- a description of the scope, scale, pathogenesis, timeframe and typology of health emergencies and of the major challenges for the health services (HS) and health-related activities;
- a conceptual approach of the health needs involved, based on health determinants and the most relevant health theories and models;
- a panoramic overview of the problem, including an analysis of the way and timeline of presentation of relevant health issues with respect to the health services, and a schematic representation of the flow of persons affected and the patient’s “journey” through the emergency medical and health service system (flowchart);
- the identification of the major stakeholders, their (re-)actions, operational role and responsibility, a description of the spectrum of the various health services involved, as well as a preliminary analysis of the critical decisions related to the most relevant health interventions ;
- a graphical scheme illustrating the complexity of communication, flow of data, exchange of information and interactions between the various stakeholders.
A brief, comprehensive analysis has been given of the complexity and issues related to the identification and selection of variables, indicators and metrics, relevant for decision-making and knowledge management in emergency situations, also in view of their use as computable data and their relation and interface with other sources of information and databases as well as with health-related digital applications and standards.
Starting from the general conceptual framework as the core of a system type-approach with respect to the consequence management of the health services in emergency situations, various elements and components have been described at five levels of granularity.
A comprehensive overview, typology and generic description have been provided of the relevant pathogenetic and salutogenetic factors (including major health hazards and health-related interventions) for all possible emergency situations.
At a third level of granularity, the conceptual framework is more systematically developed, relevant variables identified, specific taxonomies presented and health interventions described for two types of mass emergencies: :
- a classical mass casualty incident involving mechanical injury/trauma;
- a major accident with hazardous materials (HZM).
The scope of analysis will then be narrowed down to specific scenarios in order to make a detailed process description feasible. Here the system elements and variables for health status and interventions will be made tangible with the specifics of the concrete situations relevant for the 1st use case (cross-border earthquake scenario Greece-Bulgaria) and for the 2nd use case (Palermo fire scenario). Furthermore the details of a public health emergency will be elaborated for a limited number of biological agents (infectious disease outbreak).
Finally, a detailed assessment and extraction of variables of five important evaluation reports or official inquiries on real major incidents in Europe will add a fifth level of granularity. The metrics available in these reports will illustrate the highest possible level of detail that researchers and officials can find, months after a major incident, making it possible to validate the analytical approach and set the maximum standard, limiting the data variables that can be realistically expected to be useful during the response phase.
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