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Stop The Disaster! IRDR Spring Academy 2021

Joshua Anthony28 April 2021

This article is a summation of points and questions raised by members of the Institute for Disaster Risk Reduction at the 2021 Spring Academy.

The mid-afternoon sunshine passes through my east-facing window and strikes my laptop screen, where the faces of the Institute for Disaster for Risk Reduction shine back at me. It is not mid-afternoon for all: for some, they gather for the annual Spring Academy as the same sun straddles a different horizon. Due to coronavirus restrictions, we gather online, tuning in from around the globe, demonstrating the department’s widespread influence. Through activities organised by both the PhD students and research staff, we are here to engage with the diverse range of expertise in our department.

What can floods tell us about covid-19? Can the unsettling rise of water on the doorsteps of schools and hospitals inform the decisions we make during a pandemic? Using the UNDRR game, Stop the Disaster, as an illustrative tool, Qiushuang Shi and Rob Davis lead us through the process of emergency planning and management to answer these questions.

While some of us struggle to allocate funding for flood defences and deliberate over where to build the hospital in our virtual disaster village, one cannot help noticing the people that populate the little green boxes of grass next to the blue pixels of seawater. How would they respond to an early warning system, and would it work if it were a virus and not flood water knocking at their door?

A snapshot of the UNDRR game Stop the Disaster.

Once the unfortunate villagers are subject to the 8-bit flood water, Rob and Qiushuang move us on to discuss what we have learnt. There is a consensus between us that communication is vital to affect successful disaster risk reduction—across all hazards. No early warning system or public health advice it worth it if the information is not widespread and consistent and the risks properly conveyed; or if there are significant economic, cultural, political or societal conditions—such as gender structures—that inhibit this process or adherence to it. Prior knowledge and experience of a hazard within a society (or lack thereof) is likely to alter the perception of, trust, and response to the message, not to mention the political will to support and fund emergency resources and planning initiatives, which could be assisted by media initiatives.

The visceral threat of quick onset hazards may put the screws on emergency fund release at showtime, but what of slower hazards for which there is ample time to plan? For some in the world, climate change is a distant reality, while for others it is an immediate threat. Uncertainty plays a key role in the way we respond to hazards—in scientific calculations (such as for early warning systems) or in individual perceptions and acceptance of risk.

We can see that, though the propagation and imagery of flood water and coronavirus—or any hazard, for that matter—may differ, there is an unavoidable factor underlying the multitude of research topics across the Institute of Risk and Disaster Reduction’s members: vulnerability. Indeed, the most contrarian of us posit that one could approach disaster risk reduction entirely from a vulnerability perspective. This notion hangs in the balance. We move on to the next stage of the session: multi- and cascading-hazard scenarios

There are places unfortunate enough to be subject to multi-hazard events. Even now, as we live through COVID-19, one member notes, the HIV and AIDs epidemic that gained notoriety in the 1980s still affects millions of people. As we have seen over the past year, floods, forest fires, earthquakes, disease outbreaks—you-name-it—do not rest for each other, and all the while the climate still changes. Mitigation, preparedness and response procedure efforts must consider multi-hazard scenarios, and not be subject to a “flavour-of-the-month” approach to disaster risk reduction. Critical infrastructure may be pliable up to a point and break beyond that threshold. Existing and dormant vulnerabilities may be triggered under cascading disaster scenarios—otherwise interpreted as cascading vulnerabilities—as seen in the infamous triple-front attack on Tohoku in 2011, which manifested in a combination of an earthquake, a tsunami and a nuclear meltdown. The complexities of multi- and cascading-hazard scenarios are vast; one must look for interconnected and parallel vulnerabilities that transect all hazards in order to tackle the challenges. The importance of transdisciplinary research and collaboration of individual expertise are highlighted further by these situations.

Even when two hazards do not strike in unison, emergency planners must consider the impacts of a prior hazard on material and human resources for the next one. Under a changing climate, goalposts shift; resource allocation and size may change, funding options may have to be reconsidered. An example of a way to make use of existing resources in a multi-hazard scenario is suggested in adapting training facilities for one type of hazard to accommodate multiple. As we consider the way planning and management needs are altered in response to multi-hazard and cascading scenarios, one asks a question that should follow all disasters: has the learning come through? In other words, are we more or less resilient now we have experienced the crisis? This is a question one can imagine asking as we optimistically search for a light at the end of the tunnel after over a year of COVID. The darkness associated with the proverbial tunnel is often oversimplified to a period of turmoil before the promise of the light, but one overlooks its poignancy in portraying the struggle that one experiences while operating within the shadow of uncertainty.

As we close the session, the faces of IRDR, hailing from a wide array of different disciplines, stare back expectedly at me for a summary of the session proceedings. Well, here they are. However, it’s made evident—as I scrabble to collate my mish-mash of notes—that one voice solely is not enough to tackle the challenges we attempt to understand here at the IRDR.

Happy (mostly) Faces of IRDR

WHO Classification for Emergency Medical Teams: A Step in the Wrong Direction?

Navonel Glick20 April 2021

National/international medical professionals working together at a clinic in Ormoc, Philippines – a model that is no longer allowed by the current WHO EMT guidelines. Photo Credit: Boaz Arad/IsraAID (2013)

In 2013, Typhoon Haiyan devastated the Philippines and galvanised the international community. Organisations, like the American Red Cross, sent full-scale field hospitals. Others, like IsraAID, despatched medical personnel and supplies, providing surge capacity to local clinics.

Integrating external resources into existing healthcare systems is an effective strategy, with potential long-term benefits. Yet, while such activities may be a model for integrating disaster risk reduction into response, World Health Organization (WHO) guidelines do not permit them.

The WHO classification system was created to counter the variation “in capacities, competencies and adherence to professional ethics” amongst Emergency Medical Teams (EMTs). Each of the three approved EMT types must operate independently and be self-sufficient for 2–4 weeks. This emphasis on independence avoids ‘burdening’ affected populations, but it leaves no room for interventions to support national/local healthcare institutions.

In fact, the WHO’s 91-page document outlining EMT minimum standards contains no reference to existing healthcare systems, let alone strategies for cooperation. This omission perpetuates the myth that ‘helpless’ disaster-affected people need international organisations to ‘save them’, instead of recognising that disaster response is often locally driven. Further, EMTs acting alone face avoidable linguistic, cultural, and logistic obstacles that hamper the quality of care provided. Setting up alternative healthcare locations, pathways, and practices may also sow confusion, thus increasing long-term vulnerability by undermining trust in the healthcare system.

Efforts to standardise EMTs and rout out malpractice and disaster tourism are welcome. But the WHO guidelines sadly disregard successful integrated models, like IsraAID’s, instead promoting foreign intervention over local capacity and prevention. If only the WHO abided by their own Health Emergency and Disaster Risk Management framework.

Space health and disaster risk reduction

Myles Harris12 April 2021

There is an association between remote environments and health due to limited resources and accessibility to healthcare services. Thus, people who live in a remote environment have disproportionate health inequalities in comparison to those in an urban location [1]. While it is predicted global urbanisation is set to increase during the 21st century, approximately 3.1 – 3.3 billion people will still be living in a remote environment between the years 2015 and 2050, such as the remote mountain community in Figure 1 [2]. With this in mind, remote health is an important topic of research.

Figure 1 Remote mountain community

Providing healthcare in the remotest environment outer space may seem worlds away from healthcare on Earth; however, limited resources and accessibility are threads that tie remote health and space health together. For example, a minor injury or illness can rapidly become a major event if the available resources do not meet the needs of the patient, and there are limited opportunities for rapid (aero)medical evacuation should the patient’s condition deteriorate [3]. With this in mind, healthcare practitioners must provide prolonged care in the field (prehospitally) and sustainably use the resources available to them; this approach to clinical practice can be described as prolonged field care (PFC) [4,5].

It is important to note that when providing PFC in a remote environment or outer space, healthcare providers (doctors, nurses or allied health professionals) are required to meet all holistic care needs of the patient, despite being trained to specialise in one area of medicine or health. Telemedicine may offer remote consultation with specialist members of a multidisciplinary healthcare team, but this is a vulnerable dependency on internet or satellite connection, which is often unreliable due to the topography or distance from connected locations (such as Mars). There is limited literature on interdisciplinary healthcare practice, therefore, patients and practitioners are exposed to heuristically developing remote or space health practice and human error. This is a social vulnerability that increases the risk of disaster (physical or psychological deterioration of patient’s health) in environments where resources and accessibility are already limited [6].

UCL Institute for Risk and Disaster (IRDR), Space Health Risks Research Group, is a multidisciplinary community of researchers and practitioners who are investigating how the mitigation of risks to health in space can contribute to promoting good health and well-being in remote environments on Earth. On 01st September 2021, IRDR Space Health Risks Research Group will be hosting a symposium on ‘space health and disaster risk reduction’, in collaboration with industry partners and Universities of Manchester, Bristol and King’s College London. The symposium is funded by UCL Grand Challenges and booking details will be released here: https://tinyurl.com/spacehealthrisks.

The symposium will be a theoretical exploration of how interdisciplinary healthcare practice during deep space missions to explore other planetary bodies (Figure 2) can inform disaster risk reduction and remote health system on Earth, including how to promote good health and well-being. The aim is to establish a multidisciplinary consensus on the provision of prolonged, holistic healthcare (PFC) for an interdisciplinary healthcare practitioner. An underlying objective of the symposium is to identify where consensus is not achieved, thus highlighting research gaps for future systematic enquiry. The symposium is open to all healthcare providers, including those on a professional register and qualified first aiders.

Figure 2 EVA exploration of the Lunar surface

During the symposium, attendees will participate in breakout rooms with the following themes:

  • Space medicine
  • Global health (and public health)
  • Medicine, nursing and allied health (military and civilian)
  • Anthropology (biosocial, medical and data science)
  • Disaster sciences

Informal discussions will take place in the breakout rooms about how each discipline (the breakout room theme) can contribute to interdisciplinary healthcare practice during the exploration of another planetary body and when in a remote environment on Earth. Each breakout room will be facilitated by affiliate or associate members of IRDR Space Health Risks Research Group, and attendees will be invited to (anonymously) share their thoughts via an online Microsoft Form for each breakout room they participate in. The symposium will take place in-person at UCL Institute for Advanced Studies (lite refreshments provided) and online to enable world-wise participation.

Cultural engagement and perception of health differs hugely around the world, hence understanding how the perception of good health and well-being may change in space has relevance for remote health on Earth. Thus, the notions of future healthcare during deep space missions and on other planetary bodies brings into question the meaning of health, relative to remote environments. Therefore, exploring future healthcare practices and cultural engagement of health in space, through the lenses of healthcare, anthropology and disaster science, is a significant area of interest that has benefit to society. The findings of this symposium will contribute to the knowledge of interdisciplinary healthcare practice in space, and to reducing health inequalities for people in remote environments on Earth by informing remote health systems, policy and training.

12th April is the UN International Day of Human Space Flight, which celebrates the first human flight in space by Cosmonaut Yuri Gagarin and 2021 is the 60th anniversary of the famous space flight [7]. In the UN General Assembly 2011 resolution about the International Day of Human Space Flight, “the important contribution of space science and technology in achieving sustainable development goals and increasing the well-being of States and peoples,” is reaffirmed [8]. In this spirit, IRDR Space Health Risks Research Group are developing the first UK pilot analogue space mission (a simulated space mission), which will take place in Spring 2022.

Analogue space missions are an opportunity to conduct research in simulated outer space conditions [9]. There are many types of analogue missions and it is important to clearly define what aspect of space is being simulated for research impact. For the pilot analogue mission, the Lunar and Martian topography is being represented by the Cairngorm National Park mountains in Scotland, whereas the limited resources and accessibility during an extra-vehicular activity (EVA – spacewalk; Figure 2) are being simulated. Analogue astronauts will be evaluating the findings of the space health and disaster risk reduction symposium, critically appraising how their interdisciplinary clinical decision making was informed during three healthcare scenarios of the pilot analogue mission. The findings of the pilot analogue space mission will similarly inform remote health practice, policy and training on Earth; but, furthermore, it will lay the foundation for future high-fidelity analogue space mission research in the UK.

While space is a remote environment that begins 100km above our heads, remoteness is much closer than most people recognise. The recent COVID19 pandemic has created a temporary remote environment for many people, caused by self-isolation, physical distancing and transmission control precautions (Figure 3). However, the higher COVID19 transmission rates in areas with limited resources and accessibility to healthcare services exemplify the disproportionate health inequalities of people permanently living in remote environments [10]. Furthermore, perceptions of good health and well-being have changed, which echoes the concept of space health. IRDR Space Health Risks Research Group’s investigation of the interrelation between space health and disaster risk reduction aims to bridge these research gaps and contribute to remote health on Earth.

Figure 3 COVID-19 transmission control precautions

References

[1] Henning-Smith, C. (2020) The unique impact of COVID-19 on older adults in rural areas, Journal of Aging and Social Policy, 32, pp. 396-402.

[2] United Nations Department of Economic and Social Affairs. (2018) World Urbanization prospects. [online]. New York: United Nations. Available at: https://population.un.org/wup/Publications/ [Accessed 01 March 2021].

[3] DeSoucy, E., Shackelford, S., Dubose, J., Zweben, S., Rush, S., Kotwalk, R., Montgomery, H. and Keenan, S. (2017) Review of 54 cases of prolonged field care, Journal of Special Operations Medicine, 17 (1), pp. 121-129.

[4] Keenan, S. (2015) Deconstructing the definition of prolonged field care, Journal of Special Operations Medicine, 15 (4), p. 125.

[5] Keenan, S. and Riesberg, J. (2017) Prolonged field care: beyond the “golden hour”, Wilderness and Environmental Medicine, 28 (2), pp. 135-139.

[6] Ellis, P. (2019) What is evidence-based nursing?, in: Ellis, P. and Standing, M. (eds.) Evidence-based practice in nursing. 4th ed. London: SAGE Publishing Ltd.

[7] United Nations. (2021) International day of human space flight 12 April. [online]. New York: United Nations. Available at: https://www.un.org/en/observances/human-spaceflight-day [Accessed 01 March 2021].

[8] United Nations. (2021) Resolution adopted by the General Assembly on 7 April 2011. [online]. New York: United Nations. Available at: https://documents-dds-ny.un.org/doc/UNDOC/GEN/N10/528/80/PDF/N1052880.pdf?OpenElement [Accessed 01 March 2021].

[9] Groemer, G., Gruber, S., Uebermasser, S., Soucek, A., Lalla, E., Lousada, J., Sams, S., Seilora, N., Garnitschnig, S., Sattler, B. and Such, P. (2020) The AMADEE-18 Mars analog expedition in the Dhofar region of Oman, Astrobiology, 20, pp. 1276-1286.

[10] Behar, J., Liu, C., Kotzen, K., Tsutsui, K., Corino, V., Singh, J., Pimentel, M., Warrick, P., Zaunseder, S., Andreotti, F., Sebag, S., Kopanitsa, G., McSharry, P., Karlen, W., Karmaker, C. and Clifford, D. (2020) Remote health diagnosis and monitoring in the time of COVID-19,  Physiological Measurement, 41, article number 10TR01.