Evacuation Procedures Research Articles

Retrospective analysis of the surgical management of spontaneous supratentorial intracerebral hemorrhage: A single-center study.

Background: Intracerebral hemorrhage (ICH) remains a devastating disease with high morbidity and mortality. The mortality rate ranges from 40% at 1 month to 54% at 1 year, and only 12%–39% achieve good outcomes and functional independence. The current management guidelines for spontaneous supratentorial ICH are still controversial.Objective: Patients who presented with ICH and underwent craniotomy with hematoma evacuation or minimal procedures from January 2016 to May 2020 were included in the analysis. Several clinical, radiological, and surgical variables were collected to identify the variables most likely related to lower mortality and better functional outcomes.Results: A total of 87 patients presented with HMC with ICH from January 2016 to May 2020.The mean age was 44.7 (42.2–47.2) years. There were 76 male (87.4%)/11 female (12.6%) patients, which reflect the population distribution in Qatar, which is mainly male predominant. Although Qatar is mainly a Middle-Eastern country, the ethnic distribution of patients was mainly of South Asian and Indian (60.9%) and Far-Eastern (20.7%) ethnicities because of diversity. The mean baseline Glasgow coma scale (GCS) was 8.2+/ − 3.7. The mean baseline functional independence measure (FIM) score was 59.4+/ − 36.7. Most hematomas were located in the basal ganglia (79.3%%). Baseline characteristics based on long-term outcomes are summarized in Table 1. The following variables were correlated with poor outcome: low GCS on postoperative day 1 (P = 0.06), low FIM score (P = 0.006), ICH location (P = 0.04), distance of the closest point to the surface (P = 0.009), and presence of uncal herniation (P = 0.04). The baseline characteristics based on mortality are outlined in Table 2. The following variables were correlated with mortality: diabetes mellitus (P = 0.02), baseline GCS (P = 0.04), GCS on postoperative day 1 (P = 0.002), unequal pupils (P = 0.05), and postoperative midline shift (P = 0.001).Conclusion: The preoperative clinical neurological status as well as mass effect (uncal herniation and midline shift) can be determinants of functional outcome and mortality. A deeper hematoma may result in poor functional outcome because of more surgical damage in functional brain tissues. Thus, the goal of surgery in spontaneous supratentorial ICH is to reduce mortality, but no evidence support that it can improve functional outcome. Although our findings are interesting, more prospective studies with a larger sample size are needed to confirm our results.

The implementation of routine procedural transvaginal sonography to decrease retained products of conception: a quality improvement initiative

BackgroundRetained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and reoperation. Use of procedural transvaginal sonography (TVUS) in the operating room has been proposed to help decrease retained POC.MethodsA retrospective review of all first trimester uterine evacuation procedures from 1/2015 to 2/2017 was performed, noting use of transabdominal ultrasonography, retained products of conception, and complications. A practice change was implemented in May 2018, in which routine intra-procedural TVUS use was initiated. A second retrospective chart review was conducted to assess for post-implementation incidence of retained POC, re-operation, and associated complications.ResultsPrior to intra-procedural TVUS implementation, 130 eligible procedures were performed during the specified timeframe, with 9/130 (6.9%) incidence of retained products of conception. TAUS was performed in 59/130 (45.4%) of procedures, and 4/9 (44.4%) of those with retained products. There were eight re-operative procedures in seven patients, and two patients were treated with misoprostol. Complications included hemorrhage, Asherman’s syndrome and endometritis. Following implementation, 95 first trimester procedures were performed with transvaginal sonography, with 0 (0%) cases of retained POC (p = 0.01), no incidences of re-operation (p = 0.02), and one case of Asherman’s syndrome. TVUS findings led to additional focused suction curettage in 20/95 (21.0%) of procedures. The endometrium was measured on procedure completion in 64 procedures, with a mean thickness of 5.5 mm (1–12 mm).ConclusionImplementation of routine TVUS during uterine evacuation may reduce the incidence of retained POC and associated reoperation rates. Further multi-center trials are needed to confirm this finding.

Comparison of the Initial Overseas Evacuation Operations Due to COVID-19: A Focus on Asian Countries

During the early stages of the COVID-19 pandemic in 2020, state governments all over the world were forced to respond to the crisis, prioritizing not only inbound activities but also their citizens abroad. Our study focused on the reasons for the differences in the evacuation operations, procedures, and outcomes in each country. This study focused on Asian countries/territories that experienced the pandemic earlier than other regions, to compare their prompt evacuation processes between January and May, 2020. Data on the evacuation missions and COVID-19 situation in each studied country/territory were collected. The evacuation operations were reviewed and analyzed using the Business Process Model and Notation to identify the differences that made some of the operations more effective. The insight can contribute to future adaptation and development to implement more effective operations during the emergency response to a pandemic.

Neuromonitoring During Cardiac Surgery in a Patient with Ventriculo-Caval Shunt Migration: Case Report

Abstract Ventricular shunting is a well-recognised and commonly practiced method of reducing increased intracranial pressure in patients with neurologic pathology. There are possible complications related to shunt implantation, where the rarest is intracardiac migration of the distal shunt catheter. We present a case where the distal catheter migrated into the right ventricle, causing extrasystoles and was complicated with acute right ventricle failure during the endovascular shunt evacuation procedure.

Identifying gaps in early warning mechanisms and evacuation procedures for tsunamis in Sri Lanka, with a special focus on the use of social media

PurposeThe current National Early Warning System for Sri Lanka (NEWS: SL) was established after the devastations of the Indian Ocean Tsunami in 2004. Although early warning (EW) systems and evacuation procedures are in place, several areas which need improvements have been emphasized in recent studies carried out in the country. Therefore, this paper aims to outline the gaps in existing EW and EP related to tsunami and other coastal hazards with a special focus on the use of social media for disaster communication based on age groups.Design/methodology/approachThis study has drawn on a review of past studies carried out by the same research team to identify the scope of the study. In addition to that, a conceptual framework was developed for the use of social media in the event of a disaster. Based on this conceptual framework, an online questionnaire was administered to identify the current status of the use of social media in Sri Lanka during a disaster situation. In total, 408 responses were collected and analyzed using the binary logistic regression method to evaluate the variation of different predictors associated with the use of social media for disaster communication.FindingsFindings of the study revealed that the use of social media for disaster communication depends on the previous experience of users and their age. The gender of users does not affect the use of social media for disaster communication. Therefore, the accuracy and timeliness of disaster information distributed via social media should be improved further to enhance the use of social media for disaster communication. Moreover, the findings have highlighted unaddressed issues in areas such as governance; communication of technical agencies; evacuation and shelters; and response of the community.Originality/valueThis paper has identified key areas that need attention in the process of enhancing the use of social media for disaster communication. More use of technological platforms such as social media for receiving disaster-related information can address issues such as bottlenecks in communication, poor awareness and lack of last-mile dissemination. Furthermore, this paper has proposed recommendations for addressing the identified gaps in the overall EW mechanisms and EP pertaining to tsunamis and other coastal hazards to enhance the coastal disaster resilience in Sri Lanka.

Evaluation of fire smoke control in underground space

The main goal of the fire management strategy is to avoid people interaction with fire hazards, therefore several studies are carried out for optimal escape route planning as well as smoke management and mechanical ventilation design. Underground spaces are a special case of study due to their technical characteristics that create different fire spread conditions compared to conventional buildings. In this paper, a comparative study on the fire smoke propagation is carried out taking into account the use and performance of smoke mitigation techniques. The Underground Hazardous Waste Management Repository of Lavrion Technological and Cultural Park in Greece, is selected as a case study to achieve the paper objectives. A Computer Fluid Dynamic software is used to simulate various fire scenarios based on the specific characteristics of the underground space. Parameters that have significant impact on evacuation procedure and human health such as visibility and carbon monoxide concentration are monitored. Finally, the results are presented and an evaluation method is proposed based on evacuation simulation results, in order to predict the impact of the smoke control design on the conditions inside the underground space. The results reveal that the ventilation shaft (passive system) offers an effective smoke control without any other combined control system and that the installation of smoke curtains, which are activated on time, offers significant improvement on smoke spread control extending the available egress time (ASET) in case of fire.

Experimental characterization of a novel ventilation system for multi-story buildings with continuous curtain walls

PurposeThe purpose of this paper is to present the results of an experimental campaign conducted on a recently developed fire protection system (FPS), specifically designed for installation on continuous glass curtain walls systems typical of multi-story buildings.Design/methodology/approachThe authors will first present the theoretical derivation of the relevant parameters to characterize and predict the fire evolution and probability of flashover, according to existing codes and standards. Then, the results of two full-scale tests will be presented in terms of temperature fields, thermal gradients and position of the neutral plane.FindingsThe experimental evidence shows how the proposed system is able to dramatically reduce internal temperatures in the rooms interested by the fire, also allowing for safer evacuation procedures by increasing the height of the neutral plane.Originality/valueThe novel window frame element comprises an automatic doubly convergent aperture system that induces ventilation in the compartment by increasing internal convection in the rooms subject to the fire. This allows for an efficient dispersion of hot gases and fumes and a drastic improvement in safety for both the occupants and firefighting operators. The theoretical results are then compared to the experimental evidence to evaluate the performance of the proposed ventilation system in the context of existing standards and design procedures.

Tsunami awareness and preparedness in Aotearoa New Zealand: The evolution of community understanding

After catastrophic events such as the 2004 Indian Ocean tsunami and the 2011 Great East Japan earthquake and tsunami there is a clear need for vulnerable countries like Aotearoa New Zealand to get prepared for tsunami. In the last ten years, the New Zealand government initiated major efforts to raise awareness of tsunami risk among coastal residents. This study explores tsunami awareness, preparedness, and evacuation intentions among residents of the East Coast of the North Island in a 2015 survey. The ten chosen locations also participated in a tsunami survey in 2003, with results demonstrating that tsunami awareness rose in the twelve years between the surveys. The 2015 survey also included questions on preparedness and intended action. Even though coastal residents know they live in a tsunami prone area, preparedness is relatively low and high expectations of a formal warning remain, even for a local source tsunami scenario. Furthermore, survey respondents had unrealistic ideas of evacuation procedures. When asked about their evacuation intentions, respondents intended to undertake a number of different actions before evacuating their homes, which could cause significant delays in the evacuation process. Most respondents were also reluctant to evacuate on foot and prefer using their vehicles instead, which could create dangerous traffic congestion. These surveyed intentions are consistent with a study of actual evacuation behaviours in the subsequent 2016 Kaikōura earthquake and tsunami, providing validation for the survey indicators. This paper identifies the procedures least understood by the public and offers some solutions to improve tsunami preparedness.

EFFECT OF PRECONDITIONS AND UNSAFE ACTS ON EVACUATION DURATION IN FIRE DISASTER CONDITIONS (STUDY AT THE INPATIENT BUILDING OF GENERAL HOSPITAL R. KOESMA TUBAN

ABSTRACTHospital fires have the potential to cause fatalities and huge material losses, there were 22 hospital fires covered by newspapers in India in 2011-2012 with 102 dead. Buildings are considered safe if all occupants building threatened by fire must be able to exit and assembly point before available safe egress time. This study aimed to analyze the effect of preconditions and unsafe acts (violations of evacuation procedures) on evacuation duration in fire disaster conditions in the inpatient building of general hospital R. Koesma Tuban. This study was an observational study, a quantitative method and cross sectional design, which were carried out in April-July 2019. Analysis of Covariance test results stated preconditions (age, sex, exercise habits, location of inpatient ward, distance traveled) affect the duration of evacuation (p <0.05) while preconditions (interaction between workers and readiness of workers) don’t affect the duration evacuation (p> 0.05). Violation of evacuation procedures has the potential to influence the duration of evacuation (p = 0.054). The conclusions this study are age, gender, exercise habits, location of the inpatient ward, and distance traveled affect the duration of the evacuation. Keywords: Duration of evacuation, preconditions, violations of evacuation procedures, hospital

ASSESSMENT OF EFFICACY OF ELECTRONIC VACUUM ASPIRATION WITH INTRAVENOUS ANALGESIA

Objective: To assess efficacy of elecrtonic vacuum aspiration in evacuation of retained product of conception with intravenous analgesia.
 Study Design: A prospective observational study.
 Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Jan to Jun 2018.
 Methodology: All patients who were intended to undergo Electronic Vacuum Aspiration due to retained products of conception, early fetal demise, septic induced abortions and molar (all upto 12 weeks of gestation) were enrolled in this study after obtaining informed consent. Outcome measures of study were efficacy (defined as completeness of the evacuation procedure confirmed by ultrasound), occurrence of complications like uterine perforation, excessive bleeding >200ml and sepsis (diagnosed clinically or biochemically).
 Results: A total of 1080 patients underwent Electronic Vacuum Aspiration during the study period. Complete evacuation was achieved in 1026 (95%) cases. Four (<1%) patients experienced post procedure infection while none had uterine perforation. Average blood loss was <100ml while 18 (1.6%) patients had blood loss of >200ml.
 Conclusion: Electronic vacuum aspiration is a safe and efficacious method of uterine evacuation. It does not require special equipment. It is easy to learn and is readily available as well as cost effective. Hence it’s a very lucrative alternative to manual vacuum aspiration using I pass or medical termination of pregnancy in resource poor settings.

Pedestrian flow in two dimensions: Optimal psychological stress leads to less evacuation time and decongestion.

Collective motion is an innate ability of all living systems, which depends on physiological and psychosocial factors in the case of humans. Such a collective organization is becoming of great interest in collective motion in human crowds. Using a cellular automaton (CA) simulation model, we demonstrate that emergency egress from a two-dimensional corridor with optimal stress leads to less evacuation time and efficient mass evacuations. We study how three types of stress (i.e., mild stress, optimal stress, and anxiety) described in the literature have a significant impact on the collective dynamics. We found that low-stress levels could decrease the evacuation time in an entire occupied room since agents choose alternative routes rather than the shortest path to the exit and display cooperative behavior. Therefore, the combination of mild and optimal stress can lead to efficient evacuations. Also CA simulations may be used to find safer and more efficient ways to conduct mass evacuation procedures.

Analyzing the Newest Interchange Connection at Cairo Metro Network Pertaining to Passenger Flow

The French standard governing occupanckes dedicated for gatherings of individuals and institutions receiving the public, including railway stations and tunnels was used in the design of Cairo’s transit network, which consists of three lines connected through three existing interchange connections and one that is currently under construction. There is a lack of studies quantifying passenger evacuation in relation to Cairo transit, especially with regard to the interchange connections. This study assessed the viability of the evacuation methods applied to the design of interchange connections in Egypt. The emergency evacuation procedures for the future interchange connection layout between Lines 1 and 3 were assessed using the French standard and NFPA 130 Standard for Fixed Guideway Transit and Passenger Rail Systems analytical methods. The analysis accounts for the traffic forecast as presented in the Egyptian company for operation and maintenance report for Line 1 and the feasibility study of Line 3. The results demonstrated that the connection was compliant with the French standard, but it did not fully meet NFPA requirements. It was concluded that there is still room for enhancement and for gaps to be considered. Recommendations include undertaking investigations into passenger characteristics and behavior in the context of passenger flow in emergency situations using approaches such as virtual research and field surveys, and simulation techniques.

Disaster Preparedness and Mitigation in Indonesia: A Narrative Review

Background:The tectonic activities at the meeting points of three large plates make Indonesia a high-risk disaster-prone area. Nevertheless, disaster risk reduction efforts in various regions of Indonesia are still lacking, in terms of both knowledge and the ability to analyze disaster risks. This study examines the implementation of disaster preparedness and mitigation in Indonesia.Methods:The method used in this study was narrative review. The authors collected the articles through searching for 3 data sources from 2016–2019 using Google Scholar, iSeek, and Microsoft Academic. Content analysis of all information to obtain the thematic phenomena of this study completed the methodological approach.Results:After applying the exclusion criteria and removing duplicates, six studies remained that focused on disaster mitigation in remote areas of Indonesia. Implementation of regulation and policy framework in disaster management is not yet optimal. Disaster preparedness and mitigation is characterized by the low utilization of technology and information related to the disaster, and various obstacles in the process of evacuation and transportation. Promoting local wisdom and enhancing it through integrating science can increase disaster resilience.Conclusion:The existence of a disaster-resilient village is very influential in community preparedness in dealing with disasters and other emergencies. This study provides some recommendations for disaster risk reduction: a) strengthening policies related to evacuation procedures in the health sector by local government, b) integrating transportation modes in remote areas, c) enhancing all parties with education and training, d) establishing community-based information systems; and e) strengthening the disaster resilience of villages.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

Virtual World as an Interactive Safety Training Platform

Virtual training platform allows interactive and engaging learning through practice without exposing trainees to hazards. In the recent pandemic (COVID-19) situation, online training is gaining importance as it allows learning with social distancing. This research study develops two online training modes—slide-based and virtual world—and assesses them on factors such as knowledge retention, engagement, and attention. Fire safety and emergency evacuation procedures were selected for online training development, focusing on a university community. A Lean Startup methodology was employed to develop training content for virtual and slide-based safety training (SBST). A virtual university building was developed with 15 learning objectives on fire safety. An empirical evaluation of the training modes was conducted with 143 participants. The results validated that a Virtual Safety World (VSW) can provide the same knowledge as SBST but can do so in a more engaging manner. Retention of concepts after a month was higher in VSW participants. The participants’ attention levels, measured by employing qEEG, showed that participants exhibited better-sustained attention while in VSW than in SBST mode. In addition, initial studies of the virtual training platform, designed to be adaptive to the user, are performed using deep learning and qEEG.

Successful emergency evacuation from a hospital within a 5-km radius of Fukushima Daiichi Nuclear Power Plant: the importance of cooperation with an external body.

ABSTRACTEmergency evacuation during a disaster may have serious health implications in vulnerable populations. After the accident at the Fukushima Daiichi Nuclear Power Plant (FDNPP) in March 2011, the Japanese central government immediately issued an evacuation order for residents living near the plant. There is limited information on the process of evacuation from medical institutions within the evacuation zone and the challenges faced. This study collected and analyzed publicly available resources related to the Futaba Kosei Hospital, located 3.9 km northwest of the FDNPP, and reviewed the hospital’s evacuation procedures. On the day of the accident at the FDNPP, 136 patients were admitted in the aforementioned hospital. The hospital’s director received information about the situation at the FDNPP from the local disaster task force and requested the immediate evacuation of all patients. Consequently, four patients, including those with an end-stage condition, died during the evacuation. Early intervention by external organizations, such as the Japan Self-Defense Forces, helped the hospital to complete the evacuation without facing major issues. However, despite such an efficient evacuation, the death of four patients suggests that a significant burden is placed on vulnerable people during emergency hospital evacuations. Those with compromised health experience a heavy burden during a nuclear disaster. It is necessary for hospitals located close to a nuclear power plant to develop a more detailed evacuation plan by determining the methods of communication with external organizations that could provide support during evacuation to minimize the burden on vulnerable patients.

Conjunctures: Who Counts, What Circulates, and the Politics of Children

Conjunctures: Who Counts, What Circulates, and the Politics of Children

Recommending assembly points, evacuation routes, and standard operating procedures for potential flooding due to reservoir dam failures: a case study of Gondang Reservoir, Lamongan, East Java

The failures of water-retaining structures, such as reservoirs and lakes, may cause massive flooding. Located in the Gondanglor village, Lamongan, East Java, the Gondang reservoir is approximately 30 years old. Currently, the village does not have an official evacuation Standard Operating Procedure (SOP), a guide needed during disaster emergency responses, including the risk of reservoir failures. The absence of the SOP means that the community members have not prepared themselves to face any hazard that threatens their safety. This research aims to recommend assembly points, evacuation routes, and Standard Operating Procedures (SOP) as inputs for the preparedness of reservoir dam failures. Criteria used to determine the assembly point locations are the minimum space per person, accessibility of private vehicles, access to safer places, either a street or open space, minimum distance from buildings, accessibility of disaster response vehicles, safe from falls, and other hazards. The evacuation routes consider road networks and conditions, movement directions, and distance between starting and assembly points. The evacuation SOP focuses on communication flows. Community members and Gondang reservoir’s officers are interviewed, and studies related to evacuation procedures are reviewed to help accomplish the research aim. This study has successfully recommended assembly points, evacuation routes, and SOPs for evacuating villagers when the potential of Gondang reservoir failures is identified. Community members and village officers of Gondanglor were involved in the designing of assembly points, evacuation routes, and the SOP. The study has suggested five assembly points and the shortest possible routes to reach the points from varying locations in the village. SOP suggested communication flows during varying emergency stages, including the “Abnormal” (Level 1), “Alert” (Level 2), “Alert” (Level 3), or “Warning” (Level 4) status. The results are expected to increase the preparedness level of village members to reservoir dam failures.

Utilizing Population Distribution Patterns for Disaster Vulnerability Assessment: Case of Foreign Residents in the Tokyo Metropolitan Area of Japan.

Foreign residents in Japan are amongst the vulnerable groups at risk to disasters in the country. Improvement is crucial in meeting Japan’s vison of zero casualties in major disaster events. If the case of the 2005 Hurricane Katrina is to offer an insight into migrants’ characteristics in mega-disaster situations, then a broader analysis of vulnerabilities is needed to avoid mass casualties should the anticipated megathrust earthquake occur. Hence, this study analyzes the vulnerabilities of foreign residents by utilizing their spatial distribution attributes in the Tokyo metropolitan area. This study uses multiple approaches that combine geographic information systems to analyze secondary and primary datasets. The results reveal that foreign nationals are spatially clustered in some parts of the metropolis, especially within a 7 km radius of Minato city. The densities in these areas alter the earthquake community vulnerability levels from 1.23% to 2.8% and from 5.42% to 13.46%, respectively. Although only 11% of foreign residents are prepared for any disaster, there is a high sense of interaction amongst them and Japanese nationals, which almost eliminates isolation within communities. This study therefore proposes the utilization of some of these attributes in mobilizing specifically targeted evacuation procedures, management of evacuation centers, and disaster risk information dissemination.

What Is the Knowledge of Evacuation Procedures in Road Tunnels? Survey Results of Users in Poland

This paper presents a preliminary assessment of road tunnel safety issues among respondents—specifically, real and potential users of road tunnels. We recruited a group of respondents to study their knowledge of evacuation procedures and awareness of safety issues in road tunnels. We conducted surveys with 504 participants, 12.7% of whom had previously participated in real-scale evacuation experiments in a road tunnel. Analysis of respondents’ answers reveals that their knowledge of safety procedures is unfortunately not sufficient. On average, the respondents selected the most recommended answer for approximately 5.35 out of 15 questions. Only 16% of respondents correctly answered more than 50% of the survey questions; moreover, no respondent provided the correct answers for 12 or more questions. Interestingly, most respondents were convinced that they had a better knowledge of road tunnel safety issues than was actually the case. The results of the survey demonstrate a significant educational role of evacuation exercises. Individuals who have participated in an evacuation have better knowledge, allowing them to apply the correct rules of road tunnel safety procedures. Various aspects addressed in this paper can be taken into consideration in an information campaign regarding safety in road tunnels during a fire.