The combination of modern, technological hazards and overlapping government jurisdictions requires coordinated, multijurisdictional emergency management. The Three Mile Island incident clearly demonstrated the impact of technical hazards and the importance of intergovernmental cooperation. A method is required to understand intergovernmental considerations in emergency management. This thesis derives such a method by proposing a three component model. The first component considers that all intergovernmental relationships are dynamic. Efforts to describe intergovernmental systems in terms of fixed relationships are not accurate. Rather intergovernmental systems are better described by the concept of movement along a scale between relationships that are separate and distinct and relationships that overlap and are interdependent. Relationships change along the scale depending on the strength of case-specific influencing variables. Identification and use of windows of opportunity describes the second component of the model. Institutional opportunists in favor of cooperative, intergovernmental programs must be able to identify and act when opportunities exist. Understanding this second component improves the chances of implementing lasting, cooperative intergovernmental results. The final component of the model emphasizes that by taking advantage of system change at the optimal time, linkages can be established between multiple jurisdictions. In multi-jurisdictional emergency management these linkages are made by integrating emergency plans and procedures. Applying the model by utilizing a case study in multijurisdictional emergency management completes this thesis. The case study documented is an intergovernmental cooperative planning effort between the Department of Energys Savannah River Operations Office and the states of South Carolina and Georgia. / M.A.

This thesis examines the approaches taken by the International Committee of the Red Cross (ICRC) and the Office of the High Commissioner for Refugees (UNHCR) to the protection of civilians during internal armed conflict, both at the level of global policy and at the level of implementation in the Colombian context. The thesis explains how the ICRC and UNHCR approach protection, why each has adopted its particular approach, and how and why the effectiveness of each approach is limited. In doing so, it offers a theoretical framework for explaining the approaches taken by international organizations (IOs) to new tasks within their mandates as well as policy implications for the ICRC, UNHCR and other humanitarian agencies. From a theoretical perspective, this research shows that factors internal to the IO carry greater explanatory power than external factors. Most significantly, when an IO expands into a new issue-area, it frames the new task in terms of the existing tasks within its mandate, replicating the specific goals and the means of pursuing those goals. The extent to which the approach is then adapted to the specificities of the new issue-area depends on the ‘bureaucratic personality’ of the IO, and specifically the extent to which decisions are informed by field-level experience. Internal conflicts by definition include armed non-state actors, and the analysis in this thesis emphasises both their significance in determining civilian security and their neglect in existing approaches to protection. While the ICRC seeks to reduce the threat posed by all armed actors (state and non-state) in its work at the field level, it relies heavily on an international legal framework which prioritises states and this partially undermines its attention to non-state actors at the field level. UNHCR retains a state-centric focus at both the field level and the level of global policy. From a policy perspective, therefore, the thesis advocates greater attention to armed non-state actors both at the level of practice and in the development of protection norms.

Existe uma tensão extraordinária no sistema humanitário: crises e emergências atingem cada vez mais povos, duram mais e são gradativamente mais complexas. As consequências dos conflitos armados e desastres socioambientais para a saúde mental e bem-estar psicossocial de indivíduos e povos, bem como para a ecologia social e os recursos comunitários significativos, já são reconhecidas e continuamente pesquisadas. Esta tese, a seu turno, explora as práticas e políticas do setor de Saúde Mental em emergências humanitárias e toma como ponto de partida analítico o desenvolvimento das Diretrizes do Comitê Permanente Interagências (IASC) em Saúde Mental e Apoio Psicossocial (SMAPS) em emergências humanitárias, lançadas no ano de 2007, assim como sua subsequente disseminação e configuração de governança, além de sua influência sobre projetos e instituições. As diretrizes IASC representam um marco lógico de importante contribuição para o setor de ajuda humanitária, no entanto, ainda constituem um campo de várias disputas e paradoxos, não só na área das referências teóricas e práticas em SMAPS em emergências humanitárias, como também relativamente à sua inserção em uma economia-política do setor de ajuda humanitária paradoxal nos princípios humanitários e éticos. Essa inserção molda as características particulares do funcionamento das Diretrizes e influencia a maneira como se produzem práticas e políticas. Fundamentando-se na pesquisa-ação, nas experiências do autor, o qual atuou como psicólogo na linha de frente em crises humanitárias na Líbia, Gaza, Síria, Timor-Leste e outros contextos, e em entrevistas com atores internacionalmente renomados e responsáveis pela elaboração e gestão de políticas internacionais do setor global de SMAPS, esta tese examina esse processo em detalhe, considerando o desenvolvimento e evolução das Diretrizes IASC de SMAPS e como, atualmente, a área de SMAPS se configura no interior da economia-política do setor humanitário. Mais explicitamente, analisam-se as maneiras como o discurso e a prática do setor de SMAPS são transformados pela estrutura humanitária que ele engendra. Desse modo, e por meio da discussão de todos esses elementos, este trabalho objetiva realizar uma revisão de elementos que influenciam e permitem o desenvolvimento de assistência humanitária seja cooptada em formas particulares que se articulam a interesses não humanitários, moldando substancial e prejudicialmente os projetos de SMAPS em emergências humanitárias ao redor do mundo. / There is extraordinary strain placed on the humanitarian system. Crises and emergencies are occurring more often, affecting more people, and in contexts of increasingly complexity. The impacts of conflict and disaster on mental health as well as on the social ecology and community resources needed for coping and recovery are very well documented. This research explores the politics of mental health and psychosocial programmes in humanitarian settings, and its analytical starting point is the development of the Interagency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support (MHPSS) in Emergencies settings launched in the year of 2007. The research explores how the field was developed, its structural governance, trying to explore the political economy configuration of humanitarian organizations providing MHPSS in its discourses, practices and impact. It is demonstrated the MHPSS IASC guidelines unprecedent contribution to the field, however it shows how it is affected by the political economy of aid that it is fundamentally part of. This structural political economy shapes the field and influences the way SMAPS is provided. Using action research, the author\'s own experiences responding to several humanitarian crises for more than 14 years, and interviews with well-known global MHPSS policy makers, this thesis examines this process in detail, considering how the development of the guidelines has developed and evolved, and how the area currently shapes in the political economy of aid. More explicitly, it analyzes the ways in which the discourse and practice of the MHPSS field are transformed by the humanitarian structure it engenders. Despite the field achievements, action research illustrates that this process allows the development of MHPSS response to be co-opted in particular ways that articulate non-humanitarian interests, substantially and harmfully influencing the MHPSS responses.

Made available in DSpace on 2016-04-28T20:40:18Z (GMT). No. of bitstreams: 1 Adriana Silveira Cogo.pdf: 891915 bytes, checksum: 74db22cecbc1610064f8f67e7ebac8e2 (MD5) Previous issue date: 2010-06-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The psychology of emergencies and disasters is presented as a new playing field for the psychologist, as a logical consequence of various studies and experiments showing that events of this magnitude not only cause loss of lives, endanger the physical integrity of people, causing damage and economic losses, but also cause a profound emotional impact on individuals, communities, first responders and other professionals such as psychologists. In this study, therefore, from a case study, it was the experience and meaning of work in emergency psychologist with extensive work in the area and performance of psychological care in different situations. One can understand how, in terms of training, performance in this area, highlight your experience and also know the route to performance and professional training. Demonstrated the need for grounding and depth on issues relevant to disaster and emergencies, such as trauma, grief, posttraumatic stress disorder for which the trader can act with the necessary security and do a quality job / A psicologia das emergências e desastres se apresenta como um novo campo de atuação para o profissional de psicologia, como uma conseqüência lógica de vários estudos e experiências que mostram que eventos desse porte não apenas causam a perda de vidas, colocando em perigo a integridade física das pessoas, causando danos e perdas econômicas, mas também causam um profundo impacto emocional sobre os indivíduos, comunidades, socorristas e demais profissionais envolvidos, como os psicólogos. Neste estudo, portanto, a partir de um estudo de caso, verificou-se a experiência e o significado de atuar em emergência para o psicólogo com longo trabalho na área e atuação de atendimento psicológico em diferentes situações. Pode-se entender como é, do ponto de vista do profissional, a atuação nesta área, destacar sua experiência e, ainda, conhecer o percurso para atuação e formação do profissional. Demonstrou-se a necessidade de embasamento e aprofundamento nas questões pertinentes ao desastre e emergência, como trauma, luto, transtorno de estresse pós-traumático para que o profissional possa atuar com a segurança necessária e fazer um trabalho de qualidade

Submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2014. / Introduction: The Emergency Medical Service (EMS) is required to respond to cases of life threatening illness or injury which may later be found to be non-emergent thus creating a mismatch between the dispatch of limited EMS resources and actual patient need. This study proposed that such a mismatch presently exists among South African urban EMS systems resulting in unacceptably high levels of inappropriate emergency responses. The purpose of this study therefore, was to evaluate the appropriateness of EMS responses in comparison to patient needs in a South African urban EMS system. Methods: All emergency cases dispatched over a 72 hour period at the Emergency Medical Communication Centre (EMCC) of the eThekwini Emergency Medical and Rescue Service (EMRS), a public sector urban EMS system, were prospectively enrolled in a quantitative study employing a descriptive, comparative design. Computer generated Vehicle Control Forms (VCF) containing dispatch data were matched and compared with Patient Report Forms (PRF) containing epidemiological and clinical data to describe the nature and extent of inappropriate responses based on patient need. Data were subjected to simple descriptive analysis and comparisons were analysed with correlations and chi-square. The Pearson's г and Spearman's rho were used to establish significance between more than two variables. Results : A total of 1689 cases were enrolled in the study of which 1385 met the inclusion criteria; 304 cases were excluded due to incomplete or duplicated data. The demand for EMS resources fluctuated widely throughout the day with levels peaking at midday and declining sharply after midnight. The median response time across all priorities was 56 minutes (IQR 59min) with just under half (46.4%) of all cases having a response time of more than an hour and almost one in ten (9.5%) exceeding 2½ hours. Significant variations existed between dispatch and on-scene priority settings and category descriptors most notable of which was seen in the highest priority ‘red code’ category which constituted more than 56% of all cases dispatched yet accounted for less than 2% on-scene (p <0.001). Conversely, over 80% of ‘red code’ responses actually required a lower priority response. Similarly, significant discrepancies were seen in the allocation of resources compared to the interventional needs of patients where it was shown that more than 58% of all cases required no interventions and just under 36% required only basic life support (BLS) level interventions (p <0.001). Of those patients triaged as ‘red code’ on-scene, less than 12% were initially allocated an appropriate Advanced Life Support (ALS) level of response and, of particular concern, only 7% of patients found to be dead or ‘blue code’ on-scene were initially dedicated a ‘red code’ response. Conclusion: South African urban EMS systems are presently unable to meet the needs of patients in terms of demand and matching resources to patient needs with evidently high levels of inconsistent and inappropriate responses resulting in sub-optimal use of limited resources.

Dissertation submitted in fulfillment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2012. / Background In the emergency setting, the onus is on the individual practitioner’s ability to make critical decisions at critical moments in order to provide the best level of care to their patient. In order to ensure that these decisions fall in line with the best interests of the patient, the South African paramedic requires a better understanding of how to arrive at such a decision; they need to understand the clinical decision making process. This study focused on South African paramedic clinical decision making with specific reference to acute traumatic pain management, with the aim of determining the factors which influence South African paramedic clinical decision making by revealing the current method of pain management employed by South African paramedics, how they view the priority of pain management in the continuum of care and if there were any context specific factors influencing their clinical decision making. Methods A mixed method design was used to determine the factors contributing to the clinical decision making process of South African paramedics in the acute pain management of patients with acute traumatic pain. A mixture of qualitative and quantitative approaches was utilized by means of a research questionnaire as well as in-depth interviews. The questionnaires were targeted at all South African paramedics while the in-depth interviews were conducted with five participants who had been purposefully selected from the questionnaire respondents. The data analysis was conducted in a descriptive manner in order to inform the explanatory nature of the answers to the research questions and objective. Results The results provided insight into the current methods and clinical decision making processes employed by South African paramedics in the management of patients’ experiencing acute traumatic pain. The study determined that the South African paramedic’s clinical decision making process involves three key phases in the acute traumatic pain management setting, the assessment phase, the initiation/pain management phase and the conclusion/re-evaluation phase, with each phase utilizing different decision making models, the intuitive/humanist model, the hypothetico- deductive model and a model which combined both of the aforementioned models. In addition to this, numerous factors such as the provision of care in order to facilitate further management and transportation to an appropriate facility, which influenced clinical decision making, were identified. Amongst South African paramedics, pain management was identified as coming second only to the interventions required to manage immediately life threatening conditions in terms of the prioritization of treatment. Recommendations A variety of recommendations which included the need to further the development of clinical decision making and pain management through research and education as well as considerations for investigation into the potential expansion of South African paramedic scope of practice in the pain management environment were made.

CHDS State/Local / Since 9/11 much progress has been made by Federal, State and local authorities to prepare for future Catastrophic Incidents. The March 1, 2004 release of the National Incident Management System (NIMS) mandated the use of Unified Command and Incident Management Teams (IMTs) for multi-agency, multi-jurisdictional incidents. These teams have strong potential for improving complex incident management. However, the potential for interagency conflict threatens effectual IMT functioning in the absence of team skills instruction as part of a national training curriculum. The current curriculum teaches technical skills and ICS role responsibilities, and omits skills needed to build healthy team dynamics. Training for IMTs needs to include more than technical skills ("What to do"), and that Department of Homeland Security (DHS) should expand the curriculum to include team dynamics ("How to do it"). Further, DHS need not "re-invent the wheel" when looking for sources of team dynamic theory, but need only look to and adapt the experience of business and academia. Over the past 20-25 years a variety of inter-organizational networks and Work Teams have been studied and field tested. This thesis examines literature lessons on the problems shared by Work Teams and IMTs, with particular emphasis on effectiveness and managing conflict. / Division Chief, Austin Fire Department

CIVINS / The United States Navy has recognized the rising age of its nuclear reactors. With this increasing age comes increasing importance of backup generators. In addition to the need for decay heat removal common to all (naval and commercial) nuclear reactors, naval vessels with nuclear reactors also require a backup means of propulsion. All underway Navy nuclear reactors are operated with diesel generators as a backup power system, able to provide emergency electric power for reactor decay heat removal as well as enough electric power to supply an emergency propulsion mechanism. While all commercial nuclear reactors are required to incorporate muhiple backup generators, naval submarine nuclear plants feature a single backup generator. The increasing age of naval nuclear reactors, coupled with the dual reqmrements of a submarine's solitary backup generator, makes the study of submarine backup generators vital. / CIVINS / US Navy (USN) author

CHDS State/Local / The Medical Reserve Corps (MRC) was formed to provide a cadre of trained medical volunteers to support and strengthen the public health infrastructure and improve its' emergency preparedness level. Training policies and standards are left to the discretion of the local MRC coordinator so the program maintains its flexibility to meet community needs. Training varies from unit to unit, and there are no protocols in place to measure or evaluate the effectiveness of that training. According to recent studies and surveys, disaster operations are an unfamiliar role for most MRC volunteers and the public health workforce in general. Evidence also suggests that few medical and public health workers receive this important preparedness training. In 2005, MRC working group members developed a list of core competency recommendations to provide training guidance, but specific educational content to satisfy those competencies were not defined. This thesis offers specific training content guidelines and strategies for achieving competency. The MRC must be able to integrate into the disaster environment while working safely, effectively and efficiently. Standards will set the mark for success, enabling the MRC to respond in a coordinated manner and at a consistently higher level to any public health emergency. / Captain, Texas State Guard-Medical Rangers

CHDS State/Local / Accidental or intentional release of radiation may result in catastrophic consequences to urban and suburban populations. Any emergency response is compromised by insufficiently detailed protocols, and qualitative or quantitative wants in equipment and training. These challenges are no less acute for Sacramento County which is an archetype of at-risk suburban and urban settings. Recognized standards in critical patient care illustrate the need for specific considerations for radiological contaminated patients in a response protocol. Current practices in Sacramento require patient decontamination prior to treatment or transport. This may adversely affect survival profiles, despite national and international standards which specifically provide for consideration of alternate procedures. Radiation responses require a systems approach, whereby all work collaboratively toward a common goal. Incident commanders must appreciate their role in a radiation response, and how to incorporate the response into a unified multi-jurisdictional, unified command. Additionally, an essential component of any radiation response protocol is to decrease the associated "fear" of radiation in the general public as well as emergency responders. Best practices research, and recommendations at local, state, national and international levels are compiled into a usable radiation response protocol which can be utilized in formulating protocols in radiation emergency response. / Captain, Sacramento Metropolitan Fire District