Hurricanes Katrina and Rita: evacuee healthcare efforts remote from hurricane affected areas

Hurricanes Katrina and Rita produced the largest evacuation due to a natural disaster in United States history. Many people were evacuated or rescued from New Orleans and the Gulf Coast, resulting in a need for mass disaster shelters and medical care for months following the storms. The shelter healthcare system that was successfully developed in the Shreveport-Bossier City, Louisiana area was accomplished with little support from customary sources. This report is written after much discussion and introspection of community leaders involved "on the ground," who organized and provided medical services to evacuees of south Louisiana. Its purpose is to compile "lessons learned" in preparation for the next disaster recovery effort that might affect this or any other region of our country.     

Disaster preparedness: occupational and environmental health professionals' response to Hurricanes Katrina and Rita.

In disaster-related events such as these, this survey demonstrates clear need for improved preparedness efforts and communication strategies to help reduce health risks for at-risk populations. The role of occupational health nurses and occupational and environmental medicine physicians requires knowledge and skills in many areas. This includes not only clinical skills related to illness and injury that will occur, but also skills in such areas as surveillance, management, community coordination, risk management and risk communication, and health protection. The psychological impact of disasters will have far-reaching effects resulting in emotional and behavioral changes requiring both immediate and long-term interventions. Comprehensive disaster management guidance should be in place to assist health care providers and workers in pre-event, event, and post-event phases of the disaster.     

Hurricanes Katrina and Rita: role of individuals and collaborative networks in mobilizing/coordinating societal and professional resources for major disasters

The medical support for the coordinated effort for Harris County Texas (Houston) to rescue evacuees from New Orleans following Hurricane Katrina was part of an integrated collaborative network. Both public health and operational health care was structured to custom meet the needs of the evacuees and to create an exit strategy for the clinic and shelter. Integrating local hospital and physician resources into the Joint Incident Command was essential. Outside assistance, including federal and national resources must be coordinated through the local incident command.     

Hurricanes Katrina and Rita: role of individuals and collaborative networks in mobilizing/coordinating societal and professional resources for major disasters

The medical support for the coordinated effort for Harris County Texas (Houston) to rescue evacuees from New Orleans following Hurricane Katrina was part of an integrated collaborative network. Both public health and operational health care was structured to custom meet the needs of the evacuees and to create an exit strategy for the clinic and shelter. Integrating local hospital and physician resources into the Joint Incident Command was essential. Outside assistance, including federal and national resources must be coordinated through the local incident command.     

Emergency preparedness and professional competency among health care providers during hurricanes Katrina and Rita: pilot study results.

BACKGROUND: To date, no systematic examination of the preparedness of individual health care providers and their response capabilities during a large-scale disaster has been conducted. As a result, very little is known about what knowledge, skills and abilities, or professional competencies are needed, or how professional competency requirements may change depending on the circumstances of a disaster. The objective of this pilot study was to collect, explore, and describe background data on professional competencies from health care providers who were involved in the Hurricanes Katrina and/or Rita disaster responses. METHODS: Utilizing an anonymous survey of a convenience sample, 200 health care providers attending 2 disaster conferences were asked to respond to open-ended questions about the competencies they needed and performed during their disaster response. RESULTS: Of the 200 respondents, registered nurses (37%) and physicians (24%) were the largest categories of providers. Basic clinical care (39%) and triage (26%) were the most frequent response skills reported; the areas wherein respondents felt least prepared were disaster-specific response skills (22%) and systems issues (34%). Only 22% of respondents reported that they did not know a specific skill. The 200 respondents made 495 individual recommendations for future responders, including actions to improve the respondent's personal preparedness (23%) and the need for training (25%). However, only 3% of the recommendations (n = 15) actually identified a specific type of training such as Advanced Cardiac Life Support or triage. CONCLUSION: Few respondents reported knowledge deficits. Rather, what they described was an abrupt change or transition from their everyday practice worlds that required accommodation in order to practice effectively. Current training programs generally focus on providing skills information. Further research is required to determine if training programs should address facilitating the transition process.     

Explosions and Radioactive Material: A Primer for Responders

A comprehensive primer on the threat posed by radiological dispersion devices, or “dirty bombs,” and the management challenges for first responders is presented. The discussion is scenario-driven, presenting guidance for medical responders as to triage and treatment priorities in the face of radiation risk. Key questions are posed that present the need for operational and tactical planning, equipping, and training around this scenario. Decontamination priorities and potential medical management are discussed for both victims and responders.     

Successful Techniques for Retention of Study Participants in an Inner-City Population

The purpose of this work was to describe methods of retaining participants in studies of inner-city populations, including the timing and intensity of contacts; and to describe the characteristics of participants who did not complete all follow-up interviews and/or return all peak flow diaries in the National Cooperative Inner-City Asthma Study. A cohort study design was used involving hospital emergency rooms and community clinics in seven major urban areas. Participants included 1337 4- to 9-year-old asthmatic children and their caretakers. Nearly 89% of participants completed 3-, 6-, and 9-month follow-up interviews. The 15% of participants who completed a baseline interview on the weekends were significantly more likely to complete follow-up interviews on a weekend. The percent of follow-up interviews conducted in person increased over time from 5% to 8%. The percent of participants with complete follow-up increased as the number of contact names increased (86% with zero contacts, 91% with two contracts; p = 0.03, test for trend). Participants who required at least four phone calls to complete the 3- and 6-month assessment were significantly more likely to be black, have higher participant stress, and have a smoker in the household (p < 0.05). Multiple logistic regression suggests that higher social support and lower parental stress were both predictors of completed interviews. Within our study sample of inner-city minority participants with asthmatic children, only a small proportion of participants missed any follow-up interviews. Increased caretaker stress, decreased social support, and inability to provide several alternate contacts were all predictive of retention problems. Having a flexible staff, computer tracking, and face-to-face recruitment appear essential to achieving nearly complete follow-up within a population historically difficult to follow.     

Responders and Nonresponders to a Walking Intervention for Sedentary Women

Purpose: Increasing evidence has indicated that people might be differentially influenced by intervention programs. The purpose of this secondary analysis was to identify groups of women who responded differently to a walking intervention. Data used in this secondary analysis were collected in a longitudinal study of a counseling intervention to increase walking among 248 initially sedentary women.
Method: A latent growth-mixture modeling approach was used to assess treatment effects on growth in physical activity and mood over time. Subgroups of participants who were responsive versus those who were nonresponsive to intervention were also identified. Logistic-regression analysis was conducted to confirm group membership and identify predictors associated with the identified subgroups.
Results: Two subgroups (responders, nonresponders) were identified separately for physical activity and mood. Using several variables as predictors of group memberships, 92%–95% of the cases were correctly classified. The current study indicated that predictors for group membership were associated with the outcome variables.
Conclusions: These findings indicated that optimal interventions should be tailored to not only the physical, psychosocial, and environmental variables of each woman, but also to outcome variables of interest to the woman.
Clinical Relevance: Nurses practicing in community and public health settings should determine physical activity interventions that are based on scientific findings and on outcomes that are important for the individual woman.     

突发事件特勤应急部队人群的应对方式及其影响因素研究

目的研究特勤应急部队人群应对突发事件方式的特点及影响因素。方法从重庆市武警和公安消防部队整群抽取12个特勤中队，对其应对突发事件的方式及影响变量进行现况调查，比较其应对方式与军人常模的差异，评价其表现类型和成熟程度，并筛选主要影响因子。结果纳入的396例受试者中，86．36％具有突发事件任务的经历，各项应对因子平均水平与军人常模相比，差异有统计学意义（P≤O．01），整体应对行为模式为成熟型；应对行为类型与得分达标情况相关（P〈0．001），但列联系数偏低（C=0．23），显示应对方式成熟程度仍有限。从影响变量的作用效应来看：自信心不足、自我与经验不和谐、自我刻板性和缺乏危机生存技能是影响应对方式的负性因素，而社会支持、自我灵活性、责任心、任务经历是正性因素。其中，支持利用度、经验不和谐、自信心程度、逃生知识对不同应对行为的影响比较普遍，而其余因素的影响比较单一。结论特勤应急部队人群应对突发事件的方式总体上比较成熟稳定，但个体差异较大，并受多种因素影响，故有必要开展针对性的干预训练，进一步提高特定人群应对方式的成熟程度。     

Organizational description and emergency preparedness of Nationally Registered First Responders

INTRODUCTION: This study intended to describe the types of organizations and communities in which Nationally Registered First Responders (NRFR) perform their duties. Also, it aimed to estimate the number of NRFR who received disaster preparedness training. It was hypothesized that NRFR participation in disaster preparedness training was related to the types of organizations and communities in which they performed their duties. METHODS: The NRFR re-registering in 2006 were asked to report the organization type and community size in which they work. They also were asked to report the amount and content of preparedness training received during the last 24 months. Multivariable logistic regression modeling was utilized to describe the relationship between NRFR organizational characteristics and the receipt of disaster preparedness training. RESULTS: The analysis included 872 (59%) individuals who completed the survey and reported working for one or more emergency medical services (EMS) organizations. The majority of NRFR performed work in rural areas (75%) and more NRFR reported working for fire departments (61%) than for any other organization type. In all categories of service type, participants who reported working in urban areas had higher odds of receiving disaster preparedness training than those working in rural areas. Additionally, regardless of community size, individuals working in fire departments were more likely to receive disaster preparedness training. CONCLUSIONS: This study indicated that the majority of NRFR perform EMS duties for fire departments and work in rural communities. In this sample of NRFR, more than one-quarter did not receive disaster preparedness training within a 24-month period. Finally, a statistical model was constructed that indicated a relationship between service type, community size, and the participation in disaster preparedness training.     

Schools as Sites for Recruiting Participants and Implementing Research

Schools can be a valuable resource for recruitment of participants for research involving children, adolescents, and parents. Awareness of the benefits and challenges of working with schools can assist researchers in developing effective school partnerships. This article discusses the advantages of conducting research within the school system as well as the challenges that may also arise. Such challenges include developing key contacts, building relationships, logistical arrangements, and facilitating trust in the research topic and team. Suggestions for strategies to forge successful collaborative relationships with schools are provided.