Cholera is a diarrhoeal disease caused by the infection of the intestine with bacterium vibrio cholera. The diarrhoeal disease is a recurrent feature of Zimbabwe's post 1990s history. From 1993 to 2018, the country has experienced several cholera outbreaks in both rural and urban areas. The country's worst cholera outbreak occurred in 2008/2009 and resulted in over 4000 deaths. The dissertation analyses three global health actors' responses to persistent cholera outbreaks in Harare, the capital city of Zimbabwe. Building on previous scholarship of water, cholera and politics, the dissertation compares global health actors' responses to the 2008/2009 and September to November 2018 cholera outbreaks. The dissertation used the qualitative research method including analysis of existing academic literature, Zimbabwean national legislation, non-governmental organisation (NGO) publications and conference reports, news articles and Zimbabwean government policy documents. In-depth interviews with personnel from the World Health Organisation, United Nations Children's Fund, Médecins Sans Frontierès (Doctors without Borders) and the Harare City Council Health Department were conducted in Harare, Zimbabwe from June to July 2019. The dissertation demonstrates that the scope and speed of global health actors' emergency cholera interventions in Harare are shaped by Zimbabwe's political climate and the state of Harare's health, water and sanitation infrastructure.

Made available in DSpace on 2015-04-22T22:06:32Z (GMT). No. of bitstreams: 1 Jose Ricardo F Fonseca.pdf: 2443451 bytes, checksum: aaeac99e0c5ced36e21de0c5273a4ebf (MD5) Previous issue date: 2012-08-27 / O trabalho do enfermeiro em emergência, considerado estressante, demanda atenção para realização de atividades com alto grau de responsabilidade e dificuldade, exigindo um esforço físico, mental, emocional e psicológico. O estresse ocupacional é oriundo das tensões no trabalho e as fontes dessas reações são os estressores que podem influenciar o comportamento profissional, comprometendo resultados e a qualidade de vida. Tem a finalidade de avaliar o nível de estresse ocupacional em enfermeiros de unidades de emergência no município de Manaus/AM. Estudo de campo, epidemiológico e transversal, de natureza quantitativa, realizado com 39 enfermeiros de unidades de emergência. Utilizado questionário com questões sobre as características dos participantes e o seu reconhecimento do estresse, 57 questões sobre atividades relacionadas ao trabalho em emergência, associados a escala tipo likert com escala de 1 a 7. Os dados foram coletados nos períodos diurnos e noturnos, nas duas unidades de saúde selecionadas, durante os horários dos plantões, o instrumento era entregue ao enfermeiro e recolhido ao final do plantão. Os resultados mostraram que os enfermeiros estavam em médio nível de estresse com escore de 4.0, as áreas C - Atividades relacionadas ao funcionamento adequado da unidade e área F atividades relacionadas a administração de pessoal foram as mais estressoras. As atividades mais estressoras foram a solicitação de revisão e conserto de equipamentos com escore de 5.4 e, elaborar relatório mensal da unidade com escore de 5.1. O cargo gerencial teve maiores escores de estresse que o assistencial, apesar de não encontrar correlação significativa. Houve correlação entre os níveis de estresse quanto ao tempo de formação, tempo de trabalho em unidades de emergência, vínculo com outra instituição, rodizio de setores da mesma unidade e instituição com nível de significância de <5%. Observou-se correlação significativa dos níveis de estresse com instituição A relacionada ao funcionamento adequado da unidade e a administração de pessoal. Sendo assim, os dados mostram que o estresse dos enfermeiros de emergência está relacionado tanto às atividades do ambiente de trabalho, quanto às características dos sujeitos.

Ambulanssjukvården har utvecklats från att tidigare varit en transportorganisation till att vara en enhet som utför specialiserad sjukvård. Vid ett hjärtstopp där patienten behöver snabb access av läkemedel är det idag vanligast att applicera en intravenös infart. För nästan 100 år sedan började den intraosseösa infarten att användas. Vid intraosseös access ges möjlighet att direkt in i benmärgskanalen tillföra läkemedel eller vätska. Det har visat sig i olika studier att intraosseös infart är både säkert och effektivt. I akuta situationer där det misslyckats med intravenös infart kan den intraosseösa infarten utgöra skillnaden mellan liv och död. Efter att användandet minskat har den nu åter börjat tillämpas i större utsträckning. Syftet med studien var att belysa ambulanssjuksköterskors upplevelse av att applicera intraosseös infart. Metoden var kvalitativ med intervjuer som datainsamlingsmetod. Totalt intervjuades tio sjuksköterskor med specialistutbildning inom ambulanssjukvård. Materialet spelades in och transkriberades för att sedan avidentifieras genom att namnet istället fick en siffra. Materialet analyserades med en kvalitativ innehållsanalys. Resultatet redovisas i följande kategorier: kunskapsnivå, medicinteknisk kompetens, prehospitala miljön, stöd av kollegor och erfarenhet. Dessa kategorier baseras på sex underkategorier: utbildning, praktiska färdigheter, osäkerhet, trygghet i arbetsmiljön, trygghet och tidigare erfarenhet. Resultatet visade att ambulanssjuksköterskorna upplevde blandade känslor och tankar om upplevelsen av att applicera intraosseös infart. Det framkom att med erfarenhet kommer trygghet i handhavandet av intraosseös infart. Det framkom under intervjuerna även känslan av osäkerhet och betydelsen av att ha en mer erfaren kollega att ta hjälp av. Vissa ambulanssjuksköterskor upplevde ett behov av mer utbildning. Slutsatsen av denna studie är att de flesta ambulanssjuksköterskor inte upplevde applicering av intraosseös infart som något svårt. Det var några ambulanssjuksköterskor som upplevde osäkerhet och brist på kontinuerlig utbildning och därför ansåg att utbildningen i hantering av intraosseös infart skulle uppdateras kontinuerligt. Arbetsgivaren bör överväga att ha kontinuerliga och för arbetet väsentliga utbildningar vad gäller applicering av intraosseös infart. Huvudmannen skulle också återkommande kunna följa upp ambulanssjuksköterskornas kompetens i detta sällan förekommande moment, som kan vara livsavgörande för patienten.

Objectives. The aims of this survey were (1) to assess the quality of asthma treatment and control in Latin America, (2) to determine how closely asthma management guidelines are being followed, and (3) to assess perception, knowledge and attitudes related to asthma in Latin America. Methods. We surveyed a household sample of 2 184 adults or parents of children with asthma in 2003 in 11 countries in Latin America. Respondents were asked about healthcare utilization, symptom severity, activity limitations and medication use. Results. Daytime asthma symptoms were reported by 56% of the respondents, and 51 % reported being awakened by their asthma at night. More than half of those surveyed had been hospitalized, attended a hospital emergency service or made unscheduled emergency visits to other healthcare facilities for asthma during the previous year. Patient perception of asthma control did not match symptom severity, even in patients with severe persistent asthma, 44.7% of whom regarded their disease as being well or completely controlled. Only 2.4% (2.3% adults and 2.6% children) met all criteria for asthma control. Although 37% reported treatment with prescription medications, only 6% were using inhaled corticosteroids. Most adults (79%) and children (68%) in this survey reported that asthma symptoms limited their activities. Absence from school and work was reported by 58% of the children and 31% of adults, respectively. Conclusions. Asthma control in Latin America falls short of goals in international guidelines, and in many aspects asthma care and control in Latin America suffer from the same shortcomings as in other areas of the world. / Revisión por pares

Made available in DSpace on 2014-08-20T13:57:55Z (GMT). No. of bitstreams: 1 Tese_MARIA_LAURA_VIDAL_CARRET.pdf: 1263819 bytes, checksum: 538789308c1612e196f3cdb33f2eddd5 (MD5) Previous issue date: 2007-09-19 / This study evaluated the demand of emergency health service. It was performed a descriptive analyses of 1647 adults that consulted at emergency public service of Pelotas, Brazil. Older subjects, with non white skin color, lower schooling, without partner, and smokers presented higher prevalence of consultations at this service when compared with the general population. Individuals waited, on average, 15 minutes to have their consultations, exams were requested in more than 40% of the visits, and intravenous medication were administered in one third of the visits. Elderly waited longer before searching the service, but they had lowest awaiting time after arriving at emergency service and had highest percentage of regular doctor and social support. Elderly had more diagnosis related to circulatory system, while among the youngest, external causes were the most frequent. Conclusion: The low waiting average for consultation suggest this service provide an immediate care while the great number of ill-defined signs or symptoms indicate that the provided care is provisional. It is necessary to train emergency professionals to reduce the number of tests requested and to assure that either professional as the population is conscious about the importance of a continuity of care. / Objetivo: Avaliar a demanda do serviço de saúde de emergência. Método: Foi realizada análise descritiva de 1647 indivíduos adultos que consultaram no serviço público de emergência de Pelotas, Brasil. Resultados: Pessoas com mais idade, de cor não branca, menor escolaridade, sem companheiro e tabagistas consultaram mais nesse serviço, quando comparados com a população em geral. Os indivíduos esperaram em média 15 minutos pra serem atendidos, foi solicitado exame em mais de 40% dos atendimentos e administrado medicamentos endovenosos em um terço das vezes. Idosos demoraram mais para procurar atendimento, mas foram atendidos mais rapidamente quando chegaram na emergência, e tiveram mais freqüentemente médico definido e suporte social. Tiveram também mais diagnósticos relacionados com o aparelho circulatório, enquanto os mais jovens consultaram mais por causas externas. Conclusão: A baixa média de espera pelo atendimento sugere que este serviço presta um atendimento imediato, enquanto a grande quantidade de diagnósticos mal definidos indica que o atendimento é provisório. É preciso treinar os profissionais da emergência para reduzir a solicitação de exames e assegurar que tanto profissional quanto população esteja consciente da importância de uma atenção continuada.

Emergency Health Care (EHC) is an extended and multi-professional protocol designed to make communication easier in the event of a health-care emergency. Information and communication technologies (ICTs) play a vital role within EHC by coordinating emergency responses across involved departments as well as to health-care providers in the pre-hospital and hospital settings. Despite advances in ICT, there are still a variety of challenges regarding ICT usage in emergencies. To identify these challenges, a semi-structured interview was conducted with pre-hospital and hospital staff at the Emergency Departments of Vaasa Central Hospital, Finland, and Umeå University Hospital, Sweden. The findings indicate that workflow practices and the applying of medical knowledge in a pre-hospital setting is more challenging in Vaasa due to limited accessibility to the patient electronic record system. In the hospital setting, the clinical workflow and application of medical knowledge is easier in Umeå than in Vaasa as a result of there being an integrated information system in the Umeå region compared to a disintegrated system in the Vaasa region. It was discovered that the lack of a national record system in Sweden is a challenge for practitioners in the hospital setting in Umeå. In addition, badly structured information in the Finnish national record system has made collaborative activities between departments and hospitals difficult within EHC. The results reveal that the capacity of IT tools to provide on-time accessibility to patient information is fundamental for safe decision making and collaborative activities across departments and hospitals within EHC.

Asylum seekers are a socially excluded migrant population, presenting specific healthcare needs, which are often not acknowledged, nor properly addressed by national and European laws. Hailing from areas with poor sanitary attention, exposed to violence during the journey, they arrive to Italy with a high health vulnerability. The aim of this thesis is to find the discrepancies between the legislation providing healthcare access to the asylum seekers, in compliance with the fundamental human rights, and the practical healthcare responses in the Italian context of the North African Emergency (2011-2013), relying on a systematic literature review. The emergency-driven responses to the asylum inflow resulted in a heterogeneous reception and healthcare assistance, as the Italian asylum legislation focuses more on asylum procedures than healthcare, which remains regionally fragmented too. Asylum seekers faced discrimination and barriers in accessing healthcare, mainly due to information, linguistic and bureaucratic difficulties. Therefore, NGOs and associations intervened locally to fill the gap left by the institutional response, with a better focus on the social determinants of health and the importance of social integration as well. After 2013, better reception conditions were formulated and the legislation revised. However, the difference between legislation and practice on the asylum seekers healthcare access constitutes a human rights violation still present nowadays. Clearer approaches should be developed to address the issue uniformly.

Inom sjukvården finns det problem med kommunikationen mellan yrkeskategorier. Denna studie studerar frågeställningarna: hur offensiv kvalitetsutveckling skulle gå att applicera på ett förbättringsarbete inom akutsjukvården, hur kommunikationsmissar sker samt hur en kombinerad kommunikationsmodell inom sjukvården skulle kunna se ut. Detta görs inom ramarna för offensiv kvalitetsutveckling, hörnstensmodellen samt PDSA som är de kvalitetstekniska teorier som används för att beskriva problemområdet och dess lösningar. Interprofessionell kommunikation är en kommunikationsteori som också appliceras på arbetet. Denna kvalitativa studie, med hermeneutisk ansats, studerar avvikelser samt genomför enkät och intervjuer. Dokumenten visar på problem kring att patienter blir hemskickade utan korrekt information, överrapportering fallerar men också otrevligt bemötande mellan medarbetare. Enkätsvaren visar övergripande mönster med behov av mer övningar som fokuserar på kommunikation. Den offensiva kvalitetsutvecklingen redan finns inom organisationen, som uppfyller många av den offensiva kvalitetsteknikens värderingar, arbetssätt och verktyg. Vidare visar analysen att de vanliga områdena för kommunikationsmissar är människo- eller metodrelaterade, som visar sig i samarbetet mellan medarbetare och efterföljandet av rutiner.   Akutkliniken är på god väg att uppfylla värderingarna inom offensiv kvalitetsutveckling samt använder redan arbetssätt och verktyg som innefattas i denna teori.  Kommunikationsmissar beskrivs inom många olika områden, mönster som kan ses är att problem eskalerar vid ökad stress och när rutiner inte följs. Interprofessionell kommunikation kan – efter djupare förståelse hos medarbetarna – med fördel introduceras som kommunikationsmodell. / In healthcare, there are problems with communication between professionals. This study examines the questions: how Total Quality Management could be applied to improvement processes in emergency health care, how communication failures occur and what a combined communication model in health care could look like. This is done within the framework of Total Quality Management, the cornerstone model and PDSA, which are the theories within quality engineering used to describe the problem area and its solutions. Interprofessional communication is a communication theory that is also applied to the study. This qualitative study, with a hermeneutic approach, studies reported incidents and conducts a survey and interviews. The incidents show problems with patients being sent home without correct information, failures in handovers, but also bad relations between employees. The survey responses show overall patterns with a need for more training that focus on communication. Total Quality Management already exists within the organization, which meets many of the values, working methods and tools of the Total Quality Management technique. Furthermore, the analysis shows that the common areas of communication failures are people- or method-related, which are reflected in the cooperation between staff members and the adherence to procedures.   The emergency department is well on its way to fulfilling the values of Total Quality Management and is already using methods and tools included in this theory.  Communication failures are described in many different areas, patterns that can be seen are that problems escalate with increased stress and when routines are not followed. Interprofessional communication can – after deeper understanding of the employees – be introduced as a communication model.

Introduction: There are many factors to be identified and flows to be established in the interface between primary care and the emergency care network. Comparing different health systems with processes of health policies based on regionalization can result in new health planning instruments. In this sense, understanding the regional arrangements and dynamics of the Canadian health system in a comparative study with the Brazilian reality enabled the implementation of strategies for the development of innovations and health management planning in Brazil. Objective: To identify the factors that interfere in the establishment of primary care and emergency care network interfaces in different socio-spatial realities (regions) and in different health systems. Methods: Two case studies: in Brazil, using mixed methods and in Canada, qualitative methods. The study in the North-Barretos and South-Barretos regions (São Paulo, Brazil) consists of interviews with key informants and analysis of secondary data. In the Mississauga Halton Local Health Integration Network and Toronto Central Local Health Integration Network (LHIN) (Ontario, Canada) interviews were conducted with key informants. The data from the structured questionnaires were tabulated using the PHP Line Survey - Open Source software. Statistical calculations were performed using SPSS Statistics for Windows, Version 22.0. Thematic analysis of the qualitative data (interviews with open-ended questions, meeting minutes and documents) was carried out in Atlas-ti software. The results of the case studies were analyzed independently and, finally, compared to identify their differences and similarities. The study was approved by the Ethics Committee of the University of São Paulo Faculty of Medicine, under process number 045/16. Results: Aspects of policy, structure and organization interfere at different levels between primary care and the emergency care network in the regions selected for this study. Regionalization as a dimension of health policy has presented satisfactory results for planning, decision making, and resource management focused on health needs, but has been insufficient for the integration of primary care and the emergency care network. Barriers and facilitators, at policy, structural and organizational levels, were identified for the integration of primary care and the emergency services in the studied regions. Conclusion: Health managers should recognize the interfaces and integrate the different health services and share knowledge and population health diagnoses. Fragmented health management is reflected in fragmented health care. To achieve effective integration among health services, stakeholders and policy makers should prioritize better management performance, effective teamwork forums, leadership training, and monitoring programs for each dimension of integrated care / Introdução: Há muitos fatores a serem identificados e fluxos a serem estabelecidos nas interfaces entre a atenção primária e a rede de urgência e emergência. A comparação de diferentes sistemas de saúde com processos de políticas de saúde baseados na regionalização pode resultar em novos instrumentos de planejamento de saúde. Nesse sentido, compreender os arranjos e dinâmicas regionais do sistema de saúde canadense em um estudo comparativo com a realidade brasileira possibilitou a implementação de estratégias para o desenvolvimento de inovações e o planejamento da gestão em saúde no Brasil. Objetivo: Identificar os fatores que interferem no estabelecimento das interfaces da atenção primária e a rede de urgência e emergência em diferentes realidades socioespaciais (regiões) e nos diferentes sistemas de saúde. Métodos: Trata-se de dois estudos de caso: no Brasil, utilizando métodos mistos e no Canadá, métodos qualitativos. O estudo nas regiões Norte-Barretos e Sul-Barretos (São Paulo, Brasil) consiste em entrevistas com informantes-chave e análise de dados secundários. Na Mississauga Halton Local Health Integration Network e na Toronto Central Local Health Integration Network (LHIN) (Ontário, Canadá) foram realizadas entrevistas com informantes-chave. Os dados dos questionários estruturados foram tabulados usando o software PHP Line Survey - Open Source. Os cálculos estatísticos foram realizados no SPSS Statistics for Windows, versão 22.0. A análise temática dos dados qualitativos (entrevistas com questões abertas, atas de reuniões e documentos) foi realizada no software Atlas-ti. Os resultados dos estudos de caso foram analisados de forma independente e, finalmente, comparados para identificar suas diferenças e semelhanças. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade de São Paulo sob o número de processo 045/16. Resultados: Aspectos políticos, estruturais e organizacionais interferem em diferentes níveis entre a atenção primária e a rede de urgência e emergência nas regiões selecionadas para este estudo. A regionalização como dimensão da política de saúde tem apresentado resultados satisfatórios para o planejamento, a tomada de decisão e a gestão de recursos com foco nas necessidades de saúde, mas tem sido insuficiente para a integração da atenção primária e da rede de urgência e emergência. Barreiras e facilitadores, nos níveis político, estrutural e organizacional, foram identificados para a integração da atenção primária com os serviços de emergência nas regiões estudadas. Conclusão: Os gestores de saúde devem reconhecer as interfaces e integrar os diferentes serviços de saúde e compartilhar conhecimentos e diagnósticos de saúde da população. A gestão fragmentada da saúde reflete-se em cuidados de saúde fragmentados. Para alcançar uma integração eficaz entre os serviços de saúde, as partes interessadas e formuladores de políticas devem priorizar um melhor desempenho gerencial, fóruns eficazes de trabalho em equipe, treinamento de liderança e programas de monitoramento para cada dimensão do cuidado integrado

L'agglomération urbaine de Lima et Callao (9 millions d'habitants) se prépare à un séisme de grande magnitude susceptible de provoquer une crise majeure. Face à cette crise à venir, quelles connaissances peut-on produire sur la vulnérabilité du territoire urbain ? Cette recherche propose de poser les jalons d'une géographie de la gestion de crise à partir de la question de l'accessibilité aux soins à Lima et Callao. C'est une géographie urbaine à la croisée des problématiques du risque, de la crise et de la santé d'urgence, qui aborde frontalement les dimensions spatiales et territoriales de la gestion des situations de crise. La problématique de recherche s'appuie sur un panorama de grandes crises urbaines et propose une analyse critique des paradigmes de gestion des risques et des crises. Innovante, cette approche géographique impose de saisir conjointement la complexité des situations de crises et la vulnérabilité des grandes agglomérations urbaines. Partant de l'idée que la gestion de crise consiste à mettre en relation des ressources utiles au moment de l'évènement et des espaces vulnérables à secourir en priorité, une base de données géoréférencées des ressources de santé d'urgence à Lima a été construite et utilisée pour analyser les dimensions spatiales et territoriales de la gestion de crise. Différentes vulnérabilités sont mises en évidence : celles des hôpitaux majeurs, celles du dispositif de soins, et celles de la population à travers l'accessibilité aux soins en situation de crise. Elles contribuent toutes à la compréhension de la vulnérabilité du territoire. Ainsi, cette recherche propose de faire de la gestion de crise un véritable objet de recherche de la géographie, capable d'éclairer les questions urbaines au-delà de la problématique des risques et des crises. Elle propose de décrypter la vulnérabilité à partir d'une lecture conjointe des dimensions spatiales et territoriales de la gestion de crise au moment de l'événement et des processus de construction de la ville sur le temps long. Cette géographie de la crise dépasse le clivage entre prévention des risques et préparation à la gestion de crise en s'inscrivant dans un continuum risque / crise, et réintroduit le territoire et le politique au cœur de la problématique des risques et des crises en milieu urbain. / The urban area of Lima and Callao (9 million inhabitants) is preparing for an earthquake of great magnitude that could entail a major crisis. In front of this coming crisis, what do we know about the vulnerability of this urban territory? This research study suggests putting the milestones of a geography of crisis management based on the accessibility to emergency healthcare in Lima and Callao. It is an urban geography located at the crossroads of risk, crisis and emergency health issues, which directly tackles the spatial and territorial dimensions of crisis management. This research study is based on a panorama of big urban crises and presents a critical analysis of the paradigms of risk and crises. This innovative geographical approach aims at seizing both the complexity of crisis situations and the vulnerability of big urban areas. Since crisis management aims at putting in relation the resources that are useful at the moment of the event with the vulnerable spaces that need to be helped first, a georeferenced database of emergency health resources in Lima enables the analysis of the spatial and territorial dimensions of crisis management. Different vulnerabilities are evidenced, such as those of the major hospitals, of the healthcare system and of the population through the accessibility to health facilities in a crisis situation. Each and all of them contributes to understand the vulnerability of the territory. Thus, this research study considers crisis management as an object of research inside geography, since it helps answering urban problems beyond the concerns of risks and crises. It also suggests working out the issue of vulnerability thanks to a joint understanding of the spatial and territorial dimensions of crisis management at the time of the event and during the building process of the city on the long term. This geography of crisis overtakes the cleavage between risk prevention and preparation for crisis management by being part of a risk / crisis continuum, and reintroduces territory and politics at the heart of risks and crises issues in urban areas. / La aglomeración urbana de Lima y Callao (9 millones de habitantes) se prepara a un sismo de gran magnitud susceptible de provocar una crisis mayor. Frente a esta crisis por venir, ¿qué conocimientos se pueden producir sobre la vulnerabilidad del territorio urbano? Esta investigación propone iniciar una geografía de la gestión de crisis a partir de la cuestión de la atención médica en Lima y Callao. Es una geografía urbana situada entre las problemáticas del riesgo, de la crisis y de la salud de emergencia, que abarca frontalmente las dimensiones espaciales y territoriales de la gestión de crisis.La problemática de investigación se apoya en un panorama de grandes crisis urbanas y promueve un análisis crítico de los paradigmas de gestión de los riesgos y de las crisis. De forma innovadora, este enfoque geográfico considera conjuntamente la complejidad de las situaciones de crisis y la vulnerabilidad de las grandes aglomeraciones urbanas. Con la idea de que la gestión de crisis consiste en relacionar los recursos útiles al momento del evento y los espacios vulnerables a socorrer prioritariamente, se recurre a una base de datos georeferenciada de los recursos de atención médica de emergencia en Lima para analizar las dimensiones espaciales y territoriales de la gestión de crisis. Diferentes vulnerabilidades son puestas en evidencia: la de los hospitales esenciales, la del sistema de salud y la de la población, a través de la accesibilidad a la atención de salud en situación de crisis.Así, esta investigación propone la gestión de crisis como un verdadero objeto de investigación de la geografía, capaz de vislumbrar las cuestiones urbanas más allá de la problemática del riesgo y la crisis. Plantea una comprensión de la vulnerabilidad a partir de una lectura conjunta de las dimensiones espaciales y territoriales de la gestión de crisis al momento del evento y de los procesos de construcción de la ciudad a largo tiempo. Esta geografía de la crisis va más allá de la segmentación entre la prevención de los riesgos y la preparación para el manejo de emergencia, inscribiéndose en un continuum riesgo / crisis, y reintroduce el territorio y el político como elementos claves de la problemática de los riesgos y de las crisis en medio urbano.