Implementation of a medical command and control team in Switzerland

In case of a major incident or disaster, the advance medical rescue command needs to manage several essential tasks simultaneously. These include the rapid deployment of ambulance, police, fire and evacuation services, and their coordinated activity, as well as triage and emergency medical care on site. The structure of such a medical rescue command is crucial for the successful outcome of medical evacuation at major incidents. However, little data has been published on the nature and structure of the command itself. This study presents a flexible approach to command structure, with two command heads: one emergency physician and one experienced paramedic. This approach is especially suitable for Switzerland, whose federal system allows for different structures in each canton. This article examines the development of these structures and their efficiency, adaptability and limitations with respect to major incident response in the French‐speaking part of the country.     

The nuclear disaster management system in Taiwan: a case study of the third (Maanshan) nuclear power plant

This paper explores the effectiveness of the nuclear disaster management system in Taiwan via a review of the third (Maanshan) nuclear power plant. In doing so, the Fukushima Daiichi nuclear disaster in Japan on 11 March 2011 is reviewed and compared with the situation in Taiwan. The latter's nuclear disaster management system is examined with respect to three key variables: information; mobilisation; and inter‐organisational cooperation. In‐depth interviews with 10 policy stakeholders with different backgrounds serve as the research method. The results point up the need for improvement in all dimensions. In addition, they highlight three principal problems with the nuclear disaster management system: (i) it might not be possible to provide first‐hand nuclear disaster information immediately to the communities surrounding the Maanshan facility in Pingtung County, southern Taiwan; (ii) the availability of medical resources for treating radiation in Hengchun Township is limited; and (iii) the inter‐organisational relationships for addressing nuclear disasters need to be strengthened. Hence, cooperation among related organisations is necessary.     

大型海啸灾害后重伤员批量护理风险建模研究

大型海啸灾害等自然灾害的发生产生了大量重伤员,所以研究大型海啸灾害后重伤员的批量护理风险建模极为重要.通过大型海啸灾害救治流程预案启动和重伤员批量护理实施方法两部分研究大型海啸灾害后重伤员批量护理方法,并提出通过前馈控制性管理防范护理风险.提升护理风险管理的科学性以及全面性.通过护理风险防范预案提升重伤员护理质量将大型...     

The academic medical centre and nongovernmental organisation partnership following a natural disaster

The global response to the 12 January 2010 earthquake in Haiti revealed the ability to mobilise medical teams quickly and effectively when academic medical centres partner non-governmental organisations (NGO) that already have a presence in a zone of devastation. Most established NGOs based in a certain region are accustomed to managing the medical conditions that are common to that area and will need additional and specialised support to treat the flux of myriad injured persons. Furthermore, an NGO with an established presence in a region prior to a disaster appears better positioned to provide sustained recovery and rehabilitation relief. Academic medical centres can supply these essential specialised resources for a prolonged time. This relationship between NGOs and academic medical centres should be further developed prior to another disaster response. This model has great potential with regard to the rapid preparation and worldwide deployment of skilled medical and surgical teams when needed following a disaster, as well as to the subsequent critical recovery phase.     

The significance of a small, level-3 'semi evacuation' hospital in a terrorist attack in a nearby town

Terrorist attacks can occur in remote areas causing mass-casualty incidents MCIs far away from level-1 trauma centres. This study draws lessons from an MCI pertaining to the management of primary and secondary evacuation and the operational mode practiced. Data was collected from formal debriefings during and after the event, and the medical response, interactions and main outcomes analysed using Disastrous Incidents Systematic Analysis through Components, Interactions and Results (DISAST-CIR) methodology. A total of 112 people were evacuated from the scene-66 to the nearby level 3 Laniado hospital, including the eight critically and severely injured patients. Laniado hospital was instructed to act as an evacuation hospital but the flow of patients ended rapidly and it was decided to admit moderately injured victims. We introduce a novel concept of a 'semi-evacuation hospital'. This mode of operation should be selected for small-scale events in which the evacuation hospital has hospitalization capacity and is not geographically isolated. We suggest that level-3 hospitals in remote areas should be prepared and drilled to work in semi-evacuation mode during MCIs.     

Future disaster planning in the United kingdom*

1 An ideal integrated national disaster plan would include the following points: 2 First aid training for the general population. 3 Advanced training in critical care for ambulance men. 4 Principles of triage for all emergency services. 5 Application of triage by trained ambulance men. 6 Spreading the casualty load (where possible) to a number of receiving hospitals. 7 The setting up of local disaster co-ordinating committees. 8 The more widespread dissemination of disaster information and reports.     

Explaining implementation behaviour of the National Incident Management System (NIMS)

This paper explains the perceived implementation behaviour of counties in the United States with respect to the National Incident Management System (NIMS). The system represents a massive and historic policy mandate designed to restructure, standardise and thereby unify the efforts of a wide variety of emergency management entities. Specifically, this study examined variables identified in the NIMS and policy literature that might influence the behavioural intentions and actual behaviour of counties. It found that three key factors limit or promote how counties intend to implement NIMS and how they actually implement the system: policy characteristics related to NIMS, implementer views and a measure of local capacity. One additional variable—inter‐organisational characteristics—was found to influence only actual behaviour. This study's findings suggest that the purpose underlying NIMS may not be fulfilled and confirm what disaster research has long suggested: the potential for standardisation in emergency management is limited.     

Inclusion of people with disabilities,their needs and participation,into disaster management: a comparative perspective

In the field of disaster management, not many have considered the role and needs of people with disabilities despite their number and condition. The purpose of this paper is to push for specific inclusion of people with disabilities, their needs and participation, into disaster management by studying relevant cases from Indonesia, Korea, and the USA. Qualitative content analysis was used as a major methodology by comparing three factors identified in these nations: government policies, schools and advocacy groups’ efforts, and families and local communities’ awareness. Three models, one from each country, were considered major takeaways from this study: the Indonesian moral inclusion, the Korean medical treatment without exclusion, and the US’ extending social inclusion. In addressing the needs and participation of people with disabilities in disaster management, the following recommendations are put forward: for Indonesia, a move away from olden beliefs and misconceptions on disability (e.g. as a punishment) is imperative. In Korea, relevant fundamental laws (e.g. the Basic Act on Emergency and Safety Management) need to be revised while also studying advanced laws on the subject. For the USA, though the country is already advanced, overall improvement is still needed in terms of association with international non-governmental organizations, increase in the number of (emergency or disaster) response officials, and provision of better medical treatment.     

The 9/21 earthquake in Taiwan: a local government disaster rescue system1

This paper employs a three‐element model to examine how the disaster rescue system of the government of Nantou County in Middle Taiwan functioned following the earthquake of 21 September 1999. The three elements are information gathering, local government mobilisation, and inter‐organisational cooperation. The paper finds that the Nantou County government needs to address many problems associated with these three elements. Disaster information, for example, was not processed instantly because of the destruction of the electricity and telephone systems in the earthquake. Insufficient information caused ineffectiveness in the realms of mobilisation and inter‐organisational cooperation. As for mobilisation, while the Nantou County magistrate successfully used specific information to encourage flows of huge resources in the county, he did not successfully mobilise human resources there. With regard to inter‐organisational cooperation, myriad voluntary actors and international rescue teams travelled to Nantou County, but the fire and police services experienced cooperation and coordination problems.     

The World Trade Center Bombing: Injury Prevention Strategies for High-rise Building Fires

The WTC disaster provided an opportunity to look for ways to prevent morbidity among occupants of high-rise buildings during fires. This paper first describes the overall morbidity resulting from the explosion and fire, and second, presents the results of a case-control study carried out to identify risk factors for smoke-related morbidity. The main ones include: increased age, presence of a pre-existing cardio-pulmonary condition, entrapment in a lift and prolonged evacuation time. Study results point to the importance of the following safety systems during high-rise building fires: smoke-control systems with separate emergency power sources; lift-cars, lift-car position-monitoring systems, and lift-car communication systems with separate emergency power sources; two-way emergency communication systems on all floors and in stairwells; stairwells with emergency lighting and designed for the rapid egress of crowds; evacuation systems/equipment to assist in the evacuation of vulnerable people (elderly, infirm). Also important are evacuation plans that include regularly scheduled safety training and evacuation drills.     

A microcomputer-based emergency response system*

A microcomputer-based system was developed to provide local officials responsible for disaster management with assistance during the crucial period immediately following a disaster, a period when incorrect decisions could have an adverse impact on the surrounding community.
While the paper focuses on a potential disaster resulting from an accident at a commercial nuclear power generating facility, the system can be applied to other disastrous situations. Decisions involving evacuation, shelter and the deployment of resources must be made in response to floods, earthquakes, accidents in the transportation of hazardous materials, and hurricanes to name a few examples.
As a decision aid, the system was designed to enhance data display by presenting the data in the form of representations (i.e. road maps, evacuation routes, etc.) as well as in list or tabular form. The potential impact of the event (i.e. the release of radioactive material) was displayed in the form of a cloud, representing the dispersion of the radioactive material. In addition, an algorithm was developed to assist the manager in assigning response resources to demands.
The capability for modelling the impact of a disaster is discussed briefly, with reference to a system installed in the communities surrounding the Indian Point nuclear power plant in New York State.
Results demonstrate both the technical feasibility of incorporating microcomputers indecision support systems for radiological emergency response, and the acceptance of such systems by those public officials responsible for implementing the response plans.     

Sources of organisational resiliency during the Thailand floods of 2011: a test of the bonding and bridging hypotheses

Based on the Institutional Collective Action framework, this research tests the impact of two competing hypotheses—bonding and bridging—on enhancing organisational resiliency. The bonding hypothesis posits that organisational resiliency can be achieved if an organisation works closely with others, whereas the bridging hypothesis argues that such a structure places considerable stress on an organisation and advocates for an organisation to position itself as a central actor to gain access to novel resources from a diverse set of entities to achieve resiliency. The paper analyses data gathered from semi‐structured interviews with 44 public, private, and non‐profit organisations serving communities affected by the Great Floods of 2011 in the Thai capital, Bangkok (urban), and in Pathum Thani (suburban) and Ayutthaya (rural) provinces. The findings suggest that: organisational resiliency was associated with the bridging effect; organisations in the rural province were more resilient than those in the suburban and urban centres; and private and non‐governmental organisations generally were more resilient than public sector organisations. The findings highlight the importance of fostering multi‐sector partnerships to enhance organisational resiliency for disaster response.     

Household evacuation characteristics in American Samoa during the 2009 Samoa Islands tsunami

Tsunamis represent significant threats to human life and development in coastal communities. This quantitative study examines the influence of household characteristics on evacuation actions taken by 211 respondents in American Samoa who were at their homes during the 29 September 2009 M_w 8.1 Samoa Islands earthquake and tsunami disaster. Multiple logistic regression analysis of survey data was used to examine the association between evacuation and various household factors. Findings show that increases in distance to shoreline were associated with a slightly decreased likelihood of evacuation, whereas households reporting higher income had an increased probability of evacuation. The response in American Samoa was an effective one, with only 34 fatalities in a tsunami that reached shore in as little as 15 minutes. Consequently, future research should implement more qualitative study designs to identify event and cultural specific determinants of household evacuation behaviour to local tsunamis.     

The Response of the South Manchester Accident Rescue Team (SMART) to the Armenian Earthquake and Lockerbie Air Disaster: A Report to the Prime Minister's Office

The delay in receiving authorisation for the despatch of SMART significantly reduced our overall effectiveness. The majority of injured survivors were extracted during this time and our special expertise could have saved a significant number of lives. The episode has provided SMART with unique experience for a British medical team and this knowledge should not be wasted. In contrast to other major western countries the British response was fragmented. We have no central stockpile of equipment and no official response team. The British who responded were independent of each other even when from the same service. The quality of the individual British teams was as good as any and often better. However, the ability of other nations to coordinate their response centrally and draw from a pool of workers already used to working together, improved both their efficiency and effectiveness. There are great difficulties in communication during any disaster and these increase with the scale of the disaster. Incoming rescue workers were given false or misleading information and rumour was widespread. Even when few people were found alive rescue workers expressed a strong need for a medical presence in case they discovered an injured person or they them selves became ill or injured. We were told repeatedly by experienced rescuers that we were the first team of British senior doctors they had met at the front line of a disaster and they were extremely pleased to see us. Transport was a major problem both in terms of vehicles and local knowledge. It was not thought to be within the remit of a medical team to make provision for food and shelter and this was confirmed in Moscow prior to departure for Yerevan. In retrospect this was a mistake and reduced the time we could stay at the front line. If we had not equipped ourselves with special clothing we could not have gone to the front line. A medical team must be part of larger team of rescue workers. Within this unit there will be provision for food, shelter, transport and communication as well as medical and surgical equipment.     

Variations in disaster evacuation behavior: public responses versus private sector executive decision-making processes

Data obtained from 65 executives working for tourism firms in three sample communities permitted comparison with the public warning response literature regarding three topics: disaster evacuation planning, initial warning responses, and disaster evacuation behavior. Disaster evacuation planning was reported by nearly all of these business executives, although it was highly variable in content, completeness, and formality. Managerial responses to post-disaster warnings paralleled the type of complex social processes that have been documented within the public response literature, except that warning sources and confirmation behavior were significantly affected by contact with authorities. Five key areas of difference were discovered in disaster evacuation behavior pertaining to: influence of planning, firm versus family priorities, shelter selection, looting concerns, and media contacts.     

灾害医学救援中伤病员分类工作研究

灾害条件下的医学救援,要及时准确地处理大批伤病员,首先需要迅速实施伤病员分类。目前,除军队医疗机构外,其他实施灾害医学救援的各级救治机构,都还没有真正建立健全伤员分类组织,应引起重视。各级参加灾害医学救援的医疗救治机构,都应成立有经验的医疗技术人员或管理人员组成的分类组;制定出分类标准;制备分类标志和加强分类训练。做到伤病员分类迅速准确,保证救治和后送工作的顺利进行。     

A critical analysis of the South African Disaster Management Act and Policy Framework

The promulgation of the South African Disaster Management Act No. 57 of 2002 and the National Disaster Management Policy Framework of 2005 placed South Africa at the international forefront by integrating disaster risk reduction into all spheres of government through a decentralised approach. Yet, good policy and legislation do not necessarily translate into good practice. This paper provides a critical analysis of the Act and Policy Framework. Using qualitative research methods, it analyses the attitudes and perceptions of senior public officials on all levels of government, the private sector and academia. The study finds that one of the weakest aspects of the Act and Framework is the absence of clear guidance to local municipalities. The placement of the disaster risk management function on all tiers of government remains problematic, funding is inadequate and overall knowledge and capacities for disaster risk reduction are insufficient.     

Intentionally building relationships between participatory online groups and formal organisations for effective emergency response

Advances in information and communication technologies enable the public to contribute to emergency response. For instance, reporting systems set up during recent disasters allowed affected people to submit testimonies about conditions on the ground. In addition, the public has analysed data and helped to mobilise and deliver relief resources. To plan intentionally for an integrative emergency response system in the networked age, this research explores two subject areas: (i) the organisational and technical determinants of relationships forged between formal organisations and participatory online groups established by the public; and (ii) the consequences of the outcomes generated by these relationships. Four in‐depth case studies were selected for the analysis, which revealed that resource dependence, shared understanding, and the use of certain types of information technology influence the formation of such relationships. Furthermore, healthy collaborative relationships increase the chances of desirable results, including inter‐organisational alignment and minimal long‐term harm owing to a disaster.     

基于GIS和OREMS的洪灾避难系统

面对突发的灾害,人类采取避难转移的方式来减少生命和财产的损失。大范围的人口转移是一个十分复杂的过程,必须有合理的计划和有效地利用现有的交通设施。提出了基于GIS和OREMS的洪灾避难系统来模拟洪灾的避难转移过程。根据洪灾危险区的统计资料,应用基于GIS的风暴潮洪灾风险系统分析洪灾淹没范围、避难区域的人口分布、路网结构,使用OREMS避难交通模型模拟避难过程。以长兴岛为例进行洪灾避难交通模拟,得到避难耗费时间,路网拥堵路段,并且在分析模拟结果的基础上对避难计划进行优化。     

Disaster Management and Government Intervention in PNG: The Case of Lae

This paper describes government intervention in two flood disasters in Lae before and after the establishment of the Papua New Guinea disaster management body. It first describes the objectives behind the establishment of this, and second, it examines the organisational response to the 1983 and 1992 disasters in Lae. Disaster response in terms of relief operations is generally prompt and spontaneous but can at best be described as haphazard, unsystematic and often uncoordinated. Both national and provincial disaster committees are, in many aspects, ill equipped in terms of capabilities, skills and resources. Many disaster operations are unable to ensure an immediate return of the victim's lives to normality – the ultimate objective of any disaster management.