NEWS

• GOVERNANCE AND PREVENTING SCHOOL SHOOTINGS – Another tragic school shooting at Umpqua Community College in Oregon continues the dysfunctional national debate about gun violence. The issue: constitutional second amendment rights and the merits of some limits on those rights that might prevent the next mass shooting. Governance requires conversations and compromises. The initial national reaction has consisted of speeches restating each side’s position on gun control with virtually no conversation seeking compromises that would serve the interests of all.

• MEASLES OUTBREAK – A measles outbreak in the Democratic Republic of Congo has sickened more than 20,000 with more than 400 deaths. Children already suffering malnutrition and malaria have been especially vulnerable. Armed conflict, poor transportation, and the need for refrigeration have interfered with vaccination efforts.

• VACCINATIONS AND THE POLITICAL CAMPAIGN – If there wasn’t already enough misinformation in public beliefs about vaccinations, the presidential political campaign has added more, this time from aspiring national leaders. Information from the fact checkers is seldom as visible as the candidates’ speeches.

• REFUGEES – Armed conflict in the Middle East and Africa is causing a historic mass migration of refugees. See comments by NCDP’s Irwin Redlener on risks and needs faced by the children among the refugees, and the urgency to do a better job to meet those needs.

• FATALITIES AFTER THE NUCLEAR ACCIDENT AT FUKUSHIMA – After the earthquake and nuclear accident at Fukushima four years ago, emergency managers had a steep learning curve on radiation health risks. Evacuations may or may not have prevented deaths and illnesses due to radiation exposure. However, it is ironic that the real health hazards were caused by the evacuations. About 1,600 deaths have been attributed to disruption and stress of the displacement. Especially at risk: hospital inpatients and elderly residents of nursing homes. The real lesson that we need to gain is a better appreciation for the tradeoffs between evacuation and sheltering in place after radiation exposures.

TOOLS

• PSYCHOSOCIAL SUPPORT AFTER DISASTERS – The American Academy of Pediatrics Disaster Preparedness Advisory Council and Committee on Psychosocial Aspects of Child and Family Health has published guidance on providing psychosocial support to children and families after disasters and crises. 14% of children are directly exposed to a disaster. Priorities in caring for children after crises include attention to their immediate safety and avoiding further trauma. Recognition of common adjustment reactions and appropriate coping strategies and interventions are reviewed. Schools may provide important resources for children’s psychosocial support after community disruptions.

• FOREST FIRE MANAGEMENT – Drought has contributed to a severe year of forest fires. However, long standing strategies to manage forests may also be a risk factor. Suppression of every small fire results in accumulation of fuel that creates more intense future fires. New strategies to prescribe and manage fires may reduce this risk.

• ANTIBIOTIC RESISTANCE – See the new report on fighting antibiotic resistance from the Center for Disease Dynamics Economics and Policy.

SCIENCE

• PEDIATRIC CHRONIC DISEASE MANAGEMENT AFTER DISASTERS – Standard preventive clinical evaluations and complications (ketoacidosis) were assessed for children with diabetes who were displaced from home in Louisiana after Hurricane Katrina, compared with diabetic controls who lived in areas less affected by the storm. Statistical analysis was limited by the small numbers of displaced children with diabetes. While care for the displaced children was funded by temporary Medicaid emergency waivers, care and outcomes remained similar for the displaced children relative to the control group. When emergency funding ended, care and complications tended to worsen for the displaced population. What did the emergency funding provide that seems to have made a difference? Disaster recovery is associated with prolonged vulnerability in disrupted communities. How can we better provide disaster recovery funding that really accounts for the needs of the vulnerable population?

• FLOODING IN RIVER DELTAS – Sea level rise and land subsidence increases the future risk of flooding in river deltas worldwide. An assessment of risks and projected management strategies has been provided for 48 major river deltas. In resource rich nations infrastructure maintenance has controlled risks. Estimates suggest that such efforts will become too expensive to be sustainable.

• ICU EVACUATION DURING HURRICANE SANDY – A survey of providers in four evacuating hospitals indicated that few had prior experience in drills or actual crises. Communication gaps were a major obstacle. Equipment/infrastructure gaps included failed electricity, lighting, portable ventilators, and suction devices.

Edited by: Dr. Bob Kanter