Introdução Após mais de uma década de implantação do Serviço de Atendimento Móvel de Urgência (SAMU), torna-se importante lançar um olhar crítico a este serviço a fim de identificar as propostas da Política Nacional de Atenção às Urgências. Objetivo - Descrever e analisar criticamente o processo de trabalho da Central de Regulação do SAMU São Paulo (SAMU SP). Métodos Foi realizado um estudo de caso descritivo exploratório, com estratégia de métodos mistos, integrando as abordagens quantitativa (dados secundários referentes ao mês de outubro de 2012) e qualitativa (observação direta e entrevistas com três médicos reguladores). O banco de dados secundários permitiu descrever a demanda do SAMU SP e verificar a existência de padrões de associação entre as variáveis. Foi realizado o cálculo das frequências absolutas e relativas de todas as variáveis categóricas e cálculo dos tempos envolvidos no atendimento préhospitalar. As entrevistas foram transcritas e analisadas por meio da análise de conteúdo de Bardin com o objetivo identificar fatores subjetivos que não foram possíveis de serem mensurados na análise quantitativa. Foi realizada uma segunda análise estatística do banco de dados, com foco no processo de priorização das ocorrências, sendo investigadas as variáveis despacho e tempo de regulação, segundo determinante de prioridade e queixas principais. Foi utilizado o teste chi-quadrado para significância estatística. Resultados - A demanda é majoritariamente clínica (59,2 por cento ), masculina (52,2 por cento ), entre 20 e 59 anos (54,5 por cento ) e classificadas com Determinantes de alta prioridade (Echo e Delta) (52,5 por cento ). As transferências inter-hospitalares correspondem a 0,6 por cento da demanda. A frequência de despacho de ambulância é de 63,4 por cento e decresce conforme a prioridade diminui, chegando a 21,2 por cento no Determinante de menor prioridade (Ômega). O tempo resposta é inversamente proporcional ao Determinante de prioridade, e uma parte significativa de ocorrências de baixa prioridade (35,9 por cento ) são incluídas no sistema de saúde. Foram identificadas três dimensões que influenciam o processo de priorização das ocorrências: condições clínicas reportadas (parada cardiorrespiratória, problemas respiratórios, inconsciência) condições de vulnerabilidade e risco específicos (idosos e crianças abaixo de 3 anos, quedas, medo por parte do médico regulador de subestimar, presença de violência, interação com outros serviços) e condições intrínsecas ao processo de trabalho da central de operações SAMU SP (alta demanda e poucos recursos, trabalho colaborativo com outros profissionais). Conclusões A descrição e análise crítica da demanda e do processo de trabalho do SAMU SP traz elementos para a discussão sobre seu papel dentro do sistema de saúde do município. É possível afirmar que o SAMU SP tem cumprido a missão de salvar vidas, provendo assistência qualificada para pacientes classificados de altíssima prioridade que necessitam de atendimento fora do ambiente hospitalar. Ordenar a demanda de urgência e se configurar como um observatório de saúde passam pela necessidade do reconhecimento técnico e político de que se trata de um serviço integrado a rede de atenção à saúde e não apenas a rede temática da urgência / Introduction After more than a decade of Brazilian Mobile Emergency Services (SAMU) implementation, it becomes importante to launch a critical look at this service in order to identify the proposals of the National Policy for Emergency Care. Objective To critically describe and analyze the work process of SAMU Regulation Center of the city of São Paulo (SAMU SP). Methods A descriptive exploratory case study with mixed methods strategy, integrating the quantitative (secondary data for October 2012) and qualitative (direct observation and interviews with three regulatory physicians) approaches. The secondary database was used to describe SAMU SP demand and to verify the existence of patterns of association between the variables. Absolute and relative frequencies of all categorical variables and the times involved in prehospital care were calculated. The interviews were transcribed and analyzed through Bardin content analysis with the objective of identifying subjective factors that were not possible to be measured in the quantitative analysis. A second statistical analysis of the database was carried out, focusing on the prioritization of emergency incidentes. The frequency of dispatch and regulation time were investigated, according to the Priority Determinant and main complaint. The chi-square test was used for statistical significance. Results - The demand is composed mainly by clinical chief complaints (59.2 per cent ), male patients (52.2 per cent ), between 20 and 59 years old (54.5 per cent ) and classified with high priority determinants (Echo and Delta) (52.5 per cent ). Interhospital transfers correspond to 0.6 per cent of the demand. Ambulance dispatch frequency is 63.4 per cent and decreases as the priority decreases, reaching 21.2 per cent in the lowest Priority Determinant (Omega). The response time is inversely proportional to the Priority Determinant, and a significant portion of low priority occurrences (35.9 per cent ) are included in the health system. Three dimensions have been identified that influence the prioritization of emergency incidents: reported clinical conditions (cardiorespiratory arrest, respiratory problems, unconsciousness), vulnerable conditions and specific risk of the emergency incident (elderly and children under 3 years, falls, medical doctor fear of underestimation, presence of violence, interaction with other services) and work process intrinsic conditions of SAMU SP operations center (high demand and few resources, collaborative work with other professionals). Conclusions The description and critical analysis of the demand and work process of the SAMU SP brings elements to the discussion about its role within the health system of the city of São Paulo. It is possible to affirm that SAMU SP has fulfilled the mission of saving lives, providing qualified assistance to patients classified as high priority who need care outside the hospital environment. In order to SAMU SP organize the demand for urgent care and to be a health observatory, there is the need of technical and political re-recognition that it is a service integrated to the health care network and not just a thematic network of urgency

A possibilidade de revitalização e reutilização de áreas contaminadas por substâncias perigosas surgiu como grande alternativa ao abandono dos chamados Brownfields nos centros urbanos. A descontaminação desses sítios e sua reabilitação para reuso, além de apresentar-se como opção à criação de espaço nos grandes centros, se destaca como solução na proteção à segurança pública, à saúde da população e ao meio ambiente diante dos riscos oferecidos pelas substâncias ali presentes. Todavia, no tempo decorrido entre a identificação de área contaminada e sua revitalização existe a probabilidade da ocorrência de acidentes provocados pelo vazamento dos resíduos perigosos ali depositados, ocasionando efeitos danosos à população e ao meio ambiente, o que pressupõe ação imediata por parte do poder público. Com base em estudo de caso envolvendo indústria desativada utilizada como área para o armazenamento clandestino de tambores contendo resíduos perigosos, o trabalho propõe a criação de protocolo de atuação visando orientar os atores intervenientes nos cenários acidentais envolvendo Brownfields. O objetivo é oferecer ferramenta que auxilie na redução nos danos ambientais provocados por esse tipo de ocorrência além de contribuir para discussão de políticas públicas que permitam programar gestão estratégica dos Brownfields, mudando a forma de identificar, tratar e gerenciar áreas contaminadas. / The possibility of revitalizing and reusing areas contaminated by hazardous substances has emerged as a great alternative in urban centers. The decontamination of these sites, among which some known as Brownfields, and its rehabilitation for reuse, besides presenting itself as an option to the creation of space in the great centers, stands out as a solution in the protection of public safety, the health of the population and the environment by the risks offered by the substances present therein. However, in the time elapsed between the identification of contaminated area and its revitalization, there is a probability of accidents caused by the leakage of hazardous waste deposited therein, causing harmful effects to the population and the environment, which implies immediate action by the public power. Based on a case study involving deactivated industry used as an area for clandestine storage of drums containing hazardous waste, the work proposes the creation of an action protocol aiming to guide the intervening actors in the accidental scenarios involving Brownfields. The objective is to offer a tool to help reduce the environmental damage caused by this type of occurrence, in addition to contributing to the discussion of public policies that allow programming the strategic management of Brownfields, changing the way of identifying, treating and managing contaminated areas.

O descarte de resíduos químicos é uma prática lesiva ao meio ambiente e à saúde da população. Nesse trabalho foi realizado levantamento dos impactos socioambientais com base nos registros de descartes de resíduos químicos da Companhia Ambiental do Estado de São Paulo - CETESB, no período de 2005 a 2013, tomando como referência a Região Metropolitana de São Paulo - RMSP, em especial as cidades de São Paulo e Guarulhos. Dentre os resultados que nortearam o trabalho se destacam a caracterização da prática de descarte de resíduos químicos, sobrepondo a mapas temáticos georreferenciados de rodovias e recursos hídricos. Também por meio de pesquisa dirigida aos principais atores intervenientes dos cenários acidentais,foi possível conhecer os processos atuais de intervenção e de tratamento, aplicados nos descartes de resíduos químicos nas esferas municipais e estaduais. Nesse contexto, o Decreto Estadual nº 59.263/2013, que regulamenta a Lei nº 13.577/2009 sobre a proteção da qualidade do solo e gerenciamento de áreas contaminadas criou o Fundo Estadual para Prevenção e Remediação de Áreas Contaminadas (FEPRAC), destinado à identificação e remediação das áreas órfãs. O FEPRAC apresentase como um instrumento econômico capaz de elidir o perigo nos casos de emergências químicas envolvendo o descarte de resíduos sem a identificação do responsável. / The disposal of chemical waste is a harmful practice to public health and the environment.This work was carried out survey of social and environmental impacts based on the records of illegal dumping of chemical waste of the Environmental Agency of São Paulo State - CETESB, in the period 2005-2013, with reference to the Metropolitan Region of São Paulo - especially cities of São Paulo and Guarulhos. Among the results that guided the work stand out the characterization of the practice of disposal of chemical waste, overlaying the GIS thematic maps of roads and water resources. Also through research aimed at key stakeholders of accident scenarios it was possible to know the current processes of intervention and treatment applied in illegal dumping of chemical waste in the municipal and state levels. In this context, the State Decree Nº 59.263/2013, which regulates Law Nº 13.577/2009 on the protection of soil quality and management of contaminated areas created the State Fund for Prevention and Remediation of Contaminated Sites (FEPRAC) for the identification and remediation of these so-called \"orphan areas. The FEPRAC presents itself as an economic instrument that can eliminate the danger in such cases of chemical emergencies involving illegal dumping of chemical wastes without identifying the responsible.

The experiences and needs of transgendered individuals immediately following a natural or human-caused disaster are largely ignored in practice and absent from previous academic literature. Using Schneider and Ingram's conceptualization of the social construction of target populations as a theoretical framework, the purpose of this study was to investigate the experiences and perspectives of transgendered people who sought shelter in the aftermath of a natural disaster in 2018. Data were collected through interviews with 12 displaced, transgendered individuals to explore their experiences while staying at shelters in 2018. Interview data were transcribed, inductively coded, and then a thematic analysis procedure was applied. According to the key findings, participants perceived internal threats at shelters, which may have prohibited or restricted others in the same population from seeking shelter assistance. Additionally, participants perceived that a lack of understanding of the transgender community may have resulted in dissatisfactory services being provided. Most participants in this study perceived that the biases associated with negative stereotypes were persistent and pervasive, which may have resulted in disparate treatment from cisgender community members. The positive social change implications stemming from this study include recommendations to government officials and shelter staff regarding techniques to ensure that shelter services are provided in fair and equitable ways, including the need for additional training related to the unique needs of transgendered populations. Implementing these recommendations may improve shelter conditions for the transgender community and reduce the risks associated with going to evacuation shelters to secure housing during times of disaster.

Thesis (Ph.D.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Medical Sciences - Pediatrics. Title from pdf file main screen (viewed on January 24, 2010). Includes bibliographical references.

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Emergency response agencies that need to care for large crowds in real-life events, report a constant lack in human volunteers in large numbers for training purposes. Moreover, existing computerized training aides either totally omit affected crowds in their scenarios, or represent them as computer generated models. A potential solution that can provide real human input in large numbers for training purposes can be found in the form of Massive Multi-user Online Role-Playing computer Games (MMORPGs) that attract millions of users on a daily basis. In order to evaluate the use of MMORPGs as an emergency simulation platform I had to examine the in-game behaviour of participants, usability issues, data collection methods, and data reliability. I did so by constructing a multi-user computer game that included food shortage and a pandemic spread scenarios. Data collected included every possible item that could be technically logged, both qualitative (questionnaires, user’s self tagging of events) and quantitative (all in-game actions and their coordinates, players and virtual environment in-game status). The abundance of data enabled easy triangulation and verification. The main findings were: participants attention span was about 90 minutes, they demonstrated only a narrow range of behaviours necessary for their in-game survival, and this behaviour followed loosely real life behaviour patterns. Usability wise participants ignored interface components and in-game tasks that interfered with their game flow. Data reliability: unlike other methods that rely solely on participants accounts, the game had the ability to compare between actions to questionnaire answers, and was able to detect inconsistencies between people’s actions within the game and their accounts of their actions. The ability to create spatial maps of event types enabled a fast way to visually analyze data. The research concludes that MMORPGs can be used as an emergency simulation platform if: 1) its duration fits the participants’ attention span (as a result aspects of human behaviour that happen over a prolonged period of time will not be demonstrated); 2) the demographic composition of participants fits that of the population examined by the simulation; 3) participants should be properly reimbursed for their time; 4) it is known that participants’ in-game behaviour might be negatively influenced by lack of real-life experience of similar events; 5) in-game rules and mechanisms are set to filter out game abuse; 6) preliminary sessions are run to determine ideal attention span and data skewing factor.

The U.S. disability population is growing at significant rates among adults as well as youth. According to the 2000 Current Population Reports, approximately 54 million Americans about 1 in 5 - are affected by the presence of a disability stemming from birth or life incident. Demographic increases are also noted among American youth as well, with one in 166 children is diagnosed with autism - estimated 67 children each day. Consequently, there have been federal-level responses in the form of legislation, executive orders and local-level program flinding such as REMS grants - addressing various disability issues. Likewise in recent years, another critically important matter has emerged with increasing priority on the nation s policy agenda: school emergency preparedness planning. A broad spectrum of crises incidents, ranging from student-initiated assaults to natural or man-made disasters, has become a well-documented reality where schools have experienced tragic impacts sometimes as severe as mass casualties These occurrences, coupled with an expected increase in potential evacuees with special needs, demonstrate the critical need for inclusive school evacuation planning at all levels of administration that actively considers its impact on vulnerable populations. This is of particular importance to public schools today; the presence of disabled students can be deduced from U.S. Census and NOES statistics while studies conducted by Georgia Tech s Center for Assistive Technology and Environmental Access (CATEA) illustrate the presence of teachers with disabilities. As the scope of interest in this field expands, the availability of related literature becomes more prevalent as well. While disability preparedness planning in schools is briefly mentioned in some articles and reports on emergency preparedness in general, it has yet to be the sole focus of one to date. Policymakers and practitioners in preparedness planning would likely benefit by broadening to its literature scope to include research that focuses solely on analyzing policy strategies and processes used in school emergency preparedness planning for students and teachers with disabilities. Therefore, this thesis project will compile available related literature into a topology in aimotated bibliography form through the lens of disability preparedness planning and policy in public schools. The research goal is to provide a qualitative assessment of available literature in the form of a reference guide of strategies and recommendations on disability preparedness, specifically intended for public school settings. Additionally, this compilation will outline the rationale supporting a more inclusive policy and planning formulation processes that actively engage the needs students and teachers with disabilities prior to the implementation stage.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı, 2004. / Bibliyografya var.

Thesis (M.H.A.)--University of Michigan, 1965.