Improving Emergency Response in the Outpatient Clinic Setting

Background: Effective triage, assessment, and activation of necessary systems in emergent situations of clinical instability is vital in reducing morbidity and mortality of patients in any clinical setting. When medical emergencies occur outside of the hospital, organized and expedited transfer to a higher level of care reduces the potential for adverse events, lasting deficits, and patient death. Aim: The aim of this project was to identify weaknesses in the emergency response system in the community-based outpatient clinic setting and to propose solutions. Methods: The “Swiss Cheese” theoretical framework was used to do a root cause analysis of two clinical scenarios. Weaknesses in the emergency response system in the community-based outpatient clinic setting were identified. Results: Several tools were utilized including a fish bone diagram and the 5-Whys tool. Two root causes were identified. The first is that clinic staff does not have a working knowledge with specifics regarding the emergency response process. The second is that the existing emergency response checklist document is visually confusing and duties are not in sequence. Discussion and Implications for the CNL: Weaknesses in the emergency response system will be discussed. Knowledge and experience from inpatient care will be translated to the outpatient clinic setting. The role of the CNL in designing an effective emergency response system will be discussed with the proposal of several plans of action

Virtual Reality of Earthquake Ground Motions for Emergency Response

Ground motions interface earthquake science and engineering to advance understanding of seismic hazards and risk. Virtual reality provides an attractive tool to extend knowledge of the research community to a larger audience. This work visualizes emergency response under extreme motions, in the CAVE of the MARquette Visualization Laboratory. The visualization (a) displays ground motions (from the science community), (b) inputs these motions to structural models (from the engineering community) and illustrates the resulting responses, (c) translates structural responses to damage states of building elements, (d) creates a virtual room subjected to the perception associated with such earthquake shaking, and (e) introduces the human element of emergency response in this immersive environment. Building upon previous work on earthquake simulations, performance-based earthquake engineering (PBEE), building information modeling (BIM), and earthquake awareness, this study integrates elements of PBEE and BIM within the CAVE environment to provide visual information for decision making. Real-time or near real-time information via earthquake early warning (EEW) and structural health monitoring (SHM) further facilitates response within a limited time frame. As advanced technologies contribute to the future of community resilience, visualization plays an emerging role in connecting earthquake science, engineering, and policy

Emergency preparedness and response in New Zealand schools : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Emergency Management at Massey University, Wellington, New Zealand

International disaster risk reduction efforts prioritise school safety. Providing a safe learning environment for students and ensuring their continued access to education after an emergency has a positive influence on student, family, and community resilience. Existing school-based emergency management literature is limited. The project aimed to investigate current emergency preparedness and response activities in New Zealand schools, and identify key practices that support efforts to keep students safe during emergencies. A multiphase mixed methods research design, underpinned by a pragmatic philosophical approach, was employed to conduct three separate but linked studies that investigated: Emergency preparedness in schools (Study 1); Emergency management requirements and expectations of schools (Study 2); and Emergency response in schools (Study 3). Study 1 employed a survey to collect quantitative (n=355) and qualitative (n=514) data from schools throughout New Zealand about their experiences participating in the nationwide 2012 New Zealand ShakeOut earthquake drill, and the types of emergency preparedness activities undertaken. Findings identified lessons learned, and presented ways in which drills can be linked to other aspects of school preparedness. Schools were also found to undertake a range of preparedness activities (e.g., develop emergency plans, conduct frequent drills, and provide students with hazards education). However, differences in preparedness levels were identified, suggesting that some schools may be under-prepared to keep students safe in emergencies. A lack of clarity in the legislative requirements for school-based emergency management was proposed as a possible reason for differences in preparedness. Study 2 combined interviews of three emergency management practitioners with a review of New Zealand legislation, policy, and guidelines to identify the preparedness activities New Zealand schools are required to undertake to ensure the safety of the students in their care. The legislation was found to be generic, at times ambiguous, and schools were not provided with clear guidance. As a result, it was recommended that preparedness benchmarks be established and that standard operating procedures for core emergency response actions (i.e., shelter-in-place, lockdown, building evacuation, relocation, and family reunification) be developed to provide a consistent approach to school-based preparedness efforts. Studies 1 and 2 discussed emergency preparedness in New Zealand schools. However, there remained a need to investigate the link between preparing for and responding to emergencies by investigating how schools responded to real emergency events. Study 3 used three case studies to explore how three schools responded in a range of emergency events. Findings included the identification of generic, recurring response activities across a selection of emergency types, which were used to develop a six-stage school-based emergency response model. The lessons learned from participant’s first hand experiences of various emergency events enabled the identification of factors that contribute to an effective emergency response, including activities undertaken before, during, and after an emergency. Research exploring emergency management in New Zealand schools is still in its infancy. This project has contributed significant knowledge to understanding how New Zealand schools prepare for and respond to emergencies to keep their students safe. Findings from the research may also have relevance for an international audience

Community-based first aid: a program report on the intersection of community-based participatory research and first aid education in a remote Canadian Aboriginal community

Community-based first aid training is the collaborative development of locally relevant emergency response training. The Sachigo Lake Wilderness Emergency Response Education Initiative was developed, delivered, and evaluated through two intensive five-day first aid courses. Sachigo Lake First Nation is a remote aboriginal community of 450 people in northern Ontario, Canada with no local paramedical services. These courses were developed in collaboration with the community, with a goal of building community capacity to respond to medical emergencies. Issue. Most first aid training programs rely on standardized curriculum developed for urban & rural contexts with established emergency response systems. Delivering effective community-based first aid training in remote aboriginal communities required specific adaptations to conventional first aid educational content and pedagogy. Lessons Learned. Three key lessons emerged during this program that used collaborative principles to adapt conventional first aid concepts and curriculum. (1) 15 Standard algorithmic approaches may not be relevant nor appropriate. Relationships between course participants and the people they help are relevant and important. Curriculum must be attentive to existing informal and formal emergency response systems. These lessons may be instructive for the development of other programs in similar settings

Utilization of Community Health Workers in Emergency Preparedness and Response: A Literature Review

As the frequency and magnitude of disasters worldwide continues to rise, so too does the devastation that follows. This devastation extends to the whole community. In guidance put forward by the Federal Emergency Management Agency (FEMA), emergency preparedness must be represented in and reflective of the whole community, but marginalized groups or segments of the population may be left out of the conversation. Community Health Workers (CHW)s serve as a trusted liaisons and community advocates within the health care landscape. That landscape, as recent events demonstrate, includes emergency preparedness and response. This literature review is designed to assess available publications on the utilization of CHWs in emergency preparedness and/or emergency response. Four themes were identified in the literature review: response, training, political and investment. Assessments grouped by thematic type included author, title, study method, unique CHW term or phrase, and key findings. Additionally, eight articles were evaluated based on their COVID-19 focus and findings, their assessment included: CHW duties, challenges, and recommendations. A detailed narrative analysis, discussion and recommendation is provided on each theme

"5 Days in August" – How London Local Authorities used Twitter during the 2011 riots

© IFIP International Federation for Information Processing 2012This study examines effects of microblogging communications during emergency events based on the case of the summer 2011 riots in London. During five days in August 2011, parts of London and other major cities in England suffered from extensive public disorders, violence and even loss of human lives. We collected and analysed the tweets posted by the official accounts maintained by 28 London local government authorities. Those authorities used Twitter for a variety of purposes such as preventing rumours, providing official information, promoting legal actions against offenders and organising post-riot community engagement activities. The study shows how the immediacy and communicative power of microblogging can have a significant effect at the response and recovery stages of emergency events

The role local initiatives in community based disaster risk management in Kemijen, Semarang City

Community-based disaster risk reduction is one of the homegrown initiatives efforts and community empowerment oriented in disaster management. This approach is very important because no one can understand the conditions in a region better than the local communities. Therefore, the implementation of CBDRM always emphasize local initiatives in decision making. The existence of local initiative is necessary specially to anticipate the impact of climate change which is increasingly affecting towns in coastal areas, including settlements in Semarang. Kemijen Urban Village is one of the informal settlements in Semarang, which has the highest intensity of flood that is 12 times during 5 years (2011-2015). The research question is how the level of local initiatives in flood disaster management in Kemijen, Semarang? This study aims to assess the level of local initiatives in Kemijen as the community adaptive capacity of flood prevention in pre-disaster, emergency response, and post-disaster. Local initiatives assessed on water supply, sanitation, food, shelter, health, drainage maintenance and waste management. This study shows the level of local initiatives in pre-disaster and post-disaster is almost same and bigger than the response phase. Scoring results showed that pre-disaster is 35.002, 27.9577 for emergency response, and post-disaster is 34.9862 with each category that is independent, empowered, and independent. This study also shows that local initiatives in Kemijen largely formed by individual initiative and only a few were formed by a collective initiative

Innovative Mental Health Services in Rural Minnesota: Community-based Mobile Crisis Response Services

The purpose of this research project was to explore the relationship between the frequency of service utilization of the Community-based Mobile Crisis Response Services (MCR) provided by the Southwestern Mental Health Center (SWMHC) and the frequency of service utilization of emergency holds and civil commitments in Jackson and Cottonwood counties by month for the 2009 calendar year. The specific research question proposed was: Is there a relationship between the frequency of Community-Based Mobile Crisis Response Services and the frequency of emergency holds and civil commitments in Jackson and Cottonwood Counties? The significance of this research project was to explore statistically significant relationships and service utilization of MCR in rural southwestern, Minnesota. There is a large gap in research available to note MCR’s usage in geographically rural areas as well as MCR’s relationship to local emergency holds and civil commitments

A Māori love story: Community-led disaster management in response to the Ōtautahi (Christchurch) earthquakes as a framework for action

AbstractWithin the disaster response and research sectors, there is increasing recognition of the value of community-led initiatives that facilitate emergency management, risk reduction and community resilience. In contrast, the value of cultural approaches to disaster management and recovery is rarely acknowledged. The Māori disaster management response to the Christchurch earthquakes and subsequent urban recovery process constitutes an exemplar of best practice. During the emergency management phase, Māori risk management initiatives were collaborative, effective and shaped by kaupapa (cultural values), specifically the value, 'aroha nui ki te tangata' (extend love to all people). In this article, the potential value of Māori kaupapa-based technologies for shaping contextually relevant disaster management and risk reduction strategies is considered. The discussion draws from research findings arising from two projects conducted by the Joint Centre of Disaster Research in partnership with Te Rūnanga o Ngāi Tahu (resident Māori tribe) that address Māori disaster–related concerns, including factors that facilitate community recovery. An overview of the Māori emergency response, including perceived hindrances, is provided as background. Drawing upon frameworks provided within Actor-Network Theory cultural technologies that facilitate community well-being and recovery are identified and the ways in which technologies were operationalised within the emergency context, outlined. With reference to the Hyogo Framework for Action the applicability of integrating Māori technologies into national civil defence emergency management policies is also discussed and recommendations are proposed for adapting and implementing these technologies as a component of integrated disaster risk reduction at the local, national and international levels