Comportamento da Rede de Atenção à Saúde durante situações de desastres: estudo de caso da Boate Kiss em Santa Maria-RS / Behavior of the Health Care Network during disaster situations: a case study of the Kiss Nightclub in Santa Maria-RS

RESUMO O objetivo desta investigação foi avaliar o comportamento da Rede de Atenção à Saúde (RAS) durante situações de desastres. O estudo foi realizado em Santa Maria, estado do Rio Grande do Sul, e teve como objeto a atuação do Sistema Único de Saúde (SUS) após o incêndio ocorrido na Boate Kiss, em 2013. Trata-se de uma investigação qualitativa, com características da Avaliação de Quarta Geração. As principais fontes de informação foram entrevistas individuais e coletivas com representantes de grupos com diferentes interesses no tema proposto. A análise de dados identificou três momentos de atuação com características distintas. O enfrentamento inicial dependeu da capacidade de mobilização, conectividade, recursos da comunidade e capacidade convocatória; o atendimento aos sobreviventes e familiares - especialmente atendimento hospitalar - exigiu regulação, financiamento e capacidade de gestão e coordenação de equipes com visão das propostas assistenciais em disputa. Houve abertura para formas menos hierárquicas de gestão dos serviços. A institucionalidade do SUS, com mobilização de recursos, com rede e capacidade de regulação, foi o fator mais importante para enfrentar os efeitos do desastre. A fragmentação dos serviços e a fragilidade da atenção básica limitaram a qualidade da assistência imediata e dificultam o cuidado longitudinal.

ABSTRACT The aim of this study was to evaluate the behavior of the Health Care Network (RAS) during disaster situations. The study was carried out in Santa Maria, state of Rio Grande do Sul, and had as its object the performance of the Unified Health System (SUS) after the fire that took place at the Kiss Nightclub, in 2013. This is a qualitative study, with characteristics of the Fourth Generation Assessment. The main sources of information were individual and collective interviews with representatives of groups with different interests in the proposed topic. Data analysis identified three moments of action with distinct characteristics. The initial response depended on mobilization capacity, connectivity, community resources, and convening capacity; care for survivors and their families - especially hospital care - required regulation, funding, and the ability to manage and coordinate teams with a vision of the care proposals in dispute. There was openness to less hierarchical forms of service management. The institutionality of the SUS, with resource mobilization, network, and regulatory capacity, was the most important factor in facing the effects of the disaster. The fragmentation of services and the fragility of Primary Care limited the quality of immediate care and made longitudinal care difficult.

Profile of transversal skills of Nursing students to intervene in disaster situations / Perfil de competencias transversales de estudiantes de Enfermería para intervenir en situaciones de desastre / Perfil de competências transversais dos estudantes de Enfermagem para intervir em situações de catástrofe

ABSTRACT Objective: to identify the profile of transversal teaching/learning skills, which allows an adequate intervention of disaster nursing students. Methods: this is research framed in the qualitative, transversal paradigm methodology, supported by inductive and exploratory reasoning. Results: it was found that there is no consensus between Nursing Education Major Coordinators/Directors and disaster nursing experts regarding transversal skills considered decisive, due to the current absence of the theme in study plans and the limited personal and professional training of professors. Final considerations: the development and implementation of teaching/learning strategies that allow the development of transversal skills, favoring students' ability to meet this reality in a conscious, balanced and efficient way, is crucial.

RESUMEN Objetivo: identificar el perfil de competencias transversales de enseñanza/aprendizaje, que permita una adecuada intervención del estudiante de la Licenciatura en Enfermería en el dominio de la catástrofe. Resultados: se constató que no existe consenso entre los Coordinadores/Directores de la Licenciatura en Enfermería y los expertos en enfermería de catástrofes respecto a las competencias transversales consideradas cruciales. Métodos: investigación enmarcada en la metodología del paradigma cualitativo, transversal, sustentada en razonamientos inductivos y exploratorios. Consideraciones finales: es crucial el desarrollo e implementación de estrategias de enseñanza/aprendizaje que permitan el desarrollo de competencias transversales, favoreciendo la capacidad del estudiante para afrontar esta realidad de manera consciente, equilibrada y eficiente.

RESUMO Objetivo: identificar o perfil de competências transversais de ensino/aprendizagem, que permita uma intervenção adequada do estudante do Curso de Licenciatura em Enfermagem no domínio da catástrofe. Métodos: investigação enquadrada na metodologia do paradigma qualitativo, transversal, apoiada no raciocínio indutivo e exploratória. Resultados: verificou-se que não existe consenso entre os Coordenadores/Diretores dos Cursos de Licenciatura em Enfermagem e os peritos de enfermagem em catástrofe quanto às competências transversais consideradas determinantes, decorrente da atual ausência da temática nos planos de estudo e da diminuta formação pessoal e profissional dos docentes. Considerações finais: o desenvolvimento e implementação de estratégias de ensino/aprendizagem, que permitam o desenvolvimento de competências transversais, favorecendo a capacidade do estudante para se encontrar com esta realidade de maneira consciente, equilibrada e eficiente, assume-se crucial.

Algunas consideraciones sobre la organización del sistema sanitario frente a una pandemia / Considerations regarding organizing healthcare systems for a pandemic

No hay fórmula única para enfrentar una pandemia. La diversidad de liderazgos, objetivos sanitarios, escenarios, culturas, financiamiento, y organizaciones de sistemas de salud existentes obligan a cada país a buscar sus propias estrategias. La pandemia causada por el virus SARS-CoV-2 y la tremenda cantidad de información que se ha generado a su entorno ha motivado la necesidad de evaluar la preparación de los sistemas de salud para enfrentar, responder y sobrevivir a un evento de esta naturaleza. Este artículo aporta consideraciones al respecto.

There is no "one size fits all" solution for healthcare systems when it comes to pandemics. Different and diverse scenarios with regards to financing, healthcare system structure, cultural issues and political orientation force countries to seek the most appropriate strategies for their particular case. The SARS-CoV-2 pandemic and the tremendous amount of information that is has generated pressures the need for healthcare systems to seriously evaluate how prepared they are for facing, responding and emerging from an event of this nature. This article offers considerations on the subject.

Desastre da Samarco e políticas de saúde no Espírito Santo: ações aquém do SUS? / Samarco disaster and health policies in Espírito Santo

RESUMO O presente estudo buscou compreender as ações mitigadoras propostas como resposta ao impacto provocado pelo rompimento da barragem da Samarco na cidade de Mariana, Minas Gerais. Como parte de um estudo maior, este recorte enfoca as políticas públicas de saúde e as cidades de Colatina e Linhares, no estado do Espírito Santo. Por meio de métodos qualitativos, investigaram-se o arranjo político-administrativo que envolve a empresa Samarco, o Comitê Interfederativo (CIF), a Fundação Renova e os poderes públicos, interrogando sobre o papel dos atores na produção de medidas compensatórias e reparatórias. Foram utilizadas a análise de documentos, sobretudo, os relatórios disponíveis no site da Fundação Renova (de março de 2016 a maio de 2018), e sete entrevistas semiestruturadas com atores de referência nas duas cidades estudadas. A análise foi orientada pelo escopo teórico do ciclo de políticas públicas. Identificou-se uma estrutura político-administrativa formulada de forma nitidamente top down, com ênfase na etapa da formulação de políticas em detrimento da entrega de serviços e com pouca articulação entre os atores públicos e da sociedade civil na busca de solução de problemas de saúde.

ABSTRACT The present study sought to understand the mitigating actions proposed in response to the impact caused by the rupture of the Samarco dam in the city of Mariana, Minas Gerais. As part of a larger study, this section focuses on public health policies and the cities of Colatina and Linhares, in the state of Espírito Santo. Through qualitative methods, the political-administrative arrangement involving the company Samarco, the Interfederative Committee (CIF), the Renova Foundation and public authorities was investigated, questioning the role of the actors in the production of compensatory and remedial measures. Document analysis was used, especially the reports available on the Renova Foundation website (from March 2016 to May 2018), and seven semi-structured interviews with leading actors in the two cities studied. The analysis was guided by the theoretical scope of the public policy cycle. A clearly structured top-down political-administrative structure was identified, with an emphasis on the formulation of policies at the expense of service delivery and little articulation between public actors and civil society in the search for solutions to health problems.

Interlocução das políticas públicas ante a gestão de riscos de desastres: a necessidade da intersetorialidade / Interlocution of public policies regarding disaster risk management: the need for intersectoriality

RESUMO No Brasil, o modo de realizar a gestão de riscos de desastres mudou a partir da Lei nº 12.608 da Política Nacional de Proteção e Defesa Civil (PNPDEC), em 2012, que preza pelo desenvolvimento sustentável por meio da integração de políticas públicas e de suas respectivas estratégias visando à garantia dos direitos humanos. Nesse sentido, a pesquisa analisou as ações de interlocução das políticas públicas ante a gestão de riscos de desastres em uma cidade da região da Foz do Rio Itajaí, Santa Catarina, Brasil. O estudo qualitativo exploratório foi realizado mediante um roteiro de entrevista semiestruturado, respondido por 12 participantes atuantes em 9 diferentes órgãos que colaboram para a gestão de riscos de desastres. A utilização da Grounded Theory permitiu que os dados fossem analisados e discutidos por intermédio do conteúdo das respostas e fundamentos teóricos. Evidenciaram-se a ausência de ações intersetoriais voltadas à vulnerabilidade socioambiental, o enfoque em ações de resposta ao desastre e a dificuldade em dar continuidade aos trabalhos realizados devido às interrupções ocasionadas por mudanças nos cargos políticos. Sugere-se que a vulnerabilidade socioambiental seja trabalhada transversalmente em todas as etapas, articulada entre todos os atores do processo.

ABSTRACT In Brazil, the way to carry out disaster risk management has changed since Ordinance nº 12.608 of the National Policy on Protection and Civil Defense (PNPDEC), in 2012, which values sustainable development through the integration of public policies and their respective strategies for the guarantee of human rights. This way, the research analyzed the actions of public policy interaction on disaster risk management in a city located in the Foz do Rio Itajaí region, Santa Catarina, Brazil. The qualitative exploratory study was conducted through a semi-structured interview script answered by twelve participants, between employees and managers acting in nine different agencies that collaborate for the management of disaster risks. The use of the Grounded Theory allowed data to be analyzed and discussed through the content of the answers and theoretical foundations. Some topics became evident, such as the lack of intersectoral actions focused on socio-environmental vulnerability, the focus on disaster response actions, and also the difficulty in continuing the work carried out due to the interruptions caused by changes in political administrations. It is suggested that socio-environmental vulnerability be discussed in a transversal way in all stages, articulated among all actors who are part of the process.

Entre sirenes, rotas de fuga e exercícios de simulação: vida cotidiana sob os riscos de desastres / Between sirens, escape routes, and emergency drills: everyday life under the risk of disaster

RESUMO Este artigo problematiza a disseminação institucional recente de dispositivos para a redução de riscos de desastres - caracterizados pela tríade sirenes, sinalização de rotas de fuga e exercícios simulados de emergência - desde uma perspectiva sociológica e em interface com o olhar antropológico. Parte-se metodologicamente da identificação de nexos significativos entre as noções de vida cotidiana, ordem social e communitas para, então, considerar as modulações entre tais nexos no que tange à (in)viabilização do bem-estar coletivo. Embora apresentados no sistema de proteção e defesa civil como sendo estratégias eficazes ante perigos consideráveis, essa reflexão sugere que tais dispositivos de redução de riscos de desastres cumpram uma finalidade subsidiária. Tratar-se-ia de retirar da sociedade uma visão mais crítica sobre as origens dos processos socioambientais geradores de tais perigos. Ao se indagar acerca do quão efetivo esse conjunto de estratégias padronizadas poderia ser diante das dinâmicas socioambientais complexas dos diferentes contextos comunitários nos quais têm sido replicadas, conclui-se que o efeito prático mais preocupante é o de, progressivamente, converter o medo coletivo de uma possível ocorrência de desastres em um meio pelo qual se buscaria naturalizar uma ordem social baseada em comportamentos sociais dóceis a uma ordem social antidemocrática.

ABSTRACT This article aims to present the problematics of the recent institutional dissemination of a given set of disaster risk reduction strategies, characterized by the triad composed by sirens, escape routes, and emergency drills, using a sociological perspective, in interface with the anthropological view. It begins with the identification of significant links of the notions of everyday life, social order, and communitas. Then, it is analysed the modulations of such links, concerning the (in)practicability of the collective wellbeing. Although these are present in the civil protection and defense system as effective strategies when facing considerable dangers, this reflection suggests that such dispositifs for disaster reduction serve a secondary purpose. That is to hinder from society the critical perspective about the origins of the socioenvironmental processes that generates such dangers. By asking how effective this set of standardized strategies could be, given the complexity of socioenvironmental dynamics in different community contexts in which such strategies have been replicated, one concludes that their primary effect is to convert the collective fear of a possibility of occurrence of disaster into a means by which a new non-democratic social order based on docile collective behaviour is emerging.

O rejeito e suas diversas marcas: saúde dos trabalhadores da Defesa Civil no rompimento da barragem de Fundão / The reject and its various brands: health of Civil Defense workers in the rupture of the Fundão dam

RESUMO A partir do desastre socioambiental ocorrido em Mariana (MG), em 5 de novembro de 2015, o estudo buscou compreender a atividade dos técnicos da Defesa Civil que atuaram no desastre. A reflexão que aqui se desenvolve parte do esforço de dar visibilidade à atividade desses profissionais que atuam em condições permeadas de imprevisibilidades e pressões. O estudo tem como referenciais os aportes do campo da Saúde do Trabalhador e da ergologia. Trata-se de uma pesquisa empírica, de abordagem qualitativa, realizada por meio de observação direta e entrevistas individuais semiestruturadas com trabalhadores da Defesa Civil. A análise dos resultados foi organizada em duas grandes seções com os seus respectivos desdobramentos: a primeira traz uma contextualização do desastre narrada pelos diversificados profissionais que atuaram; a segunda evidencia desafios e perspectivas que os agentes de defesa civil puderam tirar da catástrofe. Diante da complexidade das situações e da dimensão imprevisível do risco, os agentes de defesa civil são constantemente convocados a 'renormatizar' e a operar escolhas a partir de sua história e de seus valores para lidar com as infidelidades do meio.

ABSTRACT From the socio-environmental disaster that took place on November 5th, 2015 in Mariana (MG), the study sought to understand the activity of Civil Defense technicians who acted in the disaster, aiming to collaborate for actions of worker's health surveillance. The reflection that develops here is part of the effort to give visibility to the activity of those professionals who work in conditions permeated with unpredictability and pressure. The study has as references the contributions from the field of Occupational Health and ergology. This is an empirical research with a qualitative approach, conducted through direct observation and semi-structured individual interviews with Civil Defense professionals. The analysis of the results was organized in two large sections with their respective consequences: the first brings a contextualization of the disaster narrated by the several professionals who worked during it; the second focuses on the challenges and perspectives that civil defense agents have been able to draw from the disaster. Faced with the complexity of situations and the unpredictable dimension of risk, civil defense agents are constantly called upon to 'renormatize' and operate choices based on their history and their values to deal with environmental infidelities.

Os cirurgiões e a pandemia do COVID-19 / The surgeons and the COVID-19 pandemic

RESUMO A atual pandemia do novo coronavírus, Covid-19, tem sido o assunto mais discutido no momento, tanto na mídia como em periódicos científicos. O medo, a incerteza e o desconhecimento sobre o comportamento da doença são os fatores preponderantes que podem justificar essa realidade. Sabe-se de antemão que a enfermidade tem grande disseminação, é mais grave entre idosos e está associada a grande impacto socioeconômico mundial. Além dos desafios em lidar com o desconhecido, há outros relacionados com a sobrecarga de informação e nesse quesito, a grande quantidade de estudos científicos, que englobam pesquisas in vitro, relatos de casos, estudos observacionais e randomizados, além de revisões sistemáticas complementam o panorama de dúvidas. Essa situação é piorada porque o conhecimento sobre o método científico não é dominado pela maioria dos profissionais de saúde, algo que há muito já vem sendo divulgado por vários autores. De sorte que em função desta realidade, torna-se fundamental que sociedades de especialidades apoiadas por dados da Organização Mundial da Saúde e do Ministério da Saúde assumam a liderança da divulgação da informação correta e confiável. O Colégio Brasileiro de Cirurgiões sugere neste documento medidas que podem auxiliar cirurgiões e outros profissionais de saúde, assim como pacientes, em caso de necessidade cirúrgica, a lidar com a atual pandemia.

ABSTRACT The current world Covid-19 pandemic has been the most discussed topic in the media and scientific journals. Fear, uncertainty, and lack of knowledge about the disease may be the significant factors that justify such reality. It has been known that the disease presents with a rapidly spreading, it is significantly more severe among the elderly, and it has a substantial global socioeconomic impact. Besides the challenges associated with the unknown, there are other factors, such as the deluge of information. In this regard, the high number of scientific publications, encompassing in vitro, case studies, observational and randomized clinical studies, and even systematic reviews add up to the uncertainty. Such a situation is even worse when considering that most healthcare professionals lack adequate knowledge to critically appraise the scientific method, something that has been previously addressed by some authors. Therefore, it is of utmost importance that expert societies supported by data provided by the World Health Organization and the National Health Department take the lead in spreading trustworthy and reliable information. The Brazilian College of Surgeons suggests in this document various initiatives that may help surgeons, healthcare providers, and patients who will have to face a surgical event under the pandemic.

Impact of the 2015 Middle East Respiratory Syndrome Outbreak on Emergency Care Utilization and Mortality in South Korea

PURPOSE: In May 2015, South Korea experienced an epidemic of Middle East respiratory syndrome (MERS). This study investigated the impacts of MERS epidemic on emergency care utilization and mortality in South Korea. MATERIALS AND METHODS: A natural experimental study was conducted using healthcare utilization and mortality data of the entire Korean population. The number of monthly emergency room (ER) visits was investigated to identify changes in emergency care utilization during the MERS epidemic; these trends were also examined according to patients' demographic factors, disease severity, and region. Deaths within 7 days after visiting an ER were analyzed to evaluate the impact of the reduction in ER visits on mortality. RESULTS: The number of ER visits during the peak of the MERS epidemic (June 2015) decreased by 33.1% compared to the average figures from June 2014 and June 2016. The decrease was observed in all age, sex, and income groups, and was more pronounced for low-acuity diseases (acute otitis media: 53.0%; upper respiratory infections: 45.2%) than for high-acuity diseases (myocardial infarctions: 14.0%; ischemic stroke: 16.6%). No substantial changes were detected for the highest-acuity diseases, with increases of 3.5% for cardiac arrest and 2.4% for hemorrhagic stroke. The number of deaths within 7 days of an ER visit did not change significantly. CONCLUSION: During the MERS epidemic, the number of ER visits decreased in all age, sex, and socioeconomic groups, and decreased most sharply for low-acuity diseases. Nonetheless, there was no significant change in deaths after emergency care.

A preliminary study on psychological crisis intervention strategies used in public emergencies / 中华健康管理学杂志

Objective To explore the strategies of using psychological crisis intervention in public emergencies.Methods In the early stage,psychological crisis intervention concepts and behavioral responses were formed through literature research and qualitative research methods.Use three rounds of Delphi for expert advice.Three indexes including positive coefficient,authority and coordination were used to test the reliability of expert consultation.Results Overall,it passed 239 out of 269 entries.The first round passed item 210,modified item 18,no consensus item 41;In the second round,8 new entries were added,and 22 entries were deleted through 24 entries.In the third round,there were 5 entries and 16 entries were deleted.The authority coefficient was 0.859,indicating that the experts were very familiar with the items.The coordination coefficient of three rounds of consultations were 0.464,0.696,and 0.407 (P＜0.001)respectively,showing that the coordination degree of experts was excellent,the credibility of feedback was high,and results were highly reliable.Conclusions The strategies of field psychological crisis intervention for public emergencies developed in this study received the consensus by domestic psychological crisis intervention experts,it is will provide a basis for systematic,comprehensive and effective guidance for this work.

Simulation of Red Blood Cell-Limited Transfusion Policy in Case of Disruption of Blood Supply by Disaster: Results of a Tertiary Care Hospital in Korea / 대한수혈학회지

BACKGROUND: Disasters themselves can increase the blood transfusion requirements due to an increase in injuries, and can lead to deficiencies in the blood transport system. To prepare for a disaster, it is important to know the actual blood requirements at the time of the disaster and the changes in blood supply according to the type of disaster. METHODS: From March 2018 to May 2018, all RBC transfusion cases at Pusan National University Yangsan Hospital were analyzed retrospectively. The patients were divided into Categories 1 to 3 according to the urgency of transfusion by disease. Priority one was defined as having only a category 1 patient receiving a transfusion, and priority two was defined as an emergency situation where only category 1 and 2 patients could receive transfusions. RESULTS: The amount of RBC concentrates used in this hospital was 53.1 units per day, which was 19.4%, 42.2%, and 38.4% in category 1, 2, and 3, respectively. The results of simulating the number of blood products that can be used according to the priorities when having a blood product inventory held by the blood banks are as follows: 2.45 days (normal), 12.64 days (P1), and 3.97 days (P2) can be used. CONCLUSION: The simulation showed the time of blood transfusion without additional blood supply in the event of a crisis, and will help establish the transfusion countermeasures in the event of a disaster.

In-person and telemedicine course models for disaster preparedness: a comparative analysis / Modelo de curso presencial e via telemedicina para preparação em desastres: uma análise comparativa

ABSTRACT Objective: to compare the students' performance in face-to-face and telemedicine courses for the training and necessary action in disasters, using telemedicine as an effective training tool. Methods: online research conducted after the end of the course of preparation in disasters, carried out in-person, as well as by videoconference. We compared the performance of students in the in-person course and through telemedicine. Results: in the comparison of the results obtained with the pre- and post-test data between the students who attended via telemedicine and in-person, we observed that in the two modalities there was an increase in knowledge (p<0.001). We also observed no statistically significant differences in the posterior evaluation between the in-person and telemedicine courses (p=1.0), however, there was a significant difference at the pre-test evaluative moment (p<0.001). Conclusion: videoconferencing can be effectively used to train health professionals in disaster management, being able to provide adequate knowledge and become an important tool to distance reaching in continuing education.

RESUMO Objetivo: comparar o desempenho dos alunos nos cursos presenciais e via telemedicina para a capacitação e atuação necessária em desastres, se valendo da telemedicina como uma ferramenta efetiva de treinamento. Métodos: pesquisa online realizada após o término do curso de preparação em desastres, realizado presencialmente, bem como, por videoconferência. Comparou-se o desempenho dos alunos do curso presencial e via telemedicina. Resultados: na comparação dos resultados obtidos com os dados pré e pós-teste entre os alunos que cursaram via telemedicina e presencialmente, observou-se que nas duas modalidades do curso houve aumento do conhecimento (p<0,001). Constatou-se ainda que não houve diferenças estatisticamente significativas na avaliação posterior entre os cursos presenciais e via telemedicina (p=1,0), no entanto, houve diferença com significância no momento avaliativo pré-teste (p<0,001). Conclusão: as videoconferências podem ser utilizadas de forma efetiva para a capacitação de profissionais da área de saúde na gestão de desastres, sendo capaz de prover o conhecimento de forma adequada e ser ferramenta importante para alcance à distância em educação continuada.

Abrigos temporários em desastres: a experiência de São José do Rio Preto, Brasil / Temporary shelters in disasters: the experience of São José do Rio Preto, Brazil

RESUMO Relato de experiência sobre o planejamento dos abrigos temporários montados em São José do Rio Preto, na catástrofe de 11 de janeiro de 2011. Objetivou-se analisar o planejamento de um abrigo, a partir de princípios de assistência, utilizando-se documentos da Secretaria Nacional de Proteção e Defesa Civil. Foram escolhidas barracas Shelter Box para a abrigagem, com áreas de convívio. A infraestrutura de apoio possuía coleta de resíduos, abastecimento de água e de alimentos satisfatórios. Estava disponível equipe de profissionais de saúde. As ações de recuperação são complexas e devem estar articuladas e direcionadas ao interesse da população atingida, adaptando-se às mudanças necessárias.

ABSTRACT Experience report on the planning of temporary shelters assembled after São José do Rio Preto's disaster on January 11, 2017. This study aimed to analyze the planning of a shelter from assistance principles, using documents from the National Protection and Civil Defense Department. Shelter Boxes were chosen for sheltering, with living areas. The support infrastructure has been satisfactory, with waste collection, and water and food supply. Health care professionals were available. Recovery actions are complex and must be articulated and directed to the interest of the population, with high adaptive capacity to the necessary changes.

Disaster Basic Physics and Disaster Paradigm / 한양의대학술지

Disasters are unpredictable and unavoidable. The definition of disaster is a serious disruption of the functioning of society, causing widespread human, material, or environmental losses that exceed the ability of affected society to cope using only its own resources. Disaster medicine is a discipline resulting from combination of emergency medicine and disaster management. The field of disaster medicine involves the study of subject matter from multiple medical disciplines, and disaster medicine presents unique ethical situations not seen in other areas of medicine. Disaster can be classified into two categories, natural disaster and manmade disaster, each type of disaster has its own characteristics. Disaster management has a cycle of 4 activities, preparedness, response, recovery, and prevention/mitigation. Disaster medicine specialists have a role in each part of this cycle. To achieve effective disaster response, the National Disaster Life Support Foundation suggests the DISASTER Paradigm(TM), which consists of detection, incident command, safety and security, assess hazards, support, triage and treatment, evacuation, and recovery.

Public Safety Communication and Networking Technologies for Disaster Response and Medical Assistance / 한양의대학술지

Future major disasters require the development of socially transparent and rational-decision-making procedures. Recent reports indicate that the frequency of human disasters are decreasing while natural disasters and social disasters are becoming more frequent. The creation of a disaster communication network, which is essential in protecting the life and property as well as providing a sense of societal security. Standards for a modern disaster communication network must be developed at the national level, with national state support for a 3rd generation partnership project such as a Public Safety-LTE that allows the construction of an effective national disaster network plan. Compliance and certification standards to ensure interoperability of communications and other equipment are necessary for the creation of a modern national disaster network that allows more efficient management of disaster situations. It can be expected that our efforts and example can help other countries to build a standard protocol for managing the national disasters.

Disaster Planning in Korea / 한양의대학술지

In response to modern events, every nation endeavors to develop plans to meet the challenges of disasters, but it is not possible to be prepared for every event and the ability to respond adequately is often limited. In the Republic of Korea, national disaster response efforts are defined by the Korea Basic Law for Disaster and Safety Management of 2004 and the establishment of the National Emergency Management Agency (NEMA) provides a framework for a holistic disaster prevention and recovery plan. However, the tragedy involving the sinking of the Sewol ferry in 2014 revealed a number of flaws in the current Korean disaster response system. In response to the shortcomings demonstrated in the Sewol incident, both NEMA and the Korean Coast Guard dissolved and the Korean disaster response system is being revised under the creation of the new Ministry of Public Safety and Security. However, the current national disaster management system still has many significant underlying and systematic problems that must be addressed. First, there is confusion concerning the responsible governmental organizations that will handle the various aspects of a comprehensive disaster management plan. Second, the relationships between the laws and government organizations involving planning, managing and reporting are in a vertical relationship, while the entities responsible for the actual response efforts exist in a horizontal relationship. This organizational limitation results in a slowdown of communication and confusion between the responsible parties. Thirdly, and consequently, there is a significant lack of unity and organization between the many organization responsible for disaster response. Finally, an efficient, accurate database of resources available to meet disasters remains to be developed. These and other limitations reveal that there is a significant amount of work that remains in order for Korea to have the same level of disaster response system of other developed nations.

Single Center Experiences to Landslides on Woo-myun Mountain: Preparedness, Response, and Lessons Learned

PURPOSE: On July 27, 2011, landslides occurred on Woomyun Mountain, resulting in development of mass casualties. Seoul St. Mary's Hospital was the primary recipient of patients. This experience prompted the drafting of a formal disaster plan. Therefore, we outline the Emergency Management External Disaster Plan of Seoul St. Mary's Hospital and discuss the time course of presentation and medical characteristics of the patients. METHODS: We conducted a retrospective review of medical records of patients who visited Seoul St. Mary's Hospital from Woo-myun Mountain landslides. In addition, we reviewed the time course of hospital disaster response. RESULTS: A total of 33 patients participated in this study. Mean age was 40.2 (+/-21.8) years; eight patients died at the time of admission and cardiopulmonary resuscitation was performed in one patient. Mean Injury Severity Score (ISS) was 9.19 and four patients were ISS above 15. Six patients were admitted to our hospital and two patients underwent an emergency operation. Overall, the emergency disaster management was appropriate due to the formal disaster plan and experiences in conduct of disaster drills. However, there were also several problems. The major problems of our disaster response were as follows: delayed activation of external disaster, difficulties in securing a treatment section, and absence of a decontamination facility. CONCLUSION: We observed several problems from our experience with Woo-myun Mountain landslides. Reassessment of the disaster plan and additional planning for other possibilities are needed.

Hospital seguro frente aos desastres: uma reflexão sobre biossegurança e arquitetura / Hospitals safe from disasters: a reflection on architecture and biosafety

Um dos maiores desafios da sociedade atual é o enfrentamento das adversidades causadas pelos desastres. Os estabelecimentos de saúde, principalmente os hospitais, são considerados essenciais nessas situações. Este trabalho discute os princípios da arquitetura do hospital seguro frente aos desastres, como propõem a Organização Mundial da Saúde e a Organização Pan-Americana da Saúde. Projetar um hospital seguro exige ações multidisciplinares, com envolvimento de administradores, arquitetos, engenheiros, médicos e enfermeiros. O planejamento de cada hospital pressupõe uma análise de riscos e aspectos de segurança específicos. Também é importante agregar a biossegurança ao conceito de hospital seguro. O equilíbrio entre aspectos arquitetônicos e biossegurança permite a compreensão dos riscos associados ao trabalho, facilitando o dimensionamento de espaços para suportar as ações de resposta frente às emergências. Em suma, a programação de um hospital seguro requer uma síntese de conhecimentos que relacionam diversos saberes, entre eles os da biossegurança e da arquitetura hospitalar. Esses princípios devem embasar as indagações sobre o hospital seguro e o planejamento de projetos arquitetônicos com foco na manutenção das instalações em capacidade máxima mesmo diante de situações adversas.

One of the biggest challenges in today’s society is facing adversity caused by disasters. Health facilities, especially hospitals, are considered essential in these situations. This article discusses the principles of architectural design of hospitals safe from disasters, as proposed by the World Health Organization and the Pan American Health Organization. Designing a safe hospital requires multidisciplinary efforts, involving administrators, architects, engineers, physicians, and nurses. The planning of each hospital demands the analysis of specific risks and safety concerns. The concept of biosafety should also be addressed in planning safe hospitals. The balance between architectural aspects and biosafety provides an understanding of work-associated risks, facilitating the adequate planning of spaces to support response actions to emergencies. In short, the planning of a safe hospital requires the synthesis of various types of expertise, including those relating to biosafety and architecture. These principles should support the appraisal of safe hospitals and architectural planning with a focus on preparing facilities to function at full capacity even in the face of adverse situations.

Interoperability in disaster medicine and emergency management / Interoperabilidade em Medicina de Desastres e Administração de Emergência

Accurate and timely information is critical for health early warning and effective emergency management. Health Information Technology (HIT) standards address the challenge of integrating information from disparate healthcare resources e.g. devices, people, and information systems to support not only the effective handling of emergencies, but also their analysis for long-term resource planning. In the management of emergencies, co-operative use of standards facilitates effective sharing of information among the parties involved in search and rescue, continuous disaster assessment, and public awareness. This paper discusses the cooperative use of interoperability standards from Health Level Seven (HL7), the Organization for the Advancement of Structured Information Standards (OASIS), the European Committee for Standardization (CEN), and other Standards Developing Organizations to harness the power of Information and Communication Technologies (ICT) in emergency preparedness and response. The paper reports on the experience gained from the deployment of ICT in the Satellites for Epidemiology and health early warning (SAFE) civil protection exercise and interoperability considerations in technical solutions to be deployed in the ?POSEIDON? exercise (earthquake followed by tsunami in the Mediterranean) still at the planning stage.

Informações acuradas e na hora oportuna são essenciais para a emissão de alertas precoces de saúde e para a gestão eficaz de situações de calamidade pública. Os padrões de Tecnologia da Informação em Saúde objetivam resolver o desafio de integrar informações de diferentes recursos de saúde, como por exemplo dispositivos, pessoas e sistemas de informação para apoiar não só o tratamento eficaz nas situações de emergência, mas também na sua análise, para planejamento de recursos de longo prazo. Na gestão de emergências, o uso cooperativo de padrões facilita o compartilhamento eficaz de informações entre as partes envolvidas na busca e salvamento, de avaliação de desastres e conscientização pública. Este artigo discute o uso cooperativo de padrões de interoperabilidade do Health Level Seven (HL7), do Organização para o Avanço de Padrões de Informação Estruturados (OASIS), Comité Europeu de Normalização (CEN), e outras normas das organizações produtoras de padões para fortalecer o poder de Tecnologias de Informação e Comunicação (TICs) na preparação e resposta a emergências. O artigo relata a experiência adquirida com a utilização das TIC nos satélites de Epidemiologia e de alerta precoce de saúde (SAFE) exercício de protecção civil e os aspectos da interoperabilidade nas soluções técnicas a serem implantados no exercício ?Poseidon? (terremoto seguido de tsunami no Mediterrâneo) ainda em fase de planejamento...

El terremoto de 2010 en Chile: respuesta del sistema de salud y de la cooperación internacional / The 2010 earthquake in Chile: the response of the health system and international cooperation

OBJETIVO: Conocer la respuesta que dieron el sistema de salud y la cooperación internacional a la situación de catástrofe generada por el terremoto y el tsunami ocurridos el 27 de febrero de 2010 en Chile, y elaborar propuestas para mejorar las estrategias dirigidas a reducir los efectos devastadores de los desastres naturales. MÉTODOS: Estudio descriptivo y cualitativo con una primera fase de análisis de información secundaria -como artículos de prensa, discursos oficiales e informes técnicos- y una segunda fase de aplicación de entrevistas semi-estructuradas a actores institucionales encargados de la respuesta al desastre desde el sector salud y a usuarios del sistema de salud que actuaron como líderes y/o dirigentes en dicha respuesta. La investigación se desarrolló entre mayo y octubre de 2010 y el levantamiento de información se focalizó en las regiones Maule, Bío Bío y Metropolitana. RESULTADOS: Faltaron procedimientos para el registro, la distribución y el control de las donaciones. Los servicios de salud sufrieron daños importantes, incluida la destrucción total de 10 hospitales. Los hospitales de campaña y los equipos médicos extranjeros fueron valorados por la comunidad. El modelo de salud familiar y el compromiso del personal facilitaron la calidad de la respuesta. Si bien hubo un buen manejo sanitario, se registraron dificultades para enfrentar los problemas de salud mental por la inexistencia de planes locales y de simulacros previos. La población más afectada fue la que vivía en condiciones de pobreza. Las mujeres se convirtieron en líderes sociales organizando a la comunidad. CONCLUSIONES: Aun cuando la respuesta sanitaria frente a la emergencia fue satisfactoria, tanto el sistema de salud como la movilización de la asistencia internacional acusaron falencias que reforzaron inequidades previamente instaladas, demostrando la necesidad de construir planes preventivos multisectoriales y participativos para estar mejor preparados frente a los desastres.

OBJECTIVE: Understand the health system and international cooperation response to the catastrophic situation left by the earthquake and tsunami of 27 February 2010 in Chile, and draft proposals for improving strategies to mitigate the devastating effects of natural disasters. METHODS: Descriptive and qualitative study with a first phase involving the analysis of secondary information-such as news articles, official statements, and technical reports-and a second phase involving semistructured interviews of institutional actors in the public health sector responsible for disaster response and users of the health system who acted as leaders and/or managers of the response. The study was conducted between May and October 2010, and information-gathering focused on the Maule, Bío Bío, and Metropolitan regions. RESULTS: Procedures for recording, distributing, and controlling donations were lacking. The health services suffered significant damage, including the complete destruction of 10 hospitals. The presence of field hospitals and foreign medical teams were appreciated by the community. The family health model and the commitment of personnel helped to ensure the quality of the response. While public health management was generally good, problems dealing with mental health issues were encountered due to a lack of local plans and predisaster simulations. The poor were the most affected. Women became social leaders, organizing the community. CONCLUSIONS: Although the health response to the emergency was satisfactory, both the health system and the mobilization of international assistance suffered from weaknesses that exacerbated existing inequities, revealing the need for multisectoral participatory mitigation plans for better disaster preparedness.