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International
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International Disaster Management, exposure monitoring and public health
by Antonio Virgili*
Each natural disaster is unique in that the regions affected have different social, economic, and health backgrounds. But, many similarities exist, and knowledge about these can ensure that the health and emergency medical relief and limited resources are well-managed. The vulnerabilities of a territory are the product of cultural, social, economic, productive and environmental practices and of incorrect political decisions or administrative/institutional weaknesses that are perpetrated through the patterns of development. It is useful to remember that the risks are increased by vulnerabilities (characteristics and circumstances that make one susceptible to damaging effects of a hazard) and decreased by capacities (combination of strengths, attitudes and resources). The March 2011 Japan earthquake was a huge wake-up call for a lot of people that disasters can be devastating even in affluent and well prepared societies as Japan is usually considered. The effects of disasters on people, infrastructures, productive systems and means of subsistence, ecosystems etc. may vary from community or neighbourhood level (small disasters), involve several communities (medium-sized disasters) or even affect great swathes of a country or region (large-scale disasters). The specific social structure and dynamics link social fragility; from a systems perspective[1] community fragility in emergency management involves four areas of complex systems including: ecosystems, social systems, sociotechnical systems, and complex adaptive systems. We wish here to consider mainly two interconnected aspects of disaster management action: exposure monitoring and health problems.
Emergency management has become better understood in terms of the skills and capabilities that emergency managers need. Time ago it was assumed that an emergency manager should be a person who had a really good understanding of command and control issues and now there’s been a lot more thinking about what are the skills and the competencies that go into making a good emergency manager. Also volunteering role is now considered in a different way, starting from the overwhelming altruistic pro-social response that most people engage in during disasters. It’s not like the disaster movies. There are many important findings about the importance of volunteer groups and emergent groups in disasters, not only to compensate limited economic resources. Ordinary community citizens can be very resourceful and can engage extensively in self-help and mutual aid when disasters happen. They don’t need to be told what to do by others. There is a growing recognition that while we need experts in emergency management — we need well trained, well educated people — that the whole community is involved in mitigating, preparing for and responding to and recovering from disasters. So as to reach out to the public through social media, which has become a necessity. There should be more resources devoted to working with community-based organizations and volunteers, working with schools, urban districts and local communities. Specialized equipment, uniforms, decontamination suits, night-vision goggles and mobile command posts availability are surely very important but we should now concentrate more on community outreach, especially outreach to organizations that serve the most vulnerable populations.
Disasters expose the general population and responders to a range of potential contaminants and stressors which may harm physical and mental health. Disaster behavioural health (DBH) is the provision of mental health, substance abuse, and stress management to disaster survivors and responders. The overall objectives of disaster management from the viewpoint of public health are: 1) needs assessments; 2) matching available resources with defined needs; 3) prevention of further adverse health effects; 4) implementation of disease-control strategies; 5) evaluation of the effectiveness of the application of these strategies; and 6) improvement in contingency planning for future disasters. The effects of sudden-onset, natural disasters on humans are quantifiable. Knowledge of the epidemiology of deaths, injuries, and illnesses is essential to determine effective responses; provide public education; establish priorities, planning, and training. In addition, the temporal patterns for the medical care required must be established so that the needs in future disasters can be anticipated. To plan adequate resources and actions in protecting persons involved in some disasters three primary questions have to be replied: (1) determining precisely who has been involved, (2) ensuring whether persons had any protective equipment and training/guidance on proper use, and (3) identifying which harmful environmental contaminants people were being exposed to or what kind of physical injuries/ damage received. In a way there are two different but complementary steps: A. to support and to care about persons directly and clearly involved; B. to support and to care about persons involved in long term health problems. Today, perhaps, the strongest potential contribution of epidemiologic studies to post-disaster management is to anticipate and prospectively build knowledge regarding potential long-term health outcomes from disasters, which often involves a complex array of exposures. People who were injured or became ill as a consequence of disasters required care and potentially incurred two types of financial costs: (1) direct costs of medical treatment received, and (2) indirect costs associated with losses of earnings capacity or related financial damages suffered.
To better understand events exposure plays a key role in the medical monitoring, for exposure to agents released in a disaster event that can lead to clinical disease[2]. Exposure science is the study of an organism's contact with chemical, physical, biological agents or other health risk (e.g. accidental) occurring in their environments, and advances knowledge of the mechanisms and dynamics of events either causing or preventing adverse health outcomes. Exposure plays a fundamental role in the development and application of epidemiology, toxicology, and risk assessment. It provides critical information for protecting human and ecosystem health. Exposure science also has the ability to play an effective role in other fields, including environmental regulation, urban, traffic safety and ecosystem planning, and disaster management; in many cases these are untapped opportunities. Exposure science links human and ecologic behaviour to environmental processes in such a way that the information generated can be used to mitigate or prevent future adverse exposures. Exposure lessons learned from disasters such as the WTC and Hurricane Katrina have significantly improved the ability to define disaster mitigation needs, characterize disaster exposures, and conduct effective post-disaster remediation. Rapid deployment of equipment is critical, along with integration and sharing of data immediately with first responders: integrated and systematic responses rely on access to high-quality exposure data. Still open research questions and needs for disaster response exposure characterization include:
From the above considerations follows that significant challenges in prioritizing resources to address a wide variety of potential population safety and security threats, including terrorist attacks, natural disasters, and accidental disasters, would have to be done. Funding is the first but not the only one challenge. Today there is a wider range of security threats from nuclear, biological, chemical, or radiological attacks to natural disasters such as hurricanes, earthquakes and volcanos. Effective technologies, practices, and policies have often made a difference in the past and could probably continue to do so. For example the key role that space activities, technologies and applications play in helping countries in achieving SDGs targets is well acknowledged and specifically recognized in Art 76 of the UNGA resolution on Agenda 2030: “We will promote transparent and accountable scaling-up of appropriate public-private cooperation to exploit the contribution to be made by a wide range of data, including Earth observation and geo-spatial information”. Space technologies are very important for the early warning systems: a fundamental component of disaster risk management, so that the population is able to take action and protect itself against an imminent danger. Specific future goals might include less vulnerable buildings, escapable high rises, and intelligent personal monitoring equipment. In the meantime, there is the need to institutionalize exposure characterization and mitigation processes for disasters. Exposure characterization must be integrated into a national framework for response planning, so that exposure characterization monitoring experts will be an integral part of the response team from the beginning. Exposure characterization should also be part of appropriate training and simulation exercises, so that it is seamlessly integrated with the overall response efforts. At present, most exercises “neglect” exposure assessment. Not less important to develop national and international standard practices for exposure characterization, including background characterization (both before and after event) and sample analysis. Monitoring both exposure and the whole rescue, support and recovery activities, constantly updating them also post-disasters, allow to ensure the opportune, appropriate and effective distribution of aid, technologies and assistance, surely reducing the costs for moving people or materials when not necessary, for non-correspondence between needs and type of interventions, avoiding longer post disaster treatments and possible duplication of actions. Last but not least, the most of goals require community support and resources, credible scientific assessment and advocacy may be able to lessen the complexities of institutional barriers and, where applicable, to integrate disaster risk reduction into strategic reforms and program for sustainable development. Social involvement relies on emotion, compassion, comradery and charity, however enduring success of disaster management actions will require scientific data to document needs and outcomes to justify program investment. This type of social partecipation requires scientific data to collect and analyse, over time, on the social and health effects of the disaster for the community and the responders, data suitable to show the effectiveness and efficiency of the surveillance and disaster management programs.
[1] Virgili Antonio, Elementi per una analisi sistemica del mutamento sociale, in Itinerari di scienze sociali, CSI, 1999
[2] For example in allergies induced pathologies, see: Virgili A. Di Criscio D., Esposito G., Infiammati, (forthcoming, 2019)
* Dr. Antonio Virgili
Commander of the Corpo Italiano di San Lazzaro, Lazarus Union Vice-President and Commmander of CSLI International Operations in Europe
by Antonio Virgili*
Each natural disaster is unique in that the regions affected have different social, economic, and health backgrounds. But, many similarities exist, and knowledge about these can ensure that the health and emergency medical relief and limited resources are well-managed. The vulnerabilities of a territory are the product of cultural, social, economic, productive and environmental practices and of incorrect political decisions or administrative/institutional weaknesses that are perpetrated through the patterns of development. It is useful to remember that the risks are increased by vulnerabilities (characteristics and circumstances that make one susceptible to damaging effects of a hazard) and decreased by capacities (combination of strengths, attitudes and resources). The March 2011 Japan earthquake was a huge wake-up call for a lot of people that disasters can be devastating even in affluent and well prepared societies as Japan is usually considered. The effects of disasters on people, infrastructures, productive systems and means of subsistence, ecosystems etc. may vary from community or neighbourhood level (small disasters), involve several communities (medium-sized disasters) or even affect great swathes of a country or region (large-scale disasters). The specific social structure and dynamics link social fragility; from a systems perspective[1] community fragility in emergency management involves four areas of complex systems including: ecosystems, social systems, sociotechnical systems, and complex adaptive systems. We wish here to consider mainly two interconnected aspects of disaster management action: exposure monitoring and health problems.
Emergency management has become better understood in terms of the skills and capabilities that emergency managers need. Time ago it was assumed that an emergency manager should be a person who had a really good understanding of command and control issues and now there’s been a lot more thinking about what are the skills and the competencies that go into making a good emergency manager. Also volunteering role is now considered in a different way, starting from the overwhelming altruistic pro-social response that most people engage in during disasters. It’s not like the disaster movies. There are many important findings about the importance of volunteer groups and emergent groups in disasters, not only to compensate limited economic resources. Ordinary community citizens can be very resourceful and can engage extensively in self-help and mutual aid when disasters happen. They don’t need to be told what to do by others. There is a growing recognition that while we need experts in emergency management — we need well trained, well educated people — that the whole community is involved in mitigating, preparing for and responding to and recovering from disasters. So as to reach out to the public through social media, which has become a necessity. There should be more resources devoted to working with community-based organizations and volunteers, working with schools, urban districts and local communities. Specialized equipment, uniforms, decontamination suits, night-vision goggles and mobile command posts availability are surely very important but we should now concentrate more on community outreach, especially outreach to organizations that serve the most vulnerable populations.
Disasters expose the general population and responders to a range of potential contaminants and stressors which may harm physical and mental health. Disaster behavioural health (DBH) is the provision of mental health, substance abuse, and stress management to disaster survivors and responders. The overall objectives of disaster management from the viewpoint of public health are: 1) needs assessments; 2) matching available resources with defined needs; 3) prevention of further adverse health effects; 4) implementation of disease-control strategies; 5) evaluation of the effectiveness of the application of these strategies; and 6) improvement in contingency planning for future disasters. The effects of sudden-onset, natural disasters on humans are quantifiable. Knowledge of the epidemiology of deaths, injuries, and illnesses is essential to determine effective responses; provide public education; establish priorities, planning, and training. In addition, the temporal patterns for the medical care required must be established so that the needs in future disasters can be anticipated. To plan adequate resources and actions in protecting persons involved in some disasters three primary questions have to be replied: (1) determining precisely who has been involved, (2) ensuring whether persons had any protective equipment and training/guidance on proper use, and (3) identifying which harmful environmental contaminants people were being exposed to or what kind of physical injuries/ damage received. In a way there are two different but complementary steps: A. to support and to care about persons directly and clearly involved; B. to support and to care about persons involved in long term health problems. Today, perhaps, the strongest potential contribution of epidemiologic studies to post-disaster management is to anticipate and prospectively build knowledge regarding potential long-term health outcomes from disasters, which often involves a complex array of exposures. People who were injured or became ill as a consequence of disasters required care and potentially incurred two types of financial costs: (1) direct costs of medical treatment received, and (2) indirect costs associated with losses of earnings capacity or related financial damages suffered.
To better understand events exposure plays a key role in the medical monitoring, for exposure to agents released in a disaster event that can lead to clinical disease[2]. Exposure science is the study of an organism's contact with chemical, physical, biological agents or other health risk (e.g. accidental) occurring in their environments, and advances knowledge of the mechanisms and dynamics of events either causing or preventing adverse health outcomes. Exposure plays a fundamental role in the development and application of epidemiology, toxicology, and risk assessment. It provides critical information for protecting human and ecosystem health. Exposure science also has the ability to play an effective role in other fields, including environmental regulation, urban, traffic safety and ecosystem planning, and disaster management; in many cases these are untapped opportunities. Exposure science links human and ecologic behaviour to environmental processes in such a way that the information generated can be used to mitigate or prevent future adverse exposures. Exposure lessons learned from disasters such as the WTC and Hurricane Katrina have significantly improved the ability to define disaster mitigation needs, characterize disaster exposures, and conduct effective post-disaster remediation. Rapid deployment of equipment is critical, along with integration and sharing of data immediately with first responders: integrated and systematic responses rely on access to high-quality exposure data. Still open research questions and needs for disaster response exposure characterization include:
- Acute event
- ◦ developing better personal protection methods;
- ◦ advancing exposure characterization and implementation of realistic modelling tools;
- ◦ devising exposure characterization standards;
- ◦ applying better exposure characterizations effectively in indoor settings.
- Long-term event or post-event
- ◦ methods for physical and chemical agent exposure characterizations are advancing, so as must do those for biological agents
- Of practical importance is to ensure a comprehensive inventory through a tracking system of impacted persons and responders/volunteers (if it possible also residents) immediately after the accident. Access to the disaster site should be restricted to necessary personnel only, to minimize the possible health impact. This should include the issuance of electronic ID cards with GPS capabilities so that additional information about time and location at the site can be automatically tracked and recorded;
- The full spectrum of public health expertise (physicians, epidemiologists, health professionals trained in disaster epidemiology, industrial hygienists, informatics experts, sociologists) should be involved in a rapid hazard vulnerability assessment of the scope of the disaster and determine public health outcome priorities based on the disaster exposure type(s) – both physical and socio-psychological – and intensity;
- Collecting, during the disaster, health and needs information focused on preventing and reducing morbidity and mortality helps to address immediate needs, adjust priorities, and allocate or gather resources. Once the disaster antecedent is known, assessments of evacuation needs, other safety restrictions and contamination considerations for food and water should be made jointly by health experts, industry, the government, and community organizations;
- Monitoring of the disaster’s long-term health effects is necessary. This requires components to be both put in place and work together: structured data collection (databases) on the physical and mental health outcomes and progression over the lifetime of the affected; detailed exposure assessment (both environmental exposure and biological measurements of the affected populations); adequate physical and mental health treatment and support needs to be provided and accessible; and risk communication must be coordinated between governmental authorities, scientific experts and social scientists. Mental, social and physical health services should be offered together, preferably in the same healthcare office or otherwise closely integrated in order to avoid the stigma commonly associated with seeking social and mental health services;
- To prevent and/or minimize the adverse health effects for all affected populations, the full spectrum of public health expertise must be involved in hazard vulnerability assessment, disaster planning, and emergency response, and the accumulated, long-term data from existing programs – along with input from community leaders, scientists, government officials, and stakeholders – should be used to improve prevention and mitigation strategies for future disasters;
- Data collection is needed in a timely manner; using evidence based and standardized assessment tools. Information and ancillary testing need to be maintained in data base program to yield documentation and comparison to exposure assessment information. Electronic medical record should be used to improve diagnosis and treatment, as well as generating longitudinal reports on health conditions and response to treatment.
From the above considerations follows that significant challenges in prioritizing resources to address a wide variety of potential population safety and security threats, including terrorist attacks, natural disasters, and accidental disasters, would have to be done. Funding is the first but not the only one challenge. Today there is a wider range of security threats from nuclear, biological, chemical, or radiological attacks to natural disasters such as hurricanes, earthquakes and volcanos. Effective technologies, practices, and policies have often made a difference in the past and could probably continue to do so. For example the key role that space activities, technologies and applications play in helping countries in achieving SDGs targets is well acknowledged and specifically recognized in Art 76 of the UNGA resolution on Agenda 2030: “We will promote transparent and accountable scaling-up of appropriate public-private cooperation to exploit the contribution to be made by a wide range of data, including Earth observation and geo-spatial information”. Space technologies are very important for the early warning systems: a fundamental component of disaster risk management, so that the population is able to take action and protect itself against an imminent danger. Specific future goals might include less vulnerable buildings, escapable high rises, and intelligent personal monitoring equipment. In the meantime, there is the need to institutionalize exposure characterization and mitigation processes for disasters. Exposure characterization must be integrated into a national framework for response planning, so that exposure characterization monitoring experts will be an integral part of the response team from the beginning. Exposure characterization should also be part of appropriate training and simulation exercises, so that it is seamlessly integrated with the overall response efforts. At present, most exercises “neglect” exposure assessment. Not less important to develop national and international standard practices for exposure characterization, including background characterization (both before and after event) and sample analysis. Monitoring both exposure and the whole rescue, support and recovery activities, constantly updating them also post-disasters, allow to ensure the opportune, appropriate and effective distribution of aid, technologies and assistance, surely reducing the costs for moving people or materials when not necessary, for non-correspondence between needs and type of interventions, avoiding longer post disaster treatments and possible duplication of actions. Last but not least, the most of goals require community support and resources, credible scientific assessment and advocacy may be able to lessen the complexities of institutional barriers and, where applicable, to integrate disaster risk reduction into strategic reforms and program for sustainable development. Social involvement relies on emotion, compassion, comradery and charity, however enduring success of disaster management actions will require scientific data to document needs and outcomes to justify program investment. This type of social partecipation requires scientific data to collect and analyse, over time, on the social and health effects of the disaster for the community and the responders, data suitable to show the effectiveness and efficiency of the surveillance and disaster management programs.
[1] Virgili Antonio, Elementi per una analisi sistemica del mutamento sociale, in Itinerari di scienze sociali, CSI, 1999
[2] For example in allergies induced pathologies, see: Virgili A. Di Criscio D., Esposito G., Infiammati, (forthcoming, 2019)
* Dr. Antonio Virgili
Commander of the Corpo Italiano di San Lazzaro, Lazarus Union Vice-President and Commmander of CSLI International Operations in Europe