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The CDC pacific emergency health initiative: a pilot study of emergency preparedness in Oceania

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Abstract and Figures

Environmental emergencies and disasters are becoming more frequent in developing nations. Between 1992 and 1996, disasters affected an annual average of 4.5 million Oceania residents. Unfortunately, public health planners in the region and responders throughout the world have little evidence on which to base measures of emergency preparedness. Indicators of preparedness must be identified, implemented and evaluated before the effectiveness of emergency planning interventions can be measured accurately. The aim of this study was to perform an objective evaluation of emergency preparedness among five nations in Oceania. A standardized retrospective review of national-level public health and institutional-level hospital emergency operations plans from a convenience sample of five Pacific nations or territories was performed. In addition, in-country interviews, observation of operations and review of documentation were conducted. The rates of affirmative responses to 957 yes/no queries in the questionnaire were tabulated according to major emergency operational planning concepts and categories of emergency support functions. The study revealed remarkably low levels of emergency planning and preparedness among health and medical sectors of five Pacific islands. These data suggest a very low level of host national capacity for development of preparedness. Further investigation is necessary to define this need throughout this region of Oceania.
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Emergency Medicine
(2001)
13
, 157–164
Blackwell Science Asia
Disaster Medicine Series
The CDC Pacific emergency health
initiative: A pilot study of emergency
preparedness in Oceania
Mark E Keim
1
and Gary J Rhyne
2
1
Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA,
1
Center for International Emergency Medical Studies, Johns Hopkins University School of
Medicine, Baltimore, Maryland,
1,2
Emergency Preparedness and Response Branch, Division of
Emergency and Environmental Health Services, National Center for Environmental Health,
Centers for Disease Control & Prevention, Altanta, Georgia,
2
Public Health Unit, Center of
Excellence for Disaster Management and Humanitarian Assistance, Baltimore, MD,
2
Department of Psychology, University of Hawaii, Hawaii, HI, United States of America
Abstract
Objective:
Environmental emergencies and disasters are becoming more frequent in developing nations.
Between 1992 and 1996, disasters affected an annual average of 4.5 million Oceania residents.
Unfortunately, public health planners in the region and responders throughout the world
have little evidence on which to base measures of emergency preparedness. Indicators of
preparedness must be identified, implemented and evaluated before the effectiveness of
emergency planning interventions can be measured accurately. The aim of this study was
to perform an objective evaluation of emergency preparedness among five nations in Oceania.
Method:
A standardized retrospective review of national-level public health and institutional-level
hospital emergency operations plans from a convenience sample of five Pacific nations or
territories was performed. In addition, in-country interviews, observation of operations
and review of documentation were conducted. The rates of affirmative responses to
957 yes/no queries in the questionnaire were tabulated according to major emergency
operational planning concepts and categories of emergency support functions.
Results:
The study revealed remarkably low levels of emergency planning and preparedness
among health and medical sectors of five Pacific islands.
Conclusion:
These data suggest a very low level of host national capacity for development of pre-
paredness. Further investigation is necessary to define this need throughout this region
of Oceania.
See Commentary, page x.
Key words
:
disaster plan, emergency preparedness, emergency response, environmental health, global
health, Oceania, Pacific basin, public health.
Correspondence: Assistant Professor Mark Keim, Director, Emergency & Disaster Public Health Sciences, Acting Associate Director
for Science, National Center for Environmental Health, Centers for Disease Control & Prevention, 4770 Buford
Highway, MS-F38 Atlanta, GA USA 30341–3724.
Mark E Keim, MD, Assistant Professor and Director, Emergency & Disaster Public Health Sciences; Gary J Rhyne, MA, Assistant Professor
and Operations Manager, Public Health Unit, Center of Excellence for Disaster Management and Humanitarian Assistance.
1
ME Keim and GJ Rhyne
158
Introduction
Serious deficiencies have been reported among some
Pacific island nations in regards to the quality and
accessibility of health care, medical workforce training
and availability, as well as health facility maintenance
and management.
1
Public health absorptive capacity and
thresholds for emergency response are highly depend-
ent upon a functional health-care system.
Environmental emergencies are becoming more
frequent in developing nations.
2
Between 1992 and 1996,
disasters affected an annual average of 4.5 million
Oceania residents.
3
This represents twice the number
of those affected throughout all of the Americas during
that period. The damage caused by disasters in
Oceania during one 10-year period (1987–1996) was
estimated to average over US$1 billion every year.
3
Recently, the overall approach to emergencies
and disasters among nations has shifted from hapha-
zard and expensive post-disaster response to a more
systematic process of risk management that also
emphasizes prevention, mitigation and preparedness.
4
The challenge for public health involving emergencies
and disasters is to then focus ever-limited resources
towards the most cost-effective and sustainable means
of risk management.
The purpose of this study was to perform an object-
ive evaluation of emergency preparedness among five
nations in Oceania.
The CDC pacific emergency
health initiative
Background
At the February 2000 meeting of the Pacific Island
Health Officers Association (PIHOA), the Centers for
Disease Control and Prevention (CDC) proposed
development of a regional strategy for assessment of
emergency public health systems and subsequent
development of emergency and disaster health skills in
the Pacific. This proposal suggested a collaboration of
governmental institutions, international agencies, Pacific
nations, the Pacific Basin Medical Association and
PIHOA. Centers for Disease Control and Prevention
also suggested a Pacific-based pilot project for develop-
ment of regional training capacity for emergency
health services and public health planning. During
2000, CDC performed comprehensive assessments of
the emergency public health and medical systems in
a total of five Pacific jurisdictions including Palau,
Samoa, American Samoa, Cook Islands, and Marshall
Islands. This project is known as the CDC Pacific
Emergency Health Initiative (PEHI).
Methods
Centers for Disease Control and Prevention staff per-
formed a retrospective review of national-level public
health and institutional-level hospital emergency
operations plans (EOP) from a convenience sample of
five Pacific nations or territories (jurisdictions 1–5).
In addition to the technical review of EOP, CDC staff also
performed in-country interviews, observation of opera-
tions and review of relevant planning documentation.
Interviews
Interviews and meetings were held with government
and private officials, hospital and public health staff,
plan stakeholders and community service organiza-
tions. These persons also included representatives
from public health, public safety, public works, educa-
tion and administration. Interviews were performed
to evaluate organizational relationships, elaborate on
planning and response issues and to validate planning
assumptions.
Observation of operations
On-site visits and observation of operations were per-
formed, for example in:
Health-care facilities: inpatient and outpatient
Public utilities: water, electricity, communication
Public safety headquarters: fire and law enforcement
National and local seats of government
Educational institutions
Transportation hubs: seaports, airports
Volunteer organization headquarters
Market and commercial retail districts
Television and radio broadcast facilities
Residential and commercial areas
Review of documentation
Where available, planning documents were reviewed
to include the national plan, the public health sector
plan and the hospital plan. Other forms of documenta-
tion reviewed included:
Health-sector strategic plans.
CDC Pacific emergency health initiative
159
Country background briefs from travel and govern-
ment information sources.
United States (US) Department of Defense disaster
preparedness and mitigation assessment reports.
Literature review for country disaster history and
hazards.
Questionnaire
A standardized questionnaire consisted of 957 yes/no
questions was used to assess all existing EOP for
presence of planning provisions related to public
health and hospital preparedness. The instrument
was designed to be applicable to island nations of the
Pacific basin region, but also elsewhere. represents a
listing of Essential emergency support functions that
were assessed according to criteria established for
hospital emergencies are listed (Table 1). Essential
emergency support functions that were assessed
according to criteria established for public health emer-
gencies are listed (Table 2). These performance indic-
ators were established in accordance with essential
health sector functions for disaster management.
5–13
Technical review
Centers for Disease Control and Prevention evaluators
performed a technical review of each available host
nation EOP. This review included evaluation of both
the national-level public health EOP and the national
hospital EOP, when either or both were in existence.
Each jurisdiction studied had one main referral hos-
pital. Plans were reviewed regarding the presence or
absence of 957 emergency planning criteria listed by
the questionnaire. These criteria were categorized
according to the following main emergency function
indicators as related to planning and preparedness:
(i) essential elements of an emergency operations plan;
(ii) hazard identification; (iii) disaster mitigation;
(iv) essential emergency functions; (v) essential dis-
aster recovery functions; (vi) general public health
functions; and (vii) hospital emergency preparedness.
Questions related to disaster management phases
other than preparedness and response (e.g. mitigation
and recovery) were limited to include those directly
applicable in the preparedness or acute emergency
response phases.
Calculation of the preparedness quotient
The rates of affirmative responses to yes/no queries
in the questionnaire were tabulated according to emer-
gency operational planning concepts (i.e. function/
task identification; direct name and line delegations of
responsibility and authority; hazard specific contin-
gencies; operating, reporting and evaluation procedures)
and for each category of emergency support function
(i.e. command and control; communications; transporta-
tion; logistics; finance–administration; operations). A
listing of positive response rates according to major
categories of emergency management is provided
(Tables 1, 2).
Table 1.Pos
i
t
i
ve response rates accor
di
ng to
h
osp
i
ta
l
emergency
f
unct
i
ons
Emergency function categories Symbol Nation 1 Nation 2 Nation 3 Nation 4 Nation 5 Mean Pq
Authority, command & control P
Command
0.64 0 0.44 0 0.60 0.34
Rapid assessment P
Assess
0.79 0 0.07 0 0.07 0.19
Finance P
Finance
000000
Administration P
Admin
0.33 0 0.17 0 0.69 0.12
Communications P
Commo
0.32 0 0.19 0 0.09 0.12
Health facility evacuation P
Evac
0.17 0 0 0 0 0.03
Transportation P
Transport
0.13 0 0.18 0 0 0.06
Security and traffic control P
Security
0.25 0 0.50 0 0.25 0.20
Search & rescue and field medical response teams P
S & R
0 0 0.04 0 0.30 0.07
Hospital utilities & maintenance P
Util
0.11 0 0.22 0 0.44 0.15
Hospital patient care P
Patient
0 0 0.14 0 0.32 0.09
Hospital-based mortuary care P
Mort
00000.50 0.10
Staff training & exercises P
Train
00000.50 0.10
Essential emergency equipment & supplies P
Equip
0.05 0 0 0 0 0.01
Medical preparedness quotient P
qMedical
0.20 0 0.14 0 0.27
ME Keim and GJ Rhyne
160
The public health preparedness quotient (Pq
PubHealth
)
was computed as the mean value for seven functional
preparedness categories areas related to public health
preparedness. The medical preparedness quotient
(Pq
Medical
) was computed as the mean value for 15
functional preparedness categories related to hospital
preparedness.
Results
Resultant positive response rates were computed
according to host nation and emergency preparedness
functional criteria categories. These results are sum-
marized (Table 3) and presented in further detail
(Tables 1, 2).
Interpretation of the public health and medical
preparedness quotients
Positive response rates may be interpreted according
to this arbitrary scale for emergency preparedness.
These quotients may also be represented as a more
simplified integer, the Preparedness Index, PI (Table 4).
In general, the study results note a remarkably low
level of emergency preparedness throughout all five
Table 2. Pos
i
t
i
ve response rates
f
or
ve Pac
ifi
c nat
i
ons accor
di
ng to pu
bli
c
h
ea
l
t
h
emergency
f
unct
i
ons
Preparedness quotients Symbol Nation 1 Nation 2 Nation 3 Nation 4 Nation 5
Essential elements of an emergency
operations plan
P
Plan
0 0 0.21 0 0.21
Basic plan 0 0 0.35 0 0.25
Functional annexes 00000
Hazard specific annexes 00000.10
Standard operating procedures 00000
Plan concepts 0 0 0.50 0 0.75
Training & exercises 0 0 0.18 0 0.45
Hazard identification P
HazardID
00000.09
Disaster mitigation P
Mitigate
00000
Essential emergency functions P
Response
0 0 0.08 0 0.19
Authority, command & control P
Command
00000.24
Rapid assessment P
Assess
00000.20
Finance P
Finance
00000
Administration P
Admin
00000.11
Communications P
Commo
0 0 0.14 0 0.40
Public health facility evacuation P
Evac
00000
Transportation P
Transport
0 0 0.08 0 0
Security and traffic control P
Security
0 0 0.17 0 0
Public health facility infrastructure
& maintenance
P
Util
0 0 0.50 0 0
Mass care & shelter P
Shelter
00000
Essential disaster recovery functions P
Recovery
0 0 0.04 0 0
Critical incident stress management 00000
Deactivation 0 0 0.25 0 0
Plan evaluation and maintenance 0 0 0.50 0 0
Damage assessment for recovery 00000
Environmental health functions P
EnvHllth
00000.13
Hazardous materials management 00000.38
Epidemiological surveillance 00000.23
Vector control 00000.07
Water & food quality 00000
Public health preparedness P
qPubHealth
0 0 0.06 0 0.10
CDC Pacific emergency health initiative
161
Pacific jurisdictions studied. Three out of five had no
public health EOP. Two out of five hospitals had no
EOP, not even for fire. Those public health EOP that
were in place were largely focused on mass casualty
care as opposed to emergency public health functions
like epidemiological surveillance, vector control, shelter,
food and water quality, sanitation, and public educa-
tion. This planning emphasis on mass casualty care does
not appear to be consistent with the actual risk. During
1972–1996 disasters in Oceania affected an annual
average of 1 008 274 persons. During this same time,
disasters injured an annual average of 634 persons
(0.06%) and killed an annual average of only 108
persons (0.01%).
2
Generally, hospital EOP were limited to basic dele-
gations of responsibility in absence of any correspond-
ing operating procedures, management systems, or
contingencies for business continuity. There is no
formal accrediting process that includes essential
elements of emergency planning. Four out of five
(80%) of jurisdictions did not have basic equipment
for disaster response. Four (80%) out of the five
jurisdictions lacked training regarding the public
health and medical consequences of disasters.
Potential sources of error
The relatively low sample size of this study may serve
to limit the validity of broader assumptions regard-
ing emergency preparedness throughout the Pacific
region. However, the remarkably low levels of emer-
gency preparedness reflected throughout this sample
(representing approximately 20% of nations in
Oceania), are suggestive of what may be a wide-
spread problem among nations in the Pacific basin.
The selection of study jurisdictions was a conven-
ience sample based upon CDC collaboration with two
coexistent regional assessment projects. The Depart-
ment of Health and Human Services Region IX Office
of Pacific Affairs and the US Army Civil Affairs Bri-
gade, Disaster Preparedness and Mitigation Assess-
ment each provided travel funding for the study.
Sample selection was therefore decided external to
the study. Three of the five jurisdictions studied are
members of the US-associated free-compact States
(one of the three is a US territory). The effect of this US
association on jurisdiction planning assumptions and
development of preparedness (if any) is unknown.
The study controlled for reporting bias by using a
standard set of criteria for evaluation of only written
documentation of an EOP. Personal interpretations
of planning contingencies varied remarkably among
interviewees within the same jurisdiction. Only those
plan provisions documented within an EOP were
counted as affirmative responses. However, while help-
ing to standardize interpretation, the yes/no format
may also have potentiated an increase in the rate of
false-negative responses. Planning provisions may
have existed in an intermediate state that was not
captured accurately by either a ‘yes’ or ‘no’ answer.
The magnitude of the effect appears to be negligible in
consideration of the remarkably low prevalence of
emergency health plans among these nations.
Absence of documented public health and medical
emergency planning
One of the most concerning findings of this study was
the complete absence of any emergency plan among
three out of the five public health sectors (60%) sur-
veyed. All of these same jurisdictions without plans
had also experienced a major national disaster event
within the past decade. Emergency plans were also
found to be completely absent for two of the five (40%)
hospitals studied. All of these hospitals had also expe-
rienced a major national disaster event within the past
Table 3.
S
ummary o
f
pu
bli
c
h
ea
l
t
h
an
d
me
di
ca
l
emergency
preparedness positive response rates according to host nation
J
urisdiction Pq
PubHealth
Pq
Medical
10.00 0.20
20.00 0.00
30.06 0.14
40.00 0.00
50.10 0.27
Mean 0.03 0.12
Median 0.00 0.16
PqPubHealth, Publ ic health preparedness quotient; PqMedical, medica
l
p
reparedness quotient.
Table 4. Interpretat
i
on o
f
t
h
e pu
bli
c
h
ea
l
t
h
an
d
me
di
ca
l
preparedness response according to positive response rates and
preparedness index
Interpretation of preparedness Preparedness
Quotient Index
No Plan 0.00 0
Very Low 0.25 1
Low 0.260.50 2
Intermediate 0.51–0.75 3
High 0.76–1.00 4
ME Keim and GJ Rhyne
162
decade. All five jurisdictions had a national level plan
in place. These national plans were without specific
reference to public health beyond that of fundamental
delegation of authority for disaster issues related to
health and medical duties.
Very low emergency preparedness among public
health and medical sectors
Only two out of five jurisdictions (40%) were found to
have an EOP in place at the national level of public
health. The positive response rates calculated for each
of these plans were 0.06 and 0.10, suggesting a very
low level of preparedness even among those jurisdic-
tions with a plan in place. Three of the jurisdictions
studied had EOP in place at their national hospitals.
The medical preparedness quotients calculated for
these three hospital plans were 0.14, 0.20 and 0.27, sug-
gesting very-low to low levels of preparedness among
all studied hospitals that had a plan.
Essential elements of a public health emergency
operations plan, P
Plan
All five preparedness quotients for essential elements
of an EOP, P
Plan
, were less than 0.25, suggesting a
very-low level of sophistication or completeness for
planning in all jurisdictions studied.
These two public health plans that were available
for study were comprised mostly of elements for a
basic plan and did not include functional annexes,
hazard-specific appendices, or Standard Operating
Plan and checklists. These basic plans contained mostly
an assignment of executive level responsibilities for
disaster response.
Hazard identification, P
HazardID
Four out of five public health jurisdictions evaluated
had no component for hazard identification, P
HazardID
.
The fifth plan evaluated was found to have hazard iden-
tification preparedness quotient of 0.09, again suggest-
ing a very low level of preparedness throughout all
jurisdictions studied. Hazard identification is an
essential first step in developing evidence-based
disaster mitigation and preparedness and priorities.
Disaster mitigation, P
Mitigate
All five public preparedness quotients for disaster
mitigation, P
Mitigate
, were zero. This suggests a total
absence of plan-related mitigation activity through-
out all jurisdictions studied. There were no contin-
gencies to ensure that essential emergency response
facilities named in the jurisdiction EOP would, in fact,
be able to function after the impact of the disaster.
Jurisdictions 1, 4 and 5 also reported a complete
lack of access to critical public safety and medical
response facilities and equipment immediately after
the impact of previous the disasters. Few mitigation
measures were taken to prevent or lessen the impact
of future events.
Essential emergency functions
Preparedness quotients for essential emergency
functions, P
Response
, were less than 0.25 among all five
jurisdictions studied, suggesting a very low level of
preparedness. Among those two public health plans
available for study, neither contained reference to the
emergency functions related to finance, facility evacu-
ation, or mass shelter. All public health plans were
missing reference to more than half of 10 essential
emergency functions (Table 2).
Calculation of the mean preparedness quotient for
all five hospitals studied revealed a value of less than
0.10 for five (50%) of the 10 essential emergency func-
tions evaluated. These functions included finance,
evacuation, transportation, hospital inpatient care and
disaster equipment/supplies. Overall, all of the plans
studied revealed an inadequate definition of positions
that would act in support functions, such as assess-
ment, planning, administration or logistical opera-
tions, that would serve to assist the more highly
visible line operational functions (medical care, search
and rescue, sheltering etc.).
Authority, command and control
The plans assigned responsibility for a task-based
approach but did not offer an incident management
system by which these various activities would be
coordinated. There were few plan parameters defined
for an organizational structure that would also corre-
late with emergency management functions.
Rapid assessment
Only one out of five (20%) jurisdictional public health
plans contained any reference to rapid health assess-
ments. These needs and situation assessments are
commonly necessary during and after a disaster in
order to accurately guide response efforts and estab-
lish priorities for external assistance.
CDC Pacific emergency health initiative
163
Finance
Plan provisions for funding, accounting, acquisition
and budgeting were notably absent from all EOP
studied.
Administration
Those plans reviewed did not include adequate descrip-
tions of general policies for human and material
resource management, including procurement and
allocations. They did not identify many of the specific
national response functions that would include staffing
of employees beyond that of hospital personnel. The
plans did not include the management of volunteers
nor methods for tracking of resources.
Communications
Planning provisions did not integrate communications
between the health and medical sectors and emer-
gency responders such as public safety or the national
emergency operations centres. Plans did not include
provisions for assurance of continuity among commun-
ication linkages that were critical to plan operation.
Other logistical functions: evacuation, transportation, security/traffic
control, utilities/maintenance
Those plans reviewed did not specify adequate
provisions for logistical support that are commonly
necessary during a disaster. These basic functions
often include direction and control of transportation,
equipment supply chain, resource staging, evacuations,
scene and facility security, operations and mainte-
nance in the setting of a loss in water and energy
utilities at critical facilities (e.g. hospital or public
health department).
Mass care and shelter
None of the five jurisdictions studied had any documented
plan for mass shelter. No efforts had been made to evaluate
and maintain facility suitability for the needs of mass
shelter. No delegations of responsibility were documented
with respect to mass care for displaced populations.
Workforce training and exercises
None of the EOP studied offered a framework for
plan development, validation or maintenance. The
workforce that would most likely involve emergency
responders within the public health and medical systems
did not have ready access to adequate training regard-
ing key methods of disaster management. These
personnel had very little or no experience with major
catastrophic health events.
Equipment and supplies
There were very few material resources specifically
dedicated to disaster preparedness and response (out-
side of those materials used in routine administration
and operation of the public health and medical sys-
tem). There were no stockpiles or stores earmarked for
use in nation-wide or hospital emergencies.
Essential disaster recovery functions
The mean preparedness quotient for essential transitional
disaster recovery functions (such as response deactiva-
tion, stress debriefing and damage assessment) for all
five jurisdictions was extremely low (< 0.01). One plan
made reference to provisions for deactivation or plan
evaluation measures.
General public health functions
Only one out of five (20%) jurisdictions had a public
health EOP that addressed common emergency public
health issues related to hazardous materials, epidemio-
logical surveillance or vector control. None of the pub-
lic health EOP contained provisions for issues related
to water quality and food safety.
Discussion
There are many factors besides planning that may
also affect preparedness. These may include the effect
of cultural, economic, social, educational, experiential,
legislative and architectural/structural influences.
Cultural factors must be addressed in order to
appreciate the context of disasters for that population.
In one example, the actual word for ‘disaster’ using the
local language implies a connotation of divine punish-
ment for sins. This may have a notable effect upon the
jurisdiction’s approach to disaster preparedness.
Economic factors also have an obvious effect in the
limitation of adequate resources that will support the
labour-intensive process of plan development, valida-
tion, exercise and maintenance. Also in some situations
where poverty forces people to live ‘from day to day’, it
becomes very difficult for those at risk to plan or allocate
resources for events of tomorrow that may have lesser
probability. The way in which a society distributes
and allocates resources may also have an effect
upon relief work. For example, emergency response
interventions in areas of Samoa should take into con-
sideration the presence of strong Aiga relationships
ME Keim and GJ Rhyne
164
and Matai social structure that include a mechanism
for distribution of wealth (as well as implications for
distribution of any disaster relief aid).
Social and religious factors also play a role in
preparedness. The concepts of volunteerism, fatalism,
existentialism, animism and issues related to personal
savings or stockpiling all come into reference when
addressing a society’s preference or social tendencies
for planning and preparedness.
Educational factors also play a role. People must be
educated regarding the presence of hazards, the health
implications of those hazards and the actual risks that
they face. Effective methods for health emergency
prevention, planning, response and recovery must be
shared with those given the task of maintaining the
public health.
The personal experience of plan stake holders and
their subjective perception of risk also have an effect upon
their willingness or intent to plan for future events.
Unfortunately, all too often a society’s interest in disaster
preparedness is directly proportional to the severity
and time passed since its last disaster. All of the
islands studied have been relatively fortunate during
recent generations in that there has been no large-scale
loss of life. This lack of recent mass fatalities may result
in a false sense of security within these regions at risk.
Legislative factors may also influence jurisdictional
preparedness. Law-makers may assign priorities
according to budgetary, administrative, political and
strategic restrictions.
Finally, engineering and architectural issues also
influence emergency preparedness. Societal preference
for traditional building styles also has an impact upon
preparedness. Traditional Pacific island dwellings
such as the falé and the abaii obviously offer much dif-
fering levels of preparedness compared to reinforced
concrete structures. Availability and cost influence the
selection of building materials. Lack of zoning or
engineering controls may also influence survivability
of critical infrastructure. Any or all of these factors
may also have attenuated the development of emer-
gency preparedness in Oceania.
Conclusion
The worrying findings of this pilot study reveal a
remarkably low prevalence of emergency planning
and very low levels of preparedness among health
and medical sectors of five Pacific islands, a region at
high risk for environmental health emergencies.
The data reflect a very low level of host national
capacity for development of preparedness. This region
is highly dependent upon external assistance in order
to maintain the public health and prevent excess
suffering, morbidity and mortality. Future interven-
tions should be guided by a more comprehensive study
that would accurately characterize emergency pre-
paredness for the entire Pacific basin. Subsequent
interventions should be based upon definitive findings
for the entire region of Oceania.
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... 7 The aim should be to achieve self-sufficiency in the early part of disaster for at least the first 72 hours. 9 In the face of disaster associated with pervasive environmental and weather hazards, personal preparedness which is critical has been shown to be instrumental in saving lives. 6,10 To respond to the continuous call to building a better prepared and more resilient community, we decided to carry out a study on family emergency plan and preparedness among medical practitioners, who, by the nature of their work, are knowledgeable and have a lot of experiences on these issues. ...
... In the principles of disaster management, it is often required that there should be proper delineation of roles at every stage, that is, when and what must be done and by who, and this delineation of roles is often clearly stated in a written policy document. 1,9 This was grossly lacking in our study area with an attending implication that, if a disaster strikes, in addition to the impact, the level or degree of damage could also result from improper management characterized by delays and confusion. Also, lack of instructions on safety pathways and areas within the community will further compound and increase further damage and losses among those that could have escaped unhurt. ...
Article
Full-text available
Background: There has been an increase in the incidence of disasters in many parts of the world. Similarly, Nigeria has witnessed a recent increase of man-made disaster events such as plane crash, fire incidents, flood, and building collapse, including bomb blast orchestrated by terrorists that often create emergency situations. Therefore, the aim of the study was to evaluate family emergency plan and preparedness among medical practitioners in Zaria. Methods: This was a cross-sectional descriptive study (May-July, 2013) of medical practitioners in Zaria, Nigeria. The structured questionnaire sought the socio-demographic features of the respondents, the availability of emergency gate(s) in the house, education of safety measures within and outside the house, well-known located shut-off devices for gases, electricity, and water in the house, and written document/policy in the event of disaster. Also, planned orientations/drills/sensitizations, whether there is contact information of family members and supporting agencies. Results: Majority of the respondents were male 56 (80.0 percent) and fall within the age group of 46-50 years (20.0 percent). Only 8.6 percent admitted having an unwritten policy on emergency management in their houses. Similarly, only 8.6 percent do create time to teach their family members on emergency management. Only 27 (38.6 percent) had emergency supplies kits and among this group, water appears to be the most essential component that the respondents had paid attention to, leaving out special items. The communication plans of respondents to likely supportive services/agencies during disaster showed that majority had contact address or have affirmative plans for hospital and ambulance services than for radio and television stations. Conclusion: Family emergency plans and preparedness among medical practitioners in Zaria are extremely low. There is a gap between knowledge of what need to be done to enhance preparedness and internalizing preparedness recommendations in the study area.
... 7 The aim should be to achieve self-sufficiency in the early part of disaster for at least the first 72 hours. 9 In the face of disaster associated with pervasive environmental and weather hazards, personal preparedness which is critical has been shown to be instrumental in saving lives. 6,10 To respond to the continuous call to building a better prepared and more resilient community, we decided to carry out a study on family emergency plan and preparedness among medical practitioners, who, by the nature of their work, are knowledgeable and have a lot of experiences on these issues. ...
... In the principles of disaster management, it is often required that there should be proper delineation of roles at every stage, that is, when and what must be done and by who, and this delineation of roles is often clearly stated in a written policy document. 1,9 This was grossly lacking in our study area with an attending implication that, if a disaster strikes, in addition to the impact, the level or degree of damage could also result from improper management characterized by delays and confusion. Also, lack of instructions on safety pathways and areas within the community will further compound and increase further damage and losses among those that could have escaped unhurt. ...
Article
Full-text available
Background: There has been an increase in the incidence of disasters in many parts of the world. Similarly, Nigeria has witnessed a recent increase of man-made disaster events such as plane crash, fire incidents, flood, and building collapse, including bomb blast orchestrated by terrorists that often create emergency situations. Therefore, the aim of the study was to evaluate family emergency plan and preparedness among medical practitioners in Zaria. Methods: This was a cross-sectional descriptive study (May-July, 2013) of medical practitioners in Zaria, Nigeria. The structured questionnaire sought the socio-demographic features of the respondents, the availability of emergency gate(s) in the house, education of safety measures within and outside the house, well-known located shut-off devices for gases, electricity, and water in the house, and written document/policy in the event of disaster. Also, planned orientations/drills/sensitizations, whether there is contact information of family members and supporting agencies. Results: Majority of the respondents were male 56 (80.0 percent) and fall within the age group of 46-50 years (20.0 percent). Only 8.6 percent admitted having an unwritten policy on emergency management in their houses. Similarly, only 8.6 percent do create time to teach their family members on emergency management. Only 27 (38.6 percent) had emergency supplies kits and among this group, water appears to be the most essential component that the respondents had paid attention to, leaving out special items. The communication plans of respondents to likely supportive services/agencies during disaster showed that majority had contact address or have affirmative plans for hospital and ambulance services than for radio and television stations. Conclusion: Family emergency plans and preparedness among medical practitioners in Zaria are extremely low. There is a gap between knowledge of what need to be done to enhance preparedness and internalizing preparedness recommendations in the study area.
... In particular, the regions and countries most affected by disaster are less wealthy, often with poorly developed healthcare systems and inadequate disaster planning (Keim & Rhyne, 2001). Teams travelling into these areas may encounter pre-existent resource deficits further compounded by the disaster event. ...
... 17,18 However, the level of preparation is unsatisfactory in many countries; for example, preparation and planning for disaster has been evaluated as weak in Oceania, which leaves these countries dependent on external aid in times of catastrophic events. 19 Inconsistency in aid strategies and lack of cooperation and coordination can result in losing time, and may cost lives in disaster situations. Coordination of assistance teams is crucial in the provision of an efficient response. ...
Article
Full-text available
Introduction The 2003 Bam, Iran earthquake resulted in high casualties and required international and national assistance. This study explored local top and middle level managers’ disaster relief experiences in the aftermath of the Bam earthquake.Methods Using qualitative interview methodology, top and middle level health managers employed during the Bam earthquake were identified. Data were collected via in-depth interviews with participants. Data were analysed using thematic analysis.Results Results showed that the managers interviewed experienced two main problems. First, inadequacy of preparation of local health organisations, which was due to lack of familiarity of the needs, unavailability of essential needs, and also increasing demands, which were above the participants’ expectations. Second, inappropriateness of delivered donations was perceived as a problem; for example, foods and sanitary materials were either poor quality or expired by date recommended for use. Participants also found international teams to be more well-equipped and organised.Conclusions During the disaster relief period of the response to the Bam earthquake, local health organizations were ill prepared for the event. In addition, donations delivered for relief were often poor quality or expired beyond a usable date. M Moosazadeh, F Zolala, K Sheikhzadeh, S Safiri, M Amiresmaili. Response to the Bam earthquake: a qualitative study on the experiences of the top and middle level health managers in Kerman, Iran. Prehosp Disaster Med. 2014;29(4):1-4 .
... These data suggested a very low level of host national capacity for development of preparedness. 15 Confidentiality was maintained at all times using number coding to identify participants. The principal investigators certify that they have NO affiliations with or involvement in any organization or entity with any financial interest or non--financial interest in the subject matter discussed in this research study. ...
Data
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he Philippines had the second most number of disasters in the first 10 months of the year with 16 recorded disasters, next only to China with 18 recorded calamities in 2012. The impact of these threats on the health and response system can be overwhelming. Likewise, the Emergency Department staff are among the first responders in the event of these disasters and are the frontlines of emergency preparedness. Thus, the objective of this research is to determine the knowledge, attitudes and practices of employees at the Department of Emergency Medicine, Philippine General Hospital regarding disaster preparedness and planning. All emergency physicians, nurses, emergency medical technicians and institutional workers of the Department of Emergency Medicine of the UP-Philippine General Hospital were enrolled in the study and yielded an 82.7% participation rate. It employed a cross-sectional study design and a self-administered questionnaire modified from the study done by Moabi, RM was used. While there seems to be a poor knowledge and practices of the DEM staff, the majority of the employees has a good, if not excellent attitude towards emergency preparedness and disaster planning. In view of these findings, there is much work needed to be done to enhance the knowledge and practices of the DEM staff to be more prepared should a major disaster strikes and eventually improve outcomes following a disaster.
... However, these long-term benefits are often overlooked for short-term gain. In a review of disaster preparedness in South-Western Pacific countries, a very low level of capability was revealed despite the disaster damage bill averaging a billion US dollars per annum (Keim and Rhyne 2001). The region is thus highly dependent on external aid and assistance and cannot in most cases mount a speedy and effective response. ...
Article
Full-text available
An organization’s preparedness agenda bears a direct relationship to its crisis response capabilities and its capacity to respond to and manage a crisis. To clarify the current level of crisis capabilities, this study investigates the level of capacity that exists in health and allied health organizations by assessing the level of planning in existence for eleven different types of crises. This evidence-based study draws on responses provided by executive decision-makers from chiropractic, physiotherapy and podiatry practices, dental and medical clinics, pharmacies, aged care facilities, and hospitals. Results show that physiotherapy, podiatry and chiropractic practices possess little crisis capacity, pharmacies are somewhat capable and medical clinics, hospitals and aged care organizations are somewhat to reasonably capable. Dental clinics are an anomaly since their performance is similar to allied health organizations rather than to health organizations. The data suggest that the organizations surveyed have fallen into the pattern of developing capabilities for certain common, expected threats rather than for what they consider unlikely or what they have not experienced. The presence of a disconnect between what is planned for and what is actually experienced is of considerable concern because it suggests that planners lack sufficient awareness of threats that their organizations encounter.
Chapter
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Research
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The study is planned to calculate and prepare the disease mapping for public health. GIS may be used to examine current patterns of use and carry out modeling of different scenarios taking into account population distribution, location of facilities, transport likes, primary health care services and range of other factors. Secondly, estimation of service areas of hospitals can be made. There are problems of accurate enumeration as the population served by a hospital is usually geographically dispersed and not neatly constrained by administrative and census boundaries. Overlay of layers address locations on census boundaries and other geographical features using GIS techniques can help to define hospital’s service area.
Article
Full-text available
Abstract Natural disasters impose a significant burden on society. Current disaster training programmes do not place an emphasis on equipping surgeons with non-technical skills for disaster response. This literature review sought to identify non-technical skills required of surgeons in disaster response through an examination of four categories of literature: "disaster"; "surgical"; "organisational management"; and "interprofessional". Literature search criteria included electronic database searches, internet searches, hand searching, ancestry searching and networking strategies. Various potential non-technical skills for surgeons in disaster response were identified including: interpersonal skills such as communication, teamwork and leadership; cognitive strategies such flexibility, adaptability, innovation, improvisation and creativity; physical and psychological self-care; conflict management, collaboration, professionalism, health advocacy and teaching. Such skills and the role of interprofessionalism should be considered for inclusion in surgical disaster response training course curricula.
Conference Paper
The Guidelines described in this Workshop report are the result of extensive research and discussions by a Steering Committee during multiple meetings over the past five years and by invited participants in an International Workshop on the Quality Control of Disaster Management conducted at the Nordic School of Public Health in Gothenburg, Sweden. The Task was the development of a structural framework for investigations into the medical and public health aspects of disasters that could be used as for the appropriate design, conduct, and reporting of evaluation and research. Such studies could investigate the absorbing capacity and preparation for the impact of the unfortunate realization of a hazard, the effectiveness and efficacy of the responses as they relate to the needs of the affected population, and benefit:cost relationships associated with medical responses to disasters worldwide. These studies will result in the ability to compare and integrate the findings of the evaluations and research of many disasters with the end-point of improving the effectiveness and decreasing costs associated with the health aspects of the prevention, vulnerability, preparedness, and responses to disasters.
Chapter
Natural and man-made disasters--earthquakes, floods, volcanic eruptions, industrial crises, and many others--have claimed more than 3 million lives during the past 20 years, adversely affected the lives of at least 800 million people, and caused more than 50 billion dollars in property damages. A major disaster occurs almost daily in some part of the world. Increasing population densities in flood plains, along vulnerable coastal areas, and near dangerous faults in the earth's crust, as well as the rapid industrialization of developing economies are factors likely to make the threat posed by natural disasters much bigger in the future. Illustrated with examples from recent research in the field, this book summarizes the most pertinent and useful information about the public health impact of natural and man-made disasters. It is divided into four sections dealing with general concerns, geophysical events, weather-related problems, and human-generated disasters. The author starts with a comprehensive discussion of the concepts and role of surveillance and epidemiology, highlighting general environmental health concerns, such as sanitation, water, shelter, and sewage. The other chapters, based on a variety of experiences and literature drawn from both developing and industrialized countries, cover discrete types of natural and technological hazards, addressing their history, origin, nature, observation, and control. Throughout the book the focus is on the level of epidemiologic knowledge on each aspect of natural and man-made disasters. Exposure-, disease-, and health-event surveillance are stressed because of the importance of objective data to disaster epidemiology. In addition, Noji pays particular attention to prevention and control measures, and provides practical recommendations in areas in which the public health practitioner needs more useful information. He advocates stronger epidemiologic awareness as the basis for better understanding and control of disasters. A comprehensive theoretical and practical treatment of the subject, The Public Health Consequences of Disasters is an invaluable tool for epidemiologists, disaster relief specialists, and physicians who treat disaster victims.
Article
Natural disasters such as floods, earthquakes, and cyclones are responsible each year for a large number of deaths and injuries. Over recent years, the emphasis in disaster management has shifted from post-disaster improvisation to pre-disaster planning. There is a strong feeling that one should be able to prevent or mitigate the human consequences through improved preparedness. The decade 1990-99 has been proclaimed by the United Nations the International Decade for Natural Disaster Reduction (IDNDR). Epidemiology is proving an essential tool to study the health effects of disasters and to suggest appropriate control measures at each of the phases of the disaster process, from prevention to long-term rehabilitation. Case-studies have shown that rescue by the disaster-struck community is the most effective way to reduce the death toll due to earthquakes. Disaster preparedness should be part and parcel of primary health care in disaster-prone areas. Appropriate information to evaluate needs should be preferred to precipitate relief. Epidemiological surveillance should replace indiscriminate vaccination. In the long term, disaster preparedness can provide a stimulus for setting up more efficient health services.
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International Federation of the Red Cross and Red Crescent Socities. Key statistics. In: 1998 World Disasters Report. New York: Oxford University Press, 1998; 140-1.
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Task Force on Quality Control of Disaster Management. Health Disaster management: Guidelines for Evaluation and Research in the Utstein Style. Executive summary. Prehosp. Disaster Med. 1999; 14 : 11-20.