Organizing the health sector for response to disasters

The Management of Psychiatric Emergencies in Situations of Public Calamity

The prevalence of mental health problems in the general population during a public calamity is high. In calamities, the number of patients who present with mental disorder outbreaks or crises may increase, but the necessary support systems to help them may be impaired if they have not been planned for. Although there are several models for addressing psychiatric emergencies, the general rules are the same, especially when it comes to making these services easily available to the affected population. In this article, we seek to review and present recommendations for the management of psychiatric emergencies in situations of public calamity, including disasters, physical and medical catastrophes, epidemics, and pandemics.

Interlocução das políticas públicas ante a gestão de riscos de desastres: a necessidade da intersetorialidade

RESUMO No Brasil, o modo de realizar a gestão de riscos de desastres mudou a partir da Lei nº 12.608 da Política Nacional de Proteção e Defesa Civil (PNPDEC), em 2012, que preza pelo desenvolvimento sustentável por meio da integração de políticas públicas e de suas respectivas estratégias visando à garantia dos direitos humanos. Nesse sentido, a pesquisa analisou as ações de interlocução das políticas públicas ante a gestão de riscos de desastres em uma cidade da região da Foz do Rio Itajaí, Santa Catarina, Brasil. O estudo qualitativo exploratório foi realizado mediante um roteiro de entrevista semiestruturado, respondido por 12 participantes atuantes em 9 diferentes órgãos que colaboram para a gestão de riscos de desastres. A utilização da Grounded Theory permitiu que os dados fossem analisados e discutidos por intermédio do conteúdo das respostas e fundamentos teóricos. Evidenciaram-se a ausência de ações intersetoriais voltadas à vulnerabilidade socioambiental, o enfoque em ações de resposta ao desastre e a dificuldade em dar continuidade aos trabalhos realizados devido às interrupções ocasionadas por mudanças nos cargos políticos. Sugere-se que a vulnerabilidade socioambiental seja trabalhada transversalmente em todas as etapas, articulada entre todos os atores do processo.

The Psychological Capital and Anxiety Felt by Post-Market Fire Disaster Victims

Introduction: Traditional markets are a financial resource for traders. Fire disasters at the traditional markets will have a bad effect in terms of generating both financial and psychological problems. There is a lack of studies about the psychological problems experienced by traditional market fire victims. The aim of this study is to identify the correlation of psychological capital (hope, self-efficacy, resilience, and optimism) with the anxiety level among the victims of market fire disasters in Central Jakarta.Methods: This study used a cross-sectional approach with a non-probability sampling method. This study involved 174 market fire victims from Central Jakarta. The independent variables were psychological capital, which includes hope, self-efficacy, resilience, and optimism. The dependent variable was anxiety level. The instruments used the Hope scale, the General Self Efficacy scale, The 14-item Resilience scale (RS-14), the Life Orientation Test-Revised (LOT-R) scale and the Generalized Anxiety Disorder scale. The data analysis used an Independent T-Test, Chi-Square, and multiple logistic regression prediction modeling.Results: The more kiosks burned, the more that the informant’s anxiety increased by about4.845 times after applying a control factor of self-efficacy and optimism with a Wald value of 23.146.Conclusion: Psychological capital (self-efficacy and optimism) have a significant correlation with anxiety in the market fire disaster victims. Good self-efficacy and optimism can reduce the level of anxiety felt.  This study highlighted that psychological capital is a part of the disaster assessment as the basis for providing disaster nursing interventions.

Physical rehabilitation in the context of a landslide that occurred in Brazil

Backgrounds

The efforts to develop research and training on physical rehabilitation in regards to disasters is considered recent worldwide. In the late evening of the 11th up until the 12th of January of 2011, the most massive natural disaster occurred in Brazil with extremely heavy downpour, abrupt flood, as well as landslides on multiple areas of the Mountain Region of Rio de Janeiro. The objective of this research was to investigate the challenges in terms of physical rehabilitation provided by this event

Methods

The cross-sectional mixed method’s study, which was conducted in the city of Nova Friburgo, used two different data sources: hospital records on traumatic injuries pre and post disaster, and interviews with key informants - victims who suffered injuries related to the disaster, professionals from rehabilitation services in the municipality, and also the city’s health service management. Pearson’s chi-squared test was performed to evaluate statistical significance between the week of a given incident and the type of injury. Interviews were transcribed and analysed through content analysis.

Results

A total of 2326 hospital records and 27 interviews were analysed. The proportion of traumatic injury in the municipal emergency service increased from 16% in the prior week, to 40% in the week post-disaster (p <  0.0001). Different injuries were identified: multiple fractures, crushing, amputation, perforation of soft tissues, inhalation of dust and establishment of chronic conditions through stress. Despite this scenario, out of the 16 health professionals interviewed, twelve did not observe an increase in the demand for outpatient rehabilitation services after the disaster. Interviews with the victims revealed that the pathways for care ran into different barriers. From 11 victims interviewed, only one received complete physiotherapy care through the public health services in the city, while all others hired additional assistance, received volunteer services, had assistance in other cities or remained without rehabilitation.

Conclusions

The needs for rehabilitation increased after the disaster; however, the demand was repressed due to different barriers such as competing needs and possible lack of medical referral. Recommendations were made, including the action of performing a search of victims with rehabilitation needs.

19S: la respuesta en salud del gobierno del estado de Morelos

El pasado 19 de septiembre de 2017 se registró un sismo, de magnitud de 7.1 grados Richter al sureste de Axochiapan, en Morelos. Lo anterior implicó un total de 74 fallecimientos, más 20 000 viviendas afectadas, así como la evacuación de 18 hospitales y 281 unidades de primer nivel de atención médica. Dos meses después, las acciones de atención por parte del sector salud a la población damnificada continúan. Esta pobla¬ción pasó de 3 173 personas pernoctantes, concentradas en 49 refugios en el pico máximo, a un total de 1 512 personas, en 23 refugios temporales. Se implementaron acciones en materia de salud pública, como protección a riesgos sanitarios, vigilancia epidemiológica, promoción a la salud, prevención de enfermedades, atención en salud y rehabilitación. El presente artículo describe las acciones realizadas durante y después del sismo por parte del sector salud, con el fin de proveer un panorama en materia de salud pública basado en evidencia para situaciones de emergencia.

Excess mortality due to indirect health effects of the 2011 triple disaster in Fukushima, Japan: a retrospective observational study

Background

Evidence on the indirect health impacts of disasters is limited. We assessed the excess mortality risk associated with the indirect health impacts of the 2011 triple disaster (earthquake, tsunami and nuclear disaster) in Fukushima, Japan.

Methods

The mortality rates in Soma and Minamisoma cities in Fukushima from 2006 to 2015 were calculated using vital statistics and resident registrations. We investigated the excess mortality risk, defined as the increased mortality risk between postdisaster and predisaster after excluding direct deaths attributed to the physical force of the disaster. Multivariate Poisson regression models were used to estimate the relative risk (RR) of mortality after adjusting for city, age and year.

Results

There were 6163 and 6125 predisaster and postdisaster deaths, respectively. The postdisaster mortality risk was significantly higher in the first month following the disaster (March 2011) than in the same month during the predisaster period (March 2006–2010). RRs among men and women were 2.64 (95% CI 2.16 to 3.24) and 2.46 (95% CI 1.99 to 3.03), respectively, demonstrating excess mortality risk due to the indirect health effects of the disaster. Age-specific subgroup analyses revealed a significantly higher mortality risk in women aged ≥85 years in the third month of the disaster compared with predisaster baseline, with an RR (95% CI) of 1.73 (1.23 to 2.44).

Conclusions

Indirect health impacts are most severe in the first month of the disaster. Early public health support, especially for the elderly, can be an important factor for reducing the indirect health effects of a disaster.

Preparedness for the Rio 2016 Olympic Games: hospital treatment capacity in georeferenced areas

Recently, Brazil has hosted mass events with recognized international relevance. The 2014 FIFA World Cup was held in 12 Brazilian state capitals and health sector preparedness drew on the history of other World Cups and Brazil's own experience with the 2013 FIFA Confederations Cup. The current article aims to analyze the treatment capacity of hospital facilities in georeferenced areas for sports events in the 2016 Olympic Games in the city of Rio de Janeiro, based on a model built drawing on references from the literature. Source of data were Brazilian health databases and the Rio 2016 website. Sports venues for the Olympic Games and surrounding hospitals in a 10km radius were located by geoprocessing and designated a "health area" referring to the probable inflow of persons to be treated in case of hospital referral. Six different factors were used to calculate needs for surge and one was used to calculate needs in case of disasters (20/1,000). Hospital treatment capacity is defined by the coincidence of beds and life support equipment, namely the number of cardiac monitors (electrocardiographs) and ventilators in each hospital unit. Maracanã followed by the Olympic Stadium (Engenhão) and the Sambódromo would have the highest single demand for hospitalizations (1,572, 1,200 and 600, respectively). Hospital treatment capacity proved capable of accommodating surges, but insufficient in cases of mass casualties. In mass events most treatments involve easy clinical management, it is expected that the current capacity will not have negative consequences for participants.