tag:theconversation.com,2011:/africa/topics/emergency-7589/articlesEmergency – The Conversation2023-10-03T19:04:57Ztag:theconversation.com,2011:article/2050312023-10-03T19:04:57Z2023-10-03T19:04:57ZNo, stress won’t dry up your milk. How to keep breastfeeding your baby in an emergency<figure><img src="https://images.theconversation.com/files/551576/original/file-20231002-29-1b6ak7.jpg?ixlib=rb-1.1.0&rect=53%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-boy-sucking-milk-mothers-1981392881">Nastyaofly/Shutterstock</a></span></figcaption></figure><p>Bushfires <a href="https://www.theguardian.com/australia-news/2023/oct/02/australia-records-driest-september-since-observations-began-as-fires-rage-in-victoria-and-nsw">currently burning</a> in Victoria, New South Wales and Tasmania bring into sharp focus the fire risks Australian families face over the coming summer months.</p>
<p>Although babies don’t understand <a href="https://theconversation.com/babies-and-toddlers-might-not-know-theres-a-fire-but-disasters-still-take-their-toll-129699">the nature of emergencies</a> such as bushfires, floods and cyclones, they and their mothers are impacted. </p>
<p>During natural disasters, electricity, clean water and food supplies may be interrupted, and <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7528-0">gastroenteritis is common</a>. At these times, breastfeeding provides babies with safe food, water, and <a href="https://waba.org.my/pdf/ilca-iycf-emergencies.pdf">protection from infection</a>, as well as a feeling of comfort and safety.</p>
<p>But mothers can find it difficult to breastfeed during emergencies, and may believe stress affects their milk supply. Some end up stopping even though they didn’t plan to and even though during a disaster is a particularly bad time to wean.</p>
<p>The good news is stress doesn’t reduce milk supply, and while breastfeeding during an emergency carries added challenges, mothers can and do breastfeed through even the worst of disasters.</p>
<h2>Demand and supply</h2>
<p>During pregnancy, hormones develop the milk-making structures inside women’s breasts. After birth, the breasts automatically make milk to feed the baby, but over time they change to a <a href="https://www.breastfeeding.asn.au/resources/how-breasts-make-milk">demand and supply</a> way of working. </p>
<p>This means that when the baby feeds and milk is removed from the breasts, the breasts make more milk. The more frequently milk is removed from the breasts, the more milk will be made.</p>
<p>Babies drink the milk made in the breasts with the help of a hormone called oxytocin. When babies suckle, oxytocin tells the muscle-like cells that surround the small structures <a href="https://link.springer.com/article/10.1007/s12015-023-10534-0">where milk is made and stored</a> to contract. This squeezes the milk towards the nipple where the baby can drink it. </p>
<p>Oxytocin is sometimes called the “<a href="https://www.health.harvard.edu/mind-and-mood/oxytocin-the-love-hormone">love hormone</a>” because it’s also produced when you feel lovingly towards someone. </p>
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Read more:
<a href="https://theconversation.com/i-regret-stopping-breastfeeding-how-do-i-start-again-143183">I regret stopping breastfeeding. How do I start again?</a>
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<h2>Stress doesn’t impact milk production</h2>
<p>There isn’t any way for stress to interfere with the demand and supply process of milk making.</p>
<p>However, <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/suboptimal-infant-and-young-child-feeding-practices-among-internally-displaced-persons-during-conflict-in-eastern-ukraine/9F4B0EA5F13A05B7724BC69AF98B593A">mothers often worry</a> that the stress of an emergency has <a href="https://www.breastfeeding.asn.au/sites/default/files/2023-06/BiBS%20Study%20Report%20Final.pdf">reduced their milk supply</a>. Usually, this is because they are noticing their baby’s behaviour has changed.</p>
<p>During emergencies, babies are often more unsettled, want to be held more, <a href="https://www.breastfeeding.asn.au/sites/default/files/2023-06/BiBS%20Study%20Report%20Final.pdf">feed more frequently</a>, may be fussy at the breast, and wake more overnight. All of this is a normal response to the disruption of an emergency. </p>
<p>Although stress won’t hamper a mother’s milk supply, it can <a href="https://journals.lww.com/greenjournal/abstract/1994/08000/influence_of_psychological_stress_on.21.aspx">temporarily reduce oxytocin release</a>, slowing the flow of milk. This is another reason a baby may be unsettled during feeding.</p>
<h2>Some challenges</h2>
<p>Emergencies like bushfires and floods are difficult for everyone, but can be <a href="https://theconversation.com/the-black-summer-bushfires-put-an-enormous-strain-on-families-with-young-children-we-cant-make-the-same-mistakes-again-205026">especially challenging</a> for parents of babies and toddlers.</p>
<p>For breastfeeding mothers, the busyness of an emergency and a lack of privacy may mean they miss their baby’s cues or delay breastfeeding. Less frequent breastfeeds <a href="https://www.ncbi.nlm.nih.gov/books/NBK153484/">can reduce milk supply</a>. </p>
<p>Another factor that can affect milk supply is dehydration. Mothers may not drink enough water during an emergency because they’re <a href="https://www.breastfeeding.asn.au/sites/default/files/2023-06/BiBS%20Study%20Report%20Final.pdf">focused on looking after their children</a>, water is limited, or they are restricting water intake because there are no toilets. </p>
<h2>How can I keep breastfeeding through an emergency?</h2>
<p>Expect your baby to breastfeed more often than usual during an emergency. They may breastfeed for comfort as well as food. Keeping your baby close, breastfeeding frequently, and drinking enough water will protect your milk supply. </p>
<p>Know the signs that your baby is getting enough milk. If they have at least five heavily wet nappies in 24 hours, their wee is pale (not dark) in colour, and their poo is runny if they are only breastfed or soft if they are also eating solid foods, you can be confident <a href="https://www.breastfeeding.asn.au/resources/baby-getting-enough-breastmilk">your baby is getting enough breastmilk</a>.</p>
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<img alt="A woman sits on a couch comforting two small children." src="https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Emergencies can be stressful for parents of young children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mom-children-hug-together-on-couch-1658307964">Natalia Lebedinskaia/Shutterstock</a></span>
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<p>You can encourage the release of oxytocin and the flow of milk when you breastfeed by looking at your baby and thinking about how much you love them. This can also help you feel less stressed.</p>
<p>You can be reassured that if your milk supply has decreased because of less frequent breastfeeding or dehydration this can be easily reversed by <a href="https://www.breastfeeding.asn.au/resources/increasing-supply">feeding more often</a> and drinking water. If you stopped breastfeeding because of an emergency, <a href="https://theconversation.com/i-regret-stopping-breastfeeding-how-do-i-start-again-143183">it’s possible to start again</a> if you want to.</p>
<p>If you are concerned about your milk supply, seek help from a health worker. The free <a href="https://www.breastfeeding.asn.au/breastfeeding-helpline">national breastfeeding helpline</a> is available 24/7 and is a good place to find support.</p>
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<img alt="" src="https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=916&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=916&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=916&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1151&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1151&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551623/original/file-20231003-19-eqmv5e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1151&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Author provided</span></span>
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<h2>Preparing for an emergency</h2>
<p>Make an emergency plan that includes packing an <a href="https://www.breastfeeding.asn.au/emergency-resources-babies-and-toddlers">evacuation kit</a>, leaving early and evacuating to a relative or friend’s home rather than an evacuation centre if possible. Ensure your evacuation kit includes a baby sling to keep your baby safe and close, and some water and snacks for you. </p>
<p>If you are exclusively expressing milk, learn how to hand express and cup feed (even very young babies can be fed <a href="https://www.cdc.gov/nutrition/emergencies-infant-feeding/cup-feeding.html">using a cup</a>). Store some paper cups so you have all you need if you are without power and water for washing.</p>
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Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
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<p>Anything emergency responders can do to reduce the burden of the emergency on mothers, such as prioritising them for services and offering them private spaces in evacuation centres, will help them to care for and breastfeed their babies. A free e-learning module for emergency responders on disaster support for babies, toddlers and their caregivers is <a href="https://www.aba.asn.au/emodule-prepare">available here</a>.</p><img src="https://counter.theconversation.com/content/205031/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karleen Gribble is Project Lead on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project and is an Australian Breastfeeding Association Scientific Advisor, Educator and Counsellor. Karleen is also on the steering committee of the international interagency collaboration the Infant and Young Child Feeding in Emergencies Core Group and has been involved in the development of international guidance and training on infant and young child feeding in emergencies for over a decade. She is a member of the Public Health Association of Australia. </span></em></p><p class="fine-print"><em><span>Michelle Hamrosi is the Community Engagement Officer on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project. Michelle is also a General Practitioner and an International Board Certified Lactation Consultant, as well as a Clinical Lecturer for the Australian National University’s Rural Medical School. Michelle volunteers as an ABA Breastfeeding Counsellor and Group Leader for the Australian Breastfeeding Association Eurobodalla Group. She is also a member of Doctors for the Environment, Climate and Health Alliance and Australian Parents for Climate Action.</span></em></p><p class="fine-print"><em><span>Nina Chad is the Infant and Young Child Feeding Consultant for the Department of Nutrition and Food Safety at the World Health Organization. She has been a volunteer breastfeeding counsellor for the Australian Breastfeeding Association for more than 20 years. </span></em></p>Being caught up in an emergency like a bushfire can make breastfeeding more challenging – but there are ways to continue.Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityMichelle Hamrosi, Clinical lecturer, Rural Clinical School, Australian National UniversityNina Jane Chad, Research Fellow, University of Sydney School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2095712023-07-16T11:56:46Z2023-07-16T11:56:46ZJoining forces: How collaboration can help tackle Canada’s escalating wildfire threat<p>Wildfires have become a hot topic in Canada this year — and for good reason. Thousands of Canadians have been evacuated from their homes. Millions have experienced smoky skies and air quality advisories. More hectares of land in Canada were burned by <a href="https://www.cbc.ca/news/canada/canada-fires-map-air-quality-1.6871563">mid-June than in any previous year </a> since records began. </p>
<p>As our experiences with wildfires <a href="https://www.unep.org/news-and-stories/press-release/number-wildfires-rise-50-2100-and-governments-are-not-prepared">become more and more common</a> in concert with <a href="https://www.bbc.com/news/science-environment-65837040">changing climates</a>, one pressing question keeps cropping up: How do we manage wildfires more effectively and efficiently to minimize impacts on Canadians? </p>
<p>A part of the answer lies in how emergency response decisions are made.</p>
<p>Decisions made by those in charge of wildfire response can have a major impact on how quickly the fire is contained. The federal government has flagged <a href="https://www.cbc.ca/news/politics/national-disaster-response-agency-1.6868209">disaster response as a national priority</a> and paved the way for a <a href="https://theconversation.com/canada-urgently-needs-a-fema-like-emergency-management-agency-207400">new disaster response agency</a> that could support stronger co-ordination and response to disasters across Canada.</p>
<p>As experts in management and governance (including disaster response, planning, policy and collaboration) we examined two major wildfires — the Fort McMurray, Alta. wildfire of 2016 and Sweden’s Västmanland wildfire of 2014 — and found that the key to minimizing the impacts of wildfires is effective collaboration.</p>
<h2>What does wildfire management look like?</h2>
<p>Most fires, when first identified, are addressed at the municipal or regional levels by local teams. When a fire escalates in size or severity, governments at the provincial or territorial levels <a href="https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/2017-mrgnc-mngmnt-frmwrk/index-en.aspx">take over management</a> roles. Resources at the federal level are engaged if this escalates further.</p>
<p>During the critical response phase of an ongoing wildfire emergency — where the fire is not considered contained — a wide range of <a href="https://doi.org/10.1111/puar.13518">resources and co-ordination</a> is required. This includes monitoring, communications, evacuation, logistics and firefighting efforts. </p>
<p>Each of these roles have different agencies, departments and organizations in charge. And those in charge during these volatile times need to quickly adapt to the shifting risks and effects associated with uncontrolled wildfires.</p>
<p>However, practically managing and co-ordinating this critical emergency response continues to be a major challenge.</p>
<p>In the <a href="https://open.alberta.ca/publications/may-2016-wood-buffalo-wildfire-post-incident-assessment-report">Fort McMurray wildfire</a> in 2016, a State of Local Emergency was declared when the fires were spotted seven kilometres away from the town. A Regional Emergency Operations Centre was then established to support the needs of the region in terms of emergency response. </p>
<p>But two days later, the fire grew to a size and severity that prompted the <a href="https://globalnews.ca/news/3031111/fort-mcmurray-wildfire-calls-for-2nd-highway-after-88k-near-misses-during-mass-evacuation/">evacuation of 88,000 people</a> and the highest operational level of emergency response engaged. </p>
<p>The wildfire management required a quick <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9780429244308-2/upscaling-collaborative-crisis-management-daniel-nohrstedt-julia-baird-%C3%B6rjan-bodin-ryan-plummer-robert-summers">‘scaling up’</a> from regional to full provincial control. This included the active involvement of regional, municipal, provincial and federal resources including firefighters and evacuation supports.</p>
<p>Despite management efforts at levels from regional to federal, the fire ultimately burned more than 500,000 hectares and destroyed 2,400 structures including many homes.</p>
<h2>Minimizing wildfire impacts</h2>
<p>As we studied the Fort McMurray and Västmanland wildfires we looked closely at the role of collaboration in emergency response under conditions of urgency and uncertainty during major wildfires. We studied not only how people communicated with each other, but also the tasks they tackled and the connections between those tasks.</p>
<p>As Canadians and policy makers engage in nationwide conversations and new plans on emergency response, our research offers three key lessons from the past that could shape a safer future.</p>
<p><strong>1) Establishing the right connections</strong></p>
<p>Working together with various emergency response teams is critical to the success of its management. </p>
<p>However, it is not a matter of “the more collaboration, the better.” That strategy can decrease the effectiveness. Instead, it is critical to establish the <a href="https://doi.org/10.1111/puar.13518">‘right’ connections</a> between emergency managers.</p>
<p>Strategic collaborations enable organizations and decision-makers to co-ordinate their work across tasks that rely on each other in some way. For example, evacuation and logistics teams can work well with co-ordinated efforts as evacuation routes need to be organized in a way that leads to shelters for evacuees and vice versa.</p>
<p><strong>2) Building relationships in calmer times</strong></p>
<p>Relationships tend to be formed with supervisors, previous contacts, members of the same organization and others that are connected to existing contacts. While these ways of connecting can be useful, they may not be the ‘right’ collaborators in times of urgency.</p>
<p>The preparatory phase of emergency management must focus on <a href="https://doi.org/10.1007/s10113-019-01546-z">how — and with whom — connections are made</a>. Making purposeful efforts to build relationships and trust among those who will work on the same, or connected, tasks in non-emergency times can be very valuable in increasing effectiveness and efficiency of emergency response.</p>
<p>An emergency manager from Alberta we interviewed stated that response happens at the “speed of trust,” where trust is assumed and second-guessing decisions is not an option. The only way to do that is to build relationships ahead of the emergency.</p>
<p><strong>3) Structure and flexibility</strong></p>
<p>Structured systems, like the <a href="https://www.alberta.ca/incident-command-system-alberta.aspx">Incident Command System</a> (ICS), are used across Canada to help manage emergency incidents and planned events. These systems set out who does what, and how, in clear terms. </p>
<p>Sweden’s approach is much more flexible and self-organized. They operate on the principle of “responsibility” that supports those in management roles retaining those same roles in times of emergency. However, Sweden has no planned approach to co-ordinate across multiple organizations and agencies in emergency situations.</p>
<p>We found that combination of <a href="https://doi.org/10.1016/j.gloenvcha.2023.102729">structure and flexibility</a> is needed for effective emergency management. </p>
<p>Structure, like in the ICS system, provides strength in having a clear framework for how to co-ordinate among those who do not usually interact. Flexibility, like in Sweden’s system, creates opportunities to work with trusted others. We advise creating more opportunities within a structured system for strategic relationship building.</p>
<h2>Co-ordination is not enough</h2>
<p>In the wake of disasters, emergency response teams working in different capacities and different levels <a href="https://doi.org/10.1016/j.gloenvcha.2023.102729">need to agree on goals and working procedures for the specific scenario</a>, and not only on improving co-ordination.</p>
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<img alt="A fire crew cuts a fire line across a boggy area." src="https://images.theconversation.com/files/537527/original/file-20230714-21802-ymm8xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537527/original/file-20230714-21802-ymm8xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=303&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537527/original/file-20230714-21802-ymm8xc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=303&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537527/original/file-20230714-21802-ymm8xc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=303&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537527/original/file-20230714-21802-ymm8xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=381&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537527/original/file-20230714-21802-ymm8xc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=381&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537527/original/file-20230714-21802-ymm8xc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=381&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Shifting authority from local emergency managers can be difficult, especially in times of uncertainty, like wildfires, that leave no room for delayed decision-making.</span>
<span class="attribution"><span class="source">(AP Photo/The Duluth News-Tribune, Bob King)</span></span>
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<p>These agreements are especially critical in efficiently <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9780429244308-2/upscaling-collaborative-crisis-management-daniel-nohrstedt-julia-baird-%C3%B6rjan-bodin-ryan-plummer-robert-summers">scaling up</a> crisis management from a local level to a broader and more collaborative one. This can be challenging as local emergency managers are connected to the place in which they work and are often the first to take control.</p>
<p>This shift, or scaling up, is further challenged by uncertainty. Wildfires are unpredictable and the situation can change quickly, leaving no room for delayed decisions. Timing is essential to mobilize resources when most urgently needed.</p>
<p>Emergency managers should consider the art and timing of scaling up — managing the shifts in authority and uncertainty — by building relationships that support agreement and collaborative skill-sets of those likely to be involved in future emergency response situations.</p><img src="https://counter.theconversation.com/content/209571/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia Baird receives funding from the Canada Research Chairs program. </span></em></p><p class="fine-print"><em><span>Angela Guerrero receives funding from the Australian Research Council and the Swedish Research Council (FORMAS).</span></em></p><p class="fine-print"><em><span>Daniel Nohrstedt receives funding from the Swedish Research Council and the Centre of Natural Hazards and Disaster Science (CNDS). </span></em></p><p class="fine-print"><em><span>Örjan Bodin receives funding from the Swedish Research Council (FORMAS) and the Swedish Environmental Protection Agency</span></em></p><p class="fine-print"><em><span>Robert J Summers receives funding from the Social Sciences and Humanities Research Council of Canada, the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada, and the University of Alberta.
</span></em></p>Effective collaboration may be a key to minimizing impacts of the growing wildfire season in Canada.Julia Baird, Associate Professor and Canada Research Chair in Human Dimensions of Water Resources and Water Resilience, Brock UniversityAngela Guerrero, Research fellow, Faculty of Engineering, Queensland University of TechnologyDaniel Nohrstedt, Professor of Political Science, Research Coordinator in Centre of Natural Hazards and Disaster Science, Uppsala UniversityÖrjan Bodin, Professor in Environmental Science/Sustainability Science, Stockholm UniversityRobert J Summers, Director, School of Urban and Regional Planning, University of AlbertaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050262023-06-25T20:03:52Z2023-06-25T20:03:52ZThe Black Summer bushfires put an enormous strain on families with young children. We can’t make the same mistakes again<figure><img src="https://images.theconversation.com/files/529740/original/file-20230602-27-y427tr.png?ixlib=rb-1.1.0&rect=16%2C0%2C1862%2C1081&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Author provided</span></span></figcaption></figure><p>Floods, bushfires, heatwaves, cyclones. Australia is no stranger to emergencies. But during disasters we’re <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7528-0">better prepared</a> to support pet owners than families with babies and toddlers. </p>
<p>Until now, the experiences and needs of families with very young children during emergencies have been largely invisible and overlooked.</p>
<p>Our new <a href="https://www.breastfeeding.asn.au/resources-community-protection-infants-and-young-children-bushfire-emergencies-project">research</a>, a collaboration between the <a href="https://www.breastfeeding.asn.au/">Australian Breastfeeding Association</a> and Western Sydney University, highlights the challenges faced by the parents of very young children in disasters, and how we need to support them.</p>
<p>We looked at families affected by Australia’s catastrophic Black Summer bushfires of 2019-20. However, there are lessons for how we prepare for, and manage, any type of future emergency.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/200-experts-dissected-the-black-summer-bushfires-in-unprecedented-detail-here-are-6-lessons-to-heed-198989">200 experts dissected the Black Summer bushfires in unprecedented detail. Here are 6 lessons to heed</a>
</strong>
</em>
</p>
<hr>
<h2>What we did and what we found</h2>
<p>We surveyed and interviewed 256 parents of children from newborn to four years old at the time of the Black Summer bushfires, and 63 emergency responders.</p>
<p>We found caring for a very young child profoundly impacted parents’ bushfire experiences. Preparing to evacuate was more complex and physically difficult. Parents were under-prepared. Many did not have an evacuation plan and found it difficult to gather what they needed when they had to leave.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman with young baby in baby carrier packing to leave" src="https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">What to pack in an emergency? Many parents found they were under-prepared.</span>
<span class="attribution"><span class="source">M. George</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
</strong>
</em>
</p>
<hr>
<h2>Evacuation centres weren’t child-friendly</h2>
<p>Women commonly evacuated on their own with their partner staying behind to protect property. </p>
<p>These mothers found it difficult to keep their children safe in large evacuation centres due to overcrowding, the presence of strangers and animals, and because there were limited resources for caring for children.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Van at evacuation centre with toddler" src="https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When parents evacuated, spaces weren’t always suitable for young children.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Some emergency responders were aware of the vulnerability of children and their caregivers in large evacuation centres. </p>
<p>They described child protection concerns and physical dangers. They described unsafe practices by unsupported caregivers, such as washing baby bottles in toilet sinks, and unsafe sleep situations. They highlighted a need to proactively support parents.</p>
<p>Parents and emergency responders repeatedly said evacuation centres should have a separate space for families with very young children.</p>
<p>Families who could evacuate to the home of family or friends or to child-friendly venues such as preschools or doctors’ surgeries fared much better. One parent who was evacuated to a preschool told us:</p>
<blockquote>
<p>to the children it was like a holiday because they had all the play equipment, they had a huge, big play area out the back.</p>
</blockquote>
<p>The kindness of emergency responders, strangers and community members was greatly appreciated. One woman described how a shop employee, after seeing her with her toddler and realising she had evacuated, immediately offered her home saying:</p>
<blockquote>
<p>Do you need somewhere to stay? […] I live just walking distance […] here’s my key.</p>
</blockquote>
<h2>Pregnant women were at risk</h2>
<p>Women prioritised their children’s wellbeing over their own and often did not eat or drink properly. This was particularly concerning for pregnant and breastfeeding women. </p>
<p>Two of the five pregnant women we interviewed fainted while queuing for food and assistance. One of these women told us:</p>
<blockquote>
<p>I was so worried about my kids. I’d given them water, supplied them with food […] that I would just forget […] to eat myself, to drink […] The ambulance people asked me, ‘Have you had anything to drink today?’ […] I couldn’t even answer the question. I was like, ‘I don’t even remember if I have or not’.</p>
</blockquote>
<h2>Feeding infants could be hard</h2>
<p>Parents often found it difficult to access the resources they needed to care for their children.</p>
<p>Those who were formula feeding found it particularly difficult as infant formula, water, detergent and electricity were often not available. One parent told us:</p>
<blockquote>
<p>I had absolutely no way to ensure the bottles were cleaned as we only had a bit of water and paper towel to wipe them out with. The bottles did not have any contact with detergent on over six days.</p>
</blockquote>
<p>Those distributing infant formula did not always check whether parents had resources such as clean water or a way of heating water. Donations of infant formula were often out-of-date, not in the location needed, or more than required. One mother told us:</p>
<blockquote>
<p>People were trying to help. However it was an overwhelming amount of formula.</p>
</blockquote>
<p>Women who were breastfeeding were often grateful they had a secure food supply for their baby. One woman said:</p>
<blockquote>
<p>I am so lucky I was still breastfeeding […] I could comfort my baby and make her feel sense of normality, I was also able to feed my child without needing to worry about safe food or bottle preparation and supplies.</p>
</blockquote>
<p>Some mothers found it difficult to breastfeed in crowded evacuation centres, became dehydrated or interpreted infant fussiness and frequent feeding as meaning there was a problem with their milk. </p>
<p>They needed support to be able to continue breastfeeding that was not always available and some stopped breastfeeding as a result.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/babies-and-toddlers-might-not-know-theres-a-fire-but-disasters-still-take-their-toll-129699">Babies and toddlers might not know there's a fire but disasters still take their toll</a>
</strong>
</em>
</p>
<hr>
<h2>We need to do better in future emergencies</h2>
<p>When asked what they would do differently if they were in another emergency, parents said pack an evacuation kit and leave earlier. </p>
<p>But the onus shouldn’t be just on parents. Australian emergency planning and response needs an overhaul to better protect infants and young children, and their caregivers. </p>
<p>Existing emergency policies, planning, and guidance should be evaluated with a “young child lens” and adjusted to ensure families are properly supported. People who are experts on young children should be involved in this work.</p><img src="https://counter.theconversation.com/content/205026/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karleen Gribble is Project Lead on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project and is an Australian Breastfeeding Association Scientific Advisor, Educator and Counsellor. Karleen is also on the steering committee of the international interagency collaboration the Infant and Young Child Feeding in Emergencies Core Group. She has been involved in the development of international guidance and training on infant and young child feeding in emergencies for over a decade. She is a member of the Public Health Association of Australia. The research described in this article was supported by an Australian Government Protecting Australian Communities-Local Stream Grant.</span></em></p><p class="fine-print"><em><span>Michelle Hamrosi is the Community Engagement Officer on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project. Michelle is also a General Practitioner and an International Board Certified Lactation Consultant, as well as a Clinical Lecturer for the Australian National University’s
Rural Medical School. Michelle volunteers as an ABA Breastfeeding Counsellor and Group Leader for the Australian Breastfeeding Association Eurobodalla Group. She is also a member of Doctors for the Environment, Climate and Health Alliance and Australian Parents for Climate Action. </span></em></p><p class="fine-print"><em><span>Naomi Hull is an RN, IBCLC, and has an MPH. She works for the Australian Breastfeeding Association (ABA) as Senior Manager, Breastfeeding Information and Research. Naomi volunteers as a Breastfeeding Counsellor on the ABA National Breastfeeding Helpline and as the National Coordinator for the World Breastfeeding Trends Initiative Australia. Naomi is also a member of the Public Health Association of Australia. </span></em></p>Parents and emergency responders repeatedly said evacuation centres should have a separate space for families with very young children. Here’s what else we could do.Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityMichelle Hamrosi, Clinical lecturer, Rural Clinical School, Australian National UniversityNaomi Hull, Research Assistant, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2051652023-05-10T18:49:55Z2023-05-10T18:49:55ZWhat does ending the emergency status of the COVID-19 pandemic in the US mean in practice? 4 questions answered<figure><img src="https://images.theconversation.com/files/524939/original/file-20230508-197326-1kuk6o.jpg?ixlib=rb-1.1.0&rect=181%2C142%2C8465%2C5418&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID-19 hasn't vanished, but at this point it's doing less damage.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-erasing-red-covid-19-virus-with-paint-roller-royalty-free-image/1292684629?phrase=covid-19&adppopup=true">Klaus Vedfelt/DigitalVision via Getty Images</a></span></figcaption></figure><p><em>The COVID-19 pandemic’s public health emergency status in the U.S. <a href="https://www.npr.org/2023/04/11/1169191865/biden-ends-covid-national-emergency">expires on May 11, 2023</a>. And on May 5, the World Health Organization declared <a href="https://www.statnews.com/2023/05/05/who-declares-end-to-covid-global-health-emergency/?">an end to the COVID-19 public health emergency of international concern</a>, or PHEIC, designation that had been in place since Jan. 30, 2020.</em> </p>
<p><em>Still, both the WHO and the White House have made clear that while the emergency phase of the pandemic has ended, the virus is here to stay and <a href="https://www.washingtonpost.com/health/2023/05/05/covid-forecast-next-two-years/">could continue to wreak havoc</a>.</em> </p>
<p><em>WHO Director General Tedros Adhanom Ghebreyesus noted that, over that time, the virus has taken the lives of <a href="https://www.washingtonpost.com/world/2023/05/05/who-covid-global-health-emergency/">more than 1 million people in the U.S.</a> and <a href="https://doi.org/10.1038/d41586-023-01559-z">about 7 million people globally</a> based on reported cases, though he said the true toll is likely <a href="https://www.npr.org/sections/goatsandsoda/2023/05/05/1174269442/who-ends-global-health-emergency-declaration-for-covid-19">closer to 20 million people worldwide</a>. While the global emergency status has ended, COVID-19 is still an “<a href="https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic">established and ongoing health issue</a>,” he said.</em></p>
<p><em>The Conversation asked public health experts <a href="https://cph.osu.edu/people/mjones">Marian Moser Jones</a> and <a href="https://cph.osu.edu/people/afairchild">Amy Lauren Fairchild</a> to put these changes into context and to explain their ramifications for the next stage of the pandemic.</em> </p>
<h2>1. What does ending the national emergency phase of the pandemic mean?</h2>
<p>Ending the federal emergency reflects both a scientific and political judgment that the acute phase of the COVID-19 pandemic crisis has ended and that special federal resources are no longer needed to prevent disease transmission across borders. </p>
<p>In practical terms, it means that two declarations – the <a href="https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx">federal Public Health Emergency</a>, first declared on Jan. 31, 2020, and the <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2022/02/18/notice-on-the-continuation-of-the-national-emergency-concerning-the-coronavirus-disease-2019-covid-19-pandemic-2/">COVID-19 national emergency</a> that former President Donald Trump announced on March 13, 2020, are expiring.</p>
<p>Declaring those emergencies enabled the federal government to cut through mountains of red tape to respond to the pandemic more efficiently. For instance, the declarations allowed <a href="https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx">funds to be made available</a> so that federal agencies could direct personnel, equipment, supplies and services to state and local governments wherever they were needed. In addition, the declarations made funding and other resources available to launch investigations into the “<a href="https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx">cause, treatment or prevention</a>” of COVID-19 and to enter into contracts with other organizations to meet needs stemming from the emergency. </p>
<p>The emergency status also allowed the federal government to make health care more widely available by <a href="https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx">suspending many requirements</a> for accessing Medicare, Medicaid and the Children’s Health Program, or CHIP. And they made it possible for people to receive free COVID-19 testing, treatment and vaccines and <a href="https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-telehealth-services.pdf">enabled Medicaid</a> and Medicare to <a href="https://telehealth.hhs.gov/providers/billing-and-reimbursement/">more easily cover telehealth services</a>. </p>
<p>Finally, the Trump administration used the national emergency to invoke <a href="https://www.dhs.gov/news/2023/01/05/dhs-continues-prepare-end-title-42-announces-new-border-enforcement-measures-and">Title 42</a>, a section of the Public Health Service Act that allows the federal government to <a href="https://theconversation.com/a-trump-era-law-used-to-restrict-immigration-is-nearing-its-end-despite-gop-warnings-of-a-looming-crisis-at-the-southern-border-194971">stop people at the nation’s borders</a> to prevent introduction of communicable diseases. Asylum seekers and others who normally undergo processing when they enter the U.S. have been turned away under this rule. </p>
<h2>2. What domestic policies are changing?</h2>
<p>An estimated 15 million people are likely to lose Medicaid or CHIP coverage, <a href="https://aspe.hhs.gov/sites/default/files/documents/a892859839a80f8c3b9a1df1fcb79844/aspe-end-mcaid-continuous-coverage.pdf">according to the federal government</a>. <a href="https://www.kff.org/medicaid/issue-brief/how-many-people-might-lose-medicaid-when-states-unwind-continuous-enrollment/">Another analysis projected</a> that as many as 24 million people will be kicked off the Medicaid rolls.</p>
<p>Before the pandemic, states required people to prove every year that they met income and other eligibility requirements. This <a href="https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-growth-estimates-by-state-and-eligibility-group-show-who-may-be-at-risk-as-continuous-enrollment-ends/">resulted in “churning”</a> – a process whereby people who did not complete renewal paperwork were being periodically disenrolled from state Medicaid programs before they could reapply and prove eligibility. </p>
<p>In March 2020, Congress enacted a continuous enrollment provision in Medicaid that prevented states from removing anyone from their rolls during the pandemic. From February 2020 to March 31, 2023, <a href="https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-growth-estimates-by-state-and-eligibility-group-show-who-may-be-at-risk-as-continuous-enrollment-ends/">enrollment in Medicaid and CHIP grew by nearly 23.5%</a> to a total of more than 93 million. In a December 2022 appropriations bill, Congress passed a provision that ended continuous enrollment on March 31, 2023.</p>
<p>The Biden administration <a href="https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf">defended this time frame as sufficient</a> to ensure that patients did not “lose access to care unpredictably” and that state Medicaid budgets – which received emergency funds beginning in 2020 – didn’t “face a radical cliff.” </p>
<p>But many people who have Medicaid or who enrolled their children in CHIP during this period may be unaware of these changes until they actually lose their benefits over the next several months.</p>
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<p>At least five states already <a href="https://ccf.georgetown.edu/2023/04/01/state-unwinding-tracker/">began disenrolling Medicaid members in April</a>. Other states are <a href="https://medicaid.ohio.gov/stakeholders-and-partners/covidunwinding/covidunwinding">sending out termination letters</a> and <a href="https://www.hhs.texas.gov/services/health/medicaid-chip/end-continuous-medicaid-coverage">renewal notices</a> and will <a href="https://ccf.georgetown.edu/2023/04/01/state-unwinding-tracker/">disenroll members starting in May, June and July</a>.</p>
<p>Only Oregon has set up a comprehensive program to minimize disenrollments. That state is running a <a href="https://www.oregon.gov/oha/HSD/Medicaid-Policy/Documents/2022-2027-1115-Demonstration-Approval.pdf">five-year federal demonstration program</a> that allows it to temporarily let people stay on Medicaid if their income is up to 200% of the federal poverty level and lets eligible children stay on Medicaid through age 6. Many other states are <a href="https://www.medicaid.gov/covid-19-phe-unwinding-section-1902e14a-waiver-approvals/index.html">trying more limited strategies</a> to improve the renewal process and decrease churning.</p>
<p>The array of telehealth services that Medicare began <a href="https://telehealth.hhs.gov/providers/billing-and-reimbursement/billing-and-coding-medicare-fee-for-service-claims/?">covering during the pandemic</a> will continue to be covered through December 2024. Medicare is also making coverage for <a href="https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency">behavioral and mental telehealth services a permanent benefit</a>.</p>
<p>The end of the emergency also means that the federal government is no longer covering the costs of COVID-19 vaccines and treatments for everyone. However, in April, the Biden administration announced a new $1.1 billion <a href="https://www.hhs.gov/about/news/2023/04/18/fact-sheet-hhs-announces-hhs-bridge-access-program-covid-19-vaccines-treatments-maintain-access-covid-19-care-uninsured.html">public-private “bridge access program</a>” that will provide COVID-19 vaccines and treatments free of charge for uninsured people through state and local health departments and pharmacies. Insured individuals may have out-of-pocket costs depending on their coverage.</p>
<p>The end of the emergency lifts the pandemic restriction on border crossing. Large numbers of migrants <a href="https://www.cnn.com/2023/05/08/us/title-42-expires-border-immigration/index.html">have gathered at the Mexico-U.S. border</a> and are expected to enter the country in the coming weeks, further straining already overwhelmed staff and facilities. </p>
<h2>3. What does this mean for the status of the pandemic?</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK143061">A pandemic declaration</a> represents an assessment that human transmission of a disease, whether well known or novel, is “extraordinary,” that it constitutes a public health risk to two or more U.S. states and that controlling it requires an international response. But declaring an end to the emergency doesn’t mean a return to business as usual.</p>
<p><a href="https://www.who.int/publications/i/item/WHO-WHE-SPP-2023.1">New global guidelines for long-term disease management</a> of COVID-19, released on May 3, 2023, urged countries “to maintain sufficient capacity, operational readiness and flexibility to scale up during surges of COVID-19, while maintaining other essential health services and preparing for the emergence of new variants with increased severity or capacity.”</p>
<p>Former White House COVID-19 response coordinator <a href="https://fortune.com/well/2023/04/29/covid-antiviral-paxlovid-evade-deborah-birx-double-deaths/">Deborah Birx recently warned</a> that the omicron COVID-19 variant continues to mutate and may become resistant to existing treatments. She called for more federally funded research into therapeutics and durable vaccines that protect against many variants. </p>
<p>Birx’s warnings come as <a href="https://www.krem.com/article/news/health/coronavirus/washington-covid-final-press-conference/293-3f109a05-5e8a-4c80-8868-18f8cd9d3fbe">remaining states have ended their COVID-19 press briefings</a> and <a href="https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/CANotify/CANotifyMain.aspx">shut down their exposure notification systems</a>, and the <a href="https://apnews.com/article/covid-home-test-78960c4c36422907a2eab3eb0dcdfadd">federal government has ended its free COVID-19 at-home test program</a>. </p>
<p>With the end of the emergency, the CDC is also changing the way it presents its COVID-19 data to a “<a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html">sustainable national COVID-19 surveillance” model</a>. This shift in COVID-19 monitoring and communication strategies accompanying the end of the emergency means that the virus is disappearing from the headlines, even though it has not disappeared from our lives and communities.</p>
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<h2>4. How will state and local pandemic measures be affected?</h2>
<p>The end of the federal emergency does not affect state-level or local-level emergency declarations. These declarations have allowed states to allocate resources to meet pandemic needs and have <a href="https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/telehealth-licensing-requirements-and-interstate-compacts/">included provisions</a> allowing them to respond to surges in COVID-19 cases by allowing out-of-state physicians and other health care providers to practice in person and through telehealth. </p>
<p>Most U.S. states, however, have ended their own public health emergency declarations. Six states – Delaware, Illinois, Massachusetts, New York, Rhode Island and Texas – still had emergency declarations in effect as of May 3, 2023, that will expire by the end of the month. So far, <a href="https://nashp.org/states-covid-19-public-health-emergency-declarations/">Massachusetts Gov. Maura Healey</a> stands alone in having indicated that she will “extend key flexibilities provided by the public health emergency” related to health care staffing and emergency medical services.</p>
<p>While some states may choose to make permanent some COVID-era emergency standards, such as looser restrictions on telemedicine or out-of-state health providers, we believe it could be a long time before either politicians or members of the public regain an appetite for any emergency orders directly related to COVID-19. </p>
<p><em>This is an updated version of an article that was <a href="https://theconversation.com/bidens-plan-for-ending-the-emergency-declaration-for-covid-19-signals-a-pivotal-point-in-the-pandemic-4-questions-answered-199060">originally published</a> on Feb. 3, 2023.</em></p><img src="https://counter.theconversation.com/content/205165/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marian Moser Jones receives funding from the National Endowment for the Humanities and The American Public Health Association. In the past she has received funding from the National Institutes of Health and the American Association for the History of Nursing, as well as the State of Maryland.</span></em></p><p class="fine-print"><em><span>Amy Lauren Fairchild has received funding from NIH, NSF, NEH, the RWJ Foundation, and the Greenwall Foundation. </span></em></p>The emergency status allowed the federal government to cut through a mountain of red tape, with the goal of responding to the pandemic more efficiently.Marian Moser Jones, Associate Professor of Health Services Management, Policy and History, The Ohio State UniversityAmy Lauren Fairchild, Dean and Professor of Public Health, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2004202023-02-27T21:26:52Z2023-02-27T21:26:52ZEmergency department crowding has gone beyond hallways onto ambulance ramps. Now there’s nowhere left to wait.<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/emergency-department-crowding-has-gone-beyond-hallways-onto-ambulance-ramps--now-there-s-nowhere-left-to-wait-" width="100%" height="400"></iframe>
<p>A hospital’s emergency department (ED) has long been considered the canary in the coal mine for the health-care system: when it’s congested, the whole hospital is congested. </p>
<p>Routine and prolonged ED congestion has since led to declarations that patients waiting in an ambulance outside the ED are the new <a href="https://theconversation.com/ambulance-ramping-is-a-signal-the-health-system-is-floundering-solutions-need-to-extend-beyond-eds-187270">canaries in the coal mine</a>. </p>
<p>But when ambulances waiting outside the ED become routine and prolonged, another new canary appears: patients at home waiting for an ambulance. They may represent the truest analogy for the canary in the coal mine because they are <a href="https://www.wsws.org/en/articles/2022/10/21/gebn-o21.html">literally dying</a> and are a clear indicator that the health-care system is congested at a dangerous level.</p>
<h2>Pinch points</h2>
<p>Delayed handovers of patients arriving by ambulance is a <a href="https://theconversation.com/bad-for-patients-bad-for-paramedics-ambulance-ramping-is-a-symptom-of-a-health-system-in-distress-169528">decades-old problem</a> challenging health-care systems around the world. In the United Kingdom, the National Health Service has made eliminating handover delays one of its three priorty reforms for pre-hospital urgent care in its 10-year <a href="https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf">Long Term Plan</a>. </p>
<p>In <a href="https://www.paramedicchiefs.ca/wp-content/uploads/2022/07/PCCStatementonOffloadDelaysJuly2022Final.pdf">Canada</a>, where health care is provided by provinces, <a href="https://www.mcmasterforum.org/docs/default-source/product-documents/rapid-responses/identifying-approaches-for-optimal-management-of-ambulance-to-hospital-offload-processes.pdf?sfvrsn=9d809fdb_7">British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Québec, New Brunswick and Nova Scotia</a> have all experienced challenges handing over patients in a timely manner. </p>
<p>Australia has <a href="https://theconversation.com/bad-for-patients-bad-for-paramedics-ambulance-ramping-is-a-symptom-of-a-health-system-in-distress-169528">likewise</a> seen long lineups of ambulances queueing at hospitals, and has committed to hiring thousands of paramedics in an effort to combat <a href="https://www.ama.com.au/articles/ama-ambulance-ramping-report-card">year-on-year increases</a> in patient handover times.</p>
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<a href="https://theconversation.com/ambulance-ramping-is-a-signal-the-health-system-is-floundering-solutions-need-to-extend-beyond-eds-187270">Ambulance ramping is a signal the health system is floundering. Solutions need to extend beyond EDs</a>
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<p>Beyond ambulance handovers, delays and congestion also occur at other areas: the ED, wards and long-term care are some of the pinch points common in health-care systems around the world. </p>
<p>As an industrial engineer researching and working in health-care patient flow, this raises the question: where’s the next pinch point? </p>
<h2>Code zero</h2>
<p>We know hospital congestion is routinely caused by <a href="https://doi.org/10.1186/s12245-020-00312-x">access block</a>, which occurs when patients are blocked from flowing through the system by a lack of downstream capacity. This is often rooted in an inability to discharge patients from the hospital, which is often due to lack of space in long-term care.</p>
<p>Naturally, this stalls the flow of patients, causing them to wait in ward beds to be discharged from the hospital, in ED hallways waiting for ward beds, in ambulances waiting for ED beds, and eventually at home waiting for an ambulance. </p>
<p>This last group represents a new pinch point. Although ambulances not meeting targeted response times is not new, it is a relatively new phenomenon that there are <em>no</em> ambulances available to respond to calls in a timely manner — a situation known as “code zero.”</p>
<p>This new pinch point however, is substantially different from the others. The patients affected have not yet been seen by health-care providers, are not within meters of health-care services, and their urgencies are not known. These patients are at home, in unknown duress, waiting. </p>
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<figcaption><span class="caption">Acute care director of the National Health Service in the U.K. discusses ambulance delays, and a family tells how delays led to tragedy.</span></figcaption>
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<p>Patients waiting with an ambulance on the “ramp” (known as “ramping”) or in a hallway between the ED and the ward are known to be at <a href="https://www.theguardian.com/society/2023/jan/25/record-exposure-to-severe-harm-from-england-ambulance-delays">higher risk</a> for adverse outcomes. Patients with hospital stays prolonged by delay are likewise at <a href="https://www.england.nhs.uk/urgent-emergency-care/reducing-length-of-stay/">higher risk</a> for hospital-borne infections and adverse outcomes. </p>
<p>Less is known about patients waiting at home for an ambulance, but given their precarious circumstance, it is logical to assume they are also at high risk.</p>
<h2>Patients at risk</h2>
<p>Many emergency services system evaluations in <a href="https://www.ama.com.au/articles/ama-ambulance-ramping-report-card">Australia</a>, <a href="https://www.niagararegion.ca/government/departments/health/ems-response-times.aspx">Canada</a> and the <a href="https://www.health.org.uk/publications/long-reads/why-have-ambulance-waiting-times-been-getting-worse">U.K.</a> have reported waiting times longer than performance targets. But the extent to which they are waiting is new. </p>
<p>It has become all too common to read about code zero situations, in which there are no ambulances available. Again there are reports from <a href="https://www.sbs.com.au/news/article/code-red-ambulance-and-triple-zero-systems-are-in-crisis-across-australia/nxf8kw7hc">Australia</a>, the <a href="https://www.mirror.co.uk/news/uk-news/nhs-crisis-brits-who-died-28897334">U.K.</a> and <a href="https://www.saltwire.com/atlantic-canada/news/paramedic-level-zeroes-more-than-doubled-in-2022-during-a-horrendous-year-for-ambulance-delays-100824629/">Canada</a>. People are dying while waiting. </p>
<p>In Australia, ambulance ramping and call delays were recently linked to <a href="https://www.wsws.org/en/articles/2022/10/21/gebn-o21.html">33 deaths over 18 months</a>. </p>
<p>In three examples from the U.K., a woman <a href="https://www.dailymail.co.uk/health/article-11594743/National-Hell-Service-Wife-dies-16-HOUR-ambulance-wait.html">died following a 16-hour wait for an ambulance</a>, a man <a href="https://www.youtube.com/watch?v=BDzhN14OFuA">died when no ambulance was available</a> to take him to the hospital, and an 87-year-old <a href="https://www.independent.co.uk/news/health/ambulance-delays-wait-nhs-glangwili-hospital-b2260228.html">died after waiting 17 hours</a> for an ambulance and then 13 hours in the ambulance at the hospital. </p>
<p>In all three U.K. cases, long handover delays and ambulance ramping were identified as the cause of ambulance unavailability.</p>
<h2>System failures spilling over</h2>
<p>In Canada, the frequency of zero ambulances available <a href="https://www.cbc.ca/news/canada/ottawa/paramedic-level-zero-incidents-2022-availability-numbers-1.6746551">doubled in Ottawa in 2022</a>, with offload delays identified as the number one cause. Code zeros are reported to be daily occurrences, with prolonged frequencies and durations <a href="https://www.thespec.com/news/hamilton-region/2022/10/17/hamilton-paramedics-ambulance-code-zero.html">in Hamilton, Ont</a>. A woman in <a href="https://globalnews.ca/news/8980799/urgences-sante-condolences-91-year-old-dies-waiting-hours-ambulance/">Montréal</a> died after waiting seven hours for an ambulance. </p>
<p>A “canary in the coal mine” is an early indicator of potential danger or failure. The response was insufficient when the ED’s canary died, and the failure spilled over to the ambulance service. Now, with prolonged offload delays routinely causing zero ambulances to be available, the ambulance ramping canary isn’t long for this world either. </p>
<p>This time when the failure spills over, the “canary” at risk is not a metaphorical bird, but is instead a patient waiting at home for an ambulance.</p><img src="https://counter.theconversation.com/content/200420/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Vanberkel receives funding from NSERC. </span></em></p>Ambulance response times have not always met targets, but the alarming new pinch point in our health-care system is that there are no ambulances at all available to respond to calls.Peter Vanberkel, Professor, Department of Industrial Engineering, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1990602023-02-03T18:10:06Z2023-02-03T18:10:06ZBiden’s plan for ending the emergency declaration for COVID-19 signals a pivotal point in the pandemic – 4 questions answered<figure><img src="https://images.theconversation.com/files/508102/original/file-20230203-8929-i0o9vk.jpg?ixlib=rb-1.1.0&rect=173%2C158%2C4851%2C2779&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID-19 emergency status prompted coordinated vaccination efforts by health care providers, paramedics, volunteers and others.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sofia-espinoza-tam-daughter-is-held-by-her-father-and-news-photo/1241629409?adppopup=true">Wesley Lapointe / Los Angeles Times via Getty Images</a></span></figcaption></figure><p><em>President Joe Biden announced on Jan. 30, 2023, that <a href="https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf">he intends to end</a> both the national emergency and the public health emergency declarations related to COVID-19 on May 11, 2023.</em></p>
<p><em>Biden’s announcement came on the same day that the World Health Organization said it still <a href="https://www.who.int/news/item/30-01-2023-statement-on-the-fourteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic">considers the COVID-19 pandemic</a> to be a <a href="https://www.who.int/publications/m/item/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum">public health emergency of international concern, or PHEIC</a>, a status that is reassessed every three months. The WHO’s advisory committee noted that although the pandemic is at a turning point, “COVID-19 remains a dangerous infectious disease with the capacity to cause substantial damage to health and health systems.”</em></p>
<p><em>The Conversation asked public health experts <a href="https://cph.osu.edu/people/mjones">Marian Moser Jones</a> and <a href="https://cph.osu.edu/people/afairchild">Amy Lauren Fairchild</a> to put these statements into context and to explain their ramifications for the next stage of the pandemic.</em></p>
<h2>What does ending the emergency phase of the COVID-19 pandemic mean?</h2>
<p>Ending the federal emergency reflects both a scientific and political judgment that the acute phase of the COVID-19 pandemic crisis has ended and that special federal resources are no longer needed to prevent disease transmission across borders. </p>
<p>In practical terms, it means that two declarations – the <a href="https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx">federal Public Health Emergency</a>, first declared on Jan. 31, 2020, and the <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2022/02/18/notice-on-the-continuation-of-the-national-emergency-concerning-the-coronavirus-disease-2019-covid-19-pandemic-2/">COVID-19 national emergency</a> that President Donald Trump announced on March 13, 2020 – will be allowed to expire in May 2023. </p>
<p>Declaring those emergencies enabled the federal government to cut through a mountain of red tape, with the goal of responding to the pandemic more efficiently. For instance, the declarations allowed <a href="https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx">funds to be made available</a> so that federal agencies could direct personnel, equipment, supplies and services to state and local governments wherever they were needed. In addition, the declarations made resources available to launch investigations into the “<a href="https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx">cause, treatment or prevention</a>” of COVID-19 and to enter into contracts with other organizations to meet needs stemming from the emergency. </p>
<p>The emergency status also allowed the federal government to make health care more widely available by <a href="https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx">suspending many requirements</a> for accessing Medicare, Medicaid and the Children’s Health Program. And they made it possible for people to receive free COVID-19 testing, treatment and vaccines and <a href="https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-telehealth-services.pdf">enabled Medicaid</a> and Medicare to <a href="https://telehealth.hhs.gov/providers/billing-and-reimbursement/">more easily cover telehealth services</a>. </p>
<h2>What policy changes will occur once the emergency is declared over?</h2>
<p>The end to the federal emergency <a href="https://theconversation.com/medicaid-coverage-is-expiring-for-millions-of-americans-but-theres-a-proven-way-to-keep-many-of-them-insured-197847">could substantially reduce</a> the number of people insured under Medicaid. Before the pandemic, states required people to prove every year that they met income and other eligibility requirements. </p>
<p>In March 2020, Congress enacted a continuous enrollment provision in Medicaid that prevented states from removing anyone from their rolls during the pandemic. In a December 2022 appropriations bill, Congress passed a provision that will end continuous enrollment on March 31, 2023. </p>
<p>The Biden administration has <a href="https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf">defended this time frame as sufficient</a> to ensure that “patients do not lose access to care unpredictably” and that state Medicaid budgets – which have been infused with emergency funds since 2020 – “don’t face a radical cliff.” But many people with Medicaid may be unaware of these changes until they actually lose their benefits.</p>
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<p>Some states have already indicated that they will <a href="https://medicaid.ohio.gov/stakeholders-and-partners/covidunwinding/covidunwinding">begin disenrolling members in April 2023</a> or require members to <a href="https://www.hhs.texas.gov/services/health/coronavirus-covid-19/coronavirus-covid-19-information-people-receiving-services/end-continuous-medicaid-coverage">apply to be considered for renewal</a>. This could result in between <a href="https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/">5 million and 14 million people</a> losing coverage.</p>
<p>People with Medicare do not have to worry about losing their benefits, since this program is age-based, not income-based. The array of telehealth services that Medicare began <a href="https://telehealth.hhs.gov/providers/billing-and-reimbursement/billing-and-coding-medicare-fee-for-service-claims/?">covering during the pandemic</a> will continue to be covered through December 2023. Medicare coverage for many telehealth services could also <a href="https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule">be made permanent</a> after this year. </p>
<p>The end of the emergency could additionally curb access to COVID-19 drugs, tests and vaccines. Federal emergency funding for free treatment or vaccination will end when the emergency status is lifted on May 11. If such programs are to continue, <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/how-much-could-covid-19-vaccines-cost-the-u-s-after-commercialization/">the cost will fall</a> to state and local health agencies or insurance companies. </p>
<p>We are concerned that the withdrawal of federal emergency funds for vaccination may further slow the already sluggish uptake of boosters. As of Jan. 25, 2023, <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html">about 20% of the population ages 5 and up</a> and <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop5">only 40.1%</a> of those 65 and older – who are <a href="https://doi.org/10.1002%2Fhsr2.657">at the highest risk of death from COVID-19</a> – had received an <a href="https://theconversation.com/will-omicron-specific-booster-shots-be-more-effective-at-combating-covid-19-5-questions-answered-189610">updated bivalent booster</a> dose. Once the emergency ends, <a href="https://doi.org/10.1377/forefront.20210303.890600">measures that allowed</a> a broad array of health providers – from pharmacist interns to retired nurses and even veterinarians – to administer vaccines will expire, which could lead to decreased access to vaccination in many parts of the U.S. </p>
<h2>What does this mean for the status of the pandemic?</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK143061">A pandemic declaration</a> represents an assessment that human transmission of a disease, whether well known or novel, is “extraordinary,” that it constitutes a public health risk to two or more states and that controlling it requires an international response. </p>
<p>At some point the WHO will end its pandemic declaration. On Jan. 30, 2023, World Health Organization Director-General Tedros Adhanom Ghebreyesus described the pandemic as being “<a href="https://www.cnn.com/2023/01/30/health/who-covid-public-health-emergency/index.html">at a transition point</a>.” But the WHO’s assessment is that the risks are still considerable. Ghebreyesus noted that COVID-19 continues to strain health care systems, exacerbate health care workforce shortages and exceed surveillance system capacities. </p>
<p>The U.S. remains one of the <a href="https://covid19.who.int">global COVID-19 hot spots</a>. With more than <a href="https://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_select_00">3,500 hospitalizations per week on average</a> in January 2023, and 3,452 deaths per week as of early February 2023, the U.S. has <a href="https://www.nytimes.com/interactive/2021/world/covid-cases.html">among the highest deaths per capita in the world</a>.</p>
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<h2>How does the Biden administration’s stance differ from the WHO’s position?</h2>
<p>In some ways they are very similar. The WHO is looking at the pandemic from a global perspective while the Biden administration is examining it from a national perspective. The WHO’s stance reflects the assessment that the world is not sufficiently vaccinated, that health care systems remain vulnerable and that unchecked disease transmission in some parts of the world should remain a source of international concern and attention. </p>
<p>China’s massive outbreak after the <a href="https://www.npr.org/2022/12/20/1143413739/confusion-and-falsehoods-spread-as-china-reverses-its-zero-covid-policy">lifting of its zero-COVID policy</a> in early December 2022 has <a href="https://www.bbc.com/news/world-asia-china-64449226">received a great deal of media attention</a>. But less noted is the fact that <a href="https://ourworldindata.org/covid-vaccinations?country=OWID_WRL#what-share-of-the-population-has-received-at-least-one-dose-and-completed-the-initial-vaccination-protocol">vaccination rates across</a> African nations average 40%, and that vaccination rates are very low in countries that are experiencing conflict, such as Syria, where only 15% of the population has received any COVID-19 vaccine.</p>
<p>The WHO’s continuation of the global pandemic status signals that there is more international coordination and work to be done. In contrast, the Biden administration is making a social and political judgment that it is time to wind down the federal role.</p>
<p>Biden’s order will not affect state-level or local-level emergency declarations. These declarations have allowed states to allocate resources to meet pandemic needs and have <a href="https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/telehealth-licensing-requirements-and-interstate-compacts/">included provisions</a> allowing them to respond to surges in COVID-19 cases by allowing out-of-state physicians and other health care providers to practice in person and through telehealth. </p>
<p>Almost all U.S. states, however, have <a href="https://nashp.org/states-covid-19-public-health-emergency-declarations-and-mask-requirements/">ended their own public health emergency</a> declarations. Eight states – California, Colorado, Delaware, Georgia, Illinois, New Mexico, Rhode Island and Texas – still have emergency declarations in effect, but all of them will expire by the end of February 2023 unless renewed. </p>
<p>While some states may choose to make permanent some COVID-era emergency standards, such as looser restrictions on telemedicine or out-of-state health providers, it could be a long time before either politicians or the public regain an appetite for any emergency orders directly related to COVID-19.</p><img src="https://counter.theconversation.com/content/199060/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>President Joe Biden’s intention to end the national COVID-19 emergency will have long-lasting ripple effects on federal programs such as Medicare, Medicaid and the Children’s Health Insurance Program.Amy Lauren Fairchild, Dean and Professor of Public Health, The Ohio State UniversityMarian Moser Jones, Associate Professor and Graduate Director of Family Science, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1920782022-10-07T12:49:18Z2022-10-07T12:49:18ZNew satellite mapping with AI can quickly pinpoint hurricane damage across an entire state to spot where people may be trapped<figure><img src="https://images.theconversation.com/files/488764/original/file-20221007-22-u8ego1.jpg?ixlib=rb-1.1.0&rect=887%2C1083%2C2942%2C1830&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New satellite mapping techniques can quickly locate washed out and damaged areas.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-aerial-picture-taken-on-october-1-2022-shows-a-broken-news-photo/1243654287">Ricardo Arduengo / AFP via Getty Images</a></span></figcaption></figure><p>Hurricane Ian left an extraordinarily broad path of destruction across much of South Florida. That was evident in reports from the ground, but it also shows up in satellite data. Using <a href="https://gers.users.earthengine.app/view/nrt-conus">a new method</a>, our team of spatial and environmental analysts was able to quickly provide a rare big picture view of damage across the entire state.</p>
<figure class="align-right ">
<img alt="State of Florida with red dots across a large swath of the state from Charlotte Harbor to the Space Coast and for large distances on either side showing likely damage" src="https://images.theconversation.com/files/488765/original/file-20221007-12-pip7x2.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/488765/original/file-20221007-12-pip7x2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=810&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488765/original/file-20221007-12-pip7x2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=810&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488765/original/file-20221007-12-pip7x2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=810&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488765/original/file-20221007-12-pip7x2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1018&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488765/original/file-20221007-12-pip7x2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1018&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488765/original/file-20221007-12-pip7x2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1018&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Satellite images and artificial intelligence reveal Hurricane Ian’s widespread damage. The dark areas have a high probability of damage.</span>
<span class="attribution"><a class="source" href="https://gers.users.earthengine.app/view/nrt-conus">Su Ye</a></span>
</figcaption>
</figure>
<p>By using satellite images from before the storm and real-time images from four satellite sensors, together with artificial intelligence, we created a disaster monitoring system that can map damage in <a href="https://gsp.humboldt.edu/olm/Lessons/GIS/08%20Rasters/FourResolutions.html">30-meter resolution</a> and continuously update the data.</p>
<p>It’s a snapshot of what faster, more targeted disaster monitoring can look like in the future – and something that could eventually be deployed nationwide.</p>
<h2>How artificial intellegence spots the damage</h2>
<p>Satellites are already used to <a href="https://doi.org/10.5772/8341">identify high-risk areas</a> for floods, wildfires, landslides and other disasters, and to pinpoint the damage after these disasters. But most satelite-based disaster management approaches rely on visually assessing the latest images, one neighborhood at a time. </p>
<p>Our technique automatically compares pre-storm images with current satellite images to <a href="https://gers.users.earthengine.app/view/nrt-conus">spot anomalies quickly over large areas</a>. Those anomalies might be sand or water where that sand or water shouldn’t be, or heavily damaged roofs that don’t match their pre-storm appearance. Each area with a significant anomaly is flagged in yellow.</p>
<figure class="align-center ">
<img alt="A damaged narrow roadway with water on both sides and damaged homes." src="https://images.theconversation.com/files/488761/original/file-20221007-18-3uq376.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488761/original/file-20221007-18-3uq376.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488761/original/file-20221007-18-3uq376.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488761/original/file-20221007-18-3uq376.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488761/original/file-20221007-18-3uq376.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488761/original/file-20221007-18-3uq376.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488761/original/file-20221007-18-3uq376.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A dump truck works to repair a washed out road after Hurricane Ian hit Matlacha, Florida, on Oct. 3, 2022.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-aerial-picture-taken-on-october-3-2022-shows-a-dump-news-photo/1243707869?phrase=Matlacha&adppopup=true">Ricardo Arduengo/AFP via Getty Images</a></span>
</figcaption>
</figure>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/488641/original/file-20221006-7794-60mcif.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/488641/original/file-20221006-7794-60mcif.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=549&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488641/original/file-20221006-7794-60mcif.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=549&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488641/original/file-20221006-7794-60mcif.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=549&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488641/original/file-20221006-7794-60mcif.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=689&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488641/original/file-20221006-7794-60mcif.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=689&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488641/original/file-20221006-7794-60mcif.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=689&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Damage detected in the same area of Matlacha as in the photo.</span>
<span class="attribution"><span class="source">Su Ye</span></span>
</figcaption>
</figure>
<p>Five days after Ian lashed Florida, the map showed yellow alert polygons all over South Florida. We found that it could spot patches of damage with about 84% accuracy.</p>
<p>A natural disaster like a hurricane or tornado often leaves behind large <a href="https://doi.org/10.1016/j.rse.2020.112167">areas of spectral change</a> at the surface, meaning changes in how light reflects off whatever is there, such as houses, ground or water. Our algorithm compares the reflectance in models based on pre-storm images with reflectance after the storm.</p>
<figure class="align-center ">
<img alt="Rows of closely spaced homes next to an inlet or lake. Several have clearly damage roofs." src="https://images.theconversation.com/files/488762/original/file-20221007-20-zivwys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488762/original/file-20221007-20-zivwys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488762/original/file-20221007-20-zivwys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488762/original/file-20221007-20-zivwys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488762/original/file-20221007-20-zivwys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488762/original/file-20221007-20-zivwys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488762/original/file-20221007-20-zivwys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Punta Gorda, Florida, was hit by storm surge and high winds from Hurricane Ian.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-this-aerial-view-damaged-homes-are-seen-after-hurricane-news-photo/1428747090">Win McNamee/Getty Images</a></span>
</figcaption>
</figure>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/488645/original/file-20221006-24-4id8g0.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/488645/original/file-20221006-24-4id8g0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=577&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488645/original/file-20221006-24-4id8g0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=577&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488645/original/file-20221006-24-4id8g0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=577&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488645/original/file-20221006-24-4id8g0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=725&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488645/original/file-20221006-24-4id8g0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=725&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488645/original/file-20221006-24-4id8g0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=725&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Damage in the same part of Punta Gorda shown in the photo.</span>
<span class="attribution"><span class="source">Su Ye</span></span>
</figcaption>
</figure>
<p>The system spots both changes in physical properties of natural areas, such as changes in wetness or brightness, and the overall intensity of the change. An <a href="https://doi.org/10.1016/j.rse.2020.112167">increase in brightness</a> often is related to exposed sand or bare land due to hurricane damage.</p>
<p>Using a machine-learning model, we can use those images to predict disturbance probabilities, which measures the influences of natural disaster on land surfaces. This approach allows us to automate disaster mapping and provide full coverage of an entire state as soon as the satellite data is released.</p>
<p>The system uses data from four satellites, <a href="https://www.usgs.gov/landsat-missions/landsat-8">Landsat 8</a> and <a href="https://www.usgs.gov/landsat-missions/landsat-9">Landsat 9</a>, both operated by NASA and the U.S. Geological Survey, and <a href="https://www.esa.int/Applications/Observing_the_Earth/Copernicus/Sentinel-2">Sentinel 2A and Sentinel 2B</a>, launched as part of the European Commission’s Copernicus program.</p>
<h2>Real-time monitoring, nationwide</h2>
<p>Extreme storms with destructive flooding have been documented with increasing frequency over large parts of the globe in recent years. </p>
<p>While disaster response teams can rely on airplane surveillance and drones to pinpoint damage in small areas, it’s much harder to see the big picture in a widespread disaster like hurricanes and other tropical cyclones, and time is of the essence. Our system provides a fast approach using free government-produced images to see the big picture. One current drawback is the timing of those images, which often aren’t released publicly until a few days after the disaster.</p>
<p>We are now working on developing near real-time monitoring of the whole conterminous United States to quickly provide the most up-to-date land information for the next natural disaster.</p><img src="https://counter.theconversation.com/content/192078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zhe Zhu receives funding from the USGS-NASA Landsat Science Team Program for Toward Near Real-time Monitoring and Characterization of Landsat Surface Change for the Conterminous US (140G0119C0008)</span></em></p><p class="fine-print"><em><span>Su Ye does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Artificial intelligence can spot differences in images from before and after a storm over wide areas in almost real time. It showed Hurricane Ian’s vast damage in Florida.Zhe Zhu, Assistant Professor of Natural Resources and the Environment, University of ConnecticutSu Ye, Postdoctoral researcher in environment and remote sensing, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1746852022-01-20T13:45:43Z2022-01-20T13:45:43ZShakeAlert earthquake warnings can give people time to protect themselves – but so far, few have actually done so<figure><img src="https://images.theconversation.com/files/441762/original/file-20220120-9372-1yk59g7.jpg?ixlib=rb-1.1.0&rect=122%2C644%2C3143%2C2029&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An app can give you a few seconds of warning before an earthquake strikes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-nations-first-statewide-earthquake-early-warning-system-news-photo/1176500973?adppopup=true">Yichuan Cao/NurPhoto via Getty Images</a></span></figcaption></figure><p>My Facebook feed exploded shortly after noon on Dec. 20, 2021, with news from friends and family in northern California: A “big one!” The 6.2 magnitude earthquake they’d just experienced had its <a href="https://earthquake.usgs.gov/earthquakes/eventpage/ew1640031020/executive">epicenter on the coast near Petrolia</a>.</p>
<p>Yet many social media posts weren’t focused on the earthquake itself, but rather the <a href="https://www.theguardian.com/us-news/2021/dec/21/california-earthquake-early-warning-system">alert</a> sent to cellphones seconds before – or, for some, just as – major shaking began.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441349/original/file-20220118-19-ygofp9.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="screenshot of Facebook post about receiving an alert" src="https://images.theconversation.com/files/441349/original/file-20220118-19-ygofp9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441349/original/file-20220118-19-ygofp9.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=266&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441349/original/file-20220118-19-ygofp9.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=266&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441349/original/file-20220118-19-ygofp9.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=266&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441349/original/file-20220118-19-ygofp9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=335&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441349/original/file-20220118-19-ygofp9.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=335&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441349/original/file-20220118-19-ygofp9.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=335&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lots of people justifiably marveled at the alert, but few seem to have taken advantage of it.</span>
<span class="attribution"><span class="source">Facebook screenshot via Dare Baldwin</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p><a href="https://www.usgs.gov/programs/earthquake-hazards/early-warningshakealertr">The ShakeAlert system</a> is a remarkable technology, years in the making. It has the potential to save tens of thousands of lives in areas where high-magnitude earthquakes occur by providing a few seconds’ warning – enough time for people to take basic safety precautions. Marvelous as it is, though, ShakeAlert saves lives only if people understand what to do when they receive such an alert – and do it.</p>
<p>I’m part of an interdisciplinary group that includes <a href="https://scholar.google.com/citations?user=pS-idGwAAAAJ&hl=en&oi=ao">psychologists like me</a> and other social scientists, natural hazards experts, seismologists, geophysicists and communication and education specialists whose goal is to design <a href="https://doi.org/10.1190/geo2021-0222.1">earthquake preparedness and response systems that optimize safe outcomes</a>. Some of us are working together to analyze video footage of various earthquakes posted to social media sites, such as Facebook, Twitter and YouTube.</p>
<p>Videos during the Petrolia-centered earthquake are the first we’ve seen of what people do – or don’t do – when they receive a ShakeAlert-powered alert. The footage suggests we have more work to do.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441568/original/file-20220119-21-1e940uy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="still of surveillance footage from a hotel" src="https://images.theconversation.com/files/441568/original/file-20220119-21-1e940uy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441568/original/file-20220119-21-1e940uy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441568/original/file-20220119-21-1e940uy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441568/original/file-20220119-21-1e940uy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441568/original/file-20220119-21-1e940uy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441568/original/file-20220119-21-1e940uy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441568/original/file-20220119-21-1e940uy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">CCTV footage, like this still from video taken in Jakarta, Indonesia, during the 2004 earthquake, reveals how people really respond during shaking.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/this-video-grab-from-metro-tv-in-jakarta-shows-a-hotel-cctv-news-photo/51893889">AFP/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>Detection and warning of imminent earthquakes</h2>
<p>ShakeAlert depends on a massive network of seismic detectors distributed around the West Coast that pick up initial earthquake shaking.</p>
<p>For people near the epicenter, the time it takes to process the data and send an alert may mean it arrives just as, or possibly even seconds after, major shaking begins. Even this roughly simultaneous notice is valuable, as it helps people realize what is happening, which often isn’t obvious.</p>
<p>For those further away from a quake’s epicenter, an alert may arrive seconds, or even tens of seconds, before strong shaking. That’s enough time to automatically shut down or alter the operations of key systems – for example, to slow or stop trains, control equipment involved in delicate medical procedures, or electrical grids. It’s also enough time to prepare mentally, as well as to take potentially life-saving protective action.</p>
<p>To maximize your chances of <a href="https://www.usgs.gov/faqs/what-should-i-do-during-earthquake">coming out of a major earthquake alive and intact</a>, most experts recommend in most cases – for California, Oregon and Washington – that you “Drop, Cover, and Hold On,” or DCHO for short. The alert message appearing on your cellphone reminds you what to do.</p>
<p>ShakeAlert is the only earthquake early warning system for the public in the U.S. It <a href="https://www.oregonlive.com/environment/2021/02/earthquake-warning-system-shakealert-coming-to-oregon-in-march.html">went live in Oregon in March 2021</a>, and in May it expanded to the entire U.S. West Coast. The system sends alerts via <a href="https://www.usgs.gov/faqs/how-do-i-sign-shakealertr-earthquake-early-warning-system">a group of delivery partners</a>. For instance, Google Android phones display alerts via their operating system. Depending where people live, they can install alert apps – MyShake, QuakeAlert USA or San Diego Emergency ShakeReadySD – to their smartphone. And the Federal Emergency Management Agency system that sends emergency messages like Amber Alerts also issues earthquake warnings.</p>
<p>Considerable prior <a href="https://doi.org/10.1016/j.ijdrr.2020.101713">research helped to shape the content</a> conveyed in ShakeAlert-powered alerts, as well as key messaging that occurs right after alerts. Getting all of this right is crucial, and it’s still a work in progress.</p>
<h2>What people do before and during quakes</h2>
<p>Until recently, researchers have had to rely primarily on after-the-fact interviews or “<a href="https://earthquake.usgs.gov/data/dyfi/">Did You Feel It?</a>” post-earthquake surveys to learn what people remembered doing during an earthquake.</p>
<p>In the last several years, closed-circuit TV footage has started to reveal how people really respond to high-intensity shaking. These recordings aren’t muddled by individuals’ understandably imperfect memories of a chaotic and stressful event. Though people frequently report having taken protective actions such as “Drop, Cover, and Hold On” during an earthquake, analyses of CCTV footage to date show that DCHO is, as yet, actually quite rare.</p>
<p>There are a few encouraging exceptions, though. For instance, CCTV footage from the 2018 7.2 magnitude earthquake in Anchorage, Alaska, shows a teacher and students in <a href="https://www.adn.com/alaska-news/anchorage/2018/12/04/this-classroom-footage-captures-anchorage-students-reacting-perfectly-to-the-earthquake/">one middle-school classroom collectively enacting DCHO</a> immediately and flawlessly.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441528/original/file-20220119-23-3ltaat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="seated person holds up cell phone to show a person who looks shocked" src="https://images.theconversation.com/files/441528/original/file-20220119-23-3ltaat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441528/original/file-20220119-23-3ltaat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441528/original/file-20220119-23-3ltaat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441528/original/file-20220119-23-3ltaat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441528/original/file-20220119-23-3ltaat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441528/original/file-20220119-23-3ltaat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441528/original/file-20220119-23-3ltaat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A still from CCTV footage just before the Petrolia earthquake seems to depict people astonished by the ShakeAlert warning, but taking no action.</span>
<span class="attribution"><span class="source">Screen grab from Earth Quake Video World</span></span>
</figcaption>
</figure>
<p>The Petrolia earthquake videos offer the first chance to see if ShakeAlert-powered messages change how people behave before, during and even after a major earthquake. So far, in the footage we’ve seen, people noticed the alert yet did nothing relevant to protecting themselves.</p>
<p>In fact, no one in any of these videos from Dec. 20 undertook “Drop, Cover, and Hold On” precautions, regardless of whether, or when, they received an alert. Many people just stayed where they were, showed the alert on their phones to others and excitedly watched as objects swayed and crashed to the floor.</p>
<h2>Frozen in the face of an emergency</h2>
<p>My colleagues and I are hoping that a better understanding of what people actually do during major earth shaking will suggest ways to tweak the alerts so they inspire people to take safer actions. It’s a big challenge because doing nothing when an earthquake begins appears to be very common.</p>
<p>A 2021 survey conducted in both Seattle and Sendai, Japan, found that stopping and staying put was the <a href="https://doi.org/10.1016/j.ijdrr.2021.102624">dominant response to major earth shaking</a>, even though it puts people at risk of serious injury from falling or being hit by falling objects. There are several likely reasons.</p>
<p>A major earthquake is a novel experience for many people, and often they simply may not know what to do. In addition, there are potential barriers to carrying out “Drop, Cover, and Hold On.” Age, disability and high body mass can make dropping to the floor and getting under cover problematic, though there are <a href="https://ars.els-cdn.com/content/image/1-s2.0-S2212420918313888-gr1_lrg.jpg">inclusive ways to DCHO</a>.</p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>Even when people do know what to do in an emergency, evidence suggests they may feel self-conscious or <a href="https://doi.org/10.1016/j.ijdrr.2019.101150">embarrassed about taking action</a>. Classic social science research points to <a href="https://doi.org/10.1016/0022-1031(72)90069-8">how contagious it can be</a>, in the face of a variety of emergencies, to do nothing, creating cascading paralysis for everyone present.</p>
<p>By dropping, covering and holding on right when you receive an alert, you might unleash similar protective action in others nearby, possibly saving them, as well as yourself, from injury or death. Seen that way, doing DCHO when you receive an alert – despite the potential for embarrassment – is actually a form of everyday heroism.</p><img src="https://counter.theconversation.com/content/174685/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dare A. Baldwin, Ph.D., is a Full Professor at the University of Oregon; her research at the University of Oregon is supported in part by the United States Geological Survey.</span></em></p>When researchers look at CCTV footage of how people really react during earthquakes – as opposed to what they report after the fact – it looks like alerts aren’t yet inspiring protective action.Dare A. Baldwin, Full Professor, Psychology and Clark Honors College, University of OregonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1736822021-12-14T19:14:54Z2021-12-14T19:14:54ZConservative MP rebellion: ‘human rights’ opposition to new COVID measures doesn’t add up<p>The UK government’s introduction of new restrictions to deal with the “<a href="https://www.bbc.co.uk/news/av/uk-59631541">omicron emergency</a>” has prompted backlash from some politicians. When the changes were put to the House of Commons, 99 Tory MPs voted against the plans. Several expressed concern over the impact measures such as having to show proof of vaccination to enter certain venues would have on people’s “civil liberties”. They have essentially been invoking human rights arguments to oppose pandemic emergency powers. However, their opposition is based on a misguided and libertarian understanding of the nature of human rights. </p>
<p>Such libertarian opposition to the new restrictions can be seen from some MPs’ recent commentary. Conservative MP Steve Baker, who is in the Covid Recovery Group and a vocal backbencher, <a href="https://www.france24.com/en/live-news/20211214-uk-s-johnson-faces-angry-mps-at-vote-on-new-virus-curbs">accused Prime Minister Boris Johnson</a> of creating a “miserable dystopia” by bringing back rules on face masks and testing and introducing vaccine passes.</p>
<p>Libertarians essentially argue that human rights prevent the state from acting or interfering with your freedom. Any interference to which you do not consent is an act of aggression and is therefore illegitimate. In my book <a href="https://bristoluniversitypress.co.uk/emergency-powers-in-a-time-of-pandemic">Emergency Powers in a Time of Pandemic</a>, I argue that libertarian understandings of rights as only restricting the power of the state are inappropriate for dealing with a pandemic. </p>
<p>On the face of it, human rights such as those in the <a href="https://www.echr.coe.int/documents/convention_eng.pdf">European Convention on Human Rights</a> and incorporated into British law by the Human Rights Act 1998 appear to require non-intervention by the state. Everyone has the right to life, everybody has the right to liberty, everybody has the right to privacy, everybody has the right to freedom of expression. Essentially, the state should just leave people alone.</p>
<p>A pandemic, however, actually requires states to be more active, taking positive steps to protect human rights. </p>
<p>For example, the right to life enshrined in Article 2 of the European Convention on Human Rights does not simply require states to refrain from taking people’s lives, it also requires states to protect people from <a href="https://hudoc.echr.coe.int/fre?i=001-58257">“real and immediate risks”</a>. Likewise, the state must spend resources and implement measures to ensure that conditions in state-run institutions (like hospitals and prisons) do not deteriorate to the level that they infringe on people’s rights to humane treatment.</p>
<p>If MPs truly want to protect people’s rights, they should be in favour of a robust pandemic response. A person cannot exercise their other rights if their right to life is not protected. A human rights law limiting the state’s ability to protect people from a deadly threat would not be of much value. Rather than conceiving of human rights law as simply stipulating non-intervention by a state, the key to the success of the human rights movement is its ability empower or “emancipate” people. This places strong obligations on states to protect and vindicate people’s rights. </p>
<h2>Whose rights matter?</h2>
<p>At the time of the vote, over <a href="https://coronavirus.data.gov.uk/">800 people</a> had died within the past seven days from COVID-19. While these numbers appear relatively low when compared with <a href="https://www.theguardian.com/world/2021/jan/20/uk-reports-1820-covid-deaths-in-record-daily-high">the height of the pandemic</a>, they are significantly higher than the deaths caused by other threats that have prompted the British state to enact draconian powers. From April 2003 to March 2020, for example, <a href="https://researchbriefings.files.parliament.uk/documents/CBP-7613/CBP-7613.pdf">95 people were killed</a> in terrorist-related incidents in England and Wales. </p>
<p>It is striking that, while they are opposing new COVID-19 restrictions on a civil liberties basis, MPs are reluctant to voice concerns over other legislation that clearly infringes on human rights. On the very same day as the vote, the government proposed <a href="https://www.gov.uk/government/news/plan-to-reform-human-rights-act">striking changes to the 1998 Human Rights Act</a>, including restricting the right to family life to make it easier to deport people. </p>
<p>Conservative MPs also recently voted through legislation allowing the home secretary to strip people of their British citizenship <a href="https://theconversation.com/stripping-british-citizenship-the-governments-new-bill-explained-173547">without notice</a>, and substantially curtailing <a href="https://www.theguardian.com/commentisfree/2021/dec/01/imprisoned-51-weeks-protesting-britain-police-state">the right of people to protest</a> —- a fundamental right in any democracy. </p>
<p>At best, this is inconsistency. At worst, it is rank hypocrisy.</p>
<p>The reason for this can be boiled down to an “us v. them” mindset. Ultimately, it is the idea that most of “us” – “ordinary”, law-abiding people – will feel that counterterrorist powers do not affect us, or that we ourselves are not at risk of being deported. Instead, we view these kinds of human rights restrictions as only impacting the rights of the “other” -— the terrorist, the undeserving. In contrast, the effects of COVID emergency powers apply to everyone.</p>
<p>While this distinction explains opposition to some rights restrictions but not others, it cannot justify this inconsistency. This idea of those deserving versus those undeserving of civil liberties has no place in human rights. We have rights by virtue of the fact that we are human, not simply because we are good citizens.</p><img src="https://counter.theconversation.com/content/173682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alan Greene does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The revolt over new restrictions comes in stark contrast to support of other draconian laws.Alan Greene, Reader in Constitutional Law and Human Rights, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1607772021-06-09T05:01:59Z2021-06-09T05:01:59ZVictoria’s COVID lockdown reminds us how many rely on food charity. Here’s how we plan for the next inevitable crisis<figure><img src="https://images.theconversation.com/files/400712/original/file-20210514-21-1k3gtfw.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sherman-tx-united-states-april-1-1711414504">Sara Carpenter/www.shutterstock.com</a></span></figcaption></figure><p>Melbourne’s latest lockdown and <a href="https://www.abc.net.au/news/2021-06-06/victoria-s-emergency-aid-providers-struggling-to-keep/100193338">increased demand</a> for emergency food aid reminds us how many people don’t have enough food for themselves and their family.
We’ve also seen this in past lockdowns.</p>
<p>However, our research shows many Australians rely on emergency and community food relief <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/hsc.13062">for years</a>, not just for short periods.</p>
<p>So how do we make emergency food aid available whether or not there’s a lockdown or other crisis?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/too-many-australians-have-to-choose-between-heating-or-eating-this-winter-99940">Too many Australians have to choose between heating or eating this winter</a>
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<h2>Why are people turning to food aid?</h2>
<p>Australian cities have some of the <a href="https://www.parliament.vic.gov.au/publications/research-papers/download/36-research-papers/13860-the-cost-of-living-an-explainer">highest costs of living</a> in the world. Housing costs <a href="https://www.abc.net.au/news/2021-04-14/house-prices-australia-climbing-not-for-the-reason-you-think/100065644">are increasing</a> and wage growth <a href="https://www.theguardian.com/australia-news/2021/jan/18/bleak-outlook-for-pay-rises-australians-might-have-to-wait-five-years-for-return-to-2-wage-growth">is stagnant</a>. So many people are running short and turning to <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/ajs4.48">charity</a> to fill the gaps in their budgets.</p>
<p>The food charity sector has grown in Australia since the 1990s and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12916">more rapidly so over the past decade</a>.</p>
<p>Four main organisations — <a href="https://www.fareshare.net.au/">FareShare</a>, <a href="https://www.ozharvest.org/">OzHarvest</a>, <a href="https://www.secondbite.org/">SecondBite</a>, and <a href="https://www.foodbank.org.au/">Foodbank</a> — distribute over <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12916">50,000 tonnes of food each year</a> to charities in Australia. And it’s these charities that provide subsidised and free food parcels, school breakfasts, and prepared meals to their communities. </p>
<p>People use food charity for many reasons including: poor health, long and short-term unemployment, high costs of living, domestic violence, family breakdowns, and emergencies including fires, floods, and pandemics. </p>
<p>For instance, our research with single mothers tells us low levels of government welfare and high costs of housing in Australia mean some go without food so they can <a href="https://doi.org/10.1332/175982716X14822521840954">afford to pay other bills</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-average-australian-wastes-200kg-of-food-a-year-yet-two-million-of-us-also-go-hungry-why-5278">The average Australian wastes 200kg of food a year - yet two million of us also go hungry. Why?</a>
</strong>
</em>
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<h2>During COVID, many turn to food aid</h2>
<p>As Melbourne has gone in and out of lockdown over the past year or so, many casual workers, <a href="https://www.abc.net.au/news/2020-09-21/melbourne-coronavirus-lockdown-international-students-struggle/12678544">including international students</a>, found themselves out of work and needing assistance for the first time.</p>
<p>Our research, <a href="https://www.tandfonline.com/doi/abs/10.1080/19320248.2021.1900974">conducted during the second COVID-19</a> lockdown in Melbourne in May 2020, confirmed more people needed food assistance. </p>
<p>Foodbank Australia also reported a huge increase in the number of people needing food assistance since the start of the pandemic; <a href="https://www.smh.com.au/politics/federal/record-1-4-million-people-relying-on-food-charity-as-recession-bites-20200701-p55821.html">1.4 million people</a> sought food aid during May 2020 up from 815,000 before the pandemic.</p>
<p>But the COVID-19 pandemic exposed vulnerability in Australia’s emergency and community relief sector.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/god-i-miss-fruit-40-of-students-at-australian-universities-may-be-going-without-food-156584">'God, I miss fruit!' 40% of students at Australian universities may be going without food</a>
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</em>
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<h2>COVID exposed vulnerabilities</h2>
<p>The increase in need for food charity, stresses on food supply chains in <a href="https://www.straitstimes.com/asia/australianz/covid-19-exposes-vulnerability-of-australias-food-security">Australia</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/23748834.2020.1791442">globally</a>, and the impact of panic buying, meant some charities had <a href="https://www.9news.com.au/national/coronavirus-homeless-and-low-income-australian-hit-hard-as-food-services-stop/059542cf-315a-47c2-9e57-651b609bf9b6">food shortages</a>.</p>
<p><strong>An increase in demand</strong></p>
<p>We saw <a href="https://www.abc.net.au/news/2020-03-24/centrelink-minister-stuart-robert-not-anticipate-coronavirus/12080612">queues of people lining up at Centrelink</a> in the first weeks of the pandemic. However, many people were protected from the <a href="https://www.tandfonline.com/doi/abs/10.1080/14733285.2021.1902943">worst of the economic impacts</a>, and protected from poverty and food insecurity. This was thanks to the temporary increase in social welfare through the introduction of the JobKeeper wage subsidy and doubling of the JobSeeker employment-seeking benefit in 2020.</p>
<p>However, according to <a href="https://treasury.gov.au/speech/opening-statement-economics-legislation-committee-0">treasury figures</a>, within four weeks of JobKeeper ending in March 2021, about 56,000 people lost their jobs.</p>
<p><strong>The impact of panic buying</strong></p>
<p>Australia produces <a href="https://www.afgc.org.au/news-and-media/2020/06/no-need-to-panic-australia-produces-enough-food-for-75-million">enough food to feed itself</a>. However, during COVID-19, many Australians saw bare supermarket shelves. </p>
<p><a href="https://theconversation.com/panic-buying-events-are-the-new-normal-heres-how-supply-chains-have-adapted-154362">Panic buying</a>, which reflected the uncertainty many people felt, meant those who could afford to, hoarded more food than they needed. This put pressure on supermarkets and left those on lower incomes reliant on whatever food was left available, often at an increased price, or on charity.</p>
<p><strong>Fewer volunteers</strong></p>
<p>Several food charities also reported a <a href="https://www.abc.net.au/news/2021-06-06/victoria-s-emergency-aid-providers-struggling-to-keep/100193338">drop in volunteers</a>. Without volunteers to collect and distribute food, food charities <a href="https://www.theguardian.com/world/2020/apr/01/australian-charity-heads-call-for-coronavirus-volunteers-as-numbers-slump">struggled</a> to meet the increased demand.</p>
<h2>Here’s how we could do this better</h2>
<p>To ensure we can assist all in need during the next inevitable crisis, we need to make sure charities are better funded, and can quickly respond to increased need.</p>
<p>Many charities apply for <a href="https://www.abc.net.au/news/2021-06-06/victoria-s-emergency-aid-providers-struggling-to-keep/100193338">short-term funding</a> often tied to helping a specific group of people. But governments need to provide long-term funding, and more of it, so charities can feed anyone who is in need. This is important if we are to cater for people, as we’ve seen during the pandemic, who have <a href="https://www.theguardian.com/australia-news/2020/oct/12/australian-food-banks-report-huge-surge-in-demand-during-covid-pandemic">never had to worry about food before</a> and are turning to food charity for the first time.</p>
<p>Most food charities are non-profit and rely heavily on volunteers. And finding volunteers will continue to be a challenge. We have seen the <a href="https://www.theguardian.com/world/2020/apr/01/australian-charity-heads-call-for-coronavirus-volunteers-as-numbers-slump">Army pick up some of the slack</a>, but this is not a long-term solution. So finding creative ways to increase the numbers of volunteers will be essential.</p>
<p>Food assistance is also usually just one part of a complex web of people’s needs. Food charities also provide a range of other services, including referring clients to accommodation, family support/domestic violence, medical and mental health care, and financial services. So we need a network that allows people to be referred to other services when they need them.</p>
<hr>
<p><em>This story is part of a series The Conversation is running on the nexus between disaster, disadvantage and resilience. It is supported by a philanthropic grant from the Paul Ramsay foundation. You can read the rest of the stories <a href="https://theconversation.com/au/topics/disaster-and-resilience-series-97537">here</a>.</em></p><img src="https://counter.theconversation.com/content/160777/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona McKay has received funding from the Give Where You Live Foundation. </span></em></p>COVID has exposed how vulnerable Australia’s food charities are in times of crisis. But we can prepare for the next disaster.Fiona McKay, Senior Lecturer in Public Health, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1569982021-04-15T15:12:17Z2021-04-15T15:12:17ZPandemic underscores flaws in Nigeria’s farming and food supply chains<figure><img src="https://images.theconversation.com/files/394771/original/file-20210413-13-lkluf8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A tomato vendor attends to buyer at a makeshift food market established to cushion the effect of COVID lockdown in Lagos.</span> <span class="attribution"><span class="source">Photo by Pius Utomi Ekpei/AFP via Getty Images</span></span></figcaption></figure><p>During the lockdown in Lagos, Nigeria, I joined a humanitarian team to distribute food to poor people in the urban slums. The project was launched because food was not available and accessible to millions of people in Africa’s <a href="https://worldpopulationreview.com/continents/cities/africa">most populous</a> city. </p>
<p>Given my background in agricultural innovation, I set about trying to understand why the supply of food was so poor – a problem that I know preceded COVID-19. My question took me back into the deep structural flaws that continue to plague Nigeria’s agricultural and food systems. I identified challenges that lie at the heart of food and nutrition insecurity in the whole country, especially the urban slums.</p>
<p>Firstly, that small-scale farmers – who represent <a href="https://www.researchgate.net/publication/324908957_Role_of_Smallholder_Farmers_in_Nigeria%27s_Food_Security">over 70%</a> of the agri-food supply chain – have limited access to market. Nigeria’s infrastructure is in a <a href="https://www.afdb.org/fileadmin/uploads/afdb/Documents/Project-and-Operations/An_Infrastructure_Action_Plan_for_Nigeria_-_Closing_the_Infrastructure_Gap_and_Accelerating_Economic_Transformation.pdf">state of disrepair</a>, including roads. And there are no urban and rural freight networks and no long-term logistics plan that guarantees healthy function between strategic locations. There is also limited innovation in the agricultural sector. </p>
<p>I concluded that Nigeria needs a total overhaul of the policies that determine the agricultural sector’s agri-food supply chain. Innovations in technologies – including handling, processing, storage, refrigeration and transport – would be an indispensable component of these policies.</p>
<h2>How long will hunger problem persist?</h2>
<p>Nigeria faces a chronic hunger problem. More than <a href="https://www.bbc.com/pidgin/media-52284567">70% of Nigeria’s</a> population has suffered hunger during the pandemic. Vendors, such as market women, don’t have food to sell. In addition, without buffer capacity in stores the cost of goods and services skyrocket. </p>
<p>The pandemic appears to have worsened the hunger situation. But Nigeria has faced food shortage problems in the past. High prices of staple food, due to limited domestic production, often drive <a href="https://www.researchgate.net/publication/272461844_Food_Insecurity_in_Nigeria_Way_Forward">these shortages</a>. This is due to the neglect of the agricultural sector and <a href="https://www.globalsecurity.org/military/world/nigeria/energy.htm">high dependence</a> on oil revenue since 1970. </p>
<p>In the past decade, Nigeria spent over <a href="https://www.ecsdev.org/images/V1N2/ojo%20199-220.pdf">US$3 billion</a> annually to import wheat, rice, sugar and dairy products due to limited agricultural production. A myriad of factors contributed to this. These included an underfunded agricultural sector, lack of research and development, limited expertise and weak agricultural extension services.</p>
<p>Continued reliance on imports undermines the agricultural sector. It also poses a significant threat to food and nutrition security in the country.</p>
<h2>What needs fixing</h2>
<p>Nigeria should prioritise domestic demand before food exports. It
must see the agricultural industry as a critical element of economic growth. </p>
<p>Science and innovation policies have an important role to play. This is particularly true of those that target specific needs of rural farmers to deliver high value agricultural products. </p>
<p>One remarkable example has been <a href="https://agricultureandfoodsecurity.biomedcentral.com/articles/10.1186/2048-7010-1-4">Brazil’s EMBRAPA</a> initiative. This successful institutional approach transformed traditional agriculture into a modern and competitive industry. </p>
<p>The initiative helped the country meet domestic demands by strengthening local production and food security. It also positioned <a href="https://www.investopedia.com/articles/investing/100615/4-countries-produce-most-food.asp">Brazil</a> as one of the world’s food export leader. </p>
<p>Secondly, Nigeria needs to prioritise new, as well as existing, technologies to boost local productivity. Modern technologies, such as gene-editing and the use of genetically modified organisms, need to be mobilised. So do traditional bio technologies, such as tissue culture and marker assisted-breeding. </p>
<p>Thirdly, Nigeria needs to get modern inputs and industrialised processes embedded in its agriculture sector. The country remains far too dependent on subsistence farming. The country can’t feed itself by continuing to use cutlasses, hoes and rudimentary farming equipment. A modern population of a quarter of a billion people requires modern inputs and industrialised processes. </p>
<p>China, Brazil and Thailand used to be <a href="https://www.iisd.org/system/files/publications/transforming-agriculture-africa-asia.pdf">dependent</a> on traditional farming. But each adopted policy innovation to industrialise agricultural sector. </p>
<p>Some policy innovations that would help include:</p>
<ul>
<li><p>subsidised financial credit to purchase farm input;</p></li>
<li><p>a national agricultural innovation system that drives research and development. Emerging technologies – such as artificial intelligence, big data, precision agriculture and internet of things – need to be mobilised. They could transform Africa’s agricultural value chain into a network of local ecosystems of innovation. Emergency preparedness could then be resilient, and literally homegrown;</p></li>
<li><p>human capital development; and,</p></li>
<li><p>building physical infrastructure. This should include post-harvest technologies, storage facilities and a good road network. Nigeria needs to create efficient rural-urban connectivity through innovative transport and improved mobility for the agric-food supply chain. Marketing and organisational innovations along the supply chain also need to be strengthened.</p></li>
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<p>Fourth, all hands need to be on the deck to develop effective collaboration across the continent to enable countries to learn from one another. Numerous innovations have been developed elsewhere. These include technologies to improve irrigation as well as information and communication technology and biotech crops. This kind of sustainable innovation involves applying modern technology, efficient machinery and new ways of farming, while minimising the impact on the environment.</p>
<p>My humanitarian experience at the height of pandemic made me realise that a lack of access to food could do more damage if Nigeria continues to reply on food imports. It’s imperative that the government expands the country’s agricultural production in a way that’s driven by science and innovation. This is fundamental to strengthening the agric-value chain. And providing access to affordable and sufficient quantity of nutritious food.</p><img src="https://counter.theconversation.com/content/156998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ademola Adenle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To overcome food insecurity, especially in a pandemic, Nigeria’s emergency preparedness requires a total overhaul of it’s agri-food supply chain.Ademola Adenle, Fellow at the School of Global Environmental Sustainability, Colorado State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1560292021-02-25T04:52:20Z2021-02-25T04:52:20ZTiger Woods’ car crash injuries explained, according to a trauma surgeon<p>Tiger Woods’ medical team has <a href="https://twitter.com/TigerWoods/status/1364447580520738820/photo/1">released a statement on Twitter</a> to explain the injuries he sustained <a href="https://edition.cnn.com/2021/02/23/us/tiger-woods-car-accident-intl-spt/index.html">in his car crash</a> earlier this week.</p>
<p>The statement was from the Harbor-UCLA Medical Center, a trauma centre, where golfer Woods was taken for emergency treatment after the <a href="https://www.espn.co.uk/golf/story/_/id/30951717/tiger-woods-hospitalized-vehicle-rolls-crash">single-vehicle accident</a>.</p>
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<p>I’m a practising orthopaedic surgeon specialising in trauma surgery and I lecture nationally and internationally on the orthopaedic treatment of fractures. </p>
<p>Here’s my explanation of some of the technical terms in the statement, and what this might mean for Woods’ recovery.</p>
<h2>What were his injuries?</h2>
<p>It appears from the statement his injuries were confined to his right lower leg. This may appear surprising to many who have seen the footage of the accident and heard that his vehicle rolled over. </p>
<p>However, it is common these days to have people admitted after bad car accidents with only injuries to their lower leg. This is because of seat belts, airbags and vehicle construction. These have done a lot to prevent the previously common facial injuries (from windscreens and steering wheels) and head, chest and abdominal injuries.</p>
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<strong>
Read more:
<a href="https://theconversation.com/smallpox-seatbelts-and-smoking-3-ways-public-health-has-saved-lives-from-history-to-the-modern-day-128300">Smallpox, seatbelts and smoking: 3 ways public health has saved lives from history to the modern day</a>
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<p>The statement says he had “comminuted open fractures affecting both the upper and lower portions of the tibia and fibula”.</p>
<p>Let me break that down. “<a href="https://medlineplus.gov/ency/imagepages/1096.htm">Comminuted</a>” means the bones had broken into many fragments, the opposite of a “simple” fracture where the bone breaks into two parts. </p>
<p>The “upper and lower portions” suggests he has what is called a “<a href="https://pssjournal.biomedcentral.com/articles/10.1186/s13037-015-0086-1/figures/13">segmental</a>” fracture, where the bone is broken in two separate locations.</p>
<p>The comminuted and segmental nature of the injury is not unexpected after high-energy injuries like car accidents and doesn’t change the treatment too much.</p>
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<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-have-bones-90246">Curious Kids: Why do we have bones?</a>
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<p>People place a lot of importance on how many pieces bones are broken into, but as long as the bones heal, they all end up in one piece regardless of how many pieces there were to start with. </p>
<p>The fact that it was a bad fracture, however, means it might be harder to get it to heal and that it might take longer. </p>
<p>“<a href="https://orthoinfo.aaos.org/en/diseases--conditions/open-fractures/">Open</a>” fractures mean the skin overlying the broken bone was broken. The main concern is that having an open fracture increases the risk of infection. However, given Woods remained in the vehicle (he had to be broken out of it with special equipment), there is unlikely to be any dirt or highly contaminated material involved.</p>
<h2>How did doctors treat his injuries?</h2>
<p>The tibia and fibula are the two bones that link the knee to the ankle, the tibia being the much larger, main bone. His tibia and fibula were “stabilized by inserting a rod into the tibia”. </p>
<p>It is routine to treat fractures like this with a rod inserted inside the bone from top to bottom to line it up. The rod only needs to go into the tibia because the fibular usually follows the tibia into alignment, as the two bones are connected.</p>
<p>The statement also said that trauma to the soft-tissues of the leg required “surgical release of the covering of the muscles to relieve pressure due to swelling”. </p>
<p>This refers to a procedure called a <a href="https://www.ncbi.nlm.nih.gov/books/NBK556153/">fasciotomy</a> which is performed for actual or impending “<a href="https://orthoinfo.aaos.org/en/diseases--conditions/compartment-syndrome/">compartment syndrome</a>” — a build-up of pressure in the leg.</p>
<p>We do not have information on whether the muscle was damaged as a result of the increased pressure (in which case there could be permanent weakness) or whether the muscle is intact. If the fasciotomy was done early and adequately, it is likely there will be no permanent muscle damage.</p>
<h2>Will he recover?</h2>
<p>The interesting thing about Woods’ injuries is that, while the “open” and “comminuted” fractures of the tibia and fibula sound very bad, if he can avoid the early problem of infection, these injuries on their own do not necessarily mean that he will have any permanent problems. </p>
<p>Once healed, the leg can potentially be just as straight and strong as it was before. Muscles can be strengthened and skin and bones usually heal.</p>
<p>The point of most concern relating to his long-term function is the part of the statement that said: “additional injuries to the bones of the foot and ankle were stabilized with a combination of screws and pins”. </p>
<p>Injuries that involve the joints — the parts where one bone joins another bone — are the ones that commonly lead to long-term problems. This is especially the case in the foot and ankle, as these joints take our whole body weight when walking. And these joints allow us to not only walk normally, but also swing a golf club. </p>
<p>If, for example, he has fractures that involve the ankle joint or any of the foot joints, this can result in permanent loss of flexibility and pain on walking.</p>
<h2>Did Woods get special treatment?</h2>
<p>People may be wondering if Woods got <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC315491/">special treatment, or was even overtreated</a>, which is something that can occur with famous people, and when people seek treatment and have the resources to pay for it. </p>
<p>With trauma though, particularly the type of trauma in this case, the treatment usually follows fairly standard practice. Although some surgeons and hospitals vary in exactly how they treat certain injuries, the management of these lower limb injuries is fairly uniform. So it is unlikely he was treated differently to any other patient who would present to that hospital.</p><img src="https://counter.theconversation.com/content/156029/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Harris does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Once his leg fracture heals, his leg can potentially be just as straight and strong as it was before. But his foot and ankle are more of a worry.Ian Harris, Professor of Orthopaedic Surgery, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1487242020-11-06T03:09:27Z2020-11-06T03:09:27ZBushfires, drought, COVID: why rural Australians’ mental health is taking a battering<figure><img src="https://images.theconversation.com/files/367365/original/file-20201104-17-8sbyb8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5000%2C3330&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Among the Bushfire Royal Commission’s 80 recommendations, <a href="https://naturaldisaster.royalcommission.gov.au/system/files/2020-11/Royal%20Commission%20into%20National%20Natural%20Disaster%20Arrangements%20-%20Report%20%20%5Baccessible%5D.pdf">released last week</a>, was a call to prioritise mental health support during and after natural disasters.</p>
<p>The Australian Medical Association this week <a href="https://ama.com.au/media/implement-bushfire-royal-commission-recommendations-now">called</a> on the federal government to implement the recommendations to lessen the health impacts of future disasters, noting the ongoing mental health fallout from the 2019-20 Black Summer bushfires.</p>
<p>The Royal Commission’s report comes as Australia heads into a bushfire season during a pandemic. Some farmers have this year lost their crops due to unseasonal rain and hail, as many rural communities anticipate further “big weather” events. Certain local economies, which are reliant on exports like wine and barley, are concerned about strained <a href="https://www.abc.net.au/news/2020-08-19/china-eyes-australian-wine-export-in-latest-trade-move/12571672">trade relations</a> with China.</p>
<p>The combined effects of these adverse events is taking a toll on the health and well-being of rural people.</p>
<h2>A year of cumulative stress</h2>
<p>Australian Bureau of Statistics <a href="https://mindframemedia.imgix.net/assets/src/uploads/ABS-Causes-of-Death-data-2019_Australian-state-and-territories-summary.pdf">figures</a> released last month showed rural suicide rates are much higher than those in the big cities. </p>
<p>The causes of psychological stress for rural people are many and varied, depending on who you are and where you live. Many are facing environmental and weather events at increasing frequency and intensity. Some of these events happen rapidly, such as fire and floods, whereas others are long-lasting and uncertain, like drought.</p>
<p>The effects of these events include direct losses such as injury and death, as well as loss of livestock and buildings. Indirect losses include declines in businesses and employment, and the disruption of social fabric when friends or family leave town. </p>
<p>Recovery or adaptation can take many years.</p>
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<strong>
Read more:
<a href="https://theconversation.com/distress-depression-and-drug-use-young-people-fear-for-their-future-after-the-bushfires-146320">Distress, depression and drug use: young people fear for their future after the bushfires</a>
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<p>These stresses of course come in addition to life’s normal challenges likes illness, bereavement and relationship breakdown.</p>
<p>For rural people, COVID has likely compounded these <a href="https://www.mdpi.com/1660-4601/17/19/7205">cumulative stresses</a> and contributed to higher levels of trauma, mental ill-health and in some cases, suicidal behaviour.</p>
<h2>Band-aid policies</h2>
<p>In most rural communities, access to mental health services is relatively poor.</p>
<p>There’s <a href="https://www.ruralhealth.org.au/sites/default/files/publications/nrha-mental-health-factsheet-dec-2017.pdf">longstanding evidence</a> Medicare Benefits Scheme expenditure for mental health services is skewed towards metropolitan services. </p>
<p>State expenditure is focused on hospital services and care for those with high and complex needs. Consequently, many rural people with mild to moderate needs are <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/MentalHealthServices/Report">under-served</a>.</p>
<p>Traditionally, governments respond to crises reactively and by treating these events as short-term and disconnected. But this isn’t the experience of rural people.</p>
<p>Each adverse event is accompanied by (usually short-term) funding announcements by governments and agencies for new Headspace centres, expanded telephone helplines, websites, counsellors, or coordinators in the most affected areas. </p>
<p>Sometimes there’s overlap of effort across different government departments, federal and state jurisdictions or from different disaster responses, potentially wasting resources.</p>
<p>For example, in NSW, the longstanding drought has recently broken. But the social and economic recovery will take longer — possibly <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-1584.2011.01225.x">up to five years</a> with consistent rain as it did following the Millennium drought. </p>
<p>Counsellors were funded to support rural residents during the drought in 2018, with more counsellors funded in response to the bushfires. And now additional services are being offered due to COVID.</p>
<p>While the extra support is welcome, the fragmentation and temporary nature of the funding means rural people may not know what services are available, and accessing services becomes confusing. </p>
<p>What’s more, with short-term contracts, it may be the same staff moving between roles and agencies, therefore not actually adding new staff to support local rural communities. This funding instability makes it <a href="https://pubmed.ncbi.nlm.nih.gov/20932079/">difficult</a> to retain a stable rural mental health workforce.</p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/budget-funding-for-beyond-blue-and-headspace-is-welcome-but-it-may-not-help-those-who-need-it-most-147661">Budget funding for Beyond Blue and Headspace is welcome. But it may not help those who need it most</a>
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<h2>What can be done?</h2>
<p>In the first instance, policymakers need to ask people living in rural areas what they need and involve them in the process of developing appropriate and accessible services.</p>
<p>Second, we need to adopt a systemic approach that examines the full range of <a href="http://dx.doi.org/10.3390/ijerph17197205">adverse events</a> that affect the mental health and well-being of individuals, families and communities. This means going beyond treating illness, to addressing environmental, economic, social and personal factors. </p>
<p>As part of this, we need people on the ground to support communities through preparedness activities such as educating people about mental health and how to access services, while stepping into disaster response and recovery as needed. Continuity and building on what already exists locally is key.</p>
<p>The Rural Fire Service is a good example of such a structure. It has a clear role in disaster response, but also works to prepare communities between disasters (for example, by conducting back-burning and educating about bushfire plans). </p>
<p>Localised support is important because preparedness and response look very different depending on where you live in rural Australia. For example, Lismore on the northern NSW coast experiences regular flooding, whereas Broken Hill in the state’s far west contends with more frequent drought, and fierce dust storms. </p>
<p>Third, to fully understand and plan for the diversity of rural communities, we need sophisticated data planning, collection and analysis <a href="https://doi.org/10.1017/S2045796020000153">systems</a>. Beyond health data, we need to look at the social, economic, environmental factors which all contribute to mental health and the way people access care. </p>
<p>If we can do this well, local planning will become easier, more transparent and tailored to need. </p>
<p>Finally, rural communities need support to develop local leadership, so they’re empowered to lead <a href="https://www.ourhealthyclarence.org.au/">local responses</a>. This is unlikely to succeed with short-term band-aid solutions, but rather with long-term investment and strategic policy to build and sustain <a href="http://dx.doi.org/10.3390/ijerph17197214">capacity to cope with adversity</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/collective-trauma-is-real-and-could-hamper-australian-communities-bushfire-recovery-131555">Collective trauma is real, and could hamper Australian communities' bushfire recovery</a>
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<img src="https://counter.theconversation.com/content/148724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Perkins receives infrastructure and program funding from NSW Health, NSW Government.</span></em></p><p class="fine-print"><em><span>Hazel Dalton receives infrastructure and program funding from NSW Health, NSW Government.</span></em></p>For rural people, these stresses are cumulative and contribute to higher levels of trauma, mental ill-health and in some cases, suicidal behaviour.David Perkins, Director, Centre for Rural and Remote Mental Health and Professor of Rural Health Research, University of NewcastleHazel Dalton, Research Leader and Senior Research Fellow, Centre for Rural and Remote Mental Health, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1488522020-10-27T17:49:02Z2020-10-27T17:49:02ZThe reality of life for seafarers like those crewing the ‘hijacked’ tanker Nave Andromeda<p>The suspected hijacking of the oil tanker Nave Andromeda off the coast of the Isle of Wight has captivated the UK press. While the heroic efforts of members of the Special Boat Service in resolving the situation have been highlighted, little public attention has been paid to the seafarers working onboard the tanker who were caught up in the incident. </p>
<p>At around 10am on October 25 the captain of the Nave Andromeda set off a security alert reporting that seven stowaways onboard had turned violent and were <a href="https://www.bbc.co.uk/news/uk-england-hampshire-54684440">threatening the crew</a> after the crew attempted to detain the stowaways in a cabin. The vessel was several miles off the coast of the Isle of Wight, and was scheduled to berth in Southampton.</p>
<p>The 22-person crew secured themselves in the citadel, a small room in the interior of the ship which is designated as a place in which to take shelter in the event of a security incident. It is understood that the crew remained sheltered in the citadel, a single room with no windows, for approximately ten hours. </p>
<p>They were able to safely exit when UK special forces boarded the vessel and detained the stowaways. This must have been a very traumatic experience for all of the seafarers. They were effectively held hostage on their own vessel, a space in which they not only work but live for months at a time.</p>
<p>Almost immediately after their ordeal, the crew proceeded to berth the ship in Southampton in the early hours of October 26. The arrival in port will have required most of the crew to have been working – people who had spent the previous night at work and the following day being held hostage in a crowded room.</p>
<p>Even without such an incident, seafarers work long hours: <a href="https://www.emerald.com/insight/content/doi/10.1108/ER-07-2019-0294/full/html?skipTracking=true&utm_source=TrendMD&utm_medium=cpc&utm_campaign=Employee_Relations_TrendMD_1&WT.mc_id=Emerald_TrendMD_1">my research</a> indicates on average ten hours each and every day that they are onboard. Stints onboard last an average of between three and six months. It is therefore hardly surprising that seafarers are known to experience substantial fatigue.</p>
<p>My own experience as a seafarer and my research into the industry tells me that seafarers such as those on the Nave Andromeda often have to continue working immediately following a traumatic event. Even after being held captive for a prolonged period of time seafarers <a href="https://www.ilo.org/wcmsp5/groups/public/---ed_norm/---normes/documents/publication/wcms_615073.pdf">would be expected</a> to follow instructions to sail the ship to a safe port. It is hard to think of another occupation in which a worker could be held hostage and then immediately resume work without any sort of break or time to rest and recuperate.</p>
<p>While some companies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544912/">have reported</a> that they would try to replace traumatised crew members, this cannot be done until the vessel reaches port. If, for example, a fatal accident occurs in the middle of the ocean, this may be several weeks away. And even once a vessel has reached port following a traumatic event it is not unusual for seafarers to remain onboard the ship for the duration of their employment contract. For example, when the M/V Boularibank was <a href="http://news.bbc.co.uk/1/hi/world/africa/8465770.stm">attacked by pirates</a>, the crew carried on working as usual. </p>
<p>I have myself experienced a traumatic incident onboard while working as crew on a product tanker. All I received following the incident was an email from the shipping company addressed to the crew asking anyone who required psychological support to contact them – otherwise it was business as usual. Perhaps a better approach would have been a confidential phone call from a trained individual with each crew member onboard, making it clear that it was OK to say that some support was needed.</p>
<p>Because although I was offered support from my employer, shore-based charities often have to step in because seafarers are reluctant to identify themselves to their employer as needing support. <a href="http://orca.cf.ac.uk/109013/">My research</a> indicates that given the temporary nature of their employment, this reluctance to draw attention to themselves is due to the fear of being unable to secure future employment. </p>
<p>This situation is particularly concerning given that seafarers are known to experience relatively <a href="https://www.seafarerstrust.org/wp-content/uploads/2019/11/ST_MentalHealthReport_Final_Digital-1.pdf">high rates</a> of mental ill health, including depression and suicide ideation. It is possible that some of those onboard may go on to experience PTSD, in a similar vein to those seafarers who have experienced <a href="https://oefresearch.org/publications/after-release-long-term-behavioral-impact-piracy-seafarers-and-families#:%7E:text=Seafarers%20with%20higher%20levels%20of,and%20many%20suffer%20lasting%20distress.">piracy attacks</a>.</p>
<p>It is also possible that some of the crew, particularly the captain, may be concerned that they will be blamed for the stowaways accessing the vessel. <a href="http://orca.cf.ac.uk/109156/2/Senu%2C%20Amaha%202018.%20The%20Global%20Assemblage%20of%20Multi-Centred%20Stowaway%20Governance.pdf">Research</a> indicates that captains feel that they are considered to be responsible for any stowaways who manage to hide away on their vessel. Although security measures in ports tend to be very high in some parts of the world, in others, local measures are inadequate. From my own experience as a seafarer I know firsthand how difficult it can be for ships crews to prevent stowaways from boarding.</p>
<p>Clearly these 22 crew members have experienced a traumatic event. It should be remembered that they are all key workers. As an island nation <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/826446/port-freight-statistics-2018.pdf">95%</a> of all UK imports and exports come by sea. Without seafarers such as those working onboard the Nave Andromeda, the UK would come to a standstill. Whilst acknowledging the heroic efforts of members of the UK Special Forces it would be remiss not to also acknowledged the heroic efforts of the 22 seafarers working onboard.</p><img src="https://counter.theconversation.com/content/148852/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Devereux has previously received funding from the Nippon Foundation.</span></em></p>Little public attention has been paid to the seafarers working onboard the tanker who were caught up in the incident.Helen Devereux, Researcher in Seafarer Health and Safety, Solent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1346762020-03-29T08:33:09Z2020-03-29T08:33:09ZCOVID-19 compromises social networks. What this means for people in humanitarian crises<figure><img src="https://images.theconversation.com/files/323191/original/file-20200326-133027-1ljilxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Iraqi, Iranian and Somali asylum seekers at a tent camp in the Netherlands</span> <span class="attribution"><span class="source">ROBIN UTRECHT/AFP/GettyImages</span></span></figcaption></figure><p>The novel coronavirus is now being transmitted through the six continents. A key concern is for those who are already extremely vulnerable – those who are caught in ongoing humanitarian emergencies, such as those in Syria, South Sudan and the Rohingya refugee crisis.</p>
<p>For people caught in these emergencies, a public health response will be a challenge, but there is another factor that has been largely overlooked: the role of people’s social networks – and how these networks might be compromised by the pandemic.</p>
<p>In crises, whether the threat is severe drought, floods, famine, conflict, or displacement, <a href="https://fic.tufts.edu/publication-item/facing-famine-somali-response/">people turn</a> for help first to their social network. Research in several countries shows that social connectedness is the main (in some cases, perhaps the <em>only</em>) source of help that ordinary people have when caught in a crisis. Assistance from these networks includes food, shelter, money or credit, forms of employment, emotional support and information or advice.</p>
<p>But what happens when the threat is embedded in that very social network? What happens to the source of support that people have learned to count on, when everyone is affected by the threat in terms of both their health and their livelihoods?</p>
<p>The current global pandemic is an unprecedented situation where the survival resource of the world’s most vulnerable people – their social networks – may become compromised and an additional risk, because the virus is transmitted between people.</p>
<p>This has massive implications for responses to this pandemic. How will it amplify the impact of existing humanitarian crises? </p>
<h2>Social networks in crises</h2>
<p>During the series of shocks (drought, hyperinflation, and conflict) that hit Somalia in 2011, aid agencies <a href="https://www.hurstpublishers.com/book/famine-in-somalia/">were hobbled</a> by the restrictions of Al-Shabaab - a terrorist group that controlled much of the affected area - and by counter-terrorism <a href="https://www.unocha.org/sites/unocha/files/CounterTerrorism_Study_Full_Report.pdf">legislation</a> in western donor countries that criminalised the diversion of aid that ended up in the hands of terrorist groups. As a result, most of the formal assistance that could have averted the crisis was very late to arrive; the crisis spiralled out of control and led to famine, <a href="https://fews.net/sites/default/files/documents/reports/Somalia_Mortality_Estimates_Final_Report_1May2013_upload.pdf">killing</a> a quarter million people.</p>
<p><a href="https://fic.tufts.edu/research-item/food-security-and-resilience-in-somalia/">Our research</a> showed that in large parts of the affected area, people mostly had only their own social networks to fall back on. </p>
<p>Those with stronger networks - particularly with people outside the affected area, or not subject to the same hazards - were the best able to cope with the crisis. </p>
<p>Social networks support their members best when only some people in the network are affected by a particular threat. People who had networks that expanded into the global diaspora of Somali people were able to cope with the crisis much better than those whose networks consisted only of people who were suffering the same fate. The latter types of networks soon ran out of resources to share, and could no longer support people.</p>
<p>Recognising and protecting social solidarity is more important than ever. But even physically distant sources of support are at risk during this pandemic. </p>
<p>Unlike previous crises, where social connections outside the immediately affected areas were mobilised to help, this pandemic knows no boundaries - people in the diaspora are also locked down, and as vulnerable to the virus as people caught in refugee or internally displaced people’s camps. Their livelihoods have been severely disrupted too.</p>
<h2>Building networks</h2>
<p>The pandemic will also affect people’s ability to forge new social connections and maintain their existing networks.</p>
<p>During the recent crisis in South Sudan, <a href="https://www.mercycorps.org/currency-connections">our research</a> shows that households mostly relied on their relatives, neighbours and friends, informal livelihood and community groups in times of need. </p>
<p>While the conflict, displacement, and family separations disrupted households’ support systems, new forms of social connections emerged. <a href="https://www.mercycorps.org/research-resources/wages-war">Similar results were found in Syria</a>, where households’ social connections were critical for successful coping and livelihood adaptation during the conflict, especially in densely populated besieged areas.</p>
<p>Even in Haiti, which has had a heavy presence of international aid efforts, social networks are often the first and only means of survival. After the earthquake that struck Haiti in 2010, even in the midst of significant international aid, most Haitians <a href="https://www.ncbi.nlm.nih.gov/pubmed/24601934">relied on</a> one another for survival and recovery.</p>
<h2>Way forward</h2>
<p>Humanitarians - both local and international - will have to pay attention to what a pandemic like this does, not only to their own programming, but also to the functioning of social networks. We don’t actually know what the effects will be. </p>
<p>In the Ebola epidemic in West Africa, stigma, rumours, and movement restrictions <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884263/">affected</a> social and economic networks, particularly of survivors and health workers. </p>
<p>Likely, the COVID-19 pandemic will limit the support people are able to mobilise through their networks, certainly in person but also through their distant connections. But in what ways, and who will be most affected by this, remain to be seen. </p>
<p>In times of crises, people’s assets can sometimes become liabilities. The current global pandemic is an unprecedented situation where the very fabric of survival for the world’s most vulnerable people – their social networks – may both become compromised and an additional risk. The humanitarian field needs to work fast to understand the implications and to adapt to this crisis that has challenged the way we work in so many ways.</p><img src="https://counter.theconversation.com/content/134676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeeyon Kim receives funding from DFID, the Center for Resilience and Office of Foreign Disaster Assistance at USAID. </span></em></p><p class="fine-print"><em><span>Daniel Maxwell receives funding from DFID, the Swiss Office of Development Cooperation, FAO, Action Against Hunger, REACH, and USAID.</span></em></p><p class="fine-print"><em><span>Sabina Robillard has recently worked on projects with CDA Collaborative Learning, the International Federation of Red Cross and Red Crescent Societies, Save the Children Denmark, and Concern International. </span></em></p>The survival resource of the world’s most vulnerable people – their social networks – may become compromisedJeeyon Kim, Senior Researcher for Resilience at Mercy Corps and a Visiting Fellow, Tufts UniversityDaniel Maxwell, Henry J. Leir Professor in Food Security, Friedman School of Nutrition Science and Policy, Tufts UniversitySabina Robillard, Doctoral student at the Friedman School of Nutrition Science and Policy, Tufts UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1313862020-02-17T01:06:39Z2020-02-17T01:06:39ZAussie Rules players risk injuring hands and wrists too<p>When people think about Australian Rules Football injuries, they tend to think about head injuries and the long-term effects of <a href="https://www.abc.net.au/news/2019-03-19/john-barnes-ex-afl-ruckman-joins-planned-concussion-class-action/10915086">concussion</a>. Or they might think of the potentially lengthy recoveries after <a href="http://www.aflcommunityclub.com.au/index.php?id=342">hamstring</a>, shoulder or ankle injuries.</p>
<p>But our <a href="https://www.jsams.org/article/S1440-2440(19)31347-7/fulltext">recently published research</a> found another leading cause of injury serious enough to take players to the emergency department – injuries to the hand or wrist. </p>
<p>These cost one Victorian public health network <a href="https://bridges.monash.edu/articles/Individual_community_and_societal_burden_following_acute_hand_and_wrist_injury/11635335">between</a> about A$250 (for a single emergency department consultation) and about A$5,300 (for surgery and rehabilitation) each time. And many of these injuries can be prevented or better managed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aussie-rules-rules-thanks-to-the-eight-hour-working-day-27630">Aussie Rules rules thanks to the eight-hour working day</a>
</strong>
</em>
</p>
<hr>
<h2>What causes these injuries?</h2>
<p>Australian Rules Football or Aussie Rules involves a mix of physical endurance, high-speed running, frequent changes of direction, jumping, sudden and forceful collisions, aggressive tackling, as well as kicking and ball-handling skills. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/XMZYZcoAcU0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How does Aussie Rules differ from other types of football?</span></figcaption>
</figure>
<p>The sport’s distinctive rules and physical demands exposes players to both unique and uncommon injuries compared to those sustained in other football codes, for instance in <a href="https://www.ncbi.nlm.nih.gov/pubmed/16247262">gridiron football</a> played in the United States and Canada or <a href="https://www.ncbi.nlm.nih.gov/pubmed/22879401">Gaelic football</a> played in Ireland. </p>
<p>Put simply, the 360-degree nature of the game (unlike rugby which is played mainly in straight lines up and down the pitch), can result in fingers, hands and wrists to be pulled, jarred, kicked and crushed. </p>
<p>Players’ hands and wrists can also be injured by other players, when falling on the grass pitch or when in contact with the hard leather ball. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-traumatic-brain-injury-and-how-is-it-treated-34697">Explainer: what is traumatic brain injury and how is it treated?</a>
</strong>
</em>
</p>
<hr>
<h2>More and more people playing around the country</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/8665278">Research published in the 1990s</a> found hand fractures were the second most frequent injury, behind concussion, for amateur Aussie Rules players. </p>
<p>Since then, the game has become much more popular. Nationally, it’s the <a href="https://www.clearinghouseforsport.gov.au/__data/assets/pdf_file/0012/796827/AusPlay_focus_Children_Participation.pdf">third most popular</a> organised sport for children (behind swimming and soccer). </p>
<p>And the number of women playing the amateur game <a href="https://www.theage.com.au/sport/afl/number-of-women-playing-footy-surges-post-aflw-20190429-p51i5j.html">has increased</a> since the introduction of the women’s professional league, <a href="https://womens.afl/">the AFLW</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/growth-of-womens-football-has-been-a-100-year-revolution-it-didnt-happen-overnight-71989">Growth of women’s football has been a 100-year revolution – it didn't happen overnight</a>
</strong>
</em>
</p>
<hr>
<p>This rise in participation at an amateur level is likely to have impacts on the number of injuries presenting to emergency departments.</p>
<p>We weren’t aware of Australian data looking at people with sports and exercise-related hand and wrist injuries who presented to the emergency department. So we decided to establish baseline data so that we could track patterns over time. </p>
<h2>What we found</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=702&fit=crop&dpr=1 600w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=702&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=702&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=883&fit=crop&dpr=1 754w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=883&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=883&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This x-ray shows a complex finger joint injury from a player who came to the emergency department after playing Aussie Rules.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our study used diagnostic codes and billing records at one Victorian public health network. Over a year, we identified and tracked 692 people with a sport and exercise-related admission to the emergency department following a hand or wrist injury.</p>
<p>People playing amateur Aussie Rules were the largest group (20.2%) followed by cyclists (15.9%). </p>
<p>The most common injuries were finger dislocations, with or without fractures, to the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/proximal-interphalangeal-joint">proximal interphalangeal joint</a> (the middle joint on the x-ray shown) of the little and ring fingers. Next came <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928373/">metacarpal fractures</a> (in the bone below the knuckles).</p>
<p>The total cost of all sport and exercise-related injuries during the year for the health network was A$790,325, with Aussie Rules accounting for close to <a href="https://bridges.monash.edu/articles/Individual_community_and_societal_burden_following_acute_hand_and_wrist_injury/11635335">A$167,000</a> alone.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/get-a-grip-the-twist-in-the-wrist-that-can-ruin-tennis-careers-90318">Get a grip: the twist in the wrist that can ruin tennis careers</a>
</strong>
</em>
</p>
<hr>
<p>As Australia’s national injury database does not capture specific hand and wrist injury data, we cannot compare injury patterns from sports and exercise across states and territories.</p>
<p>But if our study was repeated in New South Wales, for example, where other football codes are more popular, we’d expect to see a different injury profile.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rugby-world-cup-injuries-thats-gotta-hurt-3101">Rugby World Cup injuries: That's gotta hurt</a>
</strong>
</em>
</p>
<hr>
<h2>Could we prevent or better manage these injuries?</h2>
<p>Nevertheless, our finding that Aussie Rules accounts for one in five sport and exercise-related hand and wrist injuries highlights the need for further action.</p>
<p>Preventing these injuries would be challenging for a number of reasons. These include the fast pace of the game, the number of players on the pitch, and the unpredictable bounces that come with using an oval shaped ball. </p>
<p>Yet several strategies might help reduce the frequency and impact of these injuries, as well as their health-care costs.</p>
<p>These include training players from junior grassroots level the <a href="https://doi.org/10.1097/JSM.0b013e31829aa3e8">correct way to tackle, handball and mark</a>. </p>
<p>For example, when tackling, players need to avoid catching their fingers in another player’s clothing as it could lead to dislocation; players can avoid handballing with the thumb in the palm; and they can hold their fingers to the sky and their body behind their hands when <a href="https://www.youtube.com/watch?v=I9Rk7r0V_HI">marking</a> where possible.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/I9Rk7r0V_HI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How to mark in Aussie Rules.</span></figcaption>
</figure>
<p>Clubs could ensure ground conditions are safe, for instance by providing padding on goal posts and avoiding playing on hard, concrete cricket pitches.</p>
<p>And, on the ground, we could ensure there are enough club trainers or health professionals experienced in diagnosing and managing these types of hand injuries. This would reduce the risk of misdiagnosis and exposure to further injury. </p>
<p>Both of us have treated injuries made worse by a well-meaning trainer who has, for example, treated a fracture as a dislocation, leading to further displacement of the bone fragments.</p><img src="https://counter.theconversation.com/content/131386/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Running, jumping, tackling, not to mention handling the ball, means Aussie Rules players risk injuries to their hands and wrists serious enough to send them to the emergency department.Luke Robinson, Lecturer, Department of Occupational Therapy, Monash UniversityLisa O'Brien, Associate Professor, Occupational Therapy, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1242762019-12-31T13:27:23Z2019-12-31T13:27:23ZHow to avoid the dentist this holiday (and what to do if you need one in an emergency)<figure><img src="https://images.theconversation.com/files/306219/original/file-20191210-95153-19ejhvb.jpg?ixlib=rb-1.1.0&rect=2%2C2%2C995%2C610&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No-one wants to spoil their holiday with a trip to the dentist.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-trunks-toothache-beach-1410768896?src=fc4a2e52-d367-4f6f-9102-053ab85afb6c-1-13&studio=1">from www.shutterstock.com</a></span></figcaption></figure><p>Hooray it’s the holidays! Time to organise the pet sitter, mail and dentist. Wait, what? It might be worth squeezing a trip to the dentist before you go.</p>
<p>One in 12 <a href="https://www.ncbi.nlm.nih.gov/pubmed/11570540">travel insurance</a> claims are for dental emergencies. And of those emergencies, three out of four treatments could be prevented by making a timely dentist visit. </p>
<p>Here’s how to avoid an emergency dentist visit while on holiday. But life happens, and there are ways to help yourself if you get into trouble. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/prepare-for-a-healthy-holiday-with-this-a-to-e-guide-69552">Prepare for a healthy holiday with this A-to-E guide</a>
</strong>
</em>
</p>
<hr>
<h2>Book that check-up before check-in</h2>
<p>The <a href="https://www.ada.org.au/Dental-Professionals/Policies/National-Oral-Health/2-2-7-Emergency-Overseas-Dental-Treatment/ADAPolicies_2-2-7_EmergencyOverseasDentalTreatment.aspx">Australian Dental Association</a> recommends a check-up at least three months before you travel. If it’s too late for this break, you might want to add a dental visit to your “must do” list before your next trip.</p>
<p>At best, an early check-up will include only a scale and clean. However, if you need major work, such as dental implants and wisdom teeth removed, you will have ample time to complete treatment before you go away. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-often-should-i-get-my-teeth-cleaned-121310">How often should I get my teeth cleaned?</a>
</strong>
</em>
</p>
<hr>
<p>If you have dentures, allow enough time with a dentist or dental prosthetist to organise spare plate(s) in case you lose or break your regular ones while you’re away.</p>
<h2>Avoid surgery just before flying</h2>
<p>A planned dental visit before flying can help avoid complications, particularly related to surgical procedures, such as <a href="https://www.healthdirect.gov.au/surgery/removing-wisdom-teeth">removing your wisdom teeth</a>.</p>
<p>It’s generally wise to have your wisdom teeth removed well ahead of travel as you might need a hospital stay. It can also take at least two days for the extraction site to heal well enough to fly. That’s because the dry air and pressure can disturb the blood clot that forms where you’ve had your teeth removed. </p>
<p>Molar teeth (including some wisdom teeth) removed from your top jaw can cause other complications when you fly. If you fly too soon after surgery, changes in air pressure could lead to <a href="http://diposit.ub.edu/dspace/handle/2445/117330">complications related to your sinuses</a> that could see you dribbling your food and drink out of your nose. Not only is this annoying and embarrassing, it can be quite painful. You may also need further surgery to fix this. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306221/original/file-20191210-95130-b5lvt2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It can take at least two days after having your wisdom teeth removed for you to be well enough to fly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-backpacker-woman-toothache-on-isolated-1378816430">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>People can also experience toothache when flying, or even diving. That’s because of a condition called <a href="https://www.sciencedirect.com/science/article/pii/S1079210409009159">barodontalgia</a> that’s triggered by changes in air pressure, such as when a plane takes off or lands. Often, this pain is a symptom of a loose or leaking filling, a deep cavity close to the nerve inside the tooth, recent dental treatment or sinusitis. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-wisdom-teeth-and-should-i-get-mine-out-100019">Explainer: what are wisdom teeth and should I get mine out?</a>
</strong>
</em>
</p>
<hr>
<h2>If going overseas, have your travel insurance in order</h2>
<p>If you’re going overseas, before leaving the country, <a href="https://www.moneysmart.gov.au/insurance/travel-insurance">make sure</a>:</p>
<ul>
<li><p>you have finished any outstanding dental work, as some travel insurers don’t cover pre-existing conditions</p></li>
<li><p>your travel insurance covers emergency dental care </p></li>
<li><p>you keep your travel insurer’s contact numbers handy (local and international numbers)</p></li>
<li><p>you nominate a friend or family member to contact your insurer on your behalf (just in case you are unable to do so yourself).</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/going-travelling-dont-forget-insurance-and-to-read-the-fine-print-107961">Going travelling? Don't forget insurance (and to read the fine print)</a>
</strong>
</em>
</p>
<hr>
<h2>Other tips to avoid an emergency dental visit</h2>
<p>Here are some practical tips to avoid harming your teeth, braces and crowns over summer:</p>
<ul>
<li><p>use scissors, not your teeth, to open packaging</p></li>
<li><p>avoid chewing very hard foods such as ice, popcorn kernels, pork crackling, and crunchy candies. This is particularly important if you have braces, or large fillings or crowns as they can easily come unstuck or fracture </p></li>
<li><p>if you play contact sport, protect your teeth by wearing a custom fitted mouth guard.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306744/original/file-20191213-85367-rogaii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Watch how you chew your pork crackling over the holidays if you want to avoid the dentist.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/b0xman/5446437974/in/photolist-9ihqg1-8Zfu4a-e1qquH-bry8JT-66L5HV-8L6Q85-6GDdA-8L3Lat-8L3Lz8-athJYW-8L3Lpz-8L3LgP-8L3LEK-53MqYu-an6nFY-2tmm1t-7vWmwa-6jcFKt-7Up8qd-3beGNZ-SYAnyw-2tqHc1-8mG7g4-7KmBSi-zHJrfW-6hZcxW-2e4NCVj-9PRY6z-Tn5VUK-NpZST-BtSnLo-NpZSH-NaUWve-NpZSz-ssBVfe-8ADkcE-iosrfz-7aNUy8-oiJFRj-E7BAA-6Hfuix-6gnV59-7aSJNu-5o3GKC-7aSJFw-9S5E1T-6HjwyC-6Hfura-7aNUXK-byYJu7">James Box/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>I’m in pain. What do I do?</h2>
<p>Here’s <a href="https://www.qld.gov.au/health/services/oral-eye-ear/emergency-dental">what you can do</a> until you get to a dentist, if you:</p>
<ul>
<li><p><strong>have toothache</strong> — if you have spontaneous, radiating pain or a constant dull ache and/or pain and swelling, over-the-counter pain medication may help. But try to find a dentist as soon as reasonably possible</p></li>
<li><p><strong>chip or break a tooth or filling</strong> — avoid running your tongue over the site and try to get to a dentist as soon as possible</p></li>
<li><p><strong><a href="https://www.iadt-dentaltrauma.org/for-patients.html">knock out an adult (not baby) tooth</a></strong> — hold the tooth by the crown (not the root) and rinse with milk if it is dirty, then try to place the tooth back in the socket. If this is not possible, store the tooth in milk or inside your cheek and find a dentist as soon as possible</p></li>
<li><p><strong>have a dislodged crown/cap</strong> — store the crown in a container; a dentist may be able to glue it back on. </p></li>
<li><p><strong><a href="https://www.aaoinfo.org/system/files/media/documents/OrthoEmergency-FLYER-lgl-17-hl.pdf">have problems with your braces</a></strong> — shift loose wire that sticks out to make it more comfortable, then see an orthodontist or dentist as soon as possible</p></li>
<li><p><strong><a href="https://www.bmj.com/bmj/section-pdf/893386?path=/bmj/350/8001/Clinical_Review.full.pdf">get an abscess</a></strong> — seek immediate dental care, and if this not possible, find a doctor or seek emergency hospital care. An abscess can become life-threatening very quickly </p></li>
<li><p><strong>suffer trauma to your gums, mouth or face</strong> — apply firm pressure to the bleeding site with a clean bandage and seek dental or medical care</p></li>
<li><p><strong>crack or break your denture</strong> — never try to glue the broken pieces back together, but store the lose parts in a container and seek help from a dental prosthetist or dentist as soon as possible. </p></li>
</ul>
<h2>I’m away from home. How do I find a dentist?</h2>
<p>If you are holidaying in Australia, but away from home, ask a local person to recommend a dentist, or if that’s not possible, search online.</p>
<p>Then call. Although most dental practices close over the public holidays, they usually leave a message with contact numbers in case of an after-hours emergency. </p>
<p>If you need after-hours care, be prepared to pay a call-out fee of A$100-500. Often, the call-out fee is used to separate the real emergencies from those that can wait another day before the practice opens. If no help is at hand, the hospital emergency department may be able to help. </p>
<h2>I’m overseas. How can I get help?</h2>
<p>If you have a dental emergency while <a href="https://www.ada.org.au/Dental-Professionals/Policies/National-Oral-Health/2-2-7-Emergency-Overseas-Dental-Treatment/ADAPolicies_2-2-7_EmergencyOverseasDentalTreatment.aspx">overseas</a>:</p>
<ul>
<li><p>contact your travel insurer to understand what documentation is required to make a claim</p></li>
<li><p>contact the Australian embassy, high commission or consulate to help you navigate the health system in the country you’re visiting</p></li>
<li><p>if there is no Australian service, the Canadian embassy, high commission or consulate will help you find a dentist.</p></li>
</ul>
<h2>Don’t forget</h2>
<p>After emergency treatment, ask for a copy of your treatment notes, images and x-rays to be sent to your regular dentist. This is particularly important if you need follow-up care when you return home. </p>
<p>And in the unlikely event you’ll need some emergency dental work, don’t forget to enjoy the rest of your break. Happy holidays!</p><img src="https://counter.theconversation.com/content/124276/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon has received funding from Colgate for her research. She is a member of the Australian Dental Association as well as the International Association for Dental Research. She is a Fellow of the Royal Australasian College of Dental Surgeons.</span></em></p>Here’s how to avoid a trip to the emergency dentist this holiday.Arosha Weerakoon, Lecturer, General Dentist & PhD Candidate, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1275162019-11-22T02:17:37Z2019-11-22T02:17:37ZHow to manage your essential medicines in a bushfire or other emergency<figure><img src="https://images.theconversation.com/files/303054/original/file-20191121-112975-14msbiq.jpg?ixlib=rb-1.1.0&rect=2%2C4%2C994%2C652&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In an emergency, like a bushfire, making sure you have enough of your regular medication can mean the difference between life and death. But there are many ways to prepare.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/australian-bushfires-2018-nsw-1314222035?src=e0689ffc-a914-4f72-9942-0725c91c91c9-1-4&studio=1">from www.shutterstock.com</a></span></figcaption></figure><p>Some people find managing their medication difficult at the best of times. But in an emergency, like a bushfire or cyclone, this can be harder still. </p>
<p>As catastrophic bushfires burn across Australia, here’s what to think about as part of your emergency planning to make sure you have access to the medicines you need.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-you-can-do-about-the-health-impact-of-bushfire-smoke-19333">What you can do about the health impact of bushfire smoke</a>
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<p>As part of your emergency plan, list your medications and where you keep them, along with contact details for your doctor and pharmacist and any other relevant emergency services. </p>
<p>If you have advanced warning of emergency conditions, check both your supply of tablets and any prescriptions you may need. Your prescription label will tell you how many repeats you have left. Try and keep at least one week’s medication on hand.</p>
<h2>I need to evacuate. Now what?</h2>
<p>If you need to evacuate, know how best to store and transport your medication. Most medications for conditions such as blood pressure or cholesterol need to be stored below 25-30°C. These medications will be OK if temperatures are higher than this for short periods of time, while you transport them.</p>
<p>Medicines sensitive to temperature will need to be stored or transported with cold packs in an insulated container of some sort, such as an esky. Putting them in a ziplock bag will help protect them from moisture.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
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<p>Insulin is one common medication you need to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-and-insulin">store cold</a>. Your current insulin pen can be stored at room temperature. But store unused pens with a cold pack in an esky until you find refrigeration.</p>
<p>This also applies to <a href="https://www.nps.org.au/medicine-finder/eutroxsig-tablets">thyroxine</a> tablets. Fourteen days supply (usually one strip of tablets) is OK if stored at room temperature. But keep the rest with a cold pack. If you don’t think it will be possible to keep the rest below 25°C for a long time, also keep these with the cold pack.</p>
<p>Many antibiotic syrups, such as <a href="https://www.healthdirect.gov.au/cephalexin">cefalexin</a>, also need to be kept cold. But check the dispensing label or speak to your pharmacist if you are not sure.</p>
<h2>What if I run out of medicine?</h2>
<p>If you are caught without essential medication, doctors and pharmacists can help in a number of ways.</p>
<p>This is easier if you have a regular GP and pharmacist who will both have a complete record of your medication. Your pharmacist can call your GP and <a href="https://www.legislation.nsw.gov.au/#/view/regulation/2008/392/part3/div4/subDiv2/sec44">obtain verbal approval</a> to supply your medication. Your GP will then need to fax or email the prescription to your pharmacist as soon as possible and mail the original script within seven days.</p>
<p>Pharmacists can also dispense emergency supplies of cholesterol medicines and oral contraceptives, so long as you already take them. Under so-called <a href="https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/pbs-pharmacists/initiatives/continued-dispensing">continued dispensing arrangements</a>, pharmacists can dispense a single pack of these medicines once every 12 months.</p>
<p>If you cannot get in touch with your GP, in an emergency, most states allow a pharmacist to dispense a <a href="https://www.legislation.nsw.gov.au/#/view/regulation/2008/392/part3/div4/subDiv2/sec45">three-day supply</a> of your medication. But this is only if the pharmacist has enough information to make that judgement.</p>
<p>Some medicines, such as strong pain medications and sleeping tablets, are not covered by these provisions.</p>
<h2>Medicines for people with lung conditions, like asthma</h2>
<p>People with existing lung conditions (such as asthma, chronic obstructive pulmonary disease or bronchitis), older people, young children and pregnant women are most likely to be vulnerable to the effect of <a href="https://www.nationalasthma.org.au/news/2019/record-pollen-fires-wind-and-storms-a-dangerous-mix-for-asthma">bushfire smoke</a>. They can also have symptoms long after a bushfire if fine particulate matter is still in the air.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-poor-air-quality-from-bushfire-smoke-affect-our-health-126835">How does poor air quality from bushfire smoke affect our health?</a>
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<p>If you have a respiratory condition, follow the <a href="https://www.nationalasthma.org.au/living-with-asthma/asthma-action-plans">action plan</a> you will have already discussed with your doctor, which outlines what to do in an emergency. </p>
<p>This plan includes instructions on what you should do if your asthma gets worse, such as taking extra doses or additional medication. It also tells you when you should contact your doctor or go to the emergency department.</p>
<p>If you have a respiratory condition, such as asthma, and live in a bush fire prone zone, this action plan needs to be part of your fire safety survival plan.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thunderstorm-asthma-whos-at-risk-and-how-to-manage-it-86397">Thunderstorm asthma: who's at risk and how to manage it</a>
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<p>You also need to make sure you have enough <a href="https://www.nationalasthma.org.au/understanding-asthma/treatment-and-medicines">preventer and reliever medications</a>, for asthma for example, to hand just in case there is an emergency.</p>
<p>If you don’t have an action plan, taking four separate puffs of your reliever medication may relieve acute symptoms. This applies for adults and children.</p>
<h2>In a nutshell</h2>
<p>Being prepared for an emergency, like a bushfire, goes a long way to keeping you and your family safe. That applies to thinking about your supply of medicines well in advance, if possible. </p>
<p>But if conditions change rapidly and you need to evacuate, an esky containing medicines for a few days, and contact numbers for your GP and pharmacist, could save your life.</p><img src="https://counter.theconversation.com/content/127516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Bartlett is a member of the Australian College of Pharmacy</span></em></p><p class="fine-print"><em><span>Bandana Saini receives funds from the NHMRC, Australian Department of Health (via Community Pharmacy Agreements) and Asthma Australia.</span></em></p>During bushfire season, managing medication as well as respiratory conditions should be part of any emergency plan.Andrew Bartlett, Associate Lecturer Pharmacy Practice, University of SydneyBandana Saini, Associate Professor, Pharmacy Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1119392019-02-15T16:53:31Z2019-02-15T16:53:31ZCan Congress or the courts reverse Trump’s national emergency?<figure><img src="https://images.theconversation.com/files/259326/original/file-20190215-56226-g8jlun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Trump declared a national emergency in order to build a wall.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/APTOPIX-Trump-Border-Security/270e0b6237304fc3808018e5c62ebbf3/1/0">AP Photo/ Evan Vucci</a></span></figcaption></figure><p>Sixteen states <a href="https://www.nytimes.com/2019/02/18/us/politics/national-emergency-lawsuits-trump.html">are challenging</a> President Donald Trump’s <a href="https://www.cnbc.com/2019/02/15/trump-national-emergency-declaration-border-wall-spending-bill.html">national emergency declaration</a> in court.</p>
<p>The lawsuit was filed by California’s Attorney General, Xavier Bacerra. The states argue that Trump’s attempt to use billions of dollars to pay for the construction of a wall along the U.S.-Mexico border is unconstitutional.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1096439568063184896"}"></div></p>
<p>Democratic Speaker of the House Nancy Pelosi <a href="https://thehill.com/homenews/house/430098-pelosi-warns-gop-next-president-could-declare-national-emergency-on-guns">warned Trump</a> against declaring a national emergency, saying that it set a precedent for future Democratic presidents to use that power. A number of liberal organizations are also planning to file challenges in court on the grounds that Trump’s move is an abuse of power.</p>
<p>What is Congress’s role in this situation? </p>
<p>As I explain in my book “<a href="https://uwpress.wisc.edu/books/5067.htm">Emergency Presidential Power</a>,” presidents generally claim emergency power two ways: through inherent or implied authority under the U.S. Constitution or under statutory authority granted by Congress.</p>
<p>Relying on the Constitution as a basis for emergency power is controversial, and less likely to stand up to meaningful congressional or judicial review. The U.S. Constitution says nothing specific about presidential emergency power: Presidents can only claim such authority is implied or inherent.</p>
<p>The emergency powers the Constitution does describe are actually assigned to Congress. Congress has delegated some emergency powers to the president through statutes, including the National Emergencies Act. But Congress retains the power to reject a president’s declaration of a national emergency. </p>
<p>Now the question is: Will Congress use the power available to it, or will it play the role of passive spectator?</p>
<h2>Gaining congressional approval</h2>
<p>Since presidents lack any specific constitutional emergency power, they often find it necessary to gain congressional authorization. For instance, at the start of the Civil War, with Congress out of session, President Abraham Lincoln suspended habeas corpus and took other unilateral actions. He later sought and gained retroactive <a href="https://newrepublic.com/article/62296/lincoln-v-lincoln">approval from Congress</a> for these actions.</p>
<p>This precedent of gaining congressional approval was put to the test nearly 100 years later. In 1952, <a href="https://www.american.edu/spa/news/presidential-power-since-sept11-09082016.cfm">President Harry Truman</a> claimed emergency power to take control of steel factories during the Korean War in response to a labor strike. <a href="https://muse.jhu.edu/book/27307">He invoked</a> a “very great inherent power to meet great national emergencies.” Congress took no specific action to approve or disapprove, though a preexisting statute on the books weighed against Truman.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/253467/original/file-20190111-43538-rg7ykn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/253467/original/file-20190111-43538-rg7ykn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/253467/original/file-20190111-43538-rg7ykn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=782&fit=crop&dpr=1 600w, https://images.theconversation.com/files/253467/original/file-20190111-43538-rg7ykn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=782&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/253467/original/file-20190111-43538-rg7ykn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=782&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/253467/original/file-20190111-43538-rg7ykn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=983&fit=crop&dpr=1 754w, https://images.theconversation.com/files/253467/original/file-20190111-43538-rg7ykn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=983&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/253467/original/file-20190111-43538-rg7ykn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=983&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">President Harry Truman in his White House office in Washington on Dec. 16, 1950 signs a proclamation of a state of national emergency, summoning the nation to marshal its strength against the threat of ‘Communist world conquest.’</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Watchf-AP-A-DC-USA-APHS330770-President-Harry-T-/bdfcfacf891b402893865860a090f4a4/3/0">AP Photo/William J. Smith</a></span>
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</figure>
<p>When factory owners <a href="https://www.washingtonpost.com/history/2019/01/08/truman-declared-an-emergency-when-he-felt-thwarted-trump-should-know-it-didnt-end-well/?utm_term=.8a977e780d83">sued the administration</a>, the Supreme Court, by a 6-3 vote, ruled against Truman in the famous <a href="https://muse.jhu.edu/book/27307">Youngstown Sheet decision</a>. Justice Robert H. Jackson’s concurring opinion in that case has been <a href="https://www.roberthjackson.org/opinion/concurring-opinion-youngstown-v-sawyer-343-u-s-579-june-2-1952/">especially influential</a> and is often cited by legal scholars and judges. He outlined a three-part test to be used as a starting point in determining when presidential action is constitutionally permissible.</p>
<p>Under Jackson’s test, presidents are on the strongest possible footing when acting with congressional approval. In this case, Jackson said, Truman’s position was weak since he was taking action that did not comply with the relevant legislative framework. In Jackson’s view, Truman’s reliance on inherent emergency power under the Constitution would dangerously concentrate power in the president’s hands, something the framers would not have wanted.</p>
<h2>Congress’s role</h2>
<p>Jackson’s opinion in Youngstown suggested that emergency power could be defined by Congress in statutes. </p>
<p>Congress took up that suggestion with the <a href="https://www.theatlantic.com/magazine/archive/2019/01/presidential-emergency-powers/576418/">National Emergencies Act of 1976</a>. Though the act was designed to set limits on presidential power to declare national emergencies of indefinite length, it has ended up providing a largely unregulated way for presidents to take unilateral action. Congress has failed to fulfill its responsibilities under the law.</p>
<p>The National Emergencies Act permits the president to declare a national emergency without congressional approval, triggering specific statutory powers that the president can use. For instance, presidents have used this law to <a href="https://www.lawfareblog.com/emergencies-without-end-primer-federal-states-emergency">impose economic sanctions</a> against terrorists after 9/11 or regulate foreign ships in U.S. waters. Thirty-one <a href="https://www.brennancenter.org/sites/default/files/analysis/NEA%20Declarations.pdf">emergency declarations</a> are currently in effect under the statute.</p>
<p>Congress can vote at any time to terminate a state of emergency and is required by the statute to meet every six months while an emergency is in effect to consider whether it should continue. However, it has never voted on an emergency declared by a president or held meetings as required by the statute. </p>
<p>Perhaps most importantly for Trump, the National Emergencies Act provides no criteria for deciding whether a national emergency exists. We know from history that presidents can contrive emergencies as a pretext for action. </p>
<p>For example, in 1846 President James Polk <a href="https://books.google.com/books?id=4vPPAQAAQBAJ&pg=PR11&lpg=PR11&dq=james+polk+mexico+chris+edelson&source=bl&ots=Y6ZMQxgeXn&sig=BJ4G6XmRoIhg2usQeBnXJM7osRo&hl=en&sa=X&ved=2ahUKEwjX1JrZsebfAhUQjlkKHVosCCYQ6AEwAnoECAAQAQ#v=onepage&q=james%20polk%20mexico%20chris%20edelson&f=false">falsely claimed that Mexico</a> had spilled American blood on U.S. soil as a pretext for gaining a declaration of war from Congress. </p>
<p>In 1942, President Franklin D. Roosevelt justified the decision to intern 110,000 Japanese-Americans without trial <a href="https://www.smithsonianmag.com/history/injustice-japanese-americans-internment-camps-resonates-strongly-180961422/">based on false claims</a> that time was of the essence, and at least some Japanese-Americans were known to be disloyal.</p>
<p>Although both of these examples predate the 1976 Act, they serve as cautionary tales about the wisdom of accepting at face value a president’s claim that an emergency exists. However, because the law now in effect provides no specific standards to define the existence of an emergency, courts might be inclined to defer to presidential discretion. It is <a href="https://www.washingtonpost.com/opinions/2019/01/08/how-supreme-court-might-rule-if-trump-declares-an-emergency-his-wall/?utm_term=.ed598aa772fe">far from clear that courts will strike down</a> Trump’s national emergency. </p>
<p>By contrast, it would be straightforward for Congress to reverse a declaration of national emergency. The National Emergencies Act gives legislators authority to reject a presidential declaration of national emergency through <a href="https://www.vox.com/policy-and-politics/2019/1/11/18178438/national-emergency-marco-rubio-precedent-democrats-climate">simple legislation</a> that would require majorities in the House and Senate. President Trump would presumably veto such action. Legislators would have the opportunity to override a presidential veto with a two-thirds majority vote. That of course would be no easy task in the current Congress.</p>
<p>Because of the way the National Emergencies Act was drafted, Congress is better positioned to take action than the courts – assuming enough members are moved to act. If Congress does nothing, then the law could become a vehicle for presidential abuse, especially because the act’s language seems to grant the president broad discretion that could insulate an emergency declaration from legal challenge. </p>
<p>All eyes should be on Congress.</p>
<p><em>Editor’s note: This is an updated version of a story originally published <a href="https://theconversation.com/if-trump-declares-a-national-emergency-could-congress-or-the-courts-reverse-it-109752">Jan. 12, 2019</a>.</em></p><img src="https://counter.theconversation.com/content/111939/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Edelson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>History shows that Congress can play an important role in checking a president’s power.Chris Edelson, Assistant Professor of Government, American University School of Public AffairsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/936472018-03-22T00:31:14Z2018-03-22T00:31:14ZAfter the firestorm: the health implications of returning to a bushfire zone<p>Australia has a long history of bushfire disasters. The loss of almost 70 homes in <a href="http://www.afr.com/news/tathra-fire-70-homes-lost-in-nsw-coastal-town-bushfire-20180319-h0xo0u">Tathra, New South Wales</a>, and 18 homes in <a href="http://www.abc.net.au/news/2018-03-20/vic-bushfire-on-the-fireground-in-south-western-victoria/9564762">southwest Victoria</a> this week has again reminded us of the risks and huge personal costs of living in a fire-prone country. The risk is increasing as fires the world over are <a href="https://www.nature.com/articles/s41559-016-0058">expanding in every dimension</a> – in their timing, with extended seasons of favourable fire weather, frequency and severity. </p>
<p>Emergency services, communications and community support during fire disasters have become increasingly sophisticated to meet these growing challenges. An often overlooked aspect of bushfire management is post-fire risk. Many people will be returning to uncertainty. They will need to evaluate the immediate impacts on their homes and property, and the implications for their future. </p>
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Read more:
<a href="https://theconversation.com/smoke-from-bushfires-poses-a-health-hazard-for-all-of-us-11493">Smoke from bushfires poses a health hazard for all of us</a>
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<p>After the firestorm has passed, the <a href="http://www.dhhs.tas.gov.au/publichealth/alerts/standing_health_alerts/returning_home_after_a_bushfire">risks to health</a> remain. These include physical and chemical hazards associated with damaged structures, contaminated air, food and water, and the well-documented <a href="https://beyondbushfires.org.au/">risks to mental health</a> and well-being.</p>
<h2>Preparing to return</h2>
<p>There are many potential hazards in burnt properties. Returning requires caution and preparation. </p>
<p>It is important to check if the relevant emergency services have declared an area safe enough to allow residents to return and to seek guidance. Most jurisdictions provide resources relevant to their area. The Western Australian Department of Fires and Emergency Services provides particularly <a href="https://www.dfes.wa.gov.au/safetyinformation/fire/bushfire/pages/afterabushfire.aspx">comprehensive information</a>. </p>
<p>When entering a fire-affected property for the first time, use a face mask and wear protective clothing, including sturdy footwear, heavy-duty gloves, overalls with long sleeves and trousers – preferably disposable. The best face masks to use are “P2” masks, available from hardware stores. Ordinary paper dust masks, handkerchiefs or bandanas do not filter out the very fine ash and dust particles or hazards such as asbestos fibres. Bring plastic bags big enough to contain dirty clothing, which should be removed before entering a vehicle.</p>
<h2>Checking for hazards</h2>
<p>The list of potential hazards includes falling trees, branches and live power lines. Leaking gas may produce an odour or a hissing noise. Septic tanks can be damaged, leak sewage or collapse. The tank covers are at ground level and might not be visible. </p>
<p>Hot embers and smouldering vegetation can be present and ignite further fires. If there is a risk of major structural damage to buildings, a building inspector should check these before entry. </p>
<p>Fires can release potential toxins from some building materials. For example, ash from CCA-treated wood, commonly used in decking, fencing and landscaping, is harmful and skin contact and inhalation should be avoided. It is recognisable as green-coloured ash. </p>
<p>Houses built before 1990 might have asbestos cement sheeting and exposure to asbestos fibres can occur if people actively disturb ashes. If asbestos is likely to be present, a licensed asbestos removalist must do the clean-up work.</p>
<p>Other hazards can come from gas cylinders, garden chemicals, cleaning products and other burnt residues.</p>
<h2>Air quality</h2>
<p>Smoke might be present in the area from the recent fires or local smouldering debris. Smoke is toxic and can <a href="https://www.mja.com.au/journal/2017/207/6/understanding-and-managing-health-impacts-poor-air-quality-landscape-fires">worsen heart and lung problems</a> for some people. Those most at risk are children including unborn babies, the elderly, smokers and people with heart and lung diseases, including asthma. </p>
<p>Portable generators are another source of air pollution. These should always be used in well-ventilated areas to avoid the risk of carbon monoxide poisoning.</p>
<h2>Food and water safety</h2>
<p>Houses, regardless of whether they were damaged by fire, are likely to have had a period without power. Once cold or frozen food has warmed or thawed, it should be thrown out. Food, drinks or medicines that have been exposed to heat, smoke and water damage are also no longer safe for consumption. </p>
<p>If rainwater tanks are intact and the water has no abnormal look, smells or taste, the water should be safe to use, although it’s wise to boil untreated water. However, if firefighting foams or animal carcasses have contaminated water in a tank it should be drained and refilled with clean water. It’s also important to clear the house roof of carcasses or other contaminants that could end up in rainwater tanks.</p>
<h2>Personal impacts</h2>
<p>The psychological trauma of experiencing a fire can be overwhelming for adults and children alike. It is possible they are grieving for a spectrum of losses, including friends and neighbours, pets and livestock that have been killed or injured in the fire, loss of treasured personal effects and even the
wider sense of loss of place that has been called <a href="https://theconversation.com/the-age-%20of-%20solastalgia-8337">solastalgia</a>. </p>
<p>While most people do recover from the traumatic experience, the emotional toll can be serious and long lasting for some, with symptoms such as depression, anxiety, anger, fatigue, nightmares and difficulty concentrating. It is possible that people are no longer able to live in surrounds they once cherished and must move away. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-age-of-solastalgia-8337">The age of solastalgia</a>
</strong>
</em>
</p>
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<p>The onset of mental health issues can sometimes be <a href="http://journals.sagepub.com/doi/pdf/10.1177/0004867414534476">delayed</a> months and even years after the event. <a href="https://beyondbushfires.org.au/resources/help">Help</a> from a counsellor or family doctor can manage and reduce these impacts. Involvement in community activities and social connections can help promote
resilience and be protective. </p>
<p>It is important to note that post-traumatic stress has a more positive counterpart, post-traumatic growth, and it is possible that individuals and communities can become stronger and more resilient as a consequence of rebuilding and recovery following a bushfire. </p>
<p>Prompt rebuilding of community centres and restoration of community services and activities are keys to helping individuals and communities recover. For this reason firefighters will prioritise protection of community assets.</p>
<h2>Community support vital</h2>
<p>Returning to fire-affected areas can be hazardous and traumatic. Residents should be prepared and equipped for protection from potential hazards, and seek advice from appropriate authorities such as emergency services, local councils and public health agencies. </p>
<p>Ongoing social connections and community support are essential for reducing the personal and psychological impacts. This support needs to continue long after the disaster has been forgotten by the news media. </p>
<p>In the affected communities in NSW and Victoria, this work has already begun. Community meetings are taking place to start the process of support that will be crucial in the long journey of rebuilding lives and communities. </p>
<img src="https://counter.theconversation.com/content/93647/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fay Johnston does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In NSW and Victoria this week, communities were hit by bushfires. Long after such devastating fires pass, the risks to physical and mental health remain.Fay Johnston, Associate Professor, Environmental Epidemiology, Menzies Institute for Medical Research, University of Tasmania., University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/922642018-03-19T00:32:51Z2018-03-19T00:32:51ZBeyond Triple Zero: towards a digital, proactive emergency response<p>Imagine you’re camping in the Australian outback. Your friend falls and breaks a leg, and you call Triple Zero (000) – but you’re panicking, and can’t remember which roads you took to the rocky outcrop where the accident took place. </p>
<p>Getting help in this sort of situation may soon be simpler, with Apple <a href="https://www.apple.com/uk/newsroom/2018/01/apple-previews-ios-11-3/">recently announcing</a> that the iOS 11.3 update (available in coming months) will support Advanced Mobile Location technology (AML). With AML, when an emergency call is made from a mobile phone, the location of the caller is automatically sent to the emergency communication operator. </p>
<p>But one vital step is missing for this to work in Australia. AML also has to be supported by the operator that manages the emergency communication service in that country. At the moment, this happens only in <a href="http://eena.org/download.asp?item_id=209">United Kingdom, Estonia, Lithuania, Austria, Iceland, Belgium, Ireland, Finland and New Zealand</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/snakebites-are-rarer-than-you-think-but-if-you-collapse-cpr-can-save-your-life-81614">Snakebites are rarer than you think, but if you collapse, CPR can save your life</a>
</strong>
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</p>
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<p>In June 2017, the <a href="http://www.minister.communications.gov.au/mitch_fifield/news/tenders_to_be_sought_for_next-generation_triple_zero_emergency_call_service#.WpYP76jFLD5">Australian government announced</a> that a request for tender will be issued to deliver a new Triple Zero (000) service (Telstra has been the service provider since 1961).</p>
<p>This new service will need to support location-based data, with AML indicated as the preferred solution. Further, the government indicated that the new service will need to be flexible enough to support alternative technologies in the future. </p>
<p>The timing of the tender process is currently not clear. Still, Apple’s announcement means that the majority of mobile phones around the world will have AML by default – news <a href="http://www.eena.org/news/apple-anounces-aml#.WpXjH6jFLD6">welcomed with enthusiasm</a> by emergency communication professionals.</p>
<p>Close to 100% of Android phone users already have a similar setup, with AML capability automatically incorporated from July 2016 (from their <a href="https://blog.google/topics/google-europe/helping-emergency-services-find-you/">Gingerbread version</a> onwards). Android’s AML is called <a href="https://crisisresponse.google/emergencylocationservice/how-it-works/">Emergency Location Service</a>, or ELS.</p>
<h2>Emergencies in Australia</h2>
<p>Research by the <a href="https://www.acma.gov.au/theACMA/Library/researchacma/Research-reports/triple-zero-by-the-numbers">Australian Communications and Media Authority</a> shows that in Australia in 2017, around 70% of emergency calls came from mobile phones, with 14% of Australians making at least one call to Triple Zero (000) between January and June 2017.</p>
<p>To dispatch the appropriate emergency services (Police, Fire or Ambulance), the emergency operator has to know the caller’s location with an appropriate level of accuracy. </p>
<p>This can be problematic, especially in a situation of extreme distress, and when the caller is unfamiliar with their surroundings – for example, in a remote area or where a street number is not immediately visible.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/seven-ways-to-protect-your-pets-in-an-emergency-83484">Seven ways to protect your pets in an emergency</a>
</strong>
</em>
</p>
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<p>To tackle this issue, in 2015 the Push Mobile Location Identification (<a href="https://www.itnews.com.au/news/govt-wants-better-location-tracking-for-000-mobile-calls-435176">Push MoLI</a>) was introduced in Australia. This system identifies the caller’s location based on the proximity to telecommunications cellular towers and automatically sends it to the operator.</p>
<p>However, the Push MoLI only provides an area within which the caller is located. The accuracy of location largely depends on the proximity to, and the number of, nearby cell towers. In remote regions, such area can have a radius of <a href="https://www.itnews.com.au/news/why-only-60-percent-of-triple-zero-calls-will-be-tracked-466177">up to 100 kilometres</a>.</p>
<p>To address such issues, in 2014 Australia’s Triple Zero Awareness Group launched <a href="http://emergencyapp.triplezero.gov.au/">Emergency+</a>. Once downloaded, the app uses a mobile phone’s internal GPS to calculate latitude and longitude and show them on the screen. When prompted, the emergency caller can read their coordinates to the operator. Emergency+ has already exceeded 1 million downloads.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"967966416145080320"}"></div></p>
<p>Examples of Emergency+‘s effectiveness are reported in the <a href="https://www.theaustralian.com.au/business/technology/opinion/emergency-app-that-could-save-your-life-one-day/news-story/4203adf4bcddb8d7082bd89d813ae446">media</a>.</p>
<p>Nonetheless, <a href="http://necwg-anz.org/wp-content/uploads/2017/02/NECWG-ANZ-Mobile-Location-in-Emergency-Situations-White-Paper-2017_Final.pdf">some limitations</a> have been highlighted. As of June 2017, <a href="https://www.arnnet.com.au/article/631029/mobile-takes-hold-aussie-internet-explorers/">15.45 million Australian adults</a> owned a smartphone, which indicates that, at best, not more than 6.5% of them have the app. </p>
<p>Also, the process of reading one’s latitude and longitude introduces chances of human error, either by the caller or the operator. Further, some users may be unfamiliar with spelling their coordinates from a mobile app (e.g. the elderly). AML is intended to address these issues. </p>
<h2>The future of emergency communication</h2>
<p>The future of emergency communication is expected to be digital-friendly, flexible and diversified. </p>
<p>We can already see public acknowledgement of the <a href="https://www.dhs.gov/news/2011/05/04/written-statement-craig-fugate-administrator-federal-emergency-management-agency">growing importance of digital technologies</a> for emergency communications. In the UK, the Merseyside Police has recently launched an initiative for citizens to report non-urgent crimes through social media.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"959140552875835392"}"></div></p>
<p>However, it has been <a href="https://theconversation.com/the-role-of-social-media-as-cyclones-batter-australia-37835">pointed out</a> that social media should not be considered a replacement for more traditional (and sometimes reliable) forms of communication. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-role-of-social-media-as-cyclones-batter-australia-37835">The role of social media as cyclones batter Australia</a>
</strong>
</em>
</p>
<hr>
<p>The National Emergency Communication Working Group - Australia and New Zealand (<a href="http://necwg-anz.org/">NECWG-A/NZ</a>) consists of Australia and New Zealand representatives from emergency service organisations, public safety organisations, emergency call persons (the initial triage points for emergency callers, currently Telstra in Australia and Spark in New Zealand) and carrier representatives. </p>
<p>In 2014, NECWG-A/NZ produced the <a href="http://necwg-anz.org/?page_id=88">Next Generation Triple Zero Strategy (NG000)</a>. This document describes a vision for a Next Generation Emergency Call Service enabling:</p>
<blockquote>
<p>(…) any person requiring emergency assistance to use any device anywhere anytime to connect to emergency services. </p>
</blockquote>
<p>The vision consists of a multichannel approach, with inter-operable systems (allowing the different emergency agencies to be connected upon a single request) and that enables digital technologies. </p>
<p>Being proactive rather than reactive is another focus for future Triple Zero (000) and emergency communications. This idea was described in a <a href="http://necwg-anz.org/wp-content/uploads/2017/11/The-Emergency-Communication-Centre-of-the-Future-report-FINAL.pdf">recent report</a> from NECWG-A/NZ working with the <a href="http://www.chairdigitaleconomy.com.au/">Chair in Digital Economy</a> at QUT and Pricewaterhouse Coopers. </p>
<p>The emergency communication centre envisaged in this report uses data coming in from different sources (calls, videos, SMS, social media, sensors, etc.) and converts them into information used to prepare for, and possibly prevent, future emergencies. It has a constant presence of staff members from different emergency service and public safety organisations, with profiles ranging from data analysts to robotics experts and more.</p>
<p>NECWG-A/NZ is currently working on a <a href="http://necwg-anz.org/wp-content/uploads/2017/11/ECCF_Executive-Summary_A3.pdf">roadmap</a> to guide future development across three key aspects of emergency management: response, preparedness, and prevention.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/208235/original/file-20180228-36700-16q1re3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/208235/original/file-20180228-36700-16q1re3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=273&fit=crop&dpr=1 600w, https://images.theconversation.com/files/208235/original/file-20180228-36700-16q1re3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=273&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/208235/original/file-20180228-36700-16q1re3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=273&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/208235/original/file-20180228-36700-16q1re3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=343&fit=crop&dpr=1 754w, https://images.theconversation.com/files/208235/original/file-20180228-36700-16q1re3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=343&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/208235/original/file-20180228-36700-16q1re3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=343&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Building a proactive emergency communication centre.</span>
<span class="attribution"><span class="source">Authors</span></span>
</figcaption>
</figure>
<p>The Triple Zero (000) emergency service has saved the lives of many Australians. With the advent of digital technologies, it is now ready for its “Next Generation”. AML is the next step to accomplish. Beyond, lie numerous possibilities for a proactive emergency communication centre.</p>
<hr>
<p><em>The author would like to recognise a significant contribution to this article from Chris Beatson, Director, PoliceLink Command, NSW Police Force.</em></p><img src="https://counter.theconversation.com/content/92264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research cited in this article was completed during Ivano Bongiovanni's appointment as a Postdoc Researcher with the Chair in Digital Economy, Queensland University of Technology. Ivano Bongiovanni received funding from NECWG-A/NZ, QUT, PwC Australia, Queensland Government, and Brisbane Marketing. </span></em></p>Whether for police, ambulance or fire fighters, the future of emergency communication is expected to be digital-friendly, flexible and diversified.Ivano Bongiovanni, Postdoctoral Research Fellow - Adam Smith Business School, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/835692017-09-10T19:44:08Z2017-09-10T19:44:08ZMore cyclists are ending up in hospital with serious injuries, so we need to act now<figure><img src="https://images.theconversation.com/files/185200/original/file-20170908-9945-14aeavv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Serious injury rates are rising in cyclists, and are associated with significant disability and economic costs. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/573221677?src=ZUl0Yi1m8YYIQIdspWj5Gg-1-0&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Cyclists are suffering more serious injuries in road crashes than ever before, leading to significant disability, our <a href="https://www.mja.com.au/journal/2017/207/6/road-safety-serious-injuries-remain-major-unsolved-problem">new study</a> shows.</p>
<p>But what is less clear is what’s behind these injuries, which are occurring as the number of people who died in road traffic crashes has fallen.</p>
<p>In our study published today in the <a href="https://www.mja.com.au/journal/2017/207/6/road-safety-serious-injuries-remain-major-unsolved-problem">Medical Journal of Australia</a>, we investigated deaths and serious injuries after traffic crashes in Victoria from 2007 to 2015.</p>
<p>We looked at whether deaths and serious injury rates for all road users changed over time. We also looked at the disability and economic costs of these injuries.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-take-to-their-bikes-when-we-make-it-safer-and-easier-for-them-82251">People take to their bikes when we make it safer and easier for them</a>
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</em>
</p>
<hr>
<p>The total number of deaths from road traffic crashes fell over the study period. But rates of serious road traffic injuries did not.</p>
<p>There were 10,092 road traffic deaths and serious injuries over the course of our study. This led to over 77,000 disability-adjusted life years (a measure of overall disability burden, expressed as the number of years lost to disability or early death). </p>
<p>The estimated health costs associated with these road traffic injuries (known as “health loss” costs) was more than A$14 billion.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The rates of crashes resulting in serious injury in cyclists rose 8% a year.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/399077320?src=KpKNqkCaCkQBh_w3M3u2jw-1-0&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Most concerning was the rise in serious injury rates in cyclists, which increased 8% a year. In fact, the absolute number of cases more than doubled over the nine-year study period. </p>
<p>These injuries are often severe, including head injuries, spine injuries and fractures of the pelvis and limbs. They often lead to significant disability.</p>
<p>Over the course of our study, a rise in such serious injuries led to a 56% increase in disability-adjusted life years; health costs for cyclists were more than A$700 million.</p>
<h2>Why are cyclists’ serious injuries rising?</h2>
<p>However, it is not clear what’s driving these increases in serious injuries.</p>
<p>In a <a href="http://www.sciencedirect.com/science/article/pii/S0001457516302950">previous study</a>, we interviewed cyclists admitted to hospital after a crash. Of the crashes that occurred on the road, 52% involved another road user, most commonly a motor vehicle.</p>
<p>A total of 22% of all on-road crashes also occurred while cyclists were riding in a marked bicycle lane, demonstrating they are not sufficient to completely protect cyclists. While these on-road bicycle lanes provide dedicated space for cyclists, riders remain close to motorists, and people in parked cars opening doors. </p>
<p>A total of 48% of on-road crashes only involved a single cyclist. While we need more research to better understand the single cyclist-only crashes, <a href="https://trid.trb.org/view.aspx?id=1343699">researchers have previously found</a> the condition of road surfaces, distraction, mechanical issues and speed are possible factors.</p>
<h2>Are more people cycling?</h2>
<p>One of the limitations of our study was that we couldn’t adjust for the amount of time or distance cyclists travel each year. Unfortunately, we have very limited data on this in Australia. </p>
<p>The <a href="http://www.bicyclecouncil.com.au/publication/national-cycling-participation-survey-2017">National Cycling Participation Survey</a> is a telephone survey that asks how many times people cycled in the past week, month or year. The 2017 results showed the proportion of people who had cycled in the past month declined from 27% in 2011 to 22% in 2017. </p>
<p>While cycling participation overall may have declined, there may be an increase in the overall time spent riding, or the number of cyclists riding on the road, compared to on bicycle paths, for example.</p>
<h2>So, what does this mean for cyclists?</h2>
<p>So, is the message from our study, “don’t cycle”? No, not at all. The health and economic benefits of cycling are well established. A <a href="http://www.bmj.com/content/357/bmj.j1456">recent UK study</a> demonstrated that cycling to work was associated with a 41% lower risk of early death compared to commuting by car or public transport.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/better-health-is-only-a-short-bike-ride-away-3613">Better health is only a short bike ride away</a>
</strong>
</em>
</p>
<hr>
<p>And while cycling-related injury rates are on the rise, they made up only 11% of serious road traffic injuries.</p>
<p>It is clear we need greater investment in cyclist safety. We know being concerned about safety is one of the <a href="https://www.heartfoundation.org.au/images/uploads/publications/Cycling-Survey-2011-Riding-a-Bike-for-Transport.pdf">biggest barriers</a> to people cycling. </p>
<p>Interactions with motor vehicles – not just collisions, but also being in the presence of and close proximity to motor vehicles – and the absence of appropriate cycling infrastructure are some of the most common barriers people mention.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cars-bicycles-and-the-fatal-myth-of-equal-reciprocity-81034">Cars, bicycles and the fatal myth of equal reciprocity</a>
</strong>
</em>
</p>
<hr>
<p>Dedicated bike lanes that are separated from traffic are <a href="http://injuryprevention.bmj.com/content/19/5/303">an effective way</a> to reduce serious injury. </p>
<p>While we need to invest more in cycling-specific infrastructure (like bike lanes and bike paths) it is often not feasible to have this across an entire road network. So, we need a multi-faceted approach to improving safety for cyclists. </p>
<p>Reducing the speed limit in residential streets to 30km/h has been proposed as a way to improve safety for vulnerable road users, and a <a href="https://www.yarracity.vic.gov.au/news/2017/09/05/yarra-to-introduce-30kmh-speed-trial">trial</a> has recently been announced in inner Melbourne. </p>
<p>We also need to improve the culture around cyclists as legitimate road users, through changes in legislation, education and training for all road users.</p>
<p>Given the rising injury rates in cyclists, we need government and road safety organisations to act now to provide a safer environment for cyclists.</p><img src="https://counter.theconversation.com/content/83569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ben Beck receives funding from the National Health and Medical Research Council. The Victorian State Trauma Registry is funded by the Department of Health and Human Services, the state Government of Victoria and the Transport Accident Commission.</span></em></p>More cyclists are suffering from serious injuries than ever before. Here’s what we can do to provide a safer environment.Ben Beck, Research fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/816142017-07-30T20:10:53Z2017-07-30T20:10:53ZSnakebites are rarer than you think, but if you collapse, CPR can save your life<figure><img src="https://images.theconversation.com/files/180118/original/file-20170727-28974-7lutuk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bites from brown snakes like this one were the most common, followed by
tiger snakes, then red-bellied black snakes.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Eastern_Brown_Snake_(Pseudonaja_textilis)_(8582601994).jpg">Matt Clancy/SunOfErat/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Despite the common belief that Australia has some of the most venomous snakes in the world, our <a href="http://www.mja.com.au">new research shows</a> being bitten by a snake is uncommon in Australia and dying from a snakebite is very rare. </p>
<p>And of the few unlucky people to collapse after venom enters their bloodstream, a bystander performing cardiopulmonary resuscitation (CPR) is the most likely thing to save them.</p>
<p>These are just some of the findings from 10 years of data from the Australian Snakebite Project published <a href="http://www.mja.com.au">today</a> in the Medical Journal of Australia.</p>
<p>Although many people go to hospital with a suspected snakebite, many do not turn out to have envenomation (when venom enters the bloodstream) after all.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/12675626">In more than 90% of cases</a> people are bitten by a non-venomous snake, venom is not injected when the snake bites (known as a “dry bite”) or are not even bitten by a snake (known as a “stick” bite).</p>
<p>Our analysis of about 1,548 cases of suspected snakebites from all around Australia, showed there were on average just under 100 snake envenomations a year, and about two deaths a year. </p>
<p>The most common snakebites were from brown snakes, then tiger snakes and red-bellied black snakes. Brown snakes were responsible for 40% of envenomations. Collapsing, then having a heart attack out of hospital was the most common cause of death (ten out of 23), and most deaths were from brown snakes.</p>
<h2>What happens after a snakebite and how can CPR help?</h2>
<p>Venom from a snakebite travels via the <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lymphatic-system">lymphatic system</a> to the bloodstream. There, it circulates to nerves and muscles where it can cause paralysis and muscle damage. In the blood itself, the venom destroys clotting factors, which makes the blood unable to clot, increasing the risk of bleeding. </p>
<p>In the most severe cases, most commonly in brown snake bites, someone can collapse because they have low blood pressure (we don’t know for certain what causes the low blood pressure). In this situation, insufficient blood is pumped around the body for the brain and other vital organs. </p>
<p>Clearly the accurate diagnosis of snake envenomation and the timely administration of antivenom are essential to treating snakebites in hospital.</p>
<p>But when people collapse, CPR will keep the blood circulating to the vital organs – and is life-saving – however inexpertly a bystander performs it.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If a snakebite victim collapses, CPR is vital to keep the blood circulating to the vital organs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/657810997?src=gSIYdvpfkdaGnxGsgex89A-1-50&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>In other words, we found basic first aid <em>before</em> people reached hospital, of which bystander CPR is one, may be more important than any changes in how people are treated <em>in</em> hospital to improve people’s chance of survival. People who survived after collapsing received CPR on average within one minute of being bitten compared with 15 minutes for those who died.</p>
<p>Our study also showed that in most cases, people used <a href="https://theconversation.com/explainer-what-should-you-do-if-youre-bitten-by-a-snake-34238">other first-aid measures</a> (pressure bandages and immobilising both the limb and the patient). These aim to prevent the venom travelling from the bite site, via the lymphatic system, to the bloodstream.</p>
<h2>Antivenom saves lives for those who need it</h2>
<p>Our study confirmed the role of antivenom in treating snakebites and the need for it to be administered before irreversible damage is done to the nervous system and paralysis occurs. </p>
<p>However, we found one in four patients given antivenom had an allergic reaction to it and about one in 20 have severe anaphylaxis requiring urgent treatment. </p>
<p>So it is essential only patients with snake envenomation, and not just a suspected snakebite, are treated with antivenom. We found 49 patients (around 6%) were given antivenom unnecessarily, out of the total 755 patients who received it.</p>
<h2>What needs to change?</h2>
<p>We know <a href="https://www.ncbi.nlm.nih.gov/pubmed/27903075">the earlier</a> someone receives antivenom <a href="https://www.ncbi.nlm.nih.gov/pubmed/21143062">the better</a>. Yet our study found that the time from being bitten until receiving antivenom had not improved over the study period.</p>
<p>So we need to find ways to make sure patients get antivenom as early as possible. This requires laboratory tests that can identify patients with snake envenomation in the first couple of hours after the bite. </p>
<p>It is also essential anyone bitten by a snake or suspected to be bitten by a snake seeks immediate medical attention and goes to hospital by ambulance.</p>
<p>But the best thing is to avoid being bitten in the first place:</p>
<ul>
<li><strong>avoid snakes</strong>, difficult if you’re a snake handler (up to 11% of cases in our study), and take care if trying to catch or kill a snake (which led to a bite in 14% of cases)</li>
<li><strong>wear long pants and sturdy shoes</strong> when walking in the bush or rural areas (47% of snakebites were when people didn’t know one was nearby) or when gardening (8% of cases)</li>
<li><strong>be alert inside too</strong>, with 31% of snakebites near houses and 14% in buildings.</li>
</ul>
<p>Our study confirms Australian snakes <a href="https://theconversation.com/a-venomous-paradox-how-deadly-are-australias-snakes-79433">don’t really deserve</a> their deadly reputation, <a href="https://theconversation.com/yes-australian-snakes-will-definitely-kill-you-if-youre-a-mouse-51809">unless you’re a mouse</a>. But if you are bitten, or think you have been, hospital is still the best place for you.</p><img src="https://counter.theconversation.com/content/81614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geoff Isbister receives funding from the National Health and Medical Research Council. </span></em></p>Don’t hold back. Performing CPR on a snakebite victim who has collapsed can save their life, however imperfect your technique.Geoff Isbister, Director, Clinical Toxicology Research Group, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/698792017-07-05T01:03:32Z2017-07-05T01:03:32ZDoctors and nurses can’t always tell if someone’s drunk or on drugs, and misdiagnosis can be dangerous<figure><img src="https://images.theconversation.com/files/171991/original/file-20170602-22797-icl539.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even emergency department staff can have trouble telling if someone's intoxicated as clinical clues can mislead.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/159380372?src=OWQQcAH0BbqI0JnY4UHWWQ-2-85&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Bob has arrived at the emergency department at 10am on a Tuesday after breaking several fingers slamming his hand in a car door. Bob is quite anxious; he speaks quickly and paces around. When asked to sit and explain what has happened, he provides an articulate account of events. A look at past medical records indicates Bob has recently been admitted to hospital for alcohol withdrawal. Bob’s blood alcohol concentration is 0.35% (or 0.35 grams per decilitre). For the average person, this could be fatal. But Bob is sitting upright with little outward cues he has been drinking heavily.</p>
<p>Now we turn to Bruce. Bruce stumbles up the street at 1am on a dark Saturday night. He loses his footing more than once and pauses multiple times as it seems he is struggling to avoid throwing up. Bruce’s speech is slurred and incoherent. Suddenly, he collapses in the street. When passers by check on him, they notice considerable cuts and bruises to his head. The man isn’t drunk; he was in a fight earlier that night and has a head injury.</p>
<p>These examples demonstrate “common sense” doesn’t always tell you who’s drunk and who’s sober. While slurred speech or lack of coordination might help, we cannot apply these cues in all circumstances.</p>
<p>These cues can be masked in people with high levels of tolerance to alcohol, or displayed by people who are not under the influence but have medical conditions with similar symptoms. For instance, both head injuries and <a href="https://www.diabetesaustralia.com.au/ketoacidosis">diabetic ketoacidosis</a> (when people have very high blood sugar levels in type 1 diabetes) have symptoms that mimic being drunk.</p>
<p>So what if Bruce, who seems drunk but is completely sober, turns up to emergency? Would staff have made the right diagnosis?</p>
<h2>Mistakes could be deadly</h2>
<p>Many of the issues surrounding correctly diagnosing someone with alcohol intoxication apply to correctly diagnosing someone who’s taken other drugs; mistakes could lead to illness and death.</p>
<p>The consequences of falsely identifying someone as intoxicated when they really have a life-threatening condition can be severe; they can receive the wrong treatment, or not receive treatment at all.</p>
<p>It is equally important to correctly identify intoxication with alcohol or other drugs, especially identifying the exact substance taken as some drugs can produce seemingly similar effects. Again, correctly identifying intoxication avoids giving medications incompatible with what the person’s taken.</p>
<p>While alcohol and drug testing (for instance blood or urine tests) is useful to determine intoxication objectively, their cost and time constraints may sometimes mean this is impractical. So, health care staff must accurately pick up on visual and verbal cues to tell if someone’s intoxicated or not.</p>
<p>But clinical suspicion alone may lead to missing a significant proportion of people who are intoxicated. In one study, trauma surgeons <a href="http://journals.lww.com/jtrauma/Abstract/1999/12000/Detection_of_Acute_Alcohol_Intoxication_and.27.aspx">failed to identify 23%</a> of patients who were acutely alcohol intoxicated.</p>
<h2>Why intoxication might be missed</h2>
<p>In one study that assessed emergency doctors’ and nurses’ knowledge of and attitudes to intoxication, <a href="http://www.sciencedirect.com/science/article/pii/S1755599X08000967">most (73.8%)</a> had not received specific training about drug and alcohol issues.</p>
<p>And as many people go to the emergency department with drug and alcohol related issues <a href="https://www.ncbi.nlm.nih.gov/pubmed/19378442">over the weekend or after hours</a> staff may not have enough time to interact sufficiently with each patient to pick up intoxication cues. </p>
<p>In some cases it may not be whether someone is intoxicated, but what they are intoxicated with that’s the issue. For instance, someone may have taken a <a href="https://www.ncbi.nlm.nih.gov/pubmed/25588018">novel psychoactive substance</a> (a designer drug) or more than one substance at once. These make it particularly difficult to spot and so provide the right treatment. </p>
<p>Bias may also play a role. In the <a href="http://journals.lww.com/jtrauma/Abstract/1999/12000/Detection_of_Acute_Alcohol_Intoxication_and.27.aspx">trauma surgeon study</a>, patients who the surgeons thought were dishevelled or of low socio-economic status were more likely to be falsely suspected of being drunk. And men were twice as likely as women to be falsely suspected of being drunk. But doctors were more likely to miss intoxication if patients were “well groomed”. </p>
<p>These issues are also relevant for first-responders as the ability for police, ambulance staff, and firefighters to correctly identify alcohol (and other drug) intoxication will influence how they approach and interact with people.</p>
<h2>How about the rest of us?</h2>
<p>So with these experienced and trained health workers potentially missing or misinterpreting the signs of intoxication, what chances do the rest of us have?</p>
<p>We might tell if friends and family are drunk because we know them sober so can compare their behaviours. If we try to tell if a stranger’s drunk, the context (such as a bar) might help, or it might be deceptive.</p>
<p>For drugs other than alcohol, we might know what our friends or family have taken. This information is vital for health professionals to know, so tell paramedics or other health workers so they can make the right treatment choices, even if this makes you feel uncomfortable. In the majority of drug overdoses police <a href="http://www.nuaa.org.au/wp-content/uploads/2014/03/police-overdose.pdf">will not get involved</a>.</p>
<h2>What we need to do</h2>
<p>It is astonishing how little research has been devoted to the topic of accurate detection of whether or not someone’s drunk or on drugs. We still can’t be certain people are receiving adequate training in this area, not only for individual substances but also if they have taken more than one substance.</p>
<p>How much someone’s taken and individual differences in how people respond to these substances also complicate the picture.</p>
<p>As there are a range of potential reasons why clinical suspicion may not be sufficient to detect intoxication (or rule out conditions that mimic intoxication), this suggests objective alcohol and drug testing may need to be more widely applied.</p>
<p>Knowing how to reliably assess intoxication will benefit the health services (correct diagnoses), first responders in general, and ultimately the community.</p><img src="https://counter.theconversation.com/content/69879/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Monds is affiliated with NSW Health. </span></em></p><p class="fine-print"><em><span>Celine van Golde does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We all know what a drunk person looks like, right? Wrong. Even health care workers can be confused.Lauren Monds, Research Fellow in Addiction Medicine, Research Officer in Forensic Psychology, University of SydneyCeline van Golde, Associate Lecturer in Forensic Psychology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/763082017-04-19T04:29:35Z2017-04-19T04:29:35ZIf a croc bite doesn’t get you, infection will<figure><img src="https://images.theconversation.com/files/165748/original/image-20170419-32700-mceytd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Open wide ... the mouths of crocodiles like this contain bacteria that cause potentially lethal infections in people they bite.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/269526644?src=FpjaBKKNSjPO5jVUrnr_PQ-1-18&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Most people assume if you’re unlucky enough to be bitten by a crocodile, then a severed limb or other severe trauma is all you have to worry about. But new research is emerging about serious infections you can catch from a bite that might kill you instead.</p>
<p>Our study, published <a href="https://www.mja.com.au/journal/2017/206/7/microbiology-crocodile-attacks-far-north-queensland-implications-empirical">earlier this week</a>, showed the range of bacteria crocodiles can transfer to their human victims. The good news is they can be cured with a much simpler antibiotic treatment than we realised.</p>
<p>Since crocodiles were granted <a href="http://www.environment.gov.au/cgi-bin/sprat/public/publicspecies.pl?taxon_id=1774">protected species</a> status in the 1970s in Australia, they have attacked <a href="http://www.crocodile-attack.info/">more than 100 humans</a>.</p>
<p>For those lucky to survive, their injuries often become infected. Bacteria can enter the body via the deep cuts from a crocodile’s teeth or from wounds occurring when people try to escape.</p>
<p>Bacteria living in crocodiles’ mouths can come from the intestines of other animals they eat or from the water in which they live.</p>
<p>When people are trying to escape a crocodile attack, bacteria living in the soil and mud also pose a risk. And bacteria commonly living on our skin without causing problems can cause infection when the skin’s protective barrier is lost. </p>
<p>If untreated, bacteria can cause severe wound infections. Without treating these infections properly, the victim’s tissues die and their arms and legs may need to be amputated. Infection can also enter the bloodstream and spread to the rest of the body causing multiple organ failure and death.</p>
<h2>How do we treat croc bite infections?</h2>
<p><a href="https://tgldcdp.tg.org.au/guideLine?guidelinePage=Antibiotic&frompage=etgcomplete">Australian guidelines</a> recommend how to treat infections after bites from animals in general. But until recently we didn’t know much about which antibiotic is best for people who have been attacked by a crocodile.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/165739/original/image-20170418-32689-mij7lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/165739/original/image-20170418-32689-mij7lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=868&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165739/original/image-20170418-32689-mij7lb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=868&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165739/original/image-20170418-32689-mij7lb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=868&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165739/original/image-20170418-32689-mij7lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1090&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165739/original/image-20170418-32689-mij7lb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1090&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165739/original/image-20170418-32689-mij7lb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1090&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Crocodiles make the front page across Australia’s Top End.</span>
<span class="attribution"><a class="source" href="http://www.bandt.com.au/information/uploads/2016/07/croc_03_custom-f2ec6b20d09f44d5cae4485128053ff664983800.jpg">NT News</a></span>
</figcaption>
</figure>
<p>Some 25 years ago, a <a href="http://europepmc.org/abstract/med/1453999">study</a> in the Northern Territory found over half of people who had been attacked by a crocodile had infected wounds.</p>
<p>Researchers found a wide variety of bacteria you would expect to find in the water, the soil, the intestines of animals and on the skin of humans. To kill all of these potential infection causing bacteria, they recommended a complex treatment of four different antibiotics which would mean up to 14 injections a day. With so many antibiotics, this increases the risk of potential side effects and the cost of patient care.</p>
<p>So, we <a href="https://www.mja.com.au/journal/2017/206/7/microbiology-crocodile-attacks-far-north-queensland-implications-empirical">reviewed</a> all cases of people who had been treated for a crocodile attack in Far North Queensland and attended the Cairns Hospital over a 25-year period. </p>
<p>A total of 15 people needed medical attention after a crocodile attack over this time, including several crocodile handlers. Four people were clearly infected by the time they reached hospital. A further two had bacteria in their wounds and almost all needed surgery. </p>
<p>Surgery is essential to prevent new or worsening infection after any bite as surgeons can remove already-infected tissue and help flush out any bacteria hiding in the wounds.</p>
<p>Despite finding lots of different bacteria, we discovered antibiotics given orally (amoxycillin-clavulanate) in mild infections or intravenously (piperacillin-tazobactam) for severe infections would be suitable to kill almost all of the bacteria found after a crocodile attack.</p>
<p>Although all of these patients were treated at Cairns Hospital, the results of the study will likely influence national guidelines for the management of crocodile attacks. The results may even help doctors in other countries. </p>
<h2>Prevention is your best bet</h2>
<p>Although we did not find it in our study, another important thing to remember is tetanus – an infection that can be contracted through dirty wounds – may also develop after a crocodile attack and this can be prevented by <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-tetanus">vaccination</a>.</p>
<p>When it comes to crocodile attacks, like most things in health, prevention is better than cure. People should take care when visiting areas where crocodiles live. If people are attacked and lucky enough to survive, they are likely to require surgery and have a high chance of developing an infection. </p>
<p>A crocodile is a beautiful creature to observe from a distance, but in the <a href="https://genius.com/Frank-churchill-never-smile-at-a-crocodile-from-peter-pan-soundtrack-version-lyrics">words</a> of American composer Frank Churchill:</p>
<blockquote>
<p>Don’t be taken in by his welcome grin.</p>
</blockquote><img src="https://counter.theconversation.com/content/76308/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Smith does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Until recently we didn’t know much about which antibiotic is best for people who have been attacked by a crocodile.Simon Smith, Adjunct Lecturer (Clinical), Medicine, James Cook UniversityLicensed as Creative Commons – attribution, no derivatives.