UMass Disaster Medicine

06/09/2026

Twenty Years After the Anthrax Terrorist Attacks of 2001: Lessons Learned and Unlearned for
the COVID-19 Response

Summary by Zilmarie Díaz Pacheco, MD
UMass Disaster Medicine Fellow

This article describes the health system before the 2001 anthrax attacks, the response to these attacks, Influenza A (H1NI), Ebola, and Zika response in the following years, and how lessons
learned were unlearned during the COVID-19 response. Before 2001, there was limited capacity for coordination and surge response, and the health system was unprepared to diagnose and treat novel pathogens effectively. This improved during the response to the anthrax attacks, resulting in patient surge plans, interoperable communication systems, hospital evacuation
plans, and healthcare coalitions. This led to the Pandemic and All-Hazards Preparedness Act, the Model State Emergency Health Powers Act, and the National Strategic Stockpile, among
other programs. Influenza A(H1N1) was the first major test of these programs, and they seemed to pay off. After this response, emergency preparedness waned, and the same could not be said
about the Ebola and Zika virus response. By 2020, federal preparedness and public health funding had decreased significantly. The American Rescue Plan Act of 2021 had to be
established for testing, contract tracing, and mitigation. The SNS had not been replenished, leading to PPE shortages. Emergency protocols, such as mask and vaccine mandates, became
politically divisive, leading to a weakening of public health powers. The authors conclude by emphasizing the need to build core public health and hospital capacities, replenishing the SNS,
and strategic planning for further responses.

Gostin LO, Nuzzo JB. Twenty Years After the Anthrax Terrorist Attacks of 2001: Lessons Learned and Unlearned for the COVID-19 Response. JAMA. 2021 Nov 23;326(20):2009-2010. doi: 10.1001/jama.2021.19292. PMID: 34705048.

06/09/2026

Emergency Preparedness and Public Health: The Lessons of Hurricane Sandy

Summary by Zilmarie Díaz Pacheco, MD
UMass Disaster Medicine Fellow

This article describes how lessons learned from Hurricane Katrina were not applied to the Hurricane Sandy response, particularly when it comes to hospital evacuation. The authors
describe how Joint Commission accreditation standards after Katrina focused on facilities being able to function alone for 96 hours, rather than emphasizing hospitals’ particular vulnerabilities and evacuation strategies. New York hospitals had more detailed emergency plans and access to better-positioned generators on higher floors, with concrete-encased fuel pumps. They also had transport equipment, a federal Ambulance Contract, disaster medical personnel, and FEMA search and rescue teams. Despite this, hospital evacuations were incongruent, with neighboring facilities electing to evacuate before, during, and after the storm. Public health and emergency
management agencies could develop protocols to ensure capacity and guide crucial decisions, such as evacuations. Health care coalitions could also be established to ensure resiliency.

Powell T, Hanfling D, Gostin LO. Emergency preparedness and public health: the lessons of Hurricane Sandy. JAMA. 2012 Dec 26;308(24):2569-70. doi: 10.1001/jama.2012.108940. PMID: 23281545.

UMass Emergency Medicine Residency UMass Memorial Medical Center UMass Memorial LifeFlight

06/09/2026

In the Age of Climate Change, how do we cope with Floods?

Summary by Zilmarie Díaz Pacheco, MD
UMass Disaster Medicine Fellow

In this New Yorker article. John Seabrook describes the flash flood that occurred on July 4th, 2025 in Kerrville, Texas, which killed over 100 people. Seabrook argues that climate change is transforming flooding into a more frequent, unpredictable, and deadly hazard. He also mentions how the current scientific and infrastructural systems are not equipped to manage this new
reality. The understanding of flood risk is outdated. FEMA flood maps rely on old data and fail to capture current risks. The “100-year floods” are now happening more often. Continued
development in floodplains and rebuilding after disasters increase vulnerability. Property rights and economic interests make it difficult to restrict risky development. Engineering approaches such as channelizing rivers and reinforcing banks often make flooding worse over time. Rivers are dynamic systems, and forcing them into channels increases downstream destruction. Seabrook later describes the Vermont Flood Safety Act of 2024, which consists of treating rivers as “corridors” and allowing them space to flow. These policies emphasize allowing rivers to meander, restoring floodplains, and limiting development in high-risk areas. This shifts the focus from controlling water to adapting to it. This was a forward-thinking solution in Vermont, but its effective adaptation in other states will require relocating communities and infrastructure, large federal investment, and political willingness to restrict land use.

UMass Emergency Medicine Residency UMass Memorial Medical Center

06/09/2026

The Threat of Secondary Chemical Contamination of Emergency Departments and Personnel: An Uncommon, but Still Occurring Problem

Summary by Zilmarie Díaz Pacheco, MD
UMass Disaster Medicine Fellow

In this study, the authors analyzed hazardous substance release surveillance data for events involving secondary contamination of hospital emergency departments. Out of the events identified from 2007 to 2013 in the Hazardous Substances Emergency Events Surveillance system and the National Toxic Substances Incidence Program, five incidents involved secondary contamination (0.02%). They describe the events, which included exposure to sulfuric acid, methamphetamine production chemicals, and malathion. Although these events are rare, they have the potential to harm healthcare personnel and result in temporary disruption or closure of an ED.

The authors describe several best practices for ED response to hazardous substance events. They recommend establishing hospital-based decontamination protocols and training response
teams on these protocols and the selection and use of appropriate PPE. The response team should be able to initiate a basic decontamination without knowing the identity of the contaminant. When possible, there should be permanent decontamination facilities that are well-ventilated with a ventilation system independent from the hospital, with warm water, and protection from the elements. They also recommend regular refresher training and drills and continued surveillance to allow for evidence-based planning.

Larson TC, Orr MF, Auf der Heide E, Wu J, Mukhopadhyay S, Horton DK. Threat of Secondary Chemical Contamination of Emergency Departments and Personnel: An Uncommon but Recurrent Problem. Disaster Med Public Health Prep. 2016 Apr;10(2):199-202. doi: 10.1017/dmp.2015.127. Epub 2015 Nov 10. PMID: 26554546; PMCID: PMC5712456.

UMass Emergency Medicine Residency UMass Memorial Medical Center

03/20/2026

Get the book with a discount!

03/06/2026

I am excited to post that John Broach and I published our Disaster Medicine book! It's been a long road and we couldn't have done it without all the amazing authors that contributed to the book and the people at Cambridge University Press. We both hope that this adds to the growth and professionalization of disaster medicine!

"Cases in Simulated Disaster Medicine"
The book contains a series of 44 ready to go medical cases in the setting of disasters. Think a crush injury case that has occurred because an earthquake caused a building collapse. These are complete ready-to-teach cases that educators can use for a wide range of learners ... nursing students, medical students, prehospital providers, residents, fellows and more. Core disaster medicine principles are included with each case. The cases are scalable and customizable to any learning environment, from low-resource teaching settings to high-fidelity simulation labs.

We couldn't have done this without the authors:
Alexander Hart, Ameer Ibrahim, C. Clare Charbonnet, MD, Cassandra Mackey, Christopher Hayden, Cody Johnson, Colleen Donovan, MD, Daniel Saltzman, David Ruby, Denise Fernandez, Emerson Franke, MD, FACEP, FAAEM, FAEMS, Emily Marx, Guy Carmelli, Jim Aiken MD MHA FACEP, James Phillips, MD, Jennifer Carey, Jennifer E. Geller, MD, Jonathan Gammel, Jordan Hitchens, Jorge Yarzebski, Ziad Kazzi, Kyle Herbert, Larissa Unruh, Lauren Bacon, MD, MBA, Lekha Reddy, Liam Porter, Mary McGoldrick, Matthew Carlisle, Matthew Tovar, MD, Meghan Maslanka, Michael De Luca, MD, MS, Michael Weiner, MD, Morgan Ritz, Natalie Moore, Natalie Sullivan, Paul Andrew Baker, Rashed Al Remeithi, Ritu Sarin, MD, Romeo Fairley, Sukhi Atti.

Our amazing book reviewers: Paul Biddinger and Selim Suner MD, MS, FACEP. The folks at Cambridge University Press including Jessica Papworth. And of course, all the support from UMass Emergency Medicine Residency UMass Chan Medical School

https://lnkd.in/ernzBhUP

BTW - the pictures on the cover are all from simulation courses or drills at UMass!

03/04/2026

Medical Problems and Concerns with Temporary Evacuation Shelters after Great Earthquake Disasters in Japan: A Systematic Review

Summary by Zilmarie Díaz Pacheco, MD
UMass Disaster Medicine Fellow

This study reviews the literature on the medical problems and concerns that were encountered in evacuation shelters after earthquakes in Japan.

They focused on sanitation, food and nutrition, and medication.

Sanitation = they found that most shelters were poorly ventilated in the winter months and that, due to limited space, it was hard to implement droplet precautions. This led to an increased incidence of acute respiratory infections, tuberculosis, and waterborne diarrheal illnesses. The authors also mention that in most cases, there was no running water, gas, or electricity shortly after earthquakes. The lack of running water affected hygienic handling of food and perpetuated the use of latrines. Latrines were often insufficient, unsanitary, and unsafe.

Food = The food offered in evacuation shelters was not nutritionally balanced, and there was an excessive consumption of sodium by evacuees. The distribution of food between shelters was also imbalanced.

Medications = for chronic conditions were limited in quantity and variety. Many diabetic patients were unable to keep good glycemic control due to their living environment, inadequate nutrition, and lack of their chronic medications. Natural disasters have also been linked to exacerbations of peptic ulcers, COPD, physical disability, sleep disturbances, and cognitive dysfunction.

The authors recommended that health care professionals be dispatched to shelters, one for every 50 evacuees. They also emphasized the importance of providing education about hand hygiene during food preparation and after latrine use.

Tokumaru O, Fujita M, Nagai S, Minamikawa Y, Kumatani J. Medical Problems and Concerns with Temporary Evacuation Shelters after Great Earthquake Disasters in Japan: A Systematic Review. Disaster Med Public Health Prep. 2022 Aug;16(4):1645-1652. doi: 10.1017/dmp.2021.99. Epub 2021 Jun 9. PMID: 34103106.

UMass Emergency Medicine Residency UMass Memorial Medical Center UMass Chan Medical School

02/02/2026

Hospital surge capacity preparedness in disasters and emergencies: a systematic review

Publich Health, 2023

Summary by Zilmarie Díaz Pacheco, MD
UMass Disaster Medicine Fellow

Hospital surge capacity is defined as the capability to deal with the sudden influx of patients beyond the usual resulting from a disaster or emergency. It compromises four components: staff, stuff, space, and system.

In this systematic review, authors evaluated the existing evidence on surge capacity by reviewing studies from 2016-2022.

When it comes to “staff”, they found that increasing hospital workforce is the most important way to improve surge capacity. This could be done by using on-call staff, local healthcare providers and volunteers, calling in stand-by or off-duty staff, and hiring staff from other facilities. Hospitals could also expand staff capacity training specialized and non-specialized staff in disaster preparedness.

In the “stuff” and “space” domain, hospitals could stockpile pharmaceuticals and medical supplies, create additional ICUs and ORs, and triage or reallocate scarce supplies. Additional beds could be provided through safe early patient discharge, reverse triage, and cancelling elective surgeries. In the article, authors highlight the need for healthcare coalitions and collaborations strategies to reallocate and distribute the necessary supplies.

In developing surge planning or “systems”, hospitals should examine their existing preparedness and identify possible problems and gaps. This could be done with web-based simulation tools, such as the one proposed by Toerper et al. This tool enables emergency planners to estimate the hospital surge capacity proactively. Authors identified different barriers to surge capacity preparedness in developing and developed countries.

In developing countries, barriers depend on the countries’ health systems and socio-economic conditions and are mostly due to lack of sufficient staff and stuff. In developed countries, most barriers are due to lack of standardized and systemic metrics or models for assessing surge capacity, among other factors.

UMass Emergency Medicine Residency UMass Memorial Medical Center UMass Chan Medical School

01/26/2026

Assessment of active shooter preparedness in US hospital systems

American Journal of Disaster Medicine, 2023

Summary by Zilmarie Díaz Pacheco, MD
UMass Disaster Medicine Fellow

This study aims to gain insights regarding standard policies and practices currently used in response to active shooter events by surveying American healthcare leaders. It particularly focuses on insight regarding policies related to managing critically ill or otherwise immobile patients.

A total of 294 active hospital systems were asked to complete the survey, out of which representatives from 60 of these organizations answered. The hospitals were a mix of community and academic sites, both small and large. One third had experience with active shooter events. These institutions were most likely to perform drills.

Over 98% of all institutions had enacted an active shooter protocol. Of these, 24% had a dedicated plan to ensure continuity of care for patients who are critically ill or otherwise immobile.

Some had a “run-hide-fight” approach and others had a “secure-preserve-defend” approach. Authors identified that some well-prepared areas were the fact that most of these institutions had a protocol.

Half of the hospital systems routinely run drills. Most respondents indicated that their institution also has a plan to provide mental health after an event. They recognized areas of improvement such as stocking life-saving supplies and training staff on hemorrhage control.

A great part of the health systems do not have plans to manage critically ill or otherwise immobile patients. This is particularly important because the possibility of evacuating these patients during an active shooter crisis is largely infeasible and could jeopardize staff and patients.

These protocols need to be disseminated and practiced prior to events. Still, it is an ethical dilemma because at the end of the day, choosing to stay behind with patients is “not a moral obligation; it is a moral option”

UMass Emergency Medicine Residency UMass Memorial Medical Center UMass Memorial LifeFlight Brown Disaster Medicine and Emergency Preparedness

01/19/2026

Adapting Standards of Care Under Extreme Conditions

Summary by Zilmarie Díaz Pacheco, MD
UMass Disaster Medicine Fellow

Clinical decisions made during disasters and extreme conditions tend to shift to a utilitarian framework where the goal is to achieve the greatest good for the greatest number of individuals. In these events, the clinicians’ focus is on maintaining worker and patient safety, maintaining airway, breathing, and circulation, and establishing or maintaining infection control.

Although the context changes in a disaster, no emergency should change the basic standards of practice, code of ethics, competence, or values of a professional.

This report stems from wanting to understand some of the legal issues and ethical-social expectations in advance of an emergency or disaster, while coming to terms with the fact that there can be no absolute, predetermined answers to many specific questions that arise in emergencies.

The Incident Command System should provide guidance at the moment to these particular dilemmas. Several themes that are discussed are the ability to maintain a safe environment, patient education, ensuring continuity of care, managing information, and communicating effectively during these extreme emergencies.

These and other aspects of emergency care may be affected by loss of essential services, loss of infrastructure, shortage of workers, sudden increase in number of patients or acuity, and relocation to alternate care sites.

The article concludes by recommending that health professionals should consider the ethics and issues in advance, participate in planning and practice, remain committed to delivering the best care possible under the circumstances, and evaluate the response to emergencies for continuous quality improvement.

HHS Administration for Strategic Preparedness and Response UMass Emergency Medicine Residency UMass Memorial LifeFlight UMass Memorial Medical Center

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