The main topic of the thesis is the readiness for emergencies with a large number of injured and victims of the bodies of IRS in the SR. The work is divided into two main parts, theoretical and empirical. In the theoretical part of the work several bodies of the IRS in the SR, which participate during rescue and clean-up operations, are introduced. The basic bodies of the rescue system are described in detail, other bodies and bodies of the Police Force are described in brief. The work also includes categories of emergencies and brief information of disaster medicine as well. At the end, the theoretical part addresses the problem of sorting the injured by history through the categories and types of selection, sorting methods "START" and JumpSTART, a sorting card, and organization of activities in the place of an event associated with the "triage" procedures. Empirical part consists of research to determine theoretical knowledge of selected bodies of the IRS on the issue of triage. The main aim of this work was to determine the theoretical readiness of selected bodies of the IRS Fire and Rescue Service and Emergency Medical Service in the SR, confirm the need for continuous training and the organization of tactical exercises focused on mass disaster and work out and propose the same procedure of sorting the injured in incidents with a large number of injured and victims. Two hypotheses related to the theoretical readiness of selected bodies associated with sorting the injured in an emergency were established. The first assumption was that paramedics have better scope of theoretical knowledge about handling with emergencies, particularly sorting the injured than members of the Fire and Rescue Service. The second assumption was that the bodies of IRS have better knowledge about the system of sorting the injured "START" than the system "JumpSTART". Basic statistic method that allowed confirmation or refutation of hypotheses two-stage test is described in the chapter too. The methodology describes a method of data collection using a questionnaire, describes the statistical methods in detail and enriches it with the determination of basic empirical parameters and their comparison. The found discrepancies were expressed as a percentage. Data to confirm hypotheses were collected from paramedics and members of the Fire and Rescue Service. Only one hypothesis was confirmed. Empirical investigation showed that theoretical knowledge about the issue "triage" are at a much higher level in paramedics than members of the Fire and Rescue Service. Another observation was that the selected bodies do not show a difference in knowledge about the classification of adults and children, when considered together. There would be a big difference if they were compared individually. The results identified weaknesses in knowledge particularly among members of the Fire and Rescue Service and, therefore, detailed procedure for "triage" in emergencies was proposed. It will serve as a tool primarily for members of the Fire and Rescue Service as well as a study material for university graduates in the field of emergency health care. The need for emergency medical service was designed rescue bag with aids for primary triage. The need for continuous training was observed, particularly among members of the Fire and Rescue Service, who lack the information and skills. Organizing tactical exercises especially for paramedics with the possibility of cooperation with members of the Fire and Rescue Service was proposed as well. In the light of these findings, we recommend making effort to address the deficiencies in the theoretical preparedness through the organizing of continuing education, prepare similar questionnaires for verifying knowledge after the seminars, organize training of practical skills and verify knowledge through participation in exercises on dealing with catastrophe, together with the other emergency bodies.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2641. Advisers: Arnold J. Schecter; Bahman S. Roudsari. Includes bibliographical references.

POD (Point of Dispensing)-based emergency response plans involving mass prophylaxis may seem feasible when considering the choice of dispensing points within a region, overall population density, and estimated traffic demands. However, the plan may fail to serve particular vulnerable sub-populations, resulting in access disparities during emergency response. Federal authorities emphasize on the need to identify sub-populations that cannot avail regular services during an emergency due to their special needs to ensure effective response. Vulnerable individuals require the targeted allocation of appropriate resources to serve their special needs. Devising schemes to address the needs of vulnerable sub-populations is essential for the effectiveness of response plans. This research focuses on data-driven computational methods to quantify and address vulnerabilities in response plans that require the allocation of targeted resources. Data-driven methods to identify and quantify vulnerabilities in response plans are developed as part of this research. Addressing vulnerabilities requires the targeted allocation of appropriate resources to PODs. The problem of resource allocation to PODs during public health emergencies is introduced and the variants of the resource allocation problem such as the spatial allocation, spatio-temporal allocation and optimal resource subset variants are formulated. Generating optimal resource allocation and scheduling solutions can be computationally hard problems. The application of metaheuristic techniques to find near-optimal solutions to the resource allocation problem in response plans is investigated. A vulnerability analysis and resource allocation framework that facilitates the demographic analysis of population data in the context of response plans, and the optimal allocation of resources with respect to the analysis are described.

Background: Public transportation constitutes a vulnerable sector in modern day society with a high probability of generating mass casualties if attacked. By preparing for mass-casualty attacks (MCAs), response can become more effective and public transportation can become a less rewarding target. However, preparedness for attacks, much like response, implies resource constraints, and this dissertation pinpoints some major dilemmas that inhibit achieving preparedness for MCAs on public transportation in Sweden. Aim: The aim of this dissertation was to investigate preparedness for mass-casualty attacks on public transportation. This allowed for identification of major challenges for preparedness and response with a particular focus on the Swedish context. Methods: Study I included 477 MCAs identified through searches of the Global Terrorism Database, journals, newspapers and websites, which were examined with descriptive statistics. Study II thematically analyzed 105 articles attained by systematic searches of the PubMed and Scopus databases. Study III and IV statistically analyzed data from 864 responses to a purposive-designed questionnaire, from operational personnel of the Swedish emergency organizations. Study V entailed validation of a finite element (FE) simulation model of a bombing in a train carriage compared to the bombings in Madrid 2004. Results: International trends of MCAs (≥ 10 fatally injured and/or ≥ 100 non-fatally injured) on public transportation, during the years 1970-2009 (I) showed that the average number of injured increased considerably, despite a quite stable incidence rate since the 1980s. High numbers of injured people were connected to attacks on terminal buildings, multiple targets and complex tactical approaches. Few MCAs occurred in Europe, but the average number of fatalities per incident and injured per incident were the second highest among regions. The literature study (II) of previous on-scene management showed that commonly encountered challenges during unintentional incidents were added to during MCAs, implying specific issues for safety, assessment, triage and treatment, which require collaborative planning and specific training. The study regarding the Swedish emergency organizations’ perceptions of terrorist attacks (III) showed significant differences on perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence in knowledge of tasks to be performed on scene. The police respondents stood out; e.g., fewer police personnel had high estimates of their organizations’ management capability and knowledge of tasks on-scene compared to the other organizations. The study of factors that influence responders’ perceptions of preparedness for terrorism (IV) showed that these were influenced by the responders’ sex, work experience, organizational affiliation, various training arrangements and access to personal protective equipment (PPE). Investing in amenable factors, such as terrorism-related management training and provision of PPE, could improve responders’ perceptions of preparedness for terrorism. A finite-element (FE) model of an explosion in a train carriage (V) was developed and showed that FE modeling techniques could effectively model damage and injuries for explosions with applicability for preparedness and injury mitigation efforts, but, also, there was room for improvement of the model in terms of injuries. Conclusion: Achieving preparedness for MCAs on public transportation is a multiple choice balancing act between ostensible dilemmas regarding investments, disaster plans, training, response strategies, collaboration and inventions. / Bakgrund: Kollektivtrafik utgör en sårbar sektor i dagens samhälle, med hög sannolikhet att generera en situation med många drabbade vid attentat. Genom att förbereda för masskadeattentat (MCA) kan hanteringen bli effektivare och kollektivtrafiken utgöra ett mindre givande mål. Beredskap för attentat, liksom själva hanteringen, innefattar dock resursbegränsningar och denna avhandling belyser somliga avgörande utmaningar som hämmar utvecklandet av beredskap för MCA mot kollektivtrafiken i Sverige.   Syfte: Syftet med avhandlingen var att undersöka beredskapen för masskadeattentat mot kollektivtrafik. Detta möjliggjorde identifiering av stora utmaningar för beredskap och insatser, med särskilt fokus på den svenska kontexten.   Metoder: Studie I innefattade 477 MCA som identifierades genom sökningar i Global Terrorism Database, vetenskapliga tidskrifter, tidningar och webbsidor, som sedan undersöktes med deskriptiv statistik. I Studie II genomfördes en tematisk analys av 105 artiklar, funna genom systematiska sökningar i databaserna PubMed och Scopus. I Studie III och IV genomfördes statistisk analys av data från 864 respondenter till en ändamålsenligt utformad enkät, utskickad till operativ personal inom blåljusorganisationerna. Studie V innebar validering av en finita element (FE)-modell av en explosion i en tågvagn genom jämförelse med bombningarna i Madrid 2004.   Resultat: I den internationella utvecklingen av MCA (≥ 10 dödsfall eller ≥ 100 icke-dödligt skadade) mot kollektivtrafik, under åren 1970-2009 (I) visade det sig att det genomsnittliga antalet skadade ökade kraftigt, trots en tämligen stabil incidens av antalet händelser sedan 1980-talet. Skadadeutfallet var ofta stort vid angrepp på terminalbyggnader, multipla mål och användning av komplexa taktiska metoder. Få MCA inträffade i Europa, men det genomsnittliga antalet dödsfall per fall och skadade per fall var den näst högsta bland regioner. Litteraturstudien (II) av skadeplatshantering vid tidigare attentat visade att vanligt förekommande utmaningar under oavsiktliga masskadehändelser utökades under MCA med särskilda svårigheter kring säkerhet, bedömning, triage och behandling, vilket i sin tur kräver gemensam planering och särskild utbildning. Studien om de svenska blåljusorganisationernas uppfattningar om terroristattacker (III) visade signifikanta skillnader på uppfattningar om sannolikhet av olika händelser, viljan att respondera, beräknad hanteringskapacitet och förlitan till kunskap om uppgifter som ska utföras på skadeplats. Polisernas svar utmärkte sig; t.ex. hade färre inom polisen höga uppskattningar av sin organisations hanteringskapacitet och sin egen kunskap om uppgifter på plats, jämfört med de andra organisationerna. Studien av vilka faktorer som påverkade respondenternas uppfattning om beredskap för terrorism (IV) visade att uppfattningar påverkades av deras kön, arbetslivserfarenhet, organisationstillhörighet, olika former av utbildning och tillgång till personlig skyddsutrustning. Investeringar i åtgärder såsom terrorism-relaterad träning och personlig skyddsutrustning skulle kunna förbättra uppfattning om beredskap för terrorism inom blåljusorganisationerna. En FE modell av en explosion i en tågvagn (V) utvecklades och visade att FE metoden skulle kunna modellera materiella skador och personskador av explosioner, med tillämpning för beredskap och skadelindrande åtgärder, men visade också att det fanns utrymme för förbättring av modellen avseende personskador.   Slutsats: Förverkligandet av beredskap för masskadeattentat mot kollektivtrafik utgör en balansgång i beslutstagande mellan vad som förefaller vara dilemman om investeringar, krisplaner, utbildning, responsstrategier, samverkan och innovationer. / Preparedness for mass-casualty attacks on public transportation

<p>Samhällets utveckling i kombination med förändringar inom hälso- och sjukvården ökar risken att drabbas av en allvarlig händelse. Hälso- och sjukvården måste därför anpassas för att kunna hantera situationer med ett stort skadeutfall, i samma utsträckning som en oväntad minskning av tillgänglig kapacitet, till exempel vårdplatsbrist. Genom att hitta svagheter i verksamheten så ökar möjligheterna att åtgärda dessa och därmed förmågan att kunna upprätthålla de ordinarie målen för vård och behandling av patienter vid en allvarlig händelse. Syftet med denna studie var att utveckla och testa en arbetsmetod för att systematiskt kunna analysera och utvärdera katastrofmedicinsk beredskap, samt identifiera, orsaksbestämma, åtgärdsanalysera och mäta förmågan att hantera de för Landstinget i Östergötland (LiÖ) väsentliga områdena av katastrofmedicinskt beredskap. För detta ändamål utvecklades en arbetsmetod genom att kombinera en av Katastrofmedicinskt Centrum skapad strukturmall med den metod som Patientsäkerhetsenheten inom LiÖ använder sig av vid riskanalyser. Strukturmallen utgår ifrån Socialstyrelsens föreskrifter och allmänna råd (2005:13) om vad Hälso- och sjukvården särskilt bör uppmärksamma i relation till vad dess verksamhet skall baseras på. Resultatet visar att strukturmallen i kombination med patientsäkerhetsmetoden ger möjlighet att systematiskt utföra riskanalyser inom de identifierade områdena av katastrofmedicinsk beredskap. Arbetsmetoden bidrog till en samsyn om olika begrepps betydelse, samt identifiering och värdering av för den katastrofmedicinska beredskapen förekommande risker. En fortsatt utveckling av metoden krävs för att kunna analysera och utvärdera effekter av riskminskande åtgärder.</p> / <p>The aim of the study was to develop and test a new methodology for a systematic analysis of disaster preparedness in the County Council of Östergötland. The aim was also to identify, categorise and create measurability of the surge capacity within important fields of the disaster preparedness of the County Council of Östergötland.</p><p>The methodology is based on the use of a template developed by the Centre for Teaching and Research in Disaster Medicine and Traumatology (KMC), in combination with a validated patient risk assessment tool. The KMC template is based on national regulations and guidelines issued by the Swedish National Board of Health and Welfare. The template includes, in accordance with the board, what disaster preparedness should pay particular attention to in the planning process, in relation to the different components of disaster preparedness.</p><p>The results demonstrate that the template in combination with the risk assessment tool made it possible for an expert group to systematically conduct risk analysis within the identified areas of the disaster preparedness. Future development of this methodology will be needed in order to analyse and evaluate the effects of risk mitigation measures.</p>

The science of disaster medicine is more a descriptive than analytical type. Research, in most instances, has not employed quantitative methods and there is very sparse knowledge based on analytical statistics. One consequence of this is that similar mistakes are repeated over and over. Lessons that should be learned are merely observed. Moreover, there are almost no practical or ethical ways in which randomised controlled studies can be performed. The management, command and control of situations on different levels of hierarchy has eldom been evaluated and there have been no standards against which performance can be evaluated. Furthermore, the documentation of decisions and staff work is rarely sufficient enough to evaluate command and control functions. Setting standards that may be used as templates for evaluation and research is an issue that is constantly being addressed by leading experts in the field of disaster medicine and this is also an important issue that is expressed in the Utstein Template. Swedish National Board of Health and Welfare, templates of performance indicators were developed. These were tested on reports available from incidents, and our conclusion was that documentation in this form was not adequate enough for use in this method of evaluation. Documentation must be improved and data probably need to be captured and stored with the help of information systems. A template developed for the evaluation of medical command and control at the scene was tested in standardised examinations. When using this template in this setting it was possible to obtain specific information on those aspects of command and control that need to be improved. An information system using on-line Internet technique was studied twice. The first study concluded that in spite of technical disturbances the system was acceptable to the organisation but could not yet be recommended for use during major incidents. The second study concluded that the retrieval of information was, in all respects not as good as the control system, a conventional ambulance file system. In a study of staff procedure skills during training of management staffs in command and control it was concluded that documentation during training sessions was not adequate and this lack of staff procedure skills could possibly be a contributing factor to the fact that lessons in command and control are not learned from incidents. Conclusions in thesis are that measurable performance indicators can be used in the training of command and control. If performance indicators are to be used in real incidents and disasters, functioning information systems have to be developed. This may lead to a better knowledge of command and control and could possibly contribute to a process where lessons are learned and mistakes are not repeated.

Samhällets utveckling i kombination med förändringar inom hälso- och sjukvården ökar risken att drabbas av en allvarlig händelse. Hälso- och sjukvården måste därför anpassas för att kunna hantera situationer med ett stort skadeutfall, i samma utsträckning som en oväntad minskning av tillgänglig kapacitet, till exempel vårdplatsbrist. Genom att hitta svagheter i verksamheten så ökar möjligheterna att åtgärda dessa och därmed förmågan att kunna upprätthålla de ordinarie målen för vård och behandling av patienter vid en allvarlig händelse. Syftet med denna studie var att utveckla och testa en arbetsmetod för att systematiskt kunna analysera och utvärdera katastrofmedicinsk beredskap, samt identifiera, orsaksbestämma, åtgärdsanalysera och mäta förmågan att hantera de för Landstinget i Östergötland (LiÖ) väsentliga områdena av katastrofmedicinskt beredskap. För detta ändamål utvecklades en arbetsmetod genom att kombinera en av Katastrofmedicinskt Centrum skapad strukturmall med den metod som Patientsäkerhetsenheten inom LiÖ använder sig av vid riskanalyser. Strukturmallen utgår ifrån Socialstyrelsens föreskrifter och allmänna råd (2005:13) om vad Hälso- och sjukvården särskilt bör uppmärksamma i relation till vad dess verksamhet skall baseras på. Resultatet visar att strukturmallen i kombination med patientsäkerhetsmetoden ger möjlighet att systematiskt utföra riskanalyser inom de identifierade områdena av katastrofmedicinsk beredskap. Arbetsmetoden bidrog till en samsyn om olika begrepps betydelse, samt identifiering och värdering av för den katastrofmedicinska beredskapen förekommande risker. En fortsatt utveckling av metoden krävs för att kunna analysera och utvärdera effekter av riskminskande åtgärder. / The aim of the study was to develop and test a new methodology for a systematic analysis of disaster preparedness in the County Council of Östergötland. The aim was also to identify, categorise and create measurability of the surge capacity within important fields of the disaster preparedness of the County Council of Östergötland. The methodology is based on the use of a template developed by the Centre for Teaching and Research in Disaster Medicine and Traumatology (KMC), in combination with a validated patient risk assessment tool. The KMC template is based on national regulations and guidelines issued by the Swedish National Board of Health and Welfare. The template includes, in accordance with the board, what disaster preparedness should pay particular attention to in the planning process, in relation to the different components of disaster preparedness. The results demonstrate that the template in combination with the risk assessment tool made it possible for an expert group to systematically conduct risk analysis within the identified areas of the disaster preparedness. Future development of this methodology will be needed in order to analyse and evaluate the effects of risk mitigation measures.

Accidents with mass disability of people occur more and more. No matter if they are of a natural or human origin they are still a burden for both the rescuers and the civilian inhabitants. They have a huge impact on the social and economic aspects of the society. It si inevitable to be ready for such incidents in a sufficient way and thus keep the impact on the human health, lives and property as small as posssible. The purpose of this thesis is to analyse the education of paramedics in the Slovak Republic and the Czech Republic in three dimensions. First of all it is a complementary overview of the school education within the bachelor college study. The second level is addressing the providers of paramedical care and services and compiling an overview of the education at both the teoretical and practical level carried out for their employees. The third part consists of a summary of the current possibilities of individual education provided by conferences, competitions and trainings within associations or organizations. The thesis consists of 4 theoretical chapters and 3 chapters in the empirical part. In the theoretical part we define the medicine of disasters, massive accidents, incidents with a massive inflictions of persons, the sorting system START and others. We talk about the history and current practise of interventions within massive incidents. We also describe the occupation of a paramedic from the perspective of his/her competence, operation of a rescue service and methods of education. We focused mainly on trainings which are the most frequent form along with lectures. In the practical part we analyse the education of paramedics within schools by the means of the content and time. Based on the received questionaires we compare activities which are provided by paramedical care providers for the purpose of education, training and readiness of health care workers for the interventions with a large number of victims. The practical usage we illustrate in casuistics. We summarise a database of congresses, competitions and trainings carried out in given areas in the CR and SR. This thesis can be used as a base in the area of improving the education of paramedics in the area of emergency incidents for schools and paramedical services providers or the needs of the Ministry of Health, Ministry of Education. The differences found between the subjects or republics can be motivating for further progress of education. There is also space for removing all the found imperfections or development of new methods of educating.

Bakgrund Barn finns ofta bland de drabbade i samband med allvarliga händelser och har utifrån ålder och mognadsgrad behov som skiljer dem från vuxna i dessa situationer. Sjukvårdspersonal anger att det är svårare och mer påfrestande att hantera situationer där flera barn drabbats, men sjukvårdens förmåga kan optimeras om barnaspekter uppmärksammas rutinmässigt vid utformning av katastrofmedicinsk beredskap. Internationella rapporter anger att barnaspekter ofta förbises vid utformning av katastrofmedicinsk beredskap, men ämnet är bristfälligt kartlagt i Sverige. Syfte: Att undersöka om barnperspektivet uppmärksammas vid utformning av katastrofmedicinsk beredskap på regional nivå. Metod: Enkätstudie där populationen utgjordes av Sveriges 21 beredskapssamordnare på regional nivå. Resultat: I studien deltog samtliga beredskapssamordnare på regional nivå i Sverige (n=21). 16 av 20 deltagare angav att katastrofmedicinsk beredskap kan utformas efter barnets särskilda behov i hög grad. 19 av 21 deltagare uppgav dock att katastrofmedicinsk beredskap endast i liten grad är anpassad för barn. Medverkan av barnsjukvården ses som en viktig faktor för att säkerställa sjukvårdens katastrofmedicinska förmåga inför allvarliga händelser som drabbar barn. 20 av 21 deltagare angav dock att barnsjukvården är representerad endast i liten grad vid planering av katastrofmedicinsk beredskap på regional nivå. Vid risk- och sårbarhetsanalyser och systematisk kvalitetssäkring uppgav 18 av 21 respektive 17 av 18 deltagare att barnaspekter uppmärksammas i liten grad. Sex av 21 landsting/regioner synliggör barnaspekter i regional katastrofmedicinsk plan. Slutsats: Barnperspektivet uppmärksammas endast i begränsad omfattning vid utformning av regional katastrofmedicinsk beredskap. Studien påvisar nödvändigheten av att uppmärksamma och utveckla sjukvårdens katastrofmedicinska förmåga med fokus på barnets särskilda behov. / Introduction: Children are often among the victims in major incidents and have specific needs that separate them from adults in these situations. Healthcare personnel often find events including children more demanding than events only affecting adults. The health care, thus, has to integrate child aspects in all phases of disaster planning. International reports suggest that planning for disaster medical preparedness often fails to consider the special needs of children, but there is a lack of Swedish research in this field. Objective: To investigate if the child perspective is considered in regional disaster medical planning in Sweden. Method: A questionnaire was sent to the 21 regional disaster planning officers in Sweden. Results: All of the regional disaster planning officers in Sweden participated in the study (n=21). 16 of 20 participants claimed that child aspects can be integrated in disaster preparedness to a large extent. However, 19 of 21 planners indicated that disaster preparedness is adjusted to the needs of children only to a small extent. Participation of pediatric personnel in disaster medical planning was seen as an important step to ensure optimal preparedness for events including children. 20 of 21 planners stated that this is the case only to a small extent. Participants claimed that risk and vulnerability analysis (18 of 21) and quality assurance (17 of 18) reflects the needs of children to a small extent. Six of 21 participants claimed that pediatric aspects were integrated in regional disaster medical plans. Conclusion: The child perspective is considered only to a small extent in regional disaster medical planning in Sweden. This study indicates the need to highlight and develop the disaster medical capability with focus on the special needs of the pediatric population.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22337号 / 医博第4578号 / 新制||医||1041(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 佐藤 俊哉, 教授 福原 俊一, 教授 鈴木 実 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM