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DECISION MAKING AND SPECIAL POPULATIONS IN PUBLIC HEALTH DISASTERS

DECISION MAKING AND SPECIAL POPULATIONS IN PUBLIC HEALTH DISASTERS. Joseph J. Contiguglia MD MPH&TM MBA Clinical Professor of Public Health Tulane University SPH&TM. FEMA EMI HIGHER EDUCATION CONFERENCE, JUNE 2012. DISASTER. OVERVIEW LESSONS FROM THE FIELD. Introduction

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DECISION MAKING AND SPECIAL POPULATIONS IN PUBLIC HEALTH DISASTERS

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  1. DECISION MAKING AND SPECIAL POPULATIONS IN PUBLIC HEALTH DISASTERS Joseph J. Contiguglia MD MPH&TM MBA Clinical Professor of Public Health Tulane University SPH&TM FEMA EMI HIGHER EDUCATION CONFERENCE, JUNE 2012

  2. DISASTER

  3. OVERVIEWLESSONS FROM THE FIELD • Introduction • Its Not Your Father’s Planet • Needs of the Population at Risk • Enabling the Population at Large • Morale of the Team • Extend the Routine

  4. OVERVIEWLESSONS FROM THE FIELD Plan for the Worst Time is of the Essence Shelter & Evacuation You Can’t Always Get What You Want Plans are Nothing, Planning is Everything Communications

  5. LESSON 1ITS NOT YOUR FATHER’S PLANET ANY MORE Population Growth Urbanization Life Expectancy Special Needs Populations Water Food Disaster Frequency Conflict

  6. GLOBAL POPULATION GROWTH • Urban • 1800 – 3% • 2000 – 47% • Overall • Today – 6.8 B • 2040 – 9B http://www.census.gov/

  7. GLOBAL POPULATION GROWTH: URBANIZATION http://www.census.gov/

  8. GLOBAL POPULATION GROWTH: DENSITY http://www.census.gov/

  9. LIFE EXPECTANCY • US Today 1950 1900 • Male 75.6 65.5 47.9 • Female 80.8 71.0 51.7 U.S. BUREAU OF THE CENSUS

  10. SPECIAL NEEDS • Age • Disability • Medical • Acute Injury • Psychological • Culture & Lifestyle

  11. WATER • Hierarchy of needs • WHO • 78 percent of the population in less developed countries is without clean water • 85 percent without adequate fecal waste disposal CHOLERA, 1883 THE UNWELCOME VISITOR

  12. WORLD HUNGER • Poverty • Economic Systems • Conflict • Climate • But the world produces enough food • 2720 kcal/person/day UNITED NATIONS FOOD AND AGRICULTURE ORGANIZATION OCT 14, 2009

  13. DISASTER TRENDS • The number of people affected by disasters is rising. • Disasters are becoming less deadly. • Disasters are becoming more costly. • Poor countries are disproportionately affected by disaster consequences. • The number of disasters is increasing each year. COPPOLA, DAMON P., “INTRODUCTION TO INTERNATIONAL DISASTER MANAGEMENT 2ND ED., 2011

  14. AFFLICTED PER 100,000

  15. VICTIMS BY INCOME CLASS

  16. RICH COUNTRIES • Suffer higher economic losses, but have mechanisms to absorb costs • Transfer risk to insurance and reinsurance providers • Reduce loss of life, using early warning systems, enforced building codes, and zoning • Have immediate emergency and medical care that increases survivability and contains the spread of disease COPPOLA, DAMON P., “INTRODUCTION TO INTERNATIONAL DISASTER MANAGEMENT 2ND ED., 2011

  17. POOR COUNTRIES • Less at risk in terms of financial value • Little buffer to absorb financial impacts • Economic reverberations significant • Social development suffers • Lack resources to adopt advanced technologies • Little ability to enforce building codes and zoning • Generally do not participate in insurance mechanisms. • Divert funds from development programs to emergency relief and recovery COPPOLA, DAMON P., “INTRODUCTION TO INTERNATIONAL DISASTER MANAGEMENT 2ND ED., 2011

  18. LESSON 2 OPERATIONAL FOCUS MUST BE THE NEEDS OF THE POPULATION

  19. HEIRARCHY OF NEEDS KIBEHO REFUGEE CAMP, RUWANDA, 1994 • Safety • Water • Food • Shelter/heat • Clothing • Medical Care • Employment JTF SAFE HAVEN PANAMA 1995

  20. HEIRARCHY OF NEEDS • Companionship • Family envmt. • Stability • Social status & advancement • Child development • Care of elders • Mid & long term plans SCHOOL ART KOSOVO MEETING HUT, EMPIRE RANGE, JTF SAFE HAVEN

  21. LESSON 3COMPLIANCE REQUIRES ENABLING THE POPULATION AT LARGE

  22. LESSON 4VITALSTRATEGIC GOAL IS THE MORALE OF TEAM MEMBERS

  23. 9/11 FIRST RESPONDER ISSUES • Clearer delineation of roles and responsibilities • Better clarity in the chain of command • Radio communications protocols and procedures that optimize information flow Source: McKinsey & Company, 2002.

  24. 9/11 FIRST RESPONDER ISSUES • More effective mobilization of members • More efficient provisioning and distribution of emergency and donated equipment • A comprehensive disaster response plan, with a significant counterterrorism component. Source: McKinsey & Company, 2002.

  25. TRAINING NEEDS • The “all hazards” model • The concepts of prevention, preparedness, response, and recovery • The roles of public health, public safety, and public works • NIMS and incident command • WMDs (sources, agents, environmental distribution, exposure, health effects)

  26. TRAINING NEEDS • Surveillance, population and environmental monitoring • Psychosocial, mental health, risk • Communication issues • Medical countermeasures • Mass casualty handling, including dead bodies • Forensic epidemiology • Evaluation

  27. PRACTITIONER MINDSET IN DISASTER • Crosswalk needed • Clinical Paradigm • One Patient at a time • Another job well done • Spare no expense • Rescue paradigm • Life before limb • Greatest good for the greatest number • Allocate limited resources • The Expectant patient

  28. PSYCHOLOGICAL INJURY • Stress of dealing with casualties • Fatigue • Overworked • Understaffed • Sleep deprivation

  29. PSYCHOLOGICAL INJURY PREVENTION FUKUSHIMA JAPAN, 2011 • Training • Realistic • Accurate threat information • Comprehensible • Related to personal welfare • Leadership • Communication • Unit cohesion • Morale & welfare WWII SUBMARINE CREW

  30. PSYCHOLOGICAL INJURY TREATMENT • Expect large numbers of casualties • Treatment principles • Proximity • Immediacy • Expectancy SOLDIERS RESTING ON OMAHA BEACH WAR PSYCHIATRY, ZAJTCHUK

  31. LESSON 5DISASTER OPERATIONS SHOULD BE AN EXTENSION OF ROUTINE PRACTICES

  32. LESSON 6DESIGN FOR THE WORST CASE SCENARIO

  33. EXPECTING THE UNEXPECTED

  34. THINKING THE UNTHINKABLE

  35. DOING THE UNDOABLE http://adeolaadesina.blogspot.com/2010/10/thinking-unthinkable-daring-undarable.html

  36. FOR THIS JURISDICTION

  37. FOR THESE PERILS

  38. ACTION PHASESREADINESS • 1. Prevention • Shape the Battlefield • 2. Preparation • CONOPS, Assets & Infrastructure • 3. Surveillance • Scope, Sensitivity, Reliability, Security & Cycle Time • 4. Identification • Specificity, Confidence, Immediacy

  39. PREVENTION • What is the difference between PREVENTION and PREPARATION?

  40. PREVENTION • What is the difference between PREVENTION and PREPARATION? • A. PREVENTION focuses on building a resistant and resilient environment • B. PREPARATION focuses on developing the capability for a coordinated, timely & effective response

  41. ACTION PHASESEXECUTION • 5. Notification • Timely, Robust, Orderly, Functional • 6. Marshalling • “Firstest with the Mostest” • 7. Early Response • Effective, Professional, Orderly

  42. ACTION PHASESEXECUTION • 8. Full Response • Big as it needs to be to minimize casualties • Delicate as a battleship • 9. Mop Up • Thorough, Quick, Disciplined

  43. ACTION PHASESRECOVERY • 10. Clean Up • Hierarchy of needs • 11. Reconstitution • Ready to go again • 12. Convalescence/Healing • Return of functions

  44. ACTION PHASESRECOVERY • 13. Rebuilding • For the future not the past • 14. Prevention • Shape the Battlefield

  45. OPERATIONAL COMPONENTS • Concepts of operations (CONOPS) • Effective, practical, authorized & robust • Incorporated in law, plans & regulation • Personnel • Adequate numbers for initial & sustained operations • Trained in appropriate skills • Authorized for time/duty required

  46. OPERATIONAL COMPONENTS • Equipment • Available, familiar & ready • Infrastructure • Time phased logistics • Communications • Prepared Population with social tools in place • Practice & revision for evolving needs

  47. LESSON 7TIME IS OF THE ESSENCE

  48. COMMAND & CONTROL • Three Tyrannies • Time • Communications • Logistics • Authority • Legality & Jurisdiction

  49. COMMAND & CONTROL • Leadership • Realistic practical planning • Capability of execution • Concepts of Operation • Manning • Equipment • Training • Practice • Evaluation & Process Improvement LIFESAVER 2004

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