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Providing humanitarian relief to affected populations is a top priority following a major sudden onset disaster (SOD). The main form of medical relief to affected areas is the emergency medical teams (EMTs). These are groups of health professionals and support staff operating locally or outside their country of origin by providing healthcare to disaster-affected populations. Despite best intentions, for decades EMTs were disorganized and followed no clear standards. In the aftermath of the 2010 Haiti earthquake, the EMT Working Group of the World Health Organization‘s global health cluster initiated a global effort to standardize the EMTs system. This new system was put to the test in 2013 with the deployment of medical aid to the Philippines following Typhon Haiyan, and later on during the Ebola outbreak in West Africa and the earthquake in Nepal in 2015. This chapter reviews the history of medical aid to disaster affected areas, the process of coordinating and standardizing EMTs and the latest implementation of the new EMT coordination system.
Field hospitals are deployed in a wide range of scenarios including natural disasters, epidemic outbreaks, armed conflicts and refugee crises. Operation in these conditions requires adaptation to disaster medicine principles and operation in an austere environment and unfamiliar cultural milieu, whilst maintaining acceptable standards of care. For many of those involved it may be their first encounter. This book, which is the first to address the preparation and operation of field hospitals, brings together the experience of world leaders in the field. Coming from a wide variety of organizations and backgrounds, all have extensive experience in field hospital deployment in multiple scenarios. The text - containing both background information and practical guidelines - will serve all those involved in field hospital deployment, including policy makers and planners, physicians and nurses, paramedical professionals and logisticians. It will help them deliver optimal care to people around the globe in difficult times of need.
Despite efforts by civil defense authorities, levels of households’ preparedness to emergencies remain insufficient in many countries. Engaging the public in preparedness behavior is a challenge worldwide. The purpose of this study was to explore the efficacy of psychological intervention in promoting preparedness behavior to armed conflicts in Israel.
A randomized controlled trial (N = 381) with two control groups and three intervention groups was used. The psychological interventions studied were elevated threat perception, external reward, and manipulation of a cognitive cluster related to preparedness.
The results of the analysis suggest a significant effect of intervention on the increase of reported preparedness (F4,375 = 4.511, P = 0.001). The effect is attributed to the intervention group in which external reward was offered. Participants in this group were about two times more likely to report greater levels of preparedness compared to the control group (RR = 1.855; 95% CI: 1.065, 3.233).
The findings suggest that preparedness behavior can be promoted through external incentives. These are presumably effective motivators because they encourage preparedness while allowing subjects to retain their denial as an adaptive coping mechanism. Innovative thinking is required to overcome the psychological barriers associated with public reluctance to engage in preparedness. (Disaster Med Public Health Preparedness. 2018;13:713–723)
The study aimed to examine impact of think-tanks designed to create policies for emerging threats on medical teams’ perceptions of individual and systemic emergency preparedness.
Multi-professional think-tanks were established to design policies for potential attacks on civilian communities. In total, 59 multi-sector health care managers participated in think-tanks focused on: (a) primary care services in risk zones; (b) hospital care; (c) casualty evacuation policies; (d) medical services to special-needs populations; and (e) services in a “temporary military-closed zone.” Participants rotated systematically between think-tanks. Perceived individual and systemic emergency preparedness was reviewed pre-post participation in think-tanks.
A significant increase in perceived emergency preparedness pre-post-think-tanks was found in 8/10 elements including in perceived individual role proficiency (3.71±0.67 vs 4.60±0.53, respectively; P<0.001) and confidence in colleagues’ proficiency during crisis (3.56±0.75 vs 4.37±0.61, respectively; P<0.001). Individual preparedness and role perception correlates with systemic preparedness and proficiency in risk assessment.
Participation in policy-making impacts on individuals’ perceptions of empowerment including trust in colleagues’ capacities, but does not increase confidence in a system’s preparedness. Field and managerial officials should be involved in policy-making processes, as a means to empower health care managers and improve interfaces and self-efficacy that are relevant to preparedness and response for crises. (Disaster Med Public Health Prepardness. 2019;13:152–157)
We aimed to identify and seek agreement on factors that may influence decision-making related to the distribution of patients during a mass casualty incident.
A qualitative thematic analysis of a literature review identified 56 unique factors related to the distribution of patients in a mass casualty incident. A modified Delphi study was conducted and used purposive sampling to identify peer reviewers that had either (1) a peer-reviewed publication within the area of disaster management or (2) disaster management experience. In round one, peer reviewers ranked the 56 factors and identified an additional 8 factors that resulted in 64 factors being ranked during the two-round Delphi study. The criteria for agreement were defined as a median score greater than or equal to 7 (on a 9-point Likert scale) and a percentage distribution of 75% or greater of ratings being in the highest tertile.
Fifty-four disaster management peer reviewers, with hospital and prehospital practice settings most represented, assessed a total of 64 factors, of which 29 factors (45%) met the criteria for agreement.
Agreement from this formative study suggests that certain factors are influential to decision-making related to the distribution of patients during a mass casualty incident. (Disaster Med Public Health Preparedness. 2018;12:101–108)
One of the most prominent threats to the Israeli population is the risk from armed conflicts. Yet, promoting preparedness behavior proves to be highly difficult. Arguably, this is partially due to the chronic exposure of the Israeli public to this threat, a.k.a. “Victimization.” The purpose of this study was to examine whether victimization plays a prominent role in shaping preparedness behavior toward armed conflicts in Israel.
An online survey of 502 participants representing the adult Jewish population in Israel was carried out. A set of questionnaires designed to assess public perception of preparedness-affecting factors was used. The list of preparedness-affecting factors was conceptualized by an expert panel before the survey.
The results suggest that low prioritization and ignoring of civil-defense instructions during routine times are leading causes for non-compliance with preparedness recommendations. Ignoring instructions is also negatively correlated with reported preparedness. Misunderstanding the threat and fearing it also seem to be important factors.
The results of this study support the hypothesis that victimization plays an important role in shaping preparedness behavior toward armed conflicts among Jews in Israel. The findings demonstrate the complexity of the socio-psychological perspective of preparedness behavior in victimized populations. (Disaster Med Public Health Preparedness. 2018;12:67–75)