Circulatory Shock, types and stages, compensatory mechanisms
Now institute oct2012 final
1. Towards an Understanding of the
Challenges and Issues
Confronting Disaster planning
David Eisenman, MD, MSHS
Director, UCLA Center for Public Health and Disasters
Associate Professor of Medicine and Public Health
Associate Natural Scientist, RAND
Preparedness Science Officer, LACDPH
2. Four
Theories of Disasters
The Growing Risk of Disasters
What Can be Done About This?
3. Disasters as Acts of God
or Fate
(dis,
astro)—roughly, “formed on a
star.”
“Acts of God”
4. Disasters as Acts of Nature.
Lisbon 1755
– Effected everyone
so how could it be
act of God?
Root cause is
extremes of nature
– “Natural disaster”
First modern
disaster
5. Disaster as Intersection of
Nature and Society
Carr,
(1930): failure of society’s
protections is required in disaster
– Thus, man-made
– “So long as the ship rides out the storm, so long
as the city resists the earth-shocks, so long as the
levees hold, there is no disaster. It is the collapse
of the cultural protections that constitutes the
disaster proper.”
6. Disaster as Avoidable Human
Creation that Highlights
Societal Injustices & Social
Vulnerability
Not enough that there is a human component.
Now see victims of larger social forces.
Focus on the vulnerability of people.
– People who experience disaster are victims of
social forces/powerful interests who have
created the conditions for their hazard
vulnerability
Viewing as amoral the scientific (traditional)
approaches.
– Searching for blame.
7. Disaster as Highlighting Societal
Injustices & Social Vulnerability
Cannono: “disasters
are not ‘natural’ (not
even sudden ones)
because hazards
affect people
differently within
societies and may
have very different
impacts on different
societies. . .”
8.
9. Disaster is a Growth Business
World-wide,
rapidly escalating
human and economic losses
from weather-related disasters
Reason is multifactorial
10. What can be done about this:
The major tenets of building
disaster resilient communities.
Adopt a global systems perspective.
– Complementary structural and nonstructural
risk reduction
Accept responsibility for hazards and
disasters.
Challenge Traditional Planning Model
– Disasters By Design: A Reassessment of
Natural Hazards in the United States, Dennis
Mileti.
11. Disaster Risk Management Cycle
–Mitigation: limits the adverse
impact of hazard.
–Preparedness: ensures
effective response to hazard
impact
–Mitigation
–Preparedness
–Prevention
–Response
–Recovery
–Source: Keim M. Building human resilience. Am J Prev Med 2008;35(5):508-516
12.
13. What can be done about this:
The major tenets of building
disaster resilient communities.
Reject short-term thinking.
Account for social forces.
– (address the challenge of establishing the core
value of resilience in communities; building
local community capacity )
Embrace sustainable development.
– Disasters By Design: A Reassessment of
Natural Hazards in the United States, Dennis
Mileti.
15. Fostering local, community-level
disaster resilience
Resilience = ability to prepare and plan
for, absorb, recover and more
successfully adapt to adverse events
Focus on “we” vs “me”
Building social capital, social networks
Public as “asset” not something to be
commanded and controlled
Community engagement
Disastro=disaster Bc Resulting from unfavorable alignment of the stars and planets.
“Act of God” `---- Earliest (and continuing) usage = divine retribution for human misdeeds and failings
[So what are the implications of this?]
Seen as ‘just the way things are’, accept it and move on, fatalism (so why try to do anything to mitigate or prepare)
Notice sometime how officials use the terms ‘acts of God,’ ‘forces of nature’ and ‘freak events’ ---this distances themselves and their organizations from any complicity and responsibility
The Great Lisbon earthquake of 1755 = catastrophic disaster. With 80% of the buildings destroyed and 40,000 persons dead, the leading families, the rich, pious suffered as much from the 8.5- 9.0 catastrophic earthquake, fires and tsunami that pretty much destroyed Lisbon. So Act of God seems not possible.
First look for causes in the earth itself. Seen as physical agents---root cause is extremes of nature.
[Implications?]
So, Now the belief was that disasters are Acts of Nature and that they affect persons randomly. Disasters are simply bad “stuff that happens” – get used to it . Thus, just as in the “disaster as an agent of the Fates” or “God,” disaster as “an agent of Nature” is susceptible to fatalism – “being in the wrong place at the wrong time.”
The Lisbon earthquake was the first modern disaster in which the state accepted the responsibility for mobilizing the emergency response and for developing and implementing a collective effort for reconstruction and in order to accomplish that, traditional notions of supernatural causation were opposed,
the man in charge of recovery saw the call for devotional repentance might lead to personal withdrawal at a time when the city needed everyone for the tasks remaining
The supernatural is replaced by the natural….hence “natural disaster”.
In the 1930s begins recognition that it takes the failure of society’s protections to be a disaster. Disasters are simply the collapse of cultural protections; thus, they are principally man-made. Carr: So long as the ship rides out the storm, so long as the city resists the earth-shocks, so long as the levees hold, there is no disaster. It is the collapse of the cultural protections that constitutes the disaster proper.”
Not enough that there is a human component. Now see victims of larger social forces. Sees blame.
Moral stance vs amoral traditional science approach
The fact is that some groups ARE more at risk of harm than others; they are more vulnerable in disasters. One understanding now in the disaster field is tthat people and communities are not equally likely to be harmed by a hazard such as an earthquake or hurricane.
[WHAT DO YOU THINK OF THIS VIEW?]
[CAN YOU THINK OF WHO IS MORE VULNERABLE? WHY?]
Implication: It is no longer merely a matter of building to specific standards or of disallowing development in hazardous areas. . . . They are not likely to have much impact until such problems as poverty, land and income distribution and equity issues are resolved.”
[ask the students their opinion on these various ways of perceiving
disasters and then ask – does it matter?]
apathetic political atmosphere
leads to adjustments, improvements, solutions we choose if are going to act
e.g. view of disasters as social phenomena allows such happenings to be incorporated as a part of the nation’s development process. Disaster planning is not primarily the search for the implementation of technological solutions.
[Ask the students why?]
The combination of human-driven climate change, ecologically destructive practices, and rapidly changing socioeconomic conditions will set off chain reactions of devastation leading to more “catastrophic disasters” in the years to come
Increase in vulnerability driven primarily by social, rather than natural factors.
Vulnerability comes from economic, social, cultural, institutional, political, and even psychological factors that shape people’s lives and create the environment that they live in.
Vulnerable groups are living longer.
Income inequality is growing.
“But if all four billion were securely housed in well-planned communities, appropriately educated, and had access to adequate diets, health care, and well-compensated livelihoods, their vulnerability to calamities might be minimized.”
Adopt a Global Systems Perspective: Disasters are the predictable result of interactions among three major systems: The physical environment, which includes hazardous events.
The human system (i.e., the social and demographic characteristics of communities that experience hazards). Its built infrastructure—the buildings, roads, bridges, and other components of the constructed environment.
(2) Accept Responsibility for Hazards and Disasters: Human beings, not nature, are the cause of many disaster losses. All disaster losses are the result of the interaction between the physical environment and the human system. This stems from choices about where and how human development proceeds. “You can’t prevent the weather but you can prevent the damage.” Nature or God did not cause this.
IMPLICATIONS:
We need to make sure that individuals and communities who choose to build in known hazardous environments take responsibility for the risk they assume.
Lindell/Perry: “…most Americans consider natural disasters to be ‘acts of God’ or ‘acts of nature’ whose effects are more or less random and accidental. Because disaster impacts are defined as involving fate rather than choice, it follows that victims are blameless and should be assisted in recovering from their losses by the government, private sector organizations like the Red Cross, and insurance.”
There is no final solution to natural hazards, since technology cannot make the world safe from all the forces of nature and man.
3. Challenge Traditional Planning Model. He says that most strategies for managing hazards have followed a traditional planning model: Study the problem, implement one solution, and move on to the next problem. But, natural and technological hazards are not problems that can be solved in isolation. Human adaptation to hazards must become as dynamic as the problems presented by the hazards themselves. (See the Resilience Cycle)
Mitigation: structural or non-structural
Reject Short-Term Thinking. Response to hazards, as frequently conceived, is too short-sighted. In general, people have a cultural and economic predisposition to think primarily in the short-term
Move away from a disaster assistance mindset (rewarding individuals and communities for building and living in hazard-prone areas) to one that fosters long-term thinking about mitigation, loss reduction, and personal responsibility for actions.
5. Account for Social Forces.
Social forces are now known to be much more powerful than disaster specialists previously thought. Thus a better understanding of physical systems and improved technology, while necessary, are not sufficient.
Disaster planning must be recognized as residing in a context of social, cultural, political, and economic environments that shape its effectiveness.
To effectively address natural hazards, prevention and mitigation (or disaster reduction) must become basic social values.
6. Embrace Sustainable Development.
Disasters are more likely where unsustainable development occurs.
The converse is also true: Disasters hinder movement toward sustainability because, for example, they degrade the environment and undercut the quality of life.
Building a disaster resilient community means strengthening a community’s social, economic, and environmental resiliency.
To achieve sustainability, communities must take responsibility for choosing where and how development proceeds.
“Toward that end, each locality evaluates its environmental resources and hazards, chooses future losses that it is willing to bear, and ensures that development and other community actions and policies adhere to those goals.”
Kofi Annan, Secretary-General of the United Nations, in Ingleton 1999, “Statement By the Secretary-General.
IT'S PROBABLY TRUE that PREPARED Communities NOT PREPARED INDIVIDUALS ARE WHAT WE NEED MOST.
Studies show that friends and neighbors who are in the disaster with you are your key to survival in the first few days right after a disaster. Remember, in a disaster There just aren’t enough rescue personnel, firefighters, and so forth to help us all. So you will help yourself and the people around you. And the people around you will help you, too. In the first few days, they are the ones who will conduct rescues, provide first aid, transport to the hospital, provide food, water and shelter.
Analyzing data from Hurricane Katrina, 3004 Indian Ocean Tsunami, and the 1995 Kobe Earthquake the political scientist Daniel Aldrich demonstrates in his recent book on post-disaster recovery that communities with higher levels of social capital that is, more history of cooperation, greater trust of neighbors, volunteerism and participation in local events and festivals recover faster and more completely. He shows that stronger bonds between neighbors and within neighborhoods predicts better and quicker recovery from a disaster.
Community is repositioned. Community engagement is sustained not episodic, involves real community members not just local voluntary agencies active in disasters, requires attention to process and is best done by experts in community facilitation; acknowledges strengths of at-risk groups; wellness topic