Health ramifications and recovery avenues for Sudan's April 2023 armed conflict: A review

Background: Sudan's history is marred by ongoing sociopolitical challenges, with deep cultural divisions fueling numerous wars. A new conflict erupted on April 15, 2023, pushing the country closer to a full-scale civil war. This war has severely crippled Sudan's already fragile healthcare system, rendering 70% of hospitals in combat zones nonoperational, causing 12,000 deaths, thousands of injuries, and leaving 11 million in dire need of healthcare. More than seven million people are displaced, half of which are children, and are facing severe health challenges, especially vulnerable groups. Heath situation is threatening with unchecked spread of outbreaks of communicable diseases that were previously controlled and marked failure in meeting the health demands of patients with noncommunicable diseases, reproductive and child health issues, and people with serious conditions that require adequate follow-up. Moreover, the projections threaten with more catastrophic consequences including famine, environmental destruction, and further displacement of people. This review article highlights the urgency of the situation and explores potential solutions to enrich global understanding of crisis management. Methods: To comprehensively assess the impact of the crisis and propose a way forward, we drew data by exploring search engines and databases such as Google, Humanitarian Agencies Websites, Google Scholer, and PubMed along with some relevant reports. The search terms included are "Sudan's war", "impact of war on healthcare systems", and "Sudan's armed conflicts". Results: More than 19 publications on the impact of the war on health in addition to periodic reports from international organizations and governmental authorities were reviewed. Conclusion: Although all publications point to the gravity of the situation and the need for prompt response, this crisis offers a unique opportunity to rebuild Sudan's struggling healthcare system with the principles of social accountability. Through domestic and international collaboration, this sector can become a model for similar nations, meeting the needs of its people and promoting sustainable development.

Estonian response to COVID-19 pandemic: learning, cooperation, and the advantages of being a small country / Resposta da Estônia à pandemia da COVID-19: aprendizagem, cooperação e as vantagens de ser um país pequeno / Respuesta de Estonia a la pandemia de COVID-19: aprendizaje, cooperación y las ventajas de ser un país pequeño

Abstract Compared to many other countries in Europe, Estonia managed to curtail the spread of the new coronavirus rather effectively. This paper offers an overview of the measures undertaken to tackle the COVID-19 pandemic in March-May 2020 and explain why Estonia managed to successfully contain the epidemic. The paper argues that the management of the crisis was facilitated by political factors, quick policy learning, cooperation with the scientific community, and the existing ICT and e-government infrastructure.

Resumo Em comparação com outros países europeus, a Estônia conseguiu reduzir a disseminação do coronavírus de maneira bastante eficaz. Este artigo busca dar uma visão geral das medidas tomadas para enfrentar a crise da COVID-19 entre os meses de março e maio de 2020 e explicar por que a Estônia conseguiu conter a epidemia com sucesso. O artigo argumenta que a gestão da crise foi facilitada por fatores políticos, pela rapidez na aprendizagem de políticas públicas, pela cooperação com a comunidade científica e pela infraestrutura existente de TIC e governo eletrônico.

Resumen Comparada con otros países de Europa, Estonia ha logrado restringir la propagación del coronavirus relativamente bien. Este artículo se propone brindar una visión general de las medidas tomadas entre marzo y mayo del 2020 para enfrentar la crisis de la COVID-19 y explicar por qué Estonia logró contener la epidemia. El artículo argumenta que el manejo de la crisis fue facilitado por factores políticos, por el rápido aprendizaje sobre políticas públicas, por la cooperación con la comunidad científica, y por la infraestructura de tecnologías de comunicación e información y gobierno digital.

COVID-19 in Africa: a comparative analysis of early policy responses / COVID-19 na África: uma análise comparativa das primeiras políticas de resposta / COVID-19 en África: un análisis comparativo de las políticas de primera respuesta

Abstract The COVID-19 pandemic has caused turmoil around the world. In Africa, some similarities and differences could be observed in the nature of the outbreak and the policy responses across the continent. This article discusses the policy responses and reflects on their effectiveness as a containment strategy. We speculate on why these strategies seem to work or not, and the lessons therein. The analysis also examines the setting up of crisis teams and whether they indicate lack of trust in the existing public administration system. The article argues that though South African cases and testing diverged significantly from the rest of the continent, a wider similarity can be observed in pandemic management across the continent. The article identifies some factors including quick and early measures, recent experience managing epidemic/health crises, and a display of some form of community resilience acquired over years of living in a state of poor governance as some of the important factors in the management of the pandemic. We find there is a dearth of scholarship on crisis management in the context of public administration and suggest this should be an object of future study in the field. The use of ad-hoc crisis teams that assume emergency powers is a common practice, but there is insufficient rigorous analysis to show their effectiveness and impact on existing bureaucratic institutions.

Resumo A pandemia da COVID-19 causou grande turbulência em todo o mundo. Entre os países africanos pode-se perceber semelhanças e diferenças tanto em relação a natureza do surto como nas respostas políticas implementadas. Esse artigo discute essas respostas e reflete sobre sua eficácia como estratégia de contenção da pandemia. Especulamos as razões pelas quais essas estratégias parecem funcionar (ou não) e quais são as lições aprendidas, bem como examinamos a criação de 'equipes de crise' e se essas equipes demonstram confiança no sistema de administração pública existente. A análise nos permite argumentar que, embora a manifestação dos casos e os testes conduzidos na África do Sul tenham divergido significativamente do observado no resto do continente, há uma semelhança em geral em relação a gestão da pandemia em toda a África. Identificamos alguns elementos que refletem essa similaridade na gestão, entre eles a adoção de medidas rápidas e precoces, a experiência recente no gerenciamento de epidemias/crises de saúde e a existência de alguma forma de resiliência da comunidade, adquirida ao longo de anos de experiência em lidar com um estado de falta de governança. Ainda, observamos a escassez de estudos sobre gestão de crises no contexto da administração pública e sugerimos futuros trabalhos na área. Finalmente, percebemos que o uso de 'equipes de crise' constituídas especificamente e com poderes para lidar com a situação de emergência é uma prática comum. Entretanto, não há uma análise rigorosa suficiente para mostrar que essa estratégia é eficaz e tem impacto nas instituições burocráticas existentes.

Resumen La pandemia de COVID-19 causó una gran conmoción en todo el mundo. Entre los países africanos, se pueden observar similitudes y diferencias tanto en relación con la naturaleza del brote como en las respuestas políticas implementadas. Este artículo analiza esas respuestas y reflexiona sobre su eficacia como estrategia de contención de una pandemia. Especulamos sobre las razones por las que estas estrategias parecen funcionar (o no) y cuáles son las lecciones aprendidas, además de examinar la creación de "equipos de crisis" y si estos equipos muestran confianza en el sistema de administración pública existente. El análisis nos permite argumentar que, aunque la manifestación de casos y pruebas realizadas en Sudáfrica ha divergido significativamente de la observada en el resto del continente, existe una similitud en general en relación con el manejo de la pandemia en África. Identificamos algunos elementos que reflejan esta similitud en la gestión, incluida la adopción de medidas rápidas y tempranas, la experiencia reciente en el manejo de epidemias/crisis de salud y la existencia de alguna forma de resiliencia comunitaria, adquirida durante años de experiencia en lidiar con un estado de falta de gobernanza. Además, notamos la escasez de estudios sobre gestión de crisis en el contexto de la administración pública y sugerimos trabajos futuros en el área. Finalmente, percibimos que el uso de "equipos de crisis" específicamente constituidos y capacitados para hacer frente a la emergencia es una práctica común. Sin embargo, no existe un análisis suficientemente riguroso para demostrar que esta estrategia es efectiva y tiene un impacto en las instituciones burocráticas existentes.

4．Vaccine in Crisis Management and National Defense / 薬剤疫学

Cases of Pneumonia of unknown etiology detected in Wuhan City, China, at the end of 2019, was diagnosed as pneumonia caused by a new-type coronavirus （SARS-CoV-2） in a subsequent study and was named COVID-19. The infection epidemic expanded to the whole world in a moment, and the number of infected cases exceeded 90 million, and the number of deaths exceeded 2 million as of January, 2021. While Humans are in an unprecedented crisis since plague and the Spanish cold, and are trying to end COVID-19 pandemic by accelerating the development of vaccines and therapeutics at an unprecedented speed, there has been a movement toward reluctance to get vaccinated called Vaccine Hesitancy, and the hurdle to acquire herd immunity may be heightened by delayed vaccine rollout. For the future, it is also an important issue to establish a system that allows the vaccine industries to develop and produce vaccines in Japan without relying solely on imported vaccines when emerging or re-emerging infectious diseases spread in Japan. This article provides recommendations for solutions against these issues from the perspective of the vaccine industry and the private sector.

Fuego en el quirófano. Reporte de un caso / Fire in the operating room. A case report

Resumen: Existen diversos reportes en la literatura de eventos adversos dentro de quirófano, éstos pueden ser de distinta naturaleza; uno de ellos es la presencia de fuego en el quirófano, el cual no se aleja de nuestra realidad, ya que el uso de oxígeno suplementario propicia un ambiente rico en oxidante y al hacer contacto con otros dispositivos de uso común en cirugía, pueden originar un incendio. Reportamos un caso de fuego en el quirófano, en el que participaron elementos que se han visto relacionados, como el electrocauterio, oxígeno, vello y campos quirúrgicos, que resultó en quemaduras de segundo grado en el 30% de la superficie corporal total de la paciente que se sometía a cirugía. Se hizo una revisión bibliográfica de la evidencia existente al respecto, así como un repaso al algoritmo de la ASA para la prevención y manejo del fuego en el quirófano, el cual es de relevancia para el anestesiólogo y todos los profesionistas que conforman el equipo quirúrgico.

Abstract: There are several reports in the literature of adverse events within the operating room, these may be of a different nature; one of them is the presence of fire in the operating room, which does not depart from our reality, since the use of supplemental oxygen promotes an environment rich in oxidant and when contacting other devices commonly used in surgery, can cause a fire. We report a case of fire in the operating room, in which elements that have been related, such as electrocautery, oxygen, hair, and surgical fields, were involved and that resulted in 2nd degree burns in 30% total body surface of the patient who underwent surgery. A literature review of the existing evidence was made, as well as a review of the ASA algorithm for the prevention and management of fire in the operating room, which is of relevance to the anesthesiologist and all professionals who make up the surgical team.

Effect of 4R crisis management on reducing urinary tract infections in department of urology severe craniocerebral injury / 中国实用护理杂志

Objective To explore the effect of 4R crisis management theory on reducing urinary tract infections in Department of Urology severe craniocerebral injury. Methods A randomized controlled clinical trial was conducted. From January 2018 to January 2019, 92 patients with indwelling urinary catheter were selected as the study subjects in the Department of Urology, Jiangsu People's Hospital. The control group was given routine nursing of indwelling catheter, while the observation group was given nursing of indwelling catheter with 4R crisis management theory on the basis of the control group. The incidence of catheter-associated urinary tract infections (CAUTI), the occurrence time of CAUTI, the days of indwelling catheter, the days of hospitalization and the urine culture bacteria were observed. Results The incidence of CAUTI, occurrence time and days of indwelling catheter in the observation group were 8.70% (4/46), (12.417 ± 3.542) d, 5 (3,12), while those in the control group were 30.43% (14/46), (9.762 ± 2.874) d, 9 (4,21). There were significant differences in CAUTI incidence, occurrence time and days of indwelling catheter between the two groups ( χ2=7.168,t=5.838,Z=5.192,P<0.01 or 0.05); there was no significant difference in hospitalization days between the two groups ( P >0.05). Seven pathogenic bacteria were detected in urine culture of control group and three pathogenic bacteria were detected in observation group. The number of pathogenic bacteria in observation group was less than that in control group. Conlousion 4R crisis management theory can effectively reduce the incidence of CAUTI, delay the occurrence of CAUTI, shorten the days of indwelling catheter, and reduce the pathogenic bacteria in urine culture, which is worthy of clinical application.

Effect of 4R crisis management on reducing urinary tract infections in department of urology severe craniocerebral injury / 中国实用护理杂志

Objective@#To explore the effect of 4R crisis management theory on reducing urinary tract infections in Department of Urology severe craniocerebral injury.@*Methods@#A randomized controlled clinical trial was conducted. From January 2018 to January 2019, 92 patients with indwelling urinary catheter were selected as the study subjects in the Department of Urology, Jiangsu People's Hospital. The control group was given routine nursing of indwelling catheter, while the observation group was given nursing of indwelling catheter with 4R crisis management theory on the basis of the control group. The incidence of catheter-associated urinary tract infections (CAUTI), the occurrence time of CAUTI, the days of indwelling catheter, the days of hospitalization and the urine culture bacteria were observed.@*Results@#The incidence of CAUTI, occurrence time and days of indwelling catheter in the observation group were 8.70% (4/46), (12.417 ± 3.542) d, 5 (3, 12), while those in the control group were 30.43% (14/46), (9.762 ± 2.874) d, 9 (4, 21). There were significant differences in CAUTI incidence, occurrence time and days of indwelling catheter between the two groups (χ2=7.168, t=5.838, Z=5.192, P < 0.01 or 0.05); there was no significant difference in hospitalization days between the two groups (P > 0.05). Seven pathogenic bacteria were detected in urine culture of control group and three pathogenic bacteria were detected in observation group. The number of pathogenic bacteria in observation group was less than that in control group.@*Conlousion@#4R crisis management theory can effectively reduce the incidence of CAUTI, delay the occurrence of CAUTI, shorten the days of indwelling catheter, and reduce the pathogenic bacteria in urine culture, which is worthy of clinical application.

Using eye tracking technology to compare the effectiveness of malignant hyperthermia cognitive aid design / 대한마취과학회지

BACKGROUND: Malignant hyperthermia is a rare but potentially fatal complication of anesthesia, and several different cognitive aids designed to facilitate a timely and accurate response to this crisis currently exist. Eye tracking technology can measure voluntary and involuntary eye movements, gaze fixation within an area of interest, and speed of visual response and has been used to a limited extent in anesthesiology. METHODS: With eye tracking technology, we compared the accessibility of five malignant hyperthermia cognitive aids by collecting gaze data from twelve volunteer participants. Recordings were reviewed and annotated to measure the time required for participants to locate objects on the cognitive aid to provide an answer; cumulative time to answer was the primary outcome. RESULTS: For the primary outcome, there were differences detected between cumulative time to answer survival curves (P < 0.001). Participants demonstrated the shortest cumulative time to answer when viewing the Society for Pediatric Anesthesia (SPA) cognitive aid compared to four other publicly available cognitive aids for malignant hyperthermia, and this outcome was not influenced by the anesthesiologists’ years of experience. CONCLUSIONS: This is the first study to utilize eye tracking technology in a comparative evaluation of cognitive aid design, and our experience suggests that there may be additional applications of eye tracking technology in healthcare and medical education. Potentially advantageous design features of the SPA cognitive aid include a single page, linear layout, and simple typescript with minimal use of single color blocking.

Application of defect situational simulation based on crisis management in training course of cardiopulmonary resuscitation skills among non-emergency department junior nurses / 中国中西医结合急救杂志

Objective To investigate the effects of using junior nurses in non-emergency department to take part in the training course of cardiopulmonary resuscitation (CPR) skills based on the defect situational simulation of crisis management. Methods A prospective randomly controlled test method was conducted, 66 junior nurses in non-emergency department newly-contracted in 2016 admitted to the Yuyao City People's Hospital from July 1, 2017 to Augest 30th, they were divided into a control group (n = 32) and an experimental group (n = 34) by random number table method. The nurses in control group received conventional CPR situational simulation teaching method, while the nurses in observation group received the training of using crisis management mode to direct realizing the defect situational simulation. The differences in the nurse team cooperation levels were compared between the two groups. Results After training, the team cooperation scores of the two groups of non-emergency department nurses were all higher than those before the training(control group: 99.78±12.33 vs. 92.34±12.35; experiment group:116.00±12.80 vs. 93.44±10.29, both P < 0.05), and the team cooperation score in observation group was significantly higher than that of control group (116.00±12.80 vs. 99.78±12.33, P < 0.01). Conclusion The defect situational simulation based on crisis management can effectively elevate the levels of CPR skills and team work cooperation in the non-emergency department junior nurses.

Practical Exploration of Carrying Out Crisis Management Education of Medical Violence in Medical Students / 中国医学伦理学

Medical violence is a typical crisis. The survey showed that medical students generally lacked effec-tive strategies to deal with medical violence and also were looking forward to receiving related education and training subjectively. It has positive theoretical and practical significance to carry out the crisis management education of medical violence among medical students. From the four levels of crisis management, through strengthening human-istic education, psychological health education, carrying out crisis experience teaching, conducting crisis response practice in teaching and other tries, to carry out crisis management education of medical violence among medical students can improve medical students' crisis prevention awareness, early-warning ability, handling ability and recovery ability, so as to provide useful reference for preventing and resolving medical violence and building a har-monious doctor-patient relationship.

Application effect of 4R crisis management in patients with mechanical ventilation in intensive care unit / 中国基层医药

Objective To explore the application effect of 4R crisis management in patients with mechanical ventilation in intensive care unit(ICU).Methods 88 patients with mechanical ventilation in ICU were selected as the study subjects,by random number table method they were divided into observation group and control group, 44 cases in each group.The control group was treated with basic nursing intervention,the observation group received 4R crisis management of nursing intervention.After the implementation of different nursing intervention,the incidence of pressure ulcers,prevention effect and nursing satisfaction,crisis event occurrence and the quality of care were com-pared between the two groups.Results The incidence rate of pressure ulcers of the observation group was 2.27%, effectively preventive rate was 95.45%,the crisis event occurrence rate was 4.55% and nursing satisfaction rate was 97.73%,nursing quality score was (93.78 ±3.19)points,which were significantly better than those of the control groups[20.45%,68.18%,47.73%,75.00%,(87.91 ±2.75)points](χ2 =5.53,9.24,19.07,7.82,t =9.25,all P <0.05).Conclusion 4R crisis management nursing intervention can effectively improve the ICU mechanical ven-tilation patients crisis events,improve the quality of nursing and nursing satisfaction.

Mapping of courses on vector biology and vector-borne diseases systems: time for a worldwide effort

Major emergency efforts are being mounted for each vector-borne disease epidemiological crisis anew, while knowledge about the biology of arthropods vectors is dwindling slowly but continuously, as is the number of field entomologists. The discrepancy between the rates of production of knowledge and its use and need for solving crises is widening, in particular due to the highly differing time spans of the two concurrent processes. A worldwide web based search using multiple key words and search engines of onsite and online courses in English, Spanish, Portuguese, French, Italian and German concerned with the biology of vectors identified over 140 courses. They are geographically and thematically scattered, the vast majority of them are on-site, with very few courses using the latest massive open online course (MOOC) powerfulness. Over two third of them is given in English and Western Africa is particularity poorly represented. The taxonomic groups covered are highly unbalanced towards mosquitoes. A worldwide unique portal to guide students of all grades and levels of expertise, in particular those in remote locations, is badly needed. This is the objective a new activity supported by the Special Programme for Research and Training in Tropical Diseases (TDR).

Crisis interventions in online psychological counseling / Intervenções em crise nos atendimentos psicológicos online

Introduction: The world's population is often assailed by crises of various orders. Disasters caused by nature and by humans themselves also impact on people's mental health. Psychological crises, such as suicide attempts, represent a growing problem in mental health. When faced with such scenarios, specific strategies of crisis intervention are both appropriate and necessary. Objective: To conduct a systematic review of the literature dealing with online psychological crisis intervention, describing and discussing their operational design, specific characteristics and applications. Method: A systematic review of literature indexed on the PubMed, PsycINFO, and SciELO databases identified by searches conducted from January to June of 2014. Results: The searches identified 17 empirical studies about online crisis interventions which were reviewed. Three crisis contexts emerged: 1) disasters, 2) risk/prevention of suicide, and 3) trauma. Eleven different intervention programs were described and the predominant treatment approach was cognitive behavioral therapy. The results showed that research into online psychological crisis intervention has been conducted in several different countries, especially the Netherlands and Australia, and that the users of these tools benefit from them. Conclusion: Online crisis interventions have been developed and researched in many countries around the world. In Brazil, there is still a lack of investment and research in this area.

Introdução: Frequentemente a população mundial tem sido atingida por crises de diversas ordens. Desastres provocados pela natureza e também pelo homem têm impactado na saúde mental das pessoas. Crises de ordem psicológica, como tentativas de suicídio, têm representado um problema crescente em termos de saúde mental. Frente a esse panorama, estratégias diferenciadas de intervenção em crises são oportunas e necessárias. Objetivo: Revisar sistematicamente a literatura existente sobre intervenções psicológicas em crises no contexto online, e com isso descrever seu funcionamento e discutir suas particularidades e possibilidades. Método: Realizou-se uma revisão sistemática de literatura, através das bases de dados PubMed, PsycINFO e SciELO, no período de janeiro a junho de 2014. Resultados: A presente revisão resultou em 17 estudos empíricos que tratam sobre intervenções em crise no contexto online. Destes, três contextos de crise emergiram: 1) desastres, 2) risco/prevenção de suicídio e 3) trauma. Foram localizados 11 programas de intervenção, nos quais a abordagem de tratamento predominante foi a terapia cognitivo-comportamental. Os resultados mostraram que vários países têm desenvolvido pesquisas sobre intervenções psicológicas em crise no contexto virtual, em especial a Holanda e a Austrália, apresentando benefícios para quem se favorece dessa ferramenta. Conclusão: Intervenções em crise no contexto online existem e têm sido vastamente desenvolvidas ao redor do mundo. No Brasil, este tema ainda necessita investimento.

Ethics Thinking on Construction of Medical Dispute Prevention and Control Mechanism Under the Perspective of Crisis Management / 中国医学伦理学

Discussion on the construction of medical dispute prevention and control mechanism from the per -spective of crisis management and the ethical thinking are conducive to the effective prevention , control and solution of medical disputes .This can promote the healthy development of the doctor -patient relationship and has the im-portant value of ethics .At present , should strengthen the crisis management from the aspect of ethics to control medical disputes in the following aspects: establishing the medical dispute crisis -prevention mechanism by strengthening the training of medical staff′s medical ethics and medical skill;establishing the medical dispute crisis-resolution mechanism under the principle of respect for life and the patient first;establishing the medical dispute crisis assessment and post -processing mechanism around the idea of love , gratitude , and excellence development .

Changes and strategies of hospital crisis communication management under the context of new media / 中华医院管理杂志

Centering on hospital crisis communication management,the paper analyzed the relationship between hospital crises and new media environment.The new media form is studied as the basic dimension,to explore the new media′s timeliness,openness,interactivity and uncontrollability,as well as their impact on the hospital crisis management.It discussed the lack of hospital crisis communication management under the context of new media environment,and proposed how the hospitals make use of the new media,and adjust their strategies to respond to the crisis.These points prove both academic and practical for the construction of the new mechanism of China ’s hospital crisis communication management,and encourage the new media to play their social public functions.

Contingency nursing care management for ICU wards in case of power failure / 中华医院管理杂志

The paper described the practice of contingency nursing management for ICU wards in case of power breakdown in the hospital The SICU wards have developed their power failure contingency plan in which the nurses on duty are divided into Group A,B and C according to their positions and qualifications.Respectively,they take charge of patient safety,coordination and command,and medical aid.We also established the procedure of emergency response for these duties.Training and examination familiarize the medical personnel with the procedure and their duties.Four practices proved that the implementation of the plan reduces risks exposure and improves the satisfaction.With the contingency plan,the nurses in ICU can now take care of critical incidents and avoid nursing risks in ICU efficiently.

Study on the strategies of hospital crisis management / 中华医学科研管理杂志

critical incidents are significant for the management of hospitals,and it may even be critical to the survival and development of the hospital.This article introduces a series of practices adopted by the First People's Hospital of Changzhou conducted in cases of crisis,and discusses the strategies and measures in hospital crisis management.

Evaluación de riesgos y gestión en desastres: 10 preguntas para la década actual / Risk assessment and disaster management: 10 questions for the present decade

La sociedad humana está siendo tensionada por crecientes eventos destructivos o alteradores de su calidad de vida, ya sea por causas de origen natural o creadas por la acción humana. Frente a estos retos, distintas iniciativas han pretendido en las Décadas 1990-1999 y 2000-2010, corregirlas con éxito. Desafortunadamente, la mayoría de ellas, originadas en el mundo de la Ciencia y Tecnología, no parecen generar igual compromiso y entusiasmo en los niveles políticos y de toma de decisión, expresándose en Políticas Públicas, Leyes, Reglamentos y Presupuestos para una Gestión Integral del Riesgo mucho más Preventiva y permanente en la Agenda Pública. El autor ha seleccionado 10 frecuentes preguntas de su quehacer académico y que nos ayudan a entender mejor este complejo proceso. La Globalización de algunos de estos eventos, como es el caso del Cambio Climático Global, hacen necesario políticas integradoras y un despertar de la comunidad organizada.

Human society is being stressed by increasing destructive events, natural or man-made or those that can alter their quality of life. Facing this challenge, different initiatives on two Decades (1990-1999 and 2000-2010) have attemted to make useful corrections. Unfortunately, most of them born in the world of Sciences and Technology, do not seem to generate equal commitment and enthusiasm at the political and decision-making levels expressed in Public Policies, Laws, Rules and Budgets oriented to Integral Risk Management much more Preventive and Permanent on the Public Agenda. The author has selected 10 frequent questions coming from his academic duties and helping us to better understand this complex process. World-wide events as the case of Global Climatic Change, make necessary integral policies and an awakening of the organized community.

Como colocar em prática o Plano de Atendimento às Emergências (PAE) no laboratório clínico / How to implement the Plan of Care for Emergencies (LAP) in the clinical laboratory

INTRODUÇÃO: A situação socioeconômica e ambiental na qual os laboratórios clínicos vivem, aliada aos riscos ampliados do negócio nos dias atuais, exige dos dirigentes a elaboração de um plano de segurança para situações de catástrofes. OBJETIVO: Esse plano é útil para garantir a continuidade do negócio e sua recuperação após a crise. MÉTODO: O Plano de Atendimento à Emergência (PAE) é apresentado como um conjunto de procedimentos estruturados para a obtenção de respostas rápidas, adestradas e eficientes em situações de emergência no laboratório. CONCLUSÃO: Ele visa prevenir ou mitigar as eventuais consequências adversas para segurança, saúde e meio ambiente no âmbito laboratorial. RESULTADO: Este artigo discute a aplicabilidade, as responsabilidades, a elaboração e a manutenção, assim como suas implicações na rotina laboratorial.

INTRODUCTION: Nowadays, the environmental and socioeconomic contexts in which clinical laboratories are set, coupled with increased business risks, require the formulation of an emergency care plan in case of natural disasters. OBJECTIVE: This plan is useful to ensure business continuity and recovery after crisis. METHOD: The Emergency Care Plan (PAE) is presented as a structured set of procedures for obtaining rapid, efficient and trained responses in emergency situations. CONCLUSION: It aims at preventing or mitigating occasional adverse consequences regarding safety, health and environment in clinical laboratories. RESULTS: This article discusses the applicability, responsibilities, development and maintenance as well as their corresponding implications in laboratory procedures.

Risk and crisis management in intraoperative hemorrhage: Human factors in hemorrhagic critical events / 대한마취과학회지

Hemorrhage is the major cause of cardiac arrest developing in the operating room. Many human factors including surgical procedures, transfusion practices, blood supply, and anesthetic management are involved in the process that leads to hemorrhage developing into a critical situation. It is desirable for hospital transfusion committees to prepare hospital regulations on 'actions to be taken to manage critical hemorrhage', and practice the implementation of these regulations by simulated drills. If intraoperative hemorrhage seems to be critical, a state of emergency should immediately be declared to the operating room staff, the blood transfusion service staff, and blood bank staff in order to organize a systematic approach to the ongoing problem and keep all responsible staff working outside the operating room informed of events developing in the operating room. To rapidly deal with critical hemorrhage, not only cooperation between anesthesiologists and surgeons but also linkage of operating rooms with blood transfusion services and a blood bank are important. When time is short, cross-matching tests are omitted, and ABO-identical red blood cells are used. When supplies of ABO-identical red blood cells are not available, ABO-compatible, non-identical red blood cells are used. Because a systematic, not individual, approach is required to prevent and manage critical hemorrhage, whether a hospital can establish a procedure to deal with it or not depends on the overall capability of critical and crisis management of the hospital.