{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T14:34:02Z","timestamp":1786718042103,"version":"build-2736575974"},"reference-count":47,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["RC2TR004380"],"award-info":[{"award-number":["RC2TR004380"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Environ\ufffdHealth\ufffdInsights"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to identify the impacts and challenges natural disasters pose to emergency medical services (EMS) in the United States, and to develop a digital health-informed framework based on identified system-level challenges to enhance EMS resilience and effectiveness in disaster scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A scoping review was conducted on July 7, 2025, across Scopus, PubMed, CINAHL, and Global Health databases. Literature from the past five years focusing on EMS delivery during three major U.S. natural disasters was analyzed using the World Health Organization\u2019s Emergency Care System Framework to assess challenges across EMS components and stakeholders, which subsequently informed the development of a digital health-informed response framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Natural disasters significantly threaten EMS operations at the scene, transport, and facility stages. Vulnerable populations, including the elderly and socioeconomically disadvantaged, experience heightened risks and service needs. Key challenges include increased demand for emergency care and reduced capacity in disaster-affected areas. Digital health tools, such as telehealth and dynamic ambulance dispatch systems, were identified as promising solutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Findings highlight the relevance of digital health in mitigating identified EMS challenges during disasters. By addressing gaps in communication, resource allocation, and service delivery, technology can enhance system responsiveness and resilience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A specialized digital health framework was developed to strengthen EMS delivery during natural disasters. Structured across four domains, patient, transport, facility, and provider, it offers actionable strategies to improve emergency care resilience and outcomes in disaster scenarios.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11786302261479518","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T11:32:01Z","timestamp":1786534321000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impacts of Natural Disasters on Emergency Care Delivery in the United States: A Scoping Review and Digital Health-Informed Framework"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1046-3243","authenticated-orcid":false,"given":"Zhaoqiang","family":"Zhou","sequence":"first","affiliation":[{"name":"University of North Carolina at Chapel Hill"},{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L.","family":"Delamater","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"},{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Yu","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"},{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaushalya","family":"Mendis","sequence":"additional","affiliation":[{"name":"School of Nursing, University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saif","family":"Khairat","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"},{"name":"School of Nursing, University of North Carolina at Chapel Hill"},{"name":"Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.2196\/18310"},{"key":"e_1_3_5_3_2","unstructured":"Smith AB. An active year of U.S. billion-dollar weather and climate disasters. 2024. [Internet]. 2025 Jan. Available from. https:\/\/www.climate.gov\/news-features\/blogs\/beyond-data\/2024-active-year-us-billion-dollar-weather-and-climate-disasters"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.25921\/stkw-7w73"},{"key":"e_1_3_5_5_2","unstructured":"Congress Research Service. Understanding NOAA\u2019s \u201cBillion-Dollar Disasters\u201d. 2025. [Internet][cited 2025 Aug 1]. 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