CHDS State/Local / This thesis focuses on the medical as part of the public health response to Hurricane Katrina, specific to the issues of the private, non-governmental health professional. A brief survey was completed by 39 state level Bioterrorism Hospital Coordinators. Information obtained highlights the issues of the inability to deploy these private health professionals. Traditional governmental mutual aid mechanisms do not cover private non-governmental health professionals for workers compensation and death benefits. A review of the potential deployment mechanisms provides insight to the challenges and complexity specific to private health professionals. The motivation for volunteerism highlights the importance of targeting volunteer activities to the motivation of the individual volunteer. Investigating the impact thwarting the private, nongovernmental health professionals may have on future planning and response activities reinforce the need to modify the structures currently in place. The National Response Plan stresses the importance of including private industry into emergency preparedness and response strategies. This thesis outlines a strategy to pilot a project working with an established state volunteer registry by providing mechanisms to federalize those pre-identified, pre-credentialed volunteer health professionals. Once completed, this pilot could be expanded to other states ensuring a solid mechanism to quickly and safely mobilize this critical response discipline. / Bioterrorism Hospital Coordinator, Michigan Department of Community Health

CHDS State/Local / The state of Utah, like all states and the federal government, has had a long-standing need to improve communication capacity in its emergency response and public safety system. As government entities strive to meet this priority in the National Strategy for Homeland Security, it is crucial that communication systems be interoperable. Ironically, the groundwork for establishing an interoperable communication system nationwide is dependent upon effective human communication and coordination among policy makers, homeland security professionals, first responders and technologists. Accurate and complete information, in the right hands at the right time, can prevent, deter or mitigate a terror event or other mass casualty event. As hosts of the 2002 Winter Olympics, Utah understood that communication was critical to incident command and control and created a world-class 800 MHz communication system to support that mission. Since the 2002 Winter Olympics, with the leadership of former Governor Olene S. Walker and hard work and dedication from multiple agencies, Utah has developed that basic Olympic communications blueprint into the Utah Wireless Integrated Network (UWIN). It is the nationâ s first statewide, interoperable, wireless voice and data network and it is used every day by Utahâ s public safety professionals. / Executive Director, Utah Department of Administrative Services

Advisor name noted incorrectly on document as "Bordertsky". / The objective of this thesis is to review and analyze the current Command and Control communications used by the New Jersey Department of Health and Senior Services and provide best business practices of Emergency Preparedness and Response Systems capable of responding to all public health emergencies, act of terrorism and mass casualty incidents. Natural and man-made disasters, such as earthquakes, floods, plane crashes, high-rise building collapses, or major nuclear facility malfunctions, pose an ever-present danger challenge to public emergency services. In order to manage such disasters in a rapid and highly efficient and coordinated manner, the optimal provisions of information concerning any crisis situation is an essential pre-requisite. Local Police, Fire departments, Public Health Department, Civil Defense, Military and other emergency response organizations must react efficiently yet individually but most importantly, in a coordinated manner. These results in the necessity for both intra and inter organization coordination at several hierarchy levels. Since coordination requires current information, such information must be communicated within and between organizations in real-time, the need arises for an integrated communication and information system solely designated or disaster management that provides processing of relevant efficient, reliable and secure exchange of information.

This paper analyzes humanitarian assistance to complex humanitarian emergencies to understand why suboptimal outcomes result even when humanitarians have ethical principles and good intentions. It focuses on the International Committee of the Red Cross, the United Nations, and Médecins Sans Frontières to understand their core principles before looking at how these principles operationalize during emergencies. Challenges arise due to complex relationships with donors, local actors, and recipients, along with issues of marketization and competition. This paper’s case studies of the post-genocide Rwandan refugee crisis and post-9/11 Afghanistan explore how humanitarian principles clash with such dilemmas. In the end, humanitarian organizations are often unable to adhere to principles in the midst of crises and make compromises of competition and complicity that lead to suboptimal outcomes for the people they are trying to help. Looking to modern emergencies in Syria, Yemen, and South Sudan, it is critical to understand these dynamics and seek to improve institutions of humanitarian aid to make assistance actually beneficial for those in need.

Palliative Notfälle nehmen einen nicht unerheblichen Anteil an der Gesamtzahl von Rettungsdiensteinsätzen ein. Die vorliegende Arbeit beschäftigt sich mit der Thematik von Einsätzen und Patientenverfügungen bei Palliativpatienten im rettungsdienstlichen Alltag.  Im Rahmen dieser Arbeit wurden Rettungsdienstmitarbeiter der Berufsfeuerwehr Essen vor und nach einer Schulungsmaßnahme zur Thematik von Patientenverfügungen und Palliativversorgung befragt.  Es zeigte sich, dass Handlungsunsicherheit im Umgang mit Palliativpatienten und Patientenverfügungen besteht. Wünschenswert ist daher die Aufnahme des Faches Palliativmedizin in die Ausbildungscurricula der rettungsdienstlichen Berufe.  Weiterhin konnte festgestellt werden, dass die gesetzlichen Rahmenbedingungen zur Feststellung der Verbindlichkeit von Patientenverfügungen für nichtärztliches Personal nicht geklärt scheinen und dass hier Nachbesserungsbedarf besteht.

A possibilidade de revitalização e reutilização de áreas contaminadas por substâncias perigosas surgiu como grande alternativa ao abandono dos chamados Brownfields nos centros urbanos. A descontaminação desses sítios e sua reabilitação para reuso, além de apresentar-se como opção à criação de espaço nos grandes centros, se destaca como solução na proteção à segurança pública, à saúde da população e ao meio ambiente diante dos riscos oferecidos pelas substâncias ali presentes. Todavia, no tempo decorrido entre a identificação de área contaminada e sua revitalização existe a probabilidade da ocorrência de acidentes provocados pelo vazamento dos resíduos perigosos ali depositados, ocasionando efeitos danosos à população e ao meio ambiente, o que pressupõe ação imediata por parte do poder público. Com base em estudo de caso envolvendo indústria desativada utilizada como área para o armazenamento clandestino de tambores contendo resíduos perigosos, o trabalho propõe a criação de protocolo de atuação visando orientar os atores intervenientes nos cenários acidentais envolvendo Brownfields. O objetivo é oferecer ferramenta que auxilie na redução nos danos ambientais provocados por esse tipo de ocorrência além de contribuir para discussão de políticas públicas que permitam programar gestão estratégica dos Brownfields, mudando a forma de identificar, tratar e gerenciar áreas contaminadas. / The possibility of revitalizing and reusing areas contaminated by hazardous substances has emerged as a great alternative in urban centers. The decontamination of these sites, among which some known as Brownfields, and its rehabilitation for reuse, besides presenting itself as an option to the creation of space in the great centers, stands out as a solution in the protection of public safety, the health of the population and the environment by the risks offered by the substances present therein. However, in the time elapsed between the identification of contaminated area and its revitalization, there is a probability of accidents caused by the leakage of hazardous waste deposited therein, causing harmful effects to the population and the environment, which implies immediate action by the public power. Based on a case study involving deactivated industry used as an area for clandestine storage of drums containing hazardous waste, the work proposes the creation of an action protocol aiming to guide the intervening actors in the accidental scenarios involving Brownfields. The objective is to offer a tool to help reduce the environmental damage caused by this type of occurrence, in addition to contributing to the discussion of public policies that allow programming the strategic management of Brownfields, changing the way of identifying, treating and managing contaminated areas.

Profissionais de serviço de emergência experimentam diariamente inúmeras situações geradoras de ansiedade e stress. O objetivo deste estudo foi verificar se a utilização de música erudita pré-determinada produz alterações no Estado de ansiedade dos profissionais, além de conhecer a percepção dos mesmos sobre esse tipo de intervenção. A amostra constituiu-se de 49 profissionais (médicos, enfermeiros, auxiliares e técnicos de enfermagem, auxiliares administrativos, de farmácia e de limpeza) do Pronto Socorro Adulto de um hospital privado de médio porte da cidade de São Paulo. Os dados foram coletados utilizando-se o Inventário de Ansiedade Traço-Estado (IDATE) e um questionário de avaliação da percepção do profissional. Foi observado que na presença da música ambiente o Estado de ansiedade dos profissionais diminuía, à medida que a demanda de pacientes aumentava (p=0,008); 61% dos indivíduos gostaram da seleção musical, 76% perceberam alteração no ambiente e 41% acreditaram que a música alterou seu desempenho pessoal, sendo que nenhum desses aspectos interferiu na variação do escore de Estado de ansiedade. Pudemos concluir que a música erudita ambiente pode oferecer benefícios aos profissionais de emergência para além do sentido estético. / Professionals of emergency service experience countless generating situations of anxiety and stress daily. The objective of this study was to verify if the use of predetermined classical music produces alterations in the state of the professionals' anxiety, besides knowing the perception of the same ones on that intervention type. The sample was constituted of 49 professionals (doctors, nurses, nursing technicians and assistants, administrative assistants, of drugstore and of cleaning) of the ER/adult of a medium sized private hospital of the city of São Paulo. The data were collected being used the State Trait Anxiety Inventory (STAI) and a questionnaire of evaluation of the professional's perception. It was observed that in the presence of the ambient music, the state of the professionals' anxiety decreased, as the number of patients' increased (p=0,008); 61% of the individuals liked the musical selection, 76% noticed alteration in the environment and 41% believed that the music altered their personal performance, and none of those aspects interfered in the variation of the score of anxiety state. We could conclude that the ambient classical music can offer benefits to the emergency professionals beyond the aesthetic sense.

Introdução Após mais de uma década de implantação do Serviço de Atendimento Móvel de Urgência (SAMU), torna-se importante lançar um olhar crítico a este serviço a fim de identificar as propostas da Política Nacional de Atenção às Urgências. Objetivo - Descrever e analisar criticamente o processo de trabalho da Central de Regulação do SAMU São Paulo (SAMU SP). Métodos Foi realizado um estudo de caso descritivo exploratório, com estratégia de métodos mistos, integrando as abordagens quantitativa (dados secundários referentes ao mês de outubro de 2012) e qualitativa (observação direta e entrevistas com três médicos reguladores). O banco de dados secundários permitiu descrever a demanda do SAMU SP e verificar a existência de padrões de associação entre as variáveis. Foi realizado o cálculo das frequências absolutas e relativas de todas as variáveis categóricas e cálculo dos tempos envolvidos no atendimento préhospitalar. As entrevistas foram transcritas e analisadas por meio da análise de conteúdo de Bardin com o objetivo identificar fatores subjetivos que não foram possíveis de serem mensurados na análise quantitativa. Foi realizada uma segunda análise estatística do banco de dados, com foco no processo de priorização das ocorrências, sendo investigadas as variáveis despacho e tempo de regulação, segundo determinante de prioridade e queixas principais. Foi utilizado o teste chi-quadrado para significância estatística. Resultados - A demanda é majoritariamente clínica (59,2 por cento ), masculina (52,2 por cento ), entre 20 e 59 anos (54,5 por cento ) e classificadas com Determinantes de alta prioridade (Echo e Delta) (52,5 por cento ). As transferências inter-hospitalares correspondem a 0,6 por cento da demanda. A frequência de despacho de ambulância é de 63,4 por cento e decresce conforme a prioridade diminui, chegando a 21,2 por cento no Determinante de menor prioridade (Ômega). O tempo resposta é inversamente proporcional ao Determinante de prioridade, e uma parte significativa de ocorrências de baixa prioridade (35,9 por cento ) são incluídas no sistema de saúde. Foram identificadas três dimensões que influenciam o processo de priorização das ocorrências: condições clínicas reportadas (parada cardiorrespiratória, problemas respiratórios, inconsciência) condições de vulnerabilidade e risco específicos (idosos e crianças abaixo de 3 anos, quedas, medo por parte do médico regulador de subestimar, presença de violência, interação com outros serviços) e condições intrínsecas ao processo de trabalho da central de operações SAMU SP (alta demanda e poucos recursos, trabalho colaborativo com outros profissionais). Conclusões A descrição e análise crítica da demanda e do processo de trabalho do SAMU SP traz elementos para a discussão sobre seu papel dentro do sistema de saúde do município. É possível afirmar que o SAMU SP tem cumprido a missão de salvar vidas, provendo assistência qualificada para pacientes classificados de altíssima prioridade que necessitam de atendimento fora do ambiente hospitalar. Ordenar a demanda de urgência e se configurar como um observatório de saúde passam pela necessidade do reconhecimento técnico e político de que se trata de um serviço integrado a rede de atenção à saúde e não apenas a rede temática da urgência / Introduction After more than a decade of Brazilian Mobile Emergency Services (SAMU) implementation, it becomes importante to launch a critical look at this service in order to identify the proposals of the National Policy for Emergency Care. Objective To critically describe and analyze the work process of SAMU Regulation Center of the city of São Paulo (SAMU SP). Methods A descriptive exploratory case study with mixed methods strategy, integrating the quantitative (secondary data for October 2012) and qualitative (direct observation and interviews with three regulatory physicians) approaches. The secondary database was used to describe SAMU SP demand and to verify the existence of patterns of association between the variables. Absolute and relative frequencies of all categorical variables and the times involved in prehospital care were calculated. The interviews were transcribed and analyzed through Bardin content analysis with the objective of identifying subjective factors that were not possible to be measured in the quantitative analysis. A second statistical analysis of the database was carried out, focusing on the prioritization of emergency incidentes. The frequency of dispatch and regulation time were investigated, according to the Priority Determinant and main complaint. The chi-square test was used for statistical significance. Results - The demand is composed mainly by clinical chief complaints (59.2 per cent ), male patients (52.2 per cent ), between 20 and 59 years old (54.5 per cent ) and classified with high priority determinants (Echo and Delta) (52.5 per cent ). Interhospital transfers correspond to 0.6 per cent of the demand. Ambulance dispatch frequency is 63.4 per cent and decreases as the priority decreases, reaching 21.2 per cent in the lowest Priority Determinant (Omega). The response time is inversely proportional to the Priority Determinant, and a significant portion of low priority occurrences (35.9 per cent ) are included in the health system. Three dimensions have been identified that influence the prioritization of emergency incidents: reported clinical conditions (cardiorespiratory arrest, respiratory problems, unconsciousness), vulnerable conditions and specific risk of the emergency incident (elderly and children under 3 years, falls, medical doctor fear of underestimation, presence of violence, interaction with other services) and work process intrinsic conditions of SAMU SP operations center (high demand and few resources, collaborative work with other professionals). Conclusions The description and critical analysis of the demand and work process of the SAMU SP brings elements to the discussion about its role within the health system of the city of São Paulo. It is possible to affirm that SAMU SP has fulfilled the mission of saving lives, providing qualified assistance to patients classified as high priority who need care outside the hospital environment. In order to SAMU SP organize the demand for urgent care and to be a health observatory, there is the need of technical and political re-recognition that it is a service integrated to the health care network and not just a thematic network of urgency

Made available in DSpace on 2016-04-28T20:38:56Z (GMT). No. of bitstreams: 1 Rodrigo de Souza Amador Pereira.pdf: 498465 bytes, checksum: 2ea97444632fe9a11279d06c00babfc6 (MD5) Previous issue date: 2014-09-18 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Throughout the last decades, the demand for intervention by psychologists in emergency and disaster situations has risen in order to fulfill psychosocial needs and deal with people´s mental health affected directly or indirectly. Despite the occurrence of such disasters, the theoretical backdrop of the study of disaster psychology is still scarce and irregularly distributed throughout different countries, so the goal of this research was to delineate core-concepts, working concepts and actions in which Emergency and Disaster Psychology is based on in psychology-specific literature from the last decade (2004-2013). This research is of bibliographical nature and came to be by collecting data from scientific articles in the data bases BVS-ULAPSI, PsycInfo, and Portal CAPES (Periódicos e Teses). The terms used were: emergencies AND psychology; disasters AND psychology; disasters AND emergencies AND psychology; in Portuguese, Spanish and English. Results indicate that the field of emergency and disaster psychology is now a convergence between the fields of Mental Health and Community Psychology, with a growing concern for cultural differences. Disasters must be conceptualized as systemic phenomenon, since they usually involve a number of social actors, victims, survivors, their social networks, the workers in the disaster area and public opinion. A crisis situation is installed which imply both objective and subjective loss as well as complex reverberations throughout time. The concepts used in the area are mostly the same ones found in the literature from the previous decade: trauma associated with stress, trauma, psychopathologies (PTSD, depression, anxiety, panic and substance abuse), coping, as well as development processes and factors such as risk conditions, vulnerability, protection and resilience. These concepts are concerned with prevention and/or the health promotion either by identifying groups and vulnerability conditions or by developing action plans and interventions. What was found, were changes in emphasis and, specially, consolidations in what pertains to how and why to act. Even though we have confirmed that the bibliographical production is unevenly distributed, and the Brazilian production is still small, we have found agreement of perspectives and core-concepts / Nas últimas décadas cresceu a demanda por ações dos psicólogos em situações de emergências e desastres para atender as necessidades psicossociais e os impactos na saúde mental das pessoas afetadas, direta ou indiretamente. A despeito de ocorrerem desastres em todo mundo, o campo teórico e de pesquisa nesta área ainda se estrutura e a produção acadêmica é distribuída de forma irregular pelos países. O objetivo do presente trabalho foi delimitar os pressupostos, conceitos e ações norteadores da psicologia das emergências e dos desastres na literatura psicológica da última década (2004-2013). Tratou-se de uma pesquisa de natureza bibliográfica, realizada por meio da coleta e análise de artigos indexados nas bases de dados BVS-ULAPSI, PsycInfo e Portal CAPES (Periódicos e Teses). Foram usados como termos de busca: emergências AND psicologia; desastres AND psicologia; desastres AND emergências AND psicologia; em português, espanhol e inglês. Os resultados indicam que a área da psicologia das emergências e dos desastres, na atualidade, se refere a uma convergência entre o campo da saúde mental e da psicologia comunitária, com preocupação marcante com as diferenças culturais. Os desastres devem ser concebidos como fenômenos sistêmicos, à medida que envolve vários atores sociais: vítimas, sobreviventes, suas redes de pertinência, os socorristas e a opinião pública. Instala-se uma situação de crise que implica em perdas objetivas e subjetivas, bem como suas reverberações complexas ao longo tempo. Os conceitos utilizados na área são, em sua maioria, os mesmos já encontrados na literatura da década anterior: estresse associado ao trauma, trauma, psicopatologias (TEPT, depressão, ansiedade, pânico, abuso de substâncias), enfrentamento, bem como seus desdobramentos, como condições de risco, vulnerabilidade, proteção e resiliência. Estes conceitos se referem à prevenção e/ou promoção de saúde, quer pela identificação de grupos e condições de vulnerabilidade, quer no desenvolvimento de ações e intervenções. O que se constatou são mudanças de ênfase e principalmente consolidações no que se refere a como e para que atuar. Embora tenha se confirmado que a produção bibliográfica seja distribuída de modo desigual, e a participação de nosso país ainda seja pequena, verificaram-se basicamente concordância de perspectivas e pressupostos

Infant and young child feeding (IYCF) has a lifelong influence on health and is critically important during emergencies. Policies and guidance are designed to support IYCF in emergencies (IYCF-E), but are seldom fully implemented. Lebanon has a long history of national emergencies and is currently hosting 1.2 million Syrian refugees. Lebanese infant feeding practices are sub-optimal overall. To respond adequately in emergencies, there is a need to understand how best to address the nutritional needs of vulnerable infants and young children. This single-case study with three-level embedded units of analysis examines policies and programmes on IYCF-E in Lebanon. The study utilised a desk review comprising existing policies and guidance at all levels; a survey questionnaire targeting non-governmental organisations (n=54) (organisational level); semi-structured interviews with 12 stakeholders (central level), and focus groups with health care providers (n=8) and mothers (n=8) (service provision level). Descriptive analyses were used for survey data and thematic analysis for qualitative data. Existing policies were based on international guidance. However, despite notable efforts, these have not been fully implemented, disseminated or enforced at all levels. Policies were not part of a national strategy and IYCF-E was not integrated within national emergency preparedness plans. Programmes at each level lacked the necessary services to support mothers, notably an absence of counselling and support and a reliance on support from international organisations. Barriers include the lack of awareness and prioritisation of recommended IYCF practices and policies, gaps in human and financial resources, operational challenges and the influence of the infant formula industry which have combined to hinder the advancement of adequate IYCF policies and practices. Opportunities include the need to establish, organise, prioritise, and implement IYCF plans that are integrated within health and emergency plans, and disseminated. Any initiative needs to be evaluated and documented through rigorous implementation research.