J Community Health (2012) 37:725–733
DOI 10.1007/s10900-011-9488-x
REVIEW
Household Emergency Preparedness: A Literature Review
Joëlle Levac • Darene Toal-Sullivan •
Tracey L. O‘Sullivan
Published online: 8 October 2011
 Springer Science+Business Media, LLC 2011
Abstract Global policies on disaster risk reduction have
highlighted individual and community responsibilities and
roles in reducing risk and promoting coping capacity.
Strengthening local preparedness is viewed as an essential
element in effective response and recovery. This paper
presents a synthesis of available literature on household
preparedness published over the past 15 years. It empha-
sizes the complexity of preparedness, involving personal
and contextual factors such as health status, self-efficacy,
community support, and the nature of the emergency. In
addition, people require sufficient knowledge, motivation
and resources to engage in preparedness activities. Social
networks have been identified as one such resource which
contributes to resilience. A predominant gap in the litera-
ture is the need for evidence-informed strategies to over-
come the identified challenges to household preparedness.
In particular, the construct of social capital and how it can
be used to foster individual and community capacity in
emergency situations requires further study.
Keywords Emergency management
Preparedness

Disasters
Introduction
According to the Centre for Research on the Epidemiology
of Disasters, in 2008 there were 326 natural disasters and
J. Levac
D. Toal-Sullivan (&)
T. L. O‘Sullivan
Faculty of Health Sciences, University of Ottawa,
Ottawa, ON, Canada
e-mail: dtoalsul@uottawa.ca
T. L. O‘Sullivan
Elisabeth Bruyère Research Institute, Ottawa, ON, Canada
259 technological disasters worldwide [1]. Even though
these are the lowest numbers for both in the past decade,
the number of fatalities caused by natural disasters was the
second highest in the past 10 years. In Canada, the
potential for significant loss in a large-scale disaster has
increased, based on population growth (which has doubled
in the past 50 years) and a population shift from rural to
urban areas [2]. The majority of the Canadian population
live in urban areas, some of which are at increased risk of
seismic activity or extreme weather conditions [3, 4].
Most fatalities, injuries, and damage caused by disasters
are preventable [5]. Adequate household emergency pre-
paredness could significantly reduce the negative conse-
quences from disasters and ensure that people can care for
themselves and their families during the first 72 h follow-
ing a disaster [6, 7]. The purpose of this paper is to review
the existing literature on household emergency prepared-
ness in North America. Disaster preparedness for persons
with disabilities will also be discussed to highlight the
particular challenges facing a population deemed to be
high-risk. This review will highlight the need for disaster
management to ‘‘involve community members as active
participants’’ in preparedness activities [8, p. 299]. In
addition, an understanding of the factors that influence
preparedness will help to inform future research in the area
of household resilience.
Method
This review was conducted by searching four online liter-
ature databases (Medline, SCOPUS, Scholar’s Portal, and
PubMed) using the following key words: disasters, emer-
gencies, preparedness, household, family, community, and
vulnerable. We focused on Canadian studies; however,
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Table 1 Search results comparing four databases

Search # Search conducted MEDLINE SCOPUS Scholar’s portal PubMed
Subject area Natural Social
(if applicable) sciences sciences

1 exp *Disasters/ 25,137 52,844 37,923 34,819 12,720

2 exp *Emergencies/ 9,044 254,836 26,574 9,020 2,350
3 Public Health Practice/or Disease Outbreaks/or exp *Disaster 122,862 8,601 18,816 13,612 2,363
Planning/or Public Health/or Preparedness.mp. or Disasters/
4 household.mp. or exp *Family Characteristics/ 41,634 1,037,567 61,127 121,552 6,917
5 community.mp. or exp *Residence Characteristics/ 275,176 602,962 67,5464 1,074,979 5,575
6 1 or 2 25,137 295,346 62,904 42,674 14,837
7 4 or 5 310,968 157,6190 72,8735 1,187,404 12,352
8 3 and 6 15,138 4,692 5,032 3,004 1,246
9 7 and 8 1,513 1,090 820 540 25
10 vulnerab$.mp. [mp = title, original title, abstract, name of 51,832 58,439 85,237 47,447 1,243
substance word, subject heading word, unique identifier]
11 9 and 10 146 79 72 28 2
12 limit 11 to yr = ’’1995–2010’’ 141 76 65 28 2
13 limit 12 to (English or French) 139 76 65 28 2

North American articles were mainly used due to the lack
of Canadian-specific research. As shown in Table 1, an
advanced search using the key words was undertaken.
MeSH terms were used and grouped using Boolean oper-
ators, and key words were exploded to amplify the search.
A manual search of all referenced articles followed the
original searches. Google and Google Scholar search
engines were used to obtain referenced articles not avail-
able in the above-mentioned databases. French and English
quantitative and qualitative articles during the time period
of 1995–2010 were selected. Articles focusing on psy-
chosocial supports, children, influenza, and business con-
tinuity were not included in this study, since these topics
are beyond the scope of this review. Duplicate abstracts
found in multiple databases were read once. A manual
search was also conducted to retrieve important articles.
Results and information from 62 articles appear in this
study. The grey literature was excluded in this review,
however, 14 government and international organisation
reports were used to provide statistics and context.
The following journals were scanned manually to ensure
that no relevant articles were missed: Disasters, Interna-
tional Journal of Mass Emergencies and Disasters,
Disaster Prevention and Management, Prehospital and
Disaster Medicine, and Journal of Disaster Research.
Risk, Vulnerability, and Emergency Preparedness
Disasters can be classified into two general categories
according to the international Emergency Events Database
EM-DAT. The first category consists of natural disasters;
biological, geophysical, climatological, hydrological, and
meteorological. The second category involves technologi-
cal disasters; industrial accidents, transport accidents, and
miscellaneous accidents such as man-made explosions [1].
In the past decade, global trends have shown increased
incidence and severity of natural and technological
hazards.
Communities are more vulnerable to the negative
impacts of a disaster, because of the type and intensity of
the hazard and conditions including growth in population
numbers and density, rising rates of poverty and home-
lessness, climate change, and increased globalization
[9–11]. The human and economic losses associated with
disaster have resulted in recognition by different sectors of
society of the need to reduce risk and vulnerability. Risk,
represents the relationship between the probability of a
hazard and the potential individual, economic, social and
material losses which could be experienced by a population
or a community [9, 12–14]. The term ‘vulnerability’
describes the degree of susceptibility to ‘‘loss or disruption
from hazard activity’’ [15, pp. 271–272]. It is a dynamic
concept which recognizes that an individual or a family’s
vulnerability is influenced by the decisions and actions they
take, and demographic, cultural, social, historical, and
economic contexts [10, 12, 16]. Vulnerability therefore
changes according to the interaction among the social
determinants of health, individuals’ functional limitations,
and the nature of the emergency [17].
While it is important to identify factors which create
vulnerability, Paton and Johnston [15] caution that the

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same factor may increase or decrease vulnerability,
depending on the relationships between the individual and
the context, particularly the unique supports available to
address functional needs. For this reason, the term ‘high-
risk’ is used in this paper to refer to individuals and fam-
ilies who are more likely to experience negative impacts
during emergencies and disasters, because of variations in
the social determinants of health and/or inequalities in the
distribution of these social factors [14, 18, 19].
High-Risk Populations and Resilience
Disasters have differential impacts depending on the pop-
ulation of interest and their degree of preparedness for a
specific emergency [20, 21]. There is, however, a lack of
consensus in the literature regarding the factors which
contribute to risk. Factors such as age, gender, education
and ethnicity are the foundation for disparities in health
across different regions and have been proposed as key
elements in disaster risk [10, 12, 13, 22–26]. The Canadian
Red Cross advances an approach to conceptualizing peo-
ple’s capabilities and susceptibilities to disaster based on
the social determinants of health. Ten high-risk populations
are identified: ‘‘seniors, aboriginal residents, low-income
residents, persons with low literacy levels, transient pop-
ulations, persons with a disability, medically dependent
persons, children and youth, women, and new immigrants
and cultural minorities’’ [10, p. 26]. Other conceptualiza-
tions of high-risk groups include single parent households
and those responsible for their extended families [12, 26–29].
Studies have found that variables such as poor finan-
cial security, disability or ethnic minority status also con-
tribute to low levels of disaster preparedness [30, 31].
Many of these attributes cluster together, exacerbating risk
[12, 17].
Existing research indicates that people who are most
vulnerable during a disaster are also those who are least
prepared to care for themselves following a disaster [30]. It
is not a particular attribute that puts someone at risk, but
how that attribute influences their interaction with society,
and limits access to social, economic and physical
resources which protect people on a daily basis and during
a disaster [12, 24, 25, 32, 33]. This highlights the need to
not only enhance emergency preparedness measures among
high-risk groups, but also the need to improve their resil-
iency. Resilience, a core aspect of disaster preparedness, is
defined as ‘‘the capacity of individuals and systems to cope
and maintain positive functioning in the face of significant
adversity or risk’’ [34, p. 18]. Preparedness involves
identifying the contextual issues and conditions which
contribute to vulnerability, as well as the individual and
collective strengths to respond effectively to an adverse
727
situation [11, 29, 35]. Intervention strategies to promote
resiliency must therefore build upon these capacities and
include efforts to help people return to social and physical
environments which are less hazardous and more health-
promoting than they were before the disaster [32, 36].
Emergency Preparedness
Household Preparedness
Preparedness may be defined as the knowledge, capabilities
and actions of governments, organizations, community
groups, and individuals ‘‘to effectively anticipate, respond
to, and recover from, the impacts of likely, imminent or
current hazard events or conditions’’ [14, p. 21]. Pre-
paredness is not static in nature, but dynamic, requiring
revisions and modifications as social contexts change [35].
Caregiving or medical considerations for example, can
temporarily or permanently influence the needs of the
household [37]. One of the most effective ways to mitigate
the effects of a disaster is through proper household
emergency preparedness [5, 38]. Emergency preparedness
involves knowing the risks particular to a community,
developing an emergency plan, and having an emergency
kit in the home containing food, water, and medical sup-
plies to shelter in place for 72 h [39, 40]. The American
Red Cross [41] suggests that in addition to having an
emergency plan, preparedness also involves practicing the
plan with family members, and learning about emergency
shelters and community response evacuation plans. Public
Safety Canada [42] emphasizes the interdependence and
need for continuity throughout all phases of a disaster:
mitigation, preparedness, response and recovery.
One common method of analysing a household’s
emergency preparedness is to examine the amount of
emergency supplies on hand. Results from studies that used
this method indicate that individuals are ill-prepared for
disasters [5, 43]. Many people plan for the immediate
future overestimating their capacity to cope during a
disaster and harbouring the assumption that they can rely
on emergency relief services. The Institute for Catastrophic
Loss Reduction for the Red Cross reports that there is a
general lack of household emergency preparedness both in
the US and in Canada [5]. The report refers to a study in
which respondents from a 2001 survey in Kingston,
Ontario, showed generally low levels of preparedness for
common Canadian emergencies such as winter power-
outages, fires, and medical emergencies. Fifty-three percent
of respondents indicated that they believe household
emergency preparedness is a government responsibility,
while only 27% believed it to be a personal responsibility.
Although the study is limited to one city, the findings are
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consistent with results from other studies which indicate
that Canadians are unprepared to effectively face emer-
gencies. Lemyre et al. [43] reported that Canadian insti-
tutions are perceived as moderately prepared for a disaster
and generally people do not take proper measures to pre-
pare themselves for terrorism events. They also found that
women have engaged in fewer preparedness actions than
men.
According to Shrubsol [2], individuals live in a culture
of dependency and even local governments depend greatly
on hierarchal-ranked governments for assistance. A survey
conducted by Léger Marketing in [44] indicates that 86%
of Canadians believe emergency preparedness is important,
but nearly 50% claim they are unprepared. Despite gov-
ernment initiatives to encourage individual and household
emergency preparedness, such as the ‘72 hours… Is Your
Family Prepared’ Campaign [40], preparedness levels
remain insufficient. Studies in the US reveal that only
30–40% of Americans have emergency supplies or family
communication plans [45]. Seventy-five percent of
respondents from another study were categorised as being
‘minimally prepared’ or ‘not prepared’ because of their
lack of emergency supplies [46]. Kapucu [27] found that
despite significant experience with hurricanes, Central
Florida residents were ill-prepared for disasters. Only 8%
of respondents had enough food, water, and medication for
their family to survive autonomously for 3 days. A survey
in the UK showed 51% of respondents reported having at
least 4 of the 7 recommended emergency plans and 48%
had at least 4 out of 5 of the recommended emergency
supplies [45]. The number of people who had plans and
supplies on hand was higher among those who reported
receiving the ‘Preparing for Emergencies’ booklet distrib-
uted by the government the year before the first survey, and
2 years before the second survey [45]. This finding is
consistent with a study in Japan which found enhanced
preparedness after the government of Japan established and
promoted a Voluntary Disaster Preparedness Organization
to enhance disaster preparedness [47].
An important aspect for consideration in reviewing the
above studies is that individual or family preparedness
cannot be determined exclusively by the amount of sup-
plies on hand. This does not identify whether people pos-
sess these items coincidentally or if they were gathered
intentionally for emergency purposes [48]. In addition,
findings may be confounded by the timing of the data
collection. For example, income security influences
household preparedness and vulnerability [17]. People with
limited income may be less likely to have emergency
supplies in their possession during the week prior to their
income assistance cheques. Conversely, they are more
likely to have these supplies the week after receiving
monetary allowance.
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Establishing the Link Between Household
and Community Preparedness
Natural disasters are a direct result of the hazards and vul-
nerability in a community [12]. Being adequately prepared
to face a disaster not only means being individually pre-
pared, but also prepared to help family, friends and neigh-
bours in times of emergency [27]. Hutton [32] concurs,
recommending that people have the knowledge and skills to
protect and strengthen themselves as well as their commu-
nity. In the context of an emergency, resilient communities
have the capabilities and resources to respond to and recover
from the situation [25, 49]. Communities with shared values,
strong social and economic infrastructures, are able to sus-
tain healthy behaviours in the face of adversity, compared
to socially and economically disadvantaged communities
[50–52]. This was observed during the 1997 Red River flood
in Manitoba where more affluent communities with higher
levels of social capital, were more resilient to the disaster
[49]. More recently in New Orleans, despite the fact that all
race and income levels were affected by the flooding from
Hurricane Katrina, social vulnerability has been an impor-
tant factor affecting post-disaster recovery rates [25].
Cohesive communities improve mitigation by distrib-
uting information from one person to another. For example,
individuals frequently obtain emergency information
through their social networks such as family, friends, and
neighbours [6, 53] and they often rely on one another for
assistance and information during emergencies [35]. Peo-
ple in a community will work together for collective benefit
and will be more likely to turn preparedness initiatives into
actions when they feel a sense of strong neighbourhood
belonging [54]. These community bonds are believed to be
more apparent during and after disasters because social
barriers between individuals or groups seem to disappear,
conflicts are less common, and feelings of kindness and
helpfulness towards others are enhanced [12].
Murphy et al. [29] reviewed two community disasters to
explore the role of social capital in emergency manage-
ment. In a survey conducted during the 2003 power
blackout in the province of Ontario and parts of the North-
eastern US, 37% of people indicated that they helped
others during the emergency. Of those respondents, 25%
provided assistance to neighbours and approximately 15%
provided assistance to family and friends. Research about
the E. coli disaster which occurred in 2000 in Walkerton,
Ontario, revealed that 60% of residents surveyed, provided
assistance to others in their community. Family and friends
were the strongest form of support during the disaster.
Murphy et al. proposed that the connectedness found in
both events not only helped people to cope during the
emergency, but also improved existing social networks,
contributing to individual and community resilience.
J Community Health (2012) 37:725–733
A qualitative study conducted among people with
mobility impairments who have experienced an emergency
situation, indicated that the majority of disaster relief was
provided to them by family, friends, neighbours, and even
strangers [53]. Public organizations that have close ties to
the community are also crucial. For example, 82% of
organizations that were active in disaster response during
the 1997 Red River flood in the town of Rosenort, Manitoba
were faith-based [49]. According to Chen et al. [21] resi-
dents of close-knit communities understand and are aware
of who is at risk in their community and where they are
located. Community groups and organisations, such as
health centres, can also play a key role in identifying those
in need during disasters, since they are routinely accessed
by at-risk residents [32, 55].
Emergency Preparedness for People with Disabilities
About 14% of Canadians (4.4 million) report having a
disability [56]. Because aging is associated with higher
rates of disability, the proportion of Canadians who will
live with an acquired disability is likely to rise with the
aging population [57]. Persons with disabilities may have
specific functional limitations, depending on the social,
cultural, economic and institutional environment. This
concept is outlined in the Function-Based Framework
(C-MIST) described by Kailes and Enders [58] and is an
important element of emergency management, given that
disasters usually involve a disruption in social and physical
environments and associated supports which can exacer-
bate risk [21, 24, 31, 59–61]. For example, lack of
resources such as food, water, and medical equipment can
result in further health deterioration for persons with a
chronic illness who require ongoing support or a specific
self-care routine [30, 60, 62]. Someone who is not ill but
has a disability may require different types of support [63].
One of the requirements may be assistance from other
members of their household or caregivers for optimal
emergency response [64]. Support by volunteers, service
organisations, and formal caregivers becomes crucial for
many functional needs, and preparedness planning must
account for support needs anticipated for different scenar-
ios [62]. Families caring for someone with a disability are
encouraged to have individualised emergency plans [60]
that do not rely on the primary caregiver, who may be
incapacitated or unable to provide care during an emer-
gency [62]. In addition, properly maintaining and practic-
ing the household’s emergency plan in various scenarios is
especially important for people who have functional needs
and require support to participate in everyday life [21, 60].
Despite the numerous disaster preparedness guidelines
and resources for individuals with disabilities, people with
mobility impairments continue to have difficulties during
729
and after a disaster. Many people have been injured, and
lives have been lost because emergency plans do not take
into consideration the unique needs of people with dis-
abilities [53]. According to a survey by the National
Organization on Disability in 2004, 56% of Americans
with disabilities reported being unaware of whom to con-
tact regarding emergency plans [65]. Results reported by
Smith and Notaro [31] suggest people with disabilities are
1.2 times more likely to be unprepared for emergencies
than people without disabilities. Other determinants such as
gender, ethnicity and socioeconomic status also influence
risk of injury or death in emergencies for those with dis-
abilities. These attributes include being female, young,
uncoupled, less educated, unemployed, a member of a
cultural minority, and having a lower socioeconomic status
or living in an urban area.
The literature on household evacuation is incredibly vast
and remains beyond the scope of this paper. However, it is
important to note that persons with disabilities are less
likely to have emergency supplies on-hand and to evacuate
following a mandatory evacuation order [31]. According to
Fox et al. [65] and Rooney and White [53], less than half of
Americans with a disability have a household evacuation
plan, while only 57–68% have a workplace evacuation
plan. Similarly, persons with poor general health are less
prepared for disasters and are less likely to have emergency
communication plans, than those who perceive their health
as being excellent [66]. From an individual and household
preparedness perspective, strategies that facilitate evacua-
tion and limit barriers must be considered in the pre-
disaster phase, to ensure barriers are addressed and
supports are in place. This highlights a role for health
professionals in emergency preparedness. Olympia et al.
[67] found that only 17% of respondents claimed that their
primary care physician had discussed emergency pre-
paredness with them. These individuals were more likely to
have a family emergency response plan, a community
evacuation plan and a first aid and disaster supplies kit.
They also had higher perceived preparedness than those
who did not receive guidance from their physician. This is
a relatively new finding that must be acknowledged and
perhaps incorporated into practice guidelines for commu-
nity health workers providing care for people with func-
tional needs. Collaboration between different sectors such
as public health and emergency services is an essential
ingredient for optimal disaster preparedness and response
[68].
Factors Influencing Emergency Preparedness
As noted above, human, social, economic and demographic
factors influence the ability and desire of individuals and
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families to prepare for emergencies. In addition, people
require sufficient knowledge, beliefs about their capabili-
ties, and motivation to prepare [54]. According to Kapucu
[27] awareness interventions are the first step to encourage
the public to adopt proper disaster preparedness activities.
Risk perception and response capability depend on an
individual’s understanding of the hazard [12, 69]. For
people to take action, they must recognise the hazard,
believe it to be avoidable, and believe that there is an
advantage in taking preventative actions [6, 70]. Appraisal
of one’s resources is an important determinant of risk
perception [71]. If a person perceives that their available
resources are sufficient to resist a threat, risk perception is
minimized. The more confident or self-efficacious [72]
people are about their ability to successfully respond to a
given situation such as an emergency, the more likely they
are to engage in preparedness behaviours [48]. Peers and
families are valued means to create self-efficacy; people
are more likely to prepare if those around them believe in
preparedness. Increasing an individual’s coping abilities in
adverse situations could therefore lead to increased levels
of public emergency preparedness.
The perceived likelihood of a threat turning into an
actual event is another important factor in emergency
preparedness [73]. Certain attributes such as the predict-
ability, duration and pattern of an event, the number of
casualties or the degree of damage, and the availability of
prevention or treatment, act as risk or protective factors
which determine psychosocial effects and perception of
risk [74]. A person will take preventative action if they
perceive the hazard to be significant to them [75], or if they
are motivated by other factors such as caregiving respon-
sibilities for children or older adults [8, 67]. Motivation is
also influenced by the presence of a pet in the household
and the location and type of housing. Those living in inner-
city settings or living in an apartment with more than five
stories are more likely to engage in preparedness activities
[8, 67]. Data from Mulilis et al. [71] suggest property
owners are generally more prepared than renters, who in
turn are more prepared than student renters.
A person’s knowledge and motivation to prepare for a
disaster are also influenced by their access to media which is
the primary means to receive emergency information and
warnings [8]. While its strongest impact is during the
response phase of an emergency, media communication
should inform people about what they should do before,
during and after a disaster [76]. It must also encourage the
public to believe that they have the ability to act in an
emergency and thus reduce their vulnerability [15]. While
the media can be extremely crucial in campaigns to promote
emergency preparedness, challenges still exist. Media
information about risk can be inaccurate and confusing
messages are problematic, often enticing rumours and
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J Community Health (2012) 37:725–733
misinformation [12]. Clear, continuous and consistent
communication, which can be understood by people with
lower literacy levels, is essential throughout all phases of
emergency preparedness [15, 21]. There is also a need to
ensure that every household has the necessary equipment to
receive emergency messages prior to, and during a disaster.
Cretikos et al. [77] found that radio was the most commonly
accessed source for information during natural disasters,
even for households that do not lose electricity. Balluz et al.
[78] on the other hand, identified that television bulletins
and warning sirens were the most successful means of
issuing tornado warnings. These findings may have changed
with the increased use of social media such as the internet.
While more current data may reveal changing patterns in
communication, it is important to highlight that emergency
information should be repeated in multiple ways through
different communication mechanisms.
The literature on factors that hinder household emer-
gency preparedness is inconclusive. In a study by the
Institute for Catastrophic Loss Reduction for the Red
Cross, 78% of respondents indicated that there were no
barriers preventing them from taking part in emergency
preparedness activities [5]. The remaining 22% suggested
that their efforts were deterred by time pressures (33%),
lack of information (29%), and lack of financial resources
(26%). Conversely, two main barriers identified by Diekman
et al. [6] were supply logistics (used, expired, or misplaced
supplies), and lack of communication. Other reasons for
lack of household preparedness included (a) disregard for
emergency preparedness, (b) lack of time to prepare a kit,
(c) lack of knowledge of how to achieve preparedness,
(d) belief that a disaster will not happen to their family,
(e) lack of efficacy expectations (i.e. the belief that pre-
paredness measures cannot prevent a disaster), and (f) dis-
sociation or preferring not to think about the possibility of a
disaster happening to their family [67]. The difference in
findings may be due to the population under study, the
questions asked, and the timing of the study. This high-
lights the need for further research about barriers to pre-
paredness and strategies which enable people to take
action, to cultivate individual and community capacity in
emergency situations.
Conclusion
Emergency management and public health organisations
are faced with numerous challenges related to the promo-
tion of household emergency preparedness. The unpre-
dictable nature of disasters and perceptions about their
immediacy and potential impact, influences individuals’
preparedness intentions and actions. In addition, cognitive
factors such as the saliency attributed to the hazard, sense
J Community Health (2012) 37:725–733
of connectedness to the community, and self-efficacy to
cope with adverse situations, influences motivation to
engage in preparedness strategies. It is essential that
emergency planning policies and actions take into consid-
eration the unique needs of families caring for children,
older adults, and people with functional limitations, among
others. Strategies that facilitate all aspects of emergency
preparedness from mitigation to recovery must be consid-
ered to ensure that barriers are removed and that proper
supports are in place. Research should be directed towards
exploring strategies to overcome the identified challenges
to household preparedness. In particular, the construct of
social capital and how it can be used to foster individual
and community capacity in emergency situations requires
further investigation.
Acknowledgments The EnRiCH project (Enhancing Resilience and
Capacity for Health) is a collaborative, community-based research
initiative in emergency preparedness interventions for high risk
populations. This paper is one in a series of literature reviews con-
ducted for the EnRiCH project and was prepared on behalf of the
EnRiCH Project Consortium. The project is funded by Defence
Research and Development Canada (DRDC) Centre for Security
Science.
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