22 August 2024: Due to technical disruption, we are experiencing some delays to publication. We are working to restore services and apologise for the inconvenience. For further updates please visit our website: https://www.cambridge.org/universitypress/about-us/news-and-blogs/cambridge-university-press-publishing-update-following-technical-disruption
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
This journal utilises an Online Peer Review Service (OPRS) for submissions. By clicking "Continue" you will be taken to our partner site
https://mc.manuscriptcentral.com/pdm.
Please be aware that your Cambridge account is not valid for this OPRS and registration is required. We strongly advise you to read all "Author instructions" in the "Journal information" area prior to submitting.
To save this undefined to your undefined account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your undefined account.
Find out more about saving content to .
To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
An earthquake of 7.6 Richter scale occurred in Port Au Prince which is the capital city of Haiti on 12 January 2010. Turkish Ministry of Health offered support for the people of Haiti by sending its Health Team. In this study, the field hospital services of Turkish Health Team consisting of two groups in 67 days will be reported. Also, further affairs necessary to be done in the future and coordination with other countries will be reported. There are discussions whether there is need for field hospitals or not. With this study, the results of field hospital services were assessed. By contrast with some authorities, it is concluded that field hospital services are beneficial. Finally, UN responsibilities on this issue was discussed.
Positive collaboration between nurses and physicians is essential in all areas of care especially in emergency practice. This is because it has a significant relationship with the quality, safety, accountability, and responsibility of care. Three areas are positively related to collaborative interaction between nurses and physicians: provider outcomes, patient outcomes, and organizational outcomes.
Aim
To examine nurses' and physicians' attitudes towards nurse-physician collaboration in the Emergency Department of Dr Saiful Anwar General Hospital, Malang, Indonesia.
Methods
The study was a comparative descriptive quantitative study using a modified Jefferson Scale of Attitude towards Physician-Nurse Collaboration. Data were collected from 47 nurses and 24 physicians who participated in the study. Descriptive statistics, parametric and non-parametric inferential statistics were used to determine group scores and to examine differences between groups, as well as to determine the relationship between demographic characteristics and participants attitudes.
Results
Emergency nurses had significantly more positive attitudes toward collaboration than emergency physicians (p < 0.001). Emergency nurses had significantly higher scores in three of four underlying factors of the instrument: “physician dominance”, “nurse autonomy”, and “caring as opposed to curing”. The effects of gender, age, education, and experience in other hospitals on nurses' and physicians' attitude towards collaboration were not statistically significant. However, experience in the Emergency Department of Dr Saiful Anwar General Hospital was significantly related to participants' attitudes towards collaboration (p = 0.023).
Conclusions
The findings of this study indicate that both organizational and individual strategies should be developed to enhance the nurse-physician collaborative relationship. Inter-professional education may enhance health care professionals' attitudes towards collaboration. A larger and more representative sample is needed for future research, especially examining relationships such as between collaboration of these health professionals and patient outcomes and work place satisfaction.
This project was designed to reduce secondary injury of road traffic accidents (RTA) victims in Hai Duong (HDRC) province in Vietnam in collaboration with the Red Cross with funding from Medical Teams International (MTI). The approximate number of beneficiaries was 601,820, including the 1,820 direct beneficiaries who received first responder training and emergency treatment. The 600,000 indirect beneficiaries is the population along a 45km corridor of National Highway #5 crossing Hai Duong province.
Methods
In late October 2009 an evaluation team from MTI reviewed the training of Vietnam Red Cross volunteers in Hai Duong province. The pre-evaluation activities (review of patient contact log books and patient interviews) were conducted by the MTI-Vietnam staff. 58 trained lead volunteers and 20 community members participated in this evaluation. Additionally 92 patients who had been treated by the volunteers were also interviewed.
Results
Findings included: a) the volunteers who received training stated an increase in their confidence to respond to emergencies, b) a 65% increase of Red Cross volunteers, c) a increased awareness of EMS within the province, d) greater community engagement at emergency scenes, and e) broad respect from the community towards the HDRC volunteers.
Discussion
Considerations for the future include: a) development of a continuing education program, b) increase of supplies to volunteers, c) more training involving multi casualty incidents, d) development of a communications protocol between volunteers and other healthcare providers and e) limit CPR training to drowning related events.
Conclusion
The outcomes exceeded the planned goals: knowledge and retention of course materials and skills is good, confidence levels of volunteers increased and those that are involved in emergency events in Hai Duong province are safer. The profile of EMS and first responders as a critical component of community health has been measurably raised among key stakeholders and the community.
There are many problems, to be solved in the actual fields of disaster medicine. That is the reason why we completed the disaster medicine compendium, 2005. As the next stage, we focused upon the significance of the philosophy from the viewpoint of the disaster medicine.
Results
In the disaster situation, leaders are obliged to determine the policies under the mental/ sophisticated consideration. Basically, the following famous phrase “the greatest good (happiness) for the greatest number of people” are accepted simply/childishly without profound thought. This phrase is presented by the popular concept of Utilitarianism beggined by Jeremy Bentham, followed by John Stuart Mill, etc. This concept strongly influenced in the field of disaster medicine, especially the decision making of triage. However, several argument or criticisms have been pointed out: i.e., definition of happiness, relief of the minority or so-called CWAP, etc. Other opinions are included, as follows: John Rawls: The Principle of Justice or Maximin Principle, Kan Naoto: Minimal unhappiness/misery in the society/people, etc.
Conclusions
I basically appreciate the concept utilitarianism. But, especially, if we consider the CWAP or people in the poor countries under the actual unfavorable condition, the latter concepts should also be included.
On 11 December 2006, at 8:20h, five flats of a building containing 10 apartments collapsed due to a heater explosion. Four injured patients were transferred to a military hospital with the help of bystanders. Approximately 200 people gathered at the scene. People who were trapped in the building were rescued. The building was surrounded by safety tape. The first injured patient was discovered 4 hours after the collapse. The patinet was transferred by the National Medical Rescue Team. Rescue activities were terminated after 36 hours. A total of eight dead, including five children, and five injured people were recovered from the building. Six of the eight injured patients had superficial wounds. Two patients were monitored: one with head trauma and another with liver contusion and costa fracture.
Discussion
The explosion occurred during working hours, which contributed to the low number of injuries and deaths. The top floor of the building had the highest survival rate. Bystanders entered the scene through the safety tape, and complicated the rescue efforts.
Conclusions
Rescue efforts during disasters require a high level of education. Otherwise, it becomes impossible to control the crowd and prevent chaos. Also, considering the direction of the building collapse during the rescue activities might enable reaching more people in a shorter time period. Coordination by the departments taking part in the rescue efforts is just one of the key issues affecting a successful response.
Special needs populations are often excluded from emergency preparedness plans, despite their vulnerability. As defined by the CDC one aspect of special needs is physical disabilities which include mobility issues. In 2009 the CDC reported 16% of the US non-institutionalized population as having a physical disability. The literature is limited and empirical evidence on addressing the needs of disabled individuals in disaster preparedness is sparse. This demonstrates the need for guidelines on how to plan for the needs of individuals with physical disabilities during disasters. In July 2010 a coalition of hospitals in Central Brooklyn, NY, University Hospital Brooklyn, Kings County Hospital Center, and Kingsbrook Jewish Hospital Center conducted full scale radiological decontamination exercises which incorporated people with physical disabilities. The exercises utilized the same set of drill participants; 17 total victims and 4 victims with physical disabilities that included 2 wheelchair bound nonmobile victims. The exercise required the HAZMAT teams to address in their decontamination plan the use of accessible equipment for nonmobile individuals. As a pilot study, we hypothesized that the hospitals would be unprepared to decontaminate special needs victims, especially the nonmobile victims based on guidelines published by the US Department of Health and Human Services. By conducting this exercise we found that the hospitals were unprepared to effectively decontaminate special needs victims. We also had a secondary finding that showed that the exercise failed to reach the primary goal also because of the artificiality of the drill. By utilizing healthy actors to assume the role of special needs victims, we found that many of the challenges of special needs victims were bypassed. We share the lessons learned in this drill in both the decontamination of special needs victims and how to prevent the short cuts that can occur in drills that simulate real life scenarios.
Anti-personnel land mines are deployed in many regions of conflict around the world. A large number of civilians and militants are affected regularly due to the blasts of such mines. Once set, they remain as silent concealed killers for decades and challenge the safety of the civilians even during the times of peace. A descriptive study was carried out at the Anuradhapura Teaching Hospital during a six month period starting in July 2007. The total number of anti-personal land mine injuries admitted during this period was 89. In all cases, the body part primarily in contact with the mine had been a lower limb. Except for few occasions, extensive soft tissue damage associated with compound fractures necessitated some form of an amputation for those limbs in primary contact with the blast mines. Closed fractures of the calcareous, talus, and the tarsal bones were seen in two cases. Nearly two thirds of the patients sustained either soft tissue or bone injuries to the opposite lower limb. Twelve percent of the victims had compound fractures on the opposite tibia and fibula. Injuries to external genitalia were seen in 8% of the cases. Upper limb injuries were not rare and predominantly found on the contra lateral upper limb (17%). The majority of them were soft tissue injuries. Chest wall injuries were seen among 2% of the cases. Superficial facial injuries were seen among 7% of the cases. In one occasion a gingival injury was detected. Seven percent of the victims developed deterioration in level of consciousness. None of them clinically showed any external physical trauma to the head. In some instances, the Glasgow Coma Scale (GCS) was ranked as 7 in which tracheal intubation and ventilation were needed. It was evident in this study that the majority of the affected patients sustained severe injuries in both lower limbs in contrast to some of the previous available studies.
Upon arrival of the SUNY Downstate Medical Center team for their disaster relief mission in Port au Prince, Haiti, it was observed that obstacles to patient care were directly related to difficulty in locating supplies and medications in a timely manner. In addition, staffing schedules had not been correlated to patient flow patterns.
Methods
A survey was conducted at L'Hôpital de l'Université d'Etat d'Haïti (HUEH) in Port au Prince, Haiti by Emergency physicians and nurses from SUNY Downstate Medical Center. The following variables were obtained to assess existing resources: number and types of providers available, provider staffing schedules, medication/supply inventories and management systems. Basic ED operation and supply system flow maps were created.
Results
The assessment revealed a large volume of patients presenting in the early morning. Night shifts were inconsistently staffed with ED physicians. Although medications and supplies were reported to be available on-site, they were not tracked, inventoried, or centrally managed. As a result, this increased time to treatment and practitioner fatigue. Process improvements included: (1) Institution of swing and night shifts accommodated peak patient volumes, decreased waiting times, provided care for critical patients during off-peak hours, and decreased physician fatigue. (2) Identification and labeling of existing medications/supplies facilitated more accurate management of inventories and decreased time to treatment and disposition.
Conclusion
Process improvement through systematic analysis led to better disaster resource utilization in this tent hospital.
Previous disaster studies mainly focused on analyzing the experience from a psychological or psychiatric perspective. The occurrence of post-traumatic stress disorder also has been the central issue when studying survivors of train crashes. Research concerning being involved in train crashes is scarce.
Objective
The aim of this study was to explore the experience of surviving a severe train crash.
Methods
In 2004, a severe train crash occurred in the south of Sweden. Approximately 78 passengers were on the train. All of them were injured, and two of the passengers died. Fourteen of the survivors agreed to be interviewed five years after the crash. The interviews were narrative, transcribed verbatim, and analyzed using a phenomenological-hermeneutical method. First, a naive reading of the text, later, a structural analysis, and finally a comprehensive understanding in which the other phases were considered and discussed with relevant literature.
Results
The preliminary results show a naive understanding of being in the pre-crash, crash and post-crash phases. Four themes were recognized: (1) life is going on like being on a railway track; (2) the train derails, so do I; (3) back on track again; and (4) life goes on in a new track. The results will be elaborated and discussed together with the comprehensive understanding.
Conclusions
Surviving a severe train crash changes life immediately as well as five years later.
Disaster Drills, the world over, test several aspects of disaster response encompassing inter-agency coordination, institutional response and individual proficiency. This abstract analyzes the efficiency and gaps in patient triage in a large inter-agency disaster drill conducted in Mumbai in December 2010.
Methods
Over eighty simulated patients at the mock disaster site in Mumbai were triaged for transport to two hospitals via prioritized EMS vehicle and other modalities. Each patient was tagged with an identifier and his/her final destination compared to the intended destination to gauge accuracy of triage. Arrival and departure time-stamps at each location helped plot triage efficiency and variation in inter-group response times. EMS responders were trained in START triage during the preparatory phase.
Results
There was no significant difference in time to transport “red” and “yellow” patients to the triage zone. Patients in the “accident buses” were triaged twice as slowly as those outside in spite of the zone being declared safe to enter, by the controlling authorities. 11% of “red patients” were down-triaged and 30% of yellows were “over-triaged.” A significant bottle-neck developed between field triage zone and transport zones.
Conclusions
Our group has conducted disaster drills in several large cities in Sri Lanka, India and the Dominican Republic. Expanding focus to document time-stamps and triage accuracy highlighted need for more robust triage training, allowing local agencies to prioritize training for EMS responders in the coming months. Demonstrating how inaccurate triage could potentially overwhelm the system helped local agencies recognize the need to train first responders in START triage.
Pandemic influenza poses a great challenge to healthcare systems. Vaccinating medical teams and the population against pandemic influenza is the global recommended strategy to contain spread of the disease. As part of the efforts made to overcome the H1N1 pandemic, the Israeli Ministry of Health (MOH) initiated a general vaccination program for medical teams and the total country population. Due to low compliance rates of the medical staff, the MOH conducted regional conferences aimed at providing knowledge and encouraging staff to be vaccinated.
Objectives
To evaluate the effect of the regional conferences on the compliance rates amongst medical providers to be vaccinated against H1N1.
Methods
Medical providers from the primary health care services were invited to conferences that were conducted in 3 regions. Attitudes of the teams regarding compliance to be vaccinated were assessed pre and post the conferences. Additionally, the actual rates of vaccinations were recorded over the period of vaccination program. Actual compliance rates before and after the conferences were compared to detect differences as well as the relationship between teams' attitudes and actual vaccinations.
Results
Vaccination rates of medical providers remained low during the full vaccination period. Among the non-vaccinated, 24% to 29% reported before the conference that they agree to be vaccinated versus 57% to 62% following the conference. Analysis of the actual vaccination data among the medical providers did not demonstrate a change in compliance following the conferences and an overall decrease was noted after the first two weeks of the vaccinated project.
Conclusions
A statistically significant relationship was not found between reported attitudes of medical providers regarding readiness to be vaccinated and their actual vaccination. The MOH intervention did not achieve the expected result and did not raise compliance to be vaccinated.
Knowledge of disaster/emergency nursing is essential to nurse practitioners (NP) due to the increasing frequency of disasters. The objective of this study was to identify the knowledge and the response relating D/EN and to investigate whether the reactions vary among NPs in different level hospitals in Ningbo Area, China.
Methods
Pre- and post-test questionnaires were used. A total of 297 NPs in five hospitals (two tertiary hospitals, two secondary hospitals, one primary hospital) were involved in this study. Five lectures were implemented based on disaster/emergency nursing from 8 December 2009 to 14 April 2010.
Results
The mean age of the sample was 31.54 years. Average working experience was 9.57 years. Only 12 participants from the emergency department attended the lecture, yet the lecture was advertised one week in advance. The mean score was 8.88 (pre-test), 12.97 (post-test). Most of the low scores (< 7) on the pre-test were from primary hospitals (43%), while only 0.6% of staff from tertiary hospitals scored that low. A total of 45% of NPs failed to distinguish the contribution of different zones of triage. Nearly 24% of participants considered that the frequency of ALS training should no more than once a month. All participants comprehended the contribution of a triage system after attending lecture, 35% of NPs received perfect scores on the post-test.
Conclusions
Comprehension of disaster/emergency nursing in NPs in Ningbo is deficient. Primary hospital NPs had a lower score than high-level hospitals. Education and training programs associated with disaster/emergency nursing are necessary for NPs.
High speed train is defined as train which can run at the speed of more than 200Km/h and Korean version of high speed train (Korean Train Express: KTX) runs at 300Km/h on average. Because of high speed, safety is the most important issue of high speed train, so the early detection of technical error and operational safety have been emphasized. But the research about emergency medical system for patients occurring in the high speed train and stations is insufficient. So author analyzed the project on development of emergency medical system for cardiac arrest in the high speed train and stations.
Methods
The project on development of emergency medical system for cardiac arrest in the high speed train and stations was analyzed retrospectively and the real situation was confirmed by interviewing the staffs and visiting the high speed train and stations. The education on both basic life support and PAD (public access defibrillation) for staff of the high speed train and stations was analyzed. Simulation was perfomred for adequate distribution and arrangement of AEDs (automatic external defibrillators) in the high speed train and stations.
Results
The education on both basic life support and PAD (public access defibrillation) for staff of the high speed train and stations was performed to 1323 persons from October 2008 to June 2009. Total 51 AEDs were arranged in 6 stations and 87 AEDs were arranged in the high speed train. One AEDs were arranged for successive 6 passenger car in a train. Public education by repeated video playing in the high speed train was started.
Conclusions
The emergency medical system for cardiac arrest in the high speed train and stations was developed by training staffs and arranging AEDs initially. The next step will be developing the disaster medical system in the high speed train.
A report of black death, presumably pneumonic plague (Yersinia Pestis) occurred in the terrorist group Al Qaeda in the Land of Islamic Maghreb (AQLIM) in 2009. Up to 40 members of AQLIM are reported to have perished rapidly.
Discussion
The event was managed by Algeria, but questions remain as to the nature of this event and the level of investigation that was applied. This paper is a discussion of the principle elements of a forensic epidemiology investigation that should have, but did not take place in Algeria. The need for improved forensic epidemiology investigation capability is illustrated in this event due the unique problems inherent in the investigation of intentional outbreaks.
In the history of humankind, any new scientific discovery has shown the risk of a “dual use” for peaceful purposes or for warfare. In regard to non-conventional weapons, the recent exponential development of nanosciences and nanotechnology can provide efficient tools for counteracting these threats, by improving the detection, protection, and decontamination capabilities in the field of CBRN defence. Nevertheless, these disciplines also may offer novel, uncontrolled means of mass destruction, leading to the synthesis of new, intentionally toxic systems. Furthermore, several points of concern are linked to the new concepts of “nanotoxicology” and “nanopathology: If a multidisciplinary approach is needed to study nanosciences and nanotechnologies, a multidisciplinary approach also is needed to have a strict control on potential illegal uses of nanosystems. Experts active in various fields, such as academic, industrial, military, and health protection institutions, must work cooperatively to constantly follow the state of the art, note which kind of critical emerging technologies may lead to illicit uses, and control the diffusion of hazardous nanosystems that may be potential precursors of weapons of mass destruction, and cooperate with CBRN emergency prevention organizations in order to plan suitable countermeasures. This presentation will cover some examples of nanosystems applied to defense from non-conventional warfare agents and answer questions regarding potential misuses of basic nanoscience and nanotechnology findings.
The last thing the world needs is another war.1 Everyday about 3000 people die and 30,000 people are seriously injured on the world's roads.2 Furthermore, for people who survive the crash, additional suffering and frustration occur because of administrative, legal, and social barriers.3 Since transport to hospital usually takes 30–45 minutes, the ‘golden hour’ in which 48% of deaths occur is spent mainly in the prehospital environment.4 On March 11, 2008 at 7:30 AM a very foggy morning, a major car crash occurred on the high way from Abu Dhabi to Dubai. Initial scene response was conducted by Abu Dhabi traffic police Abu Dhabi Police Ambulance and Rescue Sections helped by Dubai. Casualities were transported to 2 hospitals in Abu Dhabi; Al Mafraq and Al Rahba. The Authors describes Al Rahba hospital response that received 159 causalities (almost half of the causalities).
Results
Three victims died immediately on scene. Most of the causalities were triaged and re triaged as Priority 3 (green), suffered from extremity trauma, were treated and discharged. Twenty patients were triaged as Priority 2 (yellow) and were admitted to the hospital, Three patients were priority one (red) were admitted to the ICU, one of them died 10 days later due to severe head and chest injuries.
This presentation will demonstrate that the use of an “Operational Readiness Assessment” was successful in identifying high-performance strategies for frontline-responders, namely surgeons, air traffic controllers, police, and world-class athletes. This research-based approach confirms that best performers in high-risk situations prepare similarly to elite athlete, specifically relating to their emphasis on mental readiness. A framework (Orlick's “Model of Excellence”) developed by researchers who worked with Olympic athletes has a proven replication within very different high-risk disciplines. Both quantitative and qualitative analysis of mental readiness was provided based on in-depth interviews with exceptional professionals regarding their best and less-than-best performances. These findings were assessed to determine the presence of common success elements, including: (1) commitment; (2) confidence; (3) mental preparedness; (4) focus/refocus; and (5) seeking and accepting feedback. This refined assessment tool combines the methodological rigour of academic research with a highly readable and practical analysis of specific techniques that increase effectiveness. Challenges were defined from a frontline-perspective. The balance between technical, physical, and mental readiness were compared. Success skills, performance blocks and influencing factors for optimal performance were detailed. Ten practical recommendations are discussed relating how preparedness of frontline-operations strengthens performance, productivity, and morale. An “Operational Readiness Assessment” is a powerful tool with proven value in hospital, paramilitary, corporate, and industrial settings in which there is a need to be well prepared for, risks of injury or death, large equipment/financial expenditures, complacency, fatigue, and significant consequences of errors. It has been described as an indispensable addition to current work in recruitment, career development, e-learning, role-modeling and future research benchmarks. For example, new performance-indicators for mental readiness were incorporated into surgical-resident evaluations, national situational-awareness training was instituted for seasoned air-traffic controllers, and mental-survival e-modules now enhance police coach-officer programs. Ultimately, a “winning” strategy for managing risk is promoting a healthy, prepared workforce resulting in a safer community.
There is a crucial need for teamwork in disaster management. Gaps in collaborative efforts resulted in significant loss of life and property during recent disasters. Such losses could have been minimized with enhanced teamwork. Unfortunately, the current US healthcare system fosters a fractured structure where health professions work in isolated silos. While coordinated disaster management has done much to overcome this, the silo mentality still inhibits maximal achievement toward the four phases of emergency and disaster preparedness and response. Since 2007, Western University of Health Sciences (Western U) has embarked upon an initiative focusing upon the concept of patient-centered, collaborative care in students from the beginning of the clinical education process. The intent of the program is to instill in all students non-technical competencies that promote teamwork such as communication, collaboration, and understanding scope of practice. The long term vision is to develop a three phase program (case based, team training and clinical experience) that will take the student through an awareness level to an application level of the competencies. The second phase of the program utilizes the TeamSTEPPS® training to instill these competencies in students. The application and assessment of the teaching points will be through community and patient safety exercises that include topics such as disaster preparedness and response. In conjunction with the TeamSTEPPS® training, the students from the nine professional programs (DO, PA, PT, PharmD, Graduate Nursing, Vet Med, Dental, Podiatry, and Optometry) will also be exposed to principles and practices of disaster response. By intensifying teamwork principles as the basis of disaster preparedness, the response pool for disaster response will be amplified, and future healthcare practitioners will be more aware of teamwork strategies necessary in a disaster setting. The intent of this presentation is to introduce this academic model including early outcome data.
In the cycle of dealing with emergencies one can distinguish four periods, that is planning, diagnosing, responding and recovering. Contingency planning is a prerequisite for emergency management in general. The principles of this planning, for Veterinary Public Health (VPH), does not differ from other cases. However, here will be seen from the point of view of VPH. VPH emergencies include zoonotic diseases and food safety aspects. Emergencies in VPH appear suddenly or expand gradually. Need to define responsibilities for proclaiming an emergency by rating the severity and ranking the situation in steps before deciding that an emergency is in place. One can suggest that surveillance is significant in relation to zoonotic diseases. In food safety, preventative Food Safety Management Systems, in which crisis management and consequent possible product recall actions are part of it, serve the same purpose. In both activities VPH is related with other professionals, a reality expressed, also, in government administrations with different services and/or agencies. Therefore, partnerships and interoperability between veterinarians and physicians on the one hand and other food professionals on the other should be established, for the purpose of efficiently serving the general public. These actions should be developed, as appropriate, in business, region or country level. In order to effectively mobilise the appropriate personnel training and simulation exercises should be part of preparedness. In preparedness, planning for early warning and early reaction should be considered as part of the overall contingency planning. In the various steps in dealing with emergencies the key tool for decision making is risk analysis, served through its three components, that is risk assessment, risk management and risk communication. This last one is very important in relation to communicating with the general public, so that a balanced informing will allow for general public diligent actions without panic.
On the evening of 07 December 2007, an ice storm occurred in the south central United States, causing severe power outages in Tulsa, Oklahoma, and leaving > 900,000 people without power for up to three weeks. Eighteen states contributed power workers to restore functioning power over a three-week period. Cleanup of debris from fallen trees took an additional five months. Hospitals and other healthcare facilities are considered to be critical infrastructure facilities in the community. During this storm, five of the six tertiary care hospitals lost power. In these hospitals, the internal telephone systems failed, internal suctioning systems failed, and the internal oxygen system failed. Water treatment plants were without power for 48 hours. Nursing home patients were discharged to homes or transferred to hospitals, as nursing homes tried to function without power for heating, patient monitoring devices, or cooking. Communication for these outlying care facilities was disrupted by the storm damage. Hospital emergency departments that had power became havens as they had heat, communication, water, and even warm food. Multiple patients with injuries due to cleaning up tree debris, falls, and carbon monoxide poisoning from ill-advised efforts to heat dwellings were seen in these emergency departments. Ambulance services had fuel shortages early in the course of the ice storm due to the inability to pump fuel (electrically operated pumps initially were non-functional). Three standards of care were altered for prehospital responders. This paper explains the efforts taken to mitigate future calamities, based on the lessons learned from this event.