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Natural Disasters
Topic Collection
March 29, 2024

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.

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Must Reads

American Meteorological Society. (2014). A Prescription for the 21st Century: Improving Resilience to High-Impact Weather for Healthcare Facilities and Services.
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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ASPR TRACIE. (2020). Issue 10: Preparing for and Responding to Wildfires and Planned Outages.
This issue of The Exchange highlights lessons learned from recent wildfires, evacuating and receiving patients, and preparing for planned power outages.
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ASPR TRACIE. (2021). Managing the Storm After the Storm: Healthcare in TX Recovers from Severe Winter Weather.
Michael Wargo (HCA Healthcare), Scott Cormier (Medxcel), and Toni Carnie (HCA Houston Healthcare Tomball) share how a rare winter storm, extreme cold, and unplanned power outages affected utilities--particularly water and water pressure--in healthcare facilities throughout Texas. This summary highlights issues that will benefit from additional mitigation and preparedness activities as extreme weather incidents increase in frequency.
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ASPR TRACIE. (2022). Climate Change Resilience and Healthcare System Considerations.
Climate change continues to negatively impact national security, environmental stability, and human health conditions. This document provides an overview of climate trends in the U.S., outlining the impacts of climate-related illness and injury on health system operations, care delivery, and patient surge. It touches on the importance of bolstering healthcare infrastructure resilience, facility hardening, and highlights three areas being affected by various elements of climate change.
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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. (2022). 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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    5/21/2020 11:03:09 PM
City of New York, Department of Health and Mental Hygiene. (2020). Heat Wave Preparedness Checklists for Vulnerable Population Service Providers.
These checklists can help healthcare and other service providers identify residents at highest risk for heat-related illnesses.
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Crimmins, A.R., C.W. Avery, D.R. Easterling, K.E., et al. (Eds). (2023). Fifth National Climate Assessment. U.S. Global Change Research Program.
This report highlights observed and projected vulnerabilities, risks, and impacts associated with climate change across the country. It includes sections on physical science, national topics (e.g., air quality, indigenous peoples, agriculture, and social systems and justice), and concerns by region. Examples of response actions that focus on community mitigation and adaptation are also included.
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Guenther, R., and Balbus, J. (2014). Primary Protection: Enhancing Health Care Resilience for a Changing Climate. U.S. Department of Health and Human Services.
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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National Academies of Sciences, Engineering, and Medicine. (2019). Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. The National Academies Press.
Workshop participants discussed the effects of wildfires on certain populations and human health; challenges associated with recovery; improving operational response; and "the impact of mitigation and preparedness."
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Novation. (n.d.). Emergency Disaster Plan Template. (Accessed 2/22/2023.)
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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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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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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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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The Lancet. (2015). Health Professionals: Be Prepared for Heatwaves.
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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The National Academies Press. (2013). Public Response to Alerts and Warnings Using Social Media: Report of a Workshop on Current Knowledge and Research Gaps.
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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The National Academies Press. (2013). Public Response to Alerts and Warnings Using Social Media: Report of a Workshop on Current Knowledge and Research Gaps. The National Academies Press.
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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The National Academies Press. (2018). Emergency Alert and Warning Systems: Current Knowledge and Future Research Directions.
This book provides a summary of conference proceedings where risk communications experts discussed the public response to mobile alerts. A free PDF download is available or physical copies can be ordered for a fee.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2021). 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 strategy, an overview, the NHSS Implementation Plan, the NHSS Evaluation of Progress, and an NHSS Archive.
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U.S. Department of Health and Human Services’ Sustainable and Climate Resilient Health Care Facilities Initiative (SCRHCFI) (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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Alerts, Warnings, and Communications

Bennet, K., Olsen, J., Harris, S., et al. (2013). The Perfect Storm of Information: Combining Traditional and Non-Traditional Data Sources for Public Health Situational Awareness During Hurricane Response.
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 concluded 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 available.
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* Centers for Disease Control and Prevention. (2022). 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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  • tamminh duong This document is very useful to me. Thank you https://tamminhduong.com/
    5/21/2020 11:03:09 PM
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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HHS emPOWER Program. (2023). HHS emPOWER Map.
The HHS emPOWER Map provides a monthly, updated de-identified total at the national, state, territory, county, and ZIP Code levels for Medicare beneficiaries currently enrolled in the Centers for Medicare and Medicaid Services (CMS) Medicare Fee-For-Service (Parts A/B) or Medicare Advantage (Part C). The map also provides a monthly updated total for the number of Medicare beneficiaries who have had an administrative claim for one or more types of electricity-dependent durable medical and assistive equipment (DME) and devices, as well as at-risk combinations data for those who rely on a health care service(s) and any electricity-dependent DME and devices.
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National Weather Service. (n.d.). Email and SMS Weather Alert Services. (Accessed 2/17/2020.)
The National Weather Service provides links to federal and external alert and warning sources.
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National Weather Service. (2020). 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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* U.S. Department of Health and Human Services. (2018). GeoHealth Platform.
This tool provides central access to federal disaster and public health related natural disaster alerts, warnings, and other resources.
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U.S. Geological Survey. (2020). 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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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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Gillings School of Global Public Health. (2020). Extreme Heat & Air Quality: Implications for Human Health. (Available for free through the train website. Free registration required.) University of North Carolina at Chapel Hill.
This evidence-based and subject matter expert reviewed training aims to inform health care and public health staff about how extreme heat can worsen air pollution. Learning objectives include defining extreme heat, understanding how heat waves impact air quality, identifying populations vulnerable to these environmental factors, and learning how communities can reduce air pollution during extreme heat.
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National Center for Disaster Medicine and Public Health. (2020). Wildfires.
This hour-long webinar features speakers discussing lessons learned from recent wildfires, including the effect of wildfire smoke on air quality and respiratory health.
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National Hurricane Program. (2022). Hurrevac.
This website contains links to recordings of the 2022 Web-based Hurrevac webinar series organized by the National Hurricane Program (NHP). The courses cover information on hurricanes and evacuation for the emergency management community, including wind forecast features, evacuation timing, storm surge, and other water hazards.
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Primary Care Development Corporation, and the National Association of Community Health Centers. (n.d.). Severe Weather Table Top Exercise. (Accessed 1/7/2020.)
This presentation addresses the purpose of the tabletop exercise, describes the severe weather scenario that impacts the community health center, and provides discussion questions for participants.
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Shakeout. (n.d.). ShakeOut Exercise Manual For Healthcare Organizations. (Accessed 1/7/2020.)
This document provides guidance for healthcare facilities that wish to participate in a ShakeOut (earthquake) exercise in their community. It includes checklists to guide planning for a drill, a tabletop exercise, and a functional exercise.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2019). HHS emPOWER Program Web-Based Training. (Free account required.)
The HHS emPOWER Program Web-Based Training is a free, publicly accessible course designed to help partners better understand the HHS emPOWER Program and integrate its tools into their emergency preparedness, mitigation, response, and recovery.
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U.S. Environmental Protection Agency. (2019). Wildfire Smoke and Your Patients' Health.
This 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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U.S. Environmental Protection Agency. (2021). Strategies for Effective Health Risk Communication During Wildfire Smoke Webinar Archive.
This webinar features information for health care communicators on encouraging community members to use the Smoke Sense app and adjust their behaviors depending on local air quality levels.
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U.S. Environmental Protection Agency. (2022). Preparing for Wildland Fire Smoke.
This webinar can help health care emergency planners and building managers prepare for and reduce smoke exposures that can occur indoors during wildfires and prescribed burning.
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U.S. Environmental Protection Agency. (2023). Wildfire Smoke and Your Patients’ Health (Web Based) - WB4244R.
This one-hour web-based course can help health care professionals learn more about the health effects associated with wildfire smoke.
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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. (Free registration required.) 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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* ASPR TRACIE. (2018). Major Earthquakes & Cascading Events: Potential Health and Medical Implications.
This ASPR TRACIE resource provides an overview of the potential significant health and medical response and recovery needs facing areas affected by a major earthquake with or without additional cascading events.
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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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Federal Emergency Management Agency. (2016). Cascadia Rising 2016 Exercise After-Action Report: Cascadia Subduction Zone (CSZ) Catastrophic Earthquake and Tsunami. U.S. Department of Homeland Security.
This report summarizes the Pacific Northwest's multi-state exercise held in June 2016. Findings are listed by core capability; public health and medical services and mass care information can be found beginning on page 13.
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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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HHS emPOWER Program. (2020). Stories from the Field: Earthquakes in Puerto Rico.
The Puerto Rico Department of Health (PRDOH) used the emPOWER Emergency Response Outreach Dataset to identify at-risk individual residences in areas impacted by severe earthquakes and directed community outreach teams comprised of PRDOH officials, Medical Reserve Corps volunteers, local nursing school students, and others to conduct wellness checks across five municipalities. Outreach teams located 166 at-risk individuals and provided them with referrals to behavioral health services, as needed, as well as informational resources and contacts for behavioral health, hygiene, human services and housing services, the Emergency Prescription Assistance Program, and other federal assistance programs.
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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. (Free registration required.) 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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Pan American Health Organization. (2011). Health Response to The Earthquake in Haiti January 2010.
This report discusses lessons learned from the immediate and early response in the first three months following the 2010 earthquake in Haiti, with the goal of improving the health response in future sudden-onset disasters.
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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. (Free registration required.) 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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Renfrow, J. (2019). Hospitals Implement Quake-Ready Technology, Teams in Seismically Active Areas. FierceHealthcare.
The author highlights strategies used by several hospitals to mitigate and prepare for the effects of future earthquakes (e.g., retrofitting buildings, adding communications tools to ensure redundancy, and monitoring seismic activity.
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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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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. 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. (Free registration required.) 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 Cold

ASPR TRACIE. (2021). Managing the Storm After the Storm: Healthcare in TX Recovers from Severe Winter Weather.
Michael Wargo (HCA Healthcare), Scott Cormier (Medxcel), and Toni Carnie (HCA Houston Healthcare Tomball) share how a rare winter storm, extreme cold, and unplanned power outages affected utilities--particularly water and water pressure--in healthcare facilities throughout Texas. This summary highlights issues that will benefit from additional mitigation and preparedness activities as extreme weather incidents increase in frequency.
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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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Gooch, K. (2018). How to Help Keep Staff Safe When Adverse Weather Strikes: 5 Hospitals Weigh in. Becker’s Hospital Review.
This article highlights lessons learned by healthcare facilities during winter storms. One facility converts exam rooms into overnight accommodations for staff and provides them with cafeteria meal vouchers. Another ensures childcare is available for staff who remain at work during a storm, and others have agreements with local hotels that provide rooms at discounted rates.
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HHS emPOWER Program. (2020). Stories from the Field: Blizzards in Goshen County, Wyoming.
During back-to-back severe blizzards, Goshen County, Wyoming, used the emPOWER Emergency Response Outreach Dataset to support numerous multi-agency coordinated response outreach activities to at-risk individuals directly impacted by the severe storms and hazardous conditions. The county partnered with the Sheriff’s office to identify areas where at-risk individuals resided in the areas affected by the power outages, then coordinated with the Sheriff’s office to conduct approximately 25 targeted wellness checks by phone.
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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. (Free registration required.) 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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* Lavigne, E., Gasparrini, A., Wang, X., et al. (2014). Extreme Ambient Temperatures and Cardiorespiratory Emergency Room Visits: Assessing Risk by Comorbid Health Conditions in a Time Series Study. Environmental Health. 13:5.
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. 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: 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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ASPR TRACIE. (2023). Extreme Heat Events: Lessons from Seattle’s Record-Breaking Summers.
Triple digit temperatures are affecting areas of the U.S. that historically never experienced them, including the City of Seattle, where home and facility air conditioning is rare or is not designed for extreme temperatures. This article features health care stakeholders sharing how lessons learned during the 2021 heat dome event and robust regional and local collaboration and communications during the pandemic facilitated connections during the heat wave in the summer of 2022.
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Casey, J., Parks, R., Bruckner, T., et al. (2023). Excess Injury Mortality in Washington State During the 2021 Heat Wave. (Abstract only.) American Journal of Public Health.
The authors used death certificate data to understand whether and how the 2021 heat wave in Washington state led to excess deaths. They used time series to compare deaths during the dates the heat wave occurred against the number of deaths that historically occurred in the same time period. The authors conclude that the heat wave was associated with an increase in injury deaths.
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Davis, R. and Novicoff, W. (2018). The Impact of Heat Waves on Emergency Department Admissions in Charlottesville, Virginia, U.S.A. International Journal of Environmental Research and Public Health. 15(7): 1436.
The authors examined more than 720,000 daily emergency department hospital admissions in Charlottesville, VA from 2005-2016 and found an overall association between heat waves and increased admissions, “across the entire disease spectrum.”
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HEAT.gov. (2023). Current Conditions and Future Outlooks. National Integrated Heat Health Information System.
This website includes a map of maximum daily temperatures across the U.S., a heat and health tracker to facilitate response to extreme heat, a climate explorer to understand how weather will change in the coming decades, and information on related events and news.
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Heidari, L., Winquist, A., Klein, M., et al. (2016). Susceptibility to Heat-Related Fluid and Electrolyte Imbalance Emergency Department Visits in Atlanta, Georgia, USA. International Journal of Environmental Research and Public Health. 13(10): 982.
The researchers studied data on daily temperature and fluid and electrolyte imbalance (FEI) emergency department (ED) visits in Atlanta, GA, between 1993 and 2012. They found that higher ambient temperature was significantly related to FEI ED visits. Analyses indicated higher risks for all populations, but particularly males.
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* Hostetter, M., and Klein, S. (2022). How Health Care Organizations Are Preparing for Climate Shocks and Protecting Vulnerable Patients. The Commonwealth Fund.
Climate change is exacerbating hurricanes, extreme heat, and other severe weather events, which requires hospitals to improve their infrastructure to withstand these events and prepare to care for affected patients. This article provides information for Federally Qualified Health Centers and other facilities serving patients who are at risk for health impacts due to climate change-related extreme weather events.
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Jagai, J., Grossman, E., Navon, L. et al. (2017). Real-Time Surveillance of Heat-Related Morbidity: Relation to Excess Mortality Associated with Extreme Heat. PLoS One. 12(9): e0184364.
The authors combined data from emergency medical services (EMS) and emergency department (ED) visits over a period of time in New York City to calculate heat-related mortality. They found a (statistically significant) 7% increase in non-external cause mortality associated with one-day lagged heat-related EMS calls and a 5% mortality increase with one-day lagged ED visits.
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* Lavigne, E., Gasparrini, A., Wang, X., et al. (2014). Extreme Ambient Temperatures and Cardiorespiratory Emergency Room Visits: Assessing Risk by Comorbid Health Conditions in a Time Series Study. Environmental Health. 13:5.
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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Li, M., Gu, S., Bi, P., et al. (2015). Heat Waves and Morbidity: Current Knowledge and Further Direction-A Comprehensive Literature Review. International Journal of Environmental Research and Public Health. 12(5): 5256-5283.
This analysis of 33 studies found that the elderly, males, children, and those with chronic diseases were more vulnerable during heat waves. The authors also found that certain social factors (e.g., lower socioeconomic status) had a relationship to heat susceptibility. They suggest incorporating morbidity indicators into heat wave early warning systems to bolster health response.
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National Weather Service. (2023). NWS HeatRisk Prototype. National Oceanic and Atmospheric Administration.
This website aims to help prepare the U.S. for extreme heat events by mapping areas at risk in the next seven days. The map uses a color scale of 0-4 to show whether areas have no elevated risk, moderate risk, high risk, or very high risk for heat waves.
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Ryan, J. (2021). 2021 Heat Wave is Now the Deadliest Weather-Related Event in Washington History. KUOW.org.
The author describes how a 2021 heat wave led to the deaths of 112 people in Washington state. The article highlights how a lack of air conditioning statewide was a factor, how the event led to a significant increase in heat-related emergency department visits, and how emissions today will lead to higher temperatures in the future.
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Soneja, S., Jiang, C., Fisher, J., et al. (2016). Exposure to Extreme Heat and Precipitation Events Associated with Increased Risk of Hospitalization for Asthma in Maryland, U.S.A.. Environmental Health. 15:57.
The researchers found that extreme heat events in Maryland increased the risk of same-day hospitalization for asthma by 3 %; higher risk was seen for extreme heat events that occur during summer months. They also found that extreme precipitation events increased the risk of summertime hospitalization by 11 % in Maryland.
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The Lancet. (2015). Health Professionals: Be Prepared for Heatwaves.
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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Washington State Department of Health. (2021). Heat Wave 2021.
This website explains why there were extreme heat-associated deaths during the 2021 heatwave in the Pacific Northwest and provides data tables on heat-related deaths broken down by county, gender, age, and race/ethnicity. They note that people aged 65+, infants and children under 4 years old, and people who are ill or taking certain medications are at higher risk for heat-related illness.
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Lessons Learned: Fire/Wildfire

ASPR TRACIE. (2019). The Last Stand: Evacuating a Hospital in the Middle of a 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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ASPR TRACIE. (2020). Issue 10: Preparing for and Responding to Wildfires and Planned Outages.
This issue of The Exchange highlights lessons learned from recent wildfires, evacuating and receiving patients, and preparing for planned power outages.
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ASPR TRACIE. (2022). Hospital Evacuation during a Wildfire and Pandemic: Avista Adventist Shares their Experience.
On December 30th, 2021, healthcare workers at Centura Health’s Avista Adventist Hospital were managing a pandemic and planning for a winter storm. The hospital, which includes a large neonatal intensive care unit, was full, with less than 5% capacity. Unbeknownst to the staff working during that holiday weekend, the Marshall Fire was approaching the building, and would cause some of them to lose their homes while forcing the hospital to evacuate in under two hours. ASPR TRACIE met with five subject matter experts to learn more about their experiences, challenges, and lessons learned.
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ASPR TRACIE. (2024). Experiences from the Field: The Signature Healthcare Brockton Hospital Fire.
On the morning of Tuesday, February 7th, 2023, a 10-alarm fire broke out at Signature Healthcare Brockton Hospital in an electrical room, causing an almost immediate failure of the hospital’s electrical system. The hospital safely evacuated 162 patients in coordination with the fire department and was subsequently closed for an extended recovery period. This article supports a webinar where three leaders who managed the response highlighted successes and challenges of incident command, communications, preparedness and response plans, and patient evacuation, transfers, and tracking during and after the incident. Access the webinar here: https://files.asprtracie.hhs.gov/documents/signature-healthcare-february-2023-fire-amp--evacuation-webinar-final.pdf
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* California Department of Public Health. (2022). Wildfire Smoke: Considerations for California's Public Health Officials.
This document contains information for California’s public health officials, emergency management professionals, and others involved in planning for and responding to wildfire smoke incidents. Information is provided on wildfire smoke and health risks, sensitive populations, strategies to reduce exposure during wildfire smoke incidents, and specific guidance for public health planning and response. Tools and best practices are included, particularly those that emphasize assessing community vulnerabilities and the protection of sensitive populations. Appendices include additional resources and links, organized by topic.
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Centers for Disease Control and Prevention. (2020). 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. The speakers highlight how lessons learned from recent extreme fire behavior can inform healthcare planning.
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Dohrenwend, P.B., Le, M.V., Bush, J.A., et al. (2013). The Impact on Emergency Department Visits for Respiratory Illness During the Southern California Wildfires. The Western Journal of Emergency Medicine. 14(2):79-84.
This article describes how Southern California’s 2007 wildfires impacted emergency department visits for respiratory issues. Complaints related to dyspnea and asthma increased significantly between pre- and post-fire periods. The authors suggest developing a virtual pack of supplies to save space locally and that can be quickly assembled and sent to sites by the distributor.
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Doubleday, A., Schulte, J., Sheppard, L., et al. (2020). Mortality Associated with Wildfire Smoke Exposure in Washington State, 2006–2017: A Case-Crossover Study. Environmental Health. 19:4.
The authors reviewed data over 12 years from Washington State and found “increased odds of mortality in the first few days following wildfire smoke exposure.” The article includes figures and tables that describe subject demographics and their relationship to wildfire smoke-related variables.
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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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HHS emPOWER Program. (2020). Stories from the Field: Wildfires in Los Angeles County, California.
During severe wildfires, Los Angeles County, California, used the emPOWER Emergency Response Outreach Individual Dataset to rapidly conduct outreach to near 40 durable medical equipment (DME) and oxygen suppliers to provide recovery assistance to more than 600 individuals impacted by the historic wildfires. LA County also developed a formal multi-agency LA County-City of LA protocol that rapidly operationalizes data and supports integrated situational awareness, decision-making and action prior to, during, and after an emergency.
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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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Mountain Plains Regional Disaster Health Response System (MPRDHRS). (2023). Marshall Fire Learning Series: EMS.
This 1.5-hour video is part of a four-video series which details how Mountain View Fire Rescue, EMS, and the Boulder County Sheriff’s Office responded to the Marshall Fire on December 31, 2021. The panel is composed of emergency responders who discuss their experiences during the fire.
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Mountain Plains Regional Disaster Health Response System (MPRDHRS). (2023). Marshall Fire Learning Series: Hospital Response.
This 1.5-hour video is part of a four-video series in which hospital, EMS, and Mountain View Fire Rescue leaders discuss the hospital evacuation during the Marshall Fire on December 31, 2021. The video includes participants from the responding health care coalition, Boulder County Public Health, and health care facilities which were affected.
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Mountain Plains Regional Disaster Health Response System (MPRDHRS). (2023). Marshall Fire Learning Series: Regional Coordination.
This 1-hour video is part of a four-video series in which stakeholders who supported the emergency response to the December 31, 2021, Marshall Fire discuss regional coordination among public health, disaster management, and the local health care coalition. They discuss emergency sheltering, evacuating residents with access and functional needs, and local coordination structures.
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Mountain Plains Regional Disaster Health Response System (MPRDHRS). (2023). Marshall Fire Learning Series: Residential Communities.
This 1 hour, 20-minute video is part of a four-video series in which stakeholders from public health and a retirement community discuss evacuation and support for residential care facilities during the Marshall Fire on December 31, 2021. The participants discuss transportation, coordination among partners, and considerations for evacuation during the COVID-19 pandemic.
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National Academies of Sciences, Engineering, and Medicine. (2019). Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. The National Academies Press.
Workshop participants discussed the effects of wildfires on certain populations and human health; challenges associated with recovery; improving operational response; and "the impact of mitigation and preparedness."
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National Resources Defense Council. (2013). Where There’s Fire, There’s Smoke: Wildfire Smoke Affects Communities Distant from Deadly Flames.
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. (Free registration required.) 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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* Author Unknown. (2018). NAI How-to Guide for Flood Warning & Response Case Study: Our Lady of Lourdes Hospital’s Flood Mitigation and Flood Response Plan.
This case study includes lessons learned from record flooding in 2006 and select flood response plan components provided by Our Lady of Lourdes Hospital in Binghamton, NY.
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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. (Free registration required.) 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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HHS emPOWER Program. (2020). Stories from the Field: Flooding and Windstorms in Broome County, New York.
The Broome County Health Department in New York used the emPOWER Emergency Response Outreach Individual Dataset to quickly identify and conduct outreach to 58 at-risk residents without power during a severe and prolonged power outage and make informed decisions on power restoration.
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HHS emPOWER Program. (2020). Stories from the Field: Severe Flooding in Nevada.
Nevada’s state and county health departments, in partnership with the Aging and Disability Services Division, a Tribe Emergency Manager, durable medical equipment suppliers, and others, used emPOWER data to conduct outreach to at-risk individuals during multiple prolonged severe flooding events.
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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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Langdon, S., Johnson, A., and Sharma, R. (2019). Debris Flow Syndrome: Injuries and Outcomes After the Montecito Debris Flow. (First page only.) The American Surgeon. 85(10): 1094-1098.
In January 2018, a 30-foot debris flow inundated Montecito, CA, leading to dozens of injuries and 21 “prehospital deaths.” The authors examined 24 patients’ injury patterns, related procedures performed (and complications), length of stay, and outcomes. They defined “debris flow syndrome…as a pattern of injuries, including soft tissue injuries, hypothermia, craniofacial trauma, corneal abrasions, orthopedic injuries, and mud impaction.”
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* McMichael, A.J. (2015). Extreme Weather Events and Infectious Disease Outbreaks. 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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National Association of County and City Health Officials. (2015). Coordinated Response to Flooding and the Mudslide in Washington State: An Interview with Therese Quinn.
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. (Free registration required.) 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: General

Barten, D., Klokman, V., Cleef, S., et al. (2021). When Disasters Strike the Emergency Department: A Case Series and Narrative Review. (Abstract only.) International Journal of Emergency Medicine. 14(1): 49.
The authors share three case stories from emergency departments (EDs) (a structural collapse, a fire, and a computer system failure) to highlight vulnerabilities and the range of hazards that can affect EDs. Hospital planners and builders are encouraged to incorporate local and other hazards into facility plans and construction.
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* Crimmins, A.R., C.W. Avery, D.R. Easterling, K.E., et al. (Eds). (2023). Fifth National Climate Assessment. U.S. Global Change Research Program.
This report highlights observed and projected vulnerabilities, risks, and impacts associated with climate change across the country. It includes sections on physical science, national topics (e.g., air quality, indigenous peoples, agriculture, and social systems and justice), and concerns by region. Examples of response actions that focus on community mitigation and adaptation are also included.
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HHS emPOWER Program. (2020). Stories from the Field: COVID-19 Response in Philadelphia County, Pennsylvania.
Philadelphia County, in collaboration with the Commonwealth of Pennsylvania, used the emPOWER Emergency Response Outreach Individual Dataset to provide targeted public health messaging and direct contact information for support services, including grocery and utility bill paying assistance, to approximately 13,000 at-risk individuals. Philadelphia also leveraged emPOWER data to identify and partner with home health agencies, to reinforce these public health and safety messages and provided additional resources for their staff and patients.
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HHS emPOWER Program. (2020). Stories from the Field: Planning for Multiple Threats in Arizona.
The Arizona Department of Health Services (ADHS) used the HHS emPOWER Map, the emPOWER Emergency Planning De-identified Dataset, and the emPOWER Emergency Response Outreach Individual Dataset to prepare for, respond to, and work to mitigate severe weather, poor air quality, and power outage threats to at-risk individuals in emergencies. ADHS developed systems, processes and deployable equipment and supply caches to support 1,000 at-risk individuals in a response.
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Lichtenberg, T. (2019). Planning and Partnerships: Coordinating Rural Resources for Emergency Preparedness and Response. The Rural Monitor.
This report highlights how rural healthcare facilities can prepare for natural and human-caused disasters and the importance of flexibility. The author also shares lessons learned from rural communities and providers who responded to a tornado in Iowa, an earthquake in Alaska, and an armed hostage standoff in South Dakota.
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* Marchigiani, R., Gordy, S., Cipolla, J., et al. (2013). Wind Disasters: A Comprehensive Review of Current Management Strategies. International Journal of Critical Illness & Injury Science. 3(2): 130-142.
The authors review wind disaster incidents (including hurricanes and cyclones) worldwide from 1980-2008, including a subcategory of tornados in the U.S. from 1950 to 1994. Results include injury data and descriptions (both prior, during, and after impact) and information on damage to healthcare facilities and infrastructure.
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National Center for Disaster Medicine and Public Health. (2018). State of Science. Uniformed Services University of the Health Sciences.
This is the first webinar in a series that discusses the current state and future direction of critical healthcare infrastructure modeling for disaster events including climate change influences. This project focuses on developing a platform that integrates several variables (“extreme event forecasts, health risk/impact assessment and population simulations, critical infrastructure (electrical, water, transportation, communication) impact and response models, healthcare facility-specific vulnerability and failure assessments, and health system/patient flow responses”) to improve regional healthcare system resilience.
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National Institute of Environmental Health Sciences. (2023). Disaster Research Response (DR2) Resources Portal.
This repository of data collection tools and related resources can facilitate human health research in response to disasters and public health emergencies. The webpage includes links to data on COVID-19, disaster behavioral health, respiratory impacts of wildfires, and other timely topics.
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Suneja, A., Chandler, T.E., Schlegelmilch, J., et al. (2018). Chronic Disease After Natural Disasters: Public Health, Policy, and Provider Perspectives. Columbia University, Earth Institute, National Center for Disaster Preparedness.
This report provides public and private state and local stakeholders with information to help them better understand and support the post-disaster needs of individuals with chronic conditions. It highlights the strengths and weaknesses that have been experienced, or are anticipated in current approaches to this issue.
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Lessons Learned: Hurricanes

Abramson, D., Van Alst, D., Merdjanoff, A., et al. (2015). The Hurricane Sandy Person Report: Disaster Exposure, Health Impacts, Economic Burden, and Social Well-Being.
The authors examine the impact of Hurricane Sandy ("the dose") on the health and well-being of New Jersey residents ("the response") exposed to the storm. Primary findings include: the negative effect housing damage had on residents' health is similar to the effect of poverty; some toxins (e.g., mold) had a double negative effect (e.g., clinically-diagnosed asthma and mental health distress); and children living in homes that experienced minor physical damage were more likely to be sad or depressed or having sleeping problems.
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American College of Emergency Physicians (ACEP). (2015). Lessons Learned from Hurricane Sandy and Recommendations for Improved Healthcare and Public Health Response and Recovery for Future Catastrophic Events.
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. (2022). Healthcare System Recovery Timeline: A White Paper for Texas.
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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* ASPR TRACIE. (2022). 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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ASPR TRACIE. (2023). The Hurricane Ian Experience at Lee Health: Wreckage, Resilience, and Recovery.
More than 150 direct and indirect deaths and over $112 billion in damage have been attributed to 2022’s Hurricane Ian, which made landfall in southwestern Florida as a Category 4 storm. Dave Kistel (Vice President and Chief Facilities Executive at Lee Health) met with ASPR TRACIE and described how the hospital system prepared for, responded to, and recovered from Hurricane Ian, which caused $12 million in damage to Lee Health facilities. Access the recording here: https://files.asprtracie.hhs.gov/documents/hurricane-ian-lee-health-wreckage-resilience-recovery.pdf
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Barkemeyer, B. (2006). Practicing Neonatology in a Blackout: The University Hospital NICU in the Midst of Hurricane Katrina: Caring for Children Without Power or Water. (Abstract only.) Pediatrics. 117(Suppl. 4):S369 -S374.
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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Becker’s Hospital Review. (2018). Hospital Disaster Preparedness: Best Practices Learned From Hurricane Irma.
The authors share lessons learned by staff in a Florida hospital that experienced the effects of Hurricane Irma in 2018, including: providing fuel for staff vehicles so they can get to work; having hard copies of plans and contact lists available for all key staff; devising staffing plans in advance of the storm to create three teams to ensure staffing before, during, and after the storm; and having emergency contacts in place with key vendors.
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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. (Free registration required.) 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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Caspers, C., Smith, S., Seth, R., et al. (2016). Observation Services Linked with an Urgent Care Center in the Absence of an Emergency Department: An Innovative Mechanism to Initiate Efficient Health Care Delivery in the Aftermath of a Natural Disaster. (Abstract only.) Disaster Medicine and Public Health Preparedness. 10(3):405-10.
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 2/17/2020.)
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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Dorsey, D., Carlton, F., and Wilson, J. (2012). The Mississippi Katrina Experience: Applying Lessons Learned to Augment Daily Operations in Disaster Preparation and Management. Southern Medical Journal. 106(1).
The authors share how lessons learned in patient movement and other planning and response capabilities have been incorporated since Hurricane Katrina struck the Gulf Coast. The authors highlight the development of Mississippi MED-COM, a statewide medical communications center, to serve as a “hub for patient coordination and movement during emergency incidents.”
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Henry J. Kaiser Family Foundation. (2018). Health Care in Puerto Rico and the U.S. Virgin Islands: A Six-Month Check-Up After the Storms.
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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HHS emPOWER Program. (2020). Stories from the Field: Hurricane Matthew in Florida.
The Florida Department of Health used the emPOWER Emergency Response Outreach Individual Dataset and their alert system to perform a reverse phone number look up to conduct rapid robo-dial outreach to over 40,000 at-risk individuals in the path of Hurricane Matthew.
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HHS emPOWER Program. (2020). Stories from the Field: Hurricane Matthew in South Carolina.
During Hurricane Matthew, the South Carolina Department of Health and Environmental Control (DHEC) used the emPOWER Emergency Response Outreach Individual Dataset to identify areas with high concentrations of at-risk individuals. Through a partnership with first-responders and FEMA Urban Search and Rescue (USAR), DHEC identified evacuation staging areas that could support a surge in at-risk individuals requiring shelter. DHEC later conducted recovery outreach to 268 at-risk individuals to assess ongoing recovery needs and level of preparedness, and provide informational resources.
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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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* Hostetter, M., and Klein, S. (2022). How Health Care Organizations Are Preparing for Climate Shocks and Protecting Vulnerable Patients. The Commonwealth Fund.
Climate change is exacerbating hurricanes, extreme heat, and other severe weather events, which requires hospitals to improve their infrastructure to withstand these events and prepare to care for affected patients. This article provides information for Federally Qualified Health Centers and other facilities serving patients who are at risk for health impacts due to climate change-related extreme weather events.
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Icenogle, M., Eastburn, S., and Arrieta, M. (2016). Katrina's Legacy: Processes for Patient Disaster Preparation Have Improved but Important Gaps Remain. American Journal of Medical Science. 352(5): 455–465.
The authors present findings from a qualitative study of participants representing healthcare and social services organizations serving health disparate residents of the Mississippi and Alabama Gulf Coast. They note that participant organizations have implemented changes to ensure continuity of care for the chronically ill in case of disasters (e.g., evacuation planning and assistance; support to find resources in evacuation destinations; equipping patients with prescription information, diagnoses, treatment plans, and advance medications when a disaster is imminent), but that additional solutions are necessary to meet the needs of disparate populations more fully.
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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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Kaiser Family Foundation. (n.d.). Addressing the Health Care Impact of Hurricane Katrina. Kaiser Commission on Medicaid and the Uninsured. (Accessed 2/21/2020.)
This paper addresses the overarching healthcare status of the areas affected by Hurricane Katrina and their potential impact on other locations across the nation. It describes issues related to public health, emergency/trauma care, primary care, medication access, acute hospital care, long term care, and mental health care.
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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. 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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Parks, R., Benavides, J., Anderson, B., et al. (2022). Association of Tropical Cyclones With County-Level Mortality in the US. (Abstract only.) Journal of the American Medical Association. 327(10):946-955.
The authors conducted a retrospective observational analysis of 33.6 million deaths in 1206 counties that experienced tropical cyclone days (i.e., days with a sustained maximal wind speed 34 knots [39 mph] or greater) from 1988-2018. They found that each additional cyclone day was associated with somewhat higher death rates for several months due to the following causes: injuries, infectious and parasitic diseases, cardiovascular diseases, neuropsychiatric conditions, and respiratory diseases.
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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. (Abstract only.) 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. (Free registration required.) 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. (Free registration required.) 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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Texas Hospital Association. (2018). Texas Hospital Association Hurricane Harvey Analysis.
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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Tsai, S., Hamby, T., Chu, A., et al. (2016). Development and Application of Syndromic Surveillance for Severe Weather Events Following Hurricane Sandy. (Free registration required.) Disaster Medicine and Public Health Preparedness. 10(3): 463-471.
The authors examined syndromic surveillance data for emergency department (ED) visits in New Jersey after Superstorm Sandy in 2012, and compared it to ED visit data during the same time periods the previous year to better understand the effects of the storm on the health of affected individuals. They found that “spikes in overall ED visits were observed immediately after the hurricane for carbon monoxide (CO) poisoning, the 3 disrupted outpatient medical care indicators, asthma, and methadone-related substance use.”
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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

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. (Free registration required.) 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. (Free registration required.) 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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Kearns, R., Stringer, L., Craig, J., et al. (2017). Relying on the National Mobile Disaster Hospital as a Business Continuity Strategy in the Aftermath of a Tornado: The Louisville Experience. (Abstract only.) Journal of Business Continuity & Emergency Planning. 10(3): 230-248.
This article details how a mobile hospital was created with Hospital Preparedness Program support in Louisville when a local hospital was deemed a structural loss after a tornado.
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* Marchigiani, R., Gordy, S., Cipolla, J., et al. (2013). Wind Disasters: A Comprehensive Review of Current Management Strategies. International Journal of Critical Illness & Injury Science. 3(2): 130-142.
The authors review wind disaster incidents (including hurricanes and cyclones) worldwide from 1980-2008, including a subcategory of tornados in the U.S. from 1950 to 1994. Results include injury data and descriptions (both prior, during, and after impact) and information on damage to healthcare facilities and infrastructure.
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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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Porth, L. (2012). Preparedness and Partnerships: Lessons Learned from the Missouri Disasters of 2011. Missouri Hospital Association.
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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Shin, P. and Jacobs, F. (2012). An HIT Solution for Clinical Care and Disaster Planning: How One Health Center in Joplin, MO Survived a Tornado and Avoided a Health Information Disaster. Online Journal of Public Health Informatics. 4(1).
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. (Free registration required.) 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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Mitigation

Administration for Strategic Preparedness and Response. (2023). RISC Toolkit 2.0. U.S. Department of Health and Human Services.
The Risk Identification and Site Criticality (RISC) Toolkit is an objective, data-driven all-hazards risk assessment that can be used by public and private organizations within the Healthcare and Public Health Sector to inform emergency preparedness planning, risk management activities, and resource investments. The RISC Toolkit provides owners/operators in the HPH Sector with nationally recognized standards-based evaluation criteria in an easy-to-follow, guided format.
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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
American Meteorological Society. (2014). A Prescription for the 21st Century: Improving Resilience to High-Impact Weather for Healthcare Facilities and Services.
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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ASPR TRACIE. (2022). Climate Change Resilience and Healthcare System Considerations.
Climate change continues to negatively impact national security, environmental stability, and human health conditions. This document provides an overview of climate trends in the U.S., outlining the impacts of climate-related illness and injury on health system operations, care delivery, and patient surge. It touches on the importance of bolstering healthcare infrastructure resilience, facility hardening, and highlights three areas being affected by various elements of climate change.
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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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* Crimmins, A.R., C.W. Avery, D.R. Easterling, K.E., et al. (Eds). (2023). Fifth National Climate Assessment. U.S. Global Change Research Program.
This report highlights observed and projected vulnerabilities, risks, and impacts associated with climate change across the country. It includes sections on physical science, national topics (e.g., air quality, indigenous peoples, agriculture, and social systems and justice), and concerns by region. Examples of response actions that focus on community mitigation and adaptation are also included.
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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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Fentem, S. (2018). 7 Years After Joplin Tornado, Mercy Builds Hospitals with Disaster in Mind.
The 2011 Joplin tornado decimated St. John’s Hospital. This article describes how builders designed an addition to a different hospital (Mercy, in Festus, MO) to withstand storm damage. Builders used window glass that can withstand winds greater than 100 miles per hour; encased power sources in the attic; reinforced stairwells; and built a wall around the perimeter to protect the hospital from floodwater.
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Guenther, R., and Balbus, J. (2014). Primary Protection: Enhancing Health Care Resilience for a Changing Climate. U.S. Department of Health and Human Services.
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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Healthcare & Public Health Sector Coordinating Councils. (n.d.). Planning for Water Supply Interruptions: A Guide for Hospitals & Healthcare Facilities. (Accessed 2/17/2020.) U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
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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HHS emPOWER Program. (2020). HHS emPOWER Map.
The HHS emPOWER Map provides monthly de-identified totals of Medicare claims submitted for one or more of the fourteen types of life-maintaining or saving electricity-dependent durable medical and assistive equipment (DME) and certain implanted electricity-dependent cardiac devices, at the national, state, territory, county, and ZIP Code levels. Users have the ability to create unique aggregations by geography and export the data, as well as the ability to access historical HHS emPOWER Map datasets for further analysis. When combined with real-time severe weather and hazard maps, the HHS emPOWER Map gives communities the power to anticipate, plan for, and address the needs of this population prior to, during, and after an incident, emergency, or disaster.
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HHS emPOWER Program. (2020). HHS emPOWER REST Service.
The HHS emPOWER REST Service allows users to readily access, consume, and apply de-identified aggregated Medicare beneficiary claims data totals at the state, territory, county, and ZIP code levels (as displayed in the HHS emPOWER Map) in their own geographic information system (GIS) application.
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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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Novation. (n.d.). Emergency Disaster Plan Template. (Accessed 2/22/2023.)
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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Oregon Health Authority. (2018). Oregon Coastal Hospitals Preparing for Cascadia.
This report summarizes a project that was conducted to determine the state of preparedness of coastal hospitals in response to a Cascadia earthquake and tsunami, and to assess what is needed to reduce earthquake damage in order to provide sufficient healthcare services following the event. The project assessed each hospital’s level of awareness and preparedness for earthquakes and tsunamis and highlighted the information and resources hospitals need to effectively plan for a magnitude 9 Cascadia earthquake and accompanying tsunami.
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The White House (2022). Fact Sheet: Vice President Harris Announces Action Plan on Global Water Security and Highlights the Administration’s Work to Build Drought Resilience.
This fact sheet frames water security around the world as a national and global security issue for the United States. The three pillars of the White House policy include leading the international effort to achieve universal, equitable access to water without increasing greenhouse gas emissions; sustainable management of water resources; ensuring collaborative multilateral action to promote water security.
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* U.S. Department of Health and Human Services. (2018). GeoHealth Platform.
This tool provides central access to federal disaster and public health related natural disaster alerts, warnings, and other resources.
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U.S. Department of Health and Human Services’ Sustainable and Climate Resilient Health Care Facilities Initiative (SCRHCFI) (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

* ASPR TRACIE. (2018). Major Earthquakes & Cascading Events: Potential Health and Medical Implications.
This ASPR TRACIE resource provides an overview of the potential significant health and medical response and recovery needs facing areas affected by a major earthquake with or without additional cascading events.
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Cascadia Region Earthquake Workgroup (CREW). (2018). Preparing Hospitals for Earthquakes: Structural and Nonstructural Issues.
This fact sheet highlights lessons learned and strategies for building mitigation and resilience by hospitals that experienced recent earthquakes.
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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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* World Health Organization. (2018). Chemical Releases Caused by Natural Hazard Events and Disasters: Information for Public Health Authorities.
This report highlights the risks and prevention and response strategies associated with flood-, earthquake-, and cyclone-related chemical releases.
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Plans, Tools, and Templates: Extreme Cold

California Association of Health Facilities. (n.d.). CAFH’s Ready, Set, Go: Extreme Cold. (Accessed 2/25/2020.)
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. This document may have specific value as a starting point for communities that do not frequently experience severe cold weather events.
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Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2019). Preparing for a Winter Storm.
This website includes a series of small checklists to guide preparation for winter weather. Considerations for communication, heating, carbon monoxide and smoke detectors, 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: Extreme Heat

Arizona Department of Health Services. (2021). Extreme Heat Incident Annex.
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 Extreme Heat Incident Annex.
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ASPR TRACIE. (2015). Heat Wave Plans.
This ASPR TRACIE TA response includes various municipal heat wave mitigation plans, toolkits, checklists, and related resources. Related Topic Collection: Natural Disasters.
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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. (2022). 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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  • tamminh duong This document is very useful to me. Thank you https://tamminhduong.com/
    5/21/2020 11:03:09 PM
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 residents at highest risk for heat-related illnesses.
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City of New York, Department of Health and Mental Hygiene. (2020). Heat Wave Preparedness Checklists for Vulnerable Population Service Providers.
These checklists can help healthcare and other service providers identify 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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Health Canada. (2011). Communicating the Health Risks of Extreme Heat Events.
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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* Lavigne, E., Gasparrini, A., Wang, X., et al. (2014). Extreme Ambient Temperatures and Cardiorespiratory Emergency Room Visits: Assessing Risk by Comorbid Health Conditions in a Time Series Study. Environmental Health. 13:5.
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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New Hampshire Department of Health and Human Services. (2014). Excessive Heat Emergency Response Plan: Appendix 2 to Emergency Services Function 8 Annex of New Hampshire State Emergency Operations Plan. (Contact the ASPR TRACIE Assistance Center for a copy of this attachment.)
This plan identifies the New Hampshire (NH) Department of Health and Human Services’ role in response to excessive heat emergencies in the state, in collaboration with the NH Public Health Regions and other state agencies, and in accordance with the National Incident Management System. It includes templates for press releases, hotline scripts, and health alert messages, and provides a heat fact sheet.
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Office of Climate Change and Health Equity. (2022). Climate and Health Outlook: Extreme Heat. U.S. Department of Health and Human Services.
This "outlook" is based on temperature projections from the National Oceanic and Atmospheric Administration and others and highlights areas of the U.S. and populations at higher health risk from extreme heat exposure. It also provides related strategies and resources for individuals, healthcare professionals, and public health officials.
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Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program. (2019). Crisis and Emergency Risk Communication Toolkit for Extreme Heat.
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 various languages.
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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

Aon Property Risk Consulting. (2021). Emergency Response: 2021 Wildfire Season, Template & Checklists. (Download PDF for access to checklists.)
This website contains a downloadable template and checklists which can assist healthcare facilities with preparing for wildfire season, especially during the COVID-19 pandemic. It includes checklists for recovery, wildfire preparedness, flood preparedness, and power and generators.
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ASHRAE. (n.d.). Planning Framework for Protecting Commercial Building Occupants from Smoke During Wildfire Events. (Accessed 6/23/2023.)
Health care building managers and emergency planners can use this framework to incorporate measures into heating, ventilation, and air conditioning, and other components that can protect patients and staff from wildfire smoke and other fine particulates. A summary document is available at https://www.epa.gov/sites/default/files/2021-05/documents/ashrae_journal_article_march_2021-tagged.pdf.
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* California Department of Public Health. (2022). Wildfire Smoke: Considerations for California's Public Health Officials.
This document contains information for California’s public health officials, emergency management professionals, and others involved in planning for and responding to wildfire smoke incidents. Information is provided on wildfire smoke and health risks, sensitive populations, strategies to reduce exposure during wildfire smoke incidents, and specific guidance for public health planning and response. Tools and best practices are included, particularly those that emphasize assessing community vulnerabilities and the protection of sensitive populations. Appendices include additional resources and links, organized by topic.
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Centers for Disease Control and Prevention. (2023). Wildfires.
This web page includes information on preparing for and staying safe during and after a wildfire. Links to information for worker safety and the effect of wildfire smoke are also included.
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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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Dwyer, K. (2018). Wildfire Health and Safety Information and Resources. National Association of County and City Health Officials.
This resource examines and contains links to resources on how local health departments respond to wildfires, the health impacts of wildfire smoke, emergency communications, shelters, clean up, and recovery.
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Environmental Protection Agency. (2023). AirNow.
This website provides air quality data for anywhere in the United States. Users can enter their zip code, state, or city to get local air quality information. The Fire and Smoke Map shows air quality conditions from fine particulate matter generated by wildfire smoke and other sources: https://fire.airnow.gov/
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HHS emPOWER Program. (n.d.). HHS emPOWER Map.
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Jagnarine, S., Van Alphen, D., Gibbs, T., et al. (2018). 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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Jefferson University Hospitals. (2012). Fire Response Plan - Code Red.
This document provides essential information on one healthcare facility’s response to a fire. It includes procedures for alarm activation, oxygen shut-off, the emergency response team, the fire department, evacuation, and declaring the facility all clear. The document may serve as a template for other healthcare facilities.
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National Institute of Environmental Health Sciences. (n.d.). Wildfires. (Accessed 5/17/2022)
This webpage contains training resources from the National Institute of Environmental Health Sciences’ Worker Training Program on wildfires, including a wildfire response training tool. Links to additional materials from the National Institutes of Health and the U.S. Department of Health and Human Services are also provided.
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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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NORCAL Group. (n.d.). Wildfires Preparedness and Response for Medical Professionals. (Accessed 5/16/22)
This website contains information for healthcare organizations on how to stay informed during wildfires, preparedness and response resources for wildfire, information on power outages, and patient care considerations.
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Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program. (n.d.). Wildfires and Smoke. (Accessed 3/26/2020.) 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. (2017). Crisis and Emergency Risk Communication.
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, Office of the Assistant Secretary for Preparedness and Response. (n.d.). GeoHEALTH Platform. (Accessed 5/16/22)
This website contains links to resources on natural hazards, incident tracking, counties where FEMA has declared a disaster, and other information related to geographic help for healthcare during wildfires.
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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 develop maps of areas at most risk and create related communication strategies.
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U.S. Environmental Protection Agency. (2021). Smoke-Ready Toolbox for Wildfires.
This toolbox includes information on the effect of wildfire smoke for individuals and healthcare and public health professionals. Links to sites that provide information on current fires are also provided.
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U.S. Environmental Protection Agency. (2021). Wildfire Smoke and Indoor Air Quality: How to Create a Clean Room at Home.
During a wildfire or prescribed fire, residents may be advised to stay indoors as smoke creates unhealthy air quality. This video highlights strategies for creating a clean room to reduce exposure to wildfire smoke while indoors.
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U.S. Environmental Protection Agency. (2023). Fire and Smoke Map.
This interactive map displays color-coded air quality levels and active fires across North and South America.
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U.S. Environmental Protection Agency, AirNow. (2023). Wildfire Guide Factsheets.
This webpage provides a list of factsheets for the general public, which provide information on how individuals can prepare for and protect themselves from wildfires and related health impacts.
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U.S. Environmental Protection Agency, U.S. Forest Service, Centers for Disease Control and Prevention, and California Air Resources Board. (2019). 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

* Author Unknown. (2018). NAI How-to Guide for Flood Warning & Response Case Study: Our Lady of Lourdes Hospital’s Flood Mitigation and Flood Response Plan.
This case study includes lessons learned from record flooding in 2006 and select flood response plan components provided by Our Lady of Lourdes Hospital in Binghamton, NY.
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California Department of Public Health. (n.d.). Statewide Medical and Health Exercise: Flood Scenario, Hospital Objectives. (Accessed 3/4/2020.)
This exercise template, while designed for facilities in CA, can be customized by other healthcare facilities interested in designing a statewide exercise to test their flood response.
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Centers for Disease Control and Prevention. (2005). Checklist for Infection Control Concerns when Reopening Healthcare Facilities Closed Due to Extensive Water and Wind Damage.
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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* 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. (2017). 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. (2018). Chemical Releases Caused by Natural Hazard Events and Disasters: Information for Public Health Authorities.
This report highlights the risks and prevention and response strategies associated with flood-, earthquake-, and cyclone-related chemical releases.
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Plans, Tools, and Templates: Hurricanes

* ASPR TRACIE. (2022). 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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ASPR TRACIE. (2022). Major Hurricanes: Potential Public Health and Medical Implications.
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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ASPR TRACIE. (2022). 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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Memorial Hospital at Gulfport (MS). (2016). Memorial Employee Hurricane Preparedness Handbook.
This booklet provides guidance that can ensure healthcare providers will be prepared at home and at work before, during, and after a hurricane. The first page describes healthcare facility-specific details (e.g., closure and reporting status, what to bring if working during a storm). The rest of the booklet provides guidance on setting up personal hurricane plans.
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National Institute of Environmental Health Sciences. (n.d.). Hurricane Worker Podcasts. (Accessed 2/17/2020.) 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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New Jersey Hospital Association. (2017). Weathering the Storm: A Hurricane Planning, Response, and Recovery Toolkit.
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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  • Meghan Treber test
    9/12/2017 2:08:57 PM
* 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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Sarasota Memorial Health Care System. (2019). Hurricane Response Plan 2019.
This plan includes 11 sections, covering four phases (mitigation, preparedness, response, and recovery) and information on staff accommodations, personal preparedness planning, document preparation for FEMA claims, and sample HICS forms.
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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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* World Health Organization. (2018). Chemical Releases Caused by Natural Hazard Events and Disasters: Information for Public Health Authorities.
This report highlights the risks and prevention and response strategies associated with flood-, earthquake-, and cyclone-related chemical releases.
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Plans, Tools, and Templates: Tornadoes

* 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

* 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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United Nations Educational, Scientific and Cultural Organization. (2020). UNESDOC Digital Library.
Users can search this digital library for current resources specific to tsunamis.
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Agencies and Organizations

Arizona Department of Health Services. Extreme Weather and Public Health: Heat Safety.
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Centers for Disease Control and Prevention. Extreme Heat.
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Extension Disaster Education Network. Heat Wave-Extreme Heat.
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Federal Emergency Management Agency.
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National Institute of Environmental Health Sciences. Disaster Research Response (R2) Program.
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National Oceanic and Atmospheric Administration.
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National Weather Service.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response. HHS emPOWER Program.
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U.S. Department of Health and Human Services. GeoHealth Platform.
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United States Geologic Survey.
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University of Washington. Collaborative on Extreme Event Resilience.
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This ASPR TRACIE Topic Collection was comprehensively reviewed in August and September 2015 by the following subject matter experts (listed in alphabetical order): Eric Alberts, BS, FPEM, CHS-V, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Orlando Health, Inc. (Hospital System); Kathryn Conlon, PhD, MPH, CDC Climate and Health Program; Stephen Curren, MS, Director, Division of Resilience, U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR), Office of Emergency Management; L. Leon Dent, MD, MS, MSCR, MMHC, FACS, Associate Professor of Surgery, Meharry Medical College; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Mark Jarrett, MD, MBA, MS, Sr. Vice President and Chief Quality Officer, Associate Chief Medical Officer, North Shore-LIJ Health System and Professor of Medicine, Hofstra – North Shore LIJ School of Medicine; and Paul J. Schramm, MS, MPH, Climate and Health Program, Centers for Disease Control and Prevention.
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