Critical Care in the Austere Environment.

Practice of critical care in austere settings involves navigating rapidly evolving environments, where physical resources, provider availability, and healthcare capacity are constrained. Austere Critical Care focuses on maintaining the highest standard of care possible for patients while also identifying resource limitations, responding to patient surges, and adhering to proper triage practices at the austere site. This includes transferring the patient when able and necessary. This article describes the current practice of critical care medicine in the austere environment, using recent natural disasters, pandemics, and conflicts as case studies.

Effects of expanded adverse childhood experiences including school bullying, childhood poverty, and natural disasters on mental health in adulthood.

The study aimed to examine the association of expanded adverse childhood experiences (ACEs) with psychological distress in adulthood. The data from nation-wide online cohort was used for analysis. Community dwelling adults in Japan were included. The ACEs was assessed by 15 items of ACE-J, including childhood poverty and school bullying. Severe psychological distress was determined as the score of Kessler 6 over 13. Multivariable logistic regression analysis was conducted, by using sample weighting. A total of 28,617 participants were analyzed. About 75% of Japanese people had one or more ACEs. The prevalence of those with ACEs over 4 was 14.7%. Those with ACEs over 4 showed adjusted odds ratio = 8.18 [95% CI 7.14-9.38] for severe psychological distress. The prevalence of childhood poverty was 29% for 50-64 year old participants and 40% of 65 or older participants. The impact of childhood poverty on psychological distress was less than other ACEs in these age cohorts. Bullying was experienced 21-27% in young generations, but 10% in 65 or older participants. However, the impact on psychological distress in adulthood was relatively high in all age groups. ACEs have impacted mental health for a long time. Future research and practice to reduce ACEs are encouraged.

Examining the effectiveness of a training program on improving knowledge, functional skills, and attitude in natural disaster volunteers.

Introduction: Disaster relief volunteers must have certain psychological and cognitive characteristics. Therefore, the present study aimed to investigate the effectiveness of the training program on improving knowledge, functional skills, and attitude among disaster volunteers. Methods: A quasi-experimental study was conducted in 2023 in Iran, including an intervention and control group and follow-ups. Ninety health volunteers were randomly selected and divided into two groups of 45. The experimental group received the training program for an hour a week for three months. The control group received no intervention. The participants of both groups completed the disaster preparedness questionnaire at the pre-test, post-test, and one and three months after the intervention. Data was analyzed using SPSS "version 26" software in the methods section. Results: The intervention effect were significant in increasing the volunteers' functional skills (F = 3.75), knowledge (F = 166.50), and attitude (F = 1.74), all in (p = 0.001). According to the results, this effect was stable over time for functional skills (F = 1.83) and knowledge (F = 18.04) all in (p < 0.05). Conclusion: Training programs can help improve skills, attitudes and knowledge in natural disaster volunteers. Researchers interested in the field of natural disaster relief, particularly health researchers, could consider further examining the aforementioned topics in their studies.

Field physical model tests on the mechanism of river blocking by debris flow in the middle reaches of the Dadu River, Southwest China.

Debris flow is a typical natural disaster in the middle reaches of the Dadu River, Southwest China. Field physical model tests were conducted to reveal the mechanism of river blocking by debris flow in the middle reaches of the Dadu River. The dynamic processes of riHver blocking by debris flows were revealed, and based on which three typical river-blocking modes of debris flow are observed, i.e. thrust-type river blocking, mixed-flow-type river blocking and progressive river blocking. The test results showed that the material composition of debris flows plays an important role in the river-blocking mode, only the tests that adopted the mixed soil and gravel exhibited the thrust-type river blocking mode. The material composition has a controlling effect on the thrust-type river-blocking model. Mixed-flow-type river-blocking mode appears most often in the tests with an intersection angle of 60°, because the small intersection angle is conducive to the mixing of the debris flow and the water in the main channel. The debris flows composed of sand tend to block the river with mixed-flow-type river-blocking mode, accounting for 50% of the occurrences in the model tests. The high flow rate and discharge in the main channel and the low flow rate and discharge in the branch channel are the key factors controlling the progressive river-blocking mode. The test results in this study can support the debris flow disaster prevention and mitigation in this area.

Short-term changes in mental health help-seeking behaviors following exposure to multiple social stressors and a natural disaster.

In 2020, unprecedented circumstances led to significant mental health consequences. Individuals faced mental health stressors that extended beyond the devastating impact of the COVID-19 pandemic, including widespread social unrest following the murder of George Floyd, an intense hurricane season in the Atlantic, and the politically divisive 2020 election. The objective of this analysis was to consider changes in help-seeking behavior following exposure to multiple social stressors and a natural disaster. Data from Crisis Text Line (CTL), a national text-based mental health crisis counseling service, was used to determine how help-seeking behavior changed in the wake of each event. Wilcoxon rank sum tests assessed changes in help-seeking behavior for each event in 2020 as compared to the same period in 2019. AutoRegressive Integrated Moving Average (ARIMA) models examined if changes in crisis conversation volumes following each event differed. Higher median conversation volumes noted for the COVID-19 pandemic (+1 to +5 conversations), Hurricane Laura (+1 to +7 conversations) and the 2020 Election (+1 to +26 conversations). ARIMA models show substantial increases in help-seeking behavior following the declaration of a national emergency for the COVID-19 pandemic (+4.3 to +38.2%) and following the 2020 election (+3 to +24.44%). Our analysis found that the mental health response following social stressors may be distinct from natural events, especially when natural disasters occur in the context of multiple social stressors. This analysis adds to the growing body of literature considering the mental health impact of exposure to multiple co-occurring societal stressors, like police violence and a global pandemic.

Enhanced Arabic disaster data classification using domain adaptation.

Natural disasters, like pandemics and earthquakes, are some of the main causes of distress and casualties. Governmental crisis management processes are crucial when dealing with these types of problems. Social media platforms are among the main sources of information regarding current events and public opinion. So, they have been used extensively to aid disaster detection and prevention efforts. Therefore, there is always a need for better automatic systems that can detect and classify disaster data of social media. In this work, we propose enhanced Arabic disaster data classification models. The suggested models utilize domain adaptation to provide state-of-the-art accuracy. We used a standard dataset of Arabic disaster data collected from Twitter for testing the proposed models. Experimental results show that the provided models significantly outperform the previous state-of-the-art results.

Social media-based demographic and sentiment analysis for disaster responses.

This study explores disaster responses across the United States for Winter Storm Jaxon in 2018 by utilizing demographic and sentiment analysis for Twitter®. This study finds that people show highly fluctuated responses across the study periods and highest natural sentiment, followed by positive sentiment and negative sentiment. Also, some sociodemographic and Twitter variables, such as gender and long text, are strongly related to human sentiment, whereas other sociodemographic and Twitter variables, such as age and the higher number of retweets, are not associated with it. The results show that governments and disaster experts should consider a multitude of sociodemographic and Twitter variables to understand human responses and sentiment during natural disaster events.

Mobile Apps to Support Mental Health Response in Natural Disasters: Scoping Review.

BACKGROUND: Disasters are becoming more frequent due to the impact of extreme weather events attributed to climate change, causing loss of lives, property, and psychological trauma. Mental health response to disasters emphasizes prevention and mitigation, and mobile health (mHealth) apps have been used for mental health promotion and treatment. However, little is known about their use in the mental health components of disaster management. OBJECTIVE: This scoping review was conducted to explore the use of mobile phone apps for mental health responses to natural disasters and to identify gaps in the literature. METHODS: We identified relevant keywords and subject headings and conducted comprehensive searches in 6 electronic databases. Studies in which participants were exposed to a man-made disaster were included if the sample also included some participants exposed to a natural hazard. Only full-text studies published in English were included. The initial titles and abstracts of the unique papers were screened by 2 independent review authors. Full texts of the selected papers that met the inclusion criteria were reviewed by the 2 independent reviewers. Data were extracted from each selected full-text paper and synthesized using a narrative approach based on the outcome measures, duration, frequency of use of the mobile phone apps, and the outcomes. This scoping review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS: Of the 1398 papers retrieved, 5 were included in this review. A total of 3 studies were conducted on participants exposed to psychological stress following a disaster while 2 were for disaster relief workers. The mobile phone apps for the interventions included Training for Life Skills, Sonoma Rises, Headspace, Psychological First Aid, and Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioural Health Disaster Response Apps. The different studies assessed the effectiveness or efficacy of the mobile app, feasibility, acceptability, and characteristics of app use or predictors of use. Different measures were used to assess the effectiveness of the apps' use as either the primary or secondary outcome. CONCLUSIONS: A limited number of studies are exploring the use of mobile phone apps for mental health responses to disasters. The 5 studies included in this review showed promising results. Mobile apps have the potential to provide effective mental health support before, during, and after disasters. However, further research is needed to explore the potential of mobile phone apps in mental health responses to all hazards.

Natural disasters, livelihood, and healthcare challenges of the people of a riverine island in Bangladesh: A mixed-method exploration.

BACKGROUND: Bangladesh's islands, because of their geographical location, frequently encounter crises like floods and river erosion, which pose significant threats to the residents' well-being and livelihoods. To delve into the effects of these disasters on livelihood and healthcare challenges, a mixed-method study was undertaken in a riverine-island near a major river of Bangladesh. METHODOLOGY: Between February 15th and February 28th, 2023, a cross-sectional study was conducted on an island in Bangladesh. The quantitative method involved conducting a survey of 442 households, with a total of 2921 participants. Additionally, 10 in-depth interviews and 10 key-informant interviews were conducted using semi-structured guidelines. Qualitative interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Triangulation was employed in this study through the integration of qualitative and quantitative analysis, resulting in the presentation of findings that offer an in-depth comprehension of the phenomenon being investigated. RESULTS: River erosions and floods are common and recurring natural disasters that significantly impact the lives of the riverine island inhabitants. These disasters often disrupted their livelihoods, forced many residents to endure substandard living conditions or relocated during flood events. The island faced a low diagnostic prevalence of chronic diseases (e.g., 5.1% of adults were hypertension and 2.5% are diabetes) because of the absence of diagnostic facilities and a shortage of certified doctors. A significant number of chronic illness people in the community turned to alternative medicine sources (39.3%) such as homeopathy, Kabiraj, and Ayurvedic medicine, especially it gets increased during periods of natural disasters. Moreover, reproductive aged women revealed that 79.4% of them gave birth at home, with 6.0% of these home deliveries resulting in miscarriage or infant death. The destruction of crops, unstable job opportunities, an inadequate educational system, and a deficient healthcare delivery system exacerbated the hardships faced by the population affected by these disasters. CONCLUSION: The failure to seek treatment for chronic diseases and undiagnosed diseases is a significant health issue among the aging adults on the island. Island residents face the challenge of establishing effective prevention strategies for the well-being of older adults especially at the period of natural disasters. It is crucial for the government and non-governmental organizations (NGOs) to collaborate to prevent the negative effects of floods and river erosions. This should include efforts to enhance the quality of education, healthcare services, job opportunities, and financial assistance for rebuilding homes.

Mass Decontamination of Companion Dogs in Disaster: Planning for Personnel, Water, and Time Requirements.

OBJECTIVE: The importance of companion animals in the daily lives of people, and the increasing incidence and severity of natural disasters impacting people and their animals, is very well documented. However, despite the advancement of companion animal response capabilities, decontamination remains an inconsistently implemented component of disaster response. The challenge for local authorities is their need for planning factors and protocols specific to companion animal decontamination which are generally lacking. Data is provided on the average time requirements, water use and containment resources necessary, and the personnel required to decontaminate (decon) a large number of companion dogs. METHODS: Sixty-three lightly contaminated, medium weight, short to medium coat, highly tractable dogs (Labradors and Hounds) from a State facility colony were used to determine the water requirements, soap effectiveness, and time required to complete decon (washing/bathing). Data were collected over a 6-mo period using 2 personnel that were randomly assigned to wash the dogs. Difference in weight, bathing time, and water use between groups was evaluated using a 2-tailed 2-sample t-test for independent data. RESULTS: The time and water requirements were significantly different between medium coated dogs and short coated dogs. On average, for a short coated dog, the amount of time to complete decon was 7 min, and the amount of water was 8-10 gal. For medium coated dogs, the time increased to 10-12 min to complete the process and 12-15 gal water. DISCUSSION: The results of this study provide important insights emergency management planners, animal response team members, and community personnel tasked with implementation of mass decontamination of companion dogs following a natural or man-made disaster.

Reproductive health challenges during a flood: A qualitative study.

AIM: The study aimed to investigate women's reproductive health challenges during floods. DESIGN: This study is qualitative, specifically employing content analysis with an inductive approach. METHODS: Data were collected through in-depth, semi-structured individual interviews between July and December 2021. The study involved 13 women affected by floods in Golestan province, Aq Qala Township, and also included seven healthcare providers and officials. Before the interviews, informed and written consent was obtained from all participants. The sampling process continued until data saturation was achieved. RESULTS: The analysis of the participants' experiences in this study revealed four main categories of requirements, which were as follows: Maternal and Child Health with four subcategories, Essentials of Women's Health Care with two subcategories, Problems of Relationships with two subcategories, and Aggression and Physical Violence with two subcategories. In conclusion, during floods, women encounter numerous challenges in preserving their reproductive health. Recognizing and understanding these challenges can be instrumental in effectively planning measures to prevent or address them during disasters like floods. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT: Every disaster has unique conditions and challenges. The health requirements of individuals impacted by floods differ from those affected by other natural disasters. By identifying the specific reproductive health needs of women affected by floods, midwives and other healthcare providers can enhance their planning efforts, enabling them to better address and fulfil these needs during such critical situations. PATIENT OR PUBLIC CONTRIBUTION: Thirteen women were affected by floods, and seven healthcare providers and officials were interviewed.

A network analysis of Hurricane Maria-related traumatic stress and substance use among Puerto Rican youth.

Youth exposed to natural disasters are at risk of developing trauma-related symptoms as well as engaging in substance use. Although previous research has established associations between disaster-related stressors and substance use in youth, less has focused on how symptoms of posttraumatic stress disorder (PTSD) may underpin this association. The current study used network analysis to identify specific PTSD symptoms associated with substance use following a natural disaster. Participants were 91,732 youths (Grades 3-12) from across Puerto Rico who completed a needs assessment 5-9 months after Hurricane Maria made landfall in September 2017. We examined associations between PTSD symptoms and substance use, identified clusters of symptoms and bridges between them, and explored age- and binary gender-related differences in associations between specific PTSD symptoms and substance use. Analyses identified two symptom communities: (a) arousal and reactivity, negative alterations in cognition and mood, and substance use, and (b) avoidance and intrusion. Broader findings suggested that substance use was most strongly associated with PTSD-related irritability and angry outbursts among youths. Surrounding nodes explained only 4.1% of the variance in substance use, but this was higher among youths who reported not having a supportive adult, R2 = 8.5; friend, R2 = 7.9; or teacher/counselor, R2 = 7.7, in their life. The bridge symptoms of sleep disruption and physiological reactivity were identified as potentially critical intervention targets for disrupting PTSD symptom networks after a natural disaster. Implications for triaged mental health care following natural disasters and directions for future research are discussed.

Exploring the impact of recovery funding on the well-being and health workforce capability of rural practices during natural disasters and emergencies.

INTRODUCTION: This study examines the impact of funding provided to support the well-being of rural health practitioners and their practice staff following the 2019-2022 bushfires. OBJECTIVE: To assess the benefits and implications of grant funding for rural practices to aid recovery following bushfires in NSW, Australia. DESIGN: An explanatory sequential mixed method design consisted of a survey and a thematic analysis of semi-structured Interviews. FINDINGS: Five key themes emerged from analysis: (1) the disasters altered the role of the practice and therapeutic relationships; (2) the funding had a positive impact on access to professional development; (3) the training had a positive impact on staff well-being and resilience; (4) the professional development had a positive impact on rural practitioner's sense of capability; and (5) important elements of future grant opportunities. DISCUSSION: The findings indicate the importance of recovering funding to facilitate access to professional development for rural health practioners during natural disasters which improved their mental health and wellbeing, capability and support to clients. CONCLUSION: Recovery funding facilitated improvement in workforce capability, professional resilience, mental health and well-being in the face of natural disasters and emergencies. There was a link between training and maintaining the capability of rural health care practitioners and their practice staff. Capability was an important factor in the well-being and resilience of the health workforce and their ability to support clients.