Search results

The purpose of this paper is to systematically review published literature for the research question “what issues are considered (and changes made) for vulnerable groups as part of the chemical, biological, radiological, nuclear or explosive (CBRNe) response for casualty collection, decontamination, triage and casualty clearing processes?”.

Seven-stage framework from the PRISMA statement for research question, eligibility (definition), search, identification of relevant papers from title and abstract, selection and retrieval of papers, appraisal and synthesis. Data sources: Medline, Embase, Cochrane Library, Web of Science, Scopus (Elsevier), Chemical Abstracts, Assia (Proquest), Sociological abstracts (Proquest), Cinahl, HMIC, Health business elite, PsycInfo (ebsco), PILOTS (Proquest) and supplemented by other search strategies (e.g. exploding reference lists). The included references were critically appraised using the mixed methods appraisal tool (MMAT).

Results: 1,855 papers were returned from the literature search, of which 221 were screened by abstract and 48 by full paper. In total, 11 papers were included for appraisal, of which three achieved a quality score of 50 per cent or over. The papers were categorised into three phases on CBRNe response; evacuation, triage and decontamination.

The limitations of the search process included the use of emerging exclusion criteria. This may have excluded research that would provide more information in some topic areas but it was felt necessary to set a high publication standard for inclusion to generate trustworthy results and recommendations. The MMAT appraisal tool has been validated for different study types and provided a useful categorisation approach for critical appraisal, albeit resulting in only three included studies. Future reviews could include papers published in a wider range of languages to include research from non-English sources.

These evidence-based results should be used by practitioners to review current operational policies for vulnerable people and plan future improvements. Evacuation accessibility can be described as characteristics for exit, route and obstacles. This takes a systems approach to consider how building planning and layout can have implications for safety critical but low frequency events. Decontamination recommendations include: at least one additional re-robe section per mass decontamination unit and adaptations to the decontamination plan including accessible equipment for non-ambulatory individuals; and additional (specialist) staff in the decontamination team (sign language, interpreters and physical therapists).

Although very little new medium/high quality research is available, the findings are summarised as considerations for building design (route choice and information), communication (including vision, hearing and language differences) and the composition of the response team. It is suggested that evidence-based practice from other care domains could be considered (patient movement and handling) for fire service and ambulance guidelines.

This study describes preparedness of emergency physicians and general practitioners following chemical, radiological and nuclear incidents.

Five emergency physicians and six general practitioners were interviewed individually, and data was analysed using qualitative content analysis.

The study results showed that physicians' preparedness for chemical, radiological and nuclear incidents is linked to one main category: to be an expert and to seek expertise and two categories: preparations before receiving CRN patients, and physical examination and treatment of CRN patients with subcategories.

The results have implications for further research on the complexity of generalist vs specialist competence and knowledge when responding to chemical, radiological and nuclear incidents.

This study provides insights regarding chemical, radiological and nuclear preparedness among physicians at emergency departments and primary healthcare centres.

The purpose of this paper is to set forth a rigorous methodology for building owners and managers to conduct a vulnerability assessment of their facilities. Such a process would facilitate the use of remediation measures to limit the loss of life and property during a disaster, whether natural or man‐made.

The author sets forth nine criteria to conduct a vulnerability assessment, along with a six‐point rating system. The criteria selected are: the level of visibility, the criticality of the site to the jurisdiction in which it is located, the impact of the site outside of the jurisdiction in which it is located, access to the site, size hazards, building height, type of construction, site population capacity, and the potential for collateral mass casualties. This evaluative process leads to five site vulnerability ratings, ranked as follows: negligible, low, medium, high, and critical.

Property owners and building managers can use this process to assess the vulnerability of their facilities and, based on this process and the resulting vulnerability rating, initiate common‐sense remediation measures to limit the loss of life and property, should a disaster occur.

The field of vulnerability assessment is a new discipline within the evolving subject of homeland security. Other methodologies will be needed in the future to determine the vulnerability of other public and private facilities, such as ports, airports, transportation centers, hospitals, colleges and universities, and other vital public and private facilities.

This research provides a framework for future research on the topic of vulnerability assessments. Refinements and modifications can be made to the proposed methodology (both to the vulnerability assessment criteria and to the vulnerability ratings).

This paper provides original research and sets forth a new methodology for conducting vulnerability assessments of public and private buildings.

The purpose of this paper is to analyse how the police, the rescue services and the emergency medical services perceive the threat of terrorism and preparedness for a terrorist-induced crisis. It also aims to unravel differences among the emergency organizations and to discuss their potential implications for emergency preparedness.

Data were collected using a questionnaire distributed to operational personnel from the emergency services in eight Swedish counties; 864 responses were received and analysed.

There were significant differences between the police, rescue and ambulance services regarding perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence with tasks to be performed on-scene. Perceived likelihood of events appeared affected by institutional logic; events within their respective domain of responsibility were perceived as more likely. The police stood out in many aspects, with more personnel with experience of violence on duty and a high grading of the probability of terrorist attacks compared to the other organizations. Fewer police had high estimates of their organizations’ management capability and knowledge of tasks on-scene.

Differences in perspectives of terrorism preparedness and response among the emergency services were shown, highlighting the importance of enabling inter-organizational insights on safety culture, with risk awareness and management strategies, as well as knowledge of the other organizations’ institutional logics and main tasks, so as to achieve an effective, collaborative response to terrorism-induced crises.

Little research has been conducted comparatively with regard to the emergency services and their perceptions of terrorism-specific threats and preparedness, particularly in the Swedish context.

The purpose of this paper is to analyse factors influencing perceptions of preparedness in the response to terrorist attacks of operational personnel in Swedish emergency organizations.

Data were collected using a questionnaire distributed to operational personnel from the police, rescue and ambulance services in eight Swedish counties; 864 responses were received and analysed.

Three aspects of the perception of preparedness for terrorist attacks among Swedish emergency responders were studied: willingness to respond; level of confidence with tasks; and estimated management capability. Factors which positively influenced these perceptions were male sex, training in first aid and dealing with mass casualty incidents, terrorism-related management training (MT), table-top simulations, participation in functional exercises, and access to personal protective equipment (PPE); work experience was inversely related. Occupation in police or rescue services was positively associated with willingness to respond whereas occupation within the emergency medical services was positively associated with estimated management capability.

These findings show that terrorism-related MT and access to PPE increase the perceptions of preparedness for terrorism among the emergency services, aiding judgements about investments in preparedness by crisis management planners.

Limited research in disaster management and hazard preparedness has been conducted in a European context, especially regarding terrorism. Little is known about aspects of preparedness for terrorism in Sweden, particularly from the perspective of the emergency responders.

Several emergency public health issues have a tremendous impact on and rely upon close coordination with law enforcement officials. Most interactions involve law enforcement personnel providing security, crowd control, and/or traffic control during public health related incidents. However, as varied chemical and biological threats have emerged over the years, this interaction has increased to include joint investigations between the two disciplines. Certain biological threats, such as pandemics, pose direct threats to the law enforcement agency operations. Understanding the role of public health in emergencies, the overlapping missions, and the threats at all levels allows law enforcement professionals to better prepare themselves and their organizations for coordinating operations and maintaining continuity of law enforcement services.

Health care organizations are accustomed to rapid and often discontinuous environmental change. Even when contemplating large scale change including the decisions to merge or integrate operations, health care managers can draw upon the expertise and advise of peers who have gone through similar experiences. However a bioterror event is a class of change that represents something totally unplanned and for which the industry has little or no experience in confronting. The objective for health care organizations is to mitigate the effects of this type of an event. Specific ideas for taking systems oriented, network-centric approach to disaster planning are provided.

Reports from small‐scale incidents in which decontamination was conducted suggest that a successful communication strategy is vital in order to increase public compliance with, and reduce public anxiety about, decontamination. However, it has not been possible to examine public behaviour during large scale incidents involving decontamination. The aim of the research reported here was to examine the relationship between people's positive perceptions of responding agencies’ communication strategies and relevant outcome variables, such as level of compliance and level of reassurance, in several field exercises involving mass decontamination.

Data were collected using feedback questionnaires completed by simulated casualties, which contained items relating to casualties’ perceptions of the success of responding agencies’ communication strategies, their confidence in emergency responders, and their compliance with the decontamination process. Path analysis was used to examine the relationships between variables.

Results show a significant relationship between responding agencies’ communication strategies, level of public reassurance, and level of public compliance. The relationship between responders’ communication strategies and the outcome variables was partially mediated by public confidence in responders.

Emergency responders should focus on communication with members of the public as a key element of the decontamination process, as failure to do so could result in high levels of anxiety and low levels of compliance among those who are affected.

This research highlights the importance of effective responder communication strategies. Further, findings indicate the value of examining feedback from field exercises in order to facilitate a greater understanding of public experiences of the decontamination process.

The purpose of this paper is to show the evolution of the concept “state of preparedness” into “state of resilience” in the context of emergency management, and the implications raised by this new concept.

This paper is a literature review (scientific and governmental) of the most important articles in the field of state of preparedness evaluation.

This article presents two trends in the state of preparedness evaluation: response capability and preparation management. These two trends contribute to the evolution of the concept “state of preparedness” into “state of resilience”, a state that is defined as the ability of a system to maintain or restore an acceptable level of functioning despite disruptions and failures.

This literature review helps define the concept of “state of preparedness” (in terms of both management and response capability) as the new trend of resilience.