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A health trust boss has warned that an "accelerating financial disaster" could hit patient care and cripple hospital budgets next year.
In an article for the Guardian, Christopher Smallwood, chairman of St George's Hospital Trust in London, says the financial burdens could leave NHS employees unpaid in 2016.
Mr Smallwood claimed hospitals were short of staff and unable to meet waiting-time targets for cancer and A&E care due to years of underfunding.
He also accused ministers of being "in denial" when it came to the seriousness of the situation, describing Health Secretary Jeremy Hunt's request that the NHS delivers ?22bn of efficiency savings by 2020 as "for the birds". A spokesman for NHS England said: "Each year the NHS faces greater demand on its services and it continues to successfully look after this growing number of patients. The Department of Health defended the NHS as one of the safest health care systems in the world. A spokeswoman said: "There is no denial that the environment is tough but the NHS must deliver its side of the plan with cost-controlling measures like clamping down on rip-off staffing agencies and expensive management consultants. Between last November and February, the service dealt with 190,000 extra A&E attendances - or a rise of 3% on the previous year.
Professor Chris Ham, chief executive of the King's Fund health think-tank, backed Mr Smallwood's views. He told The Guardian "everyone involved in the NHS" would see his views as an accurate representation of the problems. Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK. We searched Medline, CINAHL and Scopus for papers about the health impacts of power outages during extreme events published in 2011-2012. This work was carried out within the EU project ‘‘Public Health Adaptation Strategies to Extreme weather events – PHASE’’ (contract number EAHC 20101103).
In the first three months of 2013, over one million people were reported to be affected by power outages due to extreme events1 . Extreme weather events and other natural hazards are increasing in frequency and impact due to urbanisation6, and have been shown to have an adverse effect on critical infrastructure including water and sewage treatment, transportation and power supply.
Society’s growing demand for power has extended to the health sector, which is more and more dependent upon electricity to operate safely. The aim of this paper is to identify and describe the health impacts of power outages during extreme events, with the intention of identifying gaps in knowledge and shaping future research strategies. The content of the published peer reviewed literature from 2011 to 2012 was identified and analysed in order to build material for an initial assessment. Two authors selected relevant abstracts and one author extracted information on the health impacts of power outages and grouped the information into the broad themes of hospital impacts, healthcare impacts, community health impacts and impact on public health infrastructure.
Recognising the paucity of the data collected by the systematic review it was decided to undertake a further search to find more evidence on the frequency of reported extreme event power outages. Review of Extreme Events Bulletins: reports of extreme events associated power outages during the first quarter of 2013. Fifty two power outages were identified across nineteen countries in this study, all of which occurred as a direct result of extreme events.
Of the initial 125 papers identified through the keyword search, 8 duplicates were removed and 91 papers were excluded from the investigation because they were found to be not relevant from closer scrutiny of the title and abstract. Figure 2 summarises the flow of articles during the search process as per the PRISMA guidelines8.
The evidence level for the reviewed articles, according to SIGN guidelines, is summarised in Table 4 below. As can be seen by Table 4 above, the evidence base in this field is poor, with most of the literature being expert opinion. Another study explains that when the Christchurch earthquake occurred, the Christchurch Intensive Care Unit (ICU) was staffed to take 15 ventilated patients16.
Many health impacts (for example loss of transport and communication) were evident across different settings and a complex web of interactions was revealed in the literature. Communications systems were ‘overloaded and not working’ – therefore staff were unable to judge the extent of the event and prepare16. Hospital infrastructure dependent on electricity:Heating, cooling, gas and air handling, washing linen and dishes, cooking. Loss of safety mechanisms – national parks were shut due to loss of fire suppression systems.
Despite power outages being a significant public health issue with a considerable impact on health, to date very little has been published regarding this issue in the peer reviewed literature. There were fifty two reports of power outages across nineteen countries caused by extreme events during the first three months of 2013. The surprisingly high number of power outages reported in the PHE Extreme Events Bulletin is likely to be an under-representation of worldwide power outages. The literature suggests that during an extreme event, not only do hospitals have to deal with the usual intake of patients, but also with disaster related patients and patients with chronic illnesses who do not have access to the medical technologies they need12,13,16. In an era of increasing digitalisation of patient records, accessing electronic patient records and generating patient identifiers can be problematic without power16. The complexities of interactions between power and other aspects of society cannot be underestimated. Even in the community setting, light prevents accidents in the home and provides a measure of comfort and reassurance to people who are otherwise alone and vulnerable. Incorrect use of generators during extreme events has led to peaks in carbon monoxide poisoning21,22,23,24,25,29.
Power outages leading to an increase in diarrhoeal diseases has been documented in the past37. Several issues were not discussed in the peer reviewed literature but became apparent through discussions with colleagues and reading of the wider grey literature. The confusion and agitation felt by patients with dementia when faced with sudden, unexplained darkness can be imagined, though not documented in the literature.
Most hospital generators are set to provide back up power for only 8 hours, but major power outages frequently last much longer.
Many medicines should be stored at 4- 25 ?C, which can be problematic in the community and in healthcare settings, if power outages occur during heat waves. An overall approach to resilient hospital power supplies was suggested by the UK Department of Health, with the use of standby generators being just one aspect of resilience30. Some authors have made suggestions on how proper planning can mitigate the effects of power outages on health.
Another study suggests that power companies should have a list of patients using medical technologies in the community, so that their power needs can be prioritised in the event of an emergency9.
Awareness of alternative methods of managing chronic diseases during emergencies needs to be increased amongst patients and healthcare providers. Within secondary care, although many hospitals will have backup generators which supply power in the event of an emergency, this is not in itself a panacea. One study suggests that hospitals must plan for longer term power losses, when washing, cleaning, communications and cooking could also be affected, as power is redirected to clinical areas17. One study advises that policies to decrease dependence on traditional sources of power are needed and the experience and ingenuity of those living and working in resource poor settings could be invaluable9.
The literature search revealed a dearth of high quality research in this field, with most of the published articles being evidence level 3 and 4. Publication bias in the peer reviewed literature, the grey literature and the media needs to be considered.
Inconsistency in terminology when describing extreme events and health impacts is another limitation. Although there are descriptions of power outages in extreme events and the health impacts can be gleaned from these accounts, there are very few attempts to quantify health impacts in terms of morbidity, mortality or quality of life.
As with any public health issue, a key question is how to influence and change people’s behaviour, especially in extreme situations where people are faced with unusual stressors.
Scientific innovation in medical technologies and treatments is needed, so that those with functional needs are more resilient to extreme events. Finally, there is a wealth of experience within the global health community of facing extreme events and solutions which have been successful in overcoming power outages. As far as can be determined, this is the first review of the health impacts of power outages occurring during extreme events.
With scientific consensus predicting an increase in the frequency and magnitude of extreme events due to climate change, the gaps in knowledge identified within this review need to be addressed in order to mitigate the impact of power outages upon global health. Virginia Murray is the head of Extreme Events and Health Protection which would make use of this data in their daily work.
Gros DF, Price M, Gros KS, Paul LA, McCauley JL, Ruggiero KJ, Relations between loss of services and psychiatric symptoms in urban and non-urban settings following a natural disaster, Journal of Psychopathology and Behavioural Assessment, 2012, Vol.
Na foto a esquerda, o centro de San Francisco, no estado da California-EUA, completamente destruido apos o Grande Terremoto de 1906, estimado em 8? Graus na escala Richter. A cidade fica sobre uma grande falha geologica, a Falha de San Andreas, que tambem cruza muito proximo a Los Angeles, cerca de 400 quilometros mais ao Sul.
O terremoto de 11 de marco de 2011, no Japao pode ter deslocado as ilhaa cerca de 2,4 metros, anunciou o Servico Geologico dos Estados Unidos (USGS, na sigla em ingles). Segundo o Instituto, a placa do Pacifico se ajusta anualmente cerca de 83 mm, mas um terremoto de grande magnitude pode move-la consideravelmente, com consequencias catastroficas.
O ANEL DE FOGO (Ring Of Fire) do Pacifico, o encontro entre varias Placas Tectonicas no Oceano Pacifico.
As estrelas em azul marcam os locais dos maiores terremotos nos ultimos 50 anos que atingiram a Placa do Pacifico e o Anel de Fogo.
E novamente em 23 de dezembro de 2011 dois terremotos com intervalo de apenas duas horas, um de 5,3 e o outro de 5,8 graus, destruiram mais um pouco da segunda maior cidade da N.
A Falha de San Andreas que corta o litoral da California de Sul a Norte onde se encontra com a Falha de Juan de Fuca e onde grandes cidades dos EUA se situam: San Francisco, San Diego e Los Angeles. Os 103 milhoes de quilometros quadrados (64 milhoes de milhas quadrados), o relatorio continua, da Placa do Pacifico a transforma na maior placa tectonica do mundo e as forcas agora sendo exercidas sobre ela e por sobre a Falha de Juan de Fuca Plate  (localizada a noroeste da America do Norte ) e San Andreas, mais ao sul, devido aos desastres anteriores no Chile, Nova Zelandia e Japao trouxe o que e chamado de a subduccao da Zona de Cascadia para uma condicao de ruptura total. Um grupo de geologos e sismologos apresentaram uma analogia terrivel dos principais proximos terremotos e de tsunamis – que poderao ocorrer no litoral noroeste dos EUA. Caro Fanilator, para informacoes mais abrangentes, por favor, acesse o LINK.Boa leitura com Muita Luz e Paz.
Por favor, considere apoiar o nosso blog fazendo uma doacao de qualquer valor para nos ajudar em nossos custos. Sua contribuicao ajudara a manter o blog atualizado e em dia com os custos de manutencao, pesquisa, traducao e edicao do que publicamos. Contribua somente se puder, de qualquer pais e moeda, sendo um contribuinte ou nao, a sua visita sera bem-vinda e todos sempre terao acesso as noticias e artigos aqui publicados. The Ontario Mass Evacuation Plan is a supporting plan to the Provincial Emergency Response Plan (PERP). For more information on the legislative framework and authorities, see the PERP available on the EMO website. This plan supports the agreement between the Governments of Ontario and Canada (through the Department of Aboriginal Affairs and Northern Development Canada) to provide emergency response support to First Nation communities in the province. An EMO planning team in consultation with non-governmental organizations, provincial and federal partners developed the plan. This plan is meant to be used to respond to a request for a partial or complete evacuation from one or more communities to one or more host communities. Provincial coordination will involve the evacuating community, host communities, relevant Ontario ministries, federal departments, non-governmental organizations, and others, as required.
This plan is for Ontario’s far north, encompassing municipalities, unorganized territories2 and First Nation communities.
This is an overarching plan for carrying out mass evacuations and as such, many aspects are general in nature4. The Far North of Ontario spans the width of the province, from Manitoba in the west, to James Bay and Quebec in the east.
The far north is subject to several hazards covered under Ontario’s Hazard Identification and Risk Assessment.
The geography of the far north may complicate evacuations or efforts to manage or suppress the hazard. Maintain family and community unity, which is integral to maintaining community cohesion and supports. Potential threats to the communities and emergency responders are critical in determining the urgency of the evacuation and for planning resource mobilization.
Real-time threat assessment should be ongoing and coordinated among partners, particularly ministries with relevant OIC responsibilities and the community(ies) at risk.
An OIC ministry or the PEOC may recommend evacuation, or that it is safe to return, based on a real-time threat assessment.
The availability, duration, type, and location of host community facilities affect planning for the evacuation. Consideration should be given to maintaining the readiness of host communities for future hosting. Evacuating communities should identify Community Evacuation Liaisons for each host community.
The decision to deploy is typically based on requests from impacted communities, the mandate of the organization deploying staff, and staff member’s level of expertise. Depending on the scale and complexity of the operation, a senior provincial official may be deployed to coordinate the provincial response and to liaise with community and other deployed officials. Situational awareness requires continuous coordination to help collect, collate, evaluate, and disseminate information.
When planning for the return of evacuees, the number and location of host communities, and the distance to evacuated communities are key planning considerations.
Roles and responsibilities may pertain to transportation hubs, host communities, support from ministries or the federal government, or responsibilities of evacuating communities. Determine the financial and legislative roles and responsibilities for the evacuation and comply with applicable policies, agreements, procedures, etc. Emergency information needs to be coordinated among the affected communities, province, and federal government.
Once it has been decided that a community needs complete or partial evacuation, the parties involved must establish who the evacuees are, where the host locations are, and what the means of evacuation will be. Following the judgement of the authorized entity that it is safe for evacuees to return, the order of return and the methods of transportation must be established using an inclusive planning process that involves affected communities, provincial and federal partners, and other partners (i.e. Real-time threat assessment is a critical component of evacuation operations and should be ongoing. All responders involved in managing the hazard or participating in the evacuation must regularly communicate situational awareness information to those conducting real-time threat assessments and must report a changing situation as soon as feasible. OIC ministries are responsible for assessing the threat for the types of emergencies they have been assigned. EMO is responsible for real-time threat assessments for hazards that have not been assigned to an OIC ministry.
The PEOC is responsible for assessing the threat based on the real-time threat assessment and characteristics of the community(ies) or region under threat. During routine monitoring, the PEOC duty officer performs the function of real-time threat assessment. OIC ministries routinely monitor conditions in the province according to their assigned type of emergency. Uncertainty in real-time threat assessment is unavoidable, which is why persons with appropriate knowledge of the threat causing the emergency should be involved in the assessment.
During emergencies, the PEOC links with the local community and the OIC ministry acting as provincial lead to coordinate real-time threat assessment information.
Emergency managers must understand the makeup of the population who are to be evacuated before they can make key decisions about transportation modes, route selections, hosting destinations, and the many other elements of an evacuation. Medevac is used for those individuals receiving home care or residing in a health-care facility in the evacuating community that qualify for medical transfer as per the Ambulance Act (evacuation by emergency medical services (EMS) or Ornge). This stage is typically orchestrated through the existing health procedures used in the community. This includes persons with disabilities, seniors, children, pregnant women, and those with medical conditions. Among these, some require attendant care, which means both the caregiver and the Stage 1 evacuee they care for should be on the Stage 1 evacuation list. The designation of evacuees into the different stages will be determined by the First Nation Chief and Council, Head of Council, or appointed person, with the assistance of the on-site health care organization. Different types of hazards may dictate variations in the criteria for these categories (e.g.
The decision to evacuate a community is the responsibility of the First Nation Chief, Head of Council, or appointed person. For First Nations communities, AANDC and PS approve federal assistance to support an evacuation. The urgency of an evacuation is determined based on the immediacy of the threat to the community (life, safety, health, and welfare), the resilience of the community, and (depending on the nature of the threat) the availability of resources for evacuation or shelter-in-place10. Evacuations may take place prior to (pre-emptive), during, or after an incident has occurred. Given adequate warning about a hazard, adequate resources, and the likelihood of the threat actually impacting a community, it is advisable to conduct pre-emptive evacuations. If adequate resources are not available to conduct a pre-emptive evacuation, it may still be possible and necessary to carry out an evacuation even while a threat is already affecting a community.
If recommending enhanced monitoring or activation of the PEOC, consider what positions must be staffed to conduct the evacuation. Alert PS of the situation and advise them if Government of Canada support may be required to assist. Establish a regular information cycle and contact for evacuating communities, host communities, and other parties assisting with the evacuation. Consider requesting additional host communities stand-by to receive evacuees if the situation appears likely to escalate rapidly.
Establish the PEOC Command, and if it is an area or unified command, consider including additional organizations in the command meetings to better inform and coordinate the response. Determine financial accountabilities in consultation with partners and communicate the information. Determine at the outset of the operations which organization will be responsible for information management and the manner in which information will be shared.
Initiating media contacts or directing the appropriate position to do this according to established plans and procedures (e.g. Adopting an extended operational cycle in which extra positions are staffed beyond the normal working day.
Alerting other emergency responders in the province, including non-governmental organizations, that they may be requested to provide assistance.
Marshalling transportation resources, including the recall of deployed resources in preparation for redeployment.


Collecting and analyzing the data necessary to fully understand the potential impact and threat.
Weather, resource availability, and the scale of an incident can significantly affect the time required to mobilize resources.
Emergency information is primarily the community’s responsibility, but may be supplemented by the province according to the provisions of the Provincial Emergency Information Plan. Communications between the field and the PEOC, between the PEOC and partners, and within the PEOC is critical.
The PEOC (or other EOC) may request deployments to fulfil specific incident management functions, as needed (e.g. Where the scale of the incident, evacuation timeline, or availability of staff prevents the physical deployment of staff, relevant incident management functions may be performed remotely using available technology.
Information technology in the far north is not universally accessible and may be further compromised by the nature of the emergency.
All partners (but with specific reference to PEOC) should recognize the potential limitations to information technology in these regions of the province. The priorities for evacuation will be determined by the Chief and Council (for a First Nation), the Head of Council (for a municipality), or an authorized entity. Transportation planning for the evacuation will be undertaken by a joint planning team as described in Annex 7. The evacuating community should identify community evacuation liaisons at each of the host community sites to support evacuees. If an evacuation involves a First Nation community, the JEMS Service Level Evacuation Standards provides a sample flight manifest.
Service Level Evacuation Standards11 are in place for hosting First Nations community members in the event of an evacuation. Through the PEOC, EMO works with the evacuating First Nation to identify a host community or communities for its evacuees.
The selection and preparation of host facilities should be driven by the needs of the evacuees.
Another key consideration is the availability of personnel and other resources to support the host facilities.
Potential conflicts with the longer-term use of accommodations in the host community should be considered and mitigated if possible (e.g. The PEOC should begin contingency planning with partners for longer-term evacuations if it appears likely that evacuees will be displaced from their community for longer than the period discussed below.
When evacuees are members of a First Nation, the use of any facility that was used as, or could evoke comparisons to, residential schools should be avoided. Communities considering acting as a host community during an evacuation should identify emergency shelter facilities. Short-Term Basic Shelter Services: for a period of 1-14 days, in arenas, gymnasiums, recreation halls, etc. Special Accommodations: to address the requirements of medically vulnerable individuals or those with special needs. Host communities may be limited in the types of accommodations that they are able to provide.
Planning for hosting evacuees builds on information already available (typically from the manifest). Host communities are responsible for registering evacuees that are entering into their care.
Registration records should only be shared with organizations providing services to the evacuees (e.g. Before the return of evacuees, the evacuated community should be in a safe and ready state. Services have resumed and are sufficient to support returning evacuees – for example, power, water, sanitation, security, food and essential supplies, and medical services. If a community was completely evacuated it may be advisable to begin the return of evacuees with essential workers to restart systems and assess the readiness of the community to receive other returning evacuees.
Once approval has been given for all or a part of the population to return home, community leaders, working with community evacuation liaisons, will develop priorities and manifests for the return flights.
Ground transportation arrangements may be made by the host community or the provincial government. The evacuated community will take the lead for communicating re-entry procedures, with assistance from partners as required. What media sources can evacuees use for the most up-to-date information on re-entry procedures? Following a regional evacuation, multiple communities may decide at the same time that they are ready to return evacuees. The PEOC and partners will commence demobilization as host communities are cleared of evacuees. The Quick Reference Guide is a condensed version of the Ontario Mass Evacuation Plan Part 1: Far North. One of the strongest threads woven into the fabric of American culture is that of volunteer service. The Medical Reserve Corps (MRC) was founded in 2002, in response to the attacks of September 11th and the Anthrax attacks that followed. The MRC of El Paso County successfully assisted their community during the Waldo Canyon Fire when 32,000 Colorado Springs and El Paso County residents were evacuated.  Having a close working relationship with the City of Colorado Springs Office of Emergency Management (OEM), the El Paso County OEM, El Paso County Public Health and the Pikes Peak American Red Cross before the fires occurred truly made a difference for the MRC unit to prove effective. In 2011, the MRCECP participated in an exercise series called “Up in Smoke Which allowed MRC units to work out the kinks of responding to a major wildfire before an event happened. MRCEPC volunteers supported the response efforts to the Waldo Canyon Fire, donating 1,644 hours of their time and expertise. 599 hours coordinating with other agencies, attending briefings to provide support, volunteer management and preparing self, family and work to deploy. According to Frankie Gales, “After a traumatic event, you may have a wide range of normal responses. The greatest lesson learned was that preparing is of the utmost importance if the desired outcome is a successful response and eventual recovery.
Healthier communities before a disaster will be better able to handle, respond, and recover from a major crisis, no matter the cause. Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. Comment All comments posted become a part of the public domain, and users are responsible for their comments. It said it believed in the values of the NHS and highlighted a ?10bn investment for its plan for the future. Power Outages, Extreme Events and Health: a Systematic Review of the Literature from 2011-2012. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Recent examples include the February 2013 flooding in Macedonia2, the 2012 Argentine heat-wave3, 2012 Hurricane Sandy and the resultant widespread flooding in the USA4 and the Japanese Earthquake in 20115 .
Many medical technologies and modern communications are reliant upon power, whilst complex health care is increasingly being delivered in the community.
A systematic literature review was carried out, coupled with analysis of the Public Health England Extreme Event Bulletins, to ascertain the magnitude and frequency of power outages on a global scale. To be included in the review, papers had to discuss or describe the health impacts of power outages during extreme events. Additional articles which fulfilled the inclusion criteria were identified during the search process and by reviewing reference lists.
Therefore we analysed the Extreme Events Bulletin1 produced by Extreme Events and Health Protection within Public Health England (PHE) (formally Health Protection Agency).
Table 3 summarises the events identified and the kinds of extreme events which caused power outages.
Although storms, winds and snow account for the majority of power outages, many other types of extreme events for example flooding were also as responsible for such outages but to a lesser extent. A further 9 articles were excluded on reading of the full text articles as they were found to not relate to the health impacts of power outages, leaving 17 articles which fulfilled the inclusion criteria. In many instances, the articles had to be carefully scrutinised to extract information relating to health impacts. The 14 patients who were already in ICU were transferred out during the first 24 hours, only to be replaced by 18 earthquake related patients. Health impacts which frequently recurred across different settings are summarised in Figure 3. Once power was restored, medical students were sent to watch TV news and bring back updates on the situation. A precis of the limitations of this review is presented, followed by gaps in research and some practical solutions on how to respond to power outages. Overall, the results from the bulletins search gave an impression of how frequent and widespread power outages are during extreme events. This is despite the news articles included in the PHE Extreme Events Bulletin being collected from several international media sources. From the first call for help to the giving of complex clinical treatments, it is evident that healthcare is increasingly dependent on power.
There is an increasing trend for people with functional needs (for example, people with respiratory illnesses needing oxygen or nebulisers) to be cared for in their own communities in the USA9; a trend echoed in the UK and across the world32,33. However, in some instances using a distant server or cloud computing as a backup has meant that patients can be cared for at different locations with good access to their records. One study recounts how the 2003 New York blackout affected water supply as the water pumps were reliant on power34. One study reports that the most common cause of disaster related carbon monoxide poisoning was generator use accounting for 54% of non-fatal cases and 83% of fatal cases29. One study focused on food safety during power outages and found that US citizens are poorly prepared27 . For example, there were accounts of elderly people being isolated in high rise flats in New York during Hurricane Sandy, as the lifts were not working38. It was suggested that electrical distribution systems need to be robust enough to survive threats and hazards and that single points of failure should be eliminated where possible. One study states that shelters turned away patients who simply needed oxygen or the ability to recharge the batteries of their medical equipment because the shelters were poorly prepared for these simple medical needs9.
In the UK, energy companies are obliged to maintain Priority Service Registers for vulnerable populations including people reliant on medical technologies43,39.
For example, patients requiring dialysis can increase the inter-dialysis interval by maintaining a special diet which limits protein, potassium, sodium and fluid intake44. Some generators have stopped working during extreme events because they were situated in flooded basements40 whilst others were situated higher up but the fuel pumps got flooded requiring ‘bucket brigades’ to carry 5 gallon jugs of fuel up to a fuel tank on the 13th floor12,13,14. This study also suggests that policy makers need to consult patients with chronic diseases about emergency preparedness and planning so that their expertise and insights can be incorporated within the decision-making process9.
There may be a preponderance of reporting of extreme events and power outages which occur in higher income countries. As already described in the results section, in many instances, health impacts were buried deep within the peer reviewed papers and in the case of the media, the health impacts were not mentioned at all. The only area where quantification has been attempted is in the field of carbon monoxide poisoning during extreme events. Further research is needed on the most effective methods of communicating risks and safety messages during extreme events, so that population behaviour is influenced to improve health.
Examples include the development of medical technologies that can run on a sustainable power source, such as solar power, and medications which can be stored at all ambient temperatures.
This collective knowledge and experience is a valuable resource which must be explored so that innovative and effective strategies can be shared and utilised. This review has demonstrated that this area has a poor evidence base and that research into this important issue is scarce. For a safer, faster, more enjoyable user experience, please update your browser today or try a newer browser. Nosso trabalho em principio e gratuito, e desde a criacao do blog em setembro 2012 bancamos todas as despesas por nossa propria conta.
In addition, this plan references the Service Level Evacuation Standards1 developed by the Joint Emergency Management Steering (JEMS) Committee. Updates to the plan will be undertaken as required based on lessons learned from exercises and incident responses. It is a provincial coordination plan outlining how Ontario would coordinate its response and collaborate with federal and municipal governments, First Nations, non-governmental organizations, and ministry partners. It is not intended for internal evacuations of one part of a community to another part of the same community. This plan does not replace a community’s own emergency response plans, which should contain provisions for evacuations if they consider evacuations likely.
A detailed action plan that addresses the specific scenario, hazard, and threat will still be required. Evacuations are most frequently caused by forest fires and flooding (most often from spring break-up along the James Bay coast). Communities in the far north may be located significant distances from communities with road access or from regional centres where services may be available (e.g. Damage to property or the environment may also trigger an evacuation if it poses a risk to the safety, health, and welfare of people.
It also dictates what level of activation, and how many and what type of resources will be required for the evacuation. If the evacuation is for one or a few communities, planning may be restricted to movements within the same general geographic area.
Therefore, planning should include post-hosting needs, such as financial reconciliation, demobilization support, and reports on issues to be resolved before hosting evacuees in the future. This allows the incident management team, and all partners, to take informed, effective and consistent actions in a timely manner. However, as the level of activation increases, the PEOC duty officer transfers this function to a technical specialist or team, if available. These ministries have processes in place for transferring the responsibility for real-time threat assessment to specialists within their ministry when required. All activities and efforts should be focused on moving these people from the at-risk area to places of safety in a timely manner. This list should contain the names of persons needed to restart systems that must be in place before evacuees can return home (e.g. If an authorized entity decides on a partial or complete community evacuation, the community should declare an emergency.
A pre-emptive evacuation may be undertaken when it is clear that if delayed, conditions (weather or other hazard) would impede evacuation. Evacuations of this nature are done when life safety is at extreme risk and a rescue becomes essential. For example, evacuations of large populations to one or more host communities may require logistics support to secure modes of transportation from a receiving aerodrome or transportation hub to the host community. Communities are encouraged to make the decision to evacuate as soon as a significant or imminent threat is identified. In widespread evacuations, emergency information may need to be coordinated amongst all involved partners. To assist with streamlining communications, an operational cycle should be established and communicated by the PEOC to partners so they know when they are expected to provide updates on the situation from their perspective. Partners should have back-up technologies available, particularly for their deployed staff. It is preferable to host community members together, even if it means hosting them farther away from their home community. Evacuation liaisons represent the needs of evacuees when attending meetings with the host community and other agencies. If the information is not collected on the manifest, registration services can collect and provide this more detailed information. Depending on the scale of the incident, and the numbers and locations of persons to be evacuated, the needs may exceed the capacity of available resources.
The Standards provide guidance on allowable expenditures, hosting arrangements, health services, emergency social services, etc.
If requested, the PEOC could assist other communities in identifying potential host communities. It is worth noting that community health services and hospitals in the host community may experience an increased demand for their services. Representatives from provincial (through the PEOC) and federal organizations may be available to assist a host community in providing services to evacuees. It is generally understood that time of year may affect the host community’s ability to provide accommodations during an evacuation. This allows the host community to better coordinate services and seek reimbursement for expenses incurred due to hosting. The recommendation and the decision to return should be based on the results of the ongoing real-time threat assessment, plus a determination that the home community is ready to support the returning evacuees.
This may involve the coordination of an advance team that is given sufficient time and other resources to return the community to a pre-evacuation state.
It is critical that at the end of an evacuation, there is a full accounting of the operation in the form of after-action and financial reports. Currently, there are close to 1,000 MRC units across the United States and its territories with more than 204,000 volunteers.
Rather, a continuum exists, where the recovery continues long after the last of the fire is extinguished. These responses can be physical reactions such as headaches, backaches, stomach aches, change in sleep patterns and appetite or they can be emotional reactions such as fear and or anxiety, irritability, restlessness, outbursts of anger, nightmares or diminished interest in everyday activities or depression.” The MRC, in its new role with AspenPointe, a private company, is now helping to address these responses as part of the recovery. The MRCEPC leadership was faced with many personnel challenges during the Waldo Canyon Fire, as well. In addition, the partnerships and integration with the key players in emergency management, public health, and with first responders allowed the MRC to be trusted and valued.
Rather, find a way to promote the health and resilience of your neighborhood, town, city, or county through volunteering.
For many individuals, volunteering gives them a sense of purpose and meaning in their lives. Research presented by the Corporation for National and Community Service shows a strong relationship between volunteering and health: those who volunteer have lower mortality rates, greater functional ability, and lower rates of depression later in life than those who do not volunteer. This allows the on-sight providers rapid access to advanced expertise and capabilities for triage and care electronically when and where it is most needed.Telemedicine allows mobile health units access to specialist expertise regardless of where either the mobile health unit or the specialist is located. Many interlinked systems in the modern world depend on a reliable power supply to function effectively.


Recurrent themes included the difficulties of accessing healthcare, maintaining frontline services and the challenges of community healthcare. To date, the impact of power loss on health is a poorly studied area and peer reviewed literature is scarce.
Using these approaches, this review details the health impacts of power outages during extreme events and identifies key areas for further work. A key word search in Medline, CINAHL and Scopus was undertaken using the search terms outlined in Table 1. The selected articles were assessed for quality using the Scottish Intercollegiate Guidelines Network (SIGN) guidance7.
News articles are found using a 24 hour Google news search using the following key words: quake, drought, flood, bush fire, smog, hurricane, avalanche, tornado, wildfire, natural disaster, cyclone, mudslide, tsunami, volcano, blizzard, typhoon, landslide, heat wave, famine, snow storm, tropical storm, monsoon, forest fire, storm, wind storm. An additional 3 papers were discovered through the reviewing of references and during the search process.
However, the author does not go into details as to how many of these patients required ventilation and what special challenges were faced during the power outage16.
The extreme events bulletin has been a recent and invaluable resource, collating available data in an accessible format. The events and outages occurred in both economically developed and less developed nations and in island and mainland state settings. These media sources include Google News, BBC, UK broadsheets and international webpages including PreventionWeb, UNISDR and ReliefWeb.
Electricity was recognised by the UK Department of Health as the ‘most vital of all infrastructure services’ because ‘without it most other services will not function’30.
One study describes how patients continued to receive prescriptions and scheduled treatments as planned during Hurricane Sandy9, while another states that electronic medical records were ‘vital’ for continuing the rheumatology service after the 2011 Christchurch earthquake20. From basic clinical observations to more complex interventions such as operations, clinicians rely on a good light source. Other causes of carbon monoxide poisoning during disasters included heaters, stoves and grills29.
This poses the question of how well people are prepared for power outages in resource poor settings. For example, power for the computer network would be prioritised over power to air conditioning. Other suggestions include having more than one regional electrical provider, the ability to reconfigure failed supply systems and a set of actions and automated responses which are triggered in the events of mains supply failure30. Such patients would then flood into emergency departments which have already been put under strain9.
However, only 57% of dialysis patients were aware of this emergency diet during an American survey undertaken by Foster et al44.
This was reiterated by another study after an investigation of hospital preparedness and response during Hurricane Rita35 . Although the language was not limited to English, only one non-English article was found which did not meet the inclusion criteria. For example, although there were published articles on extreme events occurring in the USA, the floods which occurred in Thailand in 2011 have not featured in the peer reviewed literature yet. Although research during extreme events is difficult, it needs to be done so that we can learn from these events and improve resilience for the future. In the light of increasing demand and reliance, power outages will continue to have far-reaching impacts upon the health of vulnerable populations who are increasingly reliant on electrically powered technology. 343-350.Kosa KM, Cates SC, Godwin SL, Coppings RJ, Speller-Henderson L, Most Americans are not prepared to ensure food safety during power outages and other emergencies, Food Protection Trends, 2011, Vol. Esta e uma falha na linha de fundo do oceano, que vai do norte da California – ao norte de Vancouver, no Canada. As many of the communities in the far north are First Nations, coordination with the federal government is crucial.
Two communities falling within the focus area have road access (Mishkeegogamang and Pickle Lake) and there is a rail link to one municipality (Moosonee). However, the evacuation of multiple communities due to an area-wide emergency is likely to require out-of-area movements for hosting, particularly when the goal is to keep families and communities together. The size and demographics of the population are significant factors in determining how to conduct an evacuation. This would include: scheduling such that staff do not become overly fatigued by the operation and providing as much advance notice of scheduling as is possible given the nature of the incident. In addition, up-to-date contact lists should be maintained by all organizations for use in an emergency.
Alternate technologies that may be utilized in an evacuation include satellite phones and amateur radio. They should also be identified to the host community as resources that may be called upon to assist evacuees. This mitigates the risk of families being separated and makes the return of evacuees less complicated.
Evacuation liaisons also assist with creating manifests and determining the order of the return of evacuees in consultation with the Chief, Head of Council, or appointed person from the home community.
Once a flight manifest is prepared, it should be sent to the PEOC, which can in turn forward it to other organizations that require the information. Receiving the information in advance can help ensure that needed services are delivered quickly. In this situation, evacuations may need to be prioritized and contingency plans implemented. While the Standards provide guidance on hosting First Nations, they may also be applied to municipal or unorganized territory evacuations as they pertain to hosting arrangements. While agreements may exist between EMO and a host community, the community retains the option of not hosting during a particular evacuation. Emergency planners should assess proposed facilities based on location, capabilities, capacity, accessibility, and resources, as well as how they would route evacuee traffic. Municipal departments involved in the development of the host facility plan may be able to provide resources to support the set-up and operation of a host facility.
Registration involves creating a municipal record, which is covered under municipal privacy legislation.
Since the degree of damage will likely vary within the affected area, it might be beneficial to initiate a phased re-entry process.
In most instances, people are returned in the reverse order of when they were evacuated (i.e.
As with the initial evacuation, numerous resources, especially personnel and transportation related resources will be required to return evacuees to their home community. It also shows the various partners likely to be involved in an evacuation, broadly reflecting the actions that fall within their jurisdiction.
This national network of community-based volunteers is committed to improving the health and safety of all communities through the action of volunteers from medical and public health professions, as well as that of other community members dedicated to strengthening local public health systems, improving response capabilities, and building community resilience.
Given the unit’s established integration into the county emergency management plans and amongst its partnerships, as well as its involvement in preparedness exercises, the unit and its volunteers were not only recognized, but valued and trusted as a capable response asset. Two days before the fire, the Program Director of 10 years retired, and the new director was on the job only two days. As recognized, credentialed, and trained volunteers, those in the MRCEPC were able to make a powerful, personal, and profound impact on the response to the overwhelming wildfires.
Mobile health units can serve the community, send challenging cases or second opinion requests to a remote specialist for x-ray reads, diagnosis support, treatment advice, etc.
The health sector is no exception, but the impact of power outages on health is poorly understood.
This set of guidelines is used for assessing the quality of evidence during the development of systematic reviews and guidance in public health.
The bulletins of 1 January – 31 March 2013 were used to identify the frequency, impact, and geographical distribution of power outages.
Two studies note that ventilated patients were evacuated from flooded hospitals during Hurricane Sandy12,14 and one mentions that ‘oxygen tanks and interns were stationed at the bedside of ventilated patients’14. It is interesting to note that none of the media reports contained any reference to health impacts.
While this ensures an international perspective, it also introduces a reporting bias towards more economically developed countries. But the mechanisms for communicating to the city were also not functioning because of the blackout and even if the message were communicated, people had no means of boiling water34. Although the impact of the loss of light on health was not directly documented in the literature, the importance of light in everyday clinical care is obvious. However, loss of air conditioning can lead to excessive heat which in turn leads to computers automatically switching off.
The location of hospitals requires careful consideration, to ensure that hospitals are built within low hazard (for example low risk of flooding) so that disruption of infrastructure, including power, is minimised or prevented. In contrast, during the 2008 Hurricane Ike in Ohio, the Red Cross provided information via the media on where patients could obtain electricity for oxygen converters19.
For example, in a survey of patients requiring dialysis, only 38% of patients requiring home peritoneal dialysis had notified the local electricity supplier of their health condition44. Despite disaster related rises in carbon monoxide poisoning being documented in the literature, there were nine deaths caused by carbon monoxide poisoning during Hurricane Sandy41. This is probably the first review of this important aspect of extreme events preparedness and it provides a much needed initial assessment.
However, reports of power outages and deaths from electrocution during these floods have been presented at a conference48. Whilst ascertaining the morbidity and mortality which can be directly attributed to power outages associated with extreme events is challenging, the results of this review illustrate the difficulties faced when attempting to provide a safe healthcare provision during extreme events. O terremoto teve duracao de aproximadamente 28 segundos, tendo morrido milhares de pessoas.Outras cidades sofreram estragos importantes, nomeadamente Santa Rosa, Sao Jose e a Universidade de Stanford. This plan supports the activities being undertaken related to mass evacuation planning for ministry and community emergency management programs. There are two municipalities that fall within the focus area (Moosonee and Pickle Lake) plus more than 30 First Nation communities. This is facilitated through liaison that may be in place between OIC ministries and federal departments - for example, between the Ministry of Health and Long-Term Care, Health Canada and Local Health Integration Networks (LHIN). Alternatively, the Chief of the First Nation, Head of Council, or an appointed person may decide to conduct a complete or partial evacuation based on an assessment of the threat to area residents. This approach minimizes potentially having people in harm’s way and enables a more controlled evacuation and optimization of resources. Where possible, identify the positions, rather than individuals who may be involved in the operation. Notwithstanding this recommended practice, a host community’s capacity may be such that it is unable to accommodate an entire community. In the event that the list of potential host communities is insufficient for the size of evacuation pending, the PEOC will solicit additional host communities.
Details on the set-up and operation of the shelter should be provided in the community’s emergency response plan. Each municipality has the responsibility for managing the record in accordance with the applicable legislation and their municipal policies.
The Chief of a First Nation, Head of Council of a municipality, or appointed person, will decide when to allow evacuees to return to the community. As we recognize September as National Preparedness Month, it is important to note that being involved in preparing your community for disaster puts you in the best position to help during a disaster as well as insure your county, city, or town is able to quickly recover and regain its footing.
Now, they are providing mental health counseling and helping to restore peace of mind to those affected by the trauma of the large scale fires. Volunteering provides opportunities for social interaction with fellow volunteers while supporting an important activity in the community. It is highly unlikely that research on extreme events and disasters will be the highest level of evidence (i.e. The same time period as the literature review could not be used as the Extreme Events Bulletins for this time period were found to be incomplete.
This may account for the fourteen reports of power outages in the USA alone, whilst there were no reports from Africa. This example illustrates how the lack of power can have a domino effect and impact on health at many levels. In a survey of 213 hospitals affected by the 2011 Japanese tsunami, 121 hospitals had temporary loss of power, whilst in 12 hospitals the emergency power generators did not work at all.
However, it may be that resource poor settings are less affected as they are less reliant on electricity than their resource rich counterparts. This was an issue which was identified by some hospitals during the Great East Japan Earthquake. Similar recommendations for maintaining a resilient power supply are made by Pourbeik et al, in their analysis of the 2003 US-Canadian blackout which left 50 million people without power. Shelters need to be equipped to charge up batteries or give oxygen so that patients who normally manage their illnesses at home can be managed in a shelter and do not necessarily have to seek hospital care. This highlights the importance of public education prior to, during, and after an extreme event.
Reviewing literature from a longer time period may reveal other health impacts, but may also contradict some of the present findings or reduce the prominence of some impacts identified here. Emergency Preparedness Professionals must plan for extended power outages and the healthcare workforce must be aware of what resources are available during such emergencies.
428-436.Kosa KM, Cates SC, Karns S, Godwin SL, Coppings RJ, Are older adults prepared to ensure food safety during extended power outages and other emergencies? Cerca de 225 000 pessoas encontraram-se sem teto dos cerca de 400 000 habitantes daquelas areas, na ocasiao. It draws linkages to various hazard management plans and procedures developed by ministries. The exact population at any one time is difficult to report as people who are recorded in the census may be away from the community and some who are not recorded may be in the community. Unorganized territories, fly-in lodges and camps, and mining operations also fall into the plan area. The seasonal roads cannot be relied on for evacuation operations given the short and sometimes unpredictable length of time that they are available.
Local populations often provide the best information on the threat to their community and the region. Emergency responders may require personal protective equipment, as responder safety will be critical. Where an entire community may not be hosted together in close proximity to the home community, and if the situation allows, the community’s preference should be discussed with the Head of Council, First Nation Chief, or appointed person. The primary reason for returning the most vulnerable people last is to help ensure that support services are in place when they return.
Having exercised with other organizations on this exact scenario and having a process in place allowed MRCEPC to be on “standby” within hours of the fire starting, and when MRCEPC received the call to activate, volunteers were in place within 45 minutes. Interacting with others with a common interest in service is also a great way to create new relationships. The issue of power outages leading to the loss of light was mentioned by some authors10,13,16, but they did not elaborate the impact darkness had on patient care.
This survey also revealed that 60% of these hospitals felt that key services such as emergency surgery and heamodialysis would have to be stopped if generator power was unavailable. This was also the case in hospitals affected by Hurricane Rita (2005), where fuel shortage led to power outages and consequently loss of power led to reduced water pressure35.
For example, whilst it is common practice for people in high resource countries to eat refrigerated food, this is probably an uncommon way of storing food in resource poor settings. Communicating these messages during an extreme event is problematic34, so public awareness needs to be enhanced before such events occur.
Similarly, public education on food safety and what to do with refrigerated and frozen food will prevent an increase in diarrhoeal illness.
Innovative medical technologies and treatments are needed, so that those with functional needs are more resilient to extreme events. For example, there may be people staying at fly-in lodges that do not report year-round population. Key equipment related services such as laboratory services, imaging and sterilisation would also be stopped if generators failed31. From this point of view, there must be lessons to be learnt from resource poor settings on how best to adapt to life without power and this is an area which should be explored. Lessons must be learnt from resource poor settings where healthcare is regularly provided despite power shortages. Similarly, there may be community events that draw tourist and other visitors to the community. However, as our search was not limited to one hemisphere, different seasons have been represented to some extent. However, in longer term power outages, hospitals can be faced with limited fuel and difficulties in sourcing fuel for generators, due to transportation and communication difficulties. A review of disaster related carbon monoxide poisoning: surveillance, epidemiology and opportunities for prevention. Kist A, Scheiber A, Use of emergecny indicent command system for school located mass influenza vaccination clinics, Pedatrics, 2012, pp.
Nursing towards 2015: Alternative Scenarios for Healthcare, Nursing and Nurse Education in the UK in 2015, University of Glamorgan, 2007.
Disasters as extreme events and the importance of network interactions for disaster response management.
Initial management of hospital evacuations caused by Hurricane Rita: A systematic investigation. Elderly NYC residents in high rise buildings receive food, water and support from volunteers.
The initial health system response to the earthquake in Christchurch, New Zeland, in February, 2011. Notes from the field: carbon monoxide exposures reported to poison centers and related to hurricane Sandy -Northeaster United States 2012.
905.Lutterloh EC, Iqbal S, Clower JH, Spiller HA, Riggs MA, Sugg TJ, Humbaugh KE, Cadwell BL, Thoroughman DA, Carbon monoxide poisoning after an ice storm in Kentucky, 2009, Public Health Reports, 2011, Suppli 1, Vol.
665- 666.Baer A, Elbert Y, Burkom HS, Holtry R, Lombardo JS, Duchin JS, Usefullness of syndromic data sources for investigating morbidity resulting from a severe weather event, Disaster Medicine and Public Health Preparedness 2011, Vol.



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