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Phattharapornjaroen P, Carlström E, Atiksawedparit P, Holmqvist LD, Pitidhammabhorn D, Sittichanbuncha Y, Khorram-Manesh A. The impact of the three-level collaboration exercise on collaboration and leadership during scenario-based hospital evacuation exercises using flexible surge capacity concept: a mixed method cross-sectional study. BMC Health Serv Res 2023; 23:862. [PMID: 37580718 PMCID: PMC10426132 DOI: 10.1186/s12913-023-09882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Hospitals play a crucial role in responding to disasters and public health emergencies. However, they are also vulnerable to threats such as fire or flooding and can fail to respond or evacuate adequately due to unpreparedness and lack of evacuation measures. The United Nations Office for Disaster Risk Reduction has emphasised the importance of partnerships and capacity building in disaster response. One effective way to improve and develop disaster response is through exercises that focus on collaboration and leadership. This study aimed to examine the effectiveness of using the 3-level collaboration (3LC) exercise in developing collaboration and leadership in districts in Thailand, using the concept of flexible surge capacity (FSC) and its collaborative tool during a hospital evacuation simulation. METHODS A mixed-method cross-sectional study was conducted with 40 participants recruited from disaster-response organisations and communities. The data from several scenario-based simulations were collected according to the collaborative elements (Command and control, Safety, Communication, Assessment, Triage, Treatment, Transport), in the disaster response education, "Major Incident Medical Management and Support" using self-evaluation survey pre- and post-exercises, and direct observation. RESULTS The 3LC exercise effectively facilitated participants to gain a mutual understanding of collaboration, leadership, and individual and organisational flexibility. The exercise also identified gaps in communication and the utilisation of available resources. Additionally, the importance of early community engagement was highlighted to build up a flexible surge capacity during hospital evacuation preparedness. CONCLUSIONS the 3LC exercise is valuable for improving leadership skills and multiagency collaboration by incorporating the collaborative factors of Flexible Surge Capacity concept in hospital evacuation preparedness.
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Affiliation(s)
- Phatthranit Phattharapornjaroen
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden.
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40100, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- USN School of Business, University of South-Eastern Norway, Kongsberg, 3603, Norway
| | - Pongsakorn Atiksawedparit
- Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, 10540, Thailand
| | - Lina Dahlén Holmqvist
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg, 40530, Sweden
| | - Dhanesh Pitidhammabhorn
- Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, 10540, Thailand
| | - Yuwares Sittichanbuncha
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
- Disaster Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
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Phattharapornjaroen P, Carlström E, Holmqvist LD, Sittichanbuncha Y, Khorram-Manesh A. Assessing Thai Hospitals’ Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2023; 14:52-63. [PMCID: PMC9930065 DOI: 10.1007/s13753-023-00468-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 08/16/2023]
Abstract
According to the concept of “flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war; and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire; 43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises.
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Affiliation(s)
- Phatthranit Phattharapornjaroen
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 40100 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3603 Kongsberg, Norway
| | - Lina Dahlén Holmqvist
- Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, 40530 Gothenburg, Sweden
| | - Yuwares Sittichanbuncha
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400 Thailand
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 40100 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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Sultan MAS, Khorram-Manesh A, Sørensen JL, Berlin J, Carlström E. Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2023; 14:183-193. [PMCID: PMC10088626 DOI: 10.1007/s13753-023-00484-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 07/10/2024]
Abstract
This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills, self-confidence, and ability in team building within trans-professional groups in the second scenario, which in concordance with the integration theory, was due to the attempts made in the first scenario. Additionally, there was an improvement in the team’s maturity, which in concordance with the maturity theory, was due to the knowledge and practical skills during scenario plays. These results indicate the importance of continuous tabletop training, and the use of CSCATTT as a collaborative instrument, to promote the development of collaboration and to test the concept of preparedness.
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Affiliation(s)
- Mohammed Ali Salem Sultan
- Model of Care, Healthcare Transformation, Regional Health Directorate, Najran, 66255 Saudi Arabia
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
| | - Amir Khorram-Manesh
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45 Gothenburg, Sweden
| | - Jarle Løwe Sørensen
- USN School of Business, University of South-Eastern Norway, 3199 Borre, Norway
| | - Johan Berlin
- Department of Social and Behavioural Studies, University West, 461 86 Trolhättan, Sweden
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45 Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3199 Borre, Norway
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Tang C, Chen X, Guan C, Fang P. Attitudes and Response Capacities for Public Health Emergencies of Healthcare Workers in Primary Healthcare Institutions: A Cross-Sectional Investigation Conducted in Wuhan, China, in 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12204. [PMID: 36231505 PMCID: PMC9564888 DOI: 10.3390/ijerph191912204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Response capacities for public health emergencies (PHEs) amongst healthcare workers play important roles in the prevention and control of PHEs. This study assessed the attitudes and response capacities of PHE workers in primary healthcare (PHC) institutions. METHODS An online anonymous questionnaire survey of 803 healthcare workers sampled from 13 PHC institutions in Wuhan, China, was conducted from April to June 2020. The Kruskal-Wallis test and linear regression model were used to analyze the response capacities of PHE workers and associated factors. RESULTS The healthcare workers with longer working years, particularly 30 years and above, had higher knowledge (OR = 7.323, p < 0.001) and practical ability scores (OR = 8.012, p < 0.001) when compared to those with less than 5 working years. The nurses had higher practical ability scores (OR = 2.188, p = 0.049), and pharmacists had lower practical ability scores (OR = 0.166, p = 0.007), when compared to doctors. Moreover, the healthcare workers who had never participated in educational activities related to PHE management in the past two years (OR = 0.540, p = 0.038; OR = 0.282, p = 0.001), had not participated in a PHE drill activity (OR = 0.327, p < 0.001; OR = 0.340, p = 0.004), and had never been involved in emergency management of PHEs (OR = 0.254, p < 0.001; OR = 0.174, p < 0.001) had lower knowledge and practical ability scores. CONCLUSION The healthcare workers with longer working years had better response capacities, and nurses had better practical abilities when compared to doctors. More emergency management education and chances to be involved in PHE drill activities were encouraged amongst healthcare workers in PHC institutions for better prevention and control of PHEs. Moreover, inter-institution cooperation, a flexible response system, and dynamic adjustment of healthcare workers were suggested during PHEs.
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Affiliation(s)
- Changmin Tang
- School of Management, Hubei University of Chinese Medicine, Wuhan 430065, China
- Hubei Provincial Key Research Base of Humanities and Social Sciences, Wuhan 430065, China
| | - Xin Chen
- School of Management, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Cuiling Guan
- School of Management, Hubei University of Chinese Medicine, Wuhan 430065, China
- Hubei Provincial Key Research Base of Humanities and Social Sciences, Wuhan 430065, China
| | - Pengqian Fang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Evaluating Nursing Staff Perception of Hospital Readiness for Continuity of Essential Health Care Services and Surge Capacity in Line With COVID-19. Disaster Med Public Health Prep 2022; 17:e160. [PMID: 35514151 PMCID: PMC9300964 DOI: 10.1017/dmp.2022.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate nursing staff' perception of hospital readiness for continuity of essential health care services and surge capacity in line with COVID-19. METHODS A total of 300 nurses were recruited from one hospital in Saudi Arabia. They completed self-administered, online questionnaires. The questionnaire assessed participants' socio-demographic data and their perceptions regarding hospital readiness for continuity of essential health care services and surge capacity in line with COVID-19. RESULTS The findings revealed that nursing staff had a moderate mean score regarding hospital readiness for continuity of health care services (3.89 ± 0.61) and an average mean value regarding surge capacity of 3.83 ± 0.63. Also, the value of R2 of surge capacity in healthcare can predict 82.9% of the variance in hospital readiness for continuity of health care services in terms of surge capacity. CONCLUSION Hospital administrators could propose hospital regulations and protocols for the management of confirmed and suspected COVID-19 patients in addition to designing a continuing education program for health professionals at all levels related to prevention, control, and management of COVID-19 suspected and confirmed patients.
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Wennman I, Jacobson C, Carlström E, Hyltander A, Khorram-Manesh A. Organizational Changes Needed in Disasters and Public Health Emergencies: A Qualitative Study among Managers at a Major Hospital. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2022; 13:481-494. [PMCID: PMC9361938 DOI: 10.1007/s13753-022-00423-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 09/01/2023]
Abstract
Most hospitals have a contingency plan, based on all-risks and all-hazards assessment principles. However, emerging threats and risks often necessitate a flexible approach to emergency management at several levels of a disaster response system, for example, in hospitals. Sweden, and possibly other countries, has limited possibilities of surge capacity in the management of large-scale disasters and emergencies, which necessitates a local/national partnership and a flexible local disaster and contingency plan. This study evaluates the opinions of a selected managerial group, both at operative and strategic levels, regarding possible changes in a major hospital’s contingency plan during the ongoing COVID-19 pandemic. Semistructured interviews were conducted to explore the elements of surge capacity and an operational tool, consisting of command and control, safety, communication, assessment, triage, treatment, and transport. The results show a need to create feasible management methods that can be evaluated, establish clear leadership, put preparedness as a constant point on the highest managerial agenda, improve external monitoring, and create a regional coordinating center. Furthermore, the results emphasize the significant role played by the incident command system and qualified leadership to facilitate competent and crucial medical decision making, as well as to provide reliable communication, collaboration, and coordination in a multi-agency response system during dynamic and unexpected emergencies. These steps enable a constant connection between reactive contingency plans and the proactivity in continuous risk assessment and enhance the flexibility of the contingency plans.
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Affiliation(s)
- Ingela Wennman
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 413 46, Gothenburg, Sweden
| | - Catharina Jacobson
- Preparedness Unit, Sahlgrenska University Hospital, 413 05 Gothenburg, Sweden
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 413 46, Gothenburg, Sweden
| | - Anders Hyltander
- Preparedness Unit, Sahlgrenska University Hospital, 413 05 Gothenburg, Sweden
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45, Gothenburg, Sweden
| | - Amir Khorram-Manesh
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 413 46, Gothenburg, Sweden
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45, Gothenburg, Sweden
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The Feasibility of Implementing the Flexible Surge Capacity Concept in Bangkok: Willing Participants and Educational Gaps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157793. [PMID: 34360083 PMCID: PMC8345441 DOI: 10.3390/ijerph18157793] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022]
Abstract
The management of emergencies consists of a chain of actions with the support of staff, stuff, structure, and system, i.e., surge capacity. However, whenever the needs exceed the present resources, there should be flexibility in the system to employ other resources within communities, i.e., flexible surge capacity (FSC). This study aimed to investigate the possibility of creating alternative care facilities (ACFs) to relieve hospitals in Bangkok, Thailand. Using a Swedish questionnaire, quantitative data were compiled from facilities of interest and were completed with qualitative data obtained from interviews with key informants. Increasing interest to take part in a FSC system was identified among those interviewed. All medical facilities indicated an interest in offering minor treatments, while a select few expressed interest in offering psychosocial support or patient stabilization before transport to major hospitals and minor operations. The non-medical facilities interviewed proposed to serve food and provide spaces for the housing of victims. The lack of knowledge and scarcity of medical instruments and materials were some of the barriers to implementing the FSC response system. Despite some shortcomings, FSC seems to be applicable in Thailand. There is a need for educational initiatives, as well as a financial contingency to grant the sustainability of FSC.
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Disasters and Public Health Emergencies—Current Perspectives in Preparedness and Response. SUSTAINABILITY 2020. [DOI: 10.3390/su12208561] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Disasters and public health emergencies are inevitable and can happen anywhere and anytime [...]
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Goniewicz K, Burkle FM, Khorram-Manesh A. The gap of knowledge and skill - One reason for unsuccessful management of mass casualty incidents and disasters. Am J Emerg Med 2020; 46:744-745. [PMID: 33036863 DOI: 10.1016/j.ajem.2020.09.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08-521 Dęblin, Poland.
| | - Frederick M Burkle
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden; Department of Development and Research, Armed Forces Center for Defense Medicine, Gothenburg, 426 76, Västra Frölunda, Sweden
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Alternative Leadership in Flexible Surge Capacity—The Perceived Impact of Tabletop Simulation Exercises on Thai Emergency Physicians Capability to Manage a Major Incident. SUSTAINABILITY 2020. [DOI: 10.3390/su12156216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Flexible surge capacity aims to activate and utilize other resources than normally are surged in a community during the primary and secondary surge capacity. The presence of alternative leadership, skilled and knowledgeable in hospital and prehospital emergency management, is invaluable. Thai emergency physicians work at both levels, emphasizing their important role in emergency management of any source in a disaster-prone country. We aimed to investigate Thai emergency physicians’ ability in terms of knowledge and preparedness to manage potential emergencies using tabletop simulation exercises. Using an established method for training collaboration, two training courses were arranged for over 50 Thai emergency physicians, who were divided into three teams of prehospital, hospital, and incident command groups. Three scenarios of a terror attack along with a bomb explosion, riot, and shooting, and high building fire were presented, and the participants’ performance was evaluated regarding their preparedness, response and gained knowledge. Two senior observers followed the leadership characteristic in particular. Thai physicians’ perceived ability in command and control, communication, collaboration, coordination, and situation assessment improved in all groups systematically. New perspectives and innovative measures were presented by participants, which improved the overall management on the final day. Tabletop simulation exercise increased the perceived ability, knowledge, and attitude of Thai emergency physicians in managing major incidents and disasters. It also enabled them to lead emergency management in a situation when alternative leadership is a necessity as part of the concept of a flexible surge capacity response system.
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