Background: Caustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures. Methods: We retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005–2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality. Results: Twenty-eight patients with caustic ingestions were included in the analysis of which 18 (64 %) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79 %) and acids (n = 6; 21 %). ICU admission was required in 20 patients (71 %). Fourteen patients (50 %) underwent tracheal intubation and mechanical ventilation, of which 3 (21 %) presented with difficult airways. Seven patients (25 %) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75 %) and 11 (39 %) underwent CT examination. Five patients (18 %) required emergency surgery with a mortality of 60 %. Overall hospital mortality was 18 % whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality. Conclusions: Caustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.

This thesis aims to describe how the International Federation of Red Cross and Red Crescent Societies (IFRC) tends to maternal health care in floodings and whether it should be deemed sufficient. Floodings in Pakistan (2010), Bangladesh (2017) and Sudan (2013) are used as units of analysis when conducting a content analysis. The theoretical framework consists of critical success factors for disaster response based in the emergency management literature. A big part of the theoretical framework revolves around the importance of expertise and rationality in disaster response planning and implementation. The three floodings received relief efforts from IFRC which are presented in emergency appeal reports. Lists on essential maternal health care interventions in combination with the theoretical framework create analysis questions that are posed to the appeals. Results are presented in a table naming the prevalence of each intervention in each report. The findings show that maternal health care was seen to and deemed sufficient in only one of the three cases: Pakistan. The conclusion is that the discourse on maternal health care in natural disasters should be developed and that further research on the subject needs to be conducted.

This thesis examines the understanding of the concept of resilience in urban security with focus on countering terrorism and emergency planning in London between 2000 and 2015. It analyses the implementation of the concept and the results of it. The thesis first describes the theoretical backgrounds of the concept and creates a classification based on the evolution of the concept. A discourse analysis of security strategies and other official documents is done to demonstrate how resilience was conceptualised in the United Kingdom and how it evolved. Also the influence of private actors is evalueted. The same discourse analysis is done on the level of the city of London. The thesis then describes the specific implementation of resilience that impacts everyday lives of London citizens and it shows that the measures penetrates every aspect of it. The International Political Sociology and the theory of insecuritization is used to assess the findings. It concludes that resilience is used as a governing tool enabeling the UK government to produce an appearance of decisive governing, while it transfers the actual responsibility for everyday security to the citizens and their communities. The transfer is not accompanied by providig appropriete tools and consecquently an atmosphere of insecurity and...

Abstract Flood disasters have been a challenge in Liberia for the past 15 years. The result has been hardship for residents, which has created major disruptions to social and economic services. Global warming, poor environmental conditions and weak disaster management policies among other factors are largely blamed for the floods. The conceptual framework for this study was Barton's collective stress theory and Edwards' varied response theory, which guided this exploration of how flood victims perceive the effectiveness of the Liberian government's flood disaster management strategies. A total of 25 participants were recruited for this grounded theory study. Twenty participants were victims of flooding and 5 participants were managers from government and non-governmental organizations (NGO) entities. Data were collected from open-ended semistructured interviews with the participants. Multiple sources such as individuals and group interviews, field notes were used to support the study. Data analysis utilized descriptive coding. Results suggest community and government needs include: (a) policies on zonal regulations to reduce the problem of flooded drainages, (b) funding and other support for disaster emergency management institutions, (c) decentralizing and empowering local government agencies for disaster emergency management, and (d) empowering communities themselves through funding and training to become the first line of defense when floods occur. This dissertation may support positive social change by highlighting the need for government to strengthen disaster management policies to include zoning and building permit regulations, funding for disaster emergency management institutions, and flood control.

The purpose of this study is to examine from a public relations point-of-view, the public image impact on the United States from the efforts of the U.S. Navy and Marine Corps' response to the tsunami crisis. The thesis analyzes the disaster that affected so many nations, and the humanitarian response of the United States Navy and Marine Corps in Operation Unified Assistance and the role of Navy Public Affairs following the earthquake and tsunami disaster and the importance of visual media.

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A region's evacuation strategy encompasses a variety of areas and needs. Primary among these is the minimization of total evacuation time, represented in models as the clearance time estimate (CTE). A generic testbed simulation network model was developed. An input/output (I/O) analysis was performed to establish a theoretical baseline CTE. Results were compared with simulations; analysis showed that the I/O method underestimated simulated CTE as a function of network size, with a correction factor range of 1.09 to 1.19. A regression model was developed for the generic network. Predictors were total trips, and network size defined as a function of origin-destination distance. Total Trips ranged between 40,000 and 60,000. Holding size constant, R-squared values ranged from 97.1 to 99.3, indicating a high goodness of fit. Holding Total Trips constant, R-squared values ranged from 74.5 to 89.2. Finally, both Total Trips and size were used as predictors; the resulting regression model had an R-squared value of 97.3. This overall model is more useful, since real world situations are not fixed in nature. The overall regression model was compared to a case network. The generic network regression model provided a close CTE approximation; deltas ranged from -4.7% to 8.6%. It was concluded that a generic network can serve as a surrogate for a case network over these ranges. This study developed and evaluated heuristic strategies for evacuation using the generic network. Strategies were compared with a simultaneous departure loading scenario. Six different grouping strategies were evaluated. An initial evaluation was conducted using the generic network, and strategies that showed potential CTE reduction were implemented on the case study network. Analysis indicated that the HF-10 (half-far) grouping for 60k total trips showed potential reduction. A complete simulation was conducted on the case network for all HF scenarios; an ANOVA was run using Dunnett's comparison. Results indicated that the HF grouping with 20% and 30% departure shifts showed potential for CTE reduction. From this it was concluded that the generic network could be used as a testbed for strategies that would show success on a case network.

Crisis management has become one of the most important public policy areas in recent decades with greater numbers of manmade and natural disasters. History showed that well-implemented crisis management policies can save lives and reduce costs in a disaster. Literature offered various suggestions for more effective crisis management policies with different techniques utilizing different theoretical frameworks. Informal relationships among crisis management employees were suggested to have a positive impact on crisis management effectiveness. Yet it was not demonstrated with advanced statistical tools if there is such a relationship. This study considers crisis management effort as a network effort and employs complex adaptive systems theory in order to understand factors influencing effectiveness of crisis management networks. Complex adaptive systems theory presents that more open communication lines in a given network or an organization would increase effectiveness of it since inner processes of the network or organization would obtain more information from the chaotic environment. Quality of informal relationships (casual relationships, social capital etc.) was hypothesized as a tool to open more communication lines within an agency which would eventually increase effectiveness of the network constructed by the organization. Based on the theoretical framework, adaptiveness capacity of the agencies was also tested in order to understand a correlation between adaptation and effectiveness of crisis management networks. Multiple case-study method was employed to identify incidents that can represent crisis management in full perspective. Terrorist attacks carried upon by the same terrorist network hit New York in 2001, Istanbul in 2003, Madrid in 2004, and London in 2005 were selected. First response phase of crisis management and policy changes after and before the attacks were discussed. Public administration processes and other social-economical conditions of countries were examined in terms of crisis management structure. Names of key agencies of selected crisis management systems were suggested by a social network analysis tool-UCINET. Six key agencies per incident were targeted for surveys. Surveys included a nine-item-quality of informal relationships, four-item-adaptiveness capability, and ten-item-perceived effectiveness of crisis management networks-scales. Respondents were asked to fill in online surveys where they could refer to their colleagues in the same incidents. 230 respondents were aimed and 246 survey responses were obtained as a result. Surveys formed a structural equation model representing 23 observed factors and 2 latent constructs. Confirmatory factor analysis was utilized to validate hypothesis-driven conceptual models. Quality of informal relationships was found to have a significant positive impact on perceived crisis management network effectiveness (Standardized regression coefficient = .39). Two of the adaptiveness variables, openness to change and intra-organizational training were also positively correlated with the dependent variable of the study (Standardized regression coefficient = .40 and .26 respectively). Turkish and American groups' differences suggested a social-economical difference in societies. Majority of the respondents were some type of managers which made it possible to generalize the results for all phases of crisis management. Discussions suggested improved informal relationships among crisis management employees to provide a better crisis management during an extreme event. Collaborative social events were offered to improve crisis management effectiveness. An agency's openness to change proposed that a crisis management organization should be flexible in rules and structure to gain more efficacy. The other adaptiveness variable, intra-organizational training efforts were proposed to have certain influence on effectiveness of crisis management network. Factors built latent construct of perceived crisis management effectiveness were also found out to be important on crisis management, which of some are ability to carry out generic crisis management functions, mobilize personnel and resources efficiently, process information adequately, blend emergent and established entities, provide appropriate reports for news media etc. Study contributed to the complex adaptive system theory since the fundamentals of the theory were tested with an advanced quantitative method. Non-linear relationships within a system were tested in order to reveal a correlation as the theory suggested, where the results were convincingly positive. Crisis management networks' effectiveness was demonstrated to be validated by a ten-item-scale successfully. Future research might utilize more disaster cases both natural and manmade, search for impact of different communication tools within a system, and look at the relationships among members of crisis management networks instead looking within an organization.

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