An estimated 93,000 persons were potentially exposed to drinking water contaminated with petroleum jet propellant (JP)-5 fuel after a November 20, 2021, leak at the Red Hill Bulk Fuel Storage Facility on Oahu, Hawaii. Previous investigations identified the need to evaluate long-term mental health effects associated with JP-5 exposure.

We identified adults potentially exposed to jet fuel-contaminated water during November 20, 2021-March 18, 2022, who sought care within the military health system through February 24, 2023. We abstracted a sample of electronic medical records and categorized documented mental health conditions and symptoms as “worsening preexisting” or “persistent new.” We also assessed mental health-related medication use before and after November 20, 2021.

We abstracted medical charts for 411 adults potentially exposed to jet fuel-contaminated water. Of this cohort, 123 (29.9%) had documented worsening preexisting mental health conditions or symptoms, 86 (20.9%) had persistent new mental health conditions or symptoms, and 109 (26.5%) had at least one mental health-related medication prescribed after the exposure event.

These results highlight mental health needs during and after water contamination events. Continued access to mental health care services and monitoring for long-term mental health effects is recommended.

This study examined how social vulnerability factors—such as caregiving, economic instability, and nonregular employment—affect disaster preparedness and awareness, with a focus on nonlinear associations with evacuation and disaster awareness.

Cross-sectional analysis of a nationally representative survey

Data came from the 2023 Japan COVID-19 and Society Internet Survey (JACSIS), including 28,481 participants. Factor analysis identified two preparedness domains: evacuation awareness and disaster preparedness awareness. Generalized linear models (GLM) assessed associations between awareness scores and sociodemographic and health factors. Sensitivity analysis used a random forest model, and logistic regression examined predictors of low awareness.

Two factors explained 76% of variance in preparedness behaviors. GLM showed that older age (Estimate = 10.99, P < .001), larger household size (Estimate = 4.34, P < .001), high income (Estimate = 0.08, P < .001), and community attachment (Estimate = 0.09, P < .001) were positively related to evacuation awareness, while nonregular employment (Estimate = -0.03, P = .01) and public assistance (Estimate = -0.05, P < .001) were negatively associated. Logistic regression confirmed that reliance on public assistance (OR = 1.54, 95% CI [1.26, 1.87]) and nonregular employment increased odds of low preparedness.

Social vulnerability factors are linked to lower disaster awareness, identifying a subgroup at higher risk. Preparedness policies should account for demographic and economic disparities, emphasizing tailored, community-based strategies to improve resilience among vulnerable populations.

Disaster preparedness is a critical component of nursing education as nurses are expected to respond effectively to public health emergencies. Various disaster nursing education programs have been developed globally, but their effectiveness across cognitive, affective, and psychomotor domains remains unclear. This meta-analysis evaluated the overall impact of these programs across learning domains.

Eleven experimental or quasi-experimental studies involving nursing students and nurses were included. The pooled effect size was calculated using Hedges’ g. Heterogeneity was assessed using Cochran’s Q and the I2 statistic. Subgroup analyses were conducted by learning domain. Publication bias was assessed via a funnel plot.

The overall effect size was large (Hedges’ g = 1.80, 95% CI: 1.491-2.399, P < .001). Heterogeneity was high (Q = 377.91, P < .001, I2 = 97.4%). The affective domain showed the strongest effect (g = 2.96), followed by psychomotor (g = 1.98) and cognitive (g = 0.66). The funnel plot showed minimal publication bias.

Disaster nursing education programs significantly improve learning outcomes across domains, especially in attitudes and practical skills. These findings support the need for integrated curricula in nursing education.

Power outages can lead to food-borne and water-borne illness risks for consumers if proper protective measures are not taken at home. The purpose of this study was to understand the behaviors of Canadians related to food and water safety preparedness at home during power outages and floods.

A qualitative descriptive study was conducted, consisting of 6 virtual focus groups, each with 8 people, in July 2023. Participants were selected from geographically dispersed locations in Ontario, Canada that had experienced power outages due to weather events. Thematic analysis was conducted to generate key themes.

Four themes were generated related to participants’ food and water safety preparedness: 1) trusted information sources and lived experiences; 2) support and resources; 3) factors beyond one’s control; and 4) differences in psychosocial determinants.

Effective risk communication targeting misconceptions, incentivization programs, and community resilience planning may help prevent or reduce enteric illness risks during such emergencies.

On November 20, 2021, petroleum fuel contaminated the Red Hill well, which provides water to about 93 000 persons on Oahu, Hawaii. Initial investigations recommended further evaluations of long-term health effects of petroleum exposure in drinking water. We reviewed electronic health records of those potentially exposed to contaminated water to understand prevalence of conditions and symptoms.

A sample of persons potentially exposed during November 20, 2021-March 18, 2022 who sought care within the military health system through February 24, 2023 was identified. Abstracted records were categorized as worsening preexisting or persistent new for conditions and symptoms.

Of 653 medical charts reviewed, 357 (55%) had worsening preexisting or persistent new conditions or symptoms. Most-documented conditions included worsening preexisting migraine (8%; 50/653) and chronic pain (4%; 26/653), and persistent new migraine (2%; 14/653) and adjustment disorder (2%; 13/653). Most-documented symptoms included worsening preexisting headache (8%; 49/653) and anxiety (6%; 42/653), and persistent new rash (7%; 46/653) and headache (5%; 34/653).

Approximately half of the abstracted medical records demonstrated worsening preexisting or persistent new conditions or symptoms and might benefit from sustained access to physical, mental, and specialized health care support systems. Continued monitoring for long-term health outcomes is recommended.

The aims of this study were to field and pilot test the Korean version of the Household Emergency Preparedness Instrument (K-HEPI) and perform psychometric testing of the instrument’s reliability and validity.

The English to Korean translation followed a symmetrical translation approach utilizing a decentered process (i.e., both the source and target languages were considered equally important) focusing on the instruments remaining loyal to the content. After translation, the K-HEPI was field tested with 30 bilingual participants who all reported that the instructions were easy to understand and the items aligned closely with the original English version. The K-HEPI was then pilot tested with 399 Korean-speaking participants in a controlled, before-after study utilizing a disaster preparedness educational intervention.

Confirmatory factor analyses supported the K-HEPI retaining the factor structure of the original English version. The K-HEPI was also found to be psychometrically comparable to the original instrument.

The K-HEPI can validly and reliably assess the disaster preparedness of Korean-speaking populations, enabling clinicians, researchers, emergency management professionals, and policymakers to gather accurate data on disaster preparedness levels in Korean communities, identify gaps in preparedness, develop targeted interventions, and evaluate the effectiveness of disaster preparedness interventions over time.

Targeted identification, effective triage, and rapid hemorrhage control are essential for optimal outcomes of mass-casualty incidents (MCIs). An important aspect of Emergency Medical Service (EMS) care is field triage, but this skill is difficult to teach, assess, and research.

This study assessed triage efficacy and hemorrhage control of emergency responders from different professions who used the Sort, Assess, Life-Saving Treatment (SALT) triage algorithm in a virtual reality (VR) simulation of a terrorist subway bombing.

After a brief just-in-time training session on the SALT triage algorithm, participants applied this learning in First VResponder, a high-fidelity VR simulator (Tactical Triage Technologies, LLC; Powell, Ohio USA). Participants encountered eleven virtual patients in a virtual scene of a subway station that had experienced an explosion. Patients represented individuals with injuries of varying severity. Metrics assessed included triage accuracy and treatment efficiency, including time to control life-threatening hemorrhage. Independent Mann-Whitney analyses were used to compare two professional groups on key performance variables.

The study assessed 282 participants from the ranks of EMS clinicians and medical trainees. Most (94%) participants correctly executed both global SALT sort commands. Participants triaged and treated the entire scene in a mean time of 7.8 decimal minutes, (95%CI, 7.6-8.1; SD = 1.9 decimal minutes) with a patient triage accuracy rate of 75.8% (95%CI, 74.0-77.6; SD = 15.0%). Approximately three-quarters (77%) of participants successfully controlled all life-threatening hemorrhage, within a mean time of 5.3 decimal minutes (95%CI, 5.1-5.5; SD = 1.7 decimal minutes). Mean time to hemorrhage control per patient was 0.349 decimal minutes (SD = 0.349 decimal minutes). Overall, EMS clinicians were more accurate with triage (P ≤ .001) and were faster at triage, total hemorrhage control (P < .01), and hemorrhage control per patient (P < .004) than medical trainees.

Through assessments using VR simulation, it was observed that more experienced individuals from the paramedic (PM) workforce out-performed less experienced medical trainees. The study also observed that the medical trainees performed acceptably, even though their only formal training in SALT triage was a 30-minute, just-in-time lecture. Both of these findings are important for establishing evidence that VR can serve as a valid platform for assessing the complex skills of triage and treatment of an MCI, including the assessment of rapid hemorrhage control.

Disaster risk reduction measures are now being developed based on social vulnerability. This study aimed to identify socially vulnerable areas to disasters in Razavi Khorasan Province, Iran.

The research utilized a mixed method approach conducted in 2 stages. First, a vulnerability index was created using 8 sub-indices, and the value of the index was calculated for each of the 91 rural districts in the study area. In the second stage, spatial analysis using Anselin’s Local Moran’s I was performed to identify the most vulnerable districts.

Results indicated that 40 of 91 districts, covering 49% of the total area, had high social vulnerability to disasters. Anselin’s Local Moran’s I analysis identified 2 high-high clusters consisting of 5 districts. The study also found that areas with higher social vulnerability were more susceptible to natural hazards such as floods and earthquakes.

Nearly half of the studied areas exhibited a high level of social vulnerability and were at risk of natural disasters. Implementing general measures to improve the socio-economic status of the population, such as increasing education and income levels, along with specific actions like assisting vulnerable populations in relocating to safer areas, can help mitigate disaster risks.

As extreme weather events become more pervasive due to climate change, identifying populations with lower access to resources becomes critical for timely mitigation efforts. Here we analyzed data from a survey conducted in Louisiana after Hurricane Ida to investigate demographic and housing characteristics of those vulnerable to home damage, flooding, and mold exposure after an extreme weather event.

The survey participants comprised a convenience sample of 167 total respondents, most of whom resided in the Greater New Orleans Area. Sociodemographic, housing, and geographic factors were considered that described the population reporting home damage, flooding, and/or mold due to Hurricane Ida compared with those who did not experience these outcomes from Hurricane Ida.

Sociodemographic and housing factors predicting adverse impact from Hurricane Ida included race, retirement status, educational attainment, Social Vulnerability Index (SVI), type of home, and homeownership status. Of note, those whose homes had flooded prior to Ida had significantly higher odds of reporting home damage with Ida.

Of all the sociodemographic factors associated with Hurricane Ida damage including flooding and mold, a greater level of the SVI was most consistent and often had the strongest associations with these adverse outcomes. A public health focus on neighborhoods with higher SVI could help lead to strategies to mitigate and prevent exposure in future flood events.

Widespread disasters can obstruct all external supports and isolate hospitals. This report aimed to extract key preparedness measures from 1 such hospital in Australia, which was flood-affected and cut off from surrounding supports.

Nine interviews with key personnel behind a flood-affected hospital’s evacuation and field hospital setup were conducted, and a narrative analysis of interview transcripts, meeting notes, and published accounts of hospital evacuation was conducted to highlight important preparedness measures for other hospitals.

Findings indicate hospitals should compile a comprehensive list of resources needed to set up a field hospital. The analysis highlighted the importance of effective patient communication and in-transit tracking for safe evacuation, and revealed that staff can be better prepared if trained to expect disruptions and initiate pre-evacuation discharges.

Increase in climate change-driven extreme weather events requires a proportional increase in hospitals’ abilities to respond and adapt. This report points to key measures that can prepare hospitals to move their patients to improvised makeshift field facilities, if no external support is available.

Dentists possess critical skills that can support disaster response efforts. However, in disaster-prone countries like Iran, the integration of dentists into emergency preparedness remains underdeveloped. This study aimed to assess the knowledge, attitudes, and self-reported practices of senior dental students in Tehran regarding disaster management and their potential role in it.

A cross-sectional survey was conducted among 240 senior dental students from three major dental schools in Tehran. An online questionnaire evaluated participants’ demographics, knowledge (9 items), attitudes (8 items), and self-reported practices (3 items) related to disaster preparedness. Data were analyzed using t-tests and Pearson correlation coefficients, with significance set at P<0.05.

Students demonstrated moderate knowledge (mean score: 7.1 out of 18), favorable attitudes (13.1 out of 16), but low levels of self-reported practice (1.9 out of 6). Most respondents lacked awareness of national disaster management policies, although 92.5% acknowledged the need for disaster-related training. Only 37.9% had received any training in CPR or disaster response. Female students scored significantly higher in attitude but not in knowledge or practice. Prior disaster experience did not significantly influence preparedness scores. Positive correlations were found between knowledge and both attitude (r = 0.27) and practice (r = 0.33).

Despite a strong interest in disaster preparedness, Iranian dental students lack sufficient training and practical experience. Incorporating disaster management education into the dental curriculum is essential to empower future dentists for roles in national emergency response frameworks.

Climate change is contributing to increased frequency and intensity of wildfires in California. This study evaluated the self-reported impacts of the California Oak Fire on the health of a medically at-risk population and identified their wildfire preparedness and information needs.

A cross-sectional mixed-methods survey was conducted from April-July of 2023 of those with self-identified special needs in emergencies. The survey assessed self-reported wildfire preparedness, information needs, evacuation response, and health impacts.

A total of 53 surveys were completed for a response rate of 23.1%. Most respondents had medical conditions (94%). One-fifth (21%) of respondents reported missed or delayed medical appointments and harm to their health from the Oak Fire; these groups reported significantly more medical conditions (4.1 v. 2.5, P = 0.0055) and use of more medical devices (3.5 v 2, P = 0.007) than those without harm to their health. The most common way respondents learned about the Oak Fire was by seeing fire plumes/smelling smoke (59%); the most trusted information source was county officials (77%). Less than half of respondents (40%) evacuated during the Oak Fire.

Wildfires are associated with interruptions in medical care that harm health, particularly for medically at-risk populations.

For the National Health Service (NHS) in England, incidents are defined as events that disrupt, or might disrupt, an organisation’s normal service provision below acceptable levels and require special arrangements to be put in place. NHS England is responsible for coordinating regional responses to incidents. Integrated Care Boards (ICBs) are responsible for coordinating local responses to incidents. This review assessed the records of regional and local incident responses held by NHS England and ICBs respectively.

The outcome of interest was the quantity of information regarding days at an incident response level held by organisations responsible for coordinating that level of incident response.

NHS England had a record of the number of days at regional incident response level for 3 of its 7 regions. 24 of the 42 ICBs had records of the number of days at local incident response level.

NHS England and ICB records of incident responses for which they are responsible were incomplete. They might benefit from reviewing how they measure and record this information. This review may also be of interest to other bodies at local, regional and state level which coordinate hospitals in response to incidents.

In England, the Civil Contingencies Act (Contingency Planning) Regulations 2005 require National Health Service (NHS) Trusts which provide hospital accommodation and services in relation to accidents or emergencies to conduct Emergency Preparedness, Resilience and Response (EPRR) exercises. The NHS England EPRR Framework specifies the minimum frequencies of these exercises. This review assessed the number of Trusts conducting exercises in accordance with these frequencies one year after the national NHS COVID-19 response was stepped down.

The outcome of interest was the number of Trusts having a record of conducting their most recent exercises in accordance with the minimum frequencies required by the NHS England EPRR Framework.

Of the applicable 122 Trusts, 95 had a record of conducting a communication systems exercise, 115 had a record of conducting a table-top exercise, 106 had a record of conducting a live play exercise and 90 had a record of conducting a command post exercise in accordance with the minimum frequencies.

Over one fifth of Trusts did not have a record of conducting an EPRR communications systems exercise as required. This review may also be of interest to other state-level bodies which specify high level EPRR requirements to healthcare providers.

The World Health Organization (WHO) Health Emergency Programme funded three systematic reviews to inform development of guidance for emergency preparedness in health emergencies. The current review investigated the type of learning interventions that have been developed and used during health emergencies, and how they were developed.

We searched PubMed, CINAHL, Communication and Mass Media Complete (EBSCO), and Web of Science. Study quality was appraised by WHO-recommended method-specific checklists. Findings were extracted using a narrative summary approach.

187 studies were included. Studies were split between online, in-person, and hybrid modalities, conducted mostly by hospitals and universities, and most frequently training nurses and doctors. Studies emphasized experiential learning to develop and reinforce skills; online learning for knowledge dissemination; multi-sectoral partnerships, institutional support and carefully constructed planning task forces, rapid training development and dissemination, and use of training models.

It Most studies evaluated only knowledge or self-confidence of trainees. Relatively few assessed skills; evaluations of long-term outcomes were rare. Little evidence is available about comparative effectiveness of different approaches, or optimum frequency and length of training programming. Based on principles induced, six recommendations for future JIT training are presented.

Disaster management strategies often emphasize technical and structural solutions, overlooking the sociocultural factors that shape community resilience and disaster response. In Malaysia, a multiethnic and multireligious country frequently affected by floods and monsoon storms, cultural beliefs, social networks, and traditional practices play a pivotal role in shaping disaster preparedness and recovery. This study examines how religious beliefs, community cohesion, gender roles, and traditional knowledge influence disaster management in Malaysia.

A qualitative research approach was employed, utilizing semi-structured interviews with 15 stakeholders from diverse ethnic, religious, and social backgrounds. Participants, represented various religious groups and geographic areas. Their roles included local leaders, government officials, NGO workers, and community members, providing insights into how sociocultural factors influence disaster response and policy.

Religious beliefs serve as both a source of resilience and a potential barrier, shaping community attitudes toward disaster preparedness. Community cohesion, particularly through gotong-royong (mutual aid), plays a crucial role in mobilizing resources and support, though it often excludes marginalized groups. Gender roles significantly influence disaster response, with women taking on caregiving responsibilities yet remaining underrepresented in decision-making processes. Traditional knowledge remains valuable, particularly in rural communities, but faces challenges as younger generations increasingly rely on modern technologies.

This study highlights the need for culturally sensitive, gender-inclusive, and community-driven disaster management policies in Malaysia.Integrating sociocultural dimensions into formal frameworks can foster more adaptive and inclusive strategies. Enhancing community participation and gender inclusivity will be key to improving disaster resilience in Malaysia.

Preparedness levels have been shown to improve the outcomes for people who find themselves in an emergency. However, uptake of preparedness behaviors by the public prior to a major disaster is limited. This 2-part study examined perceived preparedness in the UK during the first months of the COVID-19 pandemic (Study 1), and 2 years later (Study 2).

Both studies investigated the effect of individual demographics (gender, age, perceived socioeconomic and health status) on perceived preparedness. Next, the studies examined the extent to which perceived preparedness was associated with mental health outcomes (anxiety, depression, and stress symptoms). Participants (Study 1, N = 409) completed an online survey in May to June 2020 during a national lockdown, with another sample (Study 2, N = 87) completing the same survey from March to July 2022.

Across both studies, participants completed 2 to 3 different preparedness activities. Greater subjective perceptions of socioeconomic status were associated with perceived preparedness. Preparedness levels were related with better mental health, and unrelated to age and gender.

Encouraging the public to engage with preparedness behaviors may not only have practical benefits but also help to protect mental well-being during a disaster.

This study investigated the psychological and physiological effects of using sleeping bag-shaped aluminum sheets during night-time sleep in winter to reduce cold stimulation and improve the sleeping environment in disaster evacuation shelters.

Sixteen healthy male participants in Hiroshima City underwent 2 experimental conditions in January and December 2023: night-time sleep in winter with and without a sleeping bag-shaped aluminum sheets. Sleep–wake rhythm during night-time sleep (discriminant analysis method), subjective sleep soundness, mood state profile, heart rate, blood pressure, and cardiac autonomic nervous system modulation were measured. Wilcoxon’s signed-rank sum test, Friedman’s test, and paired t-test were performed.

Thermal sensation of warmth and subjective sleep soundness were significantly greater with than without the aluminum sheets. Total sleep time and sleep efficiency were also significantly greater, whereas the frequency and duration of wakefulness after sleep onset were significantly less. Total mood disturbance, fatigue-inertia, and vivid-activity were significantly different between the control, aluminum sheets, and home conditions. Physiological parameters did not differ significantly.

These data suggest that using sleeping bag-shaped aluminum sheets in disaster evacuation shelters in winter could be effective in improving sleep–wake rhythms and subjective sleep soundness, although negative emotions were not improved.