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As more chronically ill people are living in the community and disasters are occurring frequently, the elderly and the medically frail vulnerable populations are experiencing significantly more disaster-related morbidity and mortality than the rest of the population. A failure to adequately address these vulnerabilities has been shown to have negative effects on the response to the disaster and the community as a whole.
Aim:
The purpose of this research was to understand how older and/or medically frail adults have experienced disaster and how this experience impacts what they do now to prepare for disaster. A second purpose was the generation of theory regarding the process through which community members prepare for disasters.
Methods:
This study employed a qualitative descriptive methodology, Situational Analysis, to explore the social processes of disaster preparedness in older and/or medically frail adults.
Results:
The core category was “Experience is the Best Teacher.” Based on the findings, it was theorized that these community members are generally considered unprepared for disaster. Their lack of preparedness is due in large part to a lack of education on how best to prepare. Once educated, motivation for self-responsibility of household emergency preparedness can be expected. Community interventions like distributing disaster supply kits and offering evacuation assistance help overcome their situational impediments to preparedness and provide the best chance for these community members to survive disasters without becoming ill or injured or experiencing a decline in their baseline functional status. If these community members are incidentally prepared, it is largely due to their past experience with disaster or their professional experience.
Discussion:
The results from this study could inform emergency plans and policy efforts to better meet the needs of elderly and medically frail community members during disaster.
The Sydney City-2-Surf is the world’s largest annual run entered by around 80,000 people. First aid planning at mass participation running events such as the City-2-Surf is an area in the medical literature that has received little attention. Consequently, first aid planning for these events is based on experience rather than evidence. The models for predicting casualties that currently exist in the literature are either dated or not statistically significant.
Aim:
The aim of this study was to characterize patterns of injuries linked to geographic location across the course of the City-2-Surf, and to explore relationships of injury types with location and meteorological conditions.
Methods:
Records for formally treated casualties and meteorological conditions were obtained for the race years 2010-2016 and statistically analyzed to find associations between meteorological conditions, geographic conditions, casualty types, and location.
Results:
The most common casualties encountered were heat exhaustion or hyperthermia (39.2%), musculoskeletal (25.4%), and physical exhaustion (10.2%). Associations were found between gradient and the location. Type of casualty incidence with the individual distribution trends of casualty types were quite clear. Clusters of musculoskeletal casualties emerged in the parts of the course with the steepest negative gradients, while a cluster of cardiovascular events was found to occur at the top of the ‘heartbreak hill,’ the longest climb of the race. Regression analysis highlighted the linear relationship between the number of heat and physical exhaustion casualties and the apparent temperature (AT) at 12pm (R²= 0.59, P=0.044). This linear equation was used to formulate a model to predict these casualties.
Discussion:
The findings of this study demonstrate the relationship between meteorological conditions, geographic conditions, and casualties. This will assist planners of other similar events to determine optimum allocation of resources to anticipated injury and illness burden.
Disasters are situations of complexity and unpredictability that require the performance of teams from various instances with preparation and qualification to assist the victims, recover the environment, and restore living conditions. Health services are essential in the response to a disaster, and nurses all over the world play a significant role in these disasters.
Aim:
To develop a valid and reliable scale to identify nursing competencies in disasters.
Methods:
Competencies were selected from those related to the framework developed by the International Council of Nurses. A methodological study was developed in two stages: I) validity of content and appearance verification and II) verification of applicability and reliability with test-retest. The participants of stage I were eight specialists in emergencies and disasters in Brazil. In stage II, 326 nurses from the Emergency Mobile Assistance Service in Southern Brazil participated. Data analysis utilized the Content Validity Index and Interest Reliability Index. Psychometric properties of the instrument were measured with Cronbach’s alpha coefficient; applicability and test-retest reliability with the use of the t-test and intraclass correlation coefficient and factorial validity.
Results:
Forty-one competencies of 51 were organized in three domains according to Factor Analysis. Cronbach’s alpha values showed good internal consistency. There was no significant difference between the test and retest scores. The intraclass correlation coefficient values were adequate. The instrument showed reproducibility and adequate applicability.
Discussion:
This tool will assess nurses’ competencies for disaster response and provide evidence for the development of educational policies in disasters, creating a reliable and prepared workforce to respond more effectively during a disaster.
Public health emergency management involves the timely translation of relevant evidence and effective coordination of diverse actors. In practice, this can be challenging in the absence of a common framework for action among diverse actors.
Aim:
To apply an Integrated Knowledge Translation (iKT) approach throughout the development of a conceptual framework and performance measurement indicators for public health emergency preparedness (PHEP), to ensure knowledge generated is relevant and useful to the field.
Methods:
The iKT approach was initiated by identifying a research question based on priorities from the field. The two phases of the study used participatory research methods as well as active engagement with potential end users at key study milestones. The Structured Interview Matrix (SIM) facilitation technique for focus groups and an expert panel using Delphi methodology were used to define the PHEP framework and performance measurement indicators, respectively. An advisory committee was assembled consisting of potential end-users of the research, in senior positions in applied and decision-making roles.
Results:
iKT was an essential component for this applied public health project, contributing to and enhancing the relevance of the knowledge generated. iKT contributed to the following: broad national engagement and interest in the study, successful recruitment in both phases, and engagement with decision-makers. This multi-dimensional participatory approach successfully generated knowledge that was important to the field demonstrated by relevance to practice and policy in jurisdictions across Canada. Furthermore, the approach fostered building resilience in local and national communities through collaboration.
Discussion:
The iKT approach was essential to generating knowledge that is relevant and useful to the field, mainly to promote health system preparedness and resilience. Future research to study the implementation of knowledge will be important to continue addressing the knowledge-to-action gap in health emergency management research.
On November 21 and 22 of 2016, Victoria witnessed an unprecedented epidemic thunderstorm asthma emergency event in size acuity and impact. This scenario was never exercised nor contemplated. The event resulted in a 73% increase in calls to the Emergency Services Telecommunications Authority and 814 ambulance cases in the six hours from 6 pm on November 21, 2016. A 58% increase in people presented to public hospital emergency departments in Melbourne and Geelong on November 21 and 22, 2016 (based on the three-year average). 313 calls were made to the nurse on call from people with breathing, respiratory, and allergy problems (compared to an average of 63 calls for the previous month). Tragically, ten deaths are linked to this event.
Methods:
A substantial amount of work has been completed, much of which goes towards addressing the Inspector-General for Emergency Management recommendations following a review of the event, including:
Release of an epidemic thunderstorm asthma campaign and education programs which were rolled out across Victoria for the community and health professionals from September through November 2017;
Development of a new epidemic thunderstorm asthma forecasting system on 1 October 2017 and updated warning protocols during the 2017 grass pollen season;
Implementation of a Real-time Health Emergency Monitoring System to alert the department of demands on public hospital emergency departments on the system; and
Introduction of a new State Health Emergency Response Plan in October 2017 to improve coordination and communications before and during a health emergency.
Discussion:
The presentation will concentrate on the lessons learned more than two years down the track from the event in November 2016.
One of the improvements in Ethiopia’s emergency medical system was the introduction of a five-level Emergency Triage System (ETS) in January 2015 that was piloted in selected Addis Ababa hospitals.
Aim:
To assess the effect of this intervention on the head injury mortality in Tikur Anbessa Specialized Hospital (TASH) Emergency Department (ED).
Methods:
Data were retrospectively collected from all medical records of head injury patients seen in Adult TASH- ED over two 6 months periods, before and after the new Emergency Triage System implementation: 01/04/2014 – 30/09/2014 versus 01/04/2016 – 30/09/2016. An inclusion criterion was age above 13 for the records that could be retrieved. Exclusion criterion was “patient declared dead on arrival.” Mortality and patterns of head injury were compared pre- and post-intervention. Chi-square was used for the analysis using STATA 14.
Results:
A total of 522 Head injury patients were analyzed in the ED in both the pre- 258 and post-264 intervention study periods. Among head injury admission in the ED in both study periods, the highest number of patients were Road Traffic Accident/RTA/ victims, males and young age (<30). Mortality rate among head injury patients decreased from a pre-intervention 44 (17.05%) to post-intervention 27 (10.2%) (OR=0.55 9. 5% CI (0.32, 0.95), p=0.02). The median age of death was 45 years in pre- and 40 years in the post-intervention period, with ages ranging from 13 to 85 and 13 to 96 years, respectively. The proportion of deaths from moderate head injury decreased significantly from 14.0% in pre-intervention to 6.3% in the post-intervention period, respectively (p<0.001).
Discussion:
The Emergency Triage System at TASH-ED has decreased mortality caused by head injury. This could increase life years saved and productivity in a cost-effective and easily achievable way in resource-poor settings.
With the increase in the number and intensity of disasters, integrated risk management has been a subject of discussion in Brazilian health system, in which the local level plays an important role. Competency Mapping of Managers working at a Municipal Health Office from a Metropolitan Area of Curitiba, Southern Brazil was developed.
Aim:
To describe gaps in core competencies identified for Surveillance and Control of Risks and Threats.
Methods:
The Public Health Core Competencies contained in the booklet: A Regional Framework for the Americas, of the Pan American Health Organization, originated a semi-structured self-assessment questionnaire. A Likert scale with levels of proficiency (from one to five) was aggregated to the 56 specific core competencies. It was applied to a sample of 78 managers between the months of October 2017 and January 2018. The data obtained were submitted to quantitative analysis. Gaps (Training Priority Degree) were defined according to the grade of importance and expression by means of a arithmetic mean and standard deviation.
Results:
Gaps were identified for the competencies: Design disaster risk management plans for natural, technological and biological threats so as to mitigate their impact on health (2.82 ± 1.16); Design investment projects for reducing the health risks of disasters (2.8 ±1.07); Provide an immediate response to threats, risks and damage from disasters based on the risk assessment, in order to protect health (2.89 ± 1.13); Plan and execute post-disaster reconstruction, based on the damage identified for the immediate restoration and protection of the population’s health (2.81 ± 1.11).
Discussion:
The degree of expression for these competencies indicate the need of preparing public health managers for surveillance, by monitoring the exposure of people or population groups to environmental agents, or their effects with an integrated approach to injuries and the etiology of emergencies and disasters.
Mass casualty incidents, specifically incidents with chemical, biological, radiological, and nuclear agents (CBRN) or terrorist attacks, challenge medical coordination, rescue, and ambulance care. Recently in the Netherlands, a new model for emergency preparedness for large-scale mass casualties and a specific approach dealing with terrorist attacks was introduced (2016).
Aim:
To provide insight into the first experiences with this approach in order to identify strengths and pitfalls.
Methods:
The study had a qualitative design and was performed between January 2017 and June 2018. A semi-structured interview included topics that were selected based on available literature. All interviews were typed out verbatim and were analyzed using a structured approach of labeling and clustering of the response.
Results:
The main issues raised by the respondents included the following:
The interpretation of definitions introduced in the new model for the mass casualty preparedness model and the terrorist attack approach differed among respondents.
All respondents supported the six points of departure in the CRBN and terrorist attack approach.
Awareness of optimal personal safety (‘safety first principle’) specific for CBRN and terrorism is lacking.
Respondents reported that several rescue workers did not feel competent to perform specific newly introduced tasks, such as the command and control of the first ambulance arriving at the scene and the coordination task of emergency transport by the dispatch nurse.
Current regional differences in preparedness may complicate interregional collaboration.
Discussion:
As the approach is new and experience is primarily based on the outcome of exercises, the systematic planning and evaluation of exercises, and sharing of opinions and knowledge, as a result, is important to ensure an unambiguous approach in a real situation.
Besides being located on the Pacific Ring of Fire, Indonesia is the largest archipelago country in the world. Some parts of the country are not very accessible. It raises difficulties in controlling and monitoring a disaster response mission remotely in real-time. Muhammadiyah, the Indonesian non-governmental organization (NGO) that has been responding to disaster since 1919, used Geographic Information Systems (GIS) for Health Disaster Response (HDR) in the Lombok Earthquake 2018, in cooperation with ESRI Indonesia, as one alternative to disaster response controlling and monitoring.
Aim:
To show the benefit of using real-time GIS for HDR in an archipelago country.
Methods:
While responding to the disaster in Lombok, the Muhammadiyah Health Disaster Response Team was collecting data of patient, medication, problem, need, location, and resource with computers and smartphones, inputting the data that was forwarded to the ArcGIS platform. The Health Disaster Response Team coordinator and Muhammadiyah Board monitored and analyzed the health response through the GIS dashboard in Yogyakarta, 652km far from Lombok Island.
Results:
Using real-time GIS has been useful for disaster response. It was efficient by cutting flight and other transport costs, connected by the internet, and communicative by graphic and map dashboard. It was a green approach since it was paperless, and analysis-friendly by real-time data compilation and computation.
Discussion:
One of the big gaps in disaster response monitoring seems to be real-time data. Especially in an archipelago country, it is costly, time-consuming, and resource consuming. Daily big data may be frustrating and can become “white paper syndrome.” One of the good approaches to that is GIS Web services although it must be realized that the internet connection in a rural area can be another challenge. It can be solved by in-gadget data memory that can be delivered while the internet connection is available.
Disaster Medicine training in most parts of the world is done in a practical manner to allow users to practice the skills of triage and resource allocation.
Aim:
To develop a low-cost tabletop simulation and measure its effectiveness from the user perspective.
Methods:
A modified Delphi approach was used in developing a low-cost tabletop simulation exercise. Simple playing cards were used as patients with specific vitals and injuries. Two Hundred trainees of the National Ambulance Service were used to test the exercise. All the participants had an equal chance to triage a patient and arrange transport to an appropriate facility.
Results:
All participants expressed their satisfaction in the design and implementation of the tabletop exercise. Over 90% showed interest in replicating the exercise in their respective setting due to the low-cost nature of the setup. During the exercise6. 0% of the patients were triaged correctly, while 80% were transported from the scene in an orderly manner. All the participants agreed on the useful and educational value of the exercise.
Discussion:
The use of a low-cost tabletop exercise in disaster medicine training is essential for low- and middle-income countries to promote education, and has been shown to be acceptable and feasible.
The prehospital disaster and emergency medical services community stands on the front-line in the response to events such as novel influenza, multi-drug resistant tuberculosis, and other high consequence diseases such as the Ebola Virus Disease.
Aim:
To address provider and community safety, we developed an online educational program utilizing a Multi-Pathogen Approach to infectious disease personal protective equipment (PPE) deployment by prehospital providers. Such vigilance starts with syndromic recognition and quickly transcends to include operational issues, clinical interventions, and public health integration.
Methods:
The University of Maryland, Baltimore County (Maryland, USA), Department of Emergency Health Services partnered with the Maryland State Department of Health (USA), to develop an online educational curriculum. The curriculum was developed through an expert panel consensus group including prehospital providers and is hybrid in design and includes awareness level training and procedural guidance.
Results:
Currently deployed online, this educational content demonstrating the use of the Multi-Pathogen Approach is accessible open-access via YouTube worldwide on computers, tablets, and smartphones. This curriculum is also accessible for continuing medical education to over 50,000 prehospital, hospital, and clinic personnel throughout Maryland and the National Capital Region of the United States. The curriculum consists of twelve modules of didactic and live videotaped demonstrations.
Discussion:
The development of the Multi-Pathogen Approach for the deployment of PPE and the use of online education modules has given prehospital providers an easily accessible open-access tool for high consequence disease management. The development of educational efforts such as these can help ensure better patient care and prehospital EMS system readiness.
The Great East Japan Earthquake (GEJE) and subsequent devastating tsunami struck the northeastern coast of Japan on March 11, 2011. According to the previous studies about displaced evacuees, increases in suicide rates and social isolation (especially among older adults) have been reported. However, the living condition of residents at prefabricated temporary housing after GEJE is unclear.
Aim:
To explore potential factors which might relate to social isolation and suicidal thoughts among older adults by using a qualitative method.
Methods:
Inclusion criteria for this study were older adults over 65 years living in prefabricated temporary housing since the GEJE. Data were collected by face-to-face-interviews with semi-structured questionnaire between October and December 2014. The protocol of this study was approved by the Ethics Board of the Tokyo Metropolitan Institute of Gerontology. This research was supported by the Ministry of Health, Labor, and Welfare of Japan (No.H25-iryou-shitei-003).
Results:
Twenty older adults participated in the study. Most of them had been engaged in agriculture or fishery and experienced the sudden loss of family members, friends, and property in the aftermath of the GEJE. Findings indicated that social connections formed through the collective construction of prefabricated temporary housing. The study found that individuals who had less emotional and financial support experienced a greater feeling of sadness, social isolation, and suicidal thoughts. The study also suggested that people who live in temporary housing are strongly affected by economic insecurity and that it aggravates the risks for social isolation and psychological distress.
Discussion:
Although there were limitations regarding standardization and compatibility, this research found that the qualitative method can obtain the data which the quantitative method cannot reach. Scale-up of universal guidelines including the knowledge from qualitative research and case report under the devastating disaster setting is anticipated for better evidence base for next coming disaster.
Assessing disaster preparedness in a given region is a complex problem. Current methods are often resource-intensive and may lack generalizability beyond a specific scenario. Computer-based stochastic simulations may be an additional method but would require systems that are valid, flexible, and easy to use. Emergo Train System (ETS) is an analog simulation system used for disaster preparedness assessments.
Aim:
To digitalize the ETS model and develop stochastic simulation software for improved disaster preparedness assessments.
Methods:
A simulation software was developed in C#. The simulation model was based on ETS. Preliminary verification and validation (V&V) tests were performed, including unit and integration testing, trace validation, and a comparison to a prior analog ETS disaster preparedness assessment exercise.
Results:
The software contains medically validated patients from ETS and is capable of automatically running disaster scenarios with stochastic variations in the injury panorama, available resources, geographical location, and other variables. It consists of two main programs: an editor where scenarios can be constructed and a simulation system to evaluate the outcome. Initial V&V testing showed that the software is reliable and internally consistent. The comparison to the analog exercise showed a general high agreement in terms of patient outcome. The analog exercise featured a train derailment with 397 injured, of which 45 patients suffered preventable death. In comparison, the computer simulation ran 100 iterations of the same scenario and indicated that a median of 41 patients (IQR 31 to 44) would suffer a preventable death.
Discussion:
Stochastic simulation methods can be a powerful complement to traditional capability assessments methods. The developed simulation software can be used for both assessing emergency preparedness with some validity and as a complement to analog capability assessment exercises, both as input and to validate results. Future work includes comparing the simulation to real disaster outcomes.
At the time of a nuclear disaster, residents should evacuate from areas with high air dose rate. In the Great East Japan Earthquake, about 10% of patients died in a hospital evacuation in which medical teams were not involved in transportation.
Aim:
To determine if hospital evacuation improved after the Fukushima nuclear accident.
Methods:
This research investigates how the medical system of a nuclear disaster in Japan changed.
Results:
There are 41 hospitals designated as Nuclear Emergency Core Hospitals, and they have 53 Nuclear Emergency Medical Assistance Teams (NEMAT; disaster medical dispatching team specialized in nuclear disasters consisting of medical doctors, nurses, and radiological technologists) that can support hospitals and information in the acute phase.
Discussion:
At the time of a nuclear disaster, NEMAT is supposed to evacuate residents from the Urgent Protective Action Planning Zone (UPZ; within about 30 km radius). Tens of thousands to one million people live in this area. Hospital evacuation of more than several thousand patients is necessary. The entry of workers for transportation vehicles and lifeline restoration is limited within UPZ, so staying in a hospital is virtually impossible. There are over 2000 Disaster Medical Assistance Teams (DMAT), and many Red Cross Relief Teams; both of which are stipulated not to conduct clinical treatment in high dose areas and are not educated on nuclear disasters. Although there are Radiation Emergency Medical Assistance Teams (REMAT) consisting of doctors and technicians specializing in radiation medicine, they are few in number. They can perform dose assessment, but general medical care cannot be performed because an emergency physician is not included. Therefore, although NEMATs will conduct emergency and hospital evacuation in the affected area, the number of teams is too small to respond. The issue of which organization is responsible for massive hospital evacuation remains unsolved.
Traditional belief holds that the human appendix is a vestigial organ devoid of any purpose, and consequently, surgical appendectomy has been the “gold standard” treatment for suspected appendicitis. Prophylactic (preventative) appendectomy remains the policy of the Australian Antarctic Division for wintering medical practitioners and has been discussed in the context of long-duration non-orbital space flight.
Aim:
New research around appendiceal function, increasing adoption of non-surgical treatment modalities for acute appendicitis, and emerging research on the long-term consequences of appendicectomy have recently enabled researchers to challenge this paradigm.
Methods:
This novel project set out to test the hypothesis that a “one size fits all” prophylactic appendectomy policy may not be in the best interest of individual expeditioners, and utilized a “mindmap” to identify several key areas for a scoping literature review. This enabled disparate research to be drawn together in an innovative way.
Results:
A growing body of research has discovered that the appendix plays an important role in the gut immune system and maintaining gut health. It acts as a reservoir of good bacteria that repopulates the gut after pathogenic challenge. This is particularly important for people with impaired immune systems, such as those that occur in extreme environments. Appendicitis can often be successfully treated with intravenous antibiotics. Prophylactic appendectomy is not without risk, as 1:4 to 1:3 people will encounter some sort of postoperative complication. After an appendectomy, there is an increased risk of many serious medical conditions, including intra-abdominal adhesions, ischaemic heart disease, inflammatory and irritable bowel diseases, rheumatoid arthritis, and many others.
Discussion:
The increased morbidity and mortality associated with appendectomy is costly for individuals (the burden of disease) and society (health economics). It also poses a currently unappreciated health risk for long-term off-world expeditions.
Emergency medical services (EMS) is a high-stress profession, which can lead to deterioration in provider mental health over time. EMS providers may find themselves in a situation where they are not only treating the general public, but also each other. Until now, there has been no active training or emphasis on provider mental health. This has taken its toll and can lead to PTSD (post-traumatic stress disorder) in field providers and managers alike.
Aim:
Identifying and managing stressors is crucial to longevity in the field of EMS. Managers must have the ability to broach sensitive matters with their subordinates, and effectively debrief them following such stressful incidents.
Methods:
Magen David Adom held a two-day seminar for its administration, from which they learned signs and symptoms of PTSD, how to approach teams who had been in stressful situations, and how to properly debrief the teams. The seminar culminated in mass casualty incident (MCI) drills, where there were 4 active scenes. Scene 1 had a team that was physically injured. Scene 2 had a team which cared for the team from scene 1. Scene 3 had a team suffering from emotional stress and ceased to function. Scene 4 had only wounded civilians. The drill focused on provider emotions and used actors and props to simulate an exceedingly complex MCI situation.
Results:
Following the drill, a debriefing was held and it was found that all of the points of interest had been noted and properly dealt with.
Discussion:
Holding a successful drill assisted in providing participants with an accurate sense of such stressful situations in which their subordinates find themselves on a daily basis. The debriefing session succeeded in identifying potential stressors for field providers and teaching the participants the appropriate way to approach such sensitive matters.
More than half of the world’s youth live in the Asia Pacific region, yet efforts to reduce disaster risk for adolescents are hindered by an absence of age-specific data on protection, health, and engagement.
Aim:
China and Nepal have faced a recent escalation in the number of climatic and geological hazards affecting urban and rural communities. We aimed to examine disaster-related threats experienced by adolescents and their caregivers in China and Nepal, determine the scope for adolescent participation, and elicit recommendations for improving disaster risk reduction.
Methods:
Sixty-nine adolescents (51% female, ages 13-19) and 72 adults (47% female, ages 22-66) participated in key informant interviews and focus group discussions in disaster-affected areas of southern China and Nepal. Using inductive content analysis, several themes were identified as key to adolescents’ needs.
Results:
Security and protection emerged as a central issue, interlinked with preparedness, timely and equitable disaster response, psychosocial support, and adolescent participation. The mental health risks emerging from trauma exposure were substantial. Adolescents made extensive contributions to disaster response including involvement in rescue efforts and delivering first aid, rebuilding homes and caring for family members. Participants forwarded a number of recommendations, including investing in psychological support, skills training, and stronger systems of protection for those at risk of family separation, trafficking, or removal from school.
Discussion:
The findings informed a multilevel, interconnected model for disaster risk reduction tailored to adolescents’ needs. Supporting adolescents’ recovery and long-term resilience after humanitarian crises will require coordinated efforts in preparedness, security, and mental health care.
Resilience is often described as a desirable holistic approach to disaster preparedness. However, the term has a wide variety of meanings and is hard to operationalize and implement in disaster management. A goal for the EU H2020 project DARWIN was to operationalize resilience for incident management teams.
Aim:
To test the resilience operationalization by analyzing command team behaviors in a major incident exercise and trace observations to resilience theory.
Methods:
A regional medical command and control team (n=11) was observed when performing in a functional simulation exercise of a mass casualty incident (300 injured, 1800 uninjured) following the collision of a cruise ship and an oil tanker close to the Swedish coast. Audio and video recordings of behaviors and communications were reviewed for resilient behaviors based on the DARWIN guidelines using the “resilience markers for small teams” framework (Furniss et al., 2011).
Results:
A total of 121 observed instances of resilient behaviors were found in the material. In 95 cases (79%) the observed behaviors followed a priori hypothesized connections between resilient strategies and general markers. Certain marker-strategy combinations occurred frequently, such as 18 observations where the strategy “understand crucial assumptions” occurred together with the marker “adapting to expected and unexpected events.”
Discussion:
Resilience has the potential to contribute to a more holistic disaster management approach. The findings that the observations, in general, correspond to the expected relationship between theoretical concretization and contextualization supports the DARWIN effort to operationalize resilience theory. This is a prerequisite for developing observational protocols for training and further studies of resilient behaviors in disaster management teams.
For recent years, we often hear the words, “never experienced before” on a weather forecast in Japan.
Aim:
To evaluate our response to “Heisei 30-year July heavy rain” in the Hyogo Emergency Medical Operations Center.
Methods:
Review our actions taken and exchanges of views with local government representatives in a time-related manner compared with public announcements of evacuation/sheltering warning.
Results:
A specialized warning of heavy rain was announced at 10:50 PM on Friday by the local meteorological observatory. At 11:50 PM, the emergency management headquarters of prefectural medical response was established in the hospital, but a connection could not be established to 10 regional health centers for the weekend. Water levels of some rivers were increasing nearly to flood levels, and an evacuation order was announced to hundreds of thousands of people. This situation continued for a few days throughout many regions. The information of flood or landslide probability was continuously monitored, but an attempt was made to decide the timing of cancellations of standby.
Discussion:
An ordinary response to disaster depends on a clear turning point, such as the occurrence time. In heavy rainfall, there are two issues. One is about actions to prevent disaster and another is a recognition of geographic points or surface. Many critiques to the response focus on the judgments and actions for prevention before a critical event. Lessons learned included the importance of preventive actions along with a timeline and the judgment of restoration.
Human Stampedes (HS) occur at religious mass gatherings. Religious events have a higher rate of morbidity and mortality than other events that experience HS. This study is a subset analysis of religious event HS data regarding the physics principles involved in HS, and the associated event morbidity and mortality.
Aim:
To analyze reports of religious HS to determine the initiating physics principles and associated morbidity and mortality.
Methods:
Thirty-four reports of religious HS were analyzed to find shared variables. Thirty-three (97.1%) were written media reports with photographic, drawn, or video documentation. 29 (85.3%) cited footage/photographs and 1 (2.9%) was not associated with visual evidence. Descriptive phrases associated with physics principles contributing to the onset of HS and morbidity data were extracted and analyzed to evaluate frequency before, during, and after events.
Results:
34 (39.1%) reports of HS found in the literature review were associated with religious HS. Of these, 83% were found to take place in an open space, and 82.3% were associated with population density changes. 82.3% of events were associated with architectural nozzles (small streets, alleys, etc). 100% were found to have loss of XY-axis motion and 89% reached an average velocity of zero. 100% had loss of proxemics and 91% had associated Z-axis displacement (falls). Minimum reported attendance for a religious HS was 3000. 100% of religious HS had reported mortality at the event and 56% with further associated morbidity.
Discussion:
HS are deadly events at religious mass gatherings. Religious events are often recurring, planned gatherings in specific geographic locations. They are frequently associated with an increase in population density, loss of proxemics and velocity, followed by Z-axis displacements, leading to injury and death. This is frequently due to architectural nozzles, which those organizing religious mass gatherings can predict and utilize to mitigate future events.