Preparação e resposta a desastres do Brasil na pandemia da COVID-19 / Preparación y respuesta a desastres de Brasil en la pandemia de COVID-19 / Disaster preparedness and response in Brazil in the face of the COVID-19 pandemic

Resumo Como a crise em saúde pública causada pela pandemia da COVID-19 ajuda a compreender o funcionamento do Sistema Nacional de Proteção e Defesa Civil (SINPDEC) nas fases de preparação e resposta a desastres em saúde no Brasil? A resposta a essa pergunta se dará por meio do seguinte objetivo geral: compreender o funcionamento do SINPDEC no enfrentamento à COVID-19, com ênfase na atuação do Ministério da Saúde (MS), órgão gestor de combate às ameaças em saúde. Para tanto, três objetivos específicos serão explorados: caracterizar a (doença) COVID-19 como evento em saúde pública com potencial causador de desastre, situar os conceitos de preparação e resposta na literatura de governança de desastres e identificar previsões legais e funcionamento da gestão de desastres no Brasil. A despeito das tensões decisórias no âmbito político, a burocracia profissional brasileira conseguiu garantir a ativação do sistema de governança de desastres relativa às fases de preparação e resposta. Contudo, sua ativação não foi suficiente para aplacar a crise, cujo agravamento expõe falhas nas fases de prevenção e mitigação de desastres, bem como a falta de uma resposta ao desastre em âmbito federativo.

Resumen ¿Cómo la crisis de salud pública causada por la pandemia de COVID-19 ayuda a comprender el funcionamiento del Sistema Nacional de Protección y Defensa Civil (SINPDEC) en las fases de preparación y respuesta a desastres de salud en Brasil? La respuesta a esta pregunta se dará mediante el siguiente objetivo general de investigación: comprender el funcionamiento del SINPDEC en el afrontamiento a la COVID-19, con énfasis en el trabajo del Ministerio de Salud, organismo gestor del combate contra las amenazas a la salud. Con este fin, se explorarán tres objetivos específicos: caracterizar la COVID-19 como un evento de salud pública con el potencial de causar un desastre; situar los conceptos de preparación y respuesta en la literatura sobre gestión de desastres; e identificar las predicciones legales y el funcionamiento de la gestión de desastres en Brasil. Se argumenta que, a pesar de las tensiones políticas en la toma de decisiones, la burocracia profesional brasileña logró garantizar la activación del sistema de gestión de desastres relacionado con las fases de preparación y respuesta. Sin embargo, su activación no fue suficiente para aplacar la crisis, cuyo empeoramiento expone fallas en las fases de prevención y mitigación de desastres, así como la falta ‒e importancia‒ de una respuesta al desastre en ámbito federativo.

Abstract This article aims to understand how the National System of Protection and Civil Defense functions in response to COVID-19, with emphasis on the work of the Ministry of Health, which is the body responsible for tackling health threats. Three specific objectives were used: the first characterizes COVID-19 as a public health event that can represent a disaster; the second situates the concepts of preparedness and response in the disaster governance literature; the third identifies the jurisprudence and the functioning of disaster management in Brazil. The findings show that, despite the political decision-making tensions, the Brazilian professional bureaucracy managed to guarantee the activation of the disaster governance system related to the preparation and response phases. However, its activation was not enough to allay the crisis. The severity of the pandemic exposed flaws in the phases of disaster prevention and mitigation, as well as the lack of coordinated government response.

Disasters and the disaster medicine

The definition of a disaster varies across research institutions, although it is generally regarded as a sudden event that demands more resources than the community can offer. Disaster medicine originates from military medicine. It is a new field of medicine that has much in common with emergency medicine, but focuses more on disaster management, targeting populations. It plays a key role both in the pre-event period by helping with disaster preparedness and in the event of a disaster by providing disaster medical services, including on-scene emergency life-saving interventions, thereby contributing to a decrease in the preventable mortality rate. Triage is a system used to sort mass disaster victims according to severity, enabling resources to be allocated, distributed, and utilized more efficiently. During disasters, a hospital should respond to the surge in patients in accordance with the standards and principles of disaster medicine by activating its emergency operation plan, converting the usual medical system into the emergency system, and putting disaster response teams into operation. Disaster medicine is the key discipline for all aspects of preparedness and response to conventional disasters, and even to chemical, biological, radiological, nuclear, and explosive events.

Health risks of selected mass gatherings in the Philippines in 2015 and implications for public health preparedness

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Mass gatherings (MG) are events that draw together a large number of people in one or several occasions happening in single or multiple places for a definite period of time. These can lead to different public health risks through exposure to infectious diseases, trauma, and environmental factors. The Philippine Department of Health (DOH) in 2015 participated in special planned events that constituted mass gatherings namely the Asia- Pacific Economic Cooperation (APEC) meetings, the Black Nazarene procession, and the Papal Visit.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study aimed to describe the different health risks arising from the three (3) identified mass gathering events in the Philippines in 2015 and relate them to public health preparedness.</p><p style="text-align: justify;"><strong>METHODS:</strong> This was a descriptive study of the health risks arising from the MG events. Sources of data were reports submitted by deployed medical teams to the Operations Center (Opcen) that closely monitored the MG.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The study found infectious causes, trauma, temperature-related conditions, and noncommunicable diseases to be the important categories of health risks in the specified mass gatherings. These validated the common health risk categories observed in previously well-studied mass gatherings.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The study highlighted important health risks and factors for consideration in public health preparedness for mass gatherings in terms of appropriate and effective public health strategies that should be established to minimize health risks and reduce health system impacts of mass gatherings.</p>

Medical needs documented by Emergency Medical Services (EMS) responders to areas affected by Typhoon Haiyan in the Philippines: Implications on disaster response policy

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Despite existing disaster preparedness policies in the Philippines, there has not been any validated assessment of the quality of disaster medical response, which would require reliable aggregate data on patient diagnoses and management.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This mixed-methods study documented the diagnoses, triage classification and case management of patients seen by Philippine EMS groups who responded to the Typhoon Haiyan disaster in the Philippines in November and December 2013, as well as difficulties associated in gathering these data, using the Utstein-style Template for Uniform Data Reporting of Acute Medical Response in Disasters as framework.</p><p style="text-align: justify;"><strong>METHODS:</strong> Three hundred (300) individuals vetted by EMS organizations were invited to answer a survey modeled after the Utstein-style template, and submit tallies of patients seen. Out of 52 responses received, policy recommendations were subsequently generated on concerns assessed by the template using the nominal group technique.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The submitted data yielded a total of 41,202 patients with information on age, sex, and diagnosis; 19,193 with triage classification; and 27,523 with information on case management. The focus group discussion underlined the absence of a standard communication and information management system. Participants recommended establishing such a system and highlighted the role of the Department of Health - Health Emergency Management Bureau in coordinating disaster medical response efforts and information management.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This study underlines the importance of effective communication, and multisectoral coordination, to generate reliable data and thus, facilitate resource allocation for disaster medical response.</p>

The German emergency and disaster medicine and management system-history and present / 中华创伤杂志(英文版)

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the "Golden Standard" of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.

Urgences et médecine de catastrophe

La concentration humaine et urbaine, le développement des technologies , les menaces de destruction et de contamination sont à l'origine d'une prise de conscience de la nécessité d'une assistance civile. L'aide médicale urgente, qui s'affirme et s'oriente vers une médecine de réseau, en partenariat avec toutes les structures concourant à l'urgence, participe à la rationalisation de la politique sociale. Les acteurs de l'aide médicale urgente contribuent ainsi à sauvegarder, tout en l'améliorant, un secteur sanitaire et social qui est désormais l'un des fondements de la démocratie et l'une de ses assises face aux défis du futur

Disaster medicine: current status and future directions of emergency medical team for overseas disaster crisis

Through the Declaration of Montevideo in 2011, the World Medical Association suggested that doctors worldwide should be trained in basic disaster response regardless of their specialty. The Haiti earthquake in 2010, which had the highest number of foreign medical team dispatched from all over the world, proved that untrained and disorganized team only brought confusion. This event led the World Health Organization to develop the ‘Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters ’ in 2013. This guideline will become the standard for organizing an international emergency medical team. We should be able to provide high standard of care through field hospital set up and continuous training of disaster medicine specialists.

Adaptando o currículo para atender a necessidades de profissionais de saúde em um desastre: uma proposta para enfermeiras brasileiras / Adaptando el currículo para atender a necesidades de profesionales de salud en un desastre: una propuesta para enfermeras brasileñas / Tailoring curricula to fit health professionals needs in a disaster: a proposal for Brazilian nurses

RESUMO Introdução Educação e capacitação são os pilares da preparação para os desastres e melhores currículos e programas de treinamento são baseados em competências. Objetivo Este artigo apresenta uma proposta para ser aplicada ao currículo de enfermagem no Brasil, baseada nas Diretrizes Curriculares Nacionais e nas recomendações para a integração de habilidades e competências no currículo de graduação propostas pela Organização Mundial da Saúde. Resultados Foi realizada uma comparação de referenciais de competências para indicar as competências específicas essenciais para enfermeiras brasileiras. Níveis de proficiência foram indicados para o estabelecimento de objetivos educacionais e experiências de aprendizado e instrumentos de avaliação recomendados da literatura. Conclusões As competências constituem o início da discussão que deverá ocorrer em cada escola de enfermagem para que todas as enfermeiras brasileiras estejam preparadas para o caso de um desastre ocorrer.

RESÚMEN Introducción Educación y capacidad son los pilares de la preparación para los desastres y mejores currículos y programas de entrenamiento son basados en competencias. Objetivo Este artículo presenta una propuesta para ser aplicada al currículo de enfermería en Brasil, basada en las Directrices Curriculares Nacionales y en las recomendaciones para la integración de habilidades y competencias en el currículo de grado propuestas por la Organización Mundial de la Salud. Resultados Se realizó una comparación de referenciales de competencias para indicar aquellas específicas esenciales para enfermeras brasileñas. Niveles de competencia fueran indicados para el establecimiento de objetivos educacionales e experiencias de aprendizaje e instrumentos de evaluación recomendados por la literatura. Conclusiones Las competencias constituyen el inicio de la discusión que deberá ocurrir en cada escuela de enfermería para que todas las enfermeras brasileñas estén preparadas para el caso de un desastre ocurrir.

ABSTRACT Introduction Education and training are the cornerstones of disaster preparedness and best curricula and training programs are competency-based. Objective This paper presents a proposal to be applied in nursing curricula in Brazil, based on the National Curriculum Guidelines and the recommendations for integrating skills and competencies into undergraduate curricula proposed by the World Health Organization. Results Comparison of competencies sets was conducted to indicate the specific competencies to be included as essential for Brazilian nurses. Levels of proficiency were indicated for the establishment of learning objectives and learning experiences and evaluation tools recommended from the literature. Conclusions The competencies provided are the beginning of the discussion that will have to take place in every nursing school, if all Brazilian nurses are to graduate ready to participate should a disaster occur.

La Medicina de Desastres en el plan de estudios del médico general / The Medicine of Disasters in the study plan of general practitioners in Villa Clara

El presente trabajo describe el programa de la asignatura Medicina de Desastres que se imparte a los estudiantes de Medicina de Villa Clara, procedentes de la Escuela Latinoamericana de Medicina desde el año 2003 como experiencia única en el mundo. Consta de 120 horas lectivas distribuidas en dos estancias que se desarrollan durante el cuarto y quinto años de la carrera, con un carácter teórico-práctico. Sus contenidos están orientados a la familiarización con la temática de los factores causantes de desastres, sus efectos sobre la salud y la dinámica de la sociedad y las comunidades, así como a la incorporación de conocimientos propios acerca del riesgo y la vulnerabilidad, además de los procedimientos vinculados a su disminución; donde priman el trabajo preparatorio a la población y la interrelación de sectores para el enfrentamiento a las adversidades.

The current work describes the program of the Medicine of Disasters subject that is imparted to the future physicians of the Latin American School of Medicine in Villa Clara since 2003, as an exclusive experience in the world. It consists of 120 teaching hours distributed in two rotations that are developed during the fourth and fifth years of the career, with a theoretical-practical character. Its contents are guided to the familiarization with the topic of the disasters-causing factors, their effects upon health and the dynamics of society and the communities, as well as to the incorporation of knowledge about risks and vulnerability, besides the associated procedures to diminish them; where the preparatory work with the population and the interrelation among sectors to face adversities are predominant.

Disaster Medicine in Korea / 한양의대학술지

No abstract available.

Emergency Medicine in Disasters / 한양의대학술지

Disaster medicine and emergency medicine are common in many parts, particularly in the acute stage of disaster, so the role of emergency medicine in disaster is very important. For adequate disaster preparation and response, interest and investment to emergency medical care for emergency and safety issues that deal with most important thing, life conservation, must be made in the future. Specifically, support to the emergency medical centers as disaster base hospitals is necessary for emergency medicine to perform adequate roles in disaster, and it is also necessary to assign the role to the hospital in the area that holds the local risk factors. Because of the poor preparedness for nuclear, chemical or biological disaster in Korea, the important things are the preparation and establishment of infrastructure based on equipment and facilities, related to special type disasters. So the government should support the emergency medical system for the adequate response to disasters as well as individual emergency care.

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.

Education and Training in Disaster Medicine / 한양의대학술지

Education and training of disaster medicine are the most important part of disaster management. There are so many training and education curriculum all over the world. However education courses based upon core competencies of disaster medicine are lacking. There is still a need to define the specific knowledge, skills, and attitudes that must be mastered by specialized professionals. Standardized core competencies for acute care medical personnel such as emergency department nurses, emergency physicians, and out-of-hospital emergency medical services personnel are needed to ensure that effective emergency medical response can be provided efficiently during all types of disasters. Therefore education and training curriculum of other countries were reviewed in this article.

Material instructivo para la docencia de las asignaturas Medicina de Desastres I y II / Instructive material for teaching of the subjects Medicine for Disasters 1 and 2

Fundamento: a partir de la inexistencia de bibliografía actualizada en las asignaturas Medicina de Desastres I y II en los temas: Papel de la comunidad y el enfrentamiento a desastres, Importancia de su capacitación y Preparación y organización del sistema de salud para el enfrentamiento a desastres, se confecciona un material instructivo. Objetivo: elaborar un material instructivo para la docencia de las asignaturas referidas que supla el déficit identificado de bibliografía. Métodos: se realizó un estudio descriptivo transversal, el universo estuvo constituido por los 12 profesores del departamento de Salud Pública de la Universidad de Ciencias Médicas de Villa Clara que integran el colectivo de las asignaturas Medicina de Desastres I y II, durante el período comprendido entre diciembre 2012 a febrero de 2013. Se utilizaron métodos teóricos y empíricos. Resultados: se logró confeccionar un material instructivo que contribuye a solucionar la carencia de bibliografía relacionada con los temas implicados en estas asignaturas que se imparten en el pregrado y el postgrado de Salud Pública, el cual fue validado por criterio de especialistas como útil y pertinente. Conclusiones: el material confeccionado ha sido de gran utilidad a los estudiantes del 4to y 5to años de la Escuela Latinoamericana de Medicina que cursan estudios en la Universidad de Ciencias Médicas de Villa Clara, profesionales que reciben cursos de postgrado de Salud Pública y sus profesores.

Background: taking into account the lack of updated bibliography in the subjects Medicine for Disasters 1 and 2 on the themes Role of the Community in Facing Disasters: importance of their training, and Organization of the Health System for Facing Disasters, it was prepared an instructive material. Objective: to prepare an instructive material for the teaching of the above mentioned subjects, that supplies the identified lack of bibliography. Methods: a descriptive transversal study was done, the universe was made up of the 12 teachers of the Public Health Department of the Villa Clara Medical Sciences University who make up the staff of the subjects Medicine for Disasters 1 and 2, during the period from December 2012 to February 2013. Theoretical and empirical methods were used, as well as percentage analysis of the results. Results: it was possible to prepare an instructive material that contributes to solve the lack of bibliography related with these themes, that are taught to undergraduate and postgraduate students of Public Health, which was validated as useful and pertinent by the criteria of specialists. Conclusions: the proposed material has been extremely useful to the students of fourth and fifth years of the Latin American School of Medicine who study at the Villa Clara University of Medical Sciences, and to professionals who take postgraduate courses on Public Health, and to their professors.

Hospital disaster plan and disaster medicine

In general, the disaster rescue team should do their work within 1 to 2 hours after disaster, and disaster medical assistance team (DMAT) should care the victims at disaster site within 3 to 6 hours. Since about 10 years ago, world health organization, world meteorological organization, and world congress of disaster emergency medicine emphasized that each countries should complete the disaster plan on 'chemical, biological, radiological, nuclear, explosives' (CBRNE) disaster. After these warnings, the most of countries has strengthened the hospital disaster plan, and also organized disaster services system such as DMAT, hazardous material information system, and others. In Korea, the most of tertiary hospitals can not operate hospital disaster plan effectively, and the government did not support hospitals on disaster plan politically and financially. As a result, only a small number of hospitals is operating DMAT, and a few hospital completed CBRNE disaster preparedness such as disaster drill, personal protective equipments, decontamination set. The poison information center that control information on hazardous material is not established yet, and most physicians can not get information on chemicals, biologics and other hazardous materials when CBRNE disaster occur. To operate effective disaster plan, each hospitals should modernize the disaster plan on internal disaster, external disaster, and CBRNE disaster. The government should support hospitals to keep DMAT and special preparedness on CBRNE disaster. When CBRNE disaster strikes, the poison information center should expand their capability to provide information on the various kinds of hazardous materials.

Experience of a Medical Assistance for Disaster Caused by a Typhoon of Haiyan in the Philippines

PURPOSE: On November 8, 2013, Typhoon Haiyan attacked the Philippines, causing damage to many houses and trees as well as loss of many lives. A medical team from our hospital and university was sent to Philippines in order to provide medical assistance. We wish to describe our experiences of disaster medicine and discuss problems and improvement points. METHODS: We analyzed the characteristics of patients who received medical treatment administered by us at Tagobon city in the Philippines for five days. RESULTS: We provided medical services to 951 patients for five days. Most patients visited us for medical treatment not trauma. Almost all chief complaints were associated with respiratory, gastrointestinal, dermatologic, and ophthalmologic symptoms. We mainly treated the patients with medications. CONCLUSION: During the subacute period after the disaster, most patients complained of medical and dermatologic problems due to lack of sanitation rather than traumatic complications. Medical assistance for disaster should be administered appropriately according to the types of diseases that occurduring each period after disaster.