Week 1 Flashcards
Do disasters contribute a large amount to the overall global burden of injury?
No.
Disasters are a small contributor to the global burden of injury
What is the definition of a disaster?
A disruption of the human ecology, which the affected population cannot overcome within its own resources. Stricken community needs extraordinary effort to cope with it, often with outside help or international aid.
Are disaster natural or man-made?
All disasters are man-made.
As a result of where people live, how they live and factors such as poverty and poor access to healthcare/poor health.
What is the main threat to health as a result of disaster?
Mass movement of people.
Brings with it complications of epidemics.
How many deaths occurred between 1975-2000 as a result of disasters?
3 million
By 2100, out of 23 major cities globally (with 10 million+ inhabitants), how many will of them will be within at-risk zones?
17
Give 3 examples of Major Natural Disasters since 2003.
Indian Ocean Tsunami 2004
Pakistan Earthquake 2015
Haiti 2010
What is the name given to the region between Asia/Oceania and the Americas where the most Earthquakes take place?
Circum-Pacific Belt
Rank the following from 1-4 with regards to which is the most important in disaster response: Communcations Transport Power Emergency Medical Aid
- Power
- Communications
- Transport
- Emergency Medical Aid
1-3 can be interchanged - emphasis on them being more important to restore/repair over emergency medical aid. Idea of limiting further loss of life and helping to save currently endangered lives.
Name 3 types of specifically man-made disasters.
War
Terrorism
Transport
Technological (Air pollution, chemical releases, fires and nuclear incidents)
What percentage of man-made disasters occur in the developing World?
95%
What is the definition of a complex emergency?
A humanitarian crisis in a country, region or society caused by conflict (internal/external) leading to a breakdown in effective authority requiring an international response that exceeds the capacity of any single agency.
Another definition is a complex emergency is a combination of: natural disaster, conflict, famine, mass population movement, social & political breakdown that occurs at the same time.
At an estimate how many people were killed and how many were injured in the Haiti Earthquake of 2010?
200,000 killed
300,000 injured
What were the macro-economic results of the Haiti Earthquake?
Substantial Economic Losses Debt High Inflation Unemployment Insured Losses
How many people currently are at risk/exposed to disaster?
2 Billion
How many people are currently living in crisis conditions?
20 million
What is in place in most developed countries in order to deal with major disasters?
Disaster/Major incident plans that have been well practiced.
What region of the world suffers with a drastic shortfall in surgeons?
East Africa - 0.25 surgeons per 100,000 population.
What is the proportion of Orthopaedic surgeons in developed countries?
80%
26 out of 191 countries
How many wars/armed conflicts have occurred since 1945?
160
How many wars/armed conflicts are currently occurring?
50
Name 5 issues regarding the delivery of emergency disaster assistance that occurred in Haiti.
- Chaotic aftermath of natural disaster
- Local infrastrcuture and resource overwhelmed
- Delayed & inaccurate assessment
- Lack of coordination between agencies / govts
- Competition between NGOs
- Inefficiency, duplication
- Lack of accountability
- Short term volunteers, no continuity of care
How did the UN Cluster System come about?
As a recommendation from the 2005 UN review of global humanitarian system which stated:
- Coordination be strengthened
- Formation of a Central emergency response fund
What are the aims of the UN Cluster System?
- Increase capacity
- Leadership (WHO for health, UNHCR for IDPs, WFP in logistics))
- Agreed objectives
- Accountability
- Field-level coordination
Where was the UN Cluster System first implemented?
Pakistan Earthquake
Who is the UN Cluster System accountable to?
UN Emergency Relief Co-ordinator - Chair - Stephen O’Brien.
How many Global Clusters make up the Cluster System?
11
How many Global Clusters make up the Cluster System?
11
Name 1 Major Aid Organisation that does not participate/operate within the UN Cluster System
ICRC
MSF
What does DFID stand for?
Department For International Development
What is another name for DFID?
UKAID
How does DFID co-ordinate its aid delivery?
Through partners such as ECHO and ICRC.
Small donations to CHASE OT and UKISAR
What does DEC stand for?
Disasters and Emergencies Committee
Describe the structure of the DEC
Up to 15 charities working in the disaster field (14 currently)
Joint fundraising
Give 3 aims of the DEC
Co-operation
Co-ordination
Accountability
Effectiveness
State the requirements for membership of the DEC (3)
- Income > £4m / yr
- Emergency work > £10m / yr
- Good governance
What is the Crisp report?
A report as part of UK contribution to Global Health Partnership in Developing Countries
When was the CRISP report published?
February 2007
What did the Crisp Report recommend?
- Links between NHS & developing world (THET)
- Education & training
- Improved UK medical response to disasters ( database, coordination, release of staff)
How many organisations were operating in Haiti 1 month after the Earthquake in 2010 (and how many were in the health field)?
600
274 in health field
What is the UKIETR?
UK Emergency Trauma Register
Up to date register of accredited and trained volunteers hosted by UKAID
What is the Humanitarian Emergency Response Review (HERR)?
A report in 2011 chaired by Paddy Ashdown commissioned by the Secretary of State which provided recommendations about how to change and improve the UK’s response to Humanitarian crises.
Give 3 examples of recommendations by the HERR.
Anticiptation Leadership Innovation Accountability Partnership Resilience
What does FMT stand for?
Foreign Medical Team
What saves most lives; Local Healthcare provisions or FMT’s?
Local Healthcare Provision - available early, and immediately
FMT’s usually come in days later and tend to deal with longer term injuries, less urgent surgeries etc.
What guideline dictates Military Involvement in Humanitarian Assistance?
Oslo Guidelines - OCHA
Name 3 advantages of military assistance in Humanitarian situations.
- Strategic Planning
- Surge Deployment
- Logistics/Communications
What does DRR stand for and what does it consist of?
Disaster Risk Reduction
- Identifies ‘at-risk’ areas
- Protection of vulnerable populations
- Investment in infrastructure as emergency preparedness
What is the HYOGO Framework?
World conference in Japan 2005, idea of building nations resilience to disasters by 2015 - 168 signatories
Name the 5 Priorities of the HYOGO Framework.
- DRR as a national/local priority
- Assess risks, enhance early warning
- Innovate/educate to build resilience
- Reduce risk factors
- Strengthen disaster preparedness
Name the framework that has superceded the HYOGO framework.
Sendai Framework 2015-2030
What is the main aim of Disaster Risk Reduction?
Mitigate the injury burden.
What is a Typhoon?
A mature tropical cyclone
Name 3 factors that a require for Typhoon formation.
Warm Sea Temperature
Atmospheric Instability
High Humidity
Coriolis Force
Which country(ies) did Typhoon Haiyan affect?
6 countries, mainly The Philippines, but also, Micronesia, China, Taiwan, Palau and Vietnam.
What is the definition of Epidemiology?
Epidemiology is the study and analysis of the patterns, causes, and effects of health and disease conditions in defined populations.
Define Conflict
Force (implied or actual); process of organised violence of one group against another; thus involves injury and death- these are inherent
What is the main aim of conflict?
– to defeat another human being(s) to change action and ULTIMATLEY alter perceptions
What is the difference in the traditional idea of war compared to wars of late with regards to the parties involved and their statuses?
Wars traditionally between states/act by a sovereign state
Conflict often intra-state or undeclared wars nowadays.
Name two key terror tools used in conflict.
Rape and Massacre.
Name the 2 absolutes of war and describe what they are.
Pacifist - No violence/conflict can ever be justified
Holy War - Actions in the name of a supreme being permit the overriding of normal human conduct.
MUTUALLY EXCLUSIVE
Describe ‘Jus In Bello’ and ‘Jus Ad Bellum’
Jus In Bello - regulates the conduct of parties engaged in an armed conflict - IHL is synonymous
Jus Ad Bellum - Right To War - is a set of criteria that are to be consulted before engaging in war in order to determine whether entering into war is permissible, that is, whether it is a just war.
What are the 5 conditions that satisfy the concept of a Just War?
Describe them.
- Proper authority
The principle of right authority suggests that a war is just only if waged by a legitimate authority. Such authority is rooted in the notion of state sovereignty.[2] - Just cause / Right intention
According to the principle of right intention, the aim of war must not be to pursue narrowly defined national interests, but rather to re-establish a just peace. This state of peace should be preferable to the conditions that would have prevailed had the war not occurred. - Probability of Success
According to this principle, there must be good grounds for concluding that aims of the just war are achievable.[2] This principle emphasizes that mass violence must not be undertaken if it is unlikely to secure the just cause.[3] - Proportionality
The principle of proportionality stipulates that the violence used in the war must be proportional to the attack suffered. For example, if one nation invades and seizes the land of another nation, this second nation has just cause for a counterattack in order to retrieve its land. However, if this second nation invades the first, reclaims its territory, and then also annexes the first nation, such military action is disproportional. - Last resort
The principle of last resort stipulates that all non-violent options must first be exhausted before the use of force can be justified.
Name 2 War Ethical Viewpoints and their founders.
- Sun Tsu, The Art of War (China, 600 BC)
- match and exploit enemy weakness (not strength)
- manoeuvrist approach: avoid bloodshed
- central psychological element - Von Clausewitz (Prussia, 19th Century)
- war an extension of politics
- combat hardens perceptions
- politicians required to stay dispassionate - Mao & Giap
- revolutionary: end justifies means
- terror and intimidation with reward
Name 4 traditional concepts of war and describe them.
Symmetrical – similar power, resources and strategies (varying execution); though there is always a cost of resources
Asymmetrical (Mack 1975)– imbalance in forces, and/or strategies eg established army and resistance (undermanned and underequipped) – insurgency/terrorist as well as counterinsurgency/terrorism
Protracted struggle – weaker party need to avoid strength of stronger appointment – thus draw it out to drive down enemy resources, perfected by Mao eg vietnam – Giap maintained the vietnamese could maintain being killed longer than Americans could maintain killing
Manoeuvrist Approach vs attrition (exploiting uncertainty)
Technocentric war – First seen in the gulf, reluctance to engage enemy directly, work at arms length through increased precision technology and acquisition/reconnaissance/
surveillance, platform will be aerial/air with change in military orthodoxy away from army and navy.
Give 2 examples of conflicts involving ethic violence.
Rwanda, Croatia, Bosnia, Kosovo.
Give 2 examples of conflicts involving civil violence.
East Timor, Sudan
Arab Spring:Egypt, Syria
Post-interstate war: Iraq, Afghanistan
Give 2 examples of inter-state wars.
Iraq & Afghanistan
What is the defining feature of Modern Era Warfare?
Terrorism - intra-state conflicts as a result of the emergence of non-state actors and international terrorist groups.
What is the underlying cause of Modern Era warfare?
Globalisation
Define Globalisation.
The process by which businesses or other organizations develop international influence or start operating on an international scale.
Name 3 Threats to the ‘West’
Bombings including suicide bombings
CBRN threats including (Dirty bombs, Chemical 7, Biological attacks, Chimeras)
Cyber warfare
Hybrid warfare
What are the issues with international law in legislating global conflict? (Name at least 2)
It is a blunt tool, used to attempt to solve complex states of warfare.
Rarely universal consensus on it.
No enforcement within a state.
Extra-state enforcement politically-dependent.
Describe the spectrum of conflict and give examples with each.
LOWEST: Military Assistance (early Vietnam)
Humanitarian Operations (Early Balkans)
Peace Support Operations (Balkans later)
Low intensity Operations (Britain’s Colonial Wars)
Mid Intensity Operations (Falklands war – Limited use of available weapons)
HIGHEST: High Intensity Operations (Iraq 2003 - Full and Integrated use of full range of weapons)
What is Lund’s curve used to describe?
Lund’s Curve of Conflict helps visualize how conflicts typically evolve over time and how different phases of conflict relate to one another.
What are the main 5 parts of the Conflict Analysis Framework?
- Actors
- Root causes
- Issues, scope and stage
- Power, resources and relationships
- History of the Relationship
Name 3 characteristics of a failed state.
- Failure of state sovereignty
- Loss of authority for enforcing legislature
- Loss of sole legimate use of force
- Non provision of public service
- Reduced interaction with international community.
What are the consequences of a failed state?
- Corruption
- Intervention by non-state actors such as terrorist groups or militias
- IDP’s
- Economic Decline.
What are the 8 Millenium Goals and who are they championed by?
UN
- Eradicate extreme poverty and hunger. …
- Achieve universal primary education. …
- Promote gender equality and empower women. …
- Reduce child mortality. …
- Improve maternal health. ..
- Combat HIV/AIDS, malaria and other diseases. …
- Ensure environmental sustainability. …
- Develop a global partnership for development.
Give 4 alternative ways of dealing with conflict.
- Deal with world poverty
- Resolve civil conflicts before they inter-nationalise
- Interdicting terrorist & rogue state funding
- Focus on recruitment & radicalisation
- Pressuring totalitarian and authoritarian states
- Look at wider causes and consequences of conflict
Name 4 characteristics of a leader.
Team builder
Self knowledge
Integrity
Life-long learner
Good communicator
Have clear vision
Have a clear strategy
Decision maker
Risk taker
Motivator
What is Dwight D. Eisenhower’s definition of leadership?
“….the art of getting someone else to do something you want done because he (she) wants to do it”.
What is the difference between leadership and management?
Management - concerend with the organisation of resources
Leadership - Concerned with organisation of people/
Give an example of 5 leadership styles
Charismatic - personality driven ‘I’d follow him/her anywhere’
Participative - hands-on
Situational
Transactional - reward or punish
Transformational - redirect subordinates’ needs & thinking. Tend to challenge & inspire
Authoritarian - close control. Often have distinctive professional relationship alongside direct supervision
Democratic - share decision-making
Free rein aka laissez faire
delegate, but provide little or no direction ,or support
Name the 3 styles of leadership which come together to form the ‘perfect leader’?
Authoritarian
Delegative
Participative
What are the 3 roles that the RMA (Royal Marines Association) considers leadership to encompass?
Command - controlling directing
Organise - Whats to be done and doing it
Manage men - Look after your people.
Name 3 practical issues with leadership and describe them
Mission analysis - Questioning, contigency preparation
Team Selection - Fit for task
Team Preparation - What ifs, so whats, rehearsal of contingency.
Name the seven secrets of a successful leader.
- Sensitive to followers
- Positive and inspirational
- Treat followers with respect
- Meeting staff expectations
- Avoidance of arrogance
- Support staff
- A good listener
What is meant by ABC?
BATLS - Resus
C - Catastrophic Haemorrhage
A - Airway
B - Breathing
C - Circulation
What is meant by Right-Turn Resuscitation?
Afghanistan war - refers to Army camp hospital where patients in seriously bad conditions are taken down the corridor and to the right which was a hybrid resus/operating theatre.
What is the trimodal death/life distribution?
A military BATLS concept:
KIA
Severe but potentially survivable injuries
Moderate to minor injuries
What is the two main aims of the damage control resusciation continuum?
Aim to maximise tissue oxygenation
Minimise blood loss.
Name 3 methods by which Damage control resuscitation is achieved?
BATLS
Advanced in-transit care
Haemostatic resuscitation
Consultant-based ED care
Tourniquet
Novel Haemostatics - Chitosan
Describe the 4 types of treatment priorities.
- T1 Immediate treatment
require emergency life-saving resus and/or surgery that is not time consuming & has a good chance of survival - T2 Delayed treatment
require major surgery/medical Rx but can wait after receiving sustaining Rx, e g, I V fluids, splintage, antibiotics. Examples: long bones; joint injury; burns. - T3 Minimal treatment
relatively minor injuries & longer delay is not life threatening. Can effectively take care of themselves or be helped by untrained people. - T4 Expectant treatment
multiply injuries, need time/materiel consuming Rx. Given supportive Rx
Why are good leadership skills essential in an austere hospital environment with regards to conflicts in a team?
Give examples of the type of conflicts/incidents that occur and how they are solved.
These conflicts must be avoided for efficient workings of a team.
Examples:
Difficult colleagues - There is not the space for interpersonal conflicts - “You are an important component, but a replaceable component”
Patient safety incidents - NHS culture pervasive - Build staff trust
High visibility + openness, be prepared to tackle difficult problems, be fair and decisive.
Name 5 potential issues to keep in mind regarding practising in a foreign environment
Culture
Language
Scope of practice
Guidelines
Governance
Why is a shorter ‘power distance index’ good in practice?
Idea that colleagues are more equal, nurses questioning doctors etc.
What 2 requirements should be taken into account when choosing a DMD?
Must have a deep knowledge of emerging trends and latest practices
Must have confidence to interdict in any area of system failure
What is the triad of death?
Coagulopathy - Hypothermia and Metabolic Acidosis
What is the idea for producing the weapon that causes the most damage?
Increasing the amount of energy it dumps in the body AKA high energy transfer weapons.
What is the difference between low energy transfer and high energy transfer bullets?
Low energy transfer bullets pass through the body - less damage.
High energy transfer stay lodged in the body, increased retardation - more damage.
What is the formula for Kinetic Energy, Mass and Velocity?
E = MV2/2
What type of transfer results in a differing in the wound track from its trajectory?
High energy transfer
What are the 2 element of a blast wave and what are their characteristics?
Shock Wave - Travels at >330m/s, high overpressures, short duration
Dynamic Overpressure - Moves objects due to gas flow, follows the shock wave - in the direction of the explosive products.
What is an EFP?
Explosively Formed Projectile
What is the relationship between Shock Wave Overpressure and Distance?
Shock wave overpressure decays rapidly with distance
Describe the interation between blast waves and the body.
Accelerates the body wall
Propagates through tissues as a pressure (stress) wave
Loses energy at air or gas/tissue interfaces such as the lungs.
