Emergency Response Coordination Research Articles

Amniotic fluid embolism: an Australian-New Zealand population-based study.

BackgroundAmniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of AFE in either country. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes.MethodsA population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96 % of women giving birth in Australia and all 24 New Zealand maternity units (100 % of women giving birth in hospitals) between January 1 2010-December 31 2011. A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation).ResultsThirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100 000 women giving birth (95 % CI 3.5 to 7.2 per 100 000). Two (6 %) events occurred at home whilst 46 % (n = 15) occurred in the birth suite and 46 % (n = 15) in the operating theatre (location not reported in one case). Fourteen women (42 %) underwent either an induction or augmentation of labour and 22 (67 %) underwent a caesarean section. Eight women (24 %) conceived using assisted reproduction technology.Thirteen (42 %) women required cardiopulmonary resuscitation, 18 % (n = 6) had a hysterectomy and 85 % (n = 28) received a transfusion of blood or blood products. Twenty (61 %) were admitted to an Intensive Care Unit (ICU), eight (24 %) were admitted to a High Dependency Unit (HDU) and seven (21 %) were transferred to another hospital for further management. Five woman died (case fatality rate 15 %) giving an estimated maternal mortality rate due to AFE of 0.8 per 100 000 women giving birth (95 % CI 0.1 % to 1.5 %). There were two deaths among 36 infants.ConclusionsA coordinated emergency response requiring resource intense multi-disciplinary input is required in the management of women with AFE. Although the case fatality rate is lower than in previously published studies, high rates of hysterectomy, resuscitation, and admission to higher care settings reflect the significant morbidity associated with AFE. Active, ongoing surveillance to document the risk factors and short and long-term outcomes of women and their babies following AFE may be helpful to guide best practice, management, counselling and service planning. A potential link between AFE and assisted reproductive technology warrants further investigation.

Development of an intelligent disaster information-integrated platform for radiation monitoring

Traditional infrastructures are subjected to disasters that carry the risk of major loss of human life if not responded to properly. Damage and injury can and should be minimized through the provision of adequate situational awareness and decision-making support, and for this reason, the internet of things (IOT) is potentially very useful for managing crisis situations via providing sound disaster management and emergency-response information. This study has developed an IOT-based intelligent disaster information-integrated platform (IDIIP) for disaster monitoring, disaster information management, and emergency-response coordination. A radiation-monitoring scenario has been selected to prove the concept of the IDIIP. However, when numerous sensors and related devices are deployed, great difficulties arise in maintaining, updating, and configuring them. To address these issues, we developed a novel IOT-based data storage and exchange framework in IDIIP. Thanks to this framework, IOT devices can be upgraded effortlessly even if site conditions or users’ requirements change. Our framework also makes it much easier to upgrade sensors without rewriting the sensor drivers. An experiment for radiation measurement was conducted to validate our prototype radiation-sensing node and IOT center node. This and an operational radiation-monitoring scenario for this platform are described in the article. All results indicate that this platform would be beneficial for radiation monitoring and disaster information dissemination to the public.

Ebola hemorrhagic fever: genetic biomarkers and vaccine development.

Ebola hemorrhagic fever: genetic biomarkers and vaccine development.

What kind of #conversation is Twitter? Mining #psycholinguistic cues for emergency coordination

The information overload created by social media messages in emergency situations challenges response organizations to find targeted content and users. We aim to select useful messages by detecting the presence of conversation as an indicator of coordinated citizen action. Using simple linguistic indicators drawn from conversation analysis in social science, we model the presence of coordination in the communication landscape of Twitter1Popular Microblogging Service: http://www.twitter.com.1 using a corpus of 1.5 million tweets for various disaster and non-disaster events spanning different periods, lengths of time, and varied social significance. Within replies, retweets and tweets that mention other Twitter users, we found that domain-independent, linguistic cues distinguish likely conversation from non-conversation in this online form of mediated communication. We demonstrate that these likely conversation subsets potentially contain more information than non-conversation subsets, whether or not the tweets are replies, retweets, or mention other Twitter users, as long as they reflect conversational properties. From a practical perspective, we have developed a model for trimming the candidate tweet corpus to identify a much smaller subset of data for submission to deeper, domain-dependent semantic analyses for the identification of actionable information nuggets for coordinated emergency response.

Collaboration and Simulation: Striving for Obstetric Excellence With the Emergency Department

<h2>Professional Issues Poster Presentation</h2><h3>Purpose for the Program</h3> To coordinate the obstetric (OB) rapid response team with the emergency department trauma team of a busy community hospital. Attendance by OB and emergency staff at an Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) webinar, Perinatal Code Management, sparked a lively dialogue from which evolved a plan for simulation. A policy on management of the OB patient for the emergency department worked well in most situations. The focus was to fine‐tune the actual response times and process. How do we work together? Is it possible to deliver a newborn via emergency cesarean within the recommended 5 minutes after cardiac arrest? Because it could be applied to the emergency department, simulation often was used on the OB unit for staff training of critical situations. <h3>Proposed Change</h3> When the OB team responds to the emergency department in critical situations, coordination of both interdisciplinary teams is important for best patient outcomes and coordinated emergency response. Training most often occurs at department levels; this silo training can lead to challenges between the teams. <h3>Implementation, Outcomes, and Evaluation</h3> Coordinators first met to identify current process, team members, best practice, and purpose of the simulation. The multidisciplinary team participants identified included members from the emergency department, labor and delivery, neonatal intensive care unit, and other ancillary departments. The following education items were identified for presimulation review: communication, team purposes, roles, and equipment. A scenario was developed for the simulation that incorporated a pregnant female who had been in a motor vehicle accident and was experiencing cardiac arrest after admission to the emergency room. The debriefing after the simulations was used to identify elements that went well and opportunities for improvement. Initial notification of the teams worked well, as did management of patient care. Some opportunities identified were access and use of equipment, wayfinding, critical times, and communication. As a result of these findings, projects were assigned to specific team members to eliminate gaps. Subsequent simulations were planned to test these changes. <h3>Implications for Nursing Practice</h3> Two separate critical response teams working together bring differences in communication and processes that must be identified and understood by all participants to promote true interdisciplinary/interspecialty coordination. Teams who normally function well in rapid response situations may react differently when taken out of familiar environments. The OB department staff was familiar with the process of unit simulations; however, the emergency department primarily used simulation for large, emergency management drills. Crew resource management processes were used for communication and identification of roles. Additional simulations are planned using additional patient situations that require support by the OB rapid response team (e.g., stroke).

Non-communicable diseases in emergencies: a call to action.

Recent years have demonstrated the devastating health consequences of complex emergencies and natural disasters and thereby highlighted the importance of comprehensive and collaborative approaches to humanitarian responses and risk reduction. Simultaneously, noncommunicable diseases are now recognised as a real and growing threat to population health and development; a threat that is magnified by and during emergencies. Noncommunicable diseases, however, continue to receive little attention from humanitarian organisations in the acute phase of disaster and emergency response. This paper calls on all sectors to recognise and address the specific health challenges posed by noncommunicable diseases in emergencies and disaster situations. This publication aims to highlight the need for: • Increased research on morbidity and mortality patterns due to noncommunicable diseases during and following emergencies; • Raised awareness through greater advocacy for the issue and challenges of noncommunicable diseases during and following emergencies; • Incorporation of noncommunicable diseases into existing emergency-related policies, standards, and resources; • Development of technical guidelines on the clinical management of noncommunicable diseases in emergencies; • Greater integration and coordination in health service provision during and following emergencies; • Integrating noncommunicable diseases into practical and academic training of emergency workers and emergency-response coordinators.

Leveraging organizational structure in safety and emergency preparedness programs

George Mason University is exploring a new strategy for preparing academic and administrative units to respond to emergencies through a system of emergency guidance documents and an administrative process that utilizes existing organizational structure to ensure effective implementation of safety programs and execution of emergency response procedures. This scalable program can be applied to organizations of various size and complexity regardless of geographic distribution. The principle advantage of this program is its novel integration into existing organizational structures and the departure from the traditional floor warden program to implement safety programs and coordinate emergency response actions during a crisis. The article focuses on the use of a unique organizational framework to develop a culture of safety and emergency preparedness in a complex multi-function institution. The following article outlines the logic of this program and an analysis of each of its components.

The Architecture of International Energy Governance

The study of international energy governance is in its youth. This fact may seem somewhat paradoxical. Many international energy institutions, such as the International Atomic Energy Agency (IAEA) and the Organization of Petroleum Exporting Countries (OPEC), have existed for fifty years or more. Energy has long been a major driver of global crises and national politics. The memory of the Arab oil embargo of 1973-1974 casts a long shadow over global energy debates, and American politics, to take but one example, continually return to the question of the appropriate balance between environmental protection and natural resource extraction. Yet despite energy's centrality to global and national politics, international energy governance--as distinct from national energy policies and international energy politics--has resisted the multilateral governance trend of the past several decades. There is no global World Energy Organization (the International Energy Agency (IEA) is an OECD agency and as such is not open for accession to most nations), and many of the major multilateral legal institutions such as the World Trade Organization (WTO) deal with energy only incidentally. Perhaps for this reason, it is only with surging demand for energy and the problems such demand creates for traditional areas of international cooperation, including trade and climate change, that energy governance has itself become an object of study again. In my remarks, I want to address three questions: Why is international energy governance so fragmented? Why is that fragmentation a problem? And what do we do about it? WHY IS INTERNATIONAL ENERGY GOVERNANCE SO FRAGMENTED? An alphabet soup of international agreements and organizations deals in some way or another with international energy: the WTO, the United Nations Framework Convention on Climate Change (UNFCCC), the Energy Charter Treaty (ECT), OPEC, the Gas Exporting Countries Forum (GECF), the IAEA, the International Energy Program (IEP) Agreement and IEA, and the International Renewable Energy Agency (IRENA), to name but a few. This list includes only intergovernmental organizations and neglects regional institutions such as the European Union or the North America Free Trade Agreement that influence international energy cooperation. The fragmentation in energy governance arises in large part because of path dependence. At no time did negotiators ever sit down and think about what an ideal international energy institution would look like. Instead, institutions were created to deal with issues and crises as they arose. Energy institutions thus tend to have mandates and powers shaped, not by considerations of desirable energy governance, but by historically contingent governance problems. The development of institutions dealing with oil illustrates the role of contingency. In the early 20th century, the most important governmental institution dealing with oil was the Texas Railroad Commission, which was able to influence global oil prices by regulating production levels in Texas. (1) In part to combat the influence on prices of U.S. authorities and multinational oil companies (the so-called Seven Sisters), oil-exporting states formed OPEC with the goal of renegotiating concession agreements with the multinational oil companies. (2) OPEC was wildly successful in this goal, and by the 1970s OPEC (and in particular Saudi Arabia) had emerged as the key swing producer of oil, capable of influencing global prices. Arab members of OPEC deployed this ability during the Arab oil embargo of 1973-1974. That crisis prompted oil-consuming nations to sign the IEP Agreement, which created the IEA and aimed to coordinate emergency response measures in the event of an oil price shock. As the development of oil institutions illustrates, the fragmentation of international energy governance is a result of the fact that many energy institutions have been created to respond to specific contingent governance problems, rather than long-term governance challenges. …

Interorganizational coordination in oil spill emergency response: a case study of the Murmansk region of Northwest Russia

Projected petroleum developments and an increase in maritime oil transportation in the Russian Arctic have raised awareness regarding the need for an effective oil spill emergency response (OSER) system. This paper examines the OSER system in the Murmansk region of Northwest Russia. The system comprises of multiple federal, regional and private organisations with functionally specified tasks. Coordination among the organisations becomes a prerequisite for the system as a whole to function. The study first discusses the different forms of formal and informal coordination mechanisms that are at play in the OSER system. Second, it analyses how the interdependencies in the OSER system affect organisational behavior, in terms of coordination or competition. We first conclude that while formal coordination mechanisms provide structure to the system, informal mechanisms facilitate the formal mechanisms and may compensate for shortcomings. Second, there is a sense of commonality of purpose related to being part of an OSER system that facilitates coordination. Meanwhile, the commercialisation of OSER services impedes coordination, in particular between response providing organisations. This is aggravated by gaps and overlaps in federal laws and policies. However, informants are positive regarding the system's ability to respond effectively in case of an oil spill.

Evaluation on training the comprehensive ability of transferring newborns with severe diseases in nurses

Objective To explore the methods and effects of training the comprehensive ability of transferring newborns with severe diseases in nurses. Methods The simulation training including neonatal advanced life support (NALS), nursing skills, emergency treatment process and response ability was performed in NICU nurses. Results The transfer related knowledge and skills were significantly improved and emergency resuscitation workflow was more efficient than before. Conclusions The simulation training can improve comprehensive ability including emergency response capability and coordination ability for NICU nurses. Key words: Nurse; Simulation training; Comprehensive abilities; Team-coordination

Practice and experiences on medical treatment assurance for major international events

A brief description of the medical treatment assurance service provided by the hospital for major international events from 2001 to 2007. The paper rounded up the practices and experiences of the hospital gained such services in a variety of international events, including the development of a detailed operative plan for medical treatment assurance, selection and preparation for medical workers, development and updating of training programs, determination of the operability of the plan and successful launch of the assurance services. It holds that provision of such services significantly upgrades the general competence of the hospital management, and its capabilities in management, emergency response, rescue and inter-department coordination. Key words: Major international events; Medical treatment assurance; Practice; Capabilities

Assessing Public Health Capabilities during Emergency Preparedness Tabletop Exercises: Reliability and Validity of a Measurement Tool

Improving the ability of local public health agencies to respond to large-scale emergencies is an ongoing challenge. Tabletop exercises can provide an opportunity for individuals and groups to practice coordination of emergency response and evaluate performance. The purpose of this study was to develop a valid and reliable self-assessment performance measurement tool for tabletop exercise participants. The study population comprised 179 public officials who attended three tabletop exercises in Massachusetts and Maine between September 2005 and November 2006. A 42-item questionnaire was developed to assess five public health functional capabilities: (1) leadership and management, (2) mass casualty care, (3) communication, (4) disease control and prevention, and (5) surveillance and epidemiology. Analyses were undertaken to examine internal consistency, associations among scales, the empirical structure of the items, and inter-rater agreement. Thirty-seven questions were retained in the final questionnaire and grouped according to the original five domains. Alpha coefficients were 0.81 or higher for all scales. The five-factor solution from the principal components analysis accounted for 60% of the total variance, and the factor structure was consistent with the five domains of the original conceptual model. Inter-rater agreement ranged from good to excellent. The resulting 37-item performance measurement tool was found to reliably measure public health functional capabilities in a tabletop exercise setting, with preliminary evidence of a factor structure consistent with the original conceptualization and of criterion-related validity.

CordNet: Toward a Distributed Behavior Model for Emergency Response Coordination

Existing studies of coordination theory in human networks have looked at coordination problems requiring stable working relationships with no environmental uncertainties. With emergency response management demanding distributed coordination in volatile situations, the designs of existing models are useful as a building block, yet flawed for application. We hypothesize that changes to interconnectedness of nodes in the network may have implications on the potential to coordinate. To test our hypotheses, we investigate survey data from state law enforcement, state emergency services, and local law enforcement by performing agency-based (macro) and cross-agency (micro) analysis to identify attributes of each network and coordination.

Avian Influenza and Pandemic Influenza Preparedness in Hong Kong

Avian influenza A H5N1 continues to be a major threat to global public health as it is a likely candidate for the next influenza pandemic. To protect public health and avert potential disruption to the economy, the Hong Kong Special Administrative Region Government has committed substantial effort in preparedness for avian and pandemic influenza. Public health infrastructures for emerging infectious diseases have been developed to enhance command, control and coordination of emergency response. Strategies against avian and pandemic influenza are formulated to reduce opportunities for human infection, detect pandemic influenza timely, and enhance emergency preparedness and response capacity. Key components of the pandemic response include strengthening disease surveillance systems, updating legislation on infectious disease prevention and control, enhancing traveller health measures, building surge capacity, maintaining adequate pharmaceutical stockpiles, and ensuring business continuity during crisis. Challenges from avian and pandemic influenza are not to be underestimated. Implementing quarantine and social distancing measures to contain or mitigate the spread of pandemic influenza is problematic in a highly urbanised city like Hong Kong as they involved complex operational and ethical issues. Sustaining effective risk communication campaigns during interpandemic times is another challenge. Being a member of the global village, Hong Kong is committed to contributing its share of efforts and collaborating with health authorities internationally in combating our common public health enemy.

Simulation of multi-organisational coordination in emergency response for system resiliency

This paper presents a multi-agent and human-in-the-loop simulator for emergency response in disasters. We identified and categorised various typical situation-oriented rules using interviews and questionnaire surveys of emergency responders who hold positions as local government officials, police and nuclear experts, as well as observed emergency exercises during various disasters. These factors were then implemented into a previously developed organisational model of intra- and inter-agency communication and coordination for emergency response. Based on this model, a multi-agent simulator for organisational behaviour in emergency response was developed. In addition, a user console on an identical simulation platform was constructed and integrated with the multi-agent simulation. Users can exchange messages through the console by using the same ontology and message format as those used by computer agents. Test simulations were executed and the results confirmed that the multi-agent, human-in-the-loop simulation creates various complicated situations that are similar to actual emergency situations and, therefore, could be a strong candidate for education, training and exercises in disaster response.

The Legal Framework for Meeting Surge Capacity Through the Use of Volunteer Health Professionals During Public Health Emergencies and Other Disasters

Recent events such as Hurricane Katrina and the global SARS outbreak underscore the importance of having public health and medical systems that are prepared to increase surge capacity in a variety of emergency scenarios. A core component to increasing surge capacity is the availability of skilled health professionals to supplement the existing health workforce. This article examines the legal context volunteer health professionals find themselves in during public health emergencies and disasters. In addition, the article makes several recommendations about how to refine the law to increase the availability of volunteer health professionals during public health emergencies and disasters. First, states should incorporate advance registration systems and protections for volunteers into laws that authorize emergency preparedness and response efforts. These laws should explicitly define the powers of state government during emergencies and clarify the legal provisions applicable to VHPs and the entities or organizations that may rely on them. Second, a floor of legal protections for volunteers is essential to achieve a minimum level of uniformity among the states and facilitate multi-jurisdictional cooperation in emergency response. Third, the scope and breadth of state based volunteer registries must be expanded to ensure comprehensive and coordinated emergency response efforts among states. Fourth, laws must ensure balanced civil liability protections for VHPs and their host entities by creating responsible immunity protections and alternative mechanisms to compensate injured patients. Fifth, states are encouraged to enact laws and regulations providing for license portability during emergencies. Sixth, VHPs should be vested with workers' compensation protections for injuries, disabilities, or deaths experienced while carrying out their duties. Finally, state and federal laws should confer robust privacy protections on volunteer registries, implement fair information practices to allow VHPs and patients to access and verify registry data, and simultaneously ensure responsible access to and use of registry information to mount an effective response.

Institutional development and scale matching in disaster response management

Recent large scale disasters have challenged institutions improve the effectiveness of their emergency response strategies. During the 2005 Katrina flood disaster in the United States institutions utilized different emergency response strategies with varying degrees of success. In this paper we consider the case of the Katrina hurricane to identify successful strategies that enable institutions to respond effectively and at the appropriate scale. The importance of cross-scale linkages matched to the size and needs of the disaster is discussed as a central component of socio-ecological resilience. A general strategy of adaptive management is proposed that emphasizes the importance of participatory planning with institutional actors where both initial response organizations, as well as institutions involved in longer term recovery are involved in emergency response exercises. Institutions should develop linkages that promote legitimacy, trust and the development of social capital that facilitates integrated and coordinated emergency response. The paper concludes by noting that new threats will require increased coordination, higher levels of institutional flexibility, and greater attention to issues of connectivity in disaster response management.

3D finite-difference simulations of strong ground motions in the Yanhuai area, Beijing, China during the 1720 Shacheng earthquake ( Ms 7.0) using a stochastic finite-fault model

Three-dimensional finite-difference (3D-FD) simulations of earthquake wave propagations in the Yanhuai area were performed for the 1720 Shacheng earthquake ( M s 7.0) using a stochastic finite-fault model, running on a parallel supercomputer Hitachi-SR8000 ( http://www.lrz-muenchen.de). A stochastic finite-fault model was implemented into the 3D-FD program. The basic idea of the stochastic finite-fault model is that the fault plane can be subdivided into several subfaults (or elements, sources). Radiation from a large earthquake is the sum of contributions from all subfaults with proper time delays, each of which acts as a small independent double-couple point source. Heterogeneity of the fault rupture process was modeled by randomizing the location of initial rupture (hypocenter), slip vectors (slip, rake), and rise-times of subfaults in this study. A 3D velocity model of the Yanhuai area was constructed based on studies that analyzed available geological and geophysical information. A grid increment of 75 m in three directions was used in the 3D-FD simulation, which made it possible to capture the short period information with a resolution as low as 0.5 s in sediment regions. The uncertainties of simulated results caused by the stochastic finite-fault model were studied with a homogeneous 3D model. We found that the effects of the randomness of source on simulated ground motions are only limited in near-fault-region including the surface exposure of the fault and its vicinities, which occupies about 5% of the whole study area. This article presents an integrated approach for simulating the strong ground motions for engineering purpose using the 3D-FD method. Such simulations would be useful for hazard mapping, land using planning, insurance rate assessment, particularly in planning, preparedness, and coordinating emergency response, which must be based on realistic situations induced by concrete (historic or scenario) earthquakes.

Modelling and simulation of inter- and intra-organisational communication and coordination in emergency response

This paper presents the modelling and simulation of the organisational behaviour of emergency response in disasters, with the aim of using them for the design and assessment of emergency response systems. We identified and categorised various rules, protocols and procedures for emergency response through task analyses, observations and records of emergency exercises, in addition to interviews with emergency responders of various organisations. We assumed one organisation or group to be a single entity with a cognitive process and then constructed a normative model of emergency response with a conventional human model incorporating the input-decision-action cycle. Based on the model, we developed a multi-agent simulator of organisational behaviour in emergency response. We carried out test simulations using a scenario of actual emergency exercises and obtained some suggestions for the current emergency response system. This paper also discusses the possible applications of this simulation to various issues of disaster management, such as disaster education, training and exercises.

Large-Scale Coordination in Emergency Response

Coordination is a key element in emergency response. This paper focuses on coordination as it occurred in a county-level Emergency Operations Center (EOC) during a simulated tornado. The EOC is responsible for locating, purchasing, and transporting resources to the disaster scene(s). The EOC is an ad hoc team made up of government agencies, private companies (i.e., hospitals, utilities, etc.), and non-governmental agencies. These decision makers come together to engage in creative problem solving in order to solve often complex logistics and coordination problems generally under intense time pressure during a rapidly evolving situation. Lessons learned from this exercise highlight coordination challenges including asymmetric information flow, natural fault lines, roles and functions, co-location benefits, emergent leadership, fragmented situation awareness, information displays, room design, and quick reference tools.