Disaster Medicine and Public Health Preparedness
Volume 9 – Issue 03 – June 2015
http://journals.cambridge.org/action/displayIssue?jid=DMP&tab=currentissue

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Brief Report
Understanding Community-Level Disaster and Emergency Response Preparedness
Crystal Shannon
Indiana University Northwest, College of Health and Human Services, School of Nursing, Gary, Indiana.
Abstract
Objective
Community-level disaster readiness is a major component of community health promotion. However, many readiness programs are focused on the response of emergency and health care personnel and not on the preparedness levels of local citizens. This potentially leaves the public unready and unprepared for emergency event response.
Methods
A 20-item survey on general states of disaster preparedness was delivered to the residents of a midsized midwestern county. The residents were asked to share their knowledge of local hazards, emergency systems, and personal preparedness.
Results
A convenience sample of 423 residents responded to the survey. Fifty-seven percent (n=241) reported limited personal preparedness. Seventy-six percent (n=321) acknowledged little to no familiarity with residential emergency systems, and 52% (n=220) reported that they did not know how to gain information on public health emergencies, such as pandemic flu and evacuation response.
Conclusions
Local citizens should become educated on the methods to support personal disaster and emergency readiness. Health care and emergency management organizations are encouraged to include these concepts in routine community health promotion activities and to pay special attention to known areas of community vulnerability. Failure to do so creates a population unable to support themselves in the provision of basic health and safety measures.
(Disaster Med Public Health Preparedness. 2015;9:239-244)

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Original Research
Vulnerability of Urban Homebound Older Adults in Disasters: A Survey of Evacuation Preparedness
Patrick J. Dostal
Master of Public Health Program and Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
Objective
Recent disasters within the United States, such as Hurricanes Katrina and Sandy, have highlighted the vulnerability of older adults, and recent litigation has upheld the responsibility of government in assisting the public during mandatory evacuations. Older adults designated as homebound due to their disabilities are at greatest risk of poor outcomes in disasters. This study aimed at assessing the willingness and ability of homebound older adults to evacuate, as well as categorizing their medical needs in the event they are relocated to an emergency shelter.
Methods
Fifty-six homebound older adults and medical decision surrogates from 1 homebound primary care practice in Philadelphia were assessed with a novel structured interview.
Results Respondents reported limitations in both their ability and their willingness to evacuate their neighborhoods. Medical needs of homebound older adults were on par with those of nursing home residents.
Conclusions
Many homebound older adults are unable or unwilling to evacuate in a mandatory evacuation situation, highlighting a need for public assistance. Their complex medical needs will require significant preparation by special needs shelters.
(Disaster Med Public Health Preparedness. 2015;9:301-306)

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Concepts in Disaster Medicine
Comparative Cost of Stockpiling Various Types of Respiratory Protective Devices to Protect the Health Care Workforce During an Influenza Pandemic
Gio Baraccoa1a2a3 c1, Sheri Eiserta1a4, Aaron Eagana1 and Lewis Radonovicha1
a1 Office of Public Health, Veterans Health Administration, National Center for Occupational Health and Infection Control, Gainesville, Florida
a2 Miami VA Healthcare System, Infectious Diseases, Miami, Florida
a3 University of Miami Miller School of Medicine, Infectious Diseases, Miami, Florida
a4 University of South Florida, Epidemiology, Tampa, Florida
Abstract
Specific guidance on the size and composition of respiratory protective device (RPD) stockpiles for use during a pandemic is lacking. We explore the economic aspects of stockpiling various types and combinations of RPDs by adapting a pandemic model that estimates the impact of a severe pandemic on a defined population, the number of potential interactions between patients and health care personnel, and the potential number of health care personnel needed to fulfill those needs. Our model calculates the number of the different types of RPDs that should be stockpiled and the consequent cost of purchase and storage, prorating this cost over the shelf life of the inventory. Compared with disposable N95 or powered air-purifying respirators, we show that stockpiling reusable elastomeric half-face respirators is the least costly approach. Disposable N95 respirators take up significantly more storage space, which increases relative costs. Reusing or extending the usable period of disposable devices may diminish some of these costs. We conclude that stockpiling a combination of disposable N95 and reusable half-face RPDs is the best approach to preparedness for most health care organizations. We recommend against stockpiling powered air-purifying respirators as they are much more costly than alternative approaches.
(Disaster Med Public Health Preparedness. 2015;9:313-318)