Topic Collection Cover Page

Natural Disasters
Topic Collection
November 14, 2019

Topic Collection: Natural Disasters

Natural disasters and their consequences (e.g., flooding, injuries experienced during clean up) can wreak havoc on healthcare facilities and the communities they serve. It is important for emergency planners to enroll in alert systems, monitor weather forecasts and have a solid natural disaster or all hazards facility response plan that complements their jurisdiction’s plan. The resources in this Topic Collection highlight lessons learned from recent events, communication tools and information, and checklists, plans, tools, and templates that can be modified to suit specific threats and needs. Articles in this Topic Collection address specific natural disasters and hazards and elements of their planning, but do not address all-hazard planning or specifics of clinical care which may be found in other topic collections.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads


This report shares workshop findings on increasing and improving the resilience of healthcare facilities and services to high-impact weather events. The workshop grouped their findings into three main categories: hardening structures, making incremental adaptations, and implementing innovative practices.
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Arnold, C., Holmes, W., Quinn, R., et al. (2007). Design Guide for Improving Hospital Safety in Earthquakes, Floods, and High Winds. Federal Emergency Management Agency.
This design guide can inform and help design professionals, hospital administrators, and facility managers employ sound mitigation measures that will decrease the vulnerability of hospitals to disruptions from natural hazard events (e.g., earthquakes, high wind events, floods).
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Bernard, S. and McGeehin, M.A. (2004). Municipal Heat Wave Response Plans. American Journal of Public Health. 94(9):1520.
The authors review heat wave plans from 18 cities and list recommendations for overcoming challenges (e.g., targeted outreach geared towards the socially isolated, begin prevention efforts before high temperatures arrive, and collect and use data to determine the effectiveness of interventions).
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Centers for Disease Control and Prevention. (2011). Extreme Heat and Your Health: Media Toolkit.
The materials on this webpage include a toolkit, web tools, and press release and other templates that can help community leaders develop communication plans for extreme heat events.
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Children's Hospital and Research Center Oakland. (n.d.). Children's Hospital Earthquake Response Guide. (Accessed 10/20/2015.)
The goal of this plan is to maintain hospital operations for at least four days after a major earthquake and to ensure that care continues for patients, visitors, and survivors of the earthquake. This plan can be adapted to meet the needs of hospital emergency response professionals and healthcare preparedness planners.
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City of New York, Department of Health and Mental Hygiene. (2013). Heat Wave Preparedness Checklists for Vulnerable Population Service Providers.
These checklists can help healthcare and other service providers identify vulnerable residents at highest risk for heat-related illnesses.
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Committee on Public Response to Alerts and Warnings on Mobile Devices: Current Knowledge and Research Gaps; National Research Council. (2011). Public Response to Alerts and Warnings on Mobile Devices: Summary of a Workshop on Current Knowledge and Research Gaps. (Free registration required for download.)
This book provides a summary of conference proceedings where risk communications experts discussed the public response to mobile alerts.
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Novation. (n.d.). Emergency Disaster Plan Template. (Accessed 9/5/2019.)
Healthcare facility emergency planners can use this template when developing their emergency operations plan. It features 12 disaster scenarios, including: hurricane, tornadoes, structure fires, earthquakes, and extreme cold.
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Office of the Assistant Secretary for Preparedness and Response. (2019). National Health Security Strategy. U.S. Department of Health and Human Services.
The goal of the National Health Security Strategy (NHSS) is to strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies. This webpage includes links to the full text of the plan, an overview, the NHSS Implementation Plan, the NHSS Evaluation of Progress, and an NHSS Archive.
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Redman, S., Fromknecht, C., Hodge, S., et al. (2017). Death Scene Investigation After Natural Disaster or Other Weather-Related Events. Centers for Disease Control and Prevention.
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Reynolds, M. (n.d.). The Joplin Tornado: The Hospital Story and Lessons Learned. (Accessed 10/16/2019.) Leading Age Missouri.
The speaker focused on four main areas: the impact of an unexpected natural disaster on healthcare services; how the nation responded to help the Joplin community; how to incorporate lessons learned into planning; and how to design enhancements that can protect against future incidents.
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Saulnier, D.D., Brolin Ribacke, K., and von Schreeb, J.. (2017). No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters. Prehospital and Disaster Medicine. 32(5): 568-579.
The authors conducted a literature review to examine health problems following flood and storm disasters. They found that illness mainly occurred within four weeks of these events. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections increased after storms; gastrointestinal infections were more likely to occur after flood events.
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The speaker presents an in-depth overview of the hospital response to earthquakes that struck California in 1971 and 1994. He divided his findings by functional and non-functional hospitals, and presented information on communication challenges, staff behavior (e.g., decisions to report to work), and potential sources of assistance should a similar earthquake strike the Jerusalem area of Israel.
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Shroades, R. (2007). Flood Preparedness: Once Bitten, Twice Ready. Facility Maintenance Decisions.
This article documents how facility staff from Memorial Hermann Hospital incorporated lessons learned after Tropical Storm Allison flooded the facility with almost 40 feet of water in 2001.
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Sugerman, D. and Armstrong, J. (2013). Prevention and Treatment of Injuries Following Hurricanes and Tornadoes. Centers for Disease Control and Prevention.
This one-hour webinar covers the provision of pre-hospital care; the patterns of injury seen after hurricanes and tornadoes, including appropriate initial management; appropriate emergency risk communication messages; and the importance of data collection to improve messaging and response efforts.
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This editorial provides an overview of factors and issues to consider during heatwaves. The article includes links to the report authored by the World Health Organization and World Meteorological Organization, guidance from the Centers for Disease Control and Prevention, and other applicable webpages.
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This report summarizes presentations made at a 2012 workshop organized by the Committee on Public Response to Alerts and Warnings Using Social Media. Chapters cover the fundamentals of alerts, warnings, and social media; how social media is used in emergencies; the dynamics of social media; message credibility; privacy and legal issues; and research gaps and other challenges.
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This report summarizes presentations made at a 2012 workshop organized by the Committee on Public Response to Alerts and Warnings Using Social Media. Chapters cover the fundamentals of alerts, warnings, and social media, how social media has been used in emergencies by local agencies, the dynamics of social media, message credibility, privacy and legal issues, and research gaps and other challenges.
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U.S. Department of Health and Human Services. (2014). Primary Protection: Enhancing Health Care Resilience for a Changing Climate.
This 86-page document is a guide and toolkit designed to assist healthcare providers, design professionals, policymakers, and others with roles and responsibilities in assuring the continuity of quality health and human care before, during, and after extreme weather events. It is focused on healthcare infrastructure resilience to climate change impacts as manifested primarily by extreme weather events.
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U.S. Department of Health and Human Services. (2016). Climate Resilient Health Care Facilities Toolkit.
This online toolkit can help healthcare facility planners learn more about implementing best practices in climate resilience. It is based on a framework composed of the following five elements: Climate Risks and Community Vulnerability Assessment; Land Use, Building Design, and Regulatory Context; Infrastructure Protection and Resilience Planning; Essential Clinical Care Service Delivery Planning; and Environmental Protection and Ecosystem Adaptations.
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U.S. Environmental Protection Agency, Office of Atmospheric Programs. (2006). Excessive Heat Events Guidebook.
This guidebook identifies best practices that have been implemented to save lives during excessive heat events in various urban areas. It provides critical information needed to help local public health officials, emergency managers, meteorologists, and others assess their community’s vulnerability to excessive heat waves, and develop and implement notification and response programs.
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At-Risk Populations


* California Department of Public Health. (2019). Wildfire Smoke: Considerations for California's Public Health Officials.
This document contains information about the health effects of wildfire smoke, strategies to reduce exposure, and potential public health actions. Links to additional resources are provided throughout the document and in the appendices.
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California Office of Statewide Health & Planning Development. (2015). Skilled Nursing Facilities.
The guidelines included on this webpage can help healthcare facility staff ensure they are in compliance with earthquake-related codes.
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* City of New York, Department of Health and Mental Hygiene. (2013). Heat Wave Preparedness Checklists for Mental Health Service Providers.
These checklists can help mental health service providers identify consumers and vulnerable residents at highest risk for heat-related illnesses.
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* City of New York, Department of Health and Mental Hygiene. (2013). Heat Wave Preparedness Checklists for Vulnerable Population Service Providers.
These checklists can help healthcare and other service providers identify vulnerable residents at highest risk for heat-related illnesses.
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Heid, A., Christman, Z., Pruchno, R., et al. (2016). Vulnerable, but Why? Post-traumatic Stress Symptoms in Older Adults Exposed to Hurricane Sandy. (Free registration required.) Disaster Medicine and Public Health Preparedness. 10(3):362-70.
Post-traumatic stress disorder symptoms were much more likely in elderly persons affected by Hurricane Sandy who had lower levels of income, positive affect, employment, and other factors that may allow for targeted interventions to increase pre-event resilience and promote post-event recovery.
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To facilitate discussions about emergency preparedness, the National Health Care for the Homeless Council has developed a series of weather-specific informational flyers specifically for people who lack housing. These resources were created with input from people who are formerly and currently homeless and  may be of interest to public health educators, emergency management officials, homeless service providers, and homeless community leaders.
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Alerts, Warnings, and Communications


This study investigated whether non-traditional data (i.e., tweets and news reports) fill a void in traditional data reporting during hurricane response, as well as whether non-traditional data improve the timeliness for reporting identified HHS Essential Elements of Information (EEI).
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Burger, J., Gochfeld, M., Jeitner, C., et al. (2013). Trusted Information Sources Used During and After Superstorm Sandy: TV and Radio Were Used More Often Than Social Media. Journal of Toxicology and Environmental Health. 76(20):1138-50.
The authors examined information sources used for Superstorm Sandy with respect to the storm, evacuation routes, shelters, safety, and health issues in Central New Jersey and Jersey Shore communities. They conclude that the reliance on traditional sources of information (i.e., TV, radio, friends) observed suggests that the extreme power outages made web, cell phones, and social media on cell phones less usable.
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* Centers for Disease Control and Prevention. (2011). Extreme Heat and Your Health: Media Toolkit.
The materials on this webpage include a toolkit, web tools, and press release and other templates that can help community leaders develop communication plans for extreme heat events.
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Committee on Public Response to Alerts and Warnings on Mobile Devices: Current Knowledge and Research Gaps; National Research Council. (2011). Public Response to Alerts and Warnings on Mobile Devices: Summary of a Workshop on Current Knowledge and Research Gaps. (Free registration required for download.)
This book provides a summary of conference proceedings where risk communications experts discussed the public response to mobile alerts.
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Users can register to subscribe to local weather, health, homeland security and cybercrime alerts delivered by email and/or text message.
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Genes, N., Chary, M., and Chason, K. (2014). Analysis of Twitter Users' Sharing of Official New York Storm Response Messages. Medicine 2.0. 3(1):e1.
The authors evaluated official New York City tweets related to Superstorm Sandy (2012) and winter storm Nemo (2013) and how often they were re-tweeted. They found that information was shared beyond existing follower bases; official tweets during Sandy had lower lexical diversity, with links to more information, and were retweeted more than unofficial Sandy tweets; and NEMO-related tweets containing more general information were retweeted more often than those containing actionable information.
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Harris Smith, S., Bennett, K.J., and Livinski, A.A. (2014). Evolution of a Search: The Use of Dynamic Twitter Searches During Superstorm Sandy. PLoS Currents. 6: ecurrents.dis.de9415573fbf90ee2c585cd0b2314547.
The authors describe how they used Twitter for situational awareness during Superstorm Sandy in 2012.
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National Weather Service. (n.d.). Email and SMS Weather Alert Services. (Accessed 10/20/2015.)
The National Weather Service provides links to federal and external alert and warning sources.
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National Weather Service. (2011). Tsunami Message Subscriptions.
The National Weather Service provides links to sources that provide tsunami event messages.
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* National Wildfire Coordinating Group. (2015). InciWeb.
This webpage provides up-to-date information on wildfires across the country. Users can search by state or incident name. Photographs, announcements, and news articles are also included.
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This report summarizes presentations made at a 2012 workshop organized by the Committee on Public Response to Alerts and Warnings Using Social Media. Chapters cover the fundamentals of alerts, warnings, and social media; how social media is used in emergencies; the dynamics of social media; message credibility; privacy and legal issues; and research gaps and other challenges.
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This report summarizes presentations made at a 2012 workshop organized by the Committee on Public Response to Alerts and Warnings Using Social Media. Chapters cover the fundamentals of alerts, warnings, and social media, how social media has been used in emergencies by local agencies, the dynamics of social media, message credibility, privacy and legal issues, and research gaps and other challenges.
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* U.S. Department of Health and Human Services. (2015). GeoHealth Platform.
This tool provides central access to federal disaster and public health related natural disaster alerts, warnings, and other resources. One tab contains a map that illustrates CMS Electrically Dependent by state.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). HHS emPOWER Map 3.0.
Healthcare providers, electric company representatives, and community members can use this map to find the monthly total of Medicare beneficiaries with electricity-dependent equipment claims at the U.S. state, territory, county, and zip code level and enable “real-time” NOAA severe weather tracking services to identify areas and populations that may be at risk of/impacted by power outages.
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U.S. Geological Survey. (2014). Earthquake Notification Service. U.S. Department of the Interior.
The U.S. Geological Survey provides this free service that notifies users when earthquakes occur in their area.
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World Meteorological Organization and World Health Organization. (2015). Heatwaves and Health: Guidance on Warning-System Development.
These guidelines provide an overview of general heat–health problem and describe how an understanding of the biometeorology, epidemiology, public-health and risk-communication aspects of heat as a hazard can be used to inform the development of a heat-health warning system (HHWS) as part of a wider heat-health action plan (HHAP).
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Education and Training


American Geosciences Institute. (2015). Communicating Cascadia's Earthquake Risk.
The speakers in this webinar discuss the earthquake risk in the Cascadia subduction zone in the Pacific Northwest. Challenges for planners and communication and mitigation strategies are also discussed.
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Federal Emergency Management Agency, Emergency Management Institute. (2013). IS-271.A: Anticipating Hazardous Weather & Community Risk, 2nd Edition.
This 9-hour course covers: weather basics and forecasting; threats analysis and hazards planning; fact sheets for weather and non-weather-related hazards; warning partnership information; and human behavior and community response.
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Federal Emergency Management Agency, Emergency Management Institute. (2013). IS-324.A: Community Hurricane Preparedness.
This 10-hour course is targeted to those involved in the decision making process for hurricanes and includes basic information about: how hurricanes form and the hazards they pose; how the National Weather Service (NWS) forecasts future hurricane behavior; and what tools and guiding principles can help emergency managers prepare their communities.
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Federal Emergency Management Agency, Emergency Management Institute. (2013). IS-325: Earthquake Basics: Science, Risk, and Mitigation.
This 30-minute course presents basic information on earthquake science, risk, and mitigation. It also discusses techniques for structural and non-structural earthquake mitigation.
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Federal Emergency Management Agency, Emergency Management Institute. (2013). IS-326: Community Tsunami Preparedness.
This 6-hour course helps emergency managers prepare their communities for tsunamis. It covers basic tsunami science, hazards produced by tsunamis, regional U.S. tsunami risks, the tsunami warning system, the importance of public education activities, and how to craft good emergency messages and develop tsunami response plans.
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U.S. Environmental Protection Agency. (2019). Wildfire Smoke and Your Patients' Health.
The course can help physicians, registered nurses, asthma educators and others learn about the negative health effects associated with wildfire smoke. Participants will also learn what to encourage patients to do to prepare for and minimize exposure to smoke during a wildfire.
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General Hazard Mitigation and Utilities Failure


* Banatin, C. and Go, M. (2010). Safe Hospitals in Emergencies and Disasters: Structural, Non-Structural and Functional Indicators. World Health Organization, Regional Office for the Western Pacific.
This vulnerability assessment highlights structural, non-structural, and functional elements that must be considered to ensure that a health facility can withstand and remain operational in emergencies.
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The author recounts the challenges associated with providing care in a university hospital’s neonatal intensive care unit before, during, and after Hurricane Katrina made landfall.
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New Mexico Department of Homeland Security and Emergency Management. (2018). New Mexico State Hazard Mitigation Plan.
This plan describes how to identify, assess, and mitigate natural hazards in New Mexico. It also addresses mitigation planning requirements for federal hazard mitigation grant funding.
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Novation. (n.d.). Emergency Disaster Plan Template. (Accessed 9/5/2019.)
Healthcare facility emergency planners can use this template when developing their emergency operations plan. It features 12 disaster scenarios, including: hurricane, tornadoes, structure fires, earthquakes, and extreme cold.
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U.S. Department of Health and Human Services. (2014). Primary Protection: Enhancing Health Care Resilience for a Changing Climate.
This 86-page document is a guide and toolkit designed to assist healthcare providers, design professionals, policymakers, and others with roles and responsibilities in assuring the continuity of quality health and human care before, during, and after extreme weather events. It is focused on healthcare infrastructure resilience to climate change impacts as manifested primarily by extreme weather events.
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* U.S. Department of Health and Human Services. (2015). GeoHealth Platform.
This tool provides central access to federal disaster and public health related natural disaster alerts, warnings, and other resources. One tab contains a map that illustrates CMS Electrically Dependent by state.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (n.d.). Working Without Technology: How Hospitals and Healthcare Organizations Can Manage Communication Failure. (Accessed 7/12/2019.)
This fact sheet summarizes steps a healthcare facility can take to ensure communication during incident response when normal technologies fail.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2014). Planning for Power Outages: A Guide for Hospitals and Healthcare Facilities.
This document highlights issues for healthcare facilities to consider regarding power outages. It also provides a checklist of key planning considerations, and recommendations for fostering a relationship with a facility's utility company.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2014). Planning for Water Supply Interruptions: A Guide for Hospitals & Healthcare Facilities.
This document provides information on the impact of water loss on healthcare facilities, and a series of questions for planners to use to prepare their facilities for water service interruptions.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). Healthcare and Public Health (HPH) Risk Identification and Site Criticality (RISC) Toolkit.
This objective, data-driven all hazards risk assessment can be used to inform emergency preparedness planning and risk management activities. The toolkit consists of three self-assessment modules allowing healthcare facilities to: identify site-specific threats and hazards; assess site-specific vulnerabilities; and evaluate criticality and consequences. (A related webinar explains the toolkit in more detail: https://files.asprtracie.hhs.gov/documents/aspr-risc-toolkit-webinar-slides-final-508.pdf.)
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  • Tony Barker Great tool that has very effective resource links. Makes the HVA process evidence based and provides an excellent format for use. Thank you to the development team!
    12/12/2018 12:56:36 PM

Lessons Learned: Earthquakes


Ardagh, M.W., Richardson, S.K., Robinson, V., et al. (2012). The Initial Health-System Response to The Earthquake in Christchurch, New Zealand, in February, 2011. (Article free with registration.) Lancet.379(9831):2109-15.
The authors describe their experiences and lessons learned working in the emergency department of the only regional acute care hospital following the 2011 New Zealand earthquake. They note that emergency department response plans should account for patients arriving in atypical ways; loss of power; the need for paper registration and tracking systems; volunteer management; and teamwork with clear leadership, among other things.
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Burnweit, C. and Stylianos, S. (2011). Disaster Response in a Pediatric Field Hospital: Lessons Learned in Haiti. (Abstract only.) Journal of Pediatric Surgery. 46(6):1131-9.
The authors describe their experiences in a pediatric field hospital in Haiti following the 2010 earthquake. They discuss requirements for equipment, manpower, medical records, and systems addressing volunteer stress, as well as ethical issues. They also note that 93% of casualties initially were surgical admissions with 40% undergoing operations in the first week after the event, mostly for fractures and wound care.
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Fuse, A. and Yokota, H. (2012). Lessons Learned From the Japan Earthquake and Tsunami, 2011. Journal of Nippon Medical School. 79(4):312-5.
The authors discuss lessons learned from the 2011 Japanese earthquake and tsunami, and present a graphic entitled the "chain of survival for disasters" to help guide decision-makers and emergency response planners during natural disasters.
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* Geiger, A., Kawauchi, K., and Bellamy, S. (2015). Innovative Disaster Responses Model Approaches from Japan's 3/11 Disaster. Japan Center for International Exchange.
The authors present four examples of initiatives that helped communities recover from Japan's earthquake/tsunami "3/11 Disaster." They stress the important role of healthcare providers in ensuring access to care and reducing stressors in survivors.
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Kang, P., Zhang, L., Liang, W., et al. (2012). Medical Evacuation Management and Clinical Characteristics of 3,255 Inpatients after the 2010 Yushu Earthquake in China. (Abstract only.) Journal of Trauma and Acute Care Surgery. 72(6): 1626-1633.
The authors conducted a medical analysis of injuries and diseases after an earthquake that struck a remote, high-altitude region. They listed related challenges and suggestions for future healthcare provider training topics.
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Kirsch, T., Mitrani-Reiser, J., Bissell, R., et al. (2010). Impact on Hospital Functions Following the 2010 Chilean Earthquake. (Free registration required.) Disaster Medicine and Public Health Preparedness. 4(2); 122-128.
The authors describe loss of functions and structural damage experienced by hospitals in Chile following a major earthquake. Loss of communications capability was cited by hospital administrators surveyed as being most problematic.
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* Li, X.H., Hou, S.K., Zheng, J.C., et al. (2012). Post-Disaster Medical Rescue Strategy in Tropical Regions. World Journal of Emergency Medicine. 3(1): 23-28.
The authors analyze the medical response to earthquakes and tsunamis in tropical regions and found that shock, infection, and heat stroke were frequently encountered by survivors.
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Lorich, D.G., Jeffcoat, D.M., MacIntyre, N.R., et al. (2010). The 2010 Haiti Earthquake: Lessons Learned? (First page only.) Techniques in Hand and Upper Extremity Surgery. 14(2):64-8.
The authors discuss how the assumptions and planning for their orthopedic surgery team deployed to assist after the 2010 Haiti earthquake were "naïve," and they present their lessons learned.
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* Miller, A. C. and Arquilla, B. (2008). Chronic Diseases and Natural Hazards: Impact of Disasters on Diabetic, Renal, and Cardiac Patients. Prehospital and Disaster Medicine. 23(2): 185-94.
The authors reviewed resources from PubMed, Ovid, and Medline combined with real-life experience treating chronic disease after disasters. They found that the international nephrology community had formed an effective organization (the Renal Disaster Relief Task Force), and emphasize that patients have emergency diet and renal fluid restriction plans and be prepared to modify dialysis schedules and methods. Suggestions for facilities are also provided.
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* Nagamatsu, S., Maekawa, T., Ujike Y., et al. (2011). The Earthquake and Tsunami--Observations by Japanese Physicians Since the 11 March Catastrophe. Critical Care. 15(3):167.
The authors discuss how lessons learned from the 1995 Hanshin earthquake and effective use of the Internet for communication and coordination assisted with the response to the 2011 earthquake and tsunami. They also describe and compare the injuries and causes of death for the two events.
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Peleg, K. and Kellerman, A. (2012). Medical Relief After Earthquakes: It’s Time for a New Paradigm. (First page only.) Annals of Emergency Medicine. 59:188-190.
The authors discuss lessons learned from recent earthquakes worldwide and explore how resources spent on search and rescue missions may diminish resources available for other needs, including healthcare.
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Rajpura, A., Boutros, I., Khan, T., and Khan, S.A. (2010). Pakistan Earthquake: Experiences of a Multidisciplinary Surgical Team. (Abstract only.) Pre-hospital and Disaster Medicine. 25(4):361-7.
The authors describe the injuries encountered in the weeks following the Pakistan earthquake in 2005, and the joint efforts by orthopedic and plastic surgeons that were required to treat them.
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Sanford, C. (2010). Post-Earthquake Medicine in Haiti: Disaster Relief at a Field Hospital. (Free registration required.) University of Washington, Northwest Center for Public Health Practice.
In this one-hour Hot Topics webinar, Dr. Sanford shares his experiences and reflects upon lessons learned that may have important implications for public health planning and response to major disasters.
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Sasabuchi, Y., Matsui, H., Yasunaga, H., and Fushimi K. (2016). Increase in Avoidable Hospital Admissions after the Great East Japan Earthquake. (Abstract only.) Journal of Epidemiology and Community Health. 71(3):248-252.
Early intervention may reduce avoidable hospital admissions for new acute conditions in the months following an area impacted by a natural disaster.
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The speaker presents an in-depth overview of the hospital response to earthquakes that struck California in 1971 and 1994. He divided his findings by functional and non-functional hospitals, and presented information on communication challenges, staff behavior (e.g., decisions to report to work), and potential sources of assistance should a similar earthquake strike the Jerusalem area of Israel.
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van Berlaer, G., Staes, T., Danschutter, D., et al. (2016). Disaster Preparedness and Response Improvement: Comparison of the 2010 Haiti Earthquake-Related Diagnoses with Baseline Medical Data. (Abstract only.) European Journal of Emergency Medicine. 24(5):382-388.
This article provides a comparison of pre-event and the two years post-event diagnoses of patients seen up to one month post-earthquake in the same location.
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Wong, H.T. and Li, S. (2016). Healthcare Services Demand in Post-disaster Settings: The 2014 Earthquake in Ludian County, Yunnan Province, China. International Journal of Disaster Risk Science. 7(4):445-449.
The authors conducted a cross-sectional, records-based study of 2,484 records obtained from a temporary hospital to investigate patterns of healthcare service demand for a rural displaced population following the 2014 Ludian County earthquake. They found that healthcare service demand from younger age groups was higher than that of the older adult group, and observed three major health problems: respiratory disease, skin problems, and ear, eye, and throat (EET) problems.
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* Yonekura, T., Ueno, S., and Iwanaka, T. (2013). Care of Children in a Natural Disaster: Lessons Learned from the Great East Japan Earthquake and Tsunami. (Abstract only.) Pediatric Surgery International. 29(10): 1047-1051.
The authors incorporate lessons learned from the Fukushima disaster into response recommendations for pediatric surgeons and physicians.
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Zhang, B., Liu, Z., Lin, Z., et al. (2012). Microbiologic Characteristics of Pathogenic Bacteria From Hospitalized Trauma Patients Who Survived Wenchuan Earthquake. (Abstract only.) European Journal of Clinical Microbiology & Infectious Diseases. 31 (10): 2529-2535.
The authors characterize the bacteria isolated from trauma patients following the 2008 Wenchuan earthquake, and associated antibiotic susceptibilities. They found that the distribution spectrum of pathogens isolated from trauma patients after the earthquake was different from that for non-earthquake trauma patients in the same hospital at the same time.
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Lessons Learned: Extreme Heat


Altman, P., Lashof, D., Knowlton, K., et al. (2012). Killer Summer Heat: Projected Death Toll from Rising Temperatures in America Due to Climate Change. Natural Resources Defense Council.
The authors of this report analyze the results of independent peer-reviewed scientific papers and present the findings of increasing heat-related mortality due to global warming for the 40 largest U.S. cities. Their findings indicate that rising temperatures, driven by persistent climate change, will increase the number of life-threatening excessive heat events.
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Anderson, B. and Bell, M. (2009). Weather-Related Mortality: How Heat, Cold, and Heat Waves Affect Mortality in the United States. Epidemiology. 20(2): 205–213.
The authors applied time-series models to a 14-year dataset featuring 107 U.S. communities to relate cold, heat, and heat wave effect estimates to community-specific variables (e.g., socioeconomic factors and urbanicity).
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The authors looked at 292,666 cardiovascular and 562,738 respiratory disease Emergency Department (ED) visits over an eight-year period in Toronto. They found that: diabetics exposed to extreme heat had more ED visits vs. non-diabetics; respiratory disease ED visits during hot weather were higher for individuals with comorbid respiratory diseases and cancer; exposure to extreme cold temperatures over a 2-week period increased cardiovascular disease ED visits for individuals with comorbid cardiovascular diseases, and kidney diseases.
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This editorial provides an overview of factors and issues to consider during heatwaves. The article includes links to the report authored by the World Health Organization and World Meteorological Organization, guidance from the Centers for Disease Control and Prevention, and other applicable webpages.
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U.S. Environmental Protection Agency, Office of Atmospheric Programs. (2006). Excessive Heat Events Guidebook.
This guidebook identifies best practices that have been implemented to save lives during excessive heat events in various urban areas. It provides critical information needed to help local public health officials, emergency managers, meteorologists, and others assess their community’s vulnerability to excessive heat waves, and develop and implement notification and response programs.
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Lessons Learned: Extreme Cold


Burstein, G., Blank, J., Fricano Chalmers, T., et al. (2015). Notes from the Field: Snowstorm-Related Mortality — Erie County, New York, November 2014. Morbidity and Mortality Weekly Report (MMWR). 64(33);920-921.
The authors describe a recent snowstorm that exceeded weather forecasts and contributed to 11 deaths in Southern Erie County (NY). Most of these deaths were "potentially preventable," and the Centers for Disease Control and Prevention developed a winter weather checklist to emphasize the importance of preparing for similar weather events.
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Giang, P.N., Dung do V., Bao Giang, K., et al. (2014). The Effect of Temperature on Cardiovascular Disease Hospital Admissions Among Elderly People in Thai Nguyen Province, Vietnam. Global Health Action. 7:23649.
Cardiovascular disease (CVD) admissions from four hospitals over 5 years were merged with weather data to determine if temperature affected hospital admissions among elderly people with CVD. The authors found that CVD admissions increased in the elderly during a period of 4-15 days following exposure to extreme cold, peaking at around a week's time after exposure.
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Hughes, H.E., Morbey, R., Hughes, T.C., et al. (2014). Using an Emergency Department Syndromic Surveillance System to Investigate the Impact of Extreme Cold Weather Events. (Abstract only.) Public Health. 128(7):628-35.
The authors looked at syndromic surveillance data from England for the 2010-11 and 2011-12 winters to characterize cold weather-related Emergency Department visits. The authors found that the strongest fit with temperature was cold-related fractures in females, and strongest fit for snowfall was cold-related fractures in both sexes.
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The authors looked at 292,666 cardiovascular and 562,738 respiratory disease Emergency Department (ED) visits over an eight-year period in Toronto. They found that: diabetics exposed to extreme heat had more ED visits vs. non-diabetics; respiratory disease ED visits during hot weather were higher for individuals with comorbid respiratory diseases and cancer; exposure to extreme cold temperatures over a 2-week period increased cardiovascular disease ED visits for individuals with comorbid cardiovascular diseases, and kidney diseases.
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Meiman, J., Anderson, H., and Tomasallo, C. (2015). Hypothermia-Related Deaths — Wisconsin, 2014, and United States, 2003–2013. Morbidity and Mortality Weekly Report. 64(06);141-143.
This MMWR describes three selected cases of hypothermia-related deaths in Wisconsin, and summarizes risk factors based on all cases that occurred in the state during the period of active surveillance in 2014. A summary of hypothermia-related deaths for the United States during 2003–2013 also is presented for comparison.
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Qiu, H., Tian, L., Ho, K., et al. (2015). Who is More Vulnerable to Death from Extremely Cold Temperatures? A Case-Only Approach in Hong Kong With a Temperate Climate. (Abstract only.) International Journal of Biometereology. 1-7.
The authors looked at 197, 680 deaths from natural causes, air temperature, and air pollution rates from November to April for 9 consecutive years. They found that individuals aged 85 and older, and those with cardiovascular diseases (including hypertensive diseases, stroke, congestive heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia) had the greatest risk of death from exposure to extreme cold temperatures.
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Lessons Learned: Fire/Wildfire


Staff from Kaiser Hospital Santa Rosa (CA) share their personal experiences with the 2017 wildfire and professional experiences evacuating a hospital in the midst of one.
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Centers for Disease Control and Prevention. (2015). Protect Yourself from Wildfire Smoke.
The information on this webpage can help first responders and community members understand the risk and protect themselves from the effects of wildfire smoke.
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Coleman, K., Marsh, M., and Henrickson, B. (2019). Northern California Wildfires and Lessons Learned: Medical Health Response and Shelters. County of Marin Health and Human Services.
This 2.5 hour recording features speakers from the state and two counties sharing lessons learned from the northern California wildfires of 2017 specific to the medical health response and the need for shelters.
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Finlay, S.E., Moffat, A., Gazzard, R., et al. (2012). Health Impacts of Wildfires. PLOS Currents Disasters. Nov 2;4:e4f959951cce2c.
The authors conducted a comprehensive literature review of international research on wildfire-related health effects and led several focus groups with study authors. Results indicated that certain populations are especially vulnerable; wood smoke has high toxicity levels; respiratory morbidity is the leading health effect, wildfire exposure is also associated with burns (and related effects) and cardiovascular, ophthalmic, and psychiatric problems.
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Readers can learn about how smoke from wildfires—both near and far—can have an effect on health. Maps that show how smoke from wildfires in 2011 affected many areas of the U.S. are included.
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Lessons Learned: Floods and Landslides


Apisarnthanarak, A., Mundy, L., Khawcharoenporn, T., et al. (2013). Hospital Infection Prevention and Control Issues Relevant to Extensive Floods. (Abstract only.) Infection Control and Hospital Epidemiology. 34(2): 200-206.
In this article, the authors discuss infection prevention and control experiences related to the reopening of medical facilities after recent disasters in Thailand and the U.S.
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Bandino, J.P., Hang, A., and Norton, S.A. (2015). The Infectious and Noninfectious Dermatological Consequences of Flooding: A Field Manual for the Responding Provider. American Journal of Clinical Dermatology. 16(5): 399-424.
The authors provide information for clinicians caring for flood victims. They describe the conditions seen in patients following floods, and characterize the causative agents of these conditions. Treatment is also discussed.
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Goldbaum, G. (2014). Public Health's Response to the Oso Mudslide. (Free registration required.) University of Washington, Northwest Center for Public Health Practice.
This one-hour webinar features Gary Goldbaum of the Snohomish Health District who shares how his health district worked with partner agencies in response to the Oso, Washington mudslide in March 2014. He also discusses the roles of public health when responding to a mass fatality disaster, key barriers to effective response during a mass fatality disaster, strategies for overcoming those barriers, and key partners for assuring effective response to a mass fatality disaster.
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Kshirsagar, N., Shinde R., and Mehta, S. (2006). Floods in Mumbai: Impact of Public Health Service by Hospital Staff and Medical Students. Journal of Postgraduate Medicine. 52(4): 312-314.
This article discusses the impact of the Mumbai floods and the provision of shelter-based and community care for over 150,000 cases of diarrhea, many consistent with leptospirosis by hospital staff and medical students, detailing the substantially increased risk of communicable disease during flooding events with poor sanitary conditions.
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* Lane, K., Charles-Guzman, K., Wheeler K., et al. (2013). Health Effects of Coastal Storms and Flooding in Urban Areas: A Review and Vulnerability Assessment. Journal of Environmental and Public Health. Article ID 913064.
The authors provide a review of the health impacts of U.S. coastal storms, with a focus on outcomes relevant to New York City (NYC) and urban coastal areas, and incorporate lessons learned from Superstorm Sandy. Based on the literature reviewed, indicators of health vulnerability were selected and mapped within NYC neighborhoods.
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* McMichael, A.J. (2015). Extreme Weather Events and Infectious Disease Outbreaks. (Abstract only.) Virulence. 6(6):539-43.
The author discusses infectious disease risks associated with extreme weather events, drawing on recent experiences, including Hurricane Katrina in 2005 and the 2010 Pakistan mega-floods. Historical examples from previous centuries of epidemics and "pestilence" associated with extreme weather disasters and climatic changes are also discussed.
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Ms. Quinn, a Medical Reserve Corps (MRC) Coordinator with Snohomish Health District, discusses the MRC response to the 2014 flooding and mudslide in Washington state.
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Pereira, B., Morales W., Cardoso, R., et al. (2013). Lessons Learned From a Landslide Catastrophe in Rio de Janeiro, Brazil. (Abstract only.) American Journal of Disaster Medicine. 8(4):253-8.
The authors discuss lessons learned from this flood and landslide event in 2011, with a focus on pre-hospital and hospital organization and management of patients. They also describe the most common injuries treated (injuries were to the extremities, most requiring only wound cleaning, debridement, and suture), and note that the primary cause of death was from asphyxia due to drowning or mud burial.
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* Saulnier, D.D., Brolin Ribacke, K., and von Schreeb, J.. (2017). No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters. Prehospital and Disaster Medicine. 32(5): 568-579.
The authors conducted a literature review to examine health problems following flood and storm disasters. They found that illness mainly occurred within four weeks of these events. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections increased after storms; gastrointestinal infections were more likely to occur after flood events.
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Shroades, R. (2007). Flood Preparedness: Once Bitten, Twice Ready. Facility Maintenance Decisions.
This article documents how facility staff from Memorial Hermann Hospital incorporated lessons learned after Tropical Storm Allison flooded the facility with almost 40 feet of water in 2001.
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Lessons Learned: Hurricanes


This report summarizes the findings from a research project conducted to evaluate how the healthcare system was negatively affected in preparation for, during, and after Hurricane Sandy. Lessons learned from the hospital, EMS, and ancillary services (i.e., pharmacies, methadone clinics, dialysis/kidney centers, and medical supply companies) sectors are noted to assist healthcare professionals, medical facilities, and public health better prepare for future disasters.
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Arrieta, M.I., Foreman, R.D., Crook, E.D., and Icenogle, M.L. (2008). Insuring Continuity of Care for Chronic Disease Patients After a Disaster: Key Preparedness Elements. American Journal of Medical Sciences. 336(2):128-33.
The authors interviewed 30 key informants (KI), including health and social service providers that provide healthcare to the under- and uninsured along the Mississippi and Alabama Gulf Coast. Pre-disaster issues of importance were patient education and preparedness; evacuation guidance and support; planning for special medical needs shelters; and health care provider preparedness. Post-disaster issues were communication; volunteer coordination/credentialing; and donation management, particularly for medications.
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Arrieta, M.I., Foreman, R.D., Crook, E.D., and Icenogle, M.L. (2009). Providing Continuity of Care for Chronic Diseases in the Aftermath of Katrina: From Field Experience to Policy Recommendations. Disaster Medicine and Public Health Preparedness. 3(3):174-82.
The authors interviewed 30 key informants, including health and social service providers that provide healthcare to the under- and uninsured along the Mississippi and Alabama Gulf Coast. Respondents indicated that mental health, diabetes mellitus, hypertension, respiratory illness, end-stage renal disease, cardiovascular disease, and cancer were medical management priorities after a disaster. The most frequently mentioned barrier to providing care was maintaining continuity of medications. Inaccessible medical records, poor patient knowledge, and financial constraints also impacted care. Implemented or suggested solutions included better pre-disaster patient education; support for electronic medical records at community health centers; and better management of donated medications/medical supplies.
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* ASPR TRACIE. (2016). Hurricane Resources at Your Fingertips. U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response.
This Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) document provides numerous hurricane-related resources applicable to a variety of stakeholders and audiences.
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Following a number of related technical assistance requests and in anticipation of future information needs from healthcare systems impacted by current and future disasters, ASPR TRACIE developed this white paper to answer the question: “How long does it take the healthcare system to recover from a major hurricane?”
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The author recounts the challenges associated with providing care in a university hospital’s neonatal intensive care unit before, during, and after Hurricane Katrina made landfall.
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Berggren, R. (2005). Hurricane Katrina. Unexpected Necessities--Inside Charity Hospital. The New England Journal of Medicine. 353(15):1550-3.
The author describes her experience in Charity Hospital following Hurricane Katrina, with a focus on the unexpected necessities (e.g., shoes, extra underwear, shift work/sleep, morale-boosting activities, a team of professionals who care about patients and each other, etc.) that arose, and how they were addressed.
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BlueCross and BlueShield of Texas. (2018). What BCBSTX Learned From Hurricane Harvey Insurance Claims.
BlueCross BlueShield of Texas reviewed member claims for the 6 months post-Harvey and compared them to the same time period the previous year and found that “many people turned to technology in the form of telemedicine for the first time.” There was a rise in mental and physical health conditions such as post-traumatic stress disorder (PTSD), as well as infectious and parasitic diseases post-Harvey. The claims data also showed an increase in substance abuse, pneumonia and Chronic Obstructive Pulmonary Disease (COPD).
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Brevard, S.B., Weintraub, S.L., Aiken, J.B., et al. (2008). Analysis of Disaster Response Plans and The Aftermath of Hurricane Katrina: Lessons Learned From a Level I Trauma Center. (Abstract only.) The Journal of Trauma. 65(5):1126-32.
The authors retrospectively reviewed their hospital's disaster plan and compared it with actual events that occurred after Hurricane Katrina. They evaluated and scored vital support areas as adequate (3 pts), partially adequate (2 pts), or inadequate (1 pt), with the following results: water-3.0, food-2.4, sanitation-1.5, communication-1.4, and power-1.5. The authors concluded that, despite writing and exercising plans, the hospital was still not fully prepared.
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This article demonstrates the usefulness and diverse population base that can be cared for by an emergency department (ED) Observation Unit. The authors examine what happened in the absence of an ED through a retrospective review of such a model created after the destruction of the NYU Langone Medical Center ED during Hurricane Sandy.
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Centers for Disease Control and Prevention. (n.d.). Morbidity and Mortality Weekly Report: Hurricanes. (Accessed 9/25/2015.)
This website contains links to all hurricane-related MMWRs, including valuable epidemiologic information from multiple hurricanes, mold-related and other post-hurricane illnesses and injuries, and longer-term health effects.
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This document provides an overview of the status of the recovery in Puerto Rico and the U.S. Virgin islands six months after Hurricanes Irma and Maria, with a focus on the health care systems and health needs of residents. It builds on earlier work that examined how residents in Puerto Rico were faring two months after the hurricanes, and key issues for recovery in Puerto Rico and the U.S. Virgin Islands identified during a Fall 2017 roundtable with key stakeholders.
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Horahan, K., Morchel, H., Raheem, M., and Stevens, L. (2014). Electronic Health Records Access During a Disaster. Online Journal of Public Health Informatics. 5(3):232.
The authors describe a novel approach to reestablishing connectivity with the electronic health records server for a hospital affected by Superstorm Sandy through resource-sharing of a disaster response asset from a hospital in a neighboring state.
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Jarrett, M., Schwartz, Z., Solazzo, M., and Tangney, E. (2018). Evacuate or Shelter in Place: A View from the Water's Edge. (Abstract only.) Journal of Emergency Management. 16(2): 95-106.
The authors share the experience of a hospital faced with deciding whether to evacuate or shelter in place while in the path of a hurricane (two years in a row). An appendix at the end can be used as a planning tool to help other facilities facing similar challenges.
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* Lane, K., Charles-Guzman, K., Wheeler K., et al. (2013). Health Effects of Coastal Storms and Flooding in Urban Areas: A Review and Vulnerability Assessment. Journal of Environmental and Public Health. Article ID 913064.
The authors provide a review of the health impacts of U.S. coastal storms, with a focus on outcomes relevant to New York City (NYC) and urban coastal areas, and incorporate lessons learned from Superstorm Sandy. Based on the literature reviewed, indicators of health vulnerability were selected and mapped within NYC neighborhoods.
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* McMichael, A.J. (2015). Extreme Weather Events and Infectious Disease Outbreaks. (Abstract only.) Virulence. 6(6):539-43.
The author discusses infectious disease risks associated with extreme weather events, drawing on recent experiences, including Hurricane Katrina in 2005 and the 2010 Pakistan mega-floods. Historical examples from previous centuries of epidemics and "pestilence" associated with extreme weather disasters and climatic changes are also discussed.
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* Miller, A. C. and Arquilla, B. (2008). Chronic Diseases and Natural Hazards: Impact of Disasters on Diabetic, Renal, and Cardiac Patients. Prehospital and Disaster Medicine. 23(2): 185-94.
The authors reviewed resources from PubMed, Ovid, and Medline combined with real-life experience treating chronic disease after disasters. They found that the international nephrology community had formed an effective organization (the Renal Disaster Relief Task Force), and emphasize that patients have emergency diet and renal fluid restriction plans and be prepared to modify dialysis schedules and methods. Suggestions for facilities are also provided.
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Mitchell, L., Anderle, D., Nastally, K., et al. (2009). Lessons Learned from Hurricane Ike. (Abstract only.) AORN Journal. 89(6):1073-8.
The authors describe how their hospital system's response plans were revised after Hurricane Rita in anticipation of Hurricane Ike in 2008. They note that, despite planning and exercising their plan, there were still a number of lessons learned that could be helpful to other hospitals during future disaster responses.
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Office of the Inspector General. (2014). Hospital Emergency Preparedness and Response During Superstorm Sandy. U.S. Department of Health and Human Services.
The authors surveyed 174 Medicare-certified hospitals located in declared disaster areas in Connecticut, New Jersey, and New York during Superstorm Sandy and conducted 10 site visits and collected other types of data. They found that a small percent of hospitals (7%) evacuated during the storm (the rest sheltered in place). The report describes several cases of flooded hospitals and recommends continued community disaster collaboration.
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Okie, S. (2008). Dr. Pou and the Hurricane — Implications for Patient Care during Disasters. The New England Journal of Medicine. 358(1):1-5.
The author discusses the circumstances surrounding the arrest of a physician and two nurses for allegedly euthanizing four elderly patients at Memorial Hospital in Louisiana after Hurricane Katrina. Issues such as altered standards of care, scarce resource allocation, triage, and indemnification and/or immunity for health professionals are included.
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Ramme, A.J., Vira, S., and McLaurin, T.M. (2015). Superstorm Sandy's Forgotten Patient: A Lesson in Emergency Preparedness in Severe Obesity. Obesity. 23(2):253-4.
The authors describe the challenges associated with evacuation of a morbidly obese patient during Superstorm Sandy, and how those challenges influenced the decision not to evacuate the patient, even in the absence of power and running water.
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Redlener, I. and Reilly, M. (2012). Lessons from Sandy — Preparing Health Systems for Future Disasters. National Center for Disaster Preparedness, Mailman School of Public Health, Columbia University, New York.
This article discusses lessons learned from the evacuation of two NYC area hospitals in response to Hurricane Sandy in 2012.
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Rosen, Y. and Yakubov, N. (2013). Hurricane Sandy: Lessons Learned from the Severely Damaged Coney Island Hospital. (First page only.) Pre-hospital and Disaster Medicine. 28(6):643.
The authors discuss the challenges and benefits of transferring their patients to other hospitals along with their care teams in preparation for, and following Hurricane Sandy.
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* Saulnier, D.D., Brolin Ribacke, K., and von Schreeb, J.. (2017). No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters. Prehospital and Disaster Medicine. 32(5): 568-579.
The authors conducted a literature review to examine health problems following flood and storm disasters. They found that illness mainly occurred within four weeks of these events. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections increased after storms; gastrointestinal infections were more likely to occur after flood events.
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Schreiber, M.D., Yin, R., Omaish, M., and Broderick, J.E. (2014). Snapshot From Superstorm Sandy: American Red Cross Mental Health Risk Surveillance in Lower New York State, Editor’s Capsule Summary. Annals of Emergency Medicine. 64(1):59-65.
Red Cross disaster mental health volunteers used an evidence-based tool called PsySTART to collect data on risk factors for post-traumatic stress disorder (PTSD), depression, and anxiety among survivors at shelters, emergency aid stations, and mobile feeding and community outreach centers. They found 17,979 risk factors, with significant differences across survivors in eight counties. They also found survivors with high risk in areas apart from those with the greatest physical damage.
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* Sugerman, D. and Armstrong, J. (2013). Prevention and Treatment of Injuries Following Hurricanes and Tornadoes. Centers for Disease Control and Prevention.
This one-hour webinar covers the provision of pre-hospital care; the patterns of injury seen after hurricanes and tornadoes, including appropriate initial management; appropriate emergency risk communication messages; and the importance of data collection to improve messaging and response efforts.
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Sullivent, E.E. 3rd, West, C.A., Noe, R.S., et al. (2006). Nonfatal Injuries Following Hurricane Katrina--New Orleans, Louisiana, 2005. (Abstract only.) Journal of Safety Research. 37(2): 213-217.
Just after Hurricane Katrina, the Centers for Disease Control and Prevention collaborated with the Louisiana Department of Health and Hospitals to establish an injury and illness surveillance system in functioning hospitals and medical clinics. The surveillance system recorded more than 7,500 nonfatal injuries in the month after the storm, with the leading "mechanisms of injury" being fall and cut/stab/pierce. Residents were more likely than relief workers to be injured.
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The Texas Hospital Association met with hospital representatives from areas affected by Hurricane Harvey and agency partners to discuss experiences prior to, during, and after the storm. This document highlights identified areas for improvement "to better equip hospitals, governmental agencies and other organizations for the next disaster" and outlines how to incorporate next steps.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). ASPR Healthcare System Recovery Guide: Hurricane Harvey.
This document highlights common post-disaster recovery planning challenges for small and medium-sized healthcare facilities; shares strategies for short- and long-term recovery; and identifies support resources. Information is presented in four categories: financial and legal; operational planning; workforce; and training and testing.
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Wang, A., Issa, A., Bayleyegn, T., et al.. (2017). Notes from the Field: Mortality Associated with Hurricane Matthew — United States, October 2016. Morbidity and Mortality Weekly Report. 66(5);145–146.
This brief article describes the causes of death associated with Hurricane Matthew in 2016. More than half of all deaths occurred in North Carolina; 18 (69%) of these were drowning deaths associated with a motor vehicle.
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Lessons Learned: Tornadoes


California Hospital Association. (2013). Hospital Emergency Response Legal Issues: Lessons from Joplin. American Health Lawyers Association.
This presentation discusses legal issues related to insurance, liability, federal reimbursement, and rebuilding experienced by affected facilities following the 2011 Joplin, MO tornado.
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Centers for Disease Control and Prevention. (2011). Notes from the Field: Fatal Fungal Soft-Tissue Infections After a Tornado --- Joplin, Missouri, 2011. Morbidity and Mortality Weekly Report. 60(29);992.
This MMWR describes 13 cases (5 of which were fatal) of cutaneous mucormycosis identified after the 2011 Tornado in Joplin, Missouri. It reminds clinicians to consider fungal infections in individuals presenting with necrotizing soft-tissue infections following tornadoes, and to begin treatment as soon as possible in suspected cases.
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Chern J.J., Miller, J.H., Tubbs, R.S., et al. (2011). Massive Pediatric Neurosurgical Injuries and Lessons Learned Following a Tornado Disaster in Alabama. Journal of Neurosurgery. Pediatrics. 8(6):588-92.
The authors review the clinical courses of 24 patients who suffered cranial, spinal, and peripheral nerve injuries due to the tornadoes that touched down in Alabama in 2011, and the medical responses of the pediatric neurosurgical team they were part of.
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Chiu, C., Schnall, A., Mertzlufft, C., et al. (2013). Mortality from a Tornado Outbreak, Alabama, April 27, 2011. American Journal of Public Health. 103(8): e52-e58.
The authors examined the demographics of the 247 decedents from the tornado outbreak in Alabama on April 27, 2011 and found that females and older adults were at highest risk for tornado-related deaths. The authors stressed the importance of local community shelters (and messaging to inform residents of shelter locations); encouragement of word-of-mouth warnings; and personal and family preparedness planning (with a focus on helping vulnerable population members take shelter).
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Daley, W., Brown, S., Archer, P., et al. (2005). Risk of Tornado-Related Death and Injury in Oklahoma, May 3, 1999. American Journal of Epidemiology. 161(12): 1144-1150.
On May 3, 1999, powerful tornadoes, including a category F5 tornado, swept through Oklahoma. The authors examined all tornado-related deaths, hospital admissions, and emergency department visits to identify important risk factors.
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Forshee-Hakala, B.A. (2015). Pneumonia Cases Following an EF-5 Tornado. (Abstract only.) American Journal of Infection Control. 43(7):682-5.
The author describes pneumonia cases admitted to Freeman Health System in Joplin, Missouri from May 2009 to May 2012. She found a higher incidence of pneumonia cases, particularly those caused by uncommon microbes, in the group of cases that lived or worked in the tornado zone in the year following the Joplin tornado. She concludes that respiratory infections many increase following tornadoes, and should be treated with broad-spectrum antibiotics, not currently standard practice for community-acquired pneumonia.
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Green, J. and Karras, D. (2010). Commentary. Annals of Emergency Medicine. 59(1):54-55.
The authors write that disaster-related wounds contaminated with soil or vegetative matter should be monitored for mucormycosis. They provide an overview of treatment strategies and encourage emergency physicians to “maintain a high index of suspicion for cutaneous mucormycosis infections when deep injuries” present.
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Neblett Fanfair, R., Benedict, K., Bos, J., et al. (2012). Necrotizing Cutaneous Mucormycosis after a Tornado in Joplin, Missouri, in 2011. The New England Journal of Medicine. 367:2214-2225.
The authors review data on 13 patients who developed necrotyzing cutaneous mucormycosis, a rare fungal infection, in addition to other injuries sustained form an F-5 tornado. The authors share risk factors, treatment strategies, and other relevant information that can help healthcare providers work with tornado survivors.
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Niederkrotenthaler, T., Parker, E.M., Ovalle, F., et al. (2013). Injuries and Post-Traumatic Stress Following Historic Tornados: Alabama, April 2011. PLoS One. 8(12): e83038.
The authors analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011. The majority of injuries were not life-threatening; the most severe injuries affected the head and chest regions.
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This report describes response and recovery operations by several hospitals during the 2011 natural disasters in Missouri, with many implications for COOP planning. It summarizes lessons learned, with a focus on the Joplin tornado.
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* Reynolds, M. (n.d.). The Joplin Tornado: The Hospital Story and Lessons Learned. (Accessed 10/16/2019.) Leading Age Missouri.
The speaker focused on four main areas: the impact of an unexpected natural disaster on healthcare services; how the nation responded to help the Joplin community; how to incorporate lessons learned into planning; and how to design enhancements that can protect against future incidents.
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This article describes the planning one health center undertook to secure its data so that it could be accessed after a disaster, and discusses why healthcare information technology must be a priority focus for planning. The authors advocate for increased federal funding and clear guidelines from federal planning partners in support of physical security, data back-up, and redundancy planning, as well as staff training to support these technology needs.
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* Sugerman, D. and Armstrong, J. (2013). Prevention and Treatment of Injuries Following Hurricanes and Tornadoes. Centers for Disease Control and Prevention.
This one-hour webinar covers the provision of pre-hospital care; the patterns of injury seen after hurricanes and tornadoes, including appropriate initial management; appropriate emergency risk communication messages; and the importance of data collection to improve messaging and response efforts.
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Watts, J. (2018). Pediatric Injuries Treated at a Level 1 Trauma Center After an F5 Tornado. (Abstract only.) Pediatric Emergency Care. 34(11):783-786.
The authors retrospectively reviewed records on 10 pediatric patients in the trauma registry following the 2011 F5 tornado in Joplin, MO to characterize their injuries. They found that traumatic brain injury was the most common diagnosis followed by orthopedic and maxillofacial injuries. Seven patients required surgical procedures in the operating room, and 8 patients were intubated and in the pediatric intensive care unit.
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Lessons Learned: Tsunamis


Carballo, M. Daita, S., and Hernandez, M. (2005). Impact of the Tsunami on Healthcare Systems. Journal of the Royal Society of Medicine. 98(9):390-395.
The authors describe the effects of the 2004 tsunami on medical facilities and systems in 10 countries.
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Centers for Disease Control and Prevention. (2005). Rapid Health Response, Assessment, and Surveillance After a Tsunami --- Thailand, 2004--2005. Morbidity and Mortality Weekly. 54(3):61-64.
This article describes the health response to the 2004 tsunami that caused nearly 225,000 deaths in eight countries on two continents. Information on rapid response, conducting health and needs assessments, and public health surveillance is included.
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Centers for Disease Control and Prevention. (2013). Tsunami-Related Information for Clinicians.
This webpage includes general information on the health effects of tsunamis, resources on handling human remains, and links to disaster mental health resources.
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* Geiger, A., Kawauchi, K., and Bellamy, S. (2015). Innovative Disaster Responses Model Approaches from Japan's 3/11 Disaster. Japan Center for International Exchange.
The authors present four examples of initiatives that helped communities recover from Japan's earthquake/tsunami "3/11 Disaster." They stress the important role of healthcare providers in ensuring access to care and reducing stressors in survivors.
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* Li, X.H., Hou, S.K., Zheng, J.C., et al. (2012). Post-Disaster Medical Rescue Strategy in Tropical Regions. World Journal of Emergency Medicine. 3(1): 23-28.
The authors analyze the medical response to earthquakes and tsunamis in tropical regions and found that shock, infection, and heat stroke were frequently encountered by survivors.
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* Nagamatsu, S., Maekawa, T., Ujike Y., et al. (2011). The Earthquake and Tsunami--Observations by Japanese Physicians Since the 11 March Catastrophe. Critical Care. 15(3):167.
The authors discuss how lessons learned from the 1995 Hanshin earthquake and effective use of the Internet for communication and coordination assisted with the response to the 2011 earthquake and tsunami. They also describe and compare the injuries and causes of death for the two events.
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* Yonekura, T., Ueno, S., and Iwanaka, T. (2013). Care of Children in a Natural Disaster: Lessons Learned from the Great East Japan Earthquake and Tsunami. (Abstract only.) Pediatric Surgery International. 29(10): 1047-1051.
The authors incorporate lessons learned from the Fukushima disaster into response recommendations for pediatric surgeons and physicians.
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Lessons Learned: Wildfires


Krilich, C. and Currie, J. (2018). What Hospital Leaders Learned from the Wildfire. American Association for Physician Leadership.
This article discusses lessons learned from hospitals in California during the 2017 wildfires. The authors credit following an established command structure for incident management as one of the reasons they were able to remain open. They also note the importance of focusing on capacity and staff care during disaster response.
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Mitigation


This report shares workshop findings on increasing and improving the resilience of healthcare facilities and services to high-impact weather events. The workshop grouped their findings into three main categories: hardening structures, making incremental adaptations, and implementing innovative practices.
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Arnold, C., Holmes, W., Quinn, R., et al. (2007). Design Guide for Improving Hospital Safety in Earthquakes, Floods, and High Winds. Federal Emergency Management Agency.
This design guide can inform and help design professionals, hospital administrators, and facility managers employ sound mitigation measures that will decrease the vulnerability of hospitals to disruptions from natural hazard events (e.g., earthquakes, high wind events, floods).
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* Banatin, C. and Go, M. (2010). Safe Hospitals in Emergencies and Disasters: Structural, Non-Structural and Functional Indicators. World Health Organization, Regional Office for the Western Pacific.
This vulnerability assessment highlights structural, non-structural, and functional elements that must be considered to ensure that a health facility can withstand and remain operational in emergencies.
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Federal Emergency Management Agency. (2013). Earthquake Mitigation for Hospitals.
The materials from this workshop can help hospital administrators and facility managers identify opportunities to implement seismic mitigation in their facilities.
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Iddona, C.R., Mills, T.C., Giridharand, R., and Lomas, K.J. (2015). The Influence of Hospital Ward Design on Resilience to Heat Waves: An Exploration Using Distributed Lag Models. Energy and Buildings. 86: 573-588.
The authors use models to measure the resilience of different medical building types to excessive heat. They found that masonry and Nightingale wards (a large room without subdivisions) fared better than rooms in light-weight modular buildings.
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Krauskopf, R. and Saavedra, R. (2004). Guidelines for Vulnerability Reduction in the Design of New Health Facilities. World Health Organization, Pan American Health Organization.
This 106-page document provides information about three potential levels of protection for hospitals and health facilities from adverse events such as disasters, or performance objectives: life safety, investment protection, and functional protection.
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* Low, D., Mahadevia, A., Perotin, M., et al. (2013). Flood Proofing Non-Residential Buildings. Federal Emergency Management Agency.
This guidance document includes two hospital-specific case studies that illustrate the successful use of floodwalls.
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Office of the Assistant Secretary for Preparedness and Response. (2019). National Health Security Strategy. U.S. Department of Health and Human Services.
The goal of the National Health Security Strategy (NHSS) is to strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies. This webpage includes links to the full text of the plan, an overview, the NHSS Implementation Plan, the NHSS Evaluation of Progress, and an NHSS Archive.
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* Reynolds, M. (n.d.). The Joplin Tornado: The Hospital Story and Lessons Learned. (Accessed 10/16/2019.) Leading Age Missouri.
The speaker focused on four main areas: the impact of an unexpected natural disaster on healthcare services; how the nation responded to help the Joplin community; how to incorporate lessons learned into planning; and how to design enhancements that can protect against future incidents.
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U.S. Department of Health and Human Services. (2016). Climate Resilient Health Care Facilities Toolkit.
This online toolkit can help healthcare facility planners learn more about implementing best practices in climate resilience. It is based on a framework composed of the following five elements: Climate Risks and Community Vulnerability Assessment; Land Use, Building Design, and Regulatory Context; Infrastructure Protection and Resilience Planning; Essential Clinical Care Service Delivery Planning; and Environmental Protection and Ecosystem Adaptations.
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World Health Organization. (2009). Save Lives: Make Hospitals Safe in Emergencies.
This document discusses how to safeguard health facilities from natural disasters, how to retrofit existing facilities, and plan and train for emergencies.
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Plans, Tools, and Templates: Earthquakes


Cascadia Region Earthquake Workgroup CREW. (2018). Preparing Hospitals for Earthquakes: Structural and Nonstructural Issues.
This fact sheet highlights lessons learned involving hospitals that experienced recent earthquakes strategies for building mitigation and resilience.
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Children's Hospital and Research Center Oakland. (n.d.). Children's Hospital Earthquake Response Guide. (Accessed 10/20/2015.)
The goal of this plan is to maintain hospital operations for at least four days after a major earthquake and to ensure that care continues for patients, visitors, and survivors of the earthquake. This plan can be adapted to meet the needs of hospital emergency response professionals and healthcare preparedness planners.
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Muhlenberg Community Hospital. (2015). Hospital Wide Earthquake Plan.
This webpage provides a summary of the hospital's earthquake plan and can help assist other hospitals as they update or develop their own earthquake plan.
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* Redman, S., Fromknecht, C., Hodge, S., et al. (2017). Death Scene Investigation After Natural Disaster or Other Weather-Related Events. Centers for Disease Control and Prevention.
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Wang, Y. (2017). Oregon Hospital and Water System Earthquake Risk Evaluation Pilot Study. Oregon Department of Geology and Mineral Industries.
The goal of this project was to evaluate the risk of hospitals and water systems from earthquakes triggered by the Cascadia subduction zone. The authors used a model and estimated the following results from major earthquake shaking (magnitude 9): "$5.1 billion in building losses, up to 80,000 damaged buildings...up to 12,500 displaced people, and about 1,900 people requiring public shelter. Human suffering in the area is estimated to be up to 2,000 people requiring medical aid, up to 600 people requiring hospital care, up to 90 people with life-threatening injuries, and up to 180 fatalities." Graphics and tables help illustrate the challenges and the author lists hospital and community resilience strategies in Section 4.2.
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Plans, Tools, and Templates: Excessive Cold


California Association of Health Facilities. (n.d.). CAFH’s Ready, Set, Go: Extreme Cold. (Accessed 12/21/2018.)
This factsheet lists components for healthcare facilities to consider when creating an extreme cold “action plan.” Information is provided under three categories: Get Ready (creating the plan); Get Set (preparing staff for cold weather); and Go! (activating the plan and policies). Additional information and links are provided at the end of the document.
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Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2014). Winter Weather Checklists.
These checklists can help residents prepare for winter weather. Checklists for communication, heating, food and safety, and car supplies are included.
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Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program. (2017). Risk Communication Toolkit for Winter Weather.
This toolkit can help local health authorities develop public messaging during periods of extreme cold weather. It includes key messages, sample press releases, factsheets, links to key resources, and sample social media messages for Twitter and Facebook.
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* Redman, S., Fromknecht, C., Hodge, S., et al. (2017). Death Scene Investigation After Natural Disaster or Other Weather-Related Events. Centers for Disease Control and Prevention.
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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St. Joseph's (MN) Medical Center. (2011). Snow Emergency Plan.
This document outlines the hospital's plan for " an anticipated or an actual snow storm, the severity or duration, or any combination in which it is necessary." It includes information on personnel practices, nurse staffing, and the transportation command center.
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Weston, B., Lappe, M., and Hick, J. (2014). Blizzard Checklist. Hennepin County Medical Center.
This checklist can help healthcare facility staff plan for and respond to major snowstorms (i.e., 12 or more inches of accumulation).
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Plans, Tools, and Templates: Excessive Heat


Arizona Department of Health Services. (2014). Arizona Department of Health Services Heat Emergency Response Plan.
This plan was developed by the Arizona Department of Health Services to address and help limit the adverse public health effects from excessive heat. It identifies conditions or events that would trigger activation of the emergency response plan, and provides a framework for coordinating efforts with other agencies that provide services to at-risk populations. The plan also includes a list of prevention and educational resources that can help mitigate heat-health adverse effects and deaths.
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Arizona Department of Health Services, Office of Environmental Health, Climate & Health Program. (2014). Arizona Heat Safety Resource Guide: Resources for Local Health Officials and Public Information Officers during Extreme Heat Events.
This guide provides local health officials and public information officers with information on health impacts of extreme heat events, decision-support tools, and useful resources for prevention of heat-related illnesses. This document also supports the Arizona Department of Health Services Heat Emergency Response Plan.
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Author Redacted. (2015). Extreme Heat Response Plan.
This extreme heat response plan can be downloaded and tailored by a local jurisdiction. It was provided to ASPR TRACIE by a state representative who requested identifying information be redacted prior to sharing with the field.
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Bernard, S. and McGeehin, M.A. (2004). Municipal Heat Wave Response Plans. American Journal of Public Health. 94(9):1520.
The authors review heat wave plans from 18 cities and list recommendations for overcoming challenges (e.g., targeted outreach geared towards the socially isolated, begin prevention efforts before high temperatures arrive, and collect and use data to determine the effectiveness of interventions).
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* Centers for Disease Control and Prevention. (2011). Extreme Heat and Your Health: Media Toolkit.
The materials on this webpage include a toolkit, web tools, and press release and other templates that can help community leaders develop communication plans for extreme heat events.
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Centers for Disease Control and Prevention. (2015). Plan for Diabetes Care in Heat & Emergencies.
This website is geared towards people with diabetes and includes tips for planning ahead for hot weather and emergency situations.
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* City of New York, Department of Health and Mental Hygiene. (2013). Heat Wave Preparedness Checklists for Mental Health Service Providers.
These checklists can help mental health service providers identify consumers and vulnerable residents at highest risk for heat-related illnesses.
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* City of New York, Department of Health and Mental Hygiene. (2013). Heat Wave Preparedness Checklists for Vulnerable Population Service Providers.
These checklists can help healthcare and other service providers identify vulnerable residents at highest risk for heat-related illnesses.
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East Central (GA) Regional Hospital. (2014). Heat Plan.
This document outlines the East Central Regional Hospital's plans for extreme heat situations. It includes response actions by title (e.g., Safety Manager, Nurse Director) and recovery actions. The plan also includes a list of preventive measures, symptoms and treatment, and a weather index chart that lists steps to follow by temperature level.
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This toolkit can help health communicators charged with developing or updating heat-health communication strategies, and features strategies for reaching specific audiences.
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The authors looked at 292,666 cardiovascular and 562,738 respiratory disease Emergency Department (ED) visits over an eight-year period in Toronto. They found that: diabetics exposed to extreme heat had more ED visits vs. non-diabetics; respiratory disease ED visits during hot weather were higher for individuals with comorbid respiratory diseases and cancer; exposure to extreme cold temperatures over a 2-week period increased cardiovascular disease ED visits for individuals with comorbid cardiovascular diseases, and kidney diseases.
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Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program. (2014). Crisis and Emergency Risk Communication Toolkit for Extreme Heat. Health Promotion Practice 9(4 Suppl):18S-25S.
This toolkit can help local health authorities develop public messaging during periods of extreme heat. It includes key messages, talking points, sample press releases, fact sheets, sample social media messages for Twitter and Facebook, and links to related information in English and Spanish.
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* Redman, S., Fromknecht, C., Hodge, S., et al. (2017). Death Scene Investigation After Natural Disaster or Other Weather-Related Events. Centers for Disease Control and Prevention.
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Weston, B., Lappe, M., and Hick, J. (2014). Heat Checklist. Hennepin County Medical Center.
This checklist can help healthcare facility staff plan for and respond to extreme heat events.
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Plans, Tools, and Templates: Fires and Wildfires


* California Department of Public Health. (2019). Wildfire Smoke: Considerations for California's Public Health Officials.
This document contains information about the health effects of wildfire smoke, strategies to reduce exposure, and potential public health actions. Links to additional resources are provided throughout the document and in the appendices.
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Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2013). Wildfires.
This webpage can help users prepare for a wildfire, take proper actions during a wildfire, and prevent injury and address physical and emotional health after a wildfire.
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Jagnarine, S., Van Alphen, D., Gibbs, T., et al. (2014). Hospitals Don't Burn!: Hospital Fire Prevention and Evacuation Guide. World Health Organization, and Pan American Health Organization.
This guidance document was developed to address the vulnerability of hospitals to fires. It is intended that all possible steps should be taken to minimize the hazard of fires in hospitals and the need for evacuation. The guide is applicable to existing hospitals that can be retrofitted to improve safety against fires, and proposed new-build facilities. It is formatted into four sections: Prevention, Suppression, Evacuation, and Training Drills.
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* National Wildfire Coordinating Group. (2015). InciWeb.
This webpage provides up-to-date information on wildfires across the country. Users can search by state or incident name. Photographs, announcements, and news articles are also included.
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Office of the Assistant Secretary for Preparedness and Response. (2017). 2017 California Wildfires.
This ASPR webpage provides useful and timely resources related to wildfires (and was created while wildfires devastated parts of California in 2017).
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Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program. (n.d.). Wildfires and Smoke. (Accessed 9/15/2015.) Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program.
This webpage includes information and links to factsheets and other resources that can help users learn about current wildfires, smoke conditions, and how to reduce the health effects of wildfire smoke.
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Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program. (2015). Crisis and Emergency Risk Communication Toolkit for Wildfire Smoke.
This toolkit can help local health authorities develop public messaging during a severe wildfire smoke event. It includes key messages, talking points, sample press releases, sample social media messages for Twitter and Facebook, and links to related information.
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* Redman, S., Fromknecht, C., Hodge, S., et al. (2017). Death Scene Investigation After Natural Disaster or Other Weather-Related Events. Centers for Disease Control and Prevention.
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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U.S. Department of Health and Human Services, Disaster Information Management Research Center. (2015). Fires and Wildfires.
This webpage provides links to fire and health-related information and other relevant resources. Information is geared towards health professionals and the general public.
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U.S. Environmental Protection Agency. (2017). Community Health Vulnerability Index.
This index can be used to identify areas at higher health risk to wildland fire smoke exposure. Officials can use this information to to develop maps of areas at most risk and create related communication strategies.
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U.S. Environmental Protection Agency * U.S. Forest Service, Centers for Disease Control and Prevention, and California Air Resources Board. (2016). Wildfire Smoke: A Guide for Public Health Officials.
This guide was developed to help local public health officials prepare for and respond to smoke events. It includes information on protective measures and strategies for communicating with the public about wildfire smoke and health.
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Plans, Tools, and Templates: Floods and Landslides


This checklist provides guidance for completing building and life safety inspections prior to restoration work, and guidance for infection control review of facilities to be done before the hospital can reopen. Attachment A includes a site specific checklist for selected areas of the facility (e.g., laboratory, pharmacy).
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Centers for Disease Control and Prevention. (2018). Flood Water After a Disaster or Emergency.
The information on this webpage can help individuals protect themselves from flood water inside and outside their homes and highlights health risks associated with exposure to flood water.
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Louisiana State University Health Sciences Center. (2010). External Flood Prevention Plan. Campus Wide/Hospital Safety Manual.
This plan was designed to help prevent floodwaters from entering the ground floor of the medical school and hospital and can be used by medical facility planners faced with similar challenges.
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  • Carolyn Koehn cannot access this plan
    5/10/2017 6:15:30 AM
* Low, D., Mahadevia, A., Perotin, M., et al. (2013). Flood Proofing Non-Residential Buildings. Federal Emergency Management Agency.
This guidance document includes two hospital-specific case studies that illustrate the successful use of floodwalls.
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Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program. (2015). Risk Communication Toolkit for Flooding.
This toolkit can help local health authorities develop public messaging during a flood event. It includes information relevant to the actual event and the recovery period: key messages, talking points, sample press releases, factsheets, links to key resources, and sample social media messages for Twitter and Facebook.
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* Redman, S., Fromknecht, C., Hodge, S., et al. (2017). Death Scene Investigation After Natural Disaster or Other Weather-Related Events. Centers for Disease Control and Prevention.
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Wisconsin Climate and Health Program. (2019). Flood Toolkit.
This tool can help local governments, health departments, and residents prepare for and recover from flooding events. It includes checklists and other guidance (e.g., regarding wells and re-entering structures after floods).
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World Health Organization, Regional Office for Europe. (2014). Floods and Health: Fact Sheets for Health Professionals.
These fact sheets are geared towards health professionals and describe steps to take during a flood, in the absence of a flood health preparedness and response plan. The sheets cover a variety of strategies including: vaccination during flood events, food safety, water and hygiene in healthcare facilities during and after flood events, and post flood disinfection strategies.
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Plans, Tools, and Templates: Hurricanes


ASPR TRACIE. (2016). After the Flood: Mold-Specific Resources. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
Damaging floods have increased in frequency, and sometimes occur in non-traditional areas. Community residents, business owners, and healthcare facility executives are often left with the arduous job of cleaning up after floods, to include preventing, identifying, and getting rid of mold. These resources can assist with those efforts.
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* ASPR TRACIE. (2016). Hurricane Resources at Your Fingertips. U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response.
This Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) document provides numerous hurricane-related resources applicable to a variety of stakeholders and audiences.
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This ASPR TRACIE resource was developed to provide a short overview of the potential significant public health and medical response and recovery needs facing hurricane- and severe storm-affected areas, based on past experience and lessons learned from Hurricanes Katrina, Sandy, Harvey, and others.
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Jackson Health System. (2012). Hurricane Response Plan.
This healthcare facility hurricane plan can serve as a model for others. It includes sections on scope and planning assumptions, hazard analysis (which can be tailored to a specific jurisdiction), concept of operations (from preparation to recovery), accommodations, employee plans, information on making claims for reimbursement for disaster-related damage, and hospital incident command system.
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Monroe Regional Medical Center. (2012). Hurricane Preparedness Plan.
This plan includes sections on pre-hurricane planning, procedures to follow during a hurricane, and recovery. It also includes appendices on a variety of topics, including a list of shelters in the area, items to bring if working during and after a storm, and visitor policy.
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National Institute of Environmental Health Sciences. (n.d.). Hurricane Worker Podcasts. (Accessed 5/3/2019.) National Clearinghouse for Worker Safety and Health Training.
These short podcasts were developed to help emergency responders and recovery workers prepare for hurricane-related hazards (e.g., mold, debris, and electrical hazards).
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This toolkit was developed to help state hospitals prepare for, respond to, and recover from hurricanes. The plan focuses on sheltering in place and recovery. Included are a series of assessment checklists, including three specifically focused on recovery (demobilization; patient transfer and discharge; and financial resources).
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    9/12/2017 2:08:57 PM
Office of the Assistant Secretary for Preparedness and Response. (2017). 2017 Hurricane Recovery.
ASPR created this webpage after Hurricanes Harvey, Irma and Maria caused major damage across a large swath of the southeastern United States and its territories. These resources can help individuals, families, communities and professionals stay up-to-date and recover from the storms.
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* Redman, S., Fromknecht, C., Hodge, S., et al. (2017). Death Scene Investigation After Natural Disaster or Other Weather-Related Events. Centers for Disease Control and Prevention.
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Toner, E., McGinty, M., Schoch–Spana, M., et al. (2017). A Community Checklist for Health Sector Resilience Informed by Hurricane Sandy. Health Security. 15(1): 53-69.
The authors incorporated lessons learned from Hurricane Sandy into this checklist of actions for healthcare, public health, nongovernmental organizations, and private entities to strengthen the resilience of their community’s health sector. There is a general checklist of actions for all stakeholders, as well as guidance provided by type of healthcare facility.
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Plans, Tools, and Templates: Tornadoes


Muhlenberg Community Hospital. (2015). Tornado Warning Plan. Muhlenberg Community Hospital.
This webpage lists the steps that will be taken by the hospital in the event of a tornado warning. Steps are listed by the person responsible for taking them.
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* Redman, S., Fromknecht, C., Hodge, S., et al. (2017). Death Scene Investigation After Natural Disaster or Other Weather-Related Events. Centers for Disease Control and Prevention.
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Plans, Tools, and Templates: Tsunamis


Intergovernmental Oceanographic Commission of UNESCO. (2008). Intergovernmental Oceanographic Commission (IOC) of UNESCO.
This document provides a general plan of action and basic framework for dealing with the unique hazards resulting from tsunamis and can be adapted for use by healthcare emergency planners.
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* Redman, S., Fromknecht, C., Hodge, S., et al. (2017). Death Scene Investigation After Natural Disaster or Other Weather-Related Events. Centers for Disease Control and Prevention.
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Agencies and Organizations


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