{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T02:36:27Z","timestamp":1768358187687,"version":"3.49.0"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Global Disaster Alert and Coordination System (GDACS) alerts are widely used after earthquakes, yet their clinical relevance is uncertain. We performed a retrospective, global, event-level study spanning 2020\u20132024. To avoid double counting, alerts were clustered into country-bounded representatives using a 48-hour gap, retaining the alert with the highest GDACS score (n\u2009=\u200985; Red\u2009=\u200917, Orange\u2009=\u200968). Primary outcomes were reported deaths and field-hospital deployment. Associations used Spearman correlation; deployment was modeled with Firth logistic regression. Sensitivity analyses used alternative deployment definitions and composite windows. The GDACS score correlated with deaths (\u03c1\u2009=\u20090.522, p\u2009=\u20093.0\u2009\u00d7\u200910\u2009\u207b\u2009\u2077). Field-hospital deployment occurred in 52.9% of Red events and 0% of Orange events. The GDACS score strongly predicted deployment (OR=42.7, 95% CI 4.7\u2013385.7), with AUC\u2009=\u20090.98 and Brier\u2009=\u20090.034. An exploratory exposure-normalized subset where GDACS reported population \u201cwithin 100 km\u201d (n\u2009=\u200919) showed directionally consistent results (\u03c1\u2009=\u20090.50, p\u2009=\u20090.029).GDACS metrics provide early, scalable indicators for surge planning, but are hazard- and exposure-centric and cannot capture mediators such as collapse dynamics or health-system resilience. Treating GDACS as a first-layer signal, complemented by subnational exposure and rapid damage assessment, can support more timely, evidence-based medical response after major earthquakes.<\/jats:p>","DOI":"10.1371\/journal.pone.0339018","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T18:23:15Z","timestamp":1768328595000},"page":"e0339018","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using GDACS to anticipate clinical and operational burden after earthquakes: A global event-level analysis (2020\u20132024)"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3173-8994","authenticated-orcid":true,"given":"Ahmet","family":"Aykut","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ertu\u011f","family":"G\u00fcnsoy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cem","family":"Y\u0131ld\u0131r\u0131m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"pone.0339018.ref001","unstructured":"Global Disaster Alert and Coordination System (GDACS). Knowledge: Overview. [Cited 2025 June 21]. https:\/\/www.gdacs.org\/knowledge\/overview.aspx"},{"key":"pone.0339018.ref002","author":"GDACS"},{"key":"pone.0339018.ref003","author":"European Commission Joint Research Centre"},{"key":"pone.0339018.ref004","volume-title":"Classification and Minimum Standards for Emergency Medical Teams (EMTs","author":"World Health Organization","year":"2021"},{"key":"pone.0339018.ref005","article-title":"The human impact of earthquakes: a historical review of events 1980-2009 and systematic literature review","volume":"5","author":"S Doocy","year":"2013","journal-title":"PLoS Curr"},{"issue":"2","key":"pone.0339018.ref006","doi-asserted-by":"crossref","first-page":"419","DOI":"10.3390\/microorganisms11020419","article-title":"The impact of earthquakes on public health: a narrative review of infectious diseases in the post-disaster period aiming to disaster risk reduction","volume":"11","author":"M Mavrouli","year":"2023","journal-title":"Microorganisms"},{"issue":"9","key":"pone.0339018.ref007","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.1007\/s40620-024-02051-1","article-title":"Epidemiological analysis of the vict\u0131ms w\u0131th crush syndrome in earthquakes of southeastern Turkey","volume":"37","author":"I Ozturk","year":"2024","journal-title":"J Nephrol"},{"issue":"4","key":"pone.0339018.ref008","doi-asserted-by":"crossref","DOI":"10.1097\/JTCCM-D-23-00008","article-title":"Crush syndrome-related acute kidney injury in earthquake victims","volume":"5","author":"G Ram\u00edrez-Guerrero","year":"2023","journal-title":"J Transl Crit Care Med"},{"issue":"2","key":"pone.0339018.ref009","doi-asserted-by":"crossref","first-page":"161","DOI":"10.5152\/turkjnephrol.2024.23639","article-title":"Analysis of crush syndrome patients with and without acute kidney injury during the 2023 kahramanmara\u015f earthquake: experience of a tertiary referral center from T\u00fcrkiye","volume":"33","author":"K Turgutalp","year":"2024","journal-title":"TJN"},{"key":"pone.0339018.ref010","author":"European Commission","year":"2025"},{"key":"pone.0339018.ref011","author":"K Poljan\u0161ek","year":"2020"},{"key":"pone.0339018.ref012","unstructured":"European Commission Joint Research Centre COIN. JRC statistical audit of the INFORM risk index. 2024. https:\/\/www.preventionweb.net\/publication\/jrc-statistical-audit-inform-risk-index"},{"issue":"1","key":"pone.0339018.ref013","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"D Firth","year":"1993","journal-title":"Biometrika"},{"issue":"16","key":"pone.0339018.ref014","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"G Heinze","year":"2002","journal-title":"Stat Med"},{"issue":"1","key":"pone.0339018.ref015","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Y Benjamini","year":"1995","journal-title":"Journal of the Royal Statistical Society Series B: Statistical Methodology"},{"issue":"1","key":"pone.0339018.ref016","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1148\/radiology.143.1.7063747","article-title":"The meaning and use of the area under a receiver operating characteristic (ROC) curve","volume":"143","author":"JA Hanley","year":"1982","journal-title":"Radiology"},{"issue":"1","key":"pone.0339018.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1175\/1520-0493(1950)078<0001:VOFEIT>2.0.CO;2","article-title":"Verification of forecasts expressed in terms of probability","volume":"78","author":"GW Brier","year":"1950","journal-title":"Mon Wea Rev"},{"key":"pone.0339018.ref018","doi-asserted-by":"crossref","DOI":"10.1002\/9781118548387","volume-title":"Applied Logistic Regression","author":"DW Hosmer","year":"2013","edition":"3"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T18:23:19Z","timestamp":1768328599000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339018"}},"subtitle":[],"editor":[{"given":"Anna","family":"Bernasconi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0339018","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]}}}