ناریا رد رطخ تیریدم یاه شلاچ file•yokohama strategy and plan of action for...

دکتر حمید رضا خانکه

معاون بحران و پدافند غیر عامل مرکز مدیریت حوادث

فوق دکتری مدیریت خطر سالمت در حوادث و بالیا از سوئد

چالش های مدیریت خطر در ایران

(1)World Conference on Natural Disaster Reduction

Yokohama, Japan, 23-27 May 1994

• Yokohama Strategy and Plan of Action for a Safer World

• Guidelines for Natural Disaster, Prevention, Preparedness and Mitigation

• Each country has the responsibility to protect its citizens from natural disasters

Hyogo Framework for action health system

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• Based on the Hyogo Framework for action disaster management system in every country should follow 5 Priorities for Action towards strengthening community and country resilience to disasters.

• Priority 1: Disaster risk management as a national and local priority

• Priority 2: Risk assessment and early warning

• Priority 3: Education and information to build a culture of safety and resilience at all levels

• Priority 4: Reduction of underlying risk factors

• Priority 5: Disaster preparedness for effective response and recovery at all levels.

(2)Six problems related disaster to be solved based on Hyogo Framework for Action

1. Disasters are an increasing threat to sustainable development.

2. Developing countries rarely have the tools or expertise to consider disaster risks through their development planning and investment.

3. DRM policies do not always translate into local action.

4. Many developing countries lack the financial capacity to respond immediately after a disaster.

5. The potential of partnership with the private sector in building resilient societies is not yet fully harnessed.

6. Support from the international community for DRM is critical, but donor financing is still response focus instead of preparedness focus.

hamid.khankeh@ki.se

(3)The Sendai Framework for Disaster Risk Reduction 2015-2030

• Framework aims to achieve the following outcome over the next 15 years:

• The substantial reduction of disaster risk and losses in lives, livelihoods and health and in the economic, physical, social, cultural and environmental assets of persons, businesses, communities and countries.

• The realization of this outcome requires the strong commitment and involvement of political leadership in every country at all levels in the implementation and follow-up of this Framework and in the creation of the necessary conducive and enabling environment.

Why we should be prepared against Emergency and Disaster?

Because…

Disasters are of significant threat for human life worldwide and can have destructive consequences for human

being

Father carries his two sons to be buried after earthquake, Bam, Iran, 27 December

A Disaster is:

حوادث و بالیا اتفاقاتی با تاثیرات منفی بر سالمت، محیط 1.زندگی، دارایی ها و خدمات مورد نیاز جامعه هستند که

منابع محلی کفایت مدیریت آنها را نکرده و نیاز به منابع .حمایتی از خارج منطقه آسیب دیده است

Civil defense

•Civil defense is an effort to protect the citizens of a country (generally civilian) from military

attack.

11 hamid.khankeh@ki.se

Threats to the health system

oThreats to health infrastructure

oThreats of health human resources

oThreats of strategic reserves for health (blood, drug ,...)

oThreats to essential health functions

o Threats to operational capability of health system

oThreat of sanctions on health system

oThreat posed by new science in health systems

12 hamid.khankeh@ki.se

Civil defense goals in health system

Increase deterrence افزایش پایداری

Reducing vulnerability کاهش آسیب پذیری

Continuity of essential functions تداوم فعالیت های اساسی

Promote national consistency تقویت انسجام ملی

Facilitate emergency management تسهیل مدیریت حوادث

13 hamid.khankeh@ki.se

Worldwide Disaster Trend

2016-03-01 Davoud Khorasani 19

Iran • Location: Middle East region

• Area: 1 648 000 km2

• Worldwide: 18th largest country

• Asia: 4th country

• Population: about 77 million

• Life expectancy: 74

• Population density:

• 39 inhabitants per km2

• Neighbour to seven countries

• 32 provinces

• 336 districts

• 1012 cities

• 64 000 villages

Problem Statement

• Iran is exposed to a wide range of natural and man-made disasters.

• “According to EM-DAT,:

1. 181 disasters were recorded in Iran from 1900–2007,

2. which caused 155,811 deaths

3. and 680,217 injuries,

4. and affected 44,037,516 people.”

Iran and Disaster

Most common disaster in Iran

1. Natural

• Earthquake

• Flood

• Drought

2. Manmade

• Road Traffic Injuries

Seismic Hazard Map, Iran

Map of Iran's earthquake

Tabriz, Iran 2012 Agust

1391تبریز تابستان

Legal Framework

عامل اصلی آمادگی ملی 10

سطح ملیسیاست ها

راهنماها

روش ها

سطح محلیبرنامه ها منابع ساختار قدرت

سطح فردیدانش مهارت نگرش

Cap

abili

tie

s an

d R

eso

urc

es

پاسخ ملی

پاسخ قطبی

پاسخ استانی

افزایش شدت و بزرگی حادثه

پاسخ محلی

استراتژی پاسخ الیه ای

Minimal Low Medium High Catastrophic

National Disaster Management Organization

دستگاهها ونهاد های وابسته به قواهای سه گانه و تصویب ضوابط هماهنگی به منظور ایجاد• .و مقررات حاکم بر مدیریت بحران در مراحل چهارگانه شورای عالی تشکیل گردید

و با عضویت وزارء اطالعات ،کشور شورای عالی مدیریت بحران به ریاست رئیس جمهور • .و رئیس سازمان تشکیل می گردد....،اقتصاد ودارایی ،

به عنوان قائم مقام حضور وزیر کشور جلسات شورای عالی در غیاب رئیس جمهور با • .تشکیل می گردد ومصوبات این شورا پس از تائید رئیس جمهور الزم االجراست

.مستقر استدبیرخانه شورا ،در سازمان مدیریت بحران •

سازمان مدیریت بحران وابسته به وزارت کشور بوده و رئیس آن به پیشنهاد وزیر کشور و • .منصوب می گرددشورای عالی و با حکم وزیر تائید

رده های سازمانی متناسب در استان ها و شهرستانها به ترتیب زیر نظر استاندار و فرماندار • .تشکیل می شود

شورای عالی مدیریت بحران کشور

(معاون امنیتی –وزارت کشور ) کارگروه نیروهای مسلح ، امنیت و انتظامات 1.

(سازمان امداد و نجات –هالل احمر ) کارگروه امداد و نجات و آموزش همگانی 2.

(بنیاد مسکن ) کارگروه تامین مسکن 3.

(وزارت نیرو ) کارگروه امور سیل و مخاطرات دریایی ، برق ، آب و فاضالب 4.

وزارت ) کارگروه مخاطرات زلزله ، لغزش الیه های زمین ، ابنیه ساختمان و شهرسازی 5. (مسکن و شهرسازی

(سازمان صدا و سیما ) کارگروه آموزش و اطالع رسانی 6.

(سازمان حفاظت محیط زیست ) کارگروه مخاطرات زیست محیطی 7.

(وزارت ارتباطات و فناوری اطالعات ) کارگروه مخابرات و ارتباطات 8.

(وزارت جهاد کشاورزی ) کارگروه خشکسالی ، سرمازدگی و مخاطرات کشاورزی 9.

(وزارت راه و ترابری ) کارگروه حمل و نقل ، بالیای جوی و طوفان 10.

(معاون اجتماعی –وزارت کشور ) کارگروه تشکل های مردم نهاد 11.

وزارت کشور ) کارگروه بازسازی و بازتوانی ، تامین و توزیع ماشین آالت ، آوار برداری 12. (معاون امور عمرانی –

( وزارت بهداشت ) کارگروه بهداشت و درمان 13.

(وزارت نفت ) کارگروه تامین سوخت 14.

اسامی کارگروه ها

Result: Challenges 1 • DRM policies did not translate into local action and did

not integrated to health policies

• the lack of planning,

• Inadequate management of resources,

• insufficient coordination,

• a lack of single emergency number in emergencies,

• which can be resulted :

• duplication efforts,

• wasting resources and time,

• organizational conflict, different emergency phone numbers,

• lack of a comprehensive NEMP,

• Lack of a system approach for providing trauma care

Result: Challenges 2

• Unclear national policies and poor organization of emergency management,

• lack of providing comprehensive recovery services

• Absence of standardized Medical Assistant Teams (DMAT) and related law and regulations,

• Shortage of resources

• and finally insufficient policies to improve the quality of pre-hospital medical care and improve interaction between pre-hospital and hospital.

What has been done?

• National campaign for RTI,s since 2005 and decreasing the number of death by 5% each year respectively

• National single emergency number

• Improving the organizational level of EMS

• Public education

• Activated Health in Emergency and Disaster Working Group(HEDWG)

High Council of NDMO

Disaster Management Coordination Council

NDMO

HEDWG

Secretariat

Departments

National chain of Command and Coordination

Achievement • 14 Working Groups that are responsible for inter and intra-sectoral

coordination of disaster risk management in Iran(NDMO).

• Health in Emergency and Disaster Working Group(HEDWG)

• This working group consists of seven committees: medical services(Curative affairs), public health, logistics(administration & Finance), education, research, rehabilitation and food and drug.

• The corresponding departments of MOHME are in charge of these various committees.

• EMC

• EOC

NEMC

Regional EOC/EMC

Provincial

EOC/EMC

EOC/ECC Secretariat for

HEDWG

HEDWG chain of Command and Coordination

Road Map for HEDWG

1. Establishing Provincial HEDWG leading by UMS,s based on national guideline

2. Developing provincial risk map based on risk assessment using national tools

3. Writing scenarios based on the results of risk assessment

4. Developing Early Warning system based on national template

5. Establishing and activating EOC and drawing chain of command and coordination

6. Developing Preparedness plan, EOP, and response plan based on national template

7. Writing Job action sheet for all involved people in Emergency Response Plan

8. Training and education based on the plans

9. Designing IMS,ICS

10. Planning for exercises from theoretical to practical

11. Post Action Revision

12. Developing Guidelines and Protocols

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Achievements

• Hospital Safety Index

• National tools for:

1. Hazard, Capacity, Vulnerability,

2. Hospital preparedness,

3. Rapid assessment,

4. Disaster Leveling,

5. Hospital mental preparedness,

• Developing 50 national scenarios

Achievements

• National strategic plan for HEDWG

• National Guideline for Emergency Operations Center (EOC).

• National guideline for Hospital Disaster Planning (HDP) and installed in all hospitals.

• A National Emergency Operation Plan developed based on National disaster Scenarios in public health, pre-hospital and hospital care.

• Integrating some disaster risk reduction indexes in National hospital accreditation system

• Developing national indexes to rank Medical universities related Disaster Risk Management

46

Final EWS Flowchart in Disaster

Result: Achievement

• PhD Program of Health in Emergency and Disaster by MOHME has been established in some Universities.

• The main intention of this initiation is to train some experts in order to develop new knowledge, solve existing problems by scientific inquiries and improve health disaster risk reduction in Iran.

Conclusion • Findings of the current study show that it is of the utmost importance

that efforts and actions focused on the disaster risk reduction been coordinated more in order to restrict the impacts of disasters and to achieve recovery as soon as possible.

• Health system should be strengthened in intra and inter-sector collaboration and coordination, information management system and community-based initiatives for disaster preparedness.

• It is also essential to focus on disaster risk reduction while enhancing the response capacity.

• Investing on research would lead to quality decision-making in disaster health management.

Conclusion

• Authorities and health system administrators should consider the physical and psychological health of their staff

• and make policies to improve the quality of pre-hospital Emergency Medical care.

Future Plan • NHERP: National health Emergency Response Plan • National Health Risk Map • National Emergency and Disaster Registry

• Integrated emergency dispatch system with common emergency number(SOS)

• National DMATeams

• Social vulnerability for older adults tool

• Community Mental Health Preparedness tool

Ongoing Projects

• Chain of Command and Coordination in Health system

• Technology development in Health in Emergencies and Disasters

• Community Based Early Warning System

• Community Based Preparedness Plan

• Traffic Psychology

• Hospital Resilience

Integrated Dispatch System(SOS)

Caller

110

115

Police

EMS

Police Dispatch

EMS Dispatch

Dispatch Amb

• Khankeh , H.R et al., Prehospital services by focus on road traffic accidents: Assessment developed and developing countries. Journal of Health Promotion Management, 2013. 2(2): p. 71-79.

• Khankeh, H.R., et al., Triage effect on wait time of receiving treatment services and patients satisfaction in the emergency department: Example from Iran. Iranian Journal of Nursing and Midwifery Research, 2013. 18(1).

• Khankeh, H., D. Khorasani-Zavareh, and G. Masoumi, Why the Prominent Improvement in Prehospital Medical Response in Iran Couldn’t Decrease the Number of Death Related Road Traffic Injuries. J Trauma Treat, 2012. 1: p. e103.

• Khankeh, H.R., et al., Disaster Health-Related Challenges and Requirements: A Grounded Theory Study in Iran. PREHOSPITAL AND DISASTER MEDICINE, 2011. 1(1): p. 1-8.

• Alipour, F.,Khankeh.HR., et al., Challenges for Resuming Normal Life After Earthquake: A Qualitative Study on Rural Areas of Iran.

• Varjoshani, N.J.,Khankeh,HR., et al., Tumultuous Atmosphere (Physical, Mental), the Main Barrier to Emergency Department Inter-Professional Communication. Global Journal of Health Science, 2014. 7(1): p. p144.

• Khorasani-Zavareh, D.,Khankeh,HR., et al., Why should being visible on the road? A challenge to prevent road traffic injuries among pedestrians in Iran. Journal of Injury and Violence Research, 2014. 7(2).

• Djalali, A., Kurland L. Khankeh , H.R et al., Hospital Disaster Preparedness as Measured by Functional Capacity: a Comparison between Iran and Sweden. Prehospital and Disaster Medicine, 2013: p. 1-8.

• Froutan, R., Khankeh,HR.,et al., Pre-hospital burn mission as a unique experience: A qualitative study. Burns, 2014.

• Alipour,F.,Khankeh,HR., Fekrazad,H.,Kamali,M.,Rafiey,H, Social Capital and Post Disaster Recovery: Evidences from Rural Areas of Iran.Journal of Applied Science and Agriculture,2014. 9(6) May 2014, Pages: 2600-2605.

• Froutan, R., Khankeh,HR.,et al., Pre-hospital burn mission as a unique experience: A qualitative study. Burns, 2014.

• Alipour,F.,Khankeh,HR., Fekrazad,H.,Kamali,M.,Rafiey,H, Social Capital and Post Disaster Recovery: Evidences from Rural Areas of Iran.Journal of Applied Science and Agriculture,2014. 9(6) May 2014, Pages: 2600-2605.

• Sohrabizadeh, S., S. Tourani, and H.R. Khankeh, The Gender Analysis Tools Applied in Natural Disasters Management: A Systematic Literature Review. PLoS Currents, 2014. 6.

• Ardalan, A., Khankeh , H.R ,…et al., Hospitals Safety from Disasters in IR Iran: The Results from Assessment of 224 Hospitals. PLoS Currents, 2013. 6.

• Khankeh , H.R et al., Life Recovery After Disasters: A Qualitative Study in the Iranian Context. Prehospital and Disaster Medicine, 2013. 28(06): p. 573-579.

• BAZREGAR, R.,Khankeh,HR., et al., THE EVALUATION OF APPLICATION OF COORDINATION BASED DISASTER RESPONSE MODEL IN RAJAYE HOSPITAL DISASTER PREPAREDNESS.Journal of Nursing Research,2013

Invest Today for a Safer Tomorrow Resilient People - Resilient Planet

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Hope to have a safe and developed

world Free of disaster risk