Evacuation Recommendations Research Articles

Data-driven modeling of downwind toxic gas dispersion in lithium-ion battery failures using computational fluid dynamics

Understanding the toxicity hazard associated with lithium-ion battery systems (electric vehicles, e-mobility devices, energy storage systems, etc.) is critical due to their increasing prevalence in densely populated areas. In this work, a meta-analysis of literature data on the main toxic gas species emitted by lithium-ion batteries was conducted. The aggregated data were used as inputs to computational fluid dynamics simulations to characterize the universe of potential toxic gas concentration profiles. These simulations were run for various ambient conditions and battery characteristics. Results are reported in terms of estimated minimum safety distances based on immediately dangerous to life or health (IDLH) values, which could help inform decisions regarding effective firefighting and evacuation recommendations. A sensitivity analysis was also run to identify the key factors that influence safety distances as well as the combination of factors that led to the largest and shortest safety distances. Additionally, using toxicity data from the literature, the downwind toxicity of an internal combustion engine vehicle fire was compared to that of an electric vehicle fire. A relatively simple simulation setup was used for all simulations to make the results as general as possible.

P-530 Which evacuation method for missed abortion is preferred by women with recurrent pregnancy loss?

Abstract Study question Is medical or surgical evacuation for missed abortion (MA) preferred by women with recurrent pregnancy loss (RPL)? Which factors are determining for the women’s preference? Summary answer Sixty-seven percent of the participants preferred surgical evacuation. Side effects and a history of unsuccessful medical evacuation in their first MA were determining factors. What is known already Guidelines currently recommend medical rather than surgical evacuation after MA. The success rates defined as adequate evacuation of the uterine cavity after MA without further intervention are reported to be 80% and 97% for medical and surgical evacuation, respectively. Medical evacuation is associated with heavier and longer duration of bleeding and higher intensity of pain. Surgical evacuation increases the risk of uterine perforation and Asherman’s syndrome. Studies have found that women are more satisfied and have better subsequent mental health when they can decide themselves which method they would choose. Study design, size, duration An online questionnaire was sent October 5th, 2022, to 157 RPL patients who had experienced both medical and surgical evacuation for MA admitted to a center for RPL between January 2016 and September 2022. Eighty-seven (55.4%) patients completed the survey before deadline after being sent reminders. Sixty (69%) of the women had received a medical evacuation and 27 (31%) surgical evacuation for their first MA. Participants/materials, setting, methods The mean age of the respondents was 37 years (SD ± 0.5) and they had had at least three pregnancy losses. The questionnaire featured questions regarding the women’s experiences with medical and surgical evacuation, preferred evacuation method if they would have another MA, and determining factors for their preference. Categorical variables were compared using χ2 test and Wilcoxon Signed Rank Test. Analyses were conducted to determine associations between potential determining factors for preferred evacuation method. Main results and the role of chance A significantly higher intensity of pain was experienced, and analgesics were required for a significantly longer period after a first medical evacuation compared to a first surgical evacuation (p < 0.001 and p = 0.006). Bleeding, pain, sick leave, and mental discomfort had a significant impact on the choice of another evacuation method at the time of next MA in women who experienced a medical abortion first. As many as 40% had experienced failure of the first medical evacuation with need for subsequent surgical evacuation for complete evacuation; this was confirmed by consulting the patient’s medical records. The odds ratio (OR) for preferring medical evacuation at next MA was 3.3 if the women had given birth before (p = 0.011). The OR for preferring medical evacuation at next MA was 0.3, if the women had received medical evacuation for their first MA (p = 0.015). There were no statistically significant associations between preferring medical evacuation and the following factors: BMI, age at first evacuation and menstrual pain. Two thirds (66.7%) of the women would prefer surgical evacuation for their next MA, while the remaining women (33.3%) would prefer medical evacuation. Limitations, reasons for caution The response rate of 55.4% was lower than expected 70% which implicates a risk of sampling bias such as a predominance of patients with a history of complicated evacuations responding to the questionnaire. Due to the retrospective design, recollection bias could also impact the results. Wider implications of the findings In this study population, medical evacuation was associated with a stronger experience of side effects and a higher failure rate than expected, which may explain why more women preferred surgical evacuation for their next MA. This may suggest current evacuation recommendations for MAs should become more individualized than currently. Trial registration number Not applicable

The Associations between Evacuation Movements and Children's Physiological Demands Analyzed via Wearable-Based Sensors.

During fire evacuations, crawling is recommended to prevent harm from toxic smoke and to access more breathable air. Few studies have evaluated the physiological burden of crawling, especially for children. The method of using wearable sensors to collect data (e.g., electrodermal activity, EDA; skin temperature, SKT) was used to evaluate the effects of different locomotive postures on children's velocity and physiological demands. Twenty-eight (28) children (13 boys and 15 girls), aged 4 to 6 years old, traveled up to 22.0 m in different postures: Upright walking (UW), stoop walking (SW), knee and hand crawling (KHC). The results showed that: (1) Gender and age had significant impacts on children's velocity (p < 0.05): Boys were always faster than girls in any of the three postures and the older the child, the faster the velocity for KHC. (2) Physiological results demonstrated that KHC was more physically demanding than bipedal walking, represented by higher scores of the EDA and SKT indicators, similar to the findings of adults. (3) Gender and age had significant impacts on children's physiological demands (p < 0.05). The physiological demands were greater for boys than girls. In addition, the higher the age, the less physiological demands he/she needs. Overall, the findings suggest that children are unnecessarily required to choose crawling precisely as adults as the best posture to respond to emergency scenarios. In a severe fire, stoop walking is suggested, as there is more respired air and children could move quickly and avoid overworking physiological burdens. The results of this study are expected to be considered in the evaluation of current evacuation recommendations and for the safety guide of preparedness to improve the effectiveness of risk reduction for children.

Accident Simulation Study for Nuclear Power Plants Impacting Louisiana: Differences in 2017 vs. 1992 Protective Action Guidelines.

Louisiana has aligned its radiological emergency program with the 2017 US Environmental Protection Agency Protective Action Guides Manual but has added a child thyroid dose evacuation threshold in lieu of distributing potassium iodide to the public. The nuclear power plants will continue to align with the 1992 manual for the foreseeable future, which could lead to possible accident scenarios in which state recommendations would differ from those of the utility. The objective of this study is to predict what accident and weather conditions will lead to a differing set of recommendations. This study performs a representative set of simulations of potential nuclear power plant accidents using a combination of the RASCAL software package, provided by the Nuclear Regulatory Commission, and a Software system used by Entergy combining an older RASCAL dose modeling methodology with plant-specific input. Four preliminary results of this study are presented: a spent fuel fire where differences in whole body dose lead to very different evacuations, a loss of coolant accident in which the child thyroid dose is the determining factor, a core melt accident using stack monitors to locate the evacuation threshold point, and a spiked coolant accident that could lead to an evacuation order before the plant declares a General Emergency. Weather plays as great a role as accident conditions in determining whether the evacuation recommendations differ. The completed results of this study can provide guidance to states as they evaluate the transition to the 2017 guidelines.

Wildfire preparedness and response during the 2016 Arouca wildfires in rural Portugal

This study examined how residents living in rural Portugal were prepared for and took action to protect themselves and their property before and during the 2016 large Arouca wildfires. Interviews were completed with 30 residents living in small rural parishes affected by the wildfires. Qualitative research findings show that interview participants were aware of the high wildfire risk in the area but had different views about the source of risk and the immediate threat posed to their own property. During the wildfires, many participants reported taking last-minute preparatory actions such as having water, hoses, water pumps and sprinklers available. We found few differences in the preparatory roles carried out by women and men. Despite official evacuation recommendations, most participants stayed behind to protect their property. Participants’ decisions to stay behind were affected by a feeling of confidence due to local knowledge and past experience, lack of trust in fire management agencies, and emotional attachment to their home and village. Participants were helped by family and village members, and in turn helped others during the wildfires. Recommendations for wildfire and emergency managers are discussed.

PSYCHOLOGICAL COMPETENCE OF MILITARY LEADERS IN COMBAT CONDITIONS

The article examines military leaders’ psychological competence in combat. The peculiarities of psychological support for military-professional activities are determined. The psychological support of combat activities includes: mobile groups for psychological support and rehabilitation, educational work (psychological education), debriefings, mini-trainings, interactive communication in recreation camps, identification of service members affected by stress factors and timely first psychological aid, detection of service members with deviant behavior to send them for an extraordinary examination by psychiatrists, recommendations for evacuation from the zones of extreme (combat) conditions. To ensure psychological services for service members, organizational and legal efforts should be applied, but methodological support is also important, in particular available hardware, writing, computerized methods (questionnaires, tests, etc.) and various techniques, first of all - trainings, helping to solve professional and psychological problems. Depending on the tasks of psychological counseling, there are several psychological regulatory programs: trainings for self-regulation, targeted program relieving mental stress or fatigue, mobilizing the body’s reserve capabilities, general health program to normalize service members’ states and recover their body. Service members’ professional competence is considered by scientists as an integral characteristic that determines their ability to solve professional problems and fulfill typical professional tasks that arise in real professional situations, using knowledge, professional and life experience, values ​​and inclinations. Combat mission efficiency is determined by a person’s intellectual and physical capabilities, as well as their responsibility, independence, emotional and volitional hardiness, flexibility, ability to make decisions and interact with other military members under stress.

Changing Logistics of Evacuation Transportation in Hazardous Settings during COVID-19

The logistics of public-sponsored evacuation include transportation assets, personnel, and infrastructure. Effective orchestration leading up to a severe weather event is a complex undertaking requiring capacity that is matched to needs. However, under the compound hurricane-pandemic scenario, the demands for evacuation assistance and the capacity to meet demands change. Pre-event planning must be adjusted and transit modified to reduce risks posed to evacuees and essential workers. This study explores how visualizations of redistributed vulnerability and transportation resources influence planning. The research identifies how transportation, emergency management, and public health officials are adapting hurricane evacuation resources during the COVID-19 pandemic using original data from compound hazard workshops and participatory stakeholder focus groups. Findings show that by the peak of hurricane season, local evacuation recommendations were favored by officials, contracts were in place for noncongregate options, and public resources were adjusted to account for those requiring congregate sheltering. A need remained for coordinating interjurisdictional information about real-time weather, resources, staffing, and traffic as well as local knowledge of roadway flooding with ongoing hazard planning.

Evacuation after a nuclear accident: Critical reviews of past nuclear accidents and proposal for future planning

Standards and guidelines for preparedness and response in the case of a nuclear accident cover radiation protection, health management and communication with affected populations. Decision makers use these recommendations to decide on measures that protect people residing around a nuclear power plant that suffers an accident from radiation exposure; for example, sheltering, evacuation and relocation. While technological and radiological criteria exist for these protective measures, studies on past radiological and nuclear emergencies have shown that evacuation and relocation result in serious health effects; this needs to be considered in accident preparedness and responses in the future. Within the framework of the Nuclear Emergency Situations Improvement of Medical and Health Surveillance (SHAMISEN) (Ohba et al., 2020), a critical review of recommendations and experiences of previous major nuclear accidents was conducted, and the current paper focuses on the lessons learned about evacuation and relocation. We reviewed the contents of official documents and literature relating to the evacuation and relocation of residents, and to the evacuation of medical and other facilities in the three largest nuclear accidents to date: the Three Mile Island accident, Chernobyl accident, and Fukushima accident. We developed recommendations classified into the preparedness phase, early and intermediate phases, and recovery phase after an accident. In the cases of Three Mile Island and Fukushima, the evacuation area was set at 8–10 km from the nuclear power plant in the disaster prevention plan, and emergency responses, such as information provision and evacuation, had been developed only in this area. When the Fukushima accident occurred, evacuation beyond this area was urgently planned or instructed, resulting in marked confusion, such as forced multiple evacuations and relocations for long periods. Furthermore, information was lacking, and personal protective measures such as respiratory protection and iodine prophylaxis were not applied to evacuees. In hospital and facility evacuation, it became more difficult to implement evacuation owing to a lack of advance planning and support in the event of the accident. In Fukushima, more than 60 people in hospitals and nursing care facilities died during or soon after evacuation. In long-term relocation, in addition to continuing adverse mental effects, there were health effects relating to relocation, such as lifestyle-related disease. The return of residents to the evacuation area required many issues, such as a delayed recovery of the living environment, to be overcome in addition to measures to reduce the effects of radiation. Recommendations for evacuation in the SHAMISEN framework were developed (SHAMISEN Consortium, 2017; Liutsko et al., 2020) from these lessons of previous accidents.

Modeling and predicting evacuation flows during hurricane Irma

Evacuations are a common practice to mitigate the potential risks and damages made by natural disasters. However, without proper coordination and management, evacuations can be inefficient and cause negative impact. Local governments and organizations need to have a better understanding of how the population responds to disasters and evacuation recommendations so as to enhance their disaster management processes. Previous studies mostly examine responses to evacuations at the individual or household level by using survey methods. However, population flows during disasters are not just the aggregation of individuals’ decisions, but a result of complex interactions with other individuals and the environment. We propose a method to model evacuation flows and reveal the patterns of evacuation flows at different spatial scales. Specifically, we gathered large-scale geotagged tweets during Hurricane Irma to conduct an empirical study. First, we present a method to characterize evacuation flows at different geographic scales: the state level, considering evacuation flows across southern states affected by Irma; the urban/rural area level, and the county level. Then we demonstrate results on the predictability of evacuation flows in the most affected state, Florida, by using the following environmental factors: the destructive force of the hurricane, the socioeconomic context, and the evacuation policy issued for counties. Feature analyses show that distance is a dominant predictive factor with counties that are geographically closer generally having larger evacuation flows. Socioeconomic levels are positively related to evacuation flows, with popular destinations associated to higher socioeconomic levels. The results presented in this paper can help decision makers to better understand population evacuation behaviors given certain environmental features, which in turn will aid in the design of efficient and informed preparedness and response strategies.

Characterizing posture and associated physiological demand during evacuation

Crawling is recommended for accessing breathable air and avoiding gases during severe fire evacuations. Few studies have evaluated the physiological burden associated with crawling, but those that have agree that crawling places high physiological demands on the body. Furthermore, with the exception of walking upright, the effect of locomotion modalities on the speed of evacuation is sparsely researched. This study evaluated distance, velocity, and the physiological costs of evacuating using different locomotion methods. Twenty-four (24) college students (12 M/12F) traveled up to 91.44 m (m) in different postures: Upright Walking (UW), Stoop-Walking (SW), Foot and Hand Crawling (FHC), Knee and Hand Crawling (KHC), and Low Crawling (LC). Crawling velocities were significantly slower than bipedal velocities (p < 0.05). Of the three crawling postures, FHC was faster (p < 0.05) than both KHC and LC. Average velocities for FHC, KHC, and LC were 1.20, 0.84, and 0.77 m/s (m/s), respectively. Velocities in all crawling postures decreased substantially after the first 9.14 m of travel. The average maximum crawling distance measured in this study was<76.2 m. Physiological results demonstrated that crawling was more physically demanding than walking, represented by higher heart rates (HR), rates of oxygen consumption (VO2), ventilation rates (VE), and respiratory exchange ratios (RERs). Crawling was perceived by subjects to be much more difficult than walking, with many subjects unable to complete the 91.44 m course. Results of this study should be considered in the evaluation of current evacuation recommendations and in the design of future evacuation routes.

Surgical plume and its implications: A review of the risk and barriers to a safe work place

Every year thousands of health care professionals worldwide are exposed to surgical smoke. There is evidence that this smoke consists of toxic gases, pathogens and particulate matter that is a hazard for patients and the perioperative team. Past research indicates that perioperative staff inconsistently comply with smoke evacuation recommendations. The aim of this study was to identify, review and discuss the issues related to surgical plume and its implications for patients and perioperative staff. The findings of this review relate to: surgical smoke content, its risks to the health of the perioperative staff, preventative measures, infection control measures, compliance with smoke evacuation systems, staff knowledge and barriers to implementing smoke evacuation practices. Of particular importance, the literature indicated that strong support from management and the implementation of regular staff education could improve practice for the management of surgical plume in the operating theatre.

Perceptions, behavioral expectations, and implementation timing for response actions in a hurricane emergency

This study examined the perceived attributes, behavioral expectations, and expected implementation timing of 11 organizational emergency response actions for hurricane emergencies. The perceived attributes of the hurricane response actions were characterized by two hazard-related attributes (effectiveness for person protection and property protection) and five resource-related attributes (financial costs, required knowledge/skill, required equipment, required time/effort, and required cooperation). A total of 155 introductory psychology students responded to a hypothetical scenario involving an approaching Category 4 hurricane. The data collected in this study explain previous findings of untimely protective action decision making. Specifically, these data reveal distinctly different patterns for the expected implementation of preparatory actions and evacuation recommendations. Participants used the hazard-related and resource-related attributes to differentiate among the response actions and the expected timing of implementation. Moreover, participants’ behavioral expectations and expected implementation timing for the response actions were most strongly correlated with those actions’ effectiveness for person protection. Finally, participants reported evacuation implementation times that were consistent with a phased evacuation strategy in which risk areas are evacuated in order of their proximity to the coast. However, the late initiation of evacuation in risk areas closest to the coast could lead to very late evacuation of risk areas farther inland.

Information Search and Decision Making in Computer-Based Wildfire Simulations

Decision making in complex environments has been investigated in many domains, including medicine, aviation, business, and police operations. However, how incident commanders (ICs) make protective-action recommendations (PARs) to populations exposed to wildfire risks is underinvestigated. In this study we examined the effect of expertise on IC non-time-limited information search and decision making and how ICs update information during the evolution of complex, computer-simulated wildfire scenarios. The results indicate that higher expertise reduces the overall amount of information being searched for, without affecting the quality of PAR decisions. In addition, a statistical trend suggests that information updating during the progression of the scenario involves disproportionate less-static information versus dynamic information. Finally, ICs demonstrated a strong preference for evacuation recommendations over alternative recommendations, even when an evacuation may result in less optimal outcomes.

Wildland firefighter entrapment avoidance: modelling evacuation triggers

Wildland firefighters are often called on to make tactical decisions under stressful conditions in order to suppress a fire. These decisions can be hindered by human factors such as insufficient knowledge of surroundings and conditions, lack of experience, overextension of resources or loss of situational awareness. One potential tool for assisting fire managers in situations where human factors can hinder decision-making is the Wildland–Urban Interface Evacuation (WUIVAC) model, which models fire minimum travel times to create geographic trigger buffers for evacuation recommendations. Utilising multiple combinations of escape routes and fire environment inputs based on the 2007 Zaca fire in California, USA, we created trigger buffers for firefighter evacuations on foot, by engine and by heavy mechanised equipment (i.e. bulldozer). Our primary objective was to examine trigger buffer sensitivity to evacuation mode and expected weather and fuel conditions. Evacuation travel time was the most important factor for determining the size and extent of modelled trigger buffers. For the examined scenarios, we show that WUIVAC can provide analytically driven, physically based triggers that can assist in entrapment avoidance and ultimately contribute to firefighter safety.

The United States Army Ocular Teleconsultation program 2004 through 2009

To describe the United States Army Ocular Teleconsultation program and all consultations received from its inception in July 2004 through December 2009. Retrospective, noncomparative, consecutive case series. All 301 consecutive ocular teleconsultations received were reviewed. The main outcome measures were differential diagnosis, evacuation recommendations, and origination of consultation. Secondary measures included patient demographics, reason for consultation, and inclusion of clinical images. The average response time was 5 hours and 41 minutes. Most consultations originated from Iraq (58.8%) and Afghanistan (18.6%). Patient care-related requests accounted for 94.7% of consultations; nonphysicians submitted 26.3% of consultations. Most patients (220/285; 77.2%) were United States military personnel; the remainder included local nationals and coalition forces. Children accounted for 23 consultations (8.1%). Anterior segment disease represented the largest grouping of cases (129/285; 45.3%); oculoplastic problems represented nearly one quarter (68/285; 23.9%). Evacuation was recommended in 123 (43.2%) of 285 cases and in 21 (58.3%) of 36 cases associated with trauma. Photographs were included in 38.2%, and use was highest for pediatric and strabismus (83.3%) and oculoplastic (67.6%) consultations. Consultants facilitated evacuation in 87 (70.7%) of 123 consultations where evacuation was recommended and avoided unnecessary evacuations in 28 (17.3%) of 162 consultations. This teleconsultation program has brought valuable tertiary level support to deployed providers, thereby helping to facilitate appropriate and timely referrals, and in some cases avoiding unnecessary evacuation. Advances in remote diagnostic and imaging technology could further enhance consultant support to distant providers and their patients.

Compliance With Surgical Smoke Evacuation Guidelines: Implications for Practice

Surgical smoke presents a serious health hazard, but perioperative nurses' compliance with smoke evacuation recommendations is not consistent. I investigated key indicators for compliance with electrosurgical smoke evacuation recommendations based on nurses' individual innovativeness characteristics, perceptions of the attributes of smoke evacuation recommendations, and organizational innovativeness characteristics. The study findings provide implications for improving nurses' compliance with smoke evacuation recommendations. Individual innovativeness characteristics, including nurses' knowledge and training, were most strongly linked to smoke evacuation compliance. The key indicators that promote surgical smoke evacuation can provide direction to guide the content of education programs and help identify the personnel and settings that are most in need of this information. Barriers to compliance included lack of equipment, physician resistance, noise, and staff member complacency. Vendor demonstrations on the ease of smoke evacuation device use can show nurses that smoke evacuation is compatible with nursing practice. Facility leaders should provide smoke evacuation policies that are easy to understand and should enforce these policies.

Surgical Smoke Evacuation Guidelines: Compliance Among Perioperative Nurses

More than 500,000 health care workers are exposed to surgical smoke every year. Toxic gases create an offensive odor, small particulate matter causes respiratory complications, and pathogens may be transmitted in the surgical smoke to the surgical team. Previous research notes that perioperative nurses do not consistently follow smoke evacuation recommendations. The purpose of this study was to determine key indicators that are associated with compliance with smoke evacuation recommendations. Data from a web-based survey completed by 777 nurse members of AORN were analyzed to examine the relationship between the key indicators and compliance with smoke evacuation recommendations. Major findings were that specific key indicators influencing compliance include increased knowledge and training, positive perceptions about the complexity of the recommendations, and increased specialization, interconnectedness, and leadership support in larger facilities. Education programs can be developed that directly address these key predictors so that a surgical environment free from surgical smoke is promoted.

PLANNING FOR THE WORST IN WASHINGTON STATE: INITIAL RESPONSE PLANNING FOR IMPROVISED NUCLEAR DEVICE EXPLOSIONS

Since 11 September 2001, improvised nuclear devices have become recognized as an important radiological threat requiring emergency response planning. Although Protective Action Guidance is well established for fixed nuclear facilities, correspondingly well-developed guidance does not exist for nuclear explosions. The Washington State Department of Health has developed preplanned Protective Action Recommendations for improvised nuclear device explosions. These recommendations recognize the need for advice to the public soon after such an event, before significant data are available. They can be used before significant outside support is available locally, and reference observable effects so people can use them if communications were disabled. The recommendations focus on early actions (24-48 h) and place priority on actions to avoid deterministic health effects due to residual fallout. Specific emphasis is placed on determining recommendations for evacuation, as well as the extent of the area for sheltering. The key recommendations developed for an initial public response are: (1) if there is ready access to robust shelter such as an underground basement or interior spaces in a multi-story structure, immediate sheltering in these areas is the best action, regardless of location; (2) if robust shelter is not available, and if fallout is observed in the area, then evacuation is the best general recommendation for locations within 16 km (10 miles) of the explosion; and (3) beyond 16 km (10 miles), the generally recommended protective action is to shelter in the best-protected location which is readily available.

Natural course of large spontaneous pneumothorax

A large pneumothorax was detected on chest x-ray film in a 41-year-old woman. She declined recommendations for evacuation of the air trapped in her right chest. The condition spontaneously resolved during 3 months after being detected.