., Methods: After informed consent, we used a modified version of the Natural Disaster Morbidity Surveillance Form to determine why patients were visiting the ED during October 16, 2017-March 28, 2018. We analyzed visits where injury was reported as the primary reason for visit and whether it was hurricane-related., Results: Among 5 116 patients, 573 (11%) reported injury as the primary reason for a visit. Of these, 10% were hurricane-related visits. The most common types of injuries were abrasions, lacerations, and cuts (43% of all injury visits and 50% of hurricane-related visits). The most common mechanisms of injury were falls, slips, trips (268, 47%), and being hit by/or against an object (88, 15%). Most injury visits occurred during the first 3 months after the hurricane., Conclusions: Surveillance after Hurricane Maria identified injury as the reason for a visit for about 1 in 10 patients visiting the ED, providing evidence on the patterns of injuries in the months following a hurricane. Public health and emergency providers can use this information to anticipate health care needs after a disaster.

Objective: Syndromic surveillance has been useful for routine surveillance on a variety of health outcomes and for informing situational awareness during public health emergencies. Following the landfall of Hurricane Maria in 2017, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented an enhanced syndromic surveillance system to characterize related emergency department (ED) visits., Methods: ED visits with any mention of specific key words ("Puerto," "Rico," "hurricane," "Maria") in the ED chief complaint or Puerto Rico patient home Zip Code were identified from the DOHMH syndromic surveillance system in the 8-week window leading up to and following landfall. Visit volume comparisons pre- and post-Hurricane Maria were performed using Fisher's exact test., Results: Analyses identified an overall increase in NYC ED utilization relating to Puerto Rico following Hurricane Maria landfall. In particular, there was a small but significant increase in visits involving a medication refill or essential medical equipment. Visits for other outcomes, such as mental illness, also increased, but the differences were not statistically significant., Conclusions: Gaining this situational awareness of medical service use was informative following Hurricane Maria, and, following any natural disaster, the same surveillance methods could be easily established to aid an effective emergency response.

The 2017 Atlantic hurricane season was especially memorable for 3 major hurricanes-Harvey, Irma, and Maria-that devastated population centers across Texas, Florida, and Puerto Rico, respectively. Each storm had unique hazard properties that posed distinctive challenges for persons living with type 1 diabetes (T1D). Diabetes care specialists and educators took on leadership roles for coordinating care and establishing insulin supply lifelines for people with T1D living in the hardest-hit neighborhoods affected by these extreme storms. Strategies and resources were customized for each population. Diabetes specialists strategized to provide mutual support and shared insulins and supplies across sites.

In August 2017, Hurricane Harvey struck the US Gulf Coast and caused more than US $125 billion in damages in Texas. The loss of lives and the economic damages resulted in an outpouring of support for the recovery efforts in the form of federal assistance and private donations. The latter has supported more creative approaches to recovery. Organizations that normally would not receive funding were able to obtain resources to use in novel manners. Using the framework of Dynes typology to identify groups and their respective structures and tasks, this report from the field analyzes Hurricane Harvey and the financial support mechanisms used to support recovery efforts in Texas, what organizations were funded to do, and where they fit into Dynes typology. The authors close by noting the importance of these emerging organizations and the need to support diversity in funding disaster response and recovery efforts beyond large nonprofit organizations.

Objectives: The aim of this study was to analyze pharmacy functionality, or the volume of operational pharmacies, among areas in North Carolina and South Carolina affected by Hurricane Florence., Methods: Using geographic information system software and data from the Federal Emergency Management Agency and Healthcare Ready, we computed, mapped, and analyzed pharmacy functionality measures for the period of September 12, 2018, through September 20, 2018, among counties in North Carolina and South Carolina to examine health-care-related disaster readiness for and response to Hurricane Florence., Results: In the Hurricane Florence-impacted region, counties located along the coast had the most suboptimal pharmacy functionality, whereas counties located more centrally within North Carolina and South Carolina had more optimal pharmacy functionality throughout the disaster. Generally, functionality was high at Hurricane Florence's landfall on September 14, 2018, for which operating pharmacy capacity was reported at 85% in North Carolina and 88% in South Carolina. Both states had the lowest functionality on September 16, 2018, at 71% for North Carolina and 62% for South Carolina., Conclusions: During the Hurricane Florence event, suboptimal pharmacy functionality was detected for coastal areas and during the disaster response period. Hurricane readiness plans and infrastructure strengthening should be emphasized for community pharmacies in hurricane-prone areas.

Objective: Using validated psychological assessment instruments, this study examined the psychological distress associated with potential language barriers experienced by over 135 000 Puerto Rican residents who either temporarily or permanently migrated to the continental United States with the landfall of Hurricane Maria in 2017., Methods: Participants were Puerto Rican residents (n = 107) who remained in Puerto Rico (control) or left the island for at least 3 months because of Hurricane Maria (migrants). Participants completed an online survey in their preferred language (Spanish or English), which assessed self-reported English language proficiency, Kessler Psychological Distress Scale (K6), Posttraumatic Stress Disorder Checklist for DSM 5, Patient Health Questionnaire 9-item depression scale, and the Generalized Anxiety Disorder 7-item scale. It was hypothesized that migrants with lower self-reported English proficiency would have comparatively higher indices of post-disaster distress than those with a higher proficiency., Results: Dividing the migrant group by preferred language for questionnaire completion, the Fisher's exact test showed significant differences in prevalence of severe mental distress, as defined by K6 scores above 13, between the Spanish-preferring migrants (30.4%), English-preferring migrants (0%), and controls (9.6%)., Conclusion: Our results support a possible correlation between decreased language proficiency in post-disaster migrants and a higher risk factor for severe mental distress.

The impact of hurricanes on emergency services is well-known. Recent history demonstrates the need for prehospital and emergency department coordination to serve communities during evacuation, storm duration, and cleanup. The use of telehealth applications may enhance this coordination while lessening the impact on health-care systems. These applications can address triage, stabilization, and diversion and may be provided in collaboration with state and local emergency management operations through various shelters, as well as during other emergency medical responses.

Project HOPE, a global health and humanitarian assistance organization, has responded to some of the world's largest natural disasters and humanitarian and health crises for more than 60 years. As natural disasters increase in frequency and intensity, otherwise effective health systems can become compromised, and - although less visible than traumatic injuries - populations with chronic diseases can be significantly impacted. Emergency preparedness and response efforts must adapt to address issues around continuity of care, access to pharmaceuticals, strengthening cold chain mechanisms, restoring supply chains, and educating patients with chronic illnesses on emergency preparedness. Project HOPE designs medical teams and supply donations to work alongside, rather than parallel to, existing health care infrastructure, laying the foundation for the long-term recovery of the health system.

Posttraumatic stress disorder (PTSD) is a psychological disorder, which could be caused by traumatic events. The prevalence of PTSD among survivors after a typhoon or hurricane varied widely. Therefore, this study aimed to determine a combined prevalence of PTSD among survivors after a typhoon or hurricane. A systematic search of literature was performed in the 3 English databases: PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Embase (Elsevier, Amsterdam, Netherlands). Also, a similar search was performed in the 2 Chinese databases such as Chinese National Knowledge Infrastructure and WanFang. Loney et al.'s criteria were used to evaluate the quality of the selected articles for this study. The combined prevalence of PTSD among the study population was estimated using the Freeman-Tukey double arcsine transformation method. Subgroup analyses and a meta-regression analysis were carried out to explore the origin of heterogeneity. Thirty-nine eligible articles were included in this study. They comprised 43 123 typhoon and hurricane survivors of which 9373 were diagnosed with PTSD. The combined prevalence of PTSD among this population was 17.81%. Subgroup analyses revealed that the combined prevalence of PTSD related to typhoon and hurricane Categories 5, 4, and 2 showing a corresponding decreasing tendency. About 18% of people who experienced a severe typhoon or hurricane develop PTSD with the prevalence decreasing with reduced severity of the typhoon or hurricane.

On September 1, 2019, Hurricane Dorian made landfall as a category 5 hurricane on Great Abaco Island, Bahamas. Hurricane Dorian matched the "Labor Day" hurricane of 1935 as the strongest recorded Atlantic hurricane to make landfall with maximum sustained winds of 185 miles/h.1 At the request of the Government of the Bahamas, Team Rubicon activated a World Health Organization Type 1 Mobile Emergency Medical Team and responded to Great Abaco Island. The team provided medical care and reconnaissance of medical clinics on the island and surrounding cays….

Objectives: Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico., Methods: We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period., Results: The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category., Conclusions: The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.

Objective: While the short-term effects of disasters on health care utilization are well documented, less is known regarding potential longer-term effects. This study investigates the effects of Hurricane Katrina on the health care utilization of older individuals with diabetes., Methods: We examined Medicare claims and enrollment data for the 2002-2004 and 2006-2008 time periods for older individuals with diabetes. Our quasi-experimental design analyzed utilization across 2 treated and 3 control groups. We compared the proportion of individuals who received a screen related to diabetes before and after Katrina in the treated groups to the proportions in the control groups. Our regression analysis employs individual and year fixed effects to control for factors specific to a given individual or to a given year., Results: We found that utilization rates in the 2002-2004 period exhibited roughly parallel trends for the treated and control groups, which provides support for our research design. The 2006-2008 utilization rates were generally lower for the treated groups than they were for the control groups. The differences were especially pronounced for older age cohorts., Conclusions: Our study suggests that the effects of disasters on health care utilization may persist for years after the event. Recovery efforts may be improved by addressing both short-term and long-term health care interruptions. (Disaster Med Public Health Preparedness. 2019;13:724-731).

Objective: To determine whether there were incremental mental health impacts, specifically on depression trajectories, as a result of the 2008 economic crisis (the Great Recession) and subsequent Hurricane Sandy., Method: Using latent growth mixture modeling and the ORANJ BOWL dataset, we examined prospective trajectories of depression among older adults (mean age, 60.67; SD, 6.86) who were exposed to the 2 events. We also collected community economic and criminal justice data to examine their impact upon depression trajectories. Participants (N=1172) were assessed at 3 times for affect, successful aging, and symptoms of depression. We additionally assessed posttraumatic stress disorder (PTSD) symptomology after Hurricane Sandy., Results: We identified 3 prospective trajectories of depression. The majority (83.6%) had no significant change in depression from before to after these events (resilience), while 7.2% of the sample increased in depression incrementally after each event (incremental depression). A third group (9.2%) went from high to low depression symptomology following the 2 events (depressive-improving). Only those in the incremental depression group had significant PTSD symptoms following Hurricane Sandy., Conclusion: We identified a small group of individuals for whom the experience of multiple stressful events had an incremental negative effect on mental health outcomes. These results highlight the importance of understanding the perseveration of depression symptomology from one event to another. (Disaster Med Public Health Preparedness. 2019;13:173-182).

Objectives: Two Category 5 storms, Hurricane Irma and Hurricane Maria, hit the U.S. Virgin Islands (USVI) within 13 days of each other in September 2017. These storms caused catastrophic damage across the territory, including widespread loss of power, destruction of homes, and devastation of critical infrastructure. During large scale disasters such as Hurricanes Irma and Maria, public health surveillance is an important tool to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The USVI Department of Health (DoH) partnered with shelter staff volunteers to monitor the health of the sheltered population and help guide response efforts., Methods: Shelter volunteers collect data on the American Red Cross Aggregate Morbidity Report form that tallies the number of client visits at a shelter's health services every 24 hours. Morbidity data were collected at all 5 shelters on St. Thomas and St. Croix between September and October 2017. This article describes the health surveillance data collected in response to Hurricanes Irma and Maria., Results: Following Hurricanes Irma and Maria, 1130 health-related client visits were reported, accounting for 1655 reasons for the visits (each client may have more than 1 reason for a single visit). Only 1 shelter reported data daily. Over half of visits (51.2%) were for health care management; 17.7% for acute illnesses, which include respiratory conditions, gastrointestinal symptoms, and pain; 14.6% for exacerbation of chronic disease; 9.8% for mental health; and 6.7% for injury. Shelter volunteers treated many clients within the shelters; however, reporting of the disposition (eg, referred to physician, pharmacist) was often missed (78.1%)., Conclusion: Shelter surveillance is an efficient means of quickly identifying and characterizing health issues and concerns in sheltered populations following disasters, allowing for the development of evidence-based strategies to address identified needs. When incorporated into broader surveillance strategies using multiple data sources, shelter data can enable disaster epidemiologists to paint a more comprehensive picture of community health, thereby planning and responding to health issues both within and outside of shelters. The findings from this report illustrated that managing chronic conditions presented a more notable resource demand than acute injuries and illnesses. Although there remains room for improvement because reporting was inconsistent throughout the response, the capacity of shelter staff to address the health needs of shelter residents and the ability to monitor the health needs in the sheltered population were critical resources for the USVI DoH overwhelmed by the disaster. (Disaster Med Public Health Preparedness. 2019;13:38-43).

ABSTRACTThe intensely active 2017 Atlantic basin hurricane season provided an opportunity to examine how climate drivers, including warming oceans and rising seas, exacerbated tropical cyclone hazards. The season also highlighted the unique vulnerabilities of populations residing on Small Island Developing States (SIDS) to the catastrophic potential of these storms. During 2017, 22 of the 29 Caribbean SIDS were affected by at least one named storm, and multiple SIDS experienced extreme damage. This paper aims to review the multiplicity of storm impacts on Caribbean SIDS throughout the 2017 season, to explicate the influences of climate drivers on storm formation and intensity, to explore the propensity of SIDS to sustain severe damage and prolonged disruption of essential services, to document the spectrum of public health consequences, and to delineate the daunting hurdles that challenged emergency response and recovery operations for island-based, disaster-affected populations. (Disaster Med Public Health Preparedness. 2019;13:5-17).

Objective: The Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) investigated 106 reported carbon monoxide (CO) exposures over a 9-day timeframe after Hurricane Irma. This report evaluates risk factors for CO poisoning and the importance of heightened surveillance following natural disasters., Methods: Data on CO poisoning cases from September 9 to 18, 2017 were extracted from Merlin, the Florida Department of Health Surveillance System. Medical records were obtained and follow-up interviews were conducted to collect data on the confirmed CO poisoning cases. Data were analyzed using SAS v9.4., Results: Ninety-one of the 106 people exposed to CO met the case definition for CO poisoning: 64 confirmed, 7 probable, and 20 suspect cases. Eighty-eight percent of the affected individuals were evaluated in emergency departments and 11.7% received hyperbaric oxygen treatment. The most frequently reported symptoms included headache (53.3%), dizziness (50.7%), and nausea (46.7%). Three patients expired due to their exposure to CO., Conclusions: Post Hurricane Irma, the DOH-Miami-Dade investigated numerous cases for CO exposure. By understanding who is most likely to be impacted by CO and the impact of generators' location on people's health, education efforts can be tailored to the population most at risk and further CO exposures and related mortalities following natural disasters can be reduced. (Disaster Med Public Health Preparedness. 2019;13:94-96).

ABSTRACTOn October 7, 2016, Hurricane Matthew traveled along the coasts of Florida, Georgia, and South Carolina causing flooding and power outages. The Georgia Department of Public Health (DPH) developed the Web-based Responder Safety, Tracking, and Resilience (R-STaR) system to monitor the health and safety of public health responders and to inform disaster response planning for Hurricane Matthew. Using R-STaR, responders (n = 126) were e-mailed a daily survey while deployed to document injuries or harmful exposures and a post-deployment survey on their post-deployment health and satisfaction with using R-STaR. DPH epidemiologists contacted responders reporting injuries or exposures to determine the need for medical care. Frequencies were tabulated for quantitative survey responses, and qualitative data were summarized into key themes. Five percent (6/126) of responders reported injuries, and 81% (43/53) found R-STaR easy to use. Suggestions for R-STaR improvement included improving accessibility using mobile platforms and conducting pre-event training of responders on R-STaR. Lessons learned from R-STaR development and evaluation can inform the development and improvement of responder health surveillance systems at other local and state health departments and disaster and emergency response agencies. (Disaster Med Public Health Preparedness. 2019;13:74-81).

Objective: Community characteristics, such as perceived collective efficacy, a measure of community strength, can affect mental health outcomes following disasters. We examined the association of perceived collective efficacy with posttraumatic stress disorder (PTSD) and frequent mental distress (14 or more mentally unhealthy days in the past month) following exposure to the 2004 and 2005 hurricane seasons., Methods: Participants were 1486 Florida Department of Health workers who completed anonymous questionnaires that were distributed electronically 9 months after the 2005 hurricane season. Participant ages ranged from 20 to 79 years (mean, 48; SD, 10.7), and the majority were female (79%), white (75%), and currently married (64%). Fifty percent had a BA/BS degree or higher., Results: In 2 separate logistic regression models, each adjusted for individual sociodemographics, community socioeconomic characteristics, individual injury/damage, and community storm damage, lower perceived collective efficacy was significantly associated with a greater likelihood of having PTSD (OR, 0.93; 95% CI, 0.90-0.96), and lower collective efficacy was significantly associated with frequent mental distress (OR, 0.94; 95% CI, 0.92-0.96)., Conclusions: Programs enhancing community collective efficacy may be a significant part of prevention practices and possibly lead to a reduction in the rate of PTSD and persistent distress postdisaster. (Disaster Med Public Health Preparedness. 2019;13:44-52).

Objective: Investigate short- and long-term effects of Superstorm Sandy on multiple morbidities among the elderly., Methods: We examined emergency department visits; outpatient visits; and hospital admissions for cardiovascular disease (CVD), respiratory disease, and injury among residents residing in 8 affected counties immediately, 4 months, and 12 months following Superstorm Sandy. Control groups were defined as visits/admissions during the identical time window in the 5 years before (2007-2011) and 1 year after (2013-2014) the storm in affected and nonaffected counties in New York. We performed Poisson regression to test whether there was an association of increased visits/admissions for periods following Superstorm Sandy while controlling for covariates., Results: We found that the risk for CVD, respiratory disease, and injury visits/admissions was more than twice as high immediately, 4 months, and 12 months after the storm than it was in the control periods. Women were at greater risk at all time periods for CVD (risk ratio [RR], 2.04) and respiratory disease (RRs: 1.89 to 1.92). Whites had higher risk for CVD, respiratory disease, and injury than other racial groups during each period., Conclusion: We observed increases in CVD, respiratory disease, and injury up to a year following Superstorm Sandy. Findings demonstrate the need to incorporate short- and long-term health effects into public health recovery. (Disaster Med Public Health Preparedness. 2019;13:28-32).

Objective: The aim of this study was the construction and validation of a novel research instrument to quantify the degree of post-hurricane trauma and distress in an affected population. The Post-Hurricane Distress Scale (PHDS) has quantitative measures of both acute and prolonged distress, attributable to meteorological and hydrological disasters., Methods: A careful evaluation of existing questionnaires, as well as extensive canvasing of the post-Maria population of Puerto Rico, availed the construction of the PHDS. The PHDS consists of 20 items, organized into 4 subscales. The PHDS was pre-validated (n=79), revised, and then distributed to a broad sampling of the post-Hurricane Maria Puerto Rican population (n=597). Validation, including factor analysis, analyses of concurrent validity, discriminant validity, and internal reliability, was performed., Results: After comparing various scales, factor loading profiles, concurrent validities, and models of fit, we show that the PHDS is best scored as a single 0-6 distress scale. When compared with the Traumatic Exposure Severity Scale, the PHDS shows superior concurrent validity, more accurately predicting scores for the Peritraumatic Distress Inventory, Impact of Event Scale - Revised, and Generalized Anxiety Disorder 7 Scale. The PHDS shows good internal reliability and discriminant validity., Conclusions: The PHDS represents a novel, useful instrument for disaster first-responders and researchers. The prompt identification of high-risk populations is possible using this instrument. (Disaster Med Public Health Preparedness. 2019;13:82-89).

In September 2005, nearly 3.7 million people evacuated the Texas coastline in advance of Hurricane Rita's landfall, making the event the largest emergency evacuation in US history. The Rita evacuation underscored the importance of planning for domestic mass-evacuation events, as the evacuation itself led to over 100 of the at least 119 deaths attributed to the storm. In the days preceding Rita's landfall, several cascading, interrelated circumstances precipitated such adverse outcomes. This article explores the series of events leading up to the evacuation's poor outcomes, the response following Rita to amend evacuation plans, and how Texas successfully implemented these changes during later storms to achieve better outcomes. (Disaster Med Public Health Preparedness. 2018;12:115-120).