EVAC-H. Evacuación de hospitales y sus áreas críticas

La evacuación de un hospital debe ser el último recurso para hacer frente a los efectos de una amenaza, pero si la evaluación de riesgo así lo determina, se llevará a cabo de forma preventiva. La evacuación de un hospital siempre representa un riesgo para la vida de los pacientes, sobre todo para aquellos que están en condiciones graves de salud. Por lo tanto, cada hospital debe desarrollar sus capacidades para ejecutar una evacuación, y que esta sea parte del “Plan hospitalario de respuesta a emergencias de salud y desastres.La evacuación y el traslado de los pacientes debe ser resultado de una planificación que incluya la capacitación del personal y que cuente con los equipos e insumos necesarios, que mantenga las rutas de evacuación completamente accesibles y que establezca los acuerdos o ajustes pertinentes con los sistemas de seguridad, traslado prehospitalario y otras instalaciones de la red de servicios de salud, que permitan una respuesta eficiente. El objetivo de esta herramienta es facilitar la elaboración o actualización del procedimiento de evacuación* como parte de la gestión de emergencias y desastres de un hospital (ítem 147 de la 2.a edición del Índice de seguridad hospitalaria [ISH] de la Organización Mundial de la Salud [OMS] y la Organización Panamericana de la Salud [OPS]). El documento está dirigido al personal directivo, planificadores y coordinadores de los hospitales que participan en la preparación para la respuesta y recuperación ante emergencias de salud y desastres.

Dreaming of a Bright Future: Statistics, Disaster, and the Birth of Energopolitics in 1930s Chile.

In 1939, directly after the worst earthquake in the country's history, the Chilean state began implementing an electrification program. This plan shaped energy goals for years to come and defined the interconnected grid that dominates the country's energy infrastructure today. Based on extensive archival work, this article describes the birth of energopolitics in the country, using technology sociologist Michel Callon's notion of "interessement" to describe the strategies of a group of engineers who acted as system builders. Their four main strategies were embracing technological futurisms, forging heterogeneous networks, articulating and mobilizing knowledge, and using crises as windows of opportunity for change. The article shows not only the historical impact of past energy choices on today's world but also that current challenges to energy transitions are not without precedent. Using a sociological framework to tell this story allows us to highlight the mechanisms through which energy systems can change.

Prevention, social emancipation, and paradigmatic transition: a 40-year interdisciplinary Brazilian trajectory on accidents and disasters. / Prevenção, emancipação social e transição paradigmática: uma trajetória interdisciplinar de 40 anos no Brasil sobre acidentes e desastres.

The article, in the form of an essay, systematizes a 40-year-long professional trajectory of interdisciplinary and socially engaged experiences around the analysis and prevention of accidents and disasters. This study was mainly developed within the scope of research and postgraduate studies in Public Health in Brazil, driven by the sanitarian movement and the construction of Brazilian Unified National Health System (SUS) in its search for democracy and social and health justices. Its empirical basis involved workers' health and environmental surveillance actions organized in networks led by SUS in conjunction with universities, unions, social movements, environmental nongovernmental organizations (NGO), and Public Prosecutors' Offices. Events of greater socio-environmental complexity in sectors such as steel, petrochemicals, mining, agribusiness, and energy forged the search for new epistemic and interdisciplinary references that encompassed two new justices, i.e., environmental and cognitive. This essay systematizes this trajectory of conceptual contributions in three movements from the 1980s to the present day (each corresponding to a socio-political and institutional context) to reflect on paradigmatic transition movements in the analysis and prevention of accidents and disasters from an interdisciplinary perspective. It ends by suggesting abyssal and emancipatory prevention to face different current crises, including environmental, health, democratic, and civilizing ones.

O artigo, na forma de ensaio, sistematiza uma trajetória profissional de experiências interdisciplinares e socialmente engajadas em torno da análise e prevenção de acidentes e desastres nos últimos 40 anos. O trabalho acadêmico se desenvolveu principalmente no âmbito da pesquisa e pós-graduação na saúde pública brasileira impulsionado pelo movimento sanitarista e a construção do Sistema Único de Saúde (SUS) em sua busca por democracia, justiça social e sanitária. A base empírica envolveu ações de vigilância em saúde dos trabalhadores e ambiental organizadas em redes protagonizadas pelo SUS em conjunto com universidades, sindicatos, movimentos sociais, organizações não governamentais (ONG) ambientalistas e Ministérios Públicos. Eventos de maior complexidade socioambiental em setores como siderurgia, petroquímico, mineração, agronegócio e energia forjaram a busca por novos referenciais epistêmicos e interdisciplinares que abarcam duas novas justiças: a ambiental e a cognitiva. Este artigo apresenta essa trajetória de contribuições conceituais em três movimentos a partir da década de 1980 até os dias atuais, cada qual correspondendo a um contexto sociopolítico e institucional, para pensar movimentos de transição paradigmática na análise e prevenção de acidentes e desastres numa perspectiva interdisciplinar. Finaliza-se com a sugestão de prevenção abissal e emancipatória para enfrentar diferentes crises da atualidade, como a ambiental, a sanitária, a democrática e a civilizatória.

El artículo, en forma de ensayo, sistematiza una trayectoria profesional de experiencias interdisciplinarias y socialmente comprometidas en torno al análisis y la prevención de accidentes y desastres en los últimos 40 años. El trabajo académico se desarrolló principalmente en el ámbito de la investigación y postgrado en Salud Colectiva brasileña, impulsado por el movimiento sanitario y la construcción del Sistema Único de Salud (SUS) en su búsqueda por democracia, justicia social y sanitaria. La base empírica involucró acciones de vigilancia en salud y ambiental de los trabajadores, organizadas en redes protagonizadas por el SUS en conjunto con universidades, sindicatos, movimientos sociales, organizaciones no gubernamentales ambientalistas y Ministerios Públicos. Los acontecimientos de mayor complejidad socioambiental en sectores como la siderurgia, el petroquímico, la minería, el agronegocio y la energía han llevado a la búsqueda de nuevas referencias epistémicas e interdisciplinarias que abarcaron dos nuevas formas de justicia, la ambiental y la cognitiva. El artículo sistematiza esa trayectoria de contribuciones conceptuales en tres movimientos a partir de la década de 1980 hasta los días actuales, cada cual, correspondiendo a un contexto sociopolítico e institucional, para pensar movimientos de transición paradigmática en el análisis y prevención de accidentes y desastres desde una perspectiva interdisciplinaria. Se finaliza con la sugerencia de prevención abisal y una prevención emancipadora para enfrentar diferentes crisis de la actualidad, como la ambiental, la sanitaria, la democrática y la de civilización.

Protecting Caribbean patients diagnosed with cancer from compounding disasters.

Caribbean small island developing states are becoming increasingly vulnerable to compounding disasters, prominently featuring climate-related hazards and pandemic diseases, which exacerbate existing barriers to cancer control in the region. We describe the complexities of cancer prevention and control efforts throughout the Caribbean small island developing states, including the unique challenges of people diagnosed with cancer in the region. We highlight potential solutions and strategies that concurrently address disaster adaptation and cancer control. Because Caribbean small island developing states are affected first and worst by the hazards of compounding disasters, the innovative solutions developed in the region are relevant for climate mitigation, disaster adaptation, and cancer control efforts globally. In the age of complex and cascading disaster scenarios, developing strategies to mitigate their effect on the cancer control continuum, and protecting the health and safety of people diagnosed with cancer from extreme events become increasingly urgent. The equitable development of such strategies relies on collaborative efforts among professionals whose diverse expertise from complementary fields infuses the local community perspective while focusing on implementing solutions.

Sociopolitical Factors and Mental Health Following the Turkey-Syria Earthquake.

This survey study evaluates the association between sociopolitical factors and mental health following the 2023 Turkey-Syria earthquake.

Rapid determination of seismic influence field based on mobile communication big data-A case study of the Luding Ms 6.8 earthquake in Sichuan, China.

Smartphone location data provide the most direct field disaster distribution data with low cost and high coverage. The large-scale continuous sampling of mobile device location data provides a new way to estimate the distribution of disasters with high temporal-spatial resolution. On September 5, 2022, a magnitude 6.8 earthquake struck Luding County, Sichuan Province, China. We quantitatively analyzed the Ms 6.8 earthquake from both temporal and geographic dimensions by combining 1,806,100 smartphone location records and 4,856 spatial grid locations collected through communication big data with the smartphone data under 24-hour continuous positioning. In this study, the deviation of multidimensional mobile terminal location data is estimated, and a methodology to estimate the distribution of out-of-service communication base stations in the disaster area by excluding micro error data users is explored. Finally, the mathematical relationship between the seismic intensity and the corresponding out-of-service rate of communication base stations is established, which provides a new technical concept and means for the rapid assessment of post-earthquake disaster distribution.

Evaluation of system based psychological first aid training on the mental health proficiency of emergency medical first responders to natural disasters in China: a cluster randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of a system based psychological first aid (PFA) training programme for emergency medical first responders in China. DESIGN: Parallel-group, assessor-blinded, cluster randomised controlled trial. SETTING: 42 clusters of health workers from various health facilities in China. PARTICIPANTS: 1399 health workers who provide emergency service for survivors of disasters. INTERVENTIONS: One-day system based PFA training programme (PFA) or training as usual (TAU). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the PFA skills, knowledge and attitude (SKA-PFA) score at 2 months postintervention. Secondary outcomes included post-traumatic growth, self-efficacy and professional quality of life. RESULTS: The intervention group (n=690) had significantly higher SKA-PFA scores than the control group (n=709) at 2 months postintervention (adjusted mean difference=4.44; 95% CI 1.17 to 7.52; p=0.007; Cohen's d=0.35). The intervention group also had higher scores on post-traumatic growth (p=0.113, d=0.24), self-efficacy (p=0.032, d=0.20) and professional quality of life (p=0.281, d=0.04). CONCLUSIONS: The system based PFA training programme was more effective than the TAU in enhancing the PFA knowledge and skills of the emergency medical first responders and in increasing their competence to provide emergency service for survivors in China. TRIAL REGISTRATION NUMBER: ChiCTR2200060464.

Disaster healthcare disparities solutions: Part 2-Response.

The purpose of this study was to explore the potential solutions for disaster healthcare disparities. This paper is the second of a three-part series that was written by the Disaster Healthcare Disparities Workgroup of the American College of Emergency Physicians Disaster Preparedness and Response Committee. The committee conducted a literature review and chose articles most representative and demonstrative of solutions to disaster healthcare disparities found in a past workgroup product. Many solutions for disaster healthcare disparities during disaster response were found. Some of these solutions have been successfully implemented and some are hypothetical. Solutions for disaster healthcare disparities seen during response are achievable but there is still much work to do. A variety of the proposed solutions can be advocated for by nondisaster specialists leading to better care for all our patients.

Cognitive maturity of Portuguese nursing students to intervene in disasters: initial training contribution.

OBJECTIVE: To understand whether, from the perspective of coordinators/directors of nursing courses and nurses with skills in the field of disasters, nursing students have the necessary cognitive maturity to articulate the various dimensions inherent to the area of disasters, allowing efficient performance. METHOD: A study with a qualitative methodological approach, based on inductive reasoning and rigorous phenomenon description, based on exploratory research. RESULTS: Given the specificity and complexity of these phenomena, the inclusion of the disaster domain in the teaching-learning process, supporting valid knowledge construction and allowing the development and maturity of nursing students' cognitive processes, is crucial. CONCLUSION: Currently, reduced technical-scientific training in the field of disasters in Portugal constitutes a barrier in the development of nursing students' cognitive maturity, impeding their ability to respond when faced with phenomena of this complexity.

Disaster healthcare disparities solutions: Part 3-Recovery and mitigation.

The purpose of this study was to explore the potential solutions for disaster healthcare disparities. This paper is the third of a three-part series that was written by the Disaster Healthcare Disparities Workgroup of the American College of Emergency Physicians Disaster Preparedness and Response Committee. The committee conducted a literature review and chose articles most representative and demonstrative of solutions to disaster healthcare disparities found in a past workgroup product. Many solutions for disaster healthcare disparities seen during recovery and mitigation were found. Some of these solutions have been successfully implemented and some remain theoretical. Solutions for disaster healthcare disparities seen during recovery and mitigation are achievable but there is still much work to do. Many of these solutions can be advocated for by nondisaster specialists.

Pediatric Pandemics and Disasters - A Summary.

Children make up approximately 25% of the population in the United States and are particularly vulnerable to the impact of disasters. The creation of federally-funded programs and advisory committees has had a positive impact on addressing the needs of children and families in disasters by identifying best practices, disseminating information, identifying gaps, and providing information with future investments that will contribute to expanding disaster science for children and their families.

Placing engineering in the earthquake response and the survival chain.

Earthquakes injure millions and simultaneously disrupt the infrastructure to protect them. This perspective argues that the current post-disaster investigation paradigm is insufficient to protect communities' health effectively. We propose the Earthquake Survival Chain as a framework to change the current engineering focus on infrastructure to health. This framework highlights four converging research opportunities to advance understanding of earthquake injuries, search and rescue, patient mobilizations, and medical treatment. We offer an interdisciplinary research agenda in engineering and health sciences, including artificial intelligence and virtual reality, to protect health and life from earthquakes.

The role of orthodontics in children identification: a case report of two victims of mass disaster.

INTRODUCTION: Human Identification based on dental evidence cannot be accomplished if antemortem dental records are unavailable or of poor quality. The involvement of the orthodontist in mass disaster victim identification processes may be crucial in relation to the amount and quality of the records which can be obtained before, during, and following the treatment. AIM: The aim of the study is the description of the contribution of the findings drawn from orthodontic records to the identification of victims of mass disasters who had received an orthodontic treatment, through the presentation of two cases. The first case involves the identification of a child victim of a plane crash and the second case involves the identification of two identical twin girls who died in a fire. In both cases, the identification was based on the findings obtained from the ante-mortem records provided by the orthodontist. CONCLUSIONS: The orthodontists apply customized orthodontic appliances and keep a comprehensive file of images, casts, radiographs, and other records in their practice. As a result, they can make a substantial contribution to the identification of young people or even adult victims of mass disasters in any case in which the authorities make a request.

Ethical-legal dilemmas of nursing practice in emergencies and disasters: a scoping review.

OBJECTIVE: To map the ethical-legal dilemmas related to nursing practice in emergency and disaster situations. METHOD: A scoping review developed in accordance with the JBI method, whose information sources were accessed in databases, in addition to gray literature. The selection was made by reading the titles, abstracts and descriptors, observing eligibility criteria, including two reviewers and a third in case of discrepancies. After reading, data extraction and content analysis of 17 selected studies were carried out. RESULTS: Thirteen ethical-legal dilemmas were mapped related to professional/functional duty towards the family, lack of personal protective equipment and unsafe conditions at work, preparation and availability for action, skills, limits imposed by victims' religion, obligation to provide care. CONCLUSION: Professionals, researchers and representatives of the category need to resolve demands that involve acting in emergencies and disasters, (re)cognizing the ethical-legal dilemma, and seeking (re)legal frameworks and observance of the fundamental/ethical principles that govern the profession, in the sense to support decision-making and the development of legally safe practices.

Study on agricultural drought disaster risk assessment in Heilongjiang reclamation area based on SSAPSO optimization projection pursuit model.

Heilongjiang reclamation area serves as a crucial hub for commodity grain production and strategic reserves in China, playing a vital role in maintaining national food security. Investigating the assessment of agricultural drought risk in this region can yield valuable insights into spatial and temporal variations in drought risk. Such insights can aid in formulating effective strategies for disaster prevention and mitigation, thereby minimizing food losses caused by drought disasters. This study employs a comprehensive indicator system comprising 17 indicators categorized into hazard, exposure, vulnerability, and resistance capacity. The projection pursuit model is applied to evaluate regional drought risk, while the PSO algorithm, optimized by the SSA algorithm, addresses the limitations of low local search ability and search accuracy during the large-scale search process of the PSO optimization algorithm. This study examines and compares the optimization and convergence capabilities of three algorithms: real number encoding-based genetic algorithm (RAGA), particle swarm optimization algorithm (PSO), and sparrow algorithm-based improved particle swarm optimization algorithm (SSAPSO). The analysis demonstrates that SSAPSO exhibits superior optimization performance and convergence properties, establishing it as a highly effective algorithm for optimization tasks. The findings reveal the following trends: over time, agricultural drought risk in Heilongjiang reclamation area has generally declined, with fluctuations observed in hazard and vulnerability, an increase in exposure, and a continuous enhancement of resistance capacity. Spatially, the western region exhibits significantly higher agricultural drought risk compared to the eastern region, primarily due to elevated hazard and vulnerability, coupled with lower resistance capacity. As the agricultural economy grows and agricultural expertise accumulates, the risk of agricultural drought decreases. However, variations in economic growth among different regions lead to diverse spatial distributions of risk.

A Longitudinal Study of Hospital Safety From Disasters in Kermanshah Province, Iran: Insights for Disaster Risk Reduction.

OBJECTIVE: The Hospital Safety Index (HSI) developed by the World Health Organization (WHO) was adopted by most countries to evaluate the safety of hospitals against disasters. This study aimed to assess the status of hospital safety from disasters between 2016 and 2022 in Kermanshah province in Iran. METHODS: This is a retrospective longitudinal study which investigated HSI data from 23 hospitals. Data were gathered by Farsi Hospital Safety Index (FHSI) and analyzed with a repeated measures analysis of variance (ANOVA). RESULTS: The risk of hydro-meteorological (from 43.1 to 32.7) and biological hazards (51.3 to 35.5) significantly decreased. Although structural safety remained constant (from 67.8 to 70.1), nonstructural (from 51.5 to 71.2), and functional (from 47.1 to 71.2) safety scores increased significantly over study period. CONCLUSIONS: The findings revealed hospitals safety in Kermanshah province gradually improved. However, the health-care stakeholders should pay the necessary attention to improving the structural safety of hospitals.

Exploring the consequences of nurses' involvement in disaster response: findings from a qualitative content analysis study.

BACKGROUND: The presence of nurses during disasters can lead to many consequences. Understanding the nurses' experiences of these consequences can provide valuable insights. Therefore, this study was conducted to explore the experiences of Iranian nurses regarding the consequences they faced when being present during disasters. METHODS: This qualitative descriptive study employed a content analysis approach to examine the topic at hand. 20 nurses working in the emergency units of Kerman hospitals were selected through purposive sampling. In-depth semi-structured interviews were conducted to collect the data. The data were analyzed using qualitative content analysis proposed by Graneheim and Lundman. MAXQDA 10 was used to manage data. RESULTS: After analysis of the interviews, two main categories were identified: overlapping of job frustrations and acquiring experience in difficult conditions. The main category of acquiring experience in difficult conditions comprised the following subcategories: improved quality of care, experience and dedication in fulfilling the role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status. On the other hand, the category of overlapping of job frustrations also consisted of the subcategories of physical strength deterioration, psychological and emotional distress, discontinued from supports, feelings of hopelessness, increased exposure to violence and aggression, and occurrence of family problems. CONCLUSION: Being present during disasters and obtaining the necessary competencies can have positive consequences that serve as turning points in the personal and professional growth of nurses. Additionally, favorable outcomes can help nurses cope with adverse circumstances. Managers can utilize the findings of this study to develop strategies aimed at reducing negative outcomes and enhancing positive ones among nurses during disasters.

Spatio-temporal detection of agricultural disaster vulnerability in the world and implications for developing climate-resilient agriculture.

Drought and floods seriously affect agriculture across the world. It is of great importance to lower down the agricultural vulnerability to disasters to build climate-resilient agriculture. The paper aims to investigate the spatio-temporal changes of agricultural vulnerability to drought and floods in the world in the period 2003-2019. Research results show that (1) the agricultural vulnerability to drought and floods is at a low level across the globe owning to the dual effects of decreasing exposure and increasing adaptability; (2) the northern parts of United States, northeastern parts of China, and the border between Russia and Kazakhstan are identified as most vulnerable areas to drought and floods; and (3) spatio-temporal mismatch of precipitation is the main factor to cause floods and drought while better adaption is beneficial to minimize the adverse effects of disasters. Based on analysis on the drivers and spatial patterns of drought and floods risk in all dimensions, tailored measures and policies are put forwards to make adaptive strategies of agriculture to climate change.