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The art and science of large-scale disasters
M. Gad-El-Hak
Bulletin of the Polish Academy of Sciences: Technical Sciences , 2009, DOI: 10.2478/v10175-010-0101-8
Abstract: The subject of large-scale disasters is broadly introduced in this article. Both the art and science of predicting, preventing and mitigating natural and manmade disasters are discussed. A universal, quantitative metric that puts all natural and manmade disasters on a common scale is proposed. Issues of prediction, control and mitigation of catastrophes are presented. The laws of nature govern the evolution of any disaster. In some cases, as for example weather-related disasters, the first-principles laws of classical mechanics could be written in the form of field equations, but exact solutions of these often nonlinear differential equations are impossible to obtain particularly for turbulent flows, and heuristic models together with intensive use of supercomputers are necessary to proceed to a reasonably accurate forecast. In other cases, as for example earthquakes, the precise laws are not even known and prediction becomes more or less a black art. Management of any type of disaster is more art than science. Nevertheless, much can be done to alleviate the resulting pain and suffering. The expansive presentation of the broad field of large-scale disasters precludes a detailed coverage of any one of the many topics touched upon. Three take-home messages are conveyed, however: a universal metric for all natural and manmade disasters is presented; all facets of the genre are described; and a proposal is made to view all disasters as dynamical systems governed for the most part by the laws of classical mechanics.
A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale) in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure  [PDF]
Michael K. Howlett,Paul R. T. Atkinson
Emergency Medicine International , 2012, DOI: 10.1155/2012/636045
Abstract: Objectives. Triage data are widely used to evaluate patient flow, disease severity, and emergency department (ED) workload, factors used in ED crowding evaluation and management. We defined an indicator-based methodology that can be easily used to review the accuracy of Canadian Triage and Acuity Scale (CTAS) performance. Methods. A trained nurse reviewer (NR) retrospectively triaged two separate month’s ED charts relative to a set of clinical indicators based on CTAS Chief Complaints. Interobserver reliability and accuracy were compared using Kappa and comparative statistics. Results. There were 2838 patients in Trial 1 and 3091 in Trial 2. The rate of inconsistent triage was 14% and 16% (Kappa 0.596 and 0.604). Clinical Indicators “pain scale, chest pain, musculoskeletal injury, respiratory illness, and headache” captured 68% and 62% of visits. Conclusions. We have demonstrated a system to measure the levels of process accuracy and reliability for triage over time. We identified five key clinical indicators which captured over 60% of visits. A simple method for quality review uses a small set of indicators, capturing a majority of cases. Performance consistency and data collection using indicators may be important areas to direct training efforts. 1. Introduction Accurate assessment of triage (a French term meaning “to sort”) processes and outcomes is central to any research on emergency department (ED) crowding. Patient volumes and acuity, the aging population, public demands for advanced technology, evidence-based medicine, and payor austerity measures increase pressure on emergency department processes. With increasing demand on EDs and increasing crowding issues, studies must examine factors that influence patient flow. These studies depend on accurate measurements of disease severity and workload. Triage data are used extensively as a proxy for both workload and patient acuity. Thus proper conduct of research into crowding and the ability to apply results across facilities depends on accuracy and reliability of the data. The five-level Canadian Triage and Acuity Scale (CTAS), using a standardized data element set including a validated Chief Complaint list, has been adopted by the Canadian Association of Emergency Physicians (CAEPs) and National Emergency Nurses Affiliation (NENA) as the standard methodology for emergency department triage [1–3]. Similar five-level systems are used in the United States, the United Kingdom, and Australia as well as in other jurisdictions. The Canadian Triage and Acuity Scale (CTAS) has been used not only for
Clinical review: Allocating ventilators during large-scale disasters – problems, planning, and process
John L Hick, Lewis Rubinson, Daniel T O'Laughlin, J Christopher Farmer
Critical Care , 2007, DOI: 10.1186/cc5929
Abstract: Current health care emergency preparedness planning recognizes that excess critical care capacity for a disaster is extremely limited. Most critical care units routinely function at or near capacity [1-3], significantly decreasing available critical care response capabilities for disasters [4-6]. These limitations are not merely a consequence of space and staffing issues; countless medical equipment and supplies are maintained in quantities sufficient only for daily operations. Unfortunately, usual medical material distribution chains are vulnerable to disruption during disasters, so additional supplies and equipment may not be readily obtainable. For some equipment and medications, traditional allocation units can be reduced and substitutions are possible (for example, oral instead of intravenous medications) to allow all in need to have adequate access to resources rather than fewer to have unlimited access.For a number of complex, durable medical devices such as mechanical ventilators, there are few acceptable alternatives [7,8]. In some circumstances, temporizing measures such as manually ventilating patients may be adequate. Such a strategy is likely to be inadequate for disasters requiring days of ventilatory support, especially for people with severe respiratory failure. Even if enough mechanical ventilators were available to meet the need of hundreds or thousands of additional critically ill patients in a community, critical care personnel may be in too short of supply to withstand the demands of pervasive disasters, like a severe influenza pandemic. The critical care response to a severe influenza pandemic will be further challenged by insufficient external relief and augmentation assets; the critical care needs of all communities may not be met [9-11]. Under these circumstances, triage of patients who are newly requiring critical care interventions and of those who have already received some degree of definitive medical care may be required in order to jus
START as the detector of choice for large-scale muon triggering systems  [PDF]
A. Akindinov,G. Bondarenko,V. Golovin,E. Grigoriev,Yu. Grishuk,D. Mal'kevich,A. Martemiyanov,A. Nedosekin,M. Ryabinin,V. Sheinkman,A. Smirnitskiy,K. Voloshin
Physics , 2006, DOI: 10.1016/J.NIMA.2006.05.071
Abstract: Further progress in building high-granular large-scale systems based on Scintillation Tiles with MRS APD light readout (START) became possible thanks to the creation of an improved version of MRS APD. The cost of the system may now be significantly reduced by using inexpensive extruded scintillator. More than 160 START samples were assembled based on this design modification and proved to possess 100% MIP detection efficiency and the intrinsic noise rate of less than 0.08 Hz. Long-term stability of START characteristics was confirmed after 3.5 months of operation.
Reliability and effectiveness of a 4-level emergency triage
Nicola Parenti,Maria Letizia Bacchi Reggiani,Diego Sangiorgi,Tiziano Lenzi
Emergency Care Journal , 2008, DOI: 10.4081/ecj.2008.5.30
Abstract: Italian guidelines require a 4-level in hospital triage based on an acuity scale measurement, but they don’t suggest common guidelines neither which triage models to adopt. Thus each hospital developed own triage guidelines based on consensus. But, to our knowledge, there aren’t data on the reliability and predictive validity of triage systems adopted by Italian Emergency Department. Also in the ED of Imola, a triage working group developed Guidelines on triage in 2001. In this study we measured the reliability and predictive validity of the Imola Triage Guidelines (LGTI).
Algorithm for Resource Redistribution Required for Recovery of Society after Large Scale Disasters  [PDF]
Vasily Lubashevskiy,Taro Kanno,Kazuo Furuta
Physics , 2013,
Abstract: The recovery of society after a large scale disaster generally consists of two phases, short- and long-term recoveries. The problem of short-term recovery is rather close to the problem of resilience in their goal, namely, bouncing the damaged system back to the operating standards. The present paper proposes an algorithm for the vital resource redistribution required for implementation of the short-term recovery. The developed model is based on the cooperative interaction of cities during the resource redistribution, ordering the cities according to their priority in resource delivery, and a generating a semi-optimal plan for the desired redistribution. Nonlinear effects caused by the city limit capacities are taken into account. Two types of systems, "uniform" and "centralized", are studied numerically. In particular it is demonstrated that the cooperation effects are able to shorten substantially the duration of the process required for its implementation.
Satellite differential SAR interferometry for the evaluation of effects of hydrogeological disasters: definition of a scale for damage evaluation  [cached]
V. Rizzo,A. Iodice
Annals of Geophysics , 2006, DOI: 10.4401/ag-3142
Abstract: In this paper we present the results of monitoring soil movements over an about 10 km2 area around the border between the Calabria and Basilicata regions in Italy. Monitoring has been performed using the satellite differential SAR interferometry measurements integrated with GPS measurements. In particular, we used ERS data acquired at time interval of several months (about two acquisitions per year), and after particularly strong pluvial events. Terrain displacement spatial and temporal analysis has been performed by employing the original method described in Berardino et al. (2002, 2003). Obtained results allow us to characterise unstable areas, and can be used within projects aimed at territory classification and characterisation, and at performing damage evaluation. Accordingly, this technique has been included in the framework of a proposed UE project (WEDELOP project) aimed at developing an integrated methodology to devise a damage scale for hydrogeological disasters. This scale is of great interest in many fields; in particular, definition of a damage scale would be highly desirable from the viewpoint of insurance companie
Resource Redistribution Method for Short-Term Recovery of Society after Large Scale Disasters  [PDF]
Vasily Lubashevskiy,Taro Kanno,Kazuo Furuta
Physics , 2014,
Abstract: Recovery of society after a large scale disaster generally consists of two phases, short- and long-term recoveries. The main goal of the short-term recovery is to bounce the damaged system back to the operating standards enabling residents in damaged cities to survive, and fast supply with vital resources to them is one of its important elements. We propose a general principle by which the required redistribution of vital resources between the affected and neighbouring cities can be efficiently implemented. The short-term recovery is a rescuer operation where uncertainty in evaluating the state of damaged region is highly probable. To allow for such an operation the developed principle involves two basic components. The first one of ethic nature is the triage concept determining the current city priority in the resource delivery. The second one is the minimization of the delivery time subjected to this priority. Finally a certain plan of the resource redistribution is generated according to this principle. Several specific examples are studied numerically. It elucidates, in particular, the effects of system characteristics such as the city limit capacity in resource delivery, the type of initial resource allocation among the cities, the number of cities able to participate in the resource redistribution, and the damage level in the affected cities. As far as the uncertainty in evaluating the state of damaged region is concerned, some specific cases were studied. It assumes the initial communication system has crashed and formation of a new one and the resource redistribution proceed synchronously. The obtained results enable us to consider the resource redistribution plan governed by the proposed method semi-optimal and rather efficient especially under uncertainty.
Eyjafjallaj?kull and 9/11: The Impact of Large-Scale Disasters on Worldwide Mobility  [PDF]
Olivia Woolley-Meza, Daniel Grady, Christian Thiemann, James P. Bagrow, Dirk Brockmann
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0069829
Abstract: Large-scale disasters that interfere with globalized socio-technical infrastructure, such as mobility and transportation networks, trigger high socio-economic costs. Although the origin of such events is often geographically confined, their impact reverberates through entire networks in ways that are poorly understood, difficult to assess, and even more difficult to predict. We investigate how the eruption of volcano Eyjafjallaj?kull, the September 11th terrorist attacks, and geographical disruptions in general interfere with worldwide mobility. To do this we track changes in effective distance in the worldwide air transportation network from the perspective of individual airports. We find that universal features exist across these events: airport susceptibilities to regional disruptions follow similar, strongly heterogeneous distributions that lack a scale. On the other hand, airports are more uniformly susceptible to attacks that target the most important hubs in the network, exhibiting a well-defined scale. The statistical behavior of susceptibility can be characterized by a single scaling exponent. Using scaling arguments that capture the interplay between individual airport characteristics and the structural properties of routes we can recover the exponent for all types of disruption. We find that the same mechanisms responsible for efficient passenger flow may also keep the system in a vulnerable state. Our approach can be applied to understand the impact of large, correlated disruptions in financial systems, ecosystems and other systems with a complex interaction structure between heterogeneous components.
Swedish emergency department triage and interventions for improved patient flows: a national update
Nasim Farrokhnia, Katarina E G?ransson
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-72
Abstract: In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74) Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows.Nearly all (97%) EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%). Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59%) of the EDs have implemented or plan to implement nurse requested X-ray.There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.When patients can not been seen by a doctor immediately upon arrival to the emergency department (ED), some sort of order for treatment is needed. ED triage, developed since the mid 1900's [1], is nowadays a universal approach for handling such queues [2-4]. Triage is often carried out by registered nurses (RNs) using a triage scale to guide their decision in allocating an acuity level. The development of ED triage varies across the world; Australia being one of the first countries to introduce a five level triage scale, the National Triage Scale (NTS), later renamed the Australasian Triage Scale (ATS) [5]. Anglo-Saxon countries have dominated the development of triage scales, and internationally commonly used scales are the Canadian Emergency Department Triage and Acuity Scale (CTAS), the Manchester Triage Scale (MTS) from the UK and the Emergenc
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