Natural disasters can increase the risk of suicidal behavior, particularly in resource-limited settings. We characterized suicidal ideation and attempts before and after Hurricanes Irma and Maria (September 2017) in Puerto Rico using crisis-hotline surveillance data.

We conducted a retrospective descriptive analysis of suicide-related calls to Línea PAS, Puerto Rico’s 24/7 government crisis hotline, from January 2015 through December 2021 (84 months). Monthly counts of suicidal-ideation and suicide-attempt calls were aggregated, stratified by sex and age group, and displayed as a time series with September 2017 as the index event, with exact Poisson and Wilson 95% confidence intervals.

Total suicide-related calls rose sharply about 2 months after landfall, peaking from November 2017 through January 2018 (maximum 4,548 calls in January 2018) before returning toward baseline by February 2018. Working-age adults (21-59 years) and women accounted for most calls. The surge coincided with prolonged power and telecommunications outages and with an independent rise in recorded suicide deaths.

These descriptive, ecological findings are consistent with a substantial mental-health burden following catastrophic hurricanes and coincided temporally with prolonged infrastructure disruption; the design cannot establish causation. They support integrating crisis-hotline-based behavioral-health surveillance and rapid utility restoration into disaster preparedness for climate-vulnerable regions.

Disasters, large-scale crises, and prolonged adversities such as pandemics can place sustained psychosocial pressure on families and disrupt everyday family functioning. Although family resilience is increasingly used to explain why some families adapt better than others, the evidence base is dispersed across conceptual, empirical, and intervention-focused work.

We searched PubMed, Scopus, and Web of Science and included peer-reviewed studies that examined family resilience or family coping in disaster, pandemic, or sustained adversity contexts. Study selection followed PRISMA 2020 principles. Data were extracted using a standardized form and synthesized using narrative and thematic approaches.

Forty-two studies were included in the qualitative synthesis. Across contexts, family resilience was most often described as a dynamic, system-level process that involves shared meaning-making, organizational flexibility, and effective communication. Parenting practices repeatedly emerged as a key pathway linking family resilience to child adjustment. Resilience-oriented family interventions reported overall beneficial effects across disaster, pandemic, and serious illness contexts, with no evidence of harm.

Family resilience is a critical contributor to psychosocial adaptation during disasters and large-scale crises. Interventions that strengthen family-level processes—especially communication, coping skills, and supportive parenting—may offer a scalable approach to improve preparedness, response, and longer-term recovery.

To describe health research following high-impact disasters (costs exceeding $1 billion) from 2010 to 2020 in the United States (U.S.) and to identify gaps and opportunities for improving post-disaster research to reduce adverse health impacts across communities.

Nine high-impact disasters were selected, and associated health research (N = 129 articles) was evaluated to characterize the health research response.

Sixteen different health outcomes were studied, with most data collection occurring more than a year after the disaster. Most studies used a surrogate of exposure (n = 92, 71%). No studies evaluated interventions, and few informed public health policies (n = 20, 16%) or resources (n = 7, 5%).

Even among the most high-impact U.S. disasters, this study identified a fragmented health research response that is largely descriptive. Improvements in post-disaster data collection and generalizable research studies are needed to better characterize health impacts, evaluate interventions, and foster evidence-based strategies to reduce morbidity and mortality of those impacted. Enhanced efforts to improve investments in, and processes to support the conduct of, health research are critical to improve disaster preparedness, response, and recovery efforts.

Rapid-onset hazards such as flash floods and tornadoes often provide limited warning lead time. When these events occur overnight, residents may be asleep and less likely to receive warnings, increasing injury and mortality risk. This study examined confidence in receiving overnight flash flood and tornado warnings and factors associated with warning reception confidence.

A cross-sectional survey of 1,008 adults across 12 southeastern U.S. states assessed confidence in receiving overnight flash flood and tornado warnings (12:00-6:00 AM) and factors associated with warning reception confidence.

Approximately half of respondents reported confidence in their ability to receive overnight flash flood (47.8%) and tornado (51.5%) warnings. Greater confidence was associated with greater warning source reliance, having a nighttime household emergency plan, higher nocturnal hazard risk perception, and greater trust in weather information. Mobile home residents reported lower confidence in receiving overnight tornado warnings than respondents residing in other housing types.

Many respondents remained uncertain about their ability to receive overnight warnings. Efforts to increase access to multiple warning sources capable of awakening residents, strengthen nighttime household preparedness planning, and improve awareness of nocturnal hazard risks may help improve overnight warning reception and support protective action.

To characterize morbidity, health care-seeking, and medication-related needs among survivors of Hurricane Katrina.

We used a two-stage sampling method to survey and interview 210 Hurricane Katrina survivors in Louisiana from 2006 to 2007. Interviews assessed injury, illness, environmental exposures, disaster-related damage, medication use, and health care-seeking behavior. Descriptive statistics were calculated.

Nearly 25% of respondents reported direct contact with hurricane-related floodwater. Nearly all experienced substantial property damage; wind (75.6%) and floodwater (67.5%) were the most common causes of damage. Before Hurricane Katrina, 70% of respondents reported good/excellent health; afterward, 35% reported worse health. Physical injury was reported by 17% of participants, emotional injury by 85%, and illness by 32%. Among those reporting injury/illness, 64% sought care for physical injuries, 21% for emotional injuries, and 63% for illnesses. Medication provision was common among those receiving care (70%-88%). Notably, 47% of respondents reported using at least one medication before the disaster, and 42% were unable to identify the specific medication they were taking.

Hurricane-related morbidity extends beyond health care system encounters and is likely underestimated by facility-based surveillance alone. Medication continuity and health care access represent important but understudied dimensions of disaster-related morbidity that remain relevant in contemporary disaster preparedness and response efforts.

To examine the frequency, distribution, and human impact (specifically fatalities and injuries) of geophysical and hydrological hazard-related disasters in Europe from 2000 to 2025.

We conducted a retrospective analysis of Emergency Events Database (EM-DAT, CRED/UCLouvain, Brussels, Belgium) records. Included events were earthquakes, volcanic activity, dry mass movements, floods, wet mass movements, and wave action. Deaths and injuries were summarized descriptively and compared using appropriate statistical tests.

A total of 566 events were identified, of which 510 (90.1%) were hydrological and 56 (9.9%) geophysical. Floods were the most frequent events (n = 492), while earthquakes ranked second overall (n = 52). Southern Europe recorded the highest number of deaths, whereas Eastern Europe had the highest number of injuries. Overall, the examined events caused 3,547 deaths and 14,470 injuries. Median deaths did not differ significantly between groups (P = 0.791), while median injuries were higher in geophysical events (P = 0.036).

In Europe, hydrological hazard-related emergency events were more common than geophysical hazard-related emergency events. However, most fatalities and injuries resulted from a few severe floods and earthquakes with distinct geographic patterns. Because event frequency does not directly reflect harm to humans, these findings further highlight the importance of an all-hazard approach to emergency planning; disaster preparedness should align resilience strategies with regional hazard profiles, population vulnerability, and health-system capacity.

To characterize the clinical manifestations of acute chlorine gas exposure and evaluate recovery outcomes at 48 hours and 14 days post-exposure.

Retrospective observational case series of 31 patients exposed to chlorine gas during a mass incident in Sohar, Oman. Information regarding clinical presentation, treatment outcomes, and post-treatment complications was collected using a structured data collection tool to ensure consistency and accuracy during data extraction. Data analysis was performed using IBM SPSS v31.

Thirty-one patients presented to the study site and were included in the analysis. All were male with a mean age of 32.3 ± 9.4 years. At presentation, 90.3% of patients were symptomatic, with respiratory manifestations being the most reported symptoms. Eight patients (25.8%) required admission, including 3 admitted to the intensive care unit. At 48-hour follow-up, 18 (58.1%) remained symptomatic. Nine of 29 patients who attended follow-up on day 14 reported persistent symptoms, most commonly cough. No fatalities occurred.

This study reports on the clinical course of acute chlorine exposure, highlighting that recovery often exceeds 2 weeks. Findings underscore the need for standardized clinical management, public awareness, and more rigorous industrial safety oversight to mitigate future chemical surge impacts.

Internal mass casualty incidents (MCIs) challenge hospital systems by requiring rapid coordination across clinical, operational, and communication domains. Simulation-based clinical systems testing (SbCST) can identify latent safety threats (LSTs), but cross-institutional patterns in internal MCI preparedness remain poorly characterized.

We conducted a multicenter simulation-based systems assessment using in situ SbCST and Failure Modes and Effects Analysis (FMEA) during simulated internal MCIs. LSTs were identified through triangulation of structured field observations, facilitator observations, and participant self-report during debriefing. Observations were consolidated through structured review, categorized into system-level domains using the HFMEA (Healthcare Failure Mode and Effect Analysis) framework by multidisciplinary consensus, and prioritized using FMEA with expert scoring followed by consensus reconciliation.

Approximately 75-80 raw observations yielded 53 unique LSTs across 2 hospitals. Recurrent vulnerabilities involved leadership, patient flow, communication, triage, and system interfaces. A substantial proportion were classified as high or very high priority, with comparable median FMEA scores across sites (Site 1: 30 [IQR 24-36]; Site 2: 32 [IQR 24-48]). Mitigation strategies were proposed for approximately 60-65% of LSTs.

Multicenter SbCST identified recurrent, high-priority system-level vulnerabilities across 2 hospitals. Prospective tracking of mitigation implementation and re-simulation are needed to determine whether identified threats are reduced over time.

This study reports two interlaboratory comparisons (ILCs) dedicated to harmonizing biological dosimetry laboratories in Spain.

Two established techniques were applied among six laboratories: the dicentric chromosome assay (DCA) and the cytokinesis-block micronucleus (CBMN) assay. In the first ILC, blood samples were irradiated ex vivo at 2.9 Gy and 1.4 Gy. In the second ILC, a 2.63 Gy exposure was delivered generating a whole-body sample and a partial-body sample.

In triage conditions using DCA, scoring 20 cells was sufficient to accurately classify doses above 2 Gy (i.e., high exposure) for rapid clinical prioritization, and 50 cells generally provided reliable estimates inside the $ \pm $0.5 Gy acceptance limit. The laboratories which could evaluate 500 cells obtained results where the 95% confidence intervals included the delivered dose. For partial-body exposures, scoring more than 50 cells was required at the tested dose (2.63 Gy) to ensure reliable DCA estimates. The CBMN assay successfully assessed whole-body exposure in the second exercise but could not identify partial-body exposure.

These ILCs demonstrate a general consistency among participant laboratories for whole-body dose assessment using both DCA and CBMN. However, further optimization is required for reliable application in partial-body triage scenarios.

Response agencies use mathematical modeling to quantify the consequences of mass-casualty incidents. Medical consequence models estimate the number of people to be treated for their injuries and rely on triage protocols based on injury severity to estimate the number of people who are expected to die. Available models ignore the time required to be rescued, which presents an incomplete picture of how many people would live long enough to be rescued and treated. We propose a new damage zone-based population sorting algorithm to improve estimates of people who would require treatment after a nuclear detonation in a U.S. urban setting.

We expanded the Administration for Strategic Preparedness and Response (ASPR)nuclear detonation model to include specific blast injuries such as casualties with fractures or hemorrhage. We evaluated 3 population sorting methods: no sorting (i.e., count everyone as treatable), sorting based on Department of War (DOW)/North Atlantic Treaty Organization (NATO) expectant rules, and damage zone-based population sorting. Damage zone-based population sorting introduces a new population category termed unrescuable, who are expected to die before being rescued based on the damage zone, injury severity, and the expected timing of response operations. We assessed the impact of population sorting on the number of injured and the number of injuries to be treated.

Damage zone-based sorting significantly decreases the estimates of expectants and increases estimates of the population requiring medical treatment for the most serious trauma injuries compared to population sorting based on DOW/NATO expectant rules.

The new damage zone-based population sorting method represents an important modeling refinement that incorporates realism into modeling results estimating the number of trauma-injured people requiring treatment and numbers of specific trauma injuries that would need to be treated in the aftermath of a nuclear detonation. We saw that the choice of population sorting method can influence the allocation of medical countermeasures required to respond in mass-casualty incidents, impacting medical countermeasure requirements, development, and investments.

Public health officials hold critical roles in nuclear emergencies, but repeated, scenario-based training is often hindered by regulatory and safety constraints surrounding the use of radioactive sources. This pilot study evaluated the feasibility and preliminary educational outcomes of a modular training program incorporating radiation source-free simulation modules for public health officials.

We developed a half-day program integrating augmented reality (AR) for simulated contamination searches and a radiation source-free measurement system (USOTOPE). Twenty local government public health officials participated; paired pre-post analyses included 19 participants. Assessments measured radiation-related knowledge and self-rated procedural confidence.

Analysis of 19 participants showed significant improvements in knowledge (P = 0.001) and procedural confidence (P < 0.001). Item-level analyses suggested larger improvements in practical contamination management and context-specific knowledge, whereas some items addressing procedural details showed smaller changes. Participants rated the AR and USOTOPE modules as highly realistic and educationally valuable. The radiation source-free simulation modules were feasible to implement without dedicated radioactive sources or specialized source-management requirements.

This modular training program incorporating radiation source-free simulation modules was associated with short-term improvements in knowledge and procedural confidence among public health officials. Further validation using objective measures of operational performance and preparedness is warranted.

To compare dermatologic outpatient diagnostic frequencies before and after the February 6, 2023 Hatay earthquake and to evaluate the implications of these temporal changes for disaster-responsive dermatologic care.

This retrospective study compared tertiary-center dermatology outpatient diagnosis records from the pre-earthquake (February 6, 2021-February 3, 2023) and post-earthquake (May 11, 2023-February 6, 2025) periods. Diagnoses were classified into 18 categories and 69 ICD-10-coded subdiagnoses. Logistic regression adjusted for age, sex, and calendar month using patient-clustered robust standard errors; aORs with 95% CIs and FDR-adjusted q values were reported.

Among 41,012 diagnosis records, 19,646 were from the pre-earthquake period and 21,366 from the post-earthquake period. After adjustment, infestations/insect bites were more frequently represented in the post-earthquake diagnostic mix (aOR 2.55, q < 0.001). Dermatitis (aOR 1.17, q < 0.001), bacterial diseases (aOR 1.58, q < 0.001), environmentally induced diseases (aOR 1.51, q = 0.003), and sexually transmitted diseases (aOR 1.50, q < 0.001) were also more frequently represented. Acneiform disorders were less frequently represented (aOR 0.61, q < 0.001). Despite a crude increase, fungal infections did not differ significantly in the adjusted analysis (aOR 1.04, q = 0.149).

Post-earthquake records showed more infestations and selected infectious and environmentally related diagnoses, but lower representation of some chronic disorders. These clinic-based associations support dermatologic surveillance, infection control, and continuity of care in disaster planning without implying population-level prevalence changes or causal earthquake effects.

On 6 February 2023, sequential Mw 7.7 and 7.6 earthquakes devastated 11 provinces in Türkiye. Two years on, the Emergency Medicine Association of Türkiye (EMAT) assessed recovery from an emergency department (ED) perspective.

We conducted a cross-sectional survey of emergency physicians and residents in the most affected provinces (Kahramanmaraş, Adıyaman, Malatya).

Respondents were predominantly male (81.1%) and residents (70.3%). Family routines had partly stabilized (48.6%), yet ongoing household mental-health problems were common (54.1%). Housing remained strained: most homes were slightly damaged (59.5%); 13.5% of physicians continued to live in temporary shelters. Concerns persisted about hospital structural safety (59.4%). Equipment issues centered on delayed maintenance/repair (64.9%). ED operations suffered from crowding (70.3%), workload related to staffing gaps (67.6%), and inadequate physical space (56.8%). Academic activity was disrupted (51.4%), with perceived declines in educational standards versus non-affected provinces (40.5%).

Two years post-earthquake, substantial deficits persist across infrastructure, workforce, equipment maintenance, psychosocial well-being, and training. EMAT recommends coordinated actions on structural safety, supply chains, psychosocial support, durable housing, academic workforce recovery, governance/coordination, targeted financial incentives, and continuous monitoring to restore resilient, high-quality emergency care in the region.

Understanding how nonpharmaceutical interventions temporally align with changes in COVID-19 transmission remains important for public health monitoring and evaluation. However, substate-level evidence remains limited. Delaware provides a useful setting for such analyses due to its small population and largely uniform statewide policy implementation during 2020.

We analyzed COVID-19 transmission dynamics in Delaware and its 3 counties (Kent, New Castle, and Sussex) between March 2020 and March 2023, with policy-focused analyses restricted to major statewide interventions implemented in 2020. Incident infections were reconstructed using a deconvolution-based approach, and the time-varying reproduction number (Rt) was estimated using the EpiEstim R package.

Rt estimates varied across policy periods and revealed substantial spatial heterogeneity. The most consistent increases in Rt were associated with the transition to hybrid school reopening, while decreases in Rt were associated with limits on social gatherings, the public mask mandate, and the stay-at-home advisory and overnight curfew. During Phase 1 reopening, Rt changes were small statewide, while Sussex County exhibited a larger increase than other counties.

COVID-19 transmission dynamics in Delaware during 2020 varied across policy periods and counties, illustrating substate heterogeneity under uniform statewide interventions and the use of Rt-based estimates for monitoring epidemic dynamics.