THU4.5: Health within disaster risk reduction
Time: Thursday, 30/Aug/2012: 1:00pm - 2:30pm
Session Chair: Monica Lynn SCHOCH-SPANA, University of Pittsburgh Medical Center
Session Chair: Christine Marie KENNEY, Edith Cowan University
Location: Wisshorn


Session Abstract


The DITAC Project - Development of a Disaster Training curriculum (DITAC)


Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Germany

Establishing a curricular training on how to respond to an international crisis and making it accessible to pertinent organizations throughout the EU will be a first step towards building a European Emergency Response Centre.

The DITAC Project will:

• analyse concepts, methods, and doctrines of crisis response and identify the relevant European competences of crisis management,

• analyse existing initiatives to generate curricula for crisis management,

• identify the requirements of the local actors in crisis management education,

• identify the needs of relevant actors and the resulting stakeholder requirements for significant improvement of trainings in international disaster response and crisis management,

• develop a didactic concept to transmit common standards for crisis management education, using state of the art methods for teaching and training,

• organise a pilot study course for suitable participants from European countries,

• develop an evaluation tool for the course.

The DITAC Project proposes to develop a holistic Training Curriculum for first responders and strategic crisis managers dealing with international crises. The DITAC Curriculum will address the key challenges for the management of disaster incidents.

The Curriculum will improve the preparedness and availability of trained personnel by providing a common language, common objectives and common tools leading to better results in the protection and assistance of people confronted with large-scale crises.

The DITAC Project will use open sources for dissemination during the project period in order to get continuous feedbacks, and will organise public meetings and congresses to reach a consensus about the Curriculum’s content. The improvement of the preparation of trained personnel will be evaluated in a pilot study. The information from the pilot study will serve to validate the Curriculum and provide feedback.

“Embedded health systems analysis”: A framework for effective disaster mitigation & response

Samantha WATSON, James RUDGE, Richard COKER

London School of Hygiene and Tropical Medicine, Thailand, Kingdom of

Over the past two decades, high profile natural-hazard events, together with increasing recognition of pandemic risk, have intensified interest in disaster mitigation and response planning. This has been accompanied by a widespread acknowledgment of the global scale, dimensions, and interconnections of disaster risk and vulnerability. An attendant, and welcome, policy trend has been to accord health systems a central role in disaster planning at all levels. There remains, however, an unmet need for integrated analysis linking likely disaster scenarios to health systems’ ability to intervene. The challenge, as various international bodies increasingly emphasise, lies in translating the uncoordinated ad hoc project/programme approach that persists into strategic action at the international, regional, national, and local levels. The recently developed “health system’s surge capacity” concept is a promising development, but it’s potential to provide a robust empirical basis for healthcare delivery strengthening in phased disaster scenarios remains underdeveloped. Existing disciplinary schisms must be bridged for this potential to be exploited. This entails uniting expertise from the physical, life, and social sciences to develop a new knowledge interface for integrated research into: i) disaster risk assessment and scenario development; ii) vulnerability modelling; and iii) health system's surge capacity / capability. These three research streams have, to date, developed largely in isolation of one another. Here we present a conceptual and analytical framework which explicitly locates the health system in the environmental, structural, institutional, and relational milieu in which it operates. This represents a major conceptual break from orthodox health systems analyses, characterized by static analytical frameworks, isolated from the complex dynamics and environmental and social locations that are key components of actual health systems. We recommend adoption of this framework as a means to develop a robust evidence base on which the nascent policy shift towards an integrated, ex-ante planning approach can proceed.

2012-2025 roadmap of I.R.Iran's Health Disaster Management

Ali ARDALAN1, Mohammad Hossein RAJAEI1, Gholamreza MASOOMI2, Seyed Ali AZIN3, Vahid ZONOOBI2, Mohammad SARVAR2, Khorshid VASKOUIE2, Elham AHMADNEZHAD1, Gelareh JAFARI1

1I.R Iran National Institute of Health Research, Iran, Islamic Republic of; 2I.R Iran Ministry of Health; 3Iranian Institute for Health Sciences Research

Along with the Iran’s Comprehensive Health Sector Road Map, the National Institute of Health Research at the Tehran University of Medical Sciences developed the 2012-2025 road map of Health Disaster Management (HDM), including goals and objectives, strategies and action priorities and related prerequisites. This article presents process and results of this road mapping project. The project started with an expanded literature review followed by stakeholder analysis to assess level of interest and impact of related organizations to HDM, STEEP.V methodology to define determinants with a potential impact on Iran’s HDM for duration of 2012 to 2025, SWOT analysis, formulation of goals and objectives and related strategies and priority actions and prerequisites. Brain storming, group discussion and interview with key informants were used for data collection, nominal group technique was used whenever prioritization was necessary and Delphi panel was applied for consensus development. STEEP.V analysis revealed the most important determinants in terms of social, technological, environmental, economical, political and value-based. Iran’s HDM mission and vision were defined respectively as “mitigation from, preparedness for, response to and recovery from consequences of natural and man-made hazards at the community and health facilities and resources of I.R.Iran” and “In 2025, Iran’s HDM will be the most developed system in the region compromising the least vulnerability, the highest readiness in health facilities and resources and the highest and most effective contribution in disaster resilience of Iranian community”, respectively. Sixteen strategies and priority programs prerequisites actions were developed. This was the first attempt of comprehensive strategic planning in the field of HDM in Iran. The current framework provides Iran’s health system with a list of clear strategies and priority programs to be considered in operational planning and actions. It, however, requires a dynamic process of evaluation and revision to ensure meeting Iran’s health system goals in 2025.

A comparison of functional outcomes at one year between two cohorts of patients with extremity limb trauma following the Haitian earthquake in 2010

Marie Christine DELAUCHE1, Hervé LE PERFF1, Nikki BLACKWELL1, Thierry ALLAFORT-DUVERGER1, Stéphane CALLENS2, Joel MULLER2, Nezha KHALLAF2, Lou SHANG2

1ALIMA (Alliance for International Medical Action), Senegal, Republic of; 2LEM UMR 8179, Lille, France

Many injured earthquake survivors have contaminated, open limb fractures, resource constraints compromise optimal care. Some advocate immediate amputation to treat haemorrhage and crush syndrome, citing the need for only basic equipment with short hospitalisation and recovery. Others promote limb preservation with reconstructive surgery, preventing disability and offering better functional outcomes. The feasibility of limb preservation in the emergency response phase is uncertain; a comparison of outcomes is needed.

This study aims to provide evidence to further this discussion.

Open prospective survey of Haitian earthquake victims after reconstructive surgery or amputation at 1 year and 2 years (on-going) with multi-dimensional evaluations. Data analysis employed conventional methods (p<0.05 (S*))

289 patients (188 amputees (A), 101 surgically reconstructed (LS)) were evaluated at 1 year. Demographics: female 58%, mean age 30 years, leg injury (69%). 47% had additional severe injuries (A:58%, LS:42%) (S*): fractures 61% (A:54%, LS:76%); soft tissue lesions: 21% (A:27%, LS:11%); open: 20% (A:21%, LS:18%), closed: 20% (A :47%, LS :5%), traumatic amputation (10%; A:15%) crush injury 12 (A:19%, LS:3%) and severe soft tissue damage 9% (A:10%, LS:7%) (S*). Mean hospitalisation was 56 days, prolonged stays (> 90 d) were more frequent in amputees (S*). 64% had persistent pain (A:78%; LS:57%)(S*); Satisfaction correlated with pain intensity. 50% of patients considered themselves “cured“ (A: 61%; LS: 31%)(S*). 100% of patients treated with a reconstructive approach would choose this management again. If an amputation was not clinically mandatory, 79% of amputees would prefer reconstructive treatment.

Humanitarian actors responding to disasters must take into account that limb trauma patients require prolonged follow-up. Given the duration of care necessary it is not always obligatory to provide ‘definitive care’ in the rudimentary conditions immediately after a catastrophe. The priority in the first days is thorough wound debridement and haemorrhage control, allowing time for specialised surgical teams and facilities to be established.

Safe water adaptability index for salinity, arsenic and drought risk in south-west of Bangladesh

Md. Anwarul ABEDIN, Rajib SHAW

Kyoto University, Japan

In 21st century, availability of safe drinking water is the most challenging problem for the world. The present water resource of world is like Coleridge’s novel’s condition of actor “water; water everywhere, but there no drop to drink”. Some of the countries in the world have severe water scarcity, but this type of worst scenario is also observed in southwest part of Bangladesh. Though, it is claimed that 16 percent of world’s safe water are in Bangladesh, but especially, southwest part of Bangladesh suffers scarcity of pure drinking water due to groundwater arsenic along with salinity intrusion and drought. To overcome the crisis of safe drinking water of this region, different international organizations, GO, NGOs, private sectors and community people are trying to cope with this. Most of them have paid their attention as single issue rather than combined. However, the problem of safe water scarcity arises through salinity, arsenic and drought that are intimately inter-linked with each other. Therefore, it is urgent to include all the issues by developing an integrated approach which will help to find a successful solution for accessing safe drinking water in the affected area. Hence, this study developed a holistic approach named “SIPE” to determine safe water adaptability index and applied it at 16 sub-districts (upazila) of Khulna and Satkhira districts in southwestern Bangladesh. It helps to measure existing level of different physico-chemical, socio-economic, environmental and institutional conditions of the targeted area and provides an overview of safe water adaptability index. Using SIPE approach, the results highlight that institutional dimension of 16 upazila has higher safe water adaptability index compare to physiochemical, socio-economic and environmental dimension. This study further tries to link this approach into policy level which facilitates to adapt and practice it through national level to local level in a sustainable way.

The role of pandemic plans in ethical preparedness and resilience


Ruhr University, Germany, Federal Republic of

Pandemic preparedness planning, as an instance of general disaster planning activities, focuses on how particular institutions and officials will seek to manage serious viral outbreaks. One prominent form of planning in anticipation of the emergence of a pandemic threat are pandemic preparedness plans created by national governments. In addition to outlining the medical and legal guidelines/processes to be followed during a pandemic, a large number of plans also include ethical considerations to be considered in informing policy and action. This inclusion reveals a recognition that not only will ethical considerations be of central relevance to pandemic planning, but that inclusion of ethical guidance will contribute to a more effective response and promote greater resilience. In addition to national pandemic plans, supranational and international documents, such as the WHO’s Addressing Ethical Issues in Pandemic Influenza Planning and EUR-OPA Major Hazards Agreement Ethical Principles on Disaster Risk Reduction and People’s Resilience to Disaster also exist with the same objectives. Unfortunately, there is little or no evidence that these plans/documents contribute to ethical preparedness or resilience, nor even that public officials have or will make use of the ethical principles listed to guide their conduct or decision-making processes. It is argue that, at least in their current form, most pandemic plans cannot be said to be properly ethically action-guiding, nor should they be thought to provide some metric by which the level or quality of ethical preparedness or prospective resilience within a community can be assessed. The mere inclusion of ethical considerations within these plans or documents is not a sufficient indicator of ethical preparedness or resilience. A great deal more work – in terms of research, development and evaluation – must be done to better understand and integrate ethical guidance within pandemic planning specifically and risk and disaster management generally.

Occupational health of front line workers responding to earthquakes in New Zealand: workplace cultures- vulnerability, resistance and resilience.


1University of Otago, New Zealand; 2Auckland University of Technology

This paper draws on a cohort study being conducted by a multidisciplinary team which focuses on a range of front line workers in Christchurch, New Zealand responding to earthquakes since September 2010 and February 2011 when a 7.1 magnitude quake resulted in the loss of 186 lives and city devastation. The study explores occupational health outcomes for these workers while simultaneously following the health of their significant other support people. Temporality is often suspended in disaster research in relation to wider social and cultural relations. Yet of course responses by front line workers are embedded within a specific social and cultural history and what has happened and is happening at home and work shapes how they respond to these events. A reflection on the recruitment and retention process demonstrates clearly that culturally embedded and socially entrenched contentious labour relations for some of the front line workers in particular firefighters play a significant role in how they have responded and coped with the earthquakes. For some workers, shifting perceptions of danger and blame underpin workplace culture and their calculations of risk. This tension with respect to labour relations leads to resistance toward their workplace conditions and their employers. At this stage it appears that resistance to workplace conditions and employers may in the short term assist resilience amongst some of these workers by reinforcing the collective and insularity and ensuring that workplace conditions remain an internal and addressable threat. In contrast, the on-going earthquakes as natural disasters are easily externalised, and with respect to temporality, as the earthquakes come they are quickly put behind them. Whereas industrial unease is on-going, relentless and unresolved. The question is: Is the vulnerability which underpins the resistance a sustainable response in an environment of lost workplaces, temporary quarters, lost homes and an uncertain landscape?