Modeling of a Nuclear Emergency Plan: Communication Management

ABSTRACT

The Nuclear Emergency influence domain spreads over a large number of systems of different natures. Nuclear Emergency Plans (NEPs) are usually designed using a top-down approach, establishing a hierarchy working as a command chain. Although this provides advantages in terms of control, it might not be flexible enough to face unpredicted emergent behaviors due to complex interactions among the systems involved. Using a real case study, this work models the organizational framework defined in a NEP and analyzes its communication and command chain network structure. We also discuss the results of the communication and command chain network analysis to facilitate the assessment of key indicators to improve the NEP: resilience, adaptability, and responsiveness.     

Stressors,Supports and the Social Ecology of Displacement: Psychosocial Dimensions of an Emergency Education Program for Chechen Adolescents Displaced in Ingushetia,Russia

This study explored the psychosocial benefits of an emergency education intervention serving adolescents displaced by the war in Chechnya. It set out to describe key stressors and sources of social support available to youth served by the International Rescue Committee's (IRC) emergency education program. Interviews were conducted with 57 Chechen adolescents living in spontaneous settlements in Ingushetia, Russia in the fall of 2000. Of particular interest was the degree to which the education program addressed specified psychosocial goals. Findings indicated that young people and their families faced a number of physical and emotional stressors. The data indicated that the emergency education program provided benefits by enriching sources of social support, providing meaningful activity and a sense of hope for the future, and creating a space for young people to spend time and connect to others. However, the contrast between the desire of adolescents “to live like other kids” and the options available to them presented a dilemma for the emergency education program: adolescents craved normalcy, but for any intervention to be delivered, it had to first begin with creative and adaptive strategies that were by no means a complete replacement for formal, mainstream education. The programmatic and policy implications of these findings are presented here.     

High-sensitivity cardiac troponin T for diagnosis of NSTEMI in the elderly emergency department patient: a clinical cohort study

Purpose: The aim of this study is to evaluate the impact of age on the diagnostic performance of high-sensitivity troponin T (hsTnT) under routine conditions.

Materials and methods: Data of 4118 consecutive emergency department (ED) patients who underwent a routine TnT measurement between 11 October 2012 and 30 November 2013 were analysed. Diagnostic accuracy of hsTnT was compared in four age categories (<50, 50–64, 65–74, ≥75 years of age) for different cut-off values. Primary endpoint was a main hospital diagnosis of NSTEMI.

Results: The median age of the study population (n?=?4118) was 61 years (IQR: 45–75 years). NSTEMI was diagnosed in 3.3% (n?=?136) of all patients. There were significant differences in hsTnT concentrations between age-groups (p?p?=?0.297). 72.2% of all patients ≥75 years of age (583/808) without NSTEMI had hsTnT concentrations above the 99th percentile of a healthy reference population. Specificity at 14?ng/L was 93.6% (95% CI: 92.12–94.87) in patients below 50 years of age and 27.9% (95% CI: 24.78–31.08) in patients 75 years of age and older.

Conclusions: Patients’ age needs to be considered at least one influencing factor on hsTnT concentrations at admission and should be included in the clinical interpretation of hsTnT concentrations for further clinical workup beneath other influencing factors like comorbidities and symptom onset time. The implementation of age-specific cut-off values could be considered for single troponin testing at admission but is associated with an increased risk of underdiagnosis of NSTEMI.     

卡托普利与心痛定治疗高血压急症的疗效观察

目的以卡托普利舌下含服治疗高血压急症,并与心痛定舌下含服治疗对照。方法卡托普利２５ｍｇ舌下含服治疗高血压急症６０例为治疗组,６０例用心痛定１０ｍｇ舌下含服作对照组。结果卡托普利组用药１５ｍｉｎ即开始有显著的降压作用（Ｐ＜０．００１）,３０ｍｉｎ、６０ｍｉｎ、１２０ｍｉｎ后疗效更显著（Ｐ＜０．００１）。心痛定组用药１５ｍｉｎ血压无显著下降（Ｐ＞０．０５）。３０ｍｉｎ、６０ｍｉｎ、１２０ｍｉｎ,血压明显下降（Ｐ＜０．００１）,两组比较,卡托普利组降压作用明显（Ｐ＜０．００１）。结论卡托普利舌下含服是治疗高血压急症较迅速、有效、安全的降压方法,无明显不良反应。     

低空无人机遥感在草原监测评价中的应用进展

低空域无人机遥感技术具有高时效性、高分辨率、低成本、易操控等优势，作为地面与高空遥感（航天与航空遥感）间测量尺度空缺的有益补充，低空无人机遥感扩展了样地样方空间尺度，提高了中、小尺度遥感观测信息的精细化程度，实现了草原生境信息的快速采集、处理与分析应用，是草原"星-空-地"一体化监测的重要组成。针对草原监测评价，总结了国内外低空无人机遥感在草原基况调查（草原草层高度监测、草原植被覆盖度监测与草原地上生物量估算）、草原动态监测（草原植被长势监测、草原产草量估测与草畜平衡监测）和草原应急管理（草原火灾、雪灾与生物灾害监测）中的应用。结合大数据、人工智能、云计算与物联网等新型技术，分析了低空无人机遥感在草原生态监测领域存在的不足和未来的发展方向，以期为低空无人机遥感关于草原监测评价与智慧草原的后续研究提供参考。     

Risk perception–based post-seismic relief supply allocation in the Longmen Shan fault area: Case study of the 2013 Lushan earthquake

Post-seismic relief supply allocation based on psychological risk perception is an important yet understudied area in emergency management. This article develops a systematic approach to assist in post-seismic relief supply allocation in the Longmen Shan fault (LSF) area where many destructive earthquakes have occurred. First, to analyze the relief supply allocation system, a system dynamics (SD) model is built for the LSF area, which we then verify in a simulation of the 2008 Wenchuan earthquake. This simulation of an actual earthquake in the area allows for the verification of direct relief supply allocation information. Then, by applying the SD model to the 2013 Lushan earthquake, a decision tree focusing on the selection of appropriate decision-makers is proposed. In summary, the combination of the SD model and the decision tree can then be used to assist the government in carrying out post-seismic relief supply allocation when coping with the actual relief environment. Further, this systematic approach will be improved using other detailed factors from subsequent research on post-seismic relief supply allocation.     

突发公共卫生事件与综合性医院重症监护超负荷扩容

医院是社会应对突发公共卫生事件的主要机构。在超出正常负荷的情况下,合理有序地进行基础卫生设施扩容是保证医院成功应对突发事件的关键。医院必须能够通过增加重症监护单元（Intensive Care Unit, ICU）容量或通过改造其他区域增加实际ICU收治能力;有次序地将相关区域改造为临时重症监护单元;储备充足的病床和相关监护设施,在应对偶发事件时必须能得到政府协助以获取额外的呼吸机;制定ICU阶段性扩容人员工作计划,保证在应对偶发事件或危机时重症监护的仍可有效执行;抽调临床专业人员参与应急管理组,共同制定和执行扩容计划;为重症监护活动提供充足的基础设施支持。     

Addition of heart score to high-sensitivity troponin T versus conventional troponin T in risk stratification of patients with chest pain at the coronary emergency rooms

Patients with chest pain have a large impact on available resources in coronary emergency rooms (CER). Clinical judgement, ECG, risk scores and biomarkers guide in risk stratification. We investigated if high-sensitivity troponin T (HsT) and the HEART Score could contribute to risk stratification at the CER. All patients with chest pain, without elevated conventional troponin levels at presentation, were included. HsT levels were determined at admission (T1), at 4–6 h (T2) and 8–10 h after symptom onset (T3). The HEART Score was calculated as risk score for the occurrence of a major adverse cardiac event (MACE). Thirty days after discharge, occurrence of MACE was registered. Eighty-nine patients were included (overall mean age 61 years (range 20–90)). At presentation, 68 patients (76 %) had a HsT below cut-off value of 14 ng/l (mean HEART Score 3.7, range 1–9). Thirty-one of these 68 patients had a HEART Score between 1–3, no MACE occurred in this group. For 3 patients (4 %) HsT levels increased above 14 ng/l. These 3 patients had a HEART Score between 4–6. The majority of patients with chest pain can be safely discharged within 4–6 h after onset of symptoms using HsT and the HEART Score. In contrast, patients with initially normal HsT but a high HEART Score need longer follow-up and repeat HsT determination.     

集束化管理模式在急诊危重患者院内转运的应用及效果评价

目的探讨集束化管理模式在急诊危重患者院内转运中的应用效果。方法选取2019年9月~2020年4月我院急诊科就诊的324例急诊危重患者为研究对象,按转运方式不同分为观察组和对照组各162例。观察组采用集束化管理模式转运危重患者,对照组采用传统模式转运危重患者,比较两组患者的院内转运时间、投诉率、转运意外发生率(包括病情变化、脱管、仪器故障等)及满意度(包括转运患者的满意度及接收科室医护人员的满意度)情况。结果观察组院内危重患者转运时间明显短于对照组(P<0.05),转运患者的投诉率、及转运意外发生率均低于对照组(均P<0.05);观察组转运患者的满意度、接收科室医护人员的满意度均明显高于对照组,差异均有统计学意义(均P<0.05)。结论集束化管理模式在急诊危重患者院内转运中可缩短患者转运时间,降低不良事件发生率,提高了患者及接收科室医护人员的满意度。