Public health in emergencies;

Basic concepts

Ragnar Andersson

Basic concepts

• Accident (Disaster/Crisis/Emergency)

• Injury (Lesion/Damage/Harm/Loss)

• Risk/Hazard (Danger/Threat/Vulnerability)

• Safety (Security/Resilience/Robustness)

Two main sets of terminologies

in safety research

• Injury-centered fields: Occupational,

traffic, home & leisure safety (with

competing views between engineering and

public health circles)

• Disaster/crisis/emergency management

“Accident” - types of definitions

• By consequence

(injury, harm)

• By event (loss of

control)

• By intention

(unintentional)

Examples

• Public health: An unintentional injury

• Engineering: A deviation beyond a system’s

inherent stability limits

• Law: An event that nobody should be

blamed for

Accidents or not?

• Boxing injuries?

• Car crashes?

• Railway suicides?

• Heart attacs?

• Nuclear reactor meltdowns?

Controversy on the term

”accident”• ”Injuries have traditionally been regarded as random, unavoidable

’accidents’. Within the last few decades, however, a better

understanding of the nature of injuries has changed these old attitudes,

and today both unintentional and intentional injuries are viewed as

largely preventable events.” (WHO, 2002)

• “Experts in the field of injury prevention avoid use of the term

'accident' to describe events that cause injury in an attempt to highlight

the predictable and preventable nature of most injuries. Such incidents

are viewed from the perspective of epidemiology - predictable and

preventable. Preferred words are more descriptive of the event itself,

rather than of its unintended nature (e.g., collision, drowning, fall,

etc.)” (Wikipedia, 2010)

BMJ bans "accidents"

Accidents are not unpredictableFor many years safety officials and public health authorities have

discouraged use of the word "accident" when it refers to injuries or the

events that produce them. An accident is often understood to be

unpredictable - a chance occurrence or an "act of God“ - and therefore

unavoidable. However, most injuries and their precipitating events are

predictable and preventable.1-3 That is why the BMJ has decided to ban

the word accident. Davies & Pless, BMJ 2001;322:1320-1321

1. Doege TC. An injury is no accident. N Engl J Med 1978; 298: 509-510.

2. Loimer H, Driur M, Guarnieri M. Accidents and acts of God: a history of the

terms. Am J Public Health 1996; 86: 101-107.

3. Doege TC. Eschewing accidents. JAMA 1999; 282: 427.

“Injury”

• Defined as a bodily lesion at the organic level

resulting from acute exposure to energy (or

insufficiency of heat/oxygene) in amounts or rates

that exceeds the threshold of physiological

tolerance.

• Operationalized as categories under chapter 19,

“injury and poisoning” or chapter 20 “external

causes” in International Classification of Diseases

Operational problems

• Definitions of injury may differ between

classifications, sectors and countries

• Comparisons must be done with caution

“Normal accidents”

”The odd term normal accident is meant to signal

that, given the system characteristics, multiple and

unexpected interactions of failures are inevitable.”

Perrow C. Normal Accidents – Living with

high risk technologies, Basic Books, 1984

Disasters as “normal accidents”

“Disasters… are all too often regarded as unusual events, not

part of “normal life.” In reality, however, the opposite is true.

Disasters and emergencies are a fundamental part of normal

life. They are consequences of the ways societies structure

themselves, economically and socially; the ways that societies

and states interact; and the ways that relationships between

the decision makers are sustained.”

International Humanitarian Law. The International

Committee of the Red Cross. Geneva, Switzerland. 1993

Disaster

”The term disaster is reserved for the actual

occurrence of events that produce casualties

and damage at levels exceeding a

community’s ability to cope”

Lindell et al. Fundamentals of emergency

Management. Washington DC: FEMA, 2006

Disaster (cont.)

• A serious disruption of the functioning of a community or

a society causing widespread human, material, economic

or environmental losses which exceed the ability of the

affected community or society to cope using its own

resources.

• A disaster is a function of the risk process. It results from

the combination of hazards, conditions of vulnerability and

insufficient capacity or measures to reduce the potential

negative consequences of risk.

UN-ISDR (International Strategy

for Disaster Reduction)

Disaster (”bad star” in Greek)

“In contemporary academia, disasters are seen as the

consequence of inappropriately managed risk. These risks

are the product of hazards and vulnerability. Hazards that

strike in areas with low vulnerability are not considered a

disaster, as is the case in uninhabited regions.”

(Wikipedia 2010, with reference to: Quarantelli E.L. (1998). Where We Have Been and Where We

Might Go. In: Quarantelli E.L. (ed). What Is A Disaster? London: Routledge. pp146-159)

Classification of disasters

Abdallah S, Burnham G (2000). The Johns Hopkins and

Red Cross / Red Crescent Public Health Guide for Emergencies

Other classifications

• Natural

• Man-made

– Technological

– Sociological

“all disasters can be seen as being human-made ... All disasters are …

the result of human failure to introduce appropriate disaster

management measures”.

(Wikipedia 2010, with reference to: B. Wisner, P. Blaikie, T. Cannon, and I. Davis (2004).

At Risk - Natural hazards, people's vulnerability and disasters. Wiltshire: Routledge)

Emergency, two notions:

• ”an event involving minor consequences for a

community – perhaps a few casualties and a

limited amount of property damage … and can be

managed successfully with local resources”

• ”the imminence of an event rather than the

severity of its consequences … a situation in

which there is higher than normal probability of an

extreme event occurring”

Lindell et al. Fundamentals of emergency

Management. Washington DC: FEMA, 2006

Relationships among hazards,

emergencies and disasters

Time/probability

Uncertain Imminent Occurred

Demand compared to

communtiy capacity

Less than Hazard Emergency Emergency

Greater than Hazard Emergency Disaster

Lindell et al. Fundamentals of emergency

Management. Washington DC: FEMA, 2006

Crisis

• An unstable situation of extreme danger or difficulty: "they went

bankrupt during the economic crisis“ (WordNet)

• A crucial stage or turning point in the course of something: "after the

crisis the patient either dies or gets better“ (WordNet)

• A crucial or decisive point or situation; a turning point. (Wiktionary)

• An unstable situation, in political, social, economic or military affairs,

especially one involving an impending abrupt change. (Wiktionary)

• A sudden change in the course of a disease, usually at which the

patient is expected to recover or die. (Wiktionary)

• A traumatic or stressful change in a person's life. (Wiktionary)

”Risk”- Different meanings

• Probability of a certain outcome, e.g. death

• A combination of probability and

consequence, usually R = P x C

• Conditions associated with danger, e.g. a

slippery spot, a spinning wheel, a sharp

object (“hazards”)

• Perceived risk (perceptions of insecurity)

Risk (in disaster management)

“the probability of harmful consequences, or

expected losses (deaths, injuries, property,

livelihoods, economic activity disrupted or

environment damaged) resulting from

interactions between natural or human-

induced hazards and vulnerable conditions”

UN-ISDR (International Strategy

for Disaster Reduction)

Hazard vs. risk

• Hazard is the potential to cause harm

• Risk on the other hand is the likelihood of harm (in

defined circumstances, and usually qualified by some

statement of the severity of the harm).

• The relationship between hazard and risk must be treated

very cautiously. If all other factors are equal - especially

the exposures and the people subject to them, then the risk

is proportional to the hazard. However all other factors are

very rarely equal.

The Concise Oxford Dictionary

Hazard, vulnerability, barriers and risk

Hazard Vulnerability

Risk

Barriers

Vulnerability (in disaster

management)

“the conditions determined by physical,

social, economic and environmental factors

or processes, which increase the

susceptibility of a community to the impact

of hazards”

UN-ISDR (International Strategy

for Disaster Reduction)

Resilience (in disaster

management)

“The ability of a system, community or

society exposed to hazards to resist, absorb,

accommodate to and recover from the

effects of a hazard in a timely and efficient

manner.”

UN-ISDR (International Strategy

for Disaster Reduction)

Safety

• The opposite to risk

• Systematic control of conditions associated

to risk

Definitions of ”safety” and “safety

promotion” (Maurice et al. 2001)

• Safety: a state in which hazards and conditions

leading to physical, psychological or material harm

are controlled in order to preserve the health and

well-being of individuals and the community.

• Safety promotion: The process applied to develop

and sustain the basic conditions for safety at a local,

national and international level by individuals,

communities, governments and others, including

enterprises and non-governmental organizations.

Security vs. safety

• Security: antagonistic threats with

significant impact on societal functions

• Safety: non-antagonsitic threats with limited

impact on societal functions

(Swedish ministry of defense)

Other meanings of security

• Social security

• Job security

• Financial security

Conclusion

• Terminologies vary between sectors and

professions

• Clear definitions are essential for correct

understanding