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Lessons Learned in Public Health Emergency Management: Personal Reflections

Published online by Cambridge University Press:  28 June 2012

Kenneth W. Kizer*
Affiliation:
President and Chief Executive Officer, The National Quality Forum
*
The National Quality Forum, 1875 Connecticut Avenue, NW Suite 640, Washington, DC, 20009, USA

Abstract

Multiple environmental, ecological, and socio-political forces are converging to increase the occurrence of both natural and technological disasters. Ten forces are of most concern in this regard. These are: 1) global warming, with its consequent weather extremes and climate changes; 2) continued rapid human population growth and concomitant increased urbanization; 3) decreased bio-diversity and consequent ecological fragility; 4) deforestation and loss of natural habitat for animal species, with resultant greater overlap of human and animal habitats, human exposure to animal pathogens, and other ecological perturbations; 5) increased technological development throughout the world (especially in developing countries with their typically immature safety programs) 6) globalization and increased population mobility; 7) sub-national religious and ethnic conflicts, and their potential for conflict escalation and large scale displacement of populations; 8) the collapse of several major countries and consequent unraveling of national identity and social order; 9) the rise of terrorism; and 10) dramatic advances in the science and technology of computing, communications, biotechnology, and genomics.

This paper describes 10 lessons learned relative to the public health aspects of emergency management, especially as they pertain to disasters. 1) Planning pays; 2) A bad situation can be made worse by inappropriate responses; 3) Most life saving interventions will occur before the disaster happens and immediately afterwards by local action; 4) Public health emergency management is not a democratic process; 5) Psychological impacts are usually greater than anticipated; 6) Communications and information management are vital, but often are the weak link in the response chain; 7) Collaboration and partnerships are essential; 8) Unsolicited volunteers and aid are inevitable and must be planned for and managed; 9) Never assume anything, and always expect the unexpected; and 10) Post-event evaluation is important, and must be coordinated.

The paramount lesson learned from past emergencies is that the untoward impact of these events can be anticipated and significantly ameliorated by appropriate planning and preparation. On the other hand, preparation for emergency events has deteriorated because of health-care financial constraints, and resources to support planning and needed infrastructure have diminished. Given these realities, the major unresolved challenge is how to ensure that planning for the common good is supported and, in fact, gets done.

Resumen

Múltiples fuerzas ambientales, ecológicas y sociopolíticas convergen para aumentar la ocurrencia de desastres tanto natuarales como tecnológicos. Diez fuerzas son de la mayor preocupación en este aspecto: 1) Calentamiento global con sus consecuentes cambios extremos en el tiempo; 2) Crecimiento poblacional humano continuo y rápido y urbanización concomitante aumentada; 3) Disminución en biodiversidad y fragilidad ecológica consiguiente; 4) deforestación y pérdida del hábitat natural para especies animates, con mayor traslape de hábitat humano y animates, exposición humana a patógenos animates y otras alteraciones ecológicas; 5) Aumento en el desarrollo tecnológico a través del mundo (especialmente en países en desarrollo con sus típicamente inmaduros programas de seguridad); 6) Globalización y mobilidad poblacional aumentada 7) Conflictos subnacionales y étnicos, y su potencial para escalamiento y su consiguiente desintegración de la identidad nacional y el órden social; 9) El aumento del terrorismo; 10) Avances dramáticos en la ciencia y tecnología de la computación, comunicaciones, biotecnología y genoma.

Este trabajo describe 10 lecciones aprendidas en relación con aspectos de salud pública del manejo de emergencias, especialmente lo pertinente a desastre: 1) Planear paga; 2) Una situación mala puede hacerse peor con respuestas inapropiadas; 3) La mayoría de las intervenciones salvadoras de vida ocurrirán antes de que suceda un desastre e inmediatamente después a través de acciones locales; 4) El manejo de la salud pública en emergencias no es un proceso democrático; 5) El impacto psicológico es usualmente mayor que lo anticipado; 6) El manejo de las comunicaciones y de información es vital, pero a menudo son un eslabon débil en la cadena de respuestas; 7) La colaboración y las asociaciones son esenciales; 8) La ayuda y el voluntariado no solicitado son inevitables y se deben manejar y planificar; 9) Núnca asuma nada y siempre espera lo inesperado; 10) La evaluación postevento es importante pero debe ser coordinada.

La principal lección aprendida de las emergencias en el pasado es que el impacto de estos eventos puede ser anticipado y disminuido significativamente por medio de una adecuada planificación y preparación.

Por otro lado, la preparación para eventos de emergencias se ha deterioridado debido a las restricciones financieras de la salud y a que los recursos para apoyar la planificación y la infraestructura necesaria han disminuido. Dadas estas realidades el mayor reto no resuelto es asegurar el apoyo para la planificación del bien común y que de hecho, se efectúe.

Type
Public Health and Disasters
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2000

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