disaster

灾难
  • 文章类型: Journal Article
    感染是众所周知的创伤后患者的并发症,经常导致高发病率和死亡率。特别是,在灾难环境中发生的创伤,自然和人为的,例如武装冲突和爆炸物爆炸,导致具有挑战性的医疗条件,阻碍了最佳管理实践。在缺乏典型危险因素(如免疫受损状态或其他)的创伤患者中,侵袭性真菌感染(IMF)的发生率正在增加。这篇叙述性综述将侧重于作为自然灾害后的直接并发症的国际金融机构,战争,以及人为的大规模破坏,并总结了有关流行病学的现有证据,临床表现,危险因素,微生物学,和适当的管理。在此设置中,其临床表现可能包括皮肤和软组织感染,骨髓炎,内脏感染,和肺炎。在战争中,应考虑暴露于无菌环境或伤口被土壤和腐烂的有机物污染的患者。
    Infections are well-known complications in patients following traumatic injuries, frequently leading to high morbidity and mortality. In particular, trauma occurring in disaster settings, both natural and man-made, such as armed conflicts and explosives detonation, results in challenging medical conditions that impede the best management practices. The incidence of invasive fungal infections (IFI) is increasing in trauma patients who lack the typical risk factors like an immune compromised state or others. This narrative review will focus on IFI as a direct complication after natural disasters, wars, and man-made mass destruction with a summary of the available evidence about the epidemiology, clinical manifestations, risk factors, microbiology, and proper management. In this setting, the clinical manifestations of IFI may include skin and soft tissue infections, osteomyelitis, visceral infections, and pneumonia. IFI should be considered in the war inflicted patients who are exposed to unsterile environments or have wounds contaminated with soil and decaying organic matter.
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  • 文章类型: Journal Article
    背景:心理方面是受灾幸存者的重要方面之一。灾害管理范式的变化是需要将以前仅专注于处理创伤后困扰综合症的干预措施转变为增加创伤后成长以预防灾后心理障碍的干预措施的原因之一。这篇综述旨在综合最近的研究,以进一步解释改善灾难幸存者创伤后成长的潜在策略。
    方法:这是对以往研究的综合综述。文章是通过SCOPUS识别的,EMBASE,JSTOR,PROQUEST,MEDLINE和灰色文学(谷歌学者)。确定了2000年至2022年的所有主题相关文献。这篇综述包括定量和定性研究以及文献综述,标准:用于改善灾难幸存者创伤后成长的所有类型的干预措施和可能影响实施的潜在影响因素以及其他相关结果。
    结果:从400项初步搜索研究中,27项研究(24项定量。一个定性的,和两种混合方法)有资格纳入审查。促进创伤后成长的一些因素包括宗教应对,文化,社会支持,创伤的严重程度,应对策略,教育水平和工作满意度。
    结论:通过系统地探索促进灾难生存创伤后成长的因素,这项综合审查将提供基本信息,以制定一项干预措施,以防止或最大程度地减少灾难对幸存者的心理影响。
    BACKGROUND: The psychological aspect is one of the important aspects of the affected disaster survivors. The change in the disaster management paradigm is one reason for the need to change interventions that previously only focused on handling posttraumatic distress syndrome into interventions to increase post-traumatic growth to prevent post-disaster psychological disorders. This review aims to synthesise recent research to develop further explanations regarding potential strategies to improve the post-traumatic growth of disaster survivors.
    METHODS: This is an integrative review of previous studies. Articles were identified via SCOPUS, EMBASE, JSTOR, PROQUEST, MEDLINE and grey literature (Google Scholar). All subject-relevant literature from 2000 to 2022 was identified. This review included quantitative and qualitative studies and literature reviews, with criteria: all types of interventions used to improve the post-traumatic growth of disaster survivors and potential influencing factors that may affect the implementation as well as other relevant outcomes.
    RESULTS: From 400 initial search studies, 27 studies (24 quantitative. one qualitative, and two mixed methods) were eligible to be included in the review. Some factors promoting post-traumatic growth included religious coping, culture, social support, the severity of the trauma, coping strategies, education level and work satisfaction.
    CONCLUSIONS: By systematically exploring the factors that foster post-traumatic growth of disaster survival, this integrative review will give fundamental information to develop an intervention that prevents or minimises the psychological impacts of a disaster towards survivors.
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  • 文章类型: Journal Article
    肾脏疾病的全球负担正在增加,与此同时,自然和人为危机的数量也在不断增加。在这些动荡的时代,获取重要的医疗保健资源变得具有挑战性,对个人构成重大风险,尤其是那些患有肾脏疾病的人。这篇综述深入研究了危机对肾脏疾病的影响,特别关注急性肾损伤(AKI),肾衰竭(KF),肾移植(KT)由于灾难的混乱性质和资源的有限可用性,经历导致AKI的挤压伤的患者可能会遇到延迟诊断。在慢性危机中,如冲突,KF患者尤其受到影响,不幸的是,与透析标准的偏差很普遍,影响发病率和死亡率。此外,危机也扰乱了肾脏移植的获取,可能损害移植结果。这篇综述强调了危机环境中肾脏疾病的准备措施和积极管理的至关重要性。政府机构之间的合作努力,救援队,医疗保健提供者,人道主义机构,非政府组织必须确保在危机时期为肾病患者提供公平合理的护理,目的是挽救生命和改善结果。
    The global burden of kidney disease is increasing, paralleled by a rising number of natural and man-made crises. During these tumultuous times, accessing vital health care resources becomes challenging, posing significant risks to individuals, particularly those with kidney disease. This review delves into the impact of crises on kidney disease, with a particular focus on acute kidney injury (AKI), kidney failure, and kidney transplant. Patients experiencing crush injuries leading to AKI may encounter delayed diagnosis due to the chaotic nature of disasters and limited availability of resources. In chronic crises such as conflicts, patients with kidney failure are particularly affected, and deviations from dialysis standards are unfortunately common, impacting morbidity and mortality rates. Additionally, crises also disrupt access to kidney transplants, potentially compromising transplant outcomes. This review underscores the critical importance of preparedness measures and proactive management for kidney disease in crisis settings. Collaborative efforts among government bodies, rescue teams, health care providers, humanitarian agencies, and nongovernmental organizations are imperative to ensure equitable and reasonable care for kidney disease patients during times of crises, with the aim of saving lives and improving outcomes.
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  • 文章类型: Journal Article
    目标:鉴于全球灾难的频率,对高效和有效的应急响应的需求日益增长。一个挑战是设计合适的回顾性图表,以便从灾害中获得知识。本研究为设计和更新回顾性研究提供了对已发表的回顾性图表综述模板的全面理解。
    方法:我们对同行评审的文章和灰色文献进行了系统综述和文本分析,用于报告的回顾性图表综述模板,分析,评估应急反应。搜索是在PubMed上进行的,科克伦,和WebofScience以及预先确定的政府和非政府组织和专业协会网站,以查找2022年7月1日之前发表的论文。使用视觉文本分析对项目和类别进行分组和组织。该研究在PROSPERO(374,928)中注册。
    结果:四个指标组,12条准则,来自21篇同行评审文章和9篇灰色文献的14种报告格式(或数据收集模板)符合资格.回顾性工具通常是基于小组共识设计的。为整个卫生系统设计了一个指南和一个报告格式,23项研究集中在应急系统上,而其他人则专注于医院。五篇论文聚焦特定事件类型,包括化学,生物,放射学,核,大规模燃烧,和大量儿科伤亡。十篇论文说明了使用工具的位置。文本分析包括123个类别和1210个特定项目;观察到较大的异质性。
    结论:现有的应急响应回顾性图表审查模板是异构的,类型不同,层次结构,和理论基础。全面的设计,标准,可行的回顾性图表需要应急响应范例,结果基线,健壮的信息获取,和区域间合作。
    OBJECTIVE: Given the frequency of disasters worldwide, there is growing demand for efficient and effective emergency responses. One challenge is to design suitable retrospective charts to enable knowledge to be gained from disasters. This study provides comprehensive understanding of published retrospective chart review templates for designing and updating retrospective research.
    METHODS: We conducted a systematic review and text analysis of peer-reviewed articles and grey literature on retrospective chart review templates for reporting, analysing, and evaluating emergency responses. The search was performed on PubMed, Cochrane, and Web of Science and pre-identified government and non-government organizational and professional association websites to find papers published before July 1, 2022. Items and categories were grouped and organised using visual text analysis. The study is registered in PROSPERO (374,928).
    RESULTS: Four index groups, 12 guidelines, and 14 report formats (or data collection templates) from 21 peer-reviewed articles and 9 grey literature papers were eligible. Retrospective tools were generally designed based on group consensus. One guideline and one report format were designed for the entire health system, 23 studies focused on emergency systems, while the others focused on hospitals. Five papers focused specific incident types, including chemical, biological, radiological, nuclear, mass burning, and mass paediatric casualties. Ten papers stated the location where the tools were used. The text analysis included 123 categories and 1210 specific items; large heterogeneity was observed.
    CONCLUSIONS: Existing retrospective chart review templates for emergency response are heterogeneous, varying in type, hierarchy, and theoretical basis. The design of comprehensive, standard, and practicable retrospective charts requires an emergency response paradigm, baseline for outcomes, robust information acquisition, and among-region cooperation.
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  • 文章类型: Journal Article
    未能发现PDG以及缺乏相应的必要干预措施,可能会破坏自然灾害幸存者在亲人去世数年后的生活。本研究旨在通过系统评价和荟萃分析研究自然灾害后的PGD。
    本研究是根据系统评价和荟萃分析指南的首选报告项目进行的。
    关注自然灾害后PGD的普遍性,直到2021年底进行的研究没有时间限制。要做到这一点,信誉良好的数据库,如PubMed,WebofScience,Scopus,Embase,谷歌学者,和科学直接被使用。随机效应模型用于对研究进行荟萃分析。为了检查研究之间的异质性,使用I2指数。使用Begg检验评估研究的发表偏倚。使用STATA软件分析数据。
    首先,根据最初的搜索收集了2566项研究,其中12项最终研究进入分析。结果显示,自然灾害后PGD的患病率为38.81%(95%CI:24.12-53.50,I2=99.7%,p=0<001)。
    建议负责灾害管理的组织制定政策和计划,派遣专门的心理-精神咨询团队,迅速容纳受伤的人,并在最短的时间内重建受损的建筑物。
    UNASSIGNED: The failure to detect PDG and lack of providing essential interventions accordingly can disrupt the lives of survivors of natural disasters years after the death of their loved ones. The present study aims to investigate PGD after natural disasters using a systematic review and meta-analysis.
    UNASSIGNED: This study was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.
    UNASSIGNED: With the focus on the prevalence of PGD after natural disasters, studies conducted until the end of 2021 were collected without a time limit. To do this, reputable databases such as PubMed, Web of Science, Scopus, Embase, Google Scholar, and Science Direct were used. The random effects model was used to perform a meta-analysis of the studies. To check the heterogeneity between the studies, the I2 index was used. The publication bias of the study was evaluated using Begg\'s test. Data were analyzed using the STATA software.
    UNASSIGNED: Primarily, 2566 studies were collected based on the initial search, from which 12 final studies were entered into the analysis. The results showed that the prevalence of PGD after natural disasters was 38.81 % (95 % CI: 24.12-53.50, I2 = 99.7 %, p = 0 < 001).
    UNASSIGNED: It is recommended that policies and plannings of the organizations responsible for disaster management be prepared to send specialized teams of psycho-spiritual counseling, quickly accommodate the injured, and reconstruct the damaged buildings in the shortest time possible.
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  • 文章类型: Journal Article
    地震是不可预测的自然灾害,造成巨大的伤害。我们旨在回顾地震肌肉骨骼损伤的外科治疗和挤压综合征的重症监护。我们在PubMed上搜索了英语文献,没有时间限制,以选择相关论文。对检索到的文章进行了严格的评估和总结。伤口应该清理干净,清创,接受抗生素治疗,接受破伤风类毒素,除非在过去5年内接种疫苗,并根据需要重新清创。下肢影响了48.5%(21.9%-81.4%)的身体区域/患者。31.1%(11.3%-78%)的身体区域/患者发生骨折。最常见的手术是切开复位和内固定,占21%(0%-76.6%),其次是巴黎石膏占18.2%(2.3%-48.8%),和外固定架在6.6%(1%-13%)的手术/患者中。开放性骨折应采用外固定架治疗。在伤口变得干净并且骨折的骨头被皮肤适当覆盖之前,不应该进行内固定,皮肤移植,或皮瓣。15%(2.8%-27.2%)进行了筋膜切开术,而在3.7%(0.4%-11.5%)的身体区域/患者中进行了截肢。治疗挤压综合征的原则包括:(1)给予适当的静脉输液以维持足够的尿量,(2)监测和管理高钾血症,(3)考虑在容量超负荷的情况下进行肾脏替代治疗,严重的高钾血症,重度酸血症,或严重尿毒症。低质量的研究针对筋膜切开术的适应症,截肢,还有高压氧治疗.有关未来地震伤害医疗管理的前瞻性数据收集应成为未来灾难准备的一部分。我们希望这篇综述将携带适当管理住院患者的地震肌肉骨骼损伤和挤压综合征所需的基本知识。
    Earthquakes are unpredictable natural disasters causing massive injuries. We aim to review the surgical management of earthquake musculoskeletal injuries and the critical care of crush syndrome. We searched the English literature in PubMed without time restriction to select relevant papers. Retrieved articles were critically appraised and summarized. Open wounds should be cleaned, debrided, receive antibiotics, receive tetanus toxoid unless vaccinated in the last 5 years, and re-debrided as needed. The lower limb affected 48.5% (21.9%-81.4%) of body regions/patients. Fractures occurred in 31.1% (11.3%-78%) of body regions/patients. The most common surgery was open reduction and internal fixation done in 21% (0%-76.6%), followed by plaster of Paris in 18.2% (2.3%-48.8%), and external fixation in 6.6% (1%-13%) of operations/patients. Open fractures should be treated with external fixation. Internal fixation should not be done until the wound becomes clean and the fractured bones are properly covered with skin, skin graft, or flap. Fasciotomies were done in 15% (2.8%-27.2%), while amputations were done in 3.7% (0.4%-11.5%) of body regions/patients. Principles of treating crush syndrome include: (1) administering proper intravenous fluids to maintain adequate urine output, (2) monitoring and managing hyperkalemia, and (3) considering renal replacement therapy in case of volume overload, severe hyperkalemia, severe acidemia, or severe uremia. Low-quality studies addressed indications for fasciotomy, amputation, and hyperbaric oxygen therapy. Prospective data collection on future medical management of earthquake injuries should be part of future disaster preparedness. We hope that this review will carry the essential knowledge needed for properly managing earthquake musculoskeletal injuries and crush syndrome in hospitalized patients.
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  • 文章类型: Journal Article
    暴露于灾难和突发公共卫生事件会对心理健康产生负面影响。在2008年汶川地震之后,记录中国对这些灾难的社会心理反应的研究急剧增加。然而,目前尚无关于中国对这些事件的心理健康和社会心理支持(MHPSS)反应的现有文献的全面评估。本范围审查系统地将有关MHPSS的现有已发表研究和灰色文献来源映射到中国的灾难和紧急情况。从2000年1月1日至2021年8月13日,我们从六个数据库和官方网站检查了中英文相关文献,并在这篇综述中纳入了77条全文记录。报告的主要干预措施类型包括a)阶梯式护理干预模式,b)个体结构化心理治疗和药物治疗,c)心理健康教育,d)心理咨询,e)基于政府的政策干预。大多数干预措施是使用评估常见精神障碍治疗的定量方法进行评估的。审查发现,快速的国家动员,强调增强韧性的干预措施,逐步护理模式的广泛使用是减少灾害不利的社会心理影响的重要组成部分。审查还确定了剩余的差距,包括a)与灾害有关的服务与现有的医疗保健系统缺乏整合,b)对MHPSS提供商的监督不足,c)对所提供服务的有限监测和评估。这些结果表明,在中国需要进行更多的研究来改善心理健康服务。它还提供了其他国家在制定和评估MHPSS应对灾害的政策和计划时可以适应的框架。
    Exposure to disasters and public health emergencies negatively affects mental health. Research documenting the psychosocial responses to these calamities in China increased dramatically after the 2008 Wenchuan earthquake. However, there is no comprehensive assessment of the available literature on China\'s mental health and psychosocial support (MHPSS) responses to these events. This scoping review systematically maps existing published research and grey literature sources regarding MHPSS to disasters and emergencies in China. We examined relevant literature in English and Chinese from six databases and official websites from Jan 1, 2000, to Aug 13, 2021, and included 77 full-text records in this review. The main types of interventions reported included a) stepped care intervention models, b) individual structured psychotherapy and pharmacotherapy, c) mental health education, d) psychological counselling, and e) government-based policy interventions. Most interventions were evaluated using quantitative methods that assessed the treatment of common mental disorders. The review found that rapid national mobilization, emphasis on resilience-strengthening interventions, and the widespread use of step-care models were essential components of reducing the adverse psychosocial effects of disasters. The review also identified remaining gaps, including a) a lack of integration of disaster-related services with the pre-existing health care system, b) inadequate supervision of MHPSS providers, and c) limited monitoring and evaluation of the services provided. These results show where additional research is needed in China to improve mental health services. It also provides a framework that other countries can adapt when developing and evaluating MHPSS policies and plans in response to disasters.
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  • 文章类型: Journal Article
    背景:关于灾难医学的能力是什么,尚无普遍共识,也没有什么能力和个人属性增加灾难响应者的价值。一些研究表明,救灾人员不仅需要技术技能,还需要非技术技能。缺乏关于需要哪些非技术技能以及如何提供这些技能的培训的共识,很少有人知道如何将非技术技能的知识应用于招聘救灾人员。因此,这项范围审查旨在确定灾难医学应对所需的非技术技能。
    方法:使用Arksey&O'Malley框架进行了调查。在数据库中进行结构化搜索,CINAHLFullPlus,WebofScience,进行了PsycInfo和Scopus。此后,数据进行了结构化和分析。
    结果:从6447篇文章的初始搜索结果来看,该研究包括34篇文章。这些涵盖了定量和定性研究以及不同的背景,包括真实的事件和训练。最常研究的真实事件是地震后的反应。最常提到的四种非技术技能:沟通技能;态势感知;人力资源知识和组织与协调技能;决策,批判性思维和解决问题的能力。审查还显示,在审查的文章中,技能或能力等术语的使用明显缺乏统一。
    结论:非技术技能是灾难救援人员需要的技能。哪些非技术技能是最需要的,如何培训和衡量非技术技能,以及如何在灾难医学中实施非技术技能需要进一步研究。
    BACKGROUND: There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes add value for disaster responders. Some studies suggest that disaster responders need not only technical skills but also non-technical skills. Consensus of which non-technical skills are needed and how training for these can be provided is lacking, and little is known about how to apply knowledge of non-technical skills in the recruitment of disaster responders. Therefore, this scoping review aimed to identify the non-technical skills required for the disaster medicine response.
    METHODS: A scooping review using the Arksey & O´Malley framework was performed. Structured searches in the databases PuBMed, CINAHL Full Plus, Web of Science, PsycInfo and Scopus was conducted. Thereafter, data were structured and analyzed.
    RESULTS: From an initial search result of 6447 articles, 34 articles were included in the study. These covered both quantitative and qualitative studies and different contexts, including real events and training. The most often studied real event were responses following earthquakes. Four non-technical skills stood out as most frequently mentioned: communication skills; situational awareness; knowledge of human resources and organization and coordination skills; decision-making, critical-thinking and problem-solving skills. The review also showed a significant lack of uniform use of terms like skills or competence in the reviewed articles.
    CONCLUSIONS: Non-technical skills are skills that disaster responders need. Which non-technical skills are most needed, how to train and measure non-technical skills, and how to implement non-technical skills in disaster medicine need further studies.
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  • 文章类型: Journal Article
    美国红十字会(ARC)每年自我报告灾后努力,可能对公众形象有偏见。缺乏对ARC干预措施的社会影响的正式审查进一步加剧了这个问题。本范围审查旨在通过总结和评估ARC国家灾难干预措施的社会影响来解决这两个问题。作为次要目标,这项审查还将提供重要信息,以指导ARC和其他组织真正履行其使命。纳入标准涉及所有年龄组的参与者,边缘化社区,流离失所者,和ARC灾难救援人员。固执己见的声明,除了轶事,被排除在外。这项审查涉及所有受灾害影响并需要ARC援助的美国(US)地区。没有搜索限制,从2023年7月至8月,在PubMed上搜索了所有证据。由两名独立审稿人进行两个阶段的筛选:标题/摘要筛选和全文筛选。在每个阶段,每篇论文都进行了质量评估。在进入下一阶段之前,每个阶段的分歧都得到了解决。通过22篇学术论文,审查概述了ARC关于备灾和现场灾难干预的综合干预措施的关键主题。然而,在ARC恢复干预措施中发现了研究空白,尤其是对撤离人员的影响.这项调查发现,ARC做出了普遍的努力来满足他们以前协助的社区的需求,during,灾难之后。因为结果表明,ARC在减少全国性灾害危害方面正朝着正确的方向发展,ARC对研究人群的社会影响大多是积极的。
    The American Red Cross (ARC) self-reports post-disaster efforts annually, potentially biased for public image. The lack of formal reviews of ARC interventions\' social impacts further exacerbates the issue. This scoping review aims to address both issues by summarizing and evaluating the social impact of ARC\'s national disaster interventions. As a secondary objective, this review will also provide important information to guide ARC and other organizations in truly fulfilling their missions. The inclusion criteria involve participants of all age groups, marginalized communities, displaced individuals, and ARC disaster responders. Opinionated statements, except for anecdotes, were excluded. This review involves all United States (US) areas that have been affected by disasters and required assistance from ARC. With no search limits, all evidence was searched on PubMed from July to August 2023. Two stages of screening were conducted by two independent reviewers: title/abstract screening and full-text screening. During each stage, each paper underwent a quality assessment. Disagreements in each stage were resolved before proceeding to the next stage. Through 22 academic papers, the review outlines key themes in ARC comprehensive interventions on disaster preparedness and on-site disaster interventions. However, research gaps were found in ARC recovery interventions, especially their impact on evacuees. This investigation found that ARC makes general efforts to address the needs of communities they assist before, during, and after disasters. Because the results suggest that ARC is moving in the correct direction in reducing the nationwide harm disasters cause, ARC\'s social impact on studied populations is mostly positive.
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  • 文章类型: Review
    残疾人,尤其是儿童和青年,在应急和备灾规划中通常不考虑,这使得他们很脆弱,并且面临更高的自然和人为灾害负面影响的风险。这项研究的目的是了解紧急情况和灾难准备的程度以及影响残疾儿童和青少年的准备和慢性疾病的因素,他们的照顾者和服务提供者。
    我们的范围审查涉及搜索六个国际数据库,确定了1146项研究,其中27项符合我们的纳入标准。
    本综述中的研究涉及2613名参与者(即,孩子们,父母,20年来,九个国家的教育工作者和临床医生)。我们的结果强调了以下趋势:(1)应急准备的程度;(2)影响应急准备的因素;(3)加强准备的干预措施。
    我们的研究结果强调,迫切需要更加关注残疾儿童和青少年的应急准备工作。他们的家庭和服务提供者,并将其纳入规划。
    需要为残疾儿童的个人应急准备提供支持,家庭和社区层面。临床医生应帮助残疾儿童及其家人制定灾难和应急准备计划,其中包括他们的医疗需求,基本供应以及与相关资源和支持的连接。临床医生和教育工作者应倡导将残疾儿童和青年纳入应急和备灾工作。
    UNASSIGNED: People with disabilities, especially children and youth, are often not considered in emergency and disaster preparedness planning, which leaves them vulnerable and at a higher risk of the negative effects of natural and human caused disasters. The purpose of this study was to understand the extent of emergency and disaster preparedness and factors influencing preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers.
    UNASSIGNED: Our scoping review involved searching six international databases that identified 1146 studies of which 27 met our inclusion criteria.
    UNASSIGNED: The studies in this review involved 2613 participants (i.e., children, parents, educators and clinicians) across nine countries over a 20-year period. Our results highlighted the following trends: (1) the extent of emergency preparedness; (2) factors affecting emergency preparedness; and (3) interventions to enhance preparedness.
    UNASSIGNED: Our findings underscore the critical need for more attention to emergency preparedness for children and youth with disabilities, their families and service providers and their inclusion in planning.
    Support is needed for emergency preparedness for children with disabilities at an individual, family and community level.Clinicians should assist children with disabilities and their families to develop a disaster and emergency preparedness plan that includes their medical needs, basic supplies and connections to relevant resources and supports.Clinicians and educators should advocate for the inclusion of children and youth with disabilities in emergency and disaster preparedness.
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