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Conference Agenda

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Session Overview
WED7.8: Health and medical interventions within emergency situations
Time: Wednesday, 29/Aug/2012: 6:55pm - 8:00pm



Evaluation of hospital vulnerability, three hospitals in Kerman-Iran

Esmaeil SHIEH1, Kiomarth HABIBI2, Mohamad amin SKANDARI1

1Iran University of Science & Technology; 2University of Kurdistan

Hospitals are one of the critical facilities, the role of hospitals in a society will be more vital; when, a mass casualty incident occurs. for example after a large earthquake, the Demands for healthcare services will be strongly increase, while the ability of providing healthcares in vulnerable hospitals will be decrease; because of, direct and indirect disaster effects. To compromise between demands and services, we should reduce the health system vulnerability. The first step for making hospitals less vulnerable to hazards is vulnerability assessment.

To know the details of hospital vulnerability, we took “PAHO hospital safety index” and used its checklist (145 questions in 3 divisions) for assessing vulnerability to most priority hazards, in three hospitals in Kerman province. Then the results analyzed by the vulnerability calculator.

The results indicate all three hospitals are in level C of Safety, the vulnerability score for most vulnerable hospital is 0.83 (the safety score = 0.27) and for the lowest vulnerable hospital is 0.72 and for the third hospital, the vulnerability score is 0.81. The most vulnerable division in one of them is based on non-structural elements, and in the rest is related to functional capacity.

In conclusion, according to the calculated safety levels for the hospitals, in all three hospitals urgent intervention measures are needed, and the hospital’s current safety levels are inadequate to protect the lives of patients and hospital staff during and after a disaster.

Adapting the” Paho Hospital Safety Index” for hospitals in Iran

Kiomarth HABIBI2, Esmaeil SHIEH1, Mohamad amin SKANDARI1

1Iran University of Science & Technology; 2University of Kurdistan

Hospitals are one of the critical facilities for any country. They play most important role in saving lives after disasters. They have an increased social and political value for an affected community too, and as such, special attention must be given to reducing their vulnerabilities to disasters.

Almost all hospitals in Iran are located in areas at high risk for disasters, mainly earthquakes; would they continue to function in emergency situations? One of the best tools may answer the question is “Paho Hospital Safety Index” which helps health facilities assess their safety. The tool has a checklist (145 items), a guideline and a formulated calculator, calculates hospitals safety scores and levels. The tool is developed for hospitals located in Latin America and the Caribbean. To use this tool in different situation for instance in Iran, maybe we need to do some changes in the checklist, weights and calculator.

In this study, at first vulnerability in 3 hospitals was assessed, using the original Paho tool. Then the checklist reviewed by three university faculties and four disaster experts, and Using Delphi method, they placed checklist’s items into three categories (no need to change, change is better, change is necessary), as a next step, the group made the necessary changes in only the items was felt into category 3, then reformulate the calculator for changed areas and items. The assessments refreshed and safety indexes recalculated, using the adapted checklist and calculator. A Comparison between the results indicates the difference between the scores calculated by the original tool and the adapted tool isn’t significant (max difference= 4%).

In conclusion, the hospital safety index could adapt for use in our country with minimum changes. Therefore, hospitals in Iran can use the tool to monitor their safety levels, and then make better mitigation and preparedness plans.

Preventive family consultation with the approach of enhancing psychological resilience and its role in promoting post-disaster psychological preparedness and mental health


1Graduate Student of Family Counseling of Hormozgan University Campus in qeshm island; 2Red Crescent Society of Hormozgan Province of Iran, Iran, Islamic Republic of; 3Hormozgan University of Medical Sciences

Intensification of climate change and global warming along with an increase of population and deficiency of resources have made the citizens, particularly in developing countries, prone to occurrence of numerous disasters and their associated negative mental and psychological consequences. Psychological consequences are regarded as a serious obstacle against coping with critical situations. In addition to the impacts on public health and the reduction of citizen’s level of participation in different sectors of crisis management cycle and decreased speed of passing from this cycle besides its economical aftermaths, these consequences could negatively affect the general safety of citizens against secondary disasters and hazards following the major disaster due to impairment of their consciousness and concentration. Psychological resilience is one of the most important personality dimensions for being secure against unpleasant mental consequences of disasters. The main pre-constructs and pre-requisites of resilience are present in the majority of people and might emerge in personality construction depending on the environment, and also on nurture and education. Instruction of life skills and preventive family consultation prior to the occurrence of disasters with the approach of promoting resilience is a crucial method of strengthening pre-constructs and pre-requisites of resilience in personality. Based on the experiences of instructions presented in relief-and-rescue operation of Red Crescent Organization in earthquakes of 2005 and 2008 in Qeshm Island in southern Iran and the performance of psychological support teams of this organization, this paper seeks to achieve a model for instructing life skills and preventive family consultation using the approach of enhancing psychological resilience in personality construction for lowering damageability and sustainable promotion of mental health of residents of incident-prone regions. This model is based on representing and simulating difficult circumstances of disasters in instruction and consultation processed, individual and collective exercises, and individual and group conversations among consultants and clients.

Providing medical support to large scale public gatherings


1Magen David Adom, Israel, State of; 2Ayuntamiento de Madrid; 3Frankfurt city health department; 4Unconventiona Concepts incorporated.

Large scale public events concentrate hundreds of thousands of spectators. These spectators although usually in good health, pose some unique challenges to EMS providers. First, these events are an attractive target for terrorist organizations a fact that requires special planning, including for a non conventional attack. The large crowd can create a multi casualty situation regardless of external causes. In times where pandemics are concern, such large gatherings are a reason for concern. Weather conditions and the crowd behavior (drug and alcohol consumption) are other issues to be considered, as well as issues related with hygiene and the need to provide "routine" medical services to the public.

The World Health Organization has created guidelines for large scale public gatherings. At the same time, great experience has been accumulated in different parts of the world, preparing for and responding to large scale public gatherings.

Objective of the session it to present and discuss the guidelines for large public gatherings and the actual experience gained from past events.

Structure of the session: (1) WHO guidelines for large scale public Gatherings - Michael Hopmeier; (2) The Madrid experience – The Pope visit and world cup celebrations – Mr. Alfonso de Gimenez – Madrid city, (3) The Frankfurt Experience – scaling up for the World Cup – Prof. Dr. Leo Latasch, Frankfurt Health department; (4) When things go wrong – a multi casualty incident in a large gathering – Mr. Guy Caspi, Operations Division Magen David Adom, Israel.

Each presentation 10 minutes followed by 5 minutes Q&A. 30 minutes interactive discussion with the public.

Impact of arsenic mitigation program on socioeconomic aspects of the beneficiaries

Md. Safiul Islam AFRAD, Md. Enamul HOQUE

Bangabandhu Sheikh Mujibur Rahman Agricultural University, Bangladesh, People's Republic of

The study delved into the socioeconomic impact of arsenic mitigation programs in Bangladesh. Two locations considering the most devastating occurrence of arsenic contamination in ground water were selected as the locale. All the arsenic patients of selected Arsenic Mitigation Programs were considered as the target population of the present study. A size of 150 patients was selected as sample of following proportionate simple random sampling technique from the total target population of 754. To validate the findings obtained from of patient respondents, another 50 neighbor non-patient respondents sample were also selected from both the locations proportionately. Quantitative and qualitative data were accumulated for the present study. Findings revealed that before participation in the arsenic mitigation programs, a lion part of the patient respondents (89%) formed a majority under medium to high socioeconomic aspects categories which was 92 percent in case of the non-patient respondents. Almost all of the patient respondents (99%) were under medium to high socioeconomic aspects categories but it was outstanding that the entire non-patient respondents (100%) belonged to same categories after being involved with mitigation programs. A large majority of the non-patient respondents (80%) showed medium to high level socioeconomic aspects change regarding arsenic and related issues due to their participation in mitigation programs. The findings of the same categories were only 59 percent in case of patient respondents. Educational qualification, farm size, number of training received, organizational participation, contact with the sources of information and annual family income of the patient respondents demonstrated significant positive association with their socioeconomic aspects’ change. Again education and contact with the sources of information jointly explained the maximum segment (55.40%) of the total variations in socioeconomic aspects of the patient respondents regarding arsenic and concerned issues while education only clarified 50.00 percent of the total variations.

Urban service monitoring system (UrSMS): reducing health risks through active monitoring in Surat, India

Umamaheshwaran RAJASEKAR, Gopalakrishna BHAT, Anup KARANTH

TARU Leading Edge, India, Republic of

Surat city is located on the west coast of India, in the southern part of Gujarat state. River Tapi flows through the city and meets the Arabian Sea after about 16km. Several minor creeks pass through the city contributing to mosquito breeding. Surat city is prone to floods due to multiple factors, including local rains, discharge from Ukai dam, rains in catchment and tidal movements. Experience of last six decades provides evidence of Surat’s vulnerability to urban floods followed by vector born diseases. In the last one decade the contribution of deaths due to malaria, rabies and tuberclosis show an increase of over two times. Effective control and prevention program should ensure absence or lower prevalence of vector born diseases. In order to achieve this, an Urban Service Monitoring System (UrSMS) was developed for Surat city under the Asian Cities Climate Resilience Network (ACCCRN) in consultation with the urban local bodies. The main aim of this system was to connect medical practitioners across the city using integrated technological options such as GIS, computing and mobile telephony. UrSMS connects over 500 hospitals, clinics and medical institutions across the city providing near real-time information about health status of the city to the municipal corporation. Within the municipal corporation qualified doctors and managers make use of the system to receive updates on health status of the city and take necessary actions to prevent the spread of key diseases. During normalcy, information collected by the system is used by the administrators to identify specific areas to focus their mitigation efforts; such as creating a situation unfavorable for vector survival and disease transmission through environmental-engineering measures, biological measures, larvicides and insecticides. This paper presents the details of UrSMS, its development, problems, pitfalls and options for implementation within other major cities to monitor city’s health and prevent epidemics.

Posttraumatic stress disorder and psychiatric co-morbidity following 2010 flood in Pakistan: the role of cognition distortion and suppression

Man Cheung CHUNG1, Muazzam NASRULLAH2, Sabeena JALAL3, Najib Ullah KHAN4

1Zayed University, United Arab Emirates; 2West Virginia University, USA; 3Dow University of Health Sciences, Pakistan; 4Abbasi Shaheed Hospital, Pakistan

Posttraumatic stress disorder (PTSD) and psychiatric co-morbidity can develop following flood (Liu et al, 2006). Suppression as a way of coping, and trauma-induced distorted cognitions about oneself , one’s environment, and the future can develop (Briere & Spinazzola, 2005) but have never been studied among flood victims.

The objective is to investigate the relationship between cognitive distortions, emotional suppression, PTSD and psychiatric co-morbidity following a disastrous 2010 flood in Pakistan.

In July 2010, flood submerged villages in Pakistan, killing at least 1,600 civilians. One hundred and fifty-four civilians (F=108, M=46) involved in the flood were recruited randomly from medical camps affiliated with Abbasi Shaheed hospital in three cities of Sindh province. They were interviewed three months after the flood using the Posttraumatic Stress Diagnostic Scale, the General Health Questionnaire-28, the Cognitive Distortion Scale, and the Courtauld Emotional Control Scale.

Half of the civilians in the study knew someone who died during the flood; 83% lost all their property; 98% thought they were going to die and worried about another flood. All civilians met the criteria for PTSD and probable psychiatric caseness, except one. After controlling for demographic variables and subjective perceptions of the flood, helplessness (β=0.49) as a distorted cognition, and suppressed anxiety (β=0.27) as a way of coping predicted PTSD; helplessness (β=-0.32) and suppressed anxiety (β=0.16) also predicted psychiatric co-morbidity along with distorted cognitions of hopelessness (β=0.46) and preoccupation with danger (β=0.53). Suppressed anxiety mediated paths between helplessness, PTSD and psychiatric co-morbidity. Preoccupation with danger mediated the path between hopelessness and psychiatric co-morbidity. These results will be discussed in terms of resilient psychological mechanisms.

Supporting literature, people can develop post-flood PTSD and psychiatric co-morbidity. Feeling helpless and suppressing anxiety had a pervasive effect on psychological health. However, feeling hopeless and being preoccupied with danger influenced non-trauma symptoms only.

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