literature review on disaster management

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Home > Books > Natural Hazards - Impacts, Adjustments and Resilience

Disaster Management: A State-of-the-Art Review

Submitted: 17 June 2020 Reviewed: 13 October 2020 Published: 12 November 2020

DOI: 10.5772/intechopen.94489

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Disaster management involves the pillars of emergency management: planning and preparation, mitigation, response, and recovery. Emergencies are serious events that threaten health, life, and property and can be managed within the capabilities of the affected organization. Disasters, on the other hand, are hypercomplex emergencies, requiring resources not immediately available. Disaster management follows the principles of emergency management, and emphasizes flexibility, collaboration, and teamwork. Lack of resources will challenge people and organizations both in effects of disasters and the ability to manage them. Poverty, climate change, governance, and education are foundations to improve capacity. Hospitals play an important role in disaster response and can prepare accordingly. Plans, to be effective, must be implemented through appropriately-targeted exercises. Building on an all-hazards approach, to more hazard-specific considerations can improve disaster preparedness as well as day-to-day efficiency. Disaster management is complex and crucial. These principles are explored through the fictional tale of Tucci1, a coastal city in the worst flood anyone can remember. Well, almost anyone…

natural disasters
emergency management
disaster management
disaster training

Author Information

Jared bly *.

University of Alberta, Canada
Royal Roads University, Canada

Louis Hugo Francescutti

Danielle weiss.

Northern Alberta Institute of Technology, Canada

*Address all correspondence to: [email protected]

1. Introduction

“Well, this is a disaster” said Jojo, the 19 year old apprentice to his mentor, Raj. They were pulling in the fishing nets near the usually beautiful seaside village of Tucci, now dull and grey and partly under water. The nets were heavy with debris from the churning sea. Raj grunted a mirthless laugh. “No. This is just a hard day of work. Tomorrow will be the disaster.”

Then the old man added, “unless it stops raining, the bridge stays above water, the power line’s fixed, and we have enough sandbags for everyone to keep their houses from washing away.”

It wasn’t totally exaggerated. The rain had been the worst in decades. Many homes in the low-lying village were already flooded. Those that were a little higher than the rest were already overcrowded with friends and relatives who’s houses were in a foot or two of water. And the bridge, the only land access to the village, was visible only as rail posts marking a dotted line through the sea between the village and the green foothills.

Disasters require both a potentially harmful event and a component of vulnerability [ 1 ]. If an event overwhelms local response capacity, whether by insufficient material resources or by inadequate social systems or structure, outside help is needed. This is a disaster. Thus the magnitude of an event that causes a disaster will vary by organizational capacity. Many of the natural events described elsewhere in this textbook (earthquakes, tsunamis, etc.) create disasters. An earthquake in a remote, uninhabited area might be called a natural disaster, but it is not truly a disaster if people are not severely impacted. Disasters occur at the interface of nature and civilization [ 2 ].

Emergency management is usually described in terms of planning, mitigation, response, and recovery. As we move along the spectrum of severity, from emergency to disaster, the same principles apply, with an emphasis on adaptability and collaboration. Specific to hospital disaster management, contextual issues such as triage, decontamination, and patient care are built upon a general and pervasive approach to disaster readiness. In resource-poor environments, the challenge is magnified as the impacts of natural disasters are greater, and the ability to respond and recover less. Education and training will be most effective if methods match the objectives. With all the uncertainty therein, training for disaster must include establishing relationships between organizations and allowing for flexibility in the face of events that can be predicted but never fully anticipated.

Not every windstorm, earth-tremor, or rush of water is a catastrophe…So long as the ship rides out the storm, so long as the city resists the earth-shocks, so long as the levees hold, there is no disaster. It is the collapse of the cultural protections that constitutes the disaster proper. ([ 3 ], p. 211)

2. Definitions

From crisis to catastrophe, emergency to disaster, there is a spectrum of events that may threaten people and organizations. Not just the event, but the characteristics of the affected population define disaster. Risk and resilience are opposing forces that must be considered with disaster management.

2.1 Emergencies

Disasters and emergencies differ in quality and magnitude but are often and inaccurately used synonymously. “Disasters are not just ‘big emergencies’” ([ 4 ], p. 293). Emergencies are time-sensitive, potentially harmful events that put life and well-being at risk. Resources are available at the local level to prevent, mitigate, or minimize the harm, and a single responding organization is responsible [ 5 , 6 ]. Local resources, as a variable in the equation, can affect what constitutes an emergency, and what goes beyond. An event of the same magnitude, in locations or situations with different capabilities and resources, may be managed within the organization (emergency) or need outside help (disaster). An example in a health care context might be a car crash involving one or two seriously injured people requiring prompt medical investigations and treatment, assuming the facility is equipped to deal with such an event.

2.2 Disasters

Disasters are sometimes considered “hypercomplex emergencies” or “major emergencies” involving multiple people at risk of harm, multiple jurisdictions responding, and resources that are not immediately available locally ([ 5 ], p. 8; [ 7 ]). Coordination between agencies, many of whom have no prior relationships, becomes a challenge [ 5 ]. Plans for resource utilization must change when those resources are overwhelmed [ 8 ]. Preparations, planning, and training at the local level, within the abilities and available resources of a single agency, do little to prepare for disaster.

Crisis is a more generic description. A crisis is a “critical event or point of decision which, if not handled in an appropriate and timely manner (or if not handled at all), may turn into a disaster or catastrophe” [ 9 ]. We use the word crisis , then, nonspecifically, as an emergency event that has potential to evolve; emergency as time-sensitive event with potential harm; and disaster as an event larger and more harmful than an emergency, with many people at risk, and where management requires resources outside of the responding organization or department.

2.4 Catastrophe

The word catastrophe , more severe than a disaster, completes the spectrum [ 5 ]. Many variations of the definition exist, but all suggest a magnitude of harm and inadequacy of response capabilities beyond what would be considered disaster [ 1 ] ( Figure 1 ).

literature review on disaster management

Spectrum of crises.

The school gymnasium was packed with wet bodies. A kind of bored panic filled the air. After all, what more could they do but wait for the worst the storm threw at them and then pick up the pieces when it blew itself out?

“Thanks for being here, I know it’s been hard for everyone. And there’s still lots of work to do to clean up after yesterday’s catastrophe” said Ros, the town’s mayor, referring to the wind that had blown off parts of a few roofs, and torn off a main limb of the biggest cedar in town, crushing a corner of J. Z.’s corner store.

Ian spoke up, “we can’t worry about yesterday’s fiasco. We gotta think about the crisis we’re gonna be in tomorrow if the power’s not back. Then it will be a real emergency!”

Our first thought when we think of a hazard will often be an event—earthquake, flood, or fire. But only thinking in terms of characteristics of the event — windspeed, the size of tsunami wave, the magnitude of an earthquake, etc. — is to neglect a critical component. To become relevant to disaster management, nature must collide with human activity [ 10 ]. Hazards can be quantified simplistically as the probability of an event occurring, causing harm [ 11 ]. And there is no separating hazard from risk and resilience [ 12 ]. So the hazard is the oncoming storm and the potential for harm to the village it approaches ( Figure 2 ).

Hazard, risk, and vulnerability illustrated.

Risk is connected choice and probability [ 11 ]. Choice by the decisions we make. We build in flood zones, we develop seaside resorts, and we ignore all but the most active fault lines when looking at real estate. We buy fire insurance or not. We upgrade the old building to comply with seismic billing codes or not. We run disaster drills or not.

Probability is the other face of risk. Risk is an abstract concept, forever in the future, always uncertain.

Risk is a complex and, at the same time, curious concept. It represents something unreal, related to random chance and possibility, with something that still has not happened. It is imaginary, difficult to grasp and can never exist in the present, only in the future. ([ 11 ], p. 47).

2.7 Vulnerability

Vulnerability will create harm from the hazard. A predisposition to be harmed, intrinsic to the organization or organism is its vulnerability [ 11 ]. Poverty, age, gender, racial identification, geography, and many social, economic, and political factors are all parts. The vulnerability can accumulate until recovery is complete [ 12 ].

2.8 Resilience

The ability to adapt is central to an organization’s ability to resist and rebound from disaster [ 13 ]. Resilience is woven through all aspects of disaster management—from preparation through mitigation, response, and recovery [ 12 , 14 ]. Resilience alters the disaster threshold. The more resilient a system, the more harm can be absorbed before the system is overcome [ 13 ]. More resilience means less susceptibility to disaster.

3. Emergency management

Preparation and planning, mitigation, response, and recovery are the basic principles of emergency management [ 15 ]. It is called emergency management, but should really be called disaster management. Necessarily limited to first responders, the title emergency management gives an illusion of control that makes it both “a misnomer and an oxymoron” ([ 16 ], p. 5). Regardless of the size of the event’s magnitude, management includes all those efforts before, during, and after to minimize physical, social, and economic damages. Both planned and improvised actions should be included [ 16 ].

Preparation occurs before the disaster and includes preventative measures [ 17 ]. Disaster preparation, then, can also raise the disaster threshold if the disaster is thus avoided. At least, effects are minimized through planned measures. In our example settlement, prevention of a storm may not have been possible, but prevention of harm was through city planning, weather warning systems, and flood-resistant housing and infrastructure. Food and fuel stores could only be built up before the flooding.

Mitigation also includes a component of prevention but is closer to the event than planning. Anything to minimize harms that are not prevented could be considered mitigation. This can be through the reduction of the effects of the hazard, vulnerability of those affected in harm’s way. In Tucci, they could build up walls of sandbags to protect their homes. They could moor their boats securely. They could evacuate, or they may have been able to if they had made adequate plans and preparations. Clearly, all these components are intricately connected.

The response may be what we typically think of when we envision a disaster. This is the responders—firefighters, paramedics, police, military, municipal forces, and volunteers—dousing the flames, treating the wounded, rescuing the stranded, and searching for victims.

Recovery entails returning, rebuilding, restoring. It is regaining a sense of normalcy, if not returning exactly to the pre-disaster state. Tucci will never be the same. The coastline will be altered. Attitudes may change forever. Lives may be lost. Houses will have to be repaired or rebuilt. Few residents will rebuild their houses exactly as they were before the storm. Recovery should focus on learning from the disaster and improving those liabilities made apparent by the wind and waves. This applies not only to the repairs to physical structures but to emotional health and economic stability.

3.1 From emergency management to disaster management

Preparation, planning, mitigation, and recovery are all important management principles for crises of any magnitude. As complexity increases towards disasters, we focus on the response at the front lines. This is because this phase sees the most variation and inconsistency [ 18 ]. On the front and back ends, in planning and recovery, the skies are clear. There is time to think. Not so in response. The response is the result of planning and facilitates recovery. To be prepared for an emergency should be routine. Preparedness for a disaster does not automatically follow.

By definition, local resources are sufficient to respond to an emergency. When these resources are overwhelmed, either by supply (nature of the event) or demand (response capabilities), the situation is a disaster ([ 19 ], Ch1). Outside help is needed. Intra-agency communication and coordination are required, usually without the benefit of established relationships and protocols. As complexity increases, more emphasis must be placed on flexibility and coordination between teams.

When the crisis moves from emergency to disaster, flexibility becomes increasingly important in planning, preparation, and response. In disaster planning, people should be prepared not to respond to specific circumstances, but to be able to adapt to the unanticipated. Training for disaster, then, ideally trains flexibility, communication, and the ability to work across organizational boundaries [ 20 , 21 ]. Some structure is necessary to create the ability to adapt the structure to the situation. Brandrud’s [ 22 ] description of their successful system is excellent: “…[the] written preparedness and response plan was structured just enough to remind the health professional of their role and task, yet flexible enough to enable them to release their creativity to improvise solutions” (p. 811).

“Anyone got a charger?” The question was becoming a little repetitive. At first, the people that asked this were given sympathetic smiles and apologies. Now, if anyone dared ask, it was only met with grunts and grumbles. Part of ‘the plan’ involved keeping in touch with people by cell phone. There were only a handful of people who still had any battery life left on their phones, and no one had reception.

All but a few of the townspeople were crammed into the school for the night. It was loud. Fifty quiet conversations, a few crying babies, the howling wind, and the incessant rain added up. And the air was thick with sweat and sewer (the toilets had all overflowed). A dozen people were standing in a circle in the middle of the gym, sorting through a pile of walky-talkies.

The side door flew open with the outside coming inside, and a group of bodies in rain gear, dripping from head to toe. It was a crew from Uah, an even smaller town down the coast. They had got their whole village out last week and came here on a few all-terrain vehicles to lend a hand. Apparently, there was a team coming from the city to take everyone out. If the rain ever stopped…

Crisis standards of care are a reflection of the flexibility needed to respond when resources are lacking for the situation’s need [ 23 ]. The same standards employed in day to day operations, or even in an emergency (when an organization has the capability to manage it), will consume valuable assets (time, supplies, personnel, cognition) when the system is asked to perform beyond capacity. Awareness of the difference between disaster standards and the standards applied to usual operations will facilitate effective disaster planning and response ( Figure 3 ).

Principles in management when emergency becomes disaster.

3.2 Disaster management: resource poor environment

Natural hazards alone do not result in disaster, but rather the vulnerability of the populations of countries impacted [ 24 ]. The complexity and chaos of disasters make management challenging in many ways. Even the best plans will be unable to address each difficulty encountered in a disaster [ 25 ].

Resources are defined as the organization’s fundamental financial, physical, individual and organizational capital attributes [ 26 , 27 ]. In resource-poor environments, the challenge is greatly magnified. The environments most often impacted by a lack of resources are those of a lower socioeconomic status. Poverty and disasters are strongly associated [ 19 ]. Developing countries are repeatedly subject to disasters resulting in reduced or negative development [ 19 ].

There was a lot of talk about fixing houses, repairing roads, upgrading the bridge. People didn’t want to talk about the deeper issues. Most would never be able to afford anything more than patching the holes. Someone brought up the idea of building up on the hillside where the waves couldn’t reach. But that was so utterly inconceivable. How would they build a new town if they couldn’t even build new houses? Some would have to leave. Hard to live in a fishing village if your boat got washed away and you got no other way to make a living.

More impoverished communities are more vulnerable to natural disasters due to a mixture of social, political, cultural and economic factors [ 28 ]. Residents within these poorer communities tend to live in environments more prone to hazards such as rural areas with limited access to resources. The reduction in resources results in a more extended reconstruction period and can further delay developmental lag [ 19 ]. For example, in 2001, both El Salvador and the United States were hit by earthquakes, resulting in $2 billion in damages [ 19 ]. Although the same monetary value, the impact on each country’s economy varied drastically. This $2 billion in damages had minimal impact on the U. S. economy, whereas, in El Salvador it resulted in 15% of the countries GDP [ 19 ]. These financial setbacks to developing countries can create a cyclical impact of further delayed development lag and economic growth.

Beyond the economic impacts, developing countries also face higher casualty rates. Over 96% of disaster-related deaths in recent years have taken place in developing countries [ 29 ]. Disasters may bring about harm to poor, developing countries in many ways beyond death, injury and destruction [ 19 ]. Some of the numerous examples include an increase in crime due to poverty and desperation, damage to schools leading to longterm impacts on education and further employment, destruction to hospitals which increase the vulnerability of disease, and the impact to vital infrastructure such as roads, bridges and airports, which may take years to rebuild and further impact resource access [ 19 ].

For meaningful disaster preparedness, the focus must be on improving availability and access to resources. This improvement should be a continual improvement effort to implement these resources to the area permanently. This implementation will help to support improvement to the quality of life to those impacted and decrease the inequity of resources and support when faced by disasters. Improved governance, combined approaches on all government levels, empowering communities, assessing vulnerability, ensuring access to quality information, and increasing the resilience of livelihood and infrastructure within these environments will reduce poverty and increase the quality of life [ 29 ].

Climate change and sustainable development both also influence the frequency and severity of disasters, particularly in resource-poor countries. Climate change, and irresponsible use of natural resources such as deforestation, make the environment more susceptible to hazards and disaster [ 30 ]. Disasters related to natural hazards, such as floods, storms and earthquakes, have significantly risen over recent years [ 30 ]. Such an increase in disasters is likely to further the frequency and severity of the impacts on the resource poor countries. Sustainable development is crucial to help reduce this burden.

3.3 Hospital disaster management

Disasters are easily forgotten. The unfortunate truth is that the longer the distance in time and space from disasters, the less influence they have on preparedness and planning [ 31 ]. This is especially relevant to hospitals because of a number of other interactions. Perception of disaster preparedness is often quite different between planners and frontline workers, the latter decidedly less optimistic about the facility’s state of readiness [ 31 ]. And the pressures and problems of everyday operations can easily push aside concerns for an unforeseeable event. The attitude of disaster preparedness needs to pervade all aspects of the organization in the face of so many unseen but real hazards [ 32 ].

Specific hospital management principles include, but are definitely not limited to, vulnerability analysis, communications, triage, surge capacity, psychosocial effects, and medicolegal issues [ 31 ]. Hospitals must consider the disaster and its effects not only on a massive influx of patients but on existing patients, as well as health care workers in and out of hospital [ 33 ]. Patient care may be complicated and compromised by issues of security, chemical or biological exposure, and capacity for definitive care [ 29 , 34 ].

Typically, an ‘all-hazards’ approach is employed as a basis of preparation for crises of any nature. More advanced preparedness will be tailored to specific hazards [ 30 , 35 ]. We cannot plan for every possibility, especially not every extreme and infrequent event covered in this textbook. Plans must be broad enough to allow adaptation as needed [ 22 ]. If plans are too narrowly focused the preparation may be ineffective. Flexibility is key.

Good thing we made it out when we did, although, an hour earlier would have been ideal. The leak that had been dripping constantly in the west corner of the gym turned into a stream, then a river, then the storm outside as the tiles gave way. The sick and the injured were evacuated first, down to Mayor Ros. Raj and me came on the last load. The hospital at Alec wasn’t used to a hundred people at all, much less all within a couple hours. It was hard to tell who was who - doctors, nurses, housekeepers — might have been the president of the hospital — who were finding blankets, mopping up the incessant streams of muddy water, handing out bottles of clean water, looking at cuts and bruises and sore throats.

Hospital disaster planning has important ramifications for capacity-building. That is, the threshold for disaster, an event that overwhelms local abilities, is intricately connected to capacity. “If a disaster is defined as an event that outstrips the organization’s ability to deliver healthcare, preparedness is a method of “vaccination,” raising the threshold not only in disaster periods but also in normal day-to-day function” ([ 31 ], p. xi). Disaster preparation is capacity-building.

Disaster preparedness is also about building networks. Again it comes back to the definition of disaster that requires help outside the immediately-affected organization. Coordination and communication between agencies are important in the success or deficiency of disaster response [ 23 , 31 , 36 ]. Establishing and enhancing relationships between organizations cannot be done in the moment of need. This should be a high priority for any organization in this time of global connectedness. Whether for a hospital, a nation, or a single-family, Alexander’s [ 32 ] words for current and future emergency managers applies here: “Nothing can substitute for personal relationships” ([ 32 , 37 ], p. 10).

The worst possible outcome of preparedness activities is to engender complacency. A “paper plan syndrome” refers to passively placing confidence in a document detailing a facility’s readiness ([ 35 ], p. 3). Written plans do not obviate problems [ 33 , 38 ]. To be effective, training needs to be continuous, team-centred, and at least as far as disasters go, focused on the non-technical aspects of working in teams [ 22 ]. They have to use existing resources and include the possibility of the loss of these resources. The loss of electrical power is particularly important to consider. Our increasing reliance on technology is a modern blessing in times of peace and a serious susceptibility when things are bad [ 12 ].

4. Training

Plans are only ‘fantasy documents’ if they have no real implementation through training ([ 39 ], p. 2). Exercises also may only be preparation in fantasy if not implemented conscientiously. When planning disaster training exercises, we should consider our purposes. Is the intent to expose participants to the disaster response plan or their roles in the organizational structure? Is it to test the implantation of the response plan, to expose its weaknesses and oversights? This is often the objective, intended or not ([ 40 ], p. 277). Evaluation and improvement of disaster plans may be a useful objective if that is the need [ 31 ]. But simply observing shortcomings does not itself remedy them. Lessons “identified” does not mean lessons “learned” ([ 40 ], p. 280) Is the intent to learn from or improve collaboration with other agencies? Is the intent to improve decision-making and specific skills? These are all valid objectives and need to be determined to meet the organization’s needs, lest any coincidental success be wrongly attributed to ineffective plans [ 41 ]. Disaster training should focus on adaptability. “Exercises and training on how to be creative and imaginative under such circumstances would be more useful than detailed disaster plans” ([ 25 ], p. 376).

A month later…

“We just need to stick to the plan next time,” Jan said, the last part sounding like a question. The storm was a memory like a bad dream. The town meeting, those who were left, was about getting ready for the next one.

The plan was new to almost everyone. Ros dug up some dusty old binder a few days ago. Too bad it made it, untouched, through the storm. It was full of detailed instructions about houses reporting to block leaders, block leaders reporting to councillors, councillors to the mayor, the mayor to the assistance team that was supposed to come from Alec, the capital city. Only thing was, households were all rearranged, trying to find somewhere dry to sleep. The block leaders didn’t even know who they were, the mayor didn’t have any councillors, and the team, well, not sure there ever was one.

4.1 Barriers to effective exercises

Disaster exercises may not accomplish what is intended during their design [ 20 ]. Excessive complexity, targeting the wrong audience, and unforeseen social psychological effects are some of the problems that can impair the efficacy of disaster education.

Complexity. More complex does not mean better when it comes to training exercises [ 21 ]. Thinking that testing more skills will improve more skills, stressing more processes will improve more processes, and designing more complex scenarios will enhance a greater repertoire of individual and systemic responses is flawed. The opposite can occur. Complexity can obscure the purpose of the exercise, lead to passivity among participants, and decrease collaboration [ 42 ]. Complexity can also interfere with learning [ 20 ]. Complex responses may be better trained by simple exercises. The goal is internal complexity with external simplicity (Loveluck cited in [ 21 ], p. 423).

Leaders versus participants. Many exercises benefit the designers and facilitators more than the participants [ 20 , 21 ]. This may be effective when that is the goal. Some exercises explicitly target leaders and not participants [ 43 ]. But often, the intent is to train participants. Even when that is the stated objective, participants may not see it that way [ 44 ]. Facilities and educators may not be training who they hope to train. It is important to consider who the exercise is for, and who is actually benefitting.

Social psychological. Recognizing that crisis simulations are meant to evoke some stress in individuals and organizations, some researchers have examined the adverse social and psychological effects of exercises [ 20 , 43 ]. Sometimes “unintended consequences” of these effects can appear as a failure to participate when trainees fear evaluation from superiors ([ 20 ], p. 422). Supervisors giving feedback can reinforce incorrect behaviors if hierarchical relationships are ignored [ 20 ].

4.2 Benefits

There is no doubt that planning and training is key to disaster preparedness [ 41 ]. Disaster exercises are beneficial when objectives are clear, and debriefing is effective. When objectives are appropriate and align with needs, response capacities improve. Debriefing helps with this and with all aspects of learning and growth. The debrief is one of the most important parts of effective exercise.

Clearly defined objectives. Objectives should identify whether the purpose of the exercise is evaluation or training, individual skills or collaboration, crisis or emergency response. Experts commonly identify the need for objectives to guide disaster exercises [ 20 , 45 ]. Yet hospital exercises often do not include specific objectives [ 46 ] or have not clearly defined them [ 47 ]. Objectives help operationalize disaster training. That means we can identify what we wish to improve, measure to see if we have improved, and actually improve in the desired area [ 20 , 21 , 43 , 46 ]. In many cases, the method of training and objectives of an exercise is not complementary and do not create the conditions for improvement in operational capacities [ 46 , 48 ].

Disaster vs emergency, stability vs flexibility, training vs drills. Disasters and emergencies are different events and require different responses [ 21 ]. Training for emergencies requires drills, practicing being able to perform planned responses to anticipated events [ 20 , 42 , 51 ]. In a disaster, responses outside an organization’s policies and protocols are required [ 20 , 44 ]. Training for disaster ideally trains flexibility, communication, and the ability to work across organizational boundaries [ 20 , 21 ].

Collaboration. Disasters require interactions across and within organizations that is outside of usual lines of communication [ 20 ]. Collaboration, then, is key. Collaborative communication can help organizations recognize crises in the first place [ 49 ] and throughout the event. If there are barriers to effective communication across organizational boundaries, the response will be less timely, flexible, and effective [ 51 ]. We should prepare for the need to collaborate through practice working within new relationships and organizational structures [ 25 ].

Debriefing. “… the only reason for running a simulation is so that an exercise can be debriefed” (Thiagarjan cited in [ 20 ], p. 421). Debriefing is essential in order for learning to occur [ 20 , 49 ]. Debriefing helps accomplish objectives, be they developing plans, training existing skills, or learning new things [ 50 ]. Learning from an exercise increases with reflection individually and collectively [ 21 , 44 , 51 ]. The utility of an effective and adequate debrief cannot be underemphasized ( Table 1 ).

Questions to ask to make disaster training effective.

Seems like a dream. A dream I’d like to forget. I said as much to Raj, adding “won’t see another one like that for a hundred years.”

He was just shaking his head. “Forget this dream and it might as well be three days till the next one. Be the same dream all over again unless you keep this one in mind.”

5. Conclusion

Disaster management is challenged by the difficulty we have as people and organizations to think about future, uncertain events. The complexity and chaos of disasters further complicate the tasks of planning, preparing, and responding. The more complex the event, the more an organization must adapt and collaborate with other organizations. This frameworks of resource management in disasters will guide organizations in their disaster preparedness activities. We have touched on some applications of these principles to hospitals and resource-poor environments. From an accurate understanding of what constitutes a disaster, education and training will more likely be effective — directed to the right people, developing the right skills in the right places.

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I went with a fictional disaster to demonstrate the principles of disaster management for a number of reasons. 1. Any current disaster would soon be overshadowed by one more recent. 2. There are many people that would have a much greater understanding than me of any historical event. 3. Any real event risks being ‘foreign’ to people in other places. The story of Tucci belongs to no one, and so applies to anyone. I agree with Robert Fulghum who wrote" …myth is more potent than history" (The storyteller’s creed in All I needed to know I learned in kindergarten). JB

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Seven Decades of Disasters: A Systematic Review of the Literature

Affiliations.

1 1Edith Cowan University,School of Medical and Health Sciences,Joondalup,Western Australia.
2 3Harvard Humanitarian Initiative,Harvard Universityand Harvard T.C. Chan School of Public Health,Cambridge,MassachusettsUSA.
3 2James Cook University,College of Public Health,Medical,and Veterinary Sciences,Division of Tropical Health and Medicine,Cairns,Australia.
4 5School of Public Health, Faculty of Health,Queensland University of Technology,Brisbane,Australia.
PMID: 30129914
DOI: 10.1017/S1049023X18000638

IntroductionThe impact of disasters and large-scale crises continues to increase around the world. To mitigate the potential disasters that confront humanity in the new millennium, an evidence-informed approach to disaster management is needed. This study provides the platform for such an evidence-informed approach by identifying peer-reviewed disaster management publications from 1947 through July 2017.

Methods: Peer-reviewed disaster management publications were identified using a comprehensive search of: MEDLINE (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); EMBASE (Elsevier; Amsterdam, Netherlands); PsychInfo (American Psychological Association; Washington DC, USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom).

Results: A total of 9,433 publications were identified. The publications were overwhelmingly descriptive (74%) while 18% of publications reported the use of a quantitative methodology and eight percent used qualitative methodologies. Only eight percent of these publications were classified as being high-level evidence. The publications were published in 918 multi-disciplinary journals. The journal Prehospital and Disaster Medicine (World Association for Disaster and Emergency Medicine; Madison, Wisconsin USA) published the greatest number of disaster-management-related publications (9%). Hurricane Katrina (2005; Gulf Coast USA) had the greatest number of disaster-specific publications, followed by the September 11, 2001 terrorist attacks (New York, Virginia, and Pennsylvania USA). Publications reporting on the application of objective evaluation tools or frameworks were growing in number.

Conclusion: The "science" of disaster management is spread across more than 900 different multi-disciplinary journals. The existing evidence-base is overwhelmingly descriptive and lacking in objective, post-disaster evaluations. SmithEC, BurkleFMJr, AitkenP, LeggattP. Seven decades of disasters: a systematic review of the literature. Prehosp Disaster Med. 2018;33(4):418-423.

Keywords: CRED Center for Research on the Epidemiology of Disasters; PPRR Prevention/Preparedness/Response/Recovery; disaster; evidence-based practice; literature review.

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Please note you do not have access to teaching notes, a systematic literature review of community disaster resilience: main and related research areas and agendas.

Continuity & Resilience Review

ISSN : 2516-7502

Article publication date: 7 September 2021

Issue publication date: 14 September 2021

This study aims to characterize the main research areas of published works, identify the disciplines that associated with the works and propose research agendas for future inquiries, based on a systematic literature review that encompasses 89 research papers from 2010 to 2020.

Design/methodology/approach

This review commenced with the definition of the three research questions, and subsequently three steps were followed: (1) defining criteria for research paper selection; (2) specifying the data bases and selecting the papers based on the criteria and (3) data analysis, conclusion and discussion of selected papers. The search was limited to the selection of research papers in English, focusing on “community disaster resilience” which is the subject of this review and referred to as keywords which were used for the online search for papers. All these three words must be present in the title of the selected papers.

The area “resilience management” and “disaster resilience assessment” accounted for 43% of the studies, and it indicates that research has emphasized the description of how community disaster resilience has been managed and assessed. Three disciplines relating to disaster resilience are disaster risk science, public health and environment, and it indicates that research has fostered core areas of community disaster resilience. Three key research agenda include a growing trend to describe successful efforts to avert a potentially catastrophic disaster through solution-based case studies; a paradigmatic shift and implementation of how communities could help the disaster victims recuperate from disasters.

Research limitations/implications

This review is limited to the numbers of chosen papers, as only full papers were chosen. However, in order to establish more rigorous and inclusive results of the study, the numbers of citations of published papers to be chosen for future inquiry should be taken into account.

Originality/value

This present review originally investigated how the concept of disaster resilience has been applied at the community level and in related areas. As resilience is a multidisciplinary concept that has been investigated by several different disciplines, such as sustainability, psychology, economy and sociology, this study looked into how disciplines related to community disaster resilience to provide agenda for future inquiries. This study therefore characterized the main research areas of published works, identified the disciplines that associated with the works and proposed a research agenda for future inquiries.

Community disaster resilience
Resilience management
Disaster resilience

Upadhyay, A. and Sa-ngiamwibool, A. (2021), "A systematic literature review of community disaster resilience: main and related research areas and agendas", Continuity & Resilience Review , Vol. 3 No. 2, pp. 192-205. https://doi.org/10.1108/CRR-03-2021-0011

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A contemporary perspective on the disaster management cycle

Purpose This study aims to examine the traditional disaster management cycle; discussing the significance of incorporating contemporary management concepts into the disaster management cycle; and proposing a conceptual model that reflects contemporary management insight for the disaster management cycle. Design/methodology/approach A literature review was made to discuss the significance of moving towards a more contemporary view to the disaster management cycle that brings more value to the final outcomes of the disaster management process. A conceptual model was then proposed to reflect a more contemporary view to the disaster management cycle. The current COVID-19 pandemic has also been addressed explicitly throughout the paper as a case that reflects the necessity of embracing contemporary insight and practise in the traditional disaster management cycle. Findings The literature indicates that people worldwide, as well as academics still rely heavily on the traditional disaster management lifecycle to manage disasters and major incidents which consists of four main stages; preparedness, mitigation, response and recovery unrecognizing that each and every disaster is a unique incident itself and that it should be treated differently. Contemporary management thought and insight is still lacking in the study of disaster and emergency management. Practical implications This research offers a contemporary view to the traditional disaster management cycle in which recent concepts of management are used to better cope with the uniqueness of the different major incidents. This view fosters wider involvement of individuals and the general public in the disaster management process and highlights elements of creativity and modernity. The current COVID-19 pandemic, despite the many adverse consequences associated with it, has contributed constructively to the ways the traditional disaster management cycle is being implemented and practised worldwide. Originality/value This research is expected to be of a substantial value for those interested in improving performance during the various stages of the disaster management process, as well as those interested in improving organizational, social and national resilience. The traditional disaster management cycle tends to be procedural and therefore needs to embrace contemporary management thought and more value-based approaches.

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The role of the constitution in effective disaster management of bangladesh.

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Quantitative Modeling in Disaster Management: A Literature Review

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A literature review on the impact of disasters on healthcare systems, the role of nursing in disaster management, and strategies for cancer care delivery in disaster-affected populations

This review article highlights the critical role of nurses in disaster management, with a specific focus on addressing blood tumors in disaster-affected populations. Disasters have a significant impact on healthcare systems and populations, and nurses play a crucial role in disaster preparedness, response, and recovery. The article provides case studies and successful examples of nursing interventions in disaster settings and tumor management, emphasizing the challenges and opportunities in providing cancer care in disaster settings. Recommendations for future research and practice in disaster nursing and blood tumor care are also presented. This information is essential for healthcare professionals and policymakers involved in disaster management, as well as researchers and clinicians working in the field of cancer care.

1. Introduction

Background information on disasters and their impact on healthcare systems.

Disasters have the potential to cause widespread disruption to healthcare systems, making it difficult to provide timely and effective care to affected populations ( 1 ). Natural disasters, such as hurricanes, earthquakes, and floods, can damage health facilities, disrupt supply chains, and cause power outages, making it difficult for healthcare workers to deliver essential services ( 2 ). Man-made disasters, such as terrorism and war, can lead to the destruction of infrastructure and loss of healthcare personnel, further exacerbating the challenges of delivering healthcare in disaster settings ( 3 ). As healthcare systems face an ever-increasing threat of disasters, it is crucial to understand the impact of disasters on healthcare delivery and to identify strategies to mitigate these impacts ( 4 ). In this review article, we explore the role of nursing in disaster management, and the challenges and opportunities for cancer care in disaster-affected populations. The research problem addressed in this article is the impact of disasters on healthcare systems, specifically focusing on the role of nursing in disaster management and response, as well as the challenges and opportunities for providing cancer care in disaster-affected populations. Disasters, whether natural or man-made, have the potential to cause significant disruptions to healthcare systems, making it difficult to provide essential services to affected populations. Nurses play a critical role in disaster response, and recent progress has highlighted the importance of integrating nursing in disaster management efforts. Disasters can also increase the incidence and prevalence of tumors due to exposure to carcinogenic substances and stress, underscoring the importance of disaster preparedness and effective cancer care in disaster settings. This article aims to explore the impact of disasters on healthcare delivery, with a particular focus on the role of nursing and the challenges and opportunities for providing cancer care in disaster-affected populations.

2. Importance of nursing in disaster management and response

Recent progress has highlighted the crucial role of nursing in disaster management and response ( 5 ). Nurses are often the first point of contact for patients in disaster settings and play a critical role in triaging patients and providing basic medical care ( 5 ). In recent years, there has been an increasing recognition of the importance of nursing in disaster response, as evidenced by the creation of the World Health Organization’s Emergency Medical Teams (EMTs) initiative ( 6 ). The EMTs are composed of healthcare professionals, including nurses, who are deployed to disaster-affected areas to provide medical assistance ( 7 ). Furthermore, the COVID-19 pandemic has highlighted the importance of nursing in disaster response ( 8 ), with nurses playing a vital role in caring for patients with the virus and in vaccination efforts ( 9 ). The integration of nursing in disaster management and response is essential to ensure that healthcare systems can effectively respond to disasters and provide care to affected populations ( 10 ). This article addresses the impact of disasters on healthcare systems, with a particular focus on the role of nursing in disaster management and response, and the challenges and opportunities for providing cancer care in disaster-affected populations. Disasters, whether natural or man-made, can cause significant disruptions to healthcare systems, making it challenging to provide essential services to affected populations. Nursing is critical in disaster response, and recent progress has highlighted the importance of integrating nursing in disaster management efforts. Disasters can also increase the incidence and prevalence of tumors due to exposure to carcinogenic substances and stress, underscoring the importance of effective cancer care in disaster settings. The study aims to develop strategies to mitigate the impacts of disasters on healthcare systems and improve cancer care in disaster-affected populations, focusing on the role of nursing in disaster management and response.

3. Prevalence and significance of tumors in disaster-affected populations

Recent progress has shed light on the prevalence and significance of tumors in disaster-affected populations ( 11 ). Studies have shown that disasters can increase the incidence and prevalence of tumors due to factors such as exposure to carcinogenic substances and stress ( 12 ). For example, a study conducted after the Fukushima nuclear disaster found that the incidence of thyroid cancer among children in the affected area was higher than expected, likely due to exposure to radioactive iodine ( 13 ). Additionally, the COVID-19 pandemic has highlighted the importance of cancer care in disaster-affected populations ( 14 ), as cancer patients may be at increased risk of severe illness and mortality from COVID-19 ( 15 ). Recent progress has focused on developing strategies to improve cancer care in disaster settings, including telemedicine and mobile clinics ( 16 ). The recognition of the prevalence and significance of tumors in disaster-affected populations underscores the importance of disaster preparedness and the need for effective cancer care in disaster settings ( 17 ). Table 1 summarizes the types of tumors that have been identified in disaster-affected populations, including thyroid cancer, mesothelioma, leukemia, lung cancer, and skin cancer. This review article focuses on the impact of disasters on healthcare systems, with an emphasis on the role of nursing in disaster management and response, as well as cancer care in disaster-affected populations. Disasters can disrupt healthcare systems, making it challenging to provide essential services to affected populations. Recent progress has highlighted the critical role of nursing in disaster response, with nurses often serving as the first point of contact for patients and providing basic medical care and triaging. Additionally, disasters can increase the incidence and prevalence of tumors due to exposure to carcinogenic substances and stress, emphasizing the need for effective cancer care in disaster settings. Recent progress has explored strategies for improving cancer care in disaster settings, such as telemedicine and mobile clinics. The World Health Organization’s Emergency Medical Teams initiative recognizes the crucial role of nursing in disaster response. Overall, understanding the impact of disasters on healthcare delivery and implementing effective strategies, including integrating nursing in disaster management, is critical for mitigating the impacts of disasters on healthcare systems and providing effective care to affected populations. This study aims to develop strategies to mitigate the impacts of disasters on healthcare systems and improve cancer care in disaster-affected populations, highlighting the critical role of nursing in disaster management and response.

Table 1

Types of tumors in disaster-affected populations.

Type of Tumor	Examples of Disasters
Thyroid Cancer	Fukushima Nuclear Disaster
Mesothelioma	9/11 Terrorist Attacks
Leukemia	Chemical Spills
Lung Cancer	Wildfires
Skin Cancer	Sun Exposure During Disasters

This article is a comprehensive literature review that examines the challenges and opportunities related to drug delivery in disaster nursing and blood tumor care. The authors conducted a systematic search of relevant literature in various electronic databases such as PubMed, CINAHL, and Cochrane Library, using keywords such as “disaster,” “nursing,” “tumor,” “healthcare delivery,” “cancer care,” “disaster management,” “disaster response,” “disaster preparedness,” “healthcare systems,” and “population health.” The search was conducted in English and limited to articles published between 2000 and 2023. The authors screened the abstracts and full texts of relevant articles and selected those that met the inclusion criteria. The inclusion criteria for the studies were that they had to focus on drug delivery challenges and opportunities in disaster nursing and blood tumor care. The studies also had to include interventions or strategies to address these challenges or opportunities. The exclusion criteria were studies that did not meet the inclusion criteria, were published before 2000, or were not written in English. The authors extracted data from the selected studies and conducted a qualitative synthesis to identify themes and patterns in the literature. The identified themes and patterns were then used to develop a comprehensive review of the challenges and opportunities in drug delivery in disaster nursing and blood tumor care.

We have added the keywords of the search along with the Boolean operators (AND/OR) in the abstract and method section. We have also referred to the PRISMA guideline, and our search period has been updated to include articles from 2000 to the present time.

4.1. Study quality assessment

We have introduced the quality review tool for the final studies extracted based on the PRISMA guideline. The methodological quality of the included studies was assessed using the following tools:

For primary research articles, the Critical Appraisal Skills Programme (CASP) checklist was used.
For review articles, the Assessment of Multiple Systematic Reviews (AMSTAR) tool was applied.
For case studies, the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Studies was utilized.

4.2. Search strategy

A comprehensive literature search was conducted using electronic databases such as PubMed, CINAHL, Web of Science, Scopus, and Cochrane Library. The search strategy involved using keywords and MeSH terms, including “disaster,” “nursing,” “tumor,” “healthcare delivery,” “cancer care,” “disaster management,” “disaster response,” “disaster preparedness,” “healthcare systems,” and “population health.” Boolean operators (AND, OR) were employed to combine the search terms. The search was limited to articles published in English between January 2000 and September 2021.

4.3. Selection of articles and documents

Two independent reviewers (WW and MH) screened the titles and abstracts of the retrieved articles. Full-text articles were obtained for further assessment if they were deemed potentially relevant. Disagreements between the reviewers were resolved through discussion or consultation with a third reviewer.

4.4. Inclusion and exclusion criteria

Inclusion criteria for the articles were as follows:

Primary research articles, review articles, and case studies focusing on the impact of disasters on healthcare systems, nursing in disaster management, and strategies for cancer care delivery in disaster-affected populations.
Studies conducted in various disaster settings, such as natural disasters, pandemics, and man-made disasters.
Articles published in peer-reviewed journals.

4.5. Exclusion criteria for the articles were as follows

Articles not published in English.

Studies not focused on healthcare systems, nursing, or cancer care in disaster settings.

Opinion pieces, editorials, and commentaries.

4.6. Database search

The search was conducted using the following databases:

Web of Science
Cochrane Library

The review article identifies several challenges related to drug delivery in disaster nursing and blood tumor care, including the shortage of essential drugs and medical supplies, limited access to healthcare facilities, and the need for specialized care and equipment. The authors also highlight the opportunities for innovative interventions, such as mobile clinics and telemedicine. The review presents case studies and successful examples of nursing interventions in disaster settings and tumor management. The authors discuss the use of telemedicine in providing remote care to cancer patients in disaster settings, which has been found to improve patient outcomes and reduce healthcare costs. The review also highlights the use of mobile clinics to provide cancer care to disaster-affected populations. The authors recommend the development of standardized protocols for disaster nursing and tumor care, the use of innovative technologies to improve access to care, and the integration of disaster preparedness into nursing education programs. Overall, the review emphasizes the critical role of nurses in disaster management and response, particularly in addressing the challenges related to drug delivery in blood tumor care. The authors call for continued research and education in disaster nursing and tumor care to improve patient outcomes and strengthen healthcare systems’ resilience in the face of disasters.

5.1. Nursing in disaster management and response

Role of nurses in disaster preparedness, response, and recovery.

Recent progress has highlighted the critical role of nursing in disaster management and response ( 18 ), including preparedness and recovery efforts ( 5 ). Nurses are integral members of disaster response teams, providing care to affected populations, coordinating efforts, and responding to emergencies ( 19 ). In recent years, there has been a growing recognition of the importance of nursing in disaster preparedness, with many initiatives aimed at increasing the capacity of nurses to respond to disasters ( 20 ). For example, the American Nurses Association (ANA) has developed a disaster nursing certification program to prepare nurses for disaster response. Furthermore, the COVID-19 pandemic has highlighted the importance of nursing in disaster response, with nurses playing a key role in caring for patients, administering vaccines, and educating the public about the virus ( 21 ). Recent progress has focused on improving the coordination and training of nursing in disaster management and response to ensure that healthcare systems can effectively respond to disasters and provide care to affected populations ( 22 ).

5.2. Challenges and opportunities for nursing in disaster settings

Recent progress has identified several challenges and opportunities for nursing in disaster settings ( 5 ). One major challenge is the shortage of healthcare workers, including nurses, in disaster-affected areas ( 23 ). Disasters can cause healthcare personnel to relocate or become unable to work, leaving affected populations without access to essential medical care ( 24 ). Another challenge is the lack of resources and infrastructure in disaster settings, which can limit the ability of nurses to provide care ( 25 ). However, recent progress has also identified several opportunities for nursing in disaster settings ( 5 ). For example, the use of technology, such as telemedicine and mobile clinics, can help to overcome geographical barriers and provide care to those in need ( 26 ). Additionally, the integration of community health workers and other non-traditional healthcare providers can help to expand the capacity of healthcare systems in disaster settings ( 27 ). The identification of challenges and opportunities for nursing in disaster settings underscores the need for ongoing research and innovation to improve the capacity of healthcare systems to respond to disasters and provide care to affected populations ( 28 ).

5.3. Best practices for nursing in disaster management

Recent progress has identified several best practices for nursing in disaster management ( 29 ). One key practice is the importance of preparation and training for disaster response ( 30 ). Nurses should receive regular training on disaster response protocols, including triage and emergency care ( 31 ). Additionally, nurses should be familiar with disaster response plans and work collaboratively with other healthcare professionals to ensure an effective response ( 5 ). Another best practice is the use of technology to improve communication and coordination among healthcare providers ( 32 ). For example, electronic medical records and telemedicine can help to ensure continuity of care and improve patient outcomes in disaster settings ( 33 ). Furthermore, the use of cultural competency and patient-centered care is essential to ensure that healthcare is delivered in a manner that is respectful and responsive to the needs of diverse populations ( 34 ). The identification of best practices for nursing in disaster management highlights the importance of ongoing education and training to ensure that nurses are prepared to respond effectively to disasters and provide quality care to affected populations ( 35 ).

6. Tumors in disaster-affected populations

6.1. types and prevalence of tumors in disaster-affected populations.

Recent progress has shed light on the types and prevalence of tumors in disaster-affected populations ( 36 ). Studies have shown that disasters can increase the incidence and prevalence of certain types of tumors due to exposure to carcinogenic substances and stress ( 37 ). For example, exposure to asbestos and other toxic substances during and after the 9/11 terrorist attacks has been linked to an increased risk of mesothelioma and other types of cancer among first responders and others who worked at the World Trade Center site. Additionally, the Fukushima nuclear disaster led to an increase in the incidence of thyroid cancer among children in the affected area ( 38 ). Recent progress has also focused on identifying disparities in cancer care among disaster-affected populations, such as those who are low-income or have limited access to healthcare ( 39 ). The identification of types and prevalence of tumors in disaster-affected populations highlights the need for effective cancer prevention and screening programs in disaster settings, as well as the need for access to quality cancer care for affected populations ( 40 ).

6.2. Factors that contribute to the development and progression of tumors in disaster settings

Recent progress has identified several factors that contribute to the development and progression of tumors in disaster settings ( 41 ). One major factor is exposure to carcinogenic substances, such as radiation, asbestos, and other toxic chemicals ( 42 ). Disasters can lead to the release of these substances into the environment, putting affected populations at risk of developing cancer ( 43 ). Additionally, stress and trauma associated with disasters can weaken the immune system and increase the risk of cancer ( 44 ). Poor nutrition and lack of access to healthcare can also contribute to the development and progression of tumors in disaster-affected populations ( 45 ). Recent progress has focused on identifying strategies to mitigate these risk factors, such as improving access to healthcare and nutrition, as well as implementing effective cancer screening and prevention programs in disaster settings ( 46 ). The identification of factors that contribute to the development and progression of tumors in disaster settings underscores the need for a comprehensive approach to cancer care in disaster settings that addresses the underlying risk factors and provides access to quality care for affected populations ( 47 ).

6.3. Challenges and opportunities for cancer care in disaster settings

Recent progress has identified several challenges and opportunities for cancer care in disaster settings ( 48 ). One major challenge is the disruption of healthcare systems and infrastructure in disaster-affected areas ( 49 ), which can limit access to cancer care and delay diagnosis and treatment ( 50 ). In addition to the challenges faced in providing cancer care in disaster settings, Table 2 highlights several opportunities for improving care, such as the use of telemedicine and mobile clinics, and the integration of community health workers and non-traditional healthcare providers. Additionally, shortages of healthcare personnel, including oncologists and other cancer specialists, can further exacerbate these challenges ( 51 ). However, recent progress has also identified several opportunities for cancer care in disaster settings ( 52 ). The use of telemedicine and mobile clinics can help to expand access to cancer care and ensure continuity of care for patients ( 53 ). Furthermore, the integration of community health workers and other non-traditional healthcare providers can help to expand the capacity of healthcare systems in disaster settings ( 54 ). The identification of challenges and opportunities for cancer care in disaster settings highlights the need for ongoing research and innovation to improve the capacity of healthcare systems to respond to disasters and provide quality cancer care to affected populations ( 55 ).

Table 2

Challenges and opportunities for cancer care in disaster settings.

Challenges	Opportunities
Limited access to healthcare and cancer specialists	Use of telemedicine and mobile clinics
Disruption of healthcare systems and infrastructure	Integration of community health workers and non-traditional healthcare providers
Shortages of healthcare personnel	Development of effective cancer screening and prevention programs
Increased risk of exposure to carcinogenic substances	Increased awareness of cancer prevention and risk reduction strategies
Lack of resources and infrastructure	Use of innovative approaches to care

7. Case studies and examples

7.1. examples of successful nursing interventions in disaster settings.

Recent progress has highlighted several examples of successful nursing interventions in disaster settings ( 56 ). One such example is the response of nursing staff to the COVID-19 pandemic ( 57 ). Nurses have played a critical role in caring for patients with COVID-19, as well as administering vaccines and providing education to the public about the virus ( 58 ). Additionally, nurses have used telemedicine and other innovative approaches to provide care to patients in quarantine or isolation ( 59 ). Another example of successful nursing intervention is the response to the Ebola outbreak in West Africa ( 60 ). Nurses played a key role in the containment and treatment of the outbreak, providing care to affected populations and educating communities about the virus ( 61 ). Furthermore, the use of community health workers and other non-traditional healthcare providers has been successful in improving access to care in disaster settings ( 62 ). These examples of successful nursing interventions in disaster settings demonstrate the importance of nursing in disaster management and response, as well as the need for ongoing education and innovation to improve the capacity of healthcare systems to respond to disasters and provide care to affected populations ( 63 ).

7.2. Case studies of tumor management in disaster-affected populations

Recent progress has identified several case studies of tumor management in disaster-affected populations ( 64 ). One such case study is the response to the Fukushima nuclear disaster in Japan. In the aftermath of the disaster, the Japanese government implemented a screening program to detect thyroid cancer among children in the affected area ( 65 ). The program detected a higher-than-expected incidence of thyroid cancer, leading to concerns about the long-term health effects of the disaster. Another case study is the response to the 9/11 terrorist attacks in New York City ( 66 ). First responders and others who worked at the World Trade Center site were exposed to asbestos and other toxic substances ( 67 ), putting them at increased risk of developing mesothelioma and other types of cancer ( 68 ). Table 3 provides examples of cancer drugs that are commonly administered by nurses, including doxorubicin, paclitaxel, tamoxifen, methotrexate, and cisplatin. The table also includes nursing considerations for each drug, such as monitoring for adverse effects and providing antiemetic medications to manage nausea and vomiting (see Table 3 ). The response to these cases underscores the importance of effective cancer screening and prevention programs in disaster settings ( 69 ), as well as the need for access to quality cancer care for affected populations ( 70 ). The identification of case studies of tumor management in disaster-affected populations highlights the need for a comprehensive approach to cancer care in disaster settings that addresses the underlying risk factors and provides access to quality care for affected populations ( 71 ).

Table 3

Examples of cancer drugs administered by nurses.

Drug	Route of Administration	Nursing Considerations
Doxorubicin	Intravenous (IV)	Monitor for cardiotoxicity, extravasation, and tissue damage at the injection site. Provide antiemetic medications to manage nausea and vomiting.
Paclitaxel	Intravenous (IV)	Monitor for hypersensitivity reactions and infusion-related reactions. Premedicate with corticosteroids and antihistamines as appropriate.
Tamoxifen	Oral	Monitor for adverse effects, such as hot flashes, vaginal discharge, and menstrual irregularities. Educate patients on the importance of taking the medication at the same time each day.
Methotrexate	Intravenous (IV) or oral	Monitor for bone marrow suppression, hepatotoxicity, and nephrotoxicity. Administer folic acid and vitamin B12 to reduce the risk of adverse effects.
Cisplatin	Intravenous (IV)	Monitor for nephrotoxicity, ototoxicity, and electrolyte imbalances. Provide antiemetic medications to manage nausea and vomiting.

7.3. Lessons learned and future directions for disaster nursing and tumor care

Recent progress has identified several key lessons learned and future directions for disaster nursing and tumor care ( 72 ). One major lesson is the importance of interdisciplinary collaboration in disaster response ( 73 ). Effective disaster response requires the collaboration of healthcare professionals from different disciplines, including nursing, medicine, and public health ( 19 ). Another lesson is the importance of preparedness and training for disaster response ( 30 ). Healthcare professionals, including nurses, should receive regular training on disaster response protocols and be familiar with disaster response plans ( 74 ). Furthermore, future directions for disaster nursing and tumor care include the development and implementation of innovative approaches to care, such as telemedicine and mobile clinics, as well as the integration of community health workers and other non-traditional healthcare providers ( 75 ). Table 4 provides examples of education programs for nurses in disaster and tumor care, including online programs, courses, in-person training, and conferences. These programs cover a range of topics, from disaster preparedness and response to cancer screening and treatment (see Table 4 ). Access to high-quality education and training is critical for nurses to effectively respond to disasters and provide quality care to affected populations ( 76 ), and these examples highlight the range of educational opportunities available to nurses in disaster and tumor care ( 77 ). The identification of lessons learned and future directions for disaster nursing and tumor care underscores the need for ongoing research and innovation to improve the capacity of healthcare systems to respond to disasters and provide quality care to affected populations ( 78 ).

Table 4

Examples of disaster and tumor care education programs for nurses.

Program Name	Description	Institution/Organization
Disaster Nursing and Tumor Care Certificate Program	Online program that provides education and training in disaster nursing and tumor care, including disaster preparedness and response, cancer screening and prevention, and innovative approaches to care.	American Nurses Association
Disaster and Oncology Nursing Course	Course that covers the principles of disaster nursing and oncology nursing, including assessment and triage of disaster victims, management of disaster-related health issues, and cancer screening and treatment.	Oncology Nursing Society
Disaster Preparedness and Response for Oncology Nurses	Online course that focuses on disaster preparedness and response for oncology nurses, including the management of cancer patients in disaster settings, communication strategies during disasters, and psychological support for patients and families.	Association of Pediatric Hematology/Oncology Nurses
Disaster Response and Tumor Care Training	In-person training program that provides hands-on experience in disaster response and tumor care, including simulation exercises and case studies.	International Society of Nurses in Cancer Care
Disaster Nursing and Tumor Care Conference	Annual conference that brings together nursing professionals from around the world to share best practices and innovations in disaster nursing and tumor care.	Global Network of WHO Collaborating Centres for Nursing and Midwifery

8. Discussion

The discussion of the review article emphasizes the importance of nurses in disaster management and response, particularly in addressing the challenges related to drug delivery in blood tumor care. The authors highlight the need for continued research and education in disaster nursing and tumor care to improve patient outcomes and strengthen healthcare systems’ resilience in the face of disasters. The authors suggest that disaster nursing and blood tumor care should be integrated into nursing education programs to ensure that nurses are adequately prepared to respond to disasters and provide effective care to cancer patients. They also recommend the development of standardized protocols for disaster nursing and tumor care to improve the consistency and quality of care provided in disaster settings. The review article highlights the use of innovative technologies such as telemedicine and mobile clinics in disaster nursing and blood tumor care. The authors suggest that these technologies can help to improve access to care and reduce healthcare costs, particularly in disaster-affected areas where resources may be limited. In conclusion, the authors emphasize the critical role of nurses in disaster management and response and the challenges and opportunities related to drug delivery in blood tumor care. They call for continued research and education in disaster nursing and tumor care to improve patient outcomes and strengthen healthcare systems’ resilience in the face of disasters. The review article provides insights into the current state of disaster nursing and tumor care and offers recommendations for advancing research and practice in this important field.

9. Conclusion

In conclusion, this review emphasizes the critical role of nurses in disaster management, specifically in addressing blood tumors in disaster-affected populations. Challenges in this context include limited resources, inadequate infrastructure, and restricted access to healthcare, while opportunities involve the integration of non-traditional healthcare providers and innovative approaches to care. Successful nursing interventions in disaster settings and case studies of tumor management offer valuable insights into effective care strategies in disaster scenarios. To enhance conditions and support beneficiaries, the researcher proposes several recommendations for future directions in disaster nursing and tumor care. These include the development and implementation of innovative care approaches, such as incorporating community health workers and telemedicine, as well as fostering interdisciplinary collaboration, preparedness, and training for disaster response. Further research is required on the epidemiology of tumors in disaster-affected populations, the creation of effective cancer screening and prevention programs in disaster settings, and the integration of telemedicine and other innovative care strategies. The implications for nursing practice, research, and policy are significant, stressing the need for ongoing education and innovation to bolster healthcare systems’ capacity to respond to disasters and deliver quality care to affected populations. Healthcare professionals and policymakers can adopt these recommendations to improve disaster response and enhance health outcomes for disaster-impacted communities. This information is crucial for researchers and clinicians in the field of cancer care, as well as healthcare professionals and policymakers engaged in disaster management.

Systematic review flow diagram. Caption: the PRISMA flow diagram for the systematic review detailing the database searches, the number of abstracts screened and the full texts retrieved.

Author contributions

HL: acquisition funding and review, revise the manuscript; WW: Writing, concept. MH: Manage, supervision, review, editing. All authors contributed to the article and approved the submitted version.

Funding Statement

Sichuan Provincial Natural Science Foundation Project (No23NSFSC0607): The role and mechanism of ion channels in the migration ofacute lymphoblastic leukemia.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Disaster education in disaster-prone schools: a systematic review

R Yusuf 1 , Razali 1 , Sanusi 1 , Maimun 1 , I Fajri 2,3 and S A Gani 1

Published under licence by IOP Publishing Ltd IOP Conference Series: Earth and Environmental Science , Volume 1041 , International Conference on Environmental, Energy and Earth Science 22/09/2021 - 23/09/2021 Online Citation R Yusuf et al 2022 IOP Conf. Ser.: Earth Environ. Sci. 1041 012034 DOI 10.1088/1755-1315/1041/1/012034

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1 Universitas Syiah Kuala, Aceh, Indonesia

2 Universitas Pendidikan Indonesia, Bandung, Indonesia

3 Universitas Islam Negeri Ar-Raniry, Aceh, Indonesia

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This paper aims to analyze disaster education in schools in disaster-prone areas, focusing on the resulting policies, supporting programs, and challenges in implementing disaster education in schools. The literature review in this paper is carried out systematically and analyzes the content as a methodology in investigating policies, programs, and challenges in implementing disaster education in disaster-prone schools in the Scopus database. The results of the analysis of the literature review highlight several important points related to disaster education in disaster-prone schools, namely (1) In supporting increased understanding of environmental management and resilience in dealing with disasters in disaster-prone areas, governments in various countries make policies by including environmental content in school materials and policies for environmental conservation. (2) School cooperation with the community and government institutions related to the environment becomes a program in increasing understanding of environmental management and disaster resilience. (3) The literature review also reveals that the material's content, the approach/learning model used, and the teacher's ability to understand the environment are challenges for implementing disaster education in disaster-prone schools. The problems in the discussion of this literature review are usable as implications for further research considerations. The findings show that disaster education in disaster-prone schools can effectively increase environmental understanding and resilience if existing policies, programs, and challenges are implemented optimally.

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Moving Towards Smart Visualization for Smart City Services: A Systematic Literature Review in Earthquake Engineering

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First Online: 27 July 2024
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Ovidiu Jianu ORCID: orcid.org/0000-0002-0699-6553 4 , 5 &
Monica Drăgoicea ORCID: orcid.org/0000-0002-4447-3219 4

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Earthquake engineering requires new tools to assess risk, respond to emergencies, increase public awareness, monitor infrastructure, and assist in post-disaster rehabilitation. In this context, the significance and uses of smart visualization become a relevant topic of research and practice. This paper proposes an incipient investigation of the relevant literature, to highlight the possible interconnections of three domains: earthquake engineering, smart visualizations, and smart city services. Within the scope of this work, a systematic literature review using the Kitchenham procedure has been conducted. The comprehensiveness and generalizability of the literature review’s conclusions is influenced by the formulation of the research questions, potential publication bias, and inherent limitations of the papers that were chosen. Based on the findings, a framework to describe a data-based layered structure of smart city services has been proposed, incorporating smart visualization tools for effective communication of intricate seismic data, facilitating informed decision-making. Various stakeholders can use the suggested framework as a guide to creating smart city services that prioritize the needs of citizens while maximizing the advantages of smart visualization in earthquake engineering, including a better insight into the decision-making process.

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Jianu, O., Drăgoicea, M. (2024). Moving Towards Smart Visualization for Smart City Services: A Systematic Literature Review in Earthquake Engineering. In: West, S., Meierhofer, J., Buecheler, T. (eds) Smart Services Summit. SMSESU 2023. Progress in IS. Springer, Cham. https://doi.org/10.1007/978-3-031-60313-6_15

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Optimal resilience and risk-driven strategies for pre-disaster protection of electric power systems against uncertain disaster scenarios, 1. introduction, 2. methodology and problem description, 2.1. system performance and resilience metrics, 2.2. problem description and setting, 3. model formulation, 3.1. risk-neutral model formulation, 3.2. formulation of the risk management model, 4. solution method, 4.1. scenario generation.

Scenario Generation
1:	Define the category (wind speed) of an anticipated hurricane disaster based on prediction information.
2:	.
3:	.
4:	Generate hurricane paths with occurrence probabilities using historical data.
5:	within the affected region along the hurricane path using Equation (25).
6:	.
7:	End for

4.2. Scenario Reduction

4.3. processing procedure of the risk management model, 4.4. stochastic model solution algorithm.

The PHA for the Model (Equations (35)–(39))
1:	, , compute
	subject to Equations (37), (38) and (39) End for
2:
3:
4:
5:	, solve the subproblem subject to Equations (36), (37) and (39) End for
6:	are identical, stop. Else, go to step 2.

5. Case Study

5.1. gta energy infrastructure system, 5.2. experimental design and parameters, 5.3. results, 5.3.1. results of risk-neutral strategy, 5.3.2. results of risk management strategy, 5.3.3. sensitivity analysis, 6. conclusions, author contributions, data availability statement, conflicts of interest, nomenclature.

Indices and Sets
	Set of systems indexed




	, and indexed by
	Electric power system/network
	between electric power network E and infrastructure
	Set of disaster scenarios characterized as link failures in electric power network, and indexed by
Parameters
	Post-disruption performance of infrastructure under scenario
	Pre-disruption performance of infrastructure
	Resilience of the integrated infrastructure system under scenario





	Predefined threshold for the resilience of the integrated system
	Budget for protection activities of the electric power system



	Weight/importance of the infrastructure system
Decision variables


	is damaged after disaster scenario
	is operational after disaster scenario
	under scenario
	under scenario
	after the occurrence of scenario
	under scenario
	operates correctly following scenario

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Click here to enlarge figure

System Components		Number	Type
Generation		7	Supply node
Substation	500 kV	4	Transmission node
Substation	230 kV	36	Demand node
Power line	500 kV	13	Link
Power line	230 kV	64	Link

Budget (USD × 10 )	Set of Transmission Lines to Be Hardened	EVR of the Integrated System
2.0	36–37, 38–46, 46–38, 46–40	0.921
4.0	29–30, 30–32, 32–39, 36–37, 37–38, 38–46, 40–46	0.945
6.0	16–23, 17–22, 23–26, 26–27, 29–30, 30–32, 32–39, 36–37, 40–43, 40–46	0.988
8.0	16–23, 17–22, 23–26, 26–27, 30–32, 31–34, 31–35, 36–37, 39–46, 40–43, 40–46	0.991

ε Value	Set of Transmission Lines to Be Hardened
0.0215	5–15, 4–31, 23–24, 26–27, 29–30, 30–32, 38–46
0.0284	4–31, 7–18, 19–21, 26–27, 27–29, 32–39, 38–46
0.0354	3–4, 7–18, 23–24, 26–27, 29–30, 32–39, 38–46
0.0424	7–18, 11–14, 23–24, 26–27, 27–29, 32–39, 42–47
0.0493	7–18, 11–14, 23–24, 26–27, 27–29, 31–32, 37–38
0.0563	11–14, 17–22, 23–24, 26–27, 29–30, 32–39, 40–46
0.0633	11–14, 17–22, 23–24, 26–27, 29–30, 32–39, 40–46
0.0702	16–23, 17–22, 23–26, 26–27, 29–30, 32–39, 36–37
0.0772	16–23, 17–22, 30–32, 36–37, 37–38, 38–46, 40–46
0.0842	29–30, 30–32, 32–39, 36–37, 37–38, 38–46, 40–46

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Wang, C.; Zhang, C.; Luo, L.; Qi, X.; Kong, J. Optimal Resilience and Risk-Driven Strategies for Pre-Disaster Protection of Electric Power Systems against Uncertain Disaster Scenarios. Energies 2024 , 17 , 3619. https://doi.org/10.3390/en17153619

Wang C, Zhang C, Luo L, Qi X, Kong J. Optimal Resilience and Risk-Driven Strategies for Pre-Disaster Protection of Electric Power Systems against Uncertain Disaster Scenarios. Energies . 2024; 17(15):3619. https://doi.org/10.3390/en17153619

Wang, Chen, Chao Zhang, Ling Luo, Xiaoman Qi, and Jingjing Kong. 2024. "Optimal Resilience and Risk-Driven Strategies for Pre-Disaster Protection of Electric Power Systems against Uncertain Disaster Scenarios" Energies 17, no. 15: 3619. https://doi.org/10.3390/en17153619

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Published: 25 July 2024

Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review

Ali Mohammad Mosadeghrad 1 ,
Mahnaz Afshari 2 ,
Parvaneh Isfahani 3 ,
Farahnaz Ezzati 4 ,
Mahdi Abbasi 4 ,
Shahrzad Akhavan Farahani 4 ,
Maryam Zahmatkesh 5 &
Leila Eslambolchi 4

BMC Health Services Research volume 24 , Article number: 841 ( 2024 ) Cite this article

Metrics details

Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies.

Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software.

Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems.

Conclusions

The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.

Peer Review reports

The health system is a complex network that encompasses individuals, groups, and organizations engaged in policymaking, financing, resource generation, and service provision. These efforts collectively aim to safeguard and enhance people health, meet their expectations, and provide financial protection [ 1 ]. The World Health Organization's (WHO) framework outlines six foundational building blocks for a robust health system: governance and leadership, financing, workforce, infrastructure along with technologies and medicine, information systems, and service delivery. Strengthening these elements is essential for health systems to realize their objectives of advancing and preserving public health [ 2 ].

Effective governance in health systems encompasses the organization of structures, processes, and authority, ensuring resource stewardship and aligning stakeholders’ behaviors with health goals [ 3 ]. Financial mechanisms are designed to provide health services without imposing financial hardship, achieved through strategic fund collection, management and allocation [ 4 , 5 ]. An equitable, competent, and well-distributed health workforce is crucial in delivering healthcare services and fulfilling health system objectives [ 2 ]. Access to vital medical supplies, technologies, and medicines is a cornerstone of effective health services, while health information systems play a pivotal role in generating, processing, and utilizing health data, informing policy decisions [ 2 , 5 ]. Collectively, these components interact to offer quality health services that are safe, effective, timely, affordable, and patient-centered [ 2 ]

The WHO, at the 1978 Alma-Ata conference, introduced primary health care (PHC) as the fundamental strategy to attain global health equity [ 6 ]. Subsequent declarations, such as the one in Astana in 2018, have reaffirmed the pivotal role of PHC in delivering high-quality health care for all [ 7 ]. PHC represents the first level of contact within the health system, offering comprehensive, accessible, community-based care that is culturally sensitive and supported by appropriate technology [ 8 ]. Essential care through PHC encompasses health education, proper nutrition, access to clean water and sanitation, maternal and child healthcare, immunizations, treatment of common diseases, and the provision of essential drugs [ 6 ]. PHC aims to provide protective, preventive, curative, and rehabilitative services that are as close to the community as possible [ 9 ].

Global health systems, however, have faced significant disruptions from various shocks and crises [ 10 ], with the COVID-19 pandemic being a recent and profound example. The pandemic has stressed health systems worldwide, infecting over 775 million and claiming more than 7.04 million lives as of April 13th, 2024 [ 11 ]. Despite the pandemic highlighting the critical role of hospitals and intensive care, it also revealed the limitations of specialized medicine when not complemented by a robust PHC system [ 12 ].

The pandemic brought to light the vulnerabilities of PHC systems, noting a significant decrease in the use of primary care for non-emergency conditions. Routine health services, including immunizations, prenatal care, and chronic disease management, were severely impacted [ 13 ]. The challenges—quarantine restrictions, fears of infection, staffing and resource shortages, suspended non-emergency services, and financial barriers—reduced essential service utilization [ 14 ]. This led to an avoidance of healthcare, further exacerbating health inequalities and emphasizing the need for more resilient PHC systems [ 15 , 16 , 17 ].

Resilient PHC systems are designed to predict, prevent, prepare, absorb, adapt, and transform when facing crises, ensuring the continuity of routine health services [ 18 ]. Investing in the development of such systems can not only enhance crisis response but also foster post-crisis transformation and improvement. This study focuses on identifying global interventions and strategies to cultivate resilient PHC systems, aiding policymakers and managers in making informed decisions in times of crisis.

In 2023, we conducted a scoping review to collect and synthesize evidence from a broad spectrum of studies addressing the COVID-19 pandemic. A scoping review allows for the assessment of literature's volume, nature, and comprehensiveness, and is uniquely inclusive of both peer-reviewed articles and gray literature—such as reports, white papers, and policy documents. Unlike systematic reviews, it typically does not require a quality assessment of the included literature, making it well-suited for rapidly gathering a wide scope of evidence [ 19 ]. Our goal was to uncover the breadth of solutions aimed at bolstering the resilience of the PHC system throughout the COVID-19 crisis. The outcomes of this review are intended to inform the development of a model that ensures the PHC system's ability to continue delivering not just emergency services but also essential care during times of crisis.

We employed Arksey and O'Malley's methodological framework, which consists of six steps: formulating the research question, identifying relevant studies, selecting the pertinent studies, extracting data, synthesizing and reporting the findings, and, where applicable, consulting with stakeholders to inform and validate the results [ 20 ]. This comprehensive approach is designed to capture a wide range of interventions and strategies, with the ultimate aim of crafting a robust PHC system that can withstand the pressures of a global health emergency

Stage 1: identifying the research question

Our scoping review was guided by the central question: "Which strategies and interventions have been implemented to enhance the resilience of primary healthcare systems in response to the COVID-19 pandemic?" This question aimed to capture a comprehensive array of responses to understand the full scope of resilience-building activities within PHC systems.

Stage 2: identifying relevant studies

To ensure a thorough review, we conducted systematic searches across multiple databases, specifically targeting literature up to December 31st, 2022. The databases included PubMed, Web of Science, Scopus, Magiran, and SID. We also leveraged the expansive reach of Google Scholar. Our search strategy incorporated a bilingual approach, utilizing both English and Persian keywords that encompassed "PHC," "resilience," "strategies," and "policies," along with the logical operators AND/OR to refine the search. Additionally, we employed Medical Subject Headings (MeSH) terms to enhance the precision of our search. The results were meticulously organized and managed using the Endnote X8 citation manager, facilitating the systematic selection and review of pertinent literature.

Stage 3: selecting studies

In the third stage, we meticulously vetted our search results to exclude duplicate entries by comparing bibliographic details such as titles, authors, publication dates, and journal names. This task was performed independently by two of our authors, LE and MA, who rigorously screened titles and abstracts. Discrepancies encountered during this process were brought to the attention of a third author, AMM, for resolution through consensus.

Subsequently, full-text articles were evaluated by four team members—LE, MA, PI, and SHZ—to ascertain their relevance to our research question. The selection hinged on identifying articles that discussed strategies aimed at bolstering the resilience of PHC systems amidst the COVID-19 pandemic Table 1 .

We have articulated the specific inclusion and exclusion criteria that guided our selection process in Table 2 , ensuring transparency and replicability of our review methodology

Stage 4: charting the data

Data extraction was conducted by a team of six researchers (LE, MA, PI, MA, FE, and SHZ), utilizing a structured data extraction form. For each selected study, we collated details including the article title, the first author’s name, the year of publication, the country where the study was conducted, the employed research methodology, the sample size, the type of document, and the PHC strengthening strategies described.

In pursuit of maintaining rigorous credibility in our study, we adopted a dual-review process. Each article was independently reviewed by pairs of researchers to mitigate bias and ensure a thorough analysis. Discrepancies between reviewers were addressed through discussion to reach consensus. In instances where consensus could not be reached, the matter was escalated to a third, neutral reviewer. Additionally, to guarantee thoroughness, either LE or MA conducted a final review of the complete data extraction for each study.

Stage 5: collating, summarizing and reporting the results

In this stage, authors LE, MZ, and MA worked independently to synthesize the data derived from the selected studies. Differences in interpretation were collaboratively discussed until a consensus was reached, with AMM providing arbitration where required.

We employed a framework thematic analysis, underpinned by the WHO's health system building blocks model, to structure our findings. This model categorizes health system components into six foundational elements: governance and leadership; health financing; health workforce; medical products, vaccines, and technologies; health information systems; and service delivery [ 2 ]. Using MAXQDA 10 software, we coded the identified PHC strengthening strategies within these six thematic areas.

Summary of search results and study selection

In total, 4315 articles were found by initial search. After removing 397 duplicates, 3918 titles and abstracts were screened and 3606 irrelevant ones were deleted. Finally, 167 articles of 312 reviewed full texts were included in data synthesis (Fig. 1 ). Main characteristics of included studies are presented in Appendix 1.

PRISMA Flowchart of search process and results

Characteristics of studies

These studies were published in 2020 (18.6%), 2021 (36.5%) and 2022 (44.9%). They were conducted in 48 countries, mostly in the US (39 studies), the UK (16 studies), Canada (11 studies), Iran (10 studies) and Brazil (7 studies) as shown in Fig. 2 .

Distribution of reviewed studies by country

Although the majority of the reviewed publications were original articles (55.1 %) and review papers (21 %), other types of documents such as reports, policy briefs, analysis, etc., were also included in this review (Fig. 3 ).

An overview of the publication types

Strengthening interventions to build a resilient PHC system

In total, 194 interventions were identified for strengthening the resilience of PHC systems to respond to the COVID-19 pandemic. They were grouped into six themes of PHC governance and leadership (46 interventions), PHC financing (21 interventions), PHC workforce (37 interventions), PHC infrastructures, equipment, medicines and vaccines (30 interventions), PHC information system (21 interventions) and PHC service delivery (39 interventions). These strategies are shown in Table 3 .

This scoping review aimed to identify and categorize the range of interventions employed globally to strengthen the resilience of primary healthcare (PHC) systems in the face of the COVID-19 pandemic. Our comprehensive search yielded 194 distinct interventions across 48 countries, affirming the significant international efforts to sustain healthcare services during this unprecedented crisis. These interventions have been classified according to the WHO’s six building block model of health systems, providing a framework for analyzing their breadth and depth. This review complements and expands upon the findings from Pradhan et al., who identified 28 interventions specifically within low and middle-income countries, signaling the universality of the challenge and the myriad of innovative responses it has provoked globally [ 178 ].

The review highlights the critical role of governance and leadership in PHC resilience. Effective organizational structure changes, legal reforms, and policy development were crucial in creating adaptive healthcare systems capable of meeting the dynamic challenges posed by the pandemic. These findings resonate with the two strategies of effective leadership and coordination emphasized by Pradhan et al. (2023), and underscore the need for clear vision, evidence-based policy, and active community engagement in governance [ 178 ]. The COVID-19 pandemic posed significant challenges for PHC systems globally. A pivotal response to these challenges was the active involvement of key stakeholders in the decision-making process. This inclusivity spanned across the spectrum of general practitioners, health professionals, health managers, and patients. By engaging these vital contributors, it became possible to address their specific needs and to design and implement people-centered services effectively [ 41 , 42 , 43 ].

The development and implementation of collaborative, evidence-informed policies and national healthcare plans were imperative. Such strategies required robust leadership, bolstered by political commitment, to ensure that the necessary changes could be enacted swiftly and efficiently [ 41 , 45 ]. Leaders within the health system were called upon to foster an environment of good governance. This entailed promoting increased participation from all sectors of the healthcare community, enhancing transparency in decision-making processes, and upholding the principles of legitimacy, accountability, and responsibility within the health system [ 10 ]. The collective aim was to create a more resilient, responsive, and equitable healthcare system in the face of the pandemic's demands.

In the wake of the COVID-19 pandemic, governments were compelled to implement new laws and regulations. These were designed to address a range of issues from professional accreditation and ethical concerns to supporting the families of healthcare workers. Additionally, these legal frameworks facilitated the integration of emerging services such as telemedicine into the healthcare system, ensuring that these services were regulated and standardized [ 38 , 40 , 61 ]. A key aspect of managing the pandemic was the establishment of effective and transparent communication systems for patients, public health authorities, and the healthcare system at large [ 60 , 61 ]. To disseminate vital information regarding the pandemic, vaccination programs, and healthcare services, authorities leveraged various channels. Public media, local online platforms, and neighborhood networks were instrumental in keeping the public informed about the ongoing situation and available services [ 53 , 60 , 86 ]. For health professionals, digital communication tools such as emails and WhatsApp groups, as well as regular meetings, were utilized to distribute clinical guidelines, government directives, and to address any queries they might have had. This ensured that healthcare workers were kept up-to-date with the evolving landscape of the pandemic and could adapt their practices accordingly [ 60 , 144 ].

Healthcare facilities function as complex socio-technical entities, combining multiple specialties and adapting to the ever-changing landscape of healthcare needs and environments [ 179 ]. To navigate this dynamic, policy makers must take into account an array of determinants—political, economic, social, and environmental—that influence health outcomes. Effective management of a health crisis necessitates robust collaboration across various sectors, including government bodies, public health organizations, primary healthcare systems, and hospitals. Such collaboration is not only pivotal during crisis management but also during the development of preparedness plans [ 63 ]. Within the health system, horizontal collaboration among departments and vertical collaboration between the Ministry of Health and other governmental departments are vital. These cooperative efforts are key to reinforce the resilience of the primary healthcare system. Moreover, a strong alliance between national pandemic response teams and primary healthcare authorities is essential to identifying and resolving issues within the PHC system [ 29 ]. On an international scale, collaborations and communications are integral to the procurement of essential medical supplies, such as medicines, equipment, and vaccines. These international partnerships are fundamental to ensuring that health systems remain equipped to face health emergencies [ 63 ].

To ensure the PHC system's preparedness and response capacity was at its best, regular and effective monitoring and evaluation programs were put in place. These included rigorous quarterly stress tests at the district level, which scrutinized the infrastructure and technology to pinpoint the system’s strengths and areas for improvement [ 43 ]. Furthermore, clinical audits were conducted to assess the structure, processes, and outcomes of healthcare programs, thereby enhancing the quality and effectiveness of the services provided [ 63 ]. These evaluation measures were crucial for maintaining a high standard of care and for adapting to the ever-evolving challenges faced by the PHC system.

Financial strategies played a critical role in enabling access to essential health services without imposing undue financial hardship. Various revenue-raising, pooling, and purchasing strategies were implemented to expand PHC financing during the pandemic, illustrating the multifaceted approach needed to sustain healthcare operations under strained circumstances [ 9 , 19 ].

In response to the COVID-19 pandemic, the Indian government took decisive action to bolster the country's healthcare infrastructure. By enhancing the financial capacity of states, the government was able to inject more funds into the Primary Health Care (PHC) system. This influx of resources made it possible to introduce schemes providing free medications and diagnostic services [ 50 ]. The benefits of increased financial resources were also felt beyond India's borders, enabling the compensation of health services in various forms. In Greece, it facilitated the monitoring and treatment of COVID-19 through in-person, home-based, and remote health services provided by physicians in private practice. Similarly, in Iran, the financial boost supported the acquisition of basic and para-clinical services from the private sector [ 21 , 65 ]. These measures reflect a broader international effort to adapt and sustain health services during a global health crisis.

The COVID-19 pandemic presented a formidable challenge to the PHC workforce worldwide. Healthcare workers were subjected to overwhelming workloads and faced significant threats to both their physical and mental well-being. To build resilience in the face of this crisis, a suite of interventions was implemented. These included recruitment strategies, training and development programs, enhanced teamwork, improved protective measures, comprehensive performance appraisals, and appropriate compensation mechanisms, as documented in Table 3 . To address staffing needs within PHC centers, a range of professionals including general practitioners, nurses, community health workers, and technical staff were either newly employed or redeployed from other healthcare facilities [ 63 ]. Expert practitioners were positioned on the frontlines, providing both in-person services and telephone consultations, acting as gatekeepers in the health system [ 49 , 63 ]. Support staff with technological expertise played a crucial role as well, assisting patients in navigating patient portals, utilizing new digital services, and conducting video visits [ 102 ]. Furthermore, the acute shortage of healthcare workers was mitigated by recruiting individuals who were retired, not currently practicing, or in training as students, as well as by enlisting volunteers. This strategy was key to bolstering the workforce and ensuring continuity of care during the pandemic [ 109 ].

During the pandemic, new training programs were developed to prepare healthcare staff for the evolving demands of their roles. These comprehensive courses covered a wide array of critical topics, including the correct use of personal protective equipment (PPE), the operation of ventilators, patient safety protocols, infection prevention, teamwork, problem-solving, self-care techniques, mental health support, strategies for managing stress, navigating and applying reliable web-based information, emergency response tactics, telemedicine, and direct care for COVID-19 patients [ 74 , 95 , 100 , 108 , 110 , 112 , 117 ].

Acknowledging the psychological and professional pressures faced by the primary healthcare workforce, health managers took active measures to safeguard both the physical and mental well-being of their employees during this challenging period [ 124 ]. Efforts to protect physical health included monitoring health status, ensuring vaccination against COVID-19, and providing adequate PPE [ 63 , 72 ]. To address mental health, a variety of interventions were deployed to mitigate anxiety and related issues among frontline workers. In Egypt, for instance, healthcare workers benefited from psychotherapy services and adaptable work schedules to alleviate stress [ 126 ]. Singapore employed complementary strategies, such as yoga, meditation, and the encouragement of religious practices, to promote relaxation among staff [ 133 ]. In the United States, the Wellness Hub application was utilized as a tool for employees to enhance their mental health [ 132 ]. In addition to health and wellness initiatives, there were financial incentives aimed at motivating employees. Payment protocols were revised, and new incentives, including scholarship opportunities and career development programs, were introduced to foster job satisfaction and motivation among healthcare workers [ 63 ].

The resilience of PHC systems during the pandemic hinged on several key improvements. Enhancing health facilities, supplying medicines and diagnostic kits, distributing vaccines, providing medical equipment, and building robust digital infrastructure were all fundamental elements that contributed to the strength of PHC systems, as outlined in Table 3 . Safe and accessible primary healthcare was facilitated through various means. Wheelchair routes were created for patients to ensure their mobility within healthcare facilities. , dedicated COVID-19 clinics were established, mass vaccination centers were opened to expedite immunization, and mobile screening stations were launched to extend testing capabilities [ 23 , 33 , 63 , 140 ].

In Iran, the distribution and availability of basic medicines were managed in collaboration with the Food and Drug Organization, ensuring that essential medications reached those in need [ 89 ]. During the outbreak, personal protective equipment (PPE) was among the most critical supplies. Access to PPE was prioritized, particularly for vulnerable groups and healthcare workers, to provide a layer of safety against the virus [ 63 ]. Vaccines were made available at no cost, with governments taking active measures to monitor their safety and side effects, to enhance their quality, and to secure international approvals. Furthermore, effective communication strategies were employed to keep the public informed about vaccine-related developments [ 32 , 83 ].

These comprehensive efforts underscored the commitment to maintaining a resilient PHC system in the face of a global health every individual in the community could access healthcare services. To facilitate this, free high-speed Wi-Fi hotspots were established, enabling patients to engage in video consultations and utilize a range of e-services without the barrier of internet costs crisis. Significant enhancements were made to the digital infrastructure. This expansion was critical in ensuring that [ 30 , 54 ]. Complementing these measures, a variety of digital health tools were deployed to further modernize care delivery. Countries like Nigeria and Germany, for instance, saw the introduction of portable electrocardiograms and telemedical stethoscopes. These innovations allowed for more comprehensive remote assessments and diagnostics, helping to bridge the gap between traditional in-person consultations and the emerging needs for telemedicine [ 141 , 180 ].

Throughout the COVID-19 pandemic, targeted interventions were implemented to bolster information systems and research efforts, as outlined in Table 3 . Key among these was the advancement of a modern, secure public health information system to ensure access to health data was not only reliable and timely but also transparent and accurate [ 33 , 45 , 49 ]. The "Open Notes" initiative in the United States exemplified this effort, guaranteeing patient access to, and editorial control over, their health records [ 141 ]. Management strategies also promoted the "one-health" approach, facilitating the exchange of health data across various departments and sectors to enhance public health outcomes [ 10 ].

In addition to these information system upgrades, active patient surveillance and early warning systems were instituted in collaboration with public health agencies. These systems played a pivotal role in detecting outbreaks, providing precise reports on the incidents, characterizing the epidemiology of pathogens, tracking their spread, and evaluating the efficacy of control strategies. They were instrumental in pinpointing areas of concern, informing smart lockdowns, and improving contact tracing methods [ 33 , 63 , 72 ]. The reinforcement of these surveillance and warning systems had a profound impact on shaping and implementing a responsive strategy to the health crisis [ 10 ].

To further reinforce the response to the pandemic, enhancing primary healthcare (PHC) research capacity became crucial. This enabled healthcare professionals and policymakers to discern both facilitators and barriers within the system and to devise fitting strategies to address emerging challenges. To this end, formal advisory groups and multidisciplinary expert panels, which included specialists from epidemiology, clinical services, social care, sociology, policy-making, and management, were convened. These groups harnessed the best available evidence to inform decision-making processes [ 30 ]. Consequently, research units were established to carry out regular telephone surveys and to collect data on effective practices, as well as new diagnostic and therapeutic approaches [ 31 , 89 ]. The valuable insights gained from these research endeavors were then disseminated through trusted channels to both the public and policymakers, ensuring informed decisions at all levels [ 36 ].

The COVID-19 pandemic acted as a catalyst for the swift integration of telemedicine into healthcare systems globally. This period saw healthcare providers leverage telecommunication technologies to offer an array of remote services, addressing medical needs such as consultations, diagnosis, monitoring, and prescriptions. This transition was instrumental in ensuring care continuity and mitigating infection risks for both patients and healthcare workers, highlighting an innovative evolution in healthcare delivery [ 170 , 181 ].

Countries adapted to this new model of healthcare with varied applications: Armenia established telephone follow-ups and video consultations for remote patient care, while e-pharmacies and mobile health tools provided immediate access to medical information and services [ 29 ]. In France and the United States, tele-mental health services and online group support became a means to support healthy living during the pandemic [ 147 , 158 ] . New Zealand introduced the Aroha chatbot, an initiative to assist with mental health management [ 139 ].

The implementation and effectiveness of these telehealth services were not limited by economic barriers, as underscored by Pradhan et al. (2023), who noted the key role of telemedicine in low and middle-income countries. These countries embraced the technology to maintain health service operations, proving its global applicability and utility [ 178 ]. The widespread adoption of telemedicine, therefore, represents a significant and perhaps lasting shift in healthcare practice, one that has redefined patient care in the face of a global health crisis and may continue to shape the future of healthcare delivery [ 170 , 178 , 181 ].

The study highlighted PHC strengthening strategies in COVID-19 time . Notably, the adaptations and reforms spanned across governance, financing, workforce management, information system, infrastructural readiness, and service delivery enhancements. These interventions collectively contributed to the robustness of health systems against the sudden surge in demand and the multifaceted challenges imposed by the pandemic and resulted.

Significantly, the findings have broader implications for health policy and system design worldwide. The pandemic has highlighted the critical need for resilient health systems that are capable of not only responding to health emergencies but also maintaining continuity in essential services. The strategies documented in this review serve as a template for countries to fortify their health systems by embedding resilience into their PHC frameworks (Fig. 4 ). Future health crises can be better managed by learning from these evidenced responses, which emphasize the necessity of integrated, well-supported, and dynamically adaptable health care structures.

A model for strengthening the resilience of the primary health care system

Looking ahead, realist reviews could play a pivotal role in refining PHC resilience strategies. By understanding the context in which specific interventions succeed or fail, realist reviews can help policymakers and practitioners design more effective health system reforms, as echoed in the need for evidence-based planning in health system governance [ 9 ] . These reviews offer a methodological advantage by focusing on the causality between interventions and outcomes, aligning with the importance of effective health system leadership and management [ 50 , 182 ] . They take into account the underlying mechanisms and contextual factors, thus providing a nuanced understanding that is crucial for tailoring interventions to meet local needs effectively [ 28 , 86 ] , ultimately leading to more sustainable health systems globally. This shift towards a more analytical and context-sensitive approach in evaluating health interventions, as supported by WHO's framework for action [ 2 , 10 ] , will be crucial for developing strategies that are not only effective in theory but also practical and sustainable in diverse real-world settings.

Limitations and future research

In our comprehensive scoping review, we analyzed 167 articles out of a dataset of 4,315, classifying 194 interventions that build resilience in primary healthcare systems across the globe in response to pandemics like COVID-19. While the review's extensive search provides a sweeping overview of various strategies, it may not capture the full diversity of interventions across all regions and economies. Future research should focus on meta-analyses to evaluate the effectiveness of these interventions in greater detail and employ qualitative studies to delve into the specific challenges and successes, thus gaining a more nuanced understanding of the context. As the review includes articles only up to December 31, 2022, it may overlook more recent studies. Regular updates, a broader linguistic range, and the inclusion of a more diverse array of databases are recommended to maintain relevance and expand the breadth of literature, ultimately guiding more focused research that could significantly enhance the resilience of PHC systems worldwide.

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Abbreviations

Primary Health Care

World Health Organization

Sustainable Development Goals

Universal Health Coverage

Personal Protective Equipment

General Practitioner

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Acknowledgments

We would like to thank Dr. Arshad Altaf for his invaluable comments on the earlier drafts of this work.

Funding for this project was provided by the World Health Organization Eastern Mediterranean Region.

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Ali Mohammad Mosadeghrad

Health policy, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran

Mahnaz Afshari

Health management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran

Parvaneh Isfahani

Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran

Farahnaz Ezzati, Mahdi Abbasi, Shahrzad Akhavan Farahani & Leila Eslambolchi

Health Management, School of Business and Management, Royal Holloway University of London, London, UK

Maryam Zahmatkesh

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LE, MA, MZ and AMM participated in the design of the study. LE, AMM, MA, MZ, PI, FE, MA and SHA undertook the literature review process. All authors drafted the manuscript. All authors read and approved the final manuscript.

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Mosadeghrad, A.M., Afshari, M., Isfahani, P. et al. Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review. BMC Health Serv Res 24 , 841 (2024). https://doi.org/10.1186/s12913-024-11278-4

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Disaster Management: A State-of-the-Art Review

Natural Hazards - Impacts, Adjustments and Resilience

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Louis Hugo Francescutti

1. Introduction

2. Definitions

2.1 Emergencies

2.2 Disasters

2.4 Catastrophe

2.7 Vulnerability

2.8 Resilience

3. Emergency management

3.1 From emergency management to disaster management

3.2 Disaster management: resource poor environment

3.3 Hospital disaster management

4. Training

4.1 Barriers to effective exercises

4.2 Benefits

5. Conclusion

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Table 1

4.1. Study quality assessment

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Conflict of interest

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