Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, June 2009. / Thesis Advisor(s): Richter, Anke. "June 2009." Description based on title screen as viewed on July 13, 2009. Author(s) subject terms: Critical mortality, triage accuracy, definitive care, damage control, regional preparedness, standard of care, mass casualty event, trauma medicine, rationing, Spain, Israel, United Kingdom, Tactical Combat Casualty Care, TCCC. Includes bibliographical references (p. 73-78). Also available in print.

Thesis (M. Sc.)--University of Canterbury, 2009. / Typescript (photocopy). Includes bibliographical references (leaves 53-54). Also available via the World Wide Web.

Orientador: Márcia Guimarães da Silva / Banca: Luciane Alarcão Dias-Melicio / Banca: Cilmery Suemi Kurokawa / Banca: Rosiane Mattar / Banca: Rodrigo Paupério Soares de Camargo / Resumo: A rotura prematura de membranas pré-termo (RPM-PT) é uma importante intercorrência obstétrica e a infecção da cavidade amniótica advinda do trato genital inferior é um dos principais fatores associados à sua fisiopatologia. As membranas corioamnióticas são barreiras mecânicas contra a ascensão de micro-organismos e possuem papel fundamental no sistema imune, pois são importantes fontes de mediadores inflamatórios como as citocinas e também de antimicrobianos naturais, como as defensinas. Em resposta à infecção, ocorrem recrutamento e ativação de leucócitos para as membranas fetais, o que caracteriza a corioamnionite histológica, que ativa a cascata inflamatória na interface materno-fetal e contribui com os mecanismos de enfraquecimento e rotura das membranas. Além acometer os tecidos gestacionais de gestações complicadas por RPM-PT, a corioamnionite histológica é um fator de risco para resultados adversos maternos e morbidades neonatais. 1) Quantificar a expressão de β defensinas (HBD1, 3 e 4) por membranas corioamnióticas de gestações complicadas por prematuridade associada à corioamnionite histológica; 2) Quantificar a expressão de RNA mensageiro (RNAm) e proteína de IL-18 em membranas corioamnióticas de mulheres com RPM-PT e correlacionar a expressão com a presença de corioamnionite histológica; 3) Avaliar os resultados neonatais adversos de gestações prétermo complicadas por corioamnionite histológica. Foram incluídas no estudo, gestantes com parto pré-termo e diagnóstico histológico de corioamnionite. Para o estudo da expressão de β defensinas, 40 fragmentos de membranas corioamnióticas, com diagnóstico histológico de corioamnionite, provenientes de gestações complicadas por rotura prematura de membranas pré-termo (RPM-PT) ou trabalho de parto prematuro com bolsa íntegra (TPP), que apresentaram parto... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The preterm premature rupture of membranes (PPROM) is an important obstetric issue, and infection in the amniotic cavity from the lower genital tract is one of the main factors associated with its physiology. Chorioamniotic membranes are mechanical barriers against the microorganism's ascension, and they play a fundamental role in the immune system, since they are important sources of inflammatory mediators, such as cytokines, and of natural antimicrobials, like as defensins. In response to infection, leukocytes are recruited and activated in fetal membranes, which characterizes histological chorioamnionitis. This condition activates the inflammatory cascade on the maternal-fetal interface and contributes to weakening mechanisms and membrane rupture. In addition to affecting the gestational tissues of pregnancies complicated by PPROM, histological chorioamnionitis is a risk factor for adverse maternal outcomes and neonatal morbidities. 1) To quantify the expression of β defensins (HBD1, 3 and 4) by chorioamniotic membranes of pregnancies complicated by prematurity associated with histological chorioamnionitis; 2) To quantify the expression of IL-18 mRNA and protein in the chorioamniotic membranes of pregnant women with PPROM and correlate expression with histological chorioamnionitis; 3) To evaluate adverse neonatal outcomes in preterm pregnancies complicated by histological chorioamnionitis. Pregnant women with preterm delivery and histological diagnosis of chorioamnionitis were included in the study. In order to study the expression of β defensins, 40 fragments of chorioamniotic membranes with histological diagnosis of chorioamnionitis from pregnancies complicated by PPROM or preterm labor with intact membranes (PTL), and with preterm labor as a gestational outcome, comprised the study group. As a control group, 40 chorioamniotic membranes without chorioamnionitis and paired... (Complete abstract click electronic access below) / Doutor

The CanMEDS 2015 Framework outlines many key competencies that must be addressed during residency training. The move towards the “Competency by Design” curriculum will require the use of simulation for assessment of these competencies. However, the use of simulation poses many challenges for residency programs including meeting the learning needs of multiple levels of learners, financial constraints, time constraints etc. We performed a program evaluation on an obstetrical emergencies simulation curriculum that involved Obstetrics and Gynecology residency trainees (PGY1-PGY5). Different levels of learners participated in various roles including; first responder (PGY2), second responder (PGY5), confederate roles including patient, nurse or family member (PGY1-3) and assessor (PGY4). This permitted assessment of the following CanMEDS competencies: medical expert and communicator (PGY2); communicator and leader (PGY5); communicator, collaborator and health advocate (PGY1-3) and scholar (PGY4). We were able to determine financial costs, faculty time, and resident time for our existing simulation curriculum and our new simulation curriculum. Residents were surveyed prior to the simulation regarding the learning environment in our pre-existing simulation curriculum and self-efficacy ratings for the competencies mentioned above. Faculty were also surveyed prior to the simulation regarding the residents’ competencies. Station scores were collected for all competencies. Focus groups allowed further exploration of the residents’ and faculty perceptions of the new simulation experience. Lastly, post-simulation surveys of both residents and faculty allowed comparison of pre- and post- learning environment assessment and self- efficacy/performance scores. We had limited station scores from our pre-existing simulation curriculum to allow direct comparison between the specific scenarios The program evaluation determined that this method of incorporating multiple levels of learners provided a feasible and acceptable method of assessing multiple CanMEDS competencies while minimizing financial costs and significantly reducing faculty time requirements. / Thesis / Master of Science (MSc) / This study examined a simulation curriculum for obstetrical emergencies using multiple postgraduate learners in various roles, to provide a learning opportunity and assessment opportunity, for a number of skills required by the Royal College of Physicians & Surgeons of Canada. It was found that involving learners in various roles, including responders; confederates acting as nurses, patients and family members; and assessors, enhanced learning in regards to patient management, communication, collaboration, assessment and health advocacy while reducing financial costs and faculty time requirements.

The legal humanitarian regime, set out in the Geneva Conventions and Additional Protocols, strives to alleviate human suffering through the provision of emergency goods and services, such as food supplies, water, temporary shelter, and medical treatment. This thesis examines how international non-government organizations (INGOs) contribute to the contestation of this regime in political emergencies, the effects of this contestation, and the factors driving INGO contestation. The thesis develops an analytical framework for understanding the nature and functioning of the legal humanitarian regime, and argues that INGO contestation occurs through the two processes of regime interpretation and regime implementation. It then goes on to identify the substantive content and effects of contestation, and the factors driving INGO contestation of the regime, through a detailed study of the policies and practices of CARE, Médecins Sans Frontiers, Oxfam, and World Vision, in Afghanistan and Sri Lanka, from 1990-2010. The thesis argues that contestation has constitutive effects, as it re-defines the meaning of the formal humanitarian regime, and the underlying rules and norms that specify the regime’s function, scope, and operating principles. Contestation also has causal effects, as it can make INGOs participants in the conflict, eroding thereby the basis on which they negotiate access and their ability to respond to humanitarian needs, and the security of their staff. It has also facilitated the subordination of humanitarian assistance by donor states and combatants to their political and security objectives. INGO identity - expressed in terms of the constituent rules and norms that define INGO membership, their mandate and goals, and the manner in which they distinguish themselves from other actors - is argued to be a necessary factor for explaining INGO contestation. The focus on identity highlights the agency of INGOs in shaping the humanitarian regime and demonstrates that INGOs are not simply at the mercy of more powerful actors or external constraints.

CHDS State/Local / Within the last three years, Homeland Security (HLS) has emerged as a new focus for local law enforcement agencies throughout the nation. While local police must effectively address community needs associated with crime and quality of life, they are also now on the front lines of the nation's battle against the forces of international terrorism. Using existing knowledge (derived primarily from the emergency management field), police agencies have worked to develop locally relevant, viable and available expertise in the developing field of HLS. If federal estimates are accurate, however, a critical mass of these experts will retire within the next five years. As these organizational experts approach retirement, their communities will be forced to deal with the consequences of an exodus of fundamental knowledge, experience and expertise. Police organizations will be challenged to continue the efficient delivery of homeland security services absent the experts who were instrumental in developing the field. Existing research in Knowledge Management (KM) may offer some guidance to managing this problem. KM seeks to offer organizational guidance on how to identify knowledge generation processes and then leverage, maintain and manage knowledge assets within an organization. This thesis seeks to explore the potential application of KM theories to the real challenges faced by local police agencies in the National Capitol Region as they attempt to effectively engage HLS management. / Assistant Chief of Police/Investigative Services, Montgomery County Department of Police

CHDS State/Local / Beginning in 2004, the Department of Homeland Security (DHS) began to define and implement a national domestic all-hazards preparedness goal, intended to improve the nation's preparedness for national catastrophes, including terrorist attacks. DHS's approach was capabilities-based planning (CBP), adopted from the Department of Defense (DoD). CPB is intended to develop the means--capabilities--for organizations to set priorities responding to a wide range of potential, but uncertain challenges and circumstances, mindful of issues of cost and sustainability. This thesis is intended to help officials better understand CBP and the factors important to its successful implementation. These factors range from setting out the business case for CBP adoption to necessary organizational and cultural enablers. In conclusion, the thesis recommends enhancing the CBP approach to national preparedness planning through integrating its approach with use of a national preparedness management standard, coverage of the mission areas of the National Strategy for Homeland Security, and encouraging performance partnership and collaborative. / Analyst-In-Charge and Senior Analyst, US Government Accountability Office

CHDS State/Local / Responding and recovering from large scale disasters is extremely labor intensive. Unfortunately, a problem confronting all communities is inability to employ on a regular basis the large number of personnel needed to effectively manage large scale disasters. One possible solution to increase workforce capacity during times of critical need is for emergency managers to integrate a volunteer component into their existing disaster management plan. The federal government is assisting local communities with volunteer recruitment by nationally sponsoring Neighborhood Watch, Volunteers in Police Service, Medical Reserve Corps, Community Emergency Response Team and Fire Corps programs through county-wide Citizen Corps Councils. The acceptance of volunteers by paid responders can vary significantly from one community to another. The results of a 13 item questionnaire from 50 CERT volunteers from a metropolitan community, who had at least one previous experience working with paid responders during the recovery phase of a large scale disaster identified that 24 percent felt as if they were in the way, 20 percent felt as if they worked harder than the paid responders, 36 percent were given assignments that did not match their skill level or training, only 48 percent were tasked immediately and only 60 percent reported that paid responders were helpful. Encouraging is the fact that even though some experiences may have been less than optimal, 100 percent reported that they would feel comfortable working with the same responders during another event. In addition, two case studies are used to tell the story of CERT volunteers that assisted with the recovery phase after the 2004 hurricane season in Florida. Each case study concludes with a list of lessons learned that emergency managers can consider when planning for similar missions. Primary issues and courses of action are provided to assist community leaders with deciding whether or not volunteers should be integrated into their existing disaster management plans. If the decision is made to integrate volunteers, several recommendations are discussed to assist planners with developing implementation strategies to address the needs and concerns of both populationâ s volunteers and paid responders. / Division Chief, Tampa Fire Rescue

This thesis addresses the problem of optimal evacuation of a naval ship. We propose the use of a dynamic escape-route system which employs a signaling system to adapt the emergency egress process to the instigating contingency. The evacuation process is represented by a nonlinear network optimization model with an objective function that integrates two conflicting goals: the average evacuation time and the ship's integrity. The nonlinearity in the model results from (a) speed being a nonlinear function of concurrent flow on passageways, and (b) delays caused by opening closures. We also account for counter-flows and passageways used by repair parties. The problem is heuristically solved through an iterative process that updates speeds and delays as it proceeds, and dynamically adds valid inequalities to avoid counter-flows. A bound on the solution quality is obtained by solving the problem under optimistic conditions. Compared to static routes in a modern frigate, model solutions show that dynamic routes can improve the average evacuation time by 20%, reduce the time of the last evacuee by 25%, and improve ship integrity. We also demonstrate that even greater improvements are achievable with minor design changes in the ship.

Safety aspects influencing emergency response on offshore installations and the influence of economic, legislative, safety management and safety engineering factors on the safety of the workforce are reviewed. The main objective of developing optimum strategies for emergency response is to reduce the risk to personnel by reducing the likelihood of precipitate or inappropriate decisions being made. This involves a judicious balance of significant predictive factors, namely: the estimated risk to personnel whilst remaining onboard and during evacuation, escape, recovery and rescue; and the estimated time required to gain control of an undesired event (or reach untenable conditions) and for evacuation and escape. The research focuses on the provision of significant information to the Offshore Installation Manager (OIM). A methodology is presented to assist in the development of optimum strategies for emergency response and in the design of a computer-based Emergency Response Information (ERI) system for providing the information. A fiamework is presented to assist in: identifying events, sequences and combinations of events and their potential consequences; and defining event type, severity and priority for emergency response. Typical resources and arrangements for responding to emergencies are reviewed and their adequacy for the effective employment of the ERI system evaluated. Typical information required at applicable activity stages is identified for defined areas of emergency response for events of varying degrees of severity. A statement of sensible and feasible' requirements of a typical ERI system is presented. A critical evaluation is presented of the feasibility of the design, manufacture and operation of the ERI system to provide the information and achieve specified requirements, namely: performance standards (functionality, reliability and survivability); and ergonomic and human resources requirements. The research concludes by examining ways in which the philosophy described in the thesis can be implemented in practice. A methodology for presenting the information is described.