People affected by an extra-ordinary public health challenge
(EOPHC), e.g. in situations of mass emergencies or disasters, cannot be reduced
to the status of (passive) victims or to irrationally acting or panicking
crowds. Even a well-prepared and coordinated Health Emergency Management System
(HEMS) cannot control or anticipate the dynamics resulting from the decisions,
actions and reactions, needs, demands and perceptions, as well as of the
healthcare-seeking behaviour of people affected by an emergency. In a mass emergency, uninjured, slightly
injured, even some seriously injured survivors, their relatives present
on-scene as well as bystanders or witnesses do not passively wait for (external)
emergency assistance and the arrival of first responders. They take actions on
site and move to hospitals nearby or even further away. This behaviour adds
even more challenges to the health system and requires flexible adaptations in
the health response. Furthermore, events
resulting in an EOPHC do not only have adverse effects on the health status of
a community, but may - even temporarily - increase feelings and acts of
solidarity and incite collaborative attitudes, contributing to disaster
resilience.
For a long time EOPHC-management focussed only on the organisation
of formal responders, as reflected by the concept of command and control, e.g.
by the Incident Command System (ICS). However, the integration of the activity
and reactions of the community, as a fully equivalent stakeholder in emergency
management, is of increasing importance.
In this respect, a wide variety of issues needs to be
considered, including:
- reactions, activities, means and needs of persons directly involved or indirectly affected (e.g. family and friends of casualties), which cannot be ‘commanded’ by a formal hierarchy (including healthcare-seeking behaviour and psychosocial aspects)
- potential and challenges of the mobilization of (untapped) resources: material and equipment as well as human resources incorporated in the formal response and as emergency support functions, including the role of NGOs[1], volunteers, community workers and lay caregivers
- community as potential source of information with respect to damage assessment, search and rescue priorities, evolving risks, etc. (e.g. crowd sourcing approach using mobile electronic applications and social media)
- general public and targeted populations at risk (PAR) as crucial actors with respect to risk control and public health measures (evacuation, shelter, social distancing, etc.)
- influence and pressure of public opinion and perceptions on policymaking and response
- approach of increasing community resilience, as an essential factor of impact mitigation and vulnerability reduction (absorbing, buffering and local response capacity)
- aspects of public relation, information and communication, including dealing with traditional press and mass media, as well as the challenges of new forms of social media and internet
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