tag:theconversation.com,2011:/id/topics/emergency-services-31258/articlesEmergency services – The Conversation2024-01-12T02:39:30Ztag:theconversation.com,2011:article/2206592024-01-12T02:39:30Z2024-01-12T02:39:30ZThousands of visitors flock to Australia’s national parks each year – and many take silly risks. How do we keep people safe?<figure><img src="https://images.theconversation.com/files/568986/original/file-20240112-25-9fua7r.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5807%2C3865&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>A man was <a href="https://www.skynews.com.au/australia-news/man-22-saved-in-miracle-rescue-after-taking-10-metre-fall-to-the-ground-and-striking-his-head-at-cedar-creek-falls-in-queensland/news-story/272bc8e6b0fa9590d7b135fa7d4dc722">airlifted to hospital</a> last weekend after falling ten metres from a waterfall in Queensland’s
Tamborine National Park, which was closed to due to storms. And last month, a major safety operation was <a href="https://7news.com.au/news/nsw/injury-leaves-nine-bushwalkers-stranded-overnight-in-nsws-wollemi-national-park-c-12603602">launched</a> to rescue nine bushwalkers in Wollemi National Park near Sydney after one walker fell from a cliff and suffered a head injury.</p>
<p>These are just the latest in a string of <a href="https://www.theguardian.com/australia-news/2023/jun/19/missing-hiker-rory-lane-found-injured-cliff-fall-lamington-national-park-gold-coast-queensland">recent</a> <a href="https://au.news.yahoo.com/woman-in-dramatic-rescue-after-falling-down-cliff-at-queensland-beach-021111682.html">incidents</a> that underscore the potential dangers of visiting Australia’s national parks. Visitor numbers to national parks are <a href="https://www.environment.nsw.gov.au/topics/parks-reserves-and-protected-areas/park-management/park-visitor-survey#:%7E:text=Domestic%20visitation%20trends,53%20million%20visits%20in%202022.">increasing</a>. This is partly due to the provision of roads, boardwalks and other infrastructure which have greatly improved accessibility. People can now reach locations that, in many cases, would previously have required more competence, care, and skill to get to. </p>
<p>It means masses of people are being funnelled into <a href="https://www.nationalparks.nsw.gov.au/things-to-do/lookouts/figure-eight-pools">potentially dangerous locations</a> for which they may be unprepared. This poses risks to human life and safety, and places a heavy burden on already <a href="https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.14219">stretched emergency services</a> called to conduct rescues and retrieve bodies. </p>
<p>An urgent rethink is needed into how we invite and prepare visitors to interact responsibly with these natural environments.</p>
<h2>Visit, but be prepared</h2>
<p>National parks need people. <a href="https://theconversation.com/our-national-parks-need-visitors-to-survive-15867">Visitors</a> to national parks are vital to maintaining community, political and financial support for their existence. And increasing visitor numbers in national parks means more people can experience the physical and mental health benefits of spending time in nature.</p>
<p>Australia’s national parks are generally <a href="https://theconversation.com/national-parks-are-the-least-locked-up-land-there-is-15138">very accessible</a>. In some popular locations, visitors can drive right up to a site and explore it via a <a href="https://www.abc.net.au/news/2022-07-23/tourism-development-national-parks-conservationists-unhappy/101261750">highly engineered boardwalk</a>. At lookouts, visitors are often protected by barriers and warning signs.</p>
<p>Social media platforms such as Instagram and TikTok play <a href="https://theconversation.com/using-social-media-for-your-holiday-inspo-can-be-risky-and-even-dangerous-heres-why-216434">a role in promoting</a> national parks as accessible destinations. In Victoria, national parks authorities have suggested unprepared visitors are taking unnecessary risks in a bid to <a href="https://www.theage.com.au/national/victoria/authorities-warn-of-chasing-social-media-photos-into-the-wild-20201218-p56ovi.html">capture social media images</a>, forcing emergency services to undertake dangerous rescues.</p>
<p>Parks authorities themselves use social media to promote access to picturesque places, but increasingly do so with safety in mind.</p>
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Read more:
<a href="https://theconversation.com/using-social-media-for-your-holiday-inspo-can-be-risky-and-even-dangerous-heres-why-216434">Using social media for your holiday 'inspo' can be risky and even dangerous – here's why</a>
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<h2>Safety first? Not always</h2>
<p>As visitor numbers to national parks increases, so too do the numbers of <a href="https://www.smh.com.au/politics/nsw/warning-over-public-safety-in-national-parks-as-popularity-soars-20190207-p50wbg.html">safety incidents</a>. </p>
<p>In Western Australia, an average of <a href="https://www.sciencedirect.com/science/article/pii/S1080603220301101">77 incidents per year</a> occurred between 2011 and 2017. Most were falls or water-related, such as drowning.</p>
<p>And in Victoria in the five years to 2020, the State Emergency Service <a href="https://www.theage.com.au/national/victoria/authorities-warn-of-chasing-social-media-photos-into-the-wild-20201218-p56ovi.html">reportedly conducted</a> 365 “high-angle rescues” – complex operations in high, steep locations.</p>
<p>Many incidents in national parks happen repeatedly at the same place. The latest incident at Cedar Creek Falls comes after a teenager <a href="https://www.brisbanetimes.com.au/national/queensland/boy-s-body-found-at-popular-gold-coast-hinterland-swimming-hole-20210409-p57hp6.html">drowned there in 2021</a>. At the Babinda Boulders in Far North Queensland, <a href="https://www.news.com.au/travel/travel-updates/warnings/grim-truth-about-deadly-queensland-waterhole/news-story/5f02dfcc25edb2978022d41eebed03ca">21 drownings</a> have reportedly been recorded. This suggests current mechanisms for enhancing safety or communicating risk at known hazardous locations aren’t working. </p>
<p>It also stands to reason that the infrastructure we build to attract people to national parks, and to guide them and keep them safe, may be propelling them into risky situations. </p>
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Read more:
<a href="https://theconversation.com/stick-to-the-path-and-stay-alive-in-national-parks-this-summer-108062">Stick to the path, and stay alive in national parks this summer</a>
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<h2>Rethinking access to the wild</h2>
<p>So how best do we prevent deaths and injuries in national parks, while still encouraging people to venture into the outdoors?</p>
<p>Many people <a href="https://www.tandfonline.com/doi/full/10.1080/02508281.2020.1745474?scroll=top&needAccess=true">do not believe</a> national parks are inherently dangerous places to visit. But erecting warning signs to alert them to the risks is not necessarily the answer. </p>
<p>One study focused on beaches in Victoria showed <a href="https://www.sciencedirect.com/science/article/abs/pii/S0925753513002129">less than half of visitors</a> even saw the signs. The answer is not to plaster an area with signs, either: an overabundance of <a href="https://theconversation.com/good-signage-in-national-parks-can-save-lives-heres-how-to-do-it-right-93483">safety messages</a> can create “information overload” and means people are likely to ignore them.</p>
<p>However, there is research to suggest signs warning people of <a href="https://injepijournal.biomedcentral.com/articles/10.1186/s40621-019-0222-y">legal consequences or fines</a>, rather than risks to their personal safety, may be more effective at ensuring safe behaviour. </p>
<p>Well-designed infrastructure in national parks <a href="https://library.wur.nl/WebQuery/wurpubs/fulltext/559248">can enhance</a> the visitor experience, and protect the environment by directing people away from sensitive areas. But parks authorities should consider whether some infrastructure is encouraging people into dangerous situations, and whether certain areas should be <a href="https://www.abc.net.au/news/2019-02-28/call-to-close-access-to-social-media-favourite-figure-8-pools/10853854">closed off</a> to the the public entirely.</p>
<p>Authorities could devise online training programs that teach people <a href="https://www.theguardian.com/australia-news/2023/dec/12/cant-read-a-map-or-use-a-first-aid-kit-australians-lack-hiking-skills-survey-shows">key outdoors skills</a>, such as basic first aid and what to do if they get lost.</p>
<p>Finally, all this raises important questions around personal responsibility. Research conducted at four national parks in Western Australia showed many people viewed safety as a <a href="https://www.tandfonline.com/doi/full/10.1080/02508281.2020.1745474">shared responsibility</a> between visitors and parks management – but when things go wrong, place the blame on parks management. The same research showed parks visitors can be reluctant to accept the shift of responsibility back onto themselves.</p>
<p>Studies are needed to determine if encouraging visitors to take more responsibility for their actions would lead to fewer safety incidents – and if so, how best to get people to adopt this attitude shift.</p>
<p>Recent tragedies in our national parks highlight the crucial need to reevaluate visitor management strategies. National parks are a public good – and we need to make sure they stay that way.</p>
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Read more:
<a href="https://theconversation.com/trampling-plants-damaging-rock-art-risking-your-life-taking-selfies-in-nature-has-a-cost-211901">Trampling plants, damaging rock art, risking your life: taking selfies in nature has a cost</a>
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<p class="fine-print"><em><span>Samuel Cornell receives funding from Meta Platforms, Inc. His research is also supported by a UNSW University Postgraduate Award, as well as project funding from the Royal Life Saving Society - Australia. He is affiliated with Surf Life Saving Australia and Surf Life Saving NSW. He is currently conducting work with Queensland National Parks and Wildlife Service in a research capacity.</span></em></p><p class="fine-print"><em><span>Amy Peden receives funding from the National Health and Medical Research Council, Meta Platforms, Royal Life Saving Society - Australia and Surf Life Saving Australia. She holds an honorary affiliation with Royal Life Saving Society - Australia.</span></em></p>Visitor numbers to national parks are increasing. It means masses of people are being funnelled into potentially dangerous locations for which they may be unprepared.Samuel Cornell, PhD Candidate, School of Population Health, UNSW SydneyAmy Peden, NHMRC Research Fellow, School of Population Health & co-founder UNSW Beach Safety Research Group, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2134172023-09-28T15:52:30Z2023-09-28T15:52:30ZVirtual reality can help emergency services navigate the complexities of real-life crises<figure><img src="https://images.theconversation.com/files/550453/original/file-20230926-29-i6fpq7.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C2363%2C1569&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Brandon May</span>, <span class="license">Author provided</span></span></figcaption></figure><p>The UK has experienced several terrorist attacks, from the 2005 London bombings, to the devastating events at Manchester Arena and London Bridge in 2017. These tragic incidents not only resulted in the loss of innocent lives but were also <a href="https://www.emerald.com/insight/content/doi/10.1108/JFP-03-2018-0007/full/html?utm_campaign=Emerald_Health_PPV_Dec22_RoN">immensely challenging for emergency response teams</a>.</p>
<p>Each of these events required coordination between several different emergency services: the police, fire services and medical teams. Combining expertise across emergency response teams is <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/joop.12349">extremely demanding</a>. </p>
<p>For instance, the ability to <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1100274/full">collaborate effectively and make ethical choices</a> is crucial for minimising harm and saving lives. However, there’s often little time in which to do so. Responders are required to make split-second decisions that can mean the difference between life and death.</p>
<p>Therefore, decision making by emergency response teams is a high stakes game that can <a href="https://link.springer.com/article/10.3758/s13421-020-01056-y">influence the outcomes of different crises</a>. Emergency personnel are often required to make quick, well-informed decisions <a href="https://militaryhealth.bmj.com/content/166/2/72.abstract">under extreme stress and with limited resources</a>. </p>
<p>We have been part of a team from the universities of Portsmouth and Winchester investigating how virtual reality (VR) can help prepare responders for these scenarios. We’ve also been looking at how to make the technology more affordable.</p>
<p>There are already <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1111/joop.12159">training scenarios</a> designed to improve what’s known as the “situational awareness” of the risks in an emergency situation – for instance, the ability to quickly grasp and understand the risks and dynamics of an incident. However, effectively implementing them necessitates competent decision making. </p>
<p>A notable obstacle is <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1111/joop.12108?casa_token=9vv_LVS-WZAAAAAA:jtwDqJv8aihy08zypWK3Sq7h8PeVrm51VaT6hU61AXKJsYzbO3tcHC1lR_cQGXpV5J5zBdsljEi1x9J1">decision inertia</a> – the inclination to stick with an existing plan, even when better alternatives emerge or the situation evolves. This inertia can have psychological origins, <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1111/joop.12309">including the fear of making mistakes or a reluctance to stray from established protocols</a>. </p>
<p>In emergencies, this can lead to less-than-desirable outcomes, such as <a href="https://www.kerslakearenareview.co.uk/media/1022/kerslake_arena_review_printed_final.pdf">delayed action</a> and a failure to distribute the right resources <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/joop.12217">where they’re most needed</a>.</p>
<h2>VR and decision making</h2>
<p>To better understand and address these challenges, researchers and those on the front line are increasingly turning to immersive technologies, <a href="https://journals.sagepub.com/doi/full/10.1177/2041386620926037">such as VR</a>. VR technology can provide users with realistic 3D simulations that closely mirror real world scenarios. This makes it an invaluable tool for studying decision making under high stress. </p>
<p>For emergency responders, there are many benefits to working with VR. Firstly, it can act as a training simulator, allowing first responders to practice critical decision making during a crisis scenario played out in a simulated environment and <a href="https://library.imaging.org/ei/articles/34/12/ERVR-299">with a VR headset</a>. Secondly, it can <a href="https://www.sciencedirect.com/science/article/pii/S0002961007000712?casa_token=L3YT6ZxCeocAAAAA:J_2a-DpYmVs28CJPwQQH4gwOPu7or6L6HzPhsO_MOZLoHw-SY_mfzfVpycl8d0aJHqYlexPDPEWL">significantly reduce errors in the real world</a>. Given these advantages, the integration of VR in emergency training could be revolutionary.</p>
<p>For example, in real world emergencies, decision makers can swiftly identify patterns and cues, such as how best to respond to an unattended bag in a crowded area. These cues can in turn activate what are called mental scripts – predefined sequences of actions or solutions that have <a href="https://www.academia.edu/83266254/Imagination_and_expectation_The_effect_of_imagining_behavioral_scripts_on_personal_influences">proven effective in similar situations in the past</a>. This can minimise harm to both personnel and the public. </p>
<p>High fidelity (highly realistic) simulations offer the most authentic and immersive training experiences. However, despite the numerous advantages of VR in training employees and supporting real time decisions, its widespread adoption faces a major hurdle – a substantial price tag. </p>
<p>Industry solutions such as the VR development tool Unreal Engine, which forms the basis of many virtual environments, have been incredibly useful for training organisations. By practising their response strategies in <a href="https://www.theseus.fi/bitstream/handle/10024/120282/Tiira_Ville.pdf?sequence=1">virtual environments</a>, response teams improve their resilience to unexpected situations and their <a href="https://isprs-annals.copernicus.org/articles/X-3-W2-2022/9/2022/isprs-annals-X-3-W2-2022-9-2022.html">efficiency when faced with extreme events</a>. However, the financial burden of such advanced systems can be prohibitive for many emergency response organisations. Some of these organisations operate on limited financing, such as <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1100274/full">austerity budgets</a>.</p>
<p>Motivated by the need for more cost effective options, we are working with other researchers to investigate more affordable solutions that don’t sacrifice training quality. We have been developing proof of concept designs for VR systems that can fit on a desktop, using a laptop for example. Similar designs have been shown to be effective in <a href="https://www.tandfonline.com/doi/abs/10.1080/01639625.2017.1407104">recreating other types of event</a>.</p>
<p>By harnessing 360-degree cameras to create immersive simulations based around simulated terrorist events, desktop VR can closely <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/emp2.12903">mirror real world emergency scenarios</a>.</p>
<h2>Outperforming older methods</h2>
<p>We have recently produced our preliminary findings. They show that desktop VR can be a particularly valuable tool in training. This realism is pivotal in influencing users’ decision making. For example, VR-based training, especially the interactive kind that responds to a user’s input, has been <a href="https://www.sciencedirect.com/science/article/pii/S0925753523001170">shown to outperform</a> traditional video-based training methods. </p>
<p>When viewed through the lens of decision inertia, this suggests that immersive VR effectively emulates the high-stress, complex conditions under which emergency responders operate.</p>
<p>These immersive simulations can also recreate the <a href="https://econtent.hogrefe.com/doi/abs/10.1027/1016-9040/a000320?journalCode=epp">psychological processes that contribute to decision inertia</a> – a major challenge in real world crises. This applies to the cheaper, <a href="https://link.springer.com/article/10.1007/s11606-022-07557-7">desktop versions</a> of the simulations too. With this in mind, the value of VR emerges not just as a training tool, but also as an instrumental medium for exploring and understanding decision making processes.</p>
<p>Using these immersive technologies provides an alternative, realistic platform with <a href="http://hcilab.uniud.it/images/stories/publications/2014-09/FearArousal_VRST2014.pdf">similar performance outcomes</a> to conventional in-person or video-based training.</p>
<p>By leveraging more cost-effective VR technologies, such as desktop VR, emergency response organisations can provide high quality training that enhances the decision making skills of their employees. Immersive simulations can also create recognisable events that activate their mental scripts – the predefined actions that have proven useful in similar, past events.</p>
<p>This opens up possibilities for the wider adoption of VR in emergency response training, making it more accessible for agencies and organisations with different budgets.</p><img src="https://counter.theconversation.com/content/213417/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>VR can help responders hone the decision making skills they’ll need in emergency scenarios.Brandon May, Lecturer in Criminology, University of WinchesterSelina Robinson, Senior Lecturer in Forensic Investigation, University of WinchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1995802023-02-09T13:34:49Z2023-02-09T13:34:49ZTwitter cutoff in Turkey amid earthquake rescue operations: A social media expert explains the danger of losing the microblogging service in times of disaster<figure><img src="https://images.theconversation.com/files/509022/original/file-20230208-29-jlpvtb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8640%2C5755&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Rescuers work at a collapsed building in southeastern Turkey.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TurkeySyriaEarthquakePhotoGallery/1bf8c21596934bfb97a74eca9bfc30ae/photo">AP Photo/Kamran Jebreili</a></span></figcaption></figure><p>Twitter was blocked in Turkey on Feb. 8, 2023, <a href="https://netblocks.org/reports/twitter-restricted-in-turkey-in-aftermath-of-earthquake-oy9LJ9B3">according to internet monitoring service NetBlocks</a>. The outage came amid the massive rescue operation and humanitarian crisis in the aftermath of the earthquakes in southern Turkey and northern Syria two days earlier. Access to Twitter <a href="https://twitter.com/netblocks/status/1623482866305753090">appeared to be restored</a> about 12 hours after it was first blocked.</p>
<p>Twitter is a microblogging platform that offers users a way to share short chunks of text, audio and video as well as the ability to post threaded conversations. Almost as soon as the main quake hit, thousands of <a href="https://www.bbc.com/news/world-64541194">eyewitnesses posted videos and photos on social media</a>, particularly on Twitter. Such first eyewitness accounts are invaluable in helping emergency relief personnel and researchers assess the extent of damage and match aid to what’s needed on the ground. </p>
<p>The Twitter blackout, which was likely the <a href="https://www.nytimes.com/live/2023/02/08/world/turkey-syria-earthquake/7968c9bc-0e56-5f2c-8625-2ef28172194b">result of governmental action</a>, appeared to have <a href="https://twitter.com/zeynep/status/1623430736232456196">impeded rescue and relief efforts</a>. NetBlocks noted that internet service providers had been blocking traffic to Twitter, and that people could circumvent the blocking by using a <a href="https://www.healthit.gov/faq/what-virtual-private-network">virtual private network</a>, or VPN.</p>
<p>Officials in numerous countries periodically <a href="https://theconversation.com/kazakhstans-internet-shutdown-is-the-latest-episode-in-an-ominous-trend-digital-authoritarianism-174651">block social media and internet access</a> in attempts to limit the flow of information. Turkey is among the countries with a long <a href="https://globalvoices.org/2022/06/03/trace-turkeys-path-to-normalizing-the-practice-of-blocking-news-websites/">history of internet censorship</a>. </p>
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<h2>Twitter’s role in disaster relief</h2>
<p>Twitter has been used widely in previous natural disasters. A U.S. <a href="https://www.dhs.gov/sites/default/files/publications/Social-Media-EM_0913-508_0.pdf">Department of Homeland Security briefing from 2013</a> reported that social media has played an important role during disasters. Twitter in particular has been an important source of crowdsourced and real-time eyewitness data that enables relief personnel to interact with affected communities. </p>
<p>A <a href="http://doi.org/10.48550/arXiv.2301.11429">recent study</a> looked at all 375 million tweets on Twitter in a single day (Sept. 21, 2022) and found that the service allowed governments to communicate crisis information to citizens and citizens to seek help and information. This type of communication and coordination of response efforts has been useful in many situations, from a <a href="https://doi.org/10.1016/j.chb.2015.06.044">water contamination crisis</a> in West Virginia to a <a href="https://doi.org/10.1016/j.trc.2021.102976">hurricane evacuation</a> in Florida.</p>
<p>Humanitarian aid and disaster relief require real-time monitoring, almost immediately after a disaster occurs. Combining Twitter feeds <a href="https://doi.org/10.1609/icwsm.v5i1.14079">with geolocation data and mapping the extracted information</a> makes it possible to visualize an unfolding crisis. Responders <a href="https://doi.org/10.1016/j.ijdrr.2022.103107">can track the locations of damage, casualties and resources</a> to determine how best to target relief efforts. </p>
<p>This kind of data also helps researchers in fields such as transportation get <a href="https://doi.org/10.1016/j.trc.2021.102976">insights about the dynamics of evacuations</a>. A <a href="https://doi.org/10.1016/j.ijdrr.2019.101176">time-based analysis of tweets during Hurricane Sandy</a> in October 2012 shows that researchers can use crowdsourced data from Twitter to quantify the intensity of a hurricane in real time. Such analyses of images of damage and flooding shared through social media help emergency managers identify storm damage and plan relief efforts. </p>
<p>Losing access to Twitter, whether from government blocking, <a href="https://theconversation.com/twitters-new-data-fees-leave-scientists-scrambling-for-funding-or-cutting-research-199238">financial barriers to Twitter’s application programming interface</a> or Twitter outages like yesterday’s <a href="https://www.nytimes.com/2023/02/08/technology/twitter-glitches-features.html">global glitch</a>, will severely restricts up-to-date information about disaster response as events unfold. It also hinders the ability to learn from the past and prepare for future emergencies.</p><img src="https://counter.theconversation.com/content/199580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anjana Susarla receives funding from the National Library of Medicine and the Omura-Saxena Professorship in Responsible AI</span></em></p>Twitter was blocked in Turkey for about 12 hours at the height of rescue and relief efforts in the aftermath of a massive earthquake, severely hampering a vital tool for disaster response.Anjana Susarla, Professor of Information Systems, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1941312022-11-16T17:22:59Z2022-11-16T17:22:59ZWhat psychology tells us about the failure of the emergency services at the Manchester Arena bombing<p>The second stage of the <a href="https://files.manchesterarenainquiry.org.uk/live/uploads/2022/11/03141804/MAI-Volume-2-Part-i.pdf">official inquiry</a> into the Manchester Arena bombing in 2017 has produced a harrowing account of what went wrong in the emergency response.</p>
<p>The terrorist attack resulted in the deaths of 22 innocent victims. Sir John Saunders, chair of the inquiry, concluded that Jesip, the joint emergency services interoperability programme, had failed – and that this was not the first time it had happened.</p>
<p>Jesip provides national strategic leadership with the aim of making it easier for different emergency services to work together – which is obviously very challenging but vital in cases such as the Manchester attack. Fire services and ambulance workers will all be on the scene trying to help people in distress while the police try to keep others safe from further harm. </p>
<p>The idea of interoperability is that people from the different emergency organisations, each with their own cultures, values and goals, can find a common set of principles to make sure that they work together smoothly in a crisis.</p>
<p>Jesip, which was established a decade ago, made several organisational changes to how the emergency services operate. A <a href="https://www.jesip.org.uk/joint-doctrine/introduction-to-the-joint-doctrine/">shared national doctrine</a> was adopted, outlining “joint principles” including that commanders should quickly co-locate at the scene. The emergency services also now share a joint decision-making model, so that each is involved in making decisions during major emergencies.</p>
<h2>Why did Jesip fail in Manchester?</h2>
<p>A fatal early failure in the response to the Manchester attack was a lack of communication between emergency services. Jesip’s goal to make emergency groups work together coherently had not been met.</p>
<p>There was conflicting communication about the location of the shared rendezvous point for emergency services. There was also no clarity over whether the attack had been declared a “major incident”. This created chaos and confusion during the first few minutes of the attack, when getting a shared grip of the situation was vital.</p>
<p>The <a href="https://psycnet.apa.org/record/2011-21802-021">psychology of groups</a> tells us that individuals are motivated to make biased and positive evaluations about their “in-group” in comparison with other “outgroups”. This occurs in social groups but also <a href="https://www.researchgate.net/publication/234021306_Identification_in_Organizations_An_Examination_of_Four_Fundamental_Questions">in the workplace</a> when individuals identify strongly with their organisation. </p>
<p>When organisations seek to change how their teams are structured, there is a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/job.2164">risk</a> that those feeling strongly connected to their pre-existing group (the police service, for example) might feel threatened by the establishment of a new collective group (such as Jesip).</p>
<p>Saunders reflected that Jesip had failed to find its way into the “muscle memory” of the emergency services. He said emergency groups continued to operate in silos, abandoning Jesip principles and falling back on existing ways of working. This suggests that buy-in to Jesip by the emergency services at Manchester was low. The group psychology in operation that day may have been focused on in-groups rather than the collective.</p>
<h2>The psychology of team decision-making</h2>
<p>The Manchester inquiry also criticised the emergency services’ failure to make joint decisions. Most notable was the lack of emergency responders operating in the City Room (the location of the explosion), where they were needed to treat and evacuate critically injured casualties. </p>
<p>There was no joint decision made to assess the risk level for emergency workers operating in this area and, crucially, whether they required personal protective equipment. This meant that some emergency responders decided to deploy whereas others did not.</p>
<p>Prior to the Manchester attack, my colleagues and I collected data from a <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1111/joop.12159">fictitious counter-terrorism</a> simulation that closely mirrored what happened in Manchester. We presented a multi-agency team of commanders with a choice about whether to commit non-specialist responders into the high-risk zone to help with casualty treatment.</p>
<p>Out of the 13 multi-agency teams involved, only four decided to commit responders. This failure of the blue light services to commit responders was exactly what happened after the Arena bombing. We also found that many teams spent a long time deliberating over this choice, when decisive action was required.</p>
<p>A possible explanation for these decision difficulties was ambiguity in Jesip’s joint decision model. Commanders in our study perceived each other to be working towards a common goal “to save lives”. But the translation of that goal into action meant different things to different services, leading to contradictory decisions.</p>
<p>The police wanted to neutralise the threat, paramedics wanted to treat casualties, and the fire service sought to ensure safe procedures were in place before taking high-risk action. These aims could not all be achieved at the same time.</p>
<p>We argued that despite being good in theory, the joint decision model might reinforce existing psychological divisions between different services in practice. This is especially problematic when coupled with the assumption that all team members are working towards the same “save life” goal.</p>
<p>The decision not to deploy staff into Manchester Arena’s City Room might have been intended to help protect the lives of emergency workers – but it also limited the saving of lives of members of the public.</p>
<h2>Avoiding a repeat of Manchester</h2>
<p>Saunders has outlined several recommendations in his report to “ensure that Jesip works in practice and not just in theory”. One of these is to ensure “regular ‘high fidelity’ training” to expose responders to the stress and pressure of a terrorist attack.</p>
<p>One way to achieve this is through <a href="https://journals.sagepub.com/doi/10.1177/2041386620926037">regular simulation-based training</a>, which closely replicates the psychological stress of a real-life event while allowing for close monitoring and evaluation.</p>
<p>Saunders has also recommended that the emergency services’ joint doctrine be reviewed and updated where necessary. Our <a href="https://crestresearch.ac.uk/projects/building-better-multi-agency-counter-terrorism-training/">current research</a> suggests the psychology of interoperability needs to be at the forefront of this review. Specifically, identifying ways to increase buy-in to Jesip by studying the psychology of groups.</p>
<p>To ensure an effective response to future terrorist attacks of this nature, the psychology of collective responding must be central to the muscle memory of the emergency services.</p><img src="https://counter.theconversation.com/content/194131/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicola Power receives funding from the Centre for Research and Evidence on Security Threats – an independent Centre commissioned by the Economic and Social Research Council (ESRC) and which is funded in part by the UK’s Home Office and security and intelligence agencies.
Thanks go to my collaborators on this research: Mrs Jennifer Alcock, Dr Richard Philpot and Prof Mark Levine.</span></em></p>Group psychology can explain why emergency services failed to cooperate effectively in the aftermath of the Manchester Arena bombing.Nicola Power, Lecturer in Psychology, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1920512022-10-30T10:52:11Z2022-10-30T10:52:11ZEmergency services in South Africa are overwhelmed: how one community created its own<figure><img src="https://images.theconversation.com/files/489554/original/file-20221013-23-dr9ek2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source"> Kristin Palitza/picture alliance via Getty Images</span></span></figcaption></figure><p>In a medical emergency, the time it takes emergency services to respond could be the difference between survival or death. Ambulance response time is a global <a href="http://www.samj.org.za/index.php/samj/article/view/9818">benchmark</a> of efficiency.</p>
<p>But no healthcare system has an endless supply of ambulances. It’s always possible that an ambulance might be sent from too far away to get to the patient in time. Ambulances may struggle to get through difficult terrain; ambulance staff may be <a href="https://www.news24.com/news24/southafrica/news/emergency-service-crew-robbed-while-waiting-for-police-escort-20220918">targeted by criminals</a>. </p>
<p>Community-based ambulance services may be one way to improve response times and to support established healthcare systems. In a <a href="https://www.sciencedirect.com/science/article/pii/S2211419X22000210">recent study</a>, we tested this idea using a volunteer community-based ambulance service in the suburb of Hout Bay in Cape Town, South Africa.</p>
<p>We found that the <a href="https://www.houtbayems.org.za/">Hout Bay Volunteer Emergency Medical Service</a> had an average response time within its own area that was 42.3% faster than the Western Cape government’s emergency medical services. Its ambulances consistently beat the target time of 15 minutes for life-threatening calls in urban areas. Because the service is based within the community – which isn’t easy to reach from elsewhere in the city because of its mountainous topography – its ambulances are able to reach people in need faster than those coming from elsewhere. </p>
<p>We believe the model can be expanded to other communities across the African continent. This is a key need: less than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234167/">9%</a> of people across Africa are served by an emergency care system. Developing effective emergency care systems could potentially save lives. The World Health Organization estimates that more than <a href="https://www.who.int/news/item/27-05-2019-72nd-world-health-assembly-adopts-resolution-on-emergency-and-trauma-care">50% of deaths</a> in low- and middle-income countries result from conditions that could be managed by emergency care. This is not the only reason for high mortality and morbidity rates. But it’s a contributing factor. </p>
<p>Collaboration and good working relationships are crucial for community-based ambulance services to work. Residents must work with each other, as well as with government departments and formal emergency medical service providers.</p>
<h2>Understanding Hout Bay</h2>
<p>Hout Bay has been <a href="https://www.houtbay.org/">recorded</a> as covering 32.3km². In the 2011 census, the official population was recorded as approximately <a href="https://www.statssa.gov.za/?page_id=4286&id=332">33,000</a> people. The umbrella term “Hout Bay” describes three sections: Hout Bay, Hangberg and Imizamo Yethu. These sections differ in terms of socioeconomic conditions, ranging from abject poverty (no bulk water, sewerage or electricity) to adequate housing and healthcare, and to luxury.</p>
<p>The Hout Bay Volunteer Emergency Medical Service was started by a group of residents in 1994. They were concerned about how long it took ambulances to respond to medical emergencies in the area. </p>
<p>Part of the reason for this is that the area is physically isolated. It is enclosed on three sides by mountains, and by the coastline on the fourth side. Vehicles can only get in and out on three two-lane roads via the mountains. This causes delays in medical emergency response times, especially in peak traffic, tourist season or bad weather. Without traffic, it takes at least 25 minutes to drive into the suburb from the central business district of the city. </p>
<p>The Hout Bay Volunteer Emergency Medical Service operates with one sponsored ambulance that’s staffed by at least two volunteers. The number of volunteers who regularly work shifts fluctuates depending on season, for example more volunteers are available over the festive season as they have leave from regular work. The average number of volunteers who contribute shifts in a year is 20. </p>
<h2>Trust, collaboration and partnerships</h2>
<p>Based on our study, we’ve identified various factors to consider when developing community-based response systems. First, these should suit the setting. One must consider the specific community needs and the disease profile. This may include the distance to the closest appropriate facility, and the number and type of emergencies commonly seen in the setting. For example, it may be an area that has a high number of road traffic accidents, requiring rescue equipment and capabilities. Or there may be a high number of pregnancies. </p>
<p>It also helps if the community-based response system is embedded within existing community programmes or systems. For instance, the first Hout Bay Volunteer Emergency Medical Service emergency care responders were volunteer members of the National Sea Rescue Institute Station 8 in Hout Bay. These volunteers organised a basic ambulance assistant course through the provincial ambulance college. The institute was already well established, and initially most members were volunteers with both organisations. This helped to develop a coordinated response to emergencies. </p>
<p>The two organisations still have a close relationship. The Hout Bay emergency services is also embedded in other community-based partnerships. These include the community policing forum, neighbourhood watch and sponsors like local businesses.</p>
<p>Identifying, establishing and maintaining stakeholder relationships is probably the most vital component when developing a community-based response system. These relationships need to be nurtured and maintained, and Hout Bay Volunteer Emergency Medical Service has seen the benefit of appointing a dedicated liaison officer within the executive committee to build and maintain stakeholder relationships. </p>
<p>While the community, other community-based organisations and sponsors are important stakeholders, the Western Cape Government Department of Health and Wellness Emergency Medical Service is the main enabler and a powerful stakeholder of the Hout Bay Volunteer Emergency Medical Service. An executive committee portfolio is dedicated to <a href="https://www.timeslive.co.za/sunday-times/opinion-and-analysis/insight/2022-07-03-how-to-rid-the-red-zones-of-fear-for-emergency-services/">maintaining this key relationship</a> and the service is permitted to function by a service level agreement between the two parties.</p>
<p>Trust is also key. Residents must know about and trust the service. This can partially be achieved simply by delivering a good, reliable service. The Hout Bay emergency service also interacts regularly with community leaders, offers community first aid training, facilitates fire prevention training, visits schools and provides medical support at community events.</p>
<h2>Conclusions</h2>
<p>Emergency medical services remain underdeveloped in many African countries, resulting in underserviced communities. The findings of this study suggest that volunteer services can have a meaningful impact in communities. This isn’t the only volunteer emergency medical service on the continent. But the longevity of the Hout Bay emergency services suggests that the model has been sustainable and provides valuable lessons for other communities.</p><img src="https://counter.theconversation.com/content/192051/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charmaine Cunningham used to be a member and executive committee member of the Hout Bay Volunteer Ambulance Service. She is no longer an active member of the service. </span></em></p>Collaboration and good working relationships are crucial for community-based ambulance services to work.Charmaine Cunningham, Senior Lecturer Emergency Medicine and Global Surgery, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1862852022-07-03T10:49:26Z2022-07-03T10:49:26ZWhat’s causing Sydney’s monster flood crisis – and 3 ways to stop it from happening again<figure><img src="https://images.theconversation.com/files/472164/original/file-20220703-18-9n4edt.jpg?ixlib=rb-1.1.0&rect=21%2C31%2C7064%2C4684&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Mick Tsikas/AAP</span></span></figcaption></figure><p>Again, thousands of residents in Western Sydney face a life-threatening flood disaster. At the time of writing, <a href="https://www.9news.com.au/national/weather-news-sydney-nsw-coast-rainfall-winds-flood-warnings/e4442509-f8f3-4328-8366-38130066f1c1">evacuation orders</a> spanned southwest and northwest Sydney and residents of the Hawkesbury-Nepean Valley were being warned the crisis was escalating.</p>
<p>It’s just over a year since the region’s long-suffering residents lived through <a href="https://theconversation.com/sydneys-disastrous-flood-wasnt-unprecedented-were-about-to-enter-a-50-year-period-of-frequent-major-floods-158427">one of the largest</a> flood events in recent history. And of course, earlier this year floods devastated the Northern NSW town of Lismore.</p>
<p>Right now, attention is rightly focused on helping those immediately affected by the disaster. But as the floodwaters subside, we must urgently act to avert a repeat of this crisis.</p>
<p>Obviously, nature is a major culprit here. But there’s plenty humans can do to plan for major flooding and make sure we’re not sitting in the path of disaster.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1543334845757079552"}"></div></p>
<h2>So what’s caused the current the flood problem?</h2>
<p>The first driver of this disaster is nature and geography.</p>
<p>For <a href="https://www.theguardian.com/australia-news/datablog/2022/apr/08/in-charts-sydneys-record-breaking-rainfall">many months now</a>, much of New South Wales has experienced significant rain and associated flooding. </p>
<p>There’s a reason both the Hawkesbury-Nepean and Lismore flood the way they do – geography. Both areas sit in low-lying bowl-like depressions in the landscape. </p>
<p>Lismore sits at <a href="https://www.abc.net.au/news/2022-03-31/floods-lismore-byron-bay-northern-rivers-why-come-in-clusters/100954926">the confluence</a> of several large rivers that each drain significant catchments – and so can deliver large floods. </p>
<p>And in the Hawkesbury-Nepean, huge rivers have to pass through a very tight “<a href="https://theconversation.com/sydneys-disastrous-flood-wasnt-unprecedented-were-about-to-enter-a-50-year-period-of-frequent-major-floods-158427">pinch point</a>” known as the Sackville Bathtub. This slows the flow, causing water to back up across the floodplain. </p>
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<p>The NSW government wants to raise the wall of the Warragamba Dam to help alleviate this problem. But as <a href="https://theconversation.com/sydneys-disastrous-flood-wasnt-unprecedented-were-about-to-enter-a-50-year-period-of-frequent-major-floods-158427">others</a> have argued, this controversial proposal might not work. That’s because raising the wall will control only about half the floodwater, and won’t prevent major floods delivered by other rivers feeding the region. </p>
<p>The second factor making the current floods so bad is the exposure of infrastructure and housing. In the Hawkesbury-Nepean region, lots of stuff people care about – such as homes, businesses and schools – is in the path of floodwaters.</p>
<p>In an ideal world, nothing would be built on a floodplain. But due to Sydney’s growing population and the housing affordability crisis, local governments in Western Sydney have been under pressure to build more and more homes, despite the known flood risk.</p>
<p>In 2018, more than 140,000 people lived or worked on the Hawkesbury-Nepean floodplain. Due to this large population and the region’s geography, the area has the <a href="https://www.infrastructure.nsw.gov.au/media/3262/interim-evaluation_december2021.pdf">most significant</a> and unmitigated community flood exposure in Australia. </p>
<p>What’s worse, the region’s population is expected to <a href="https://www.smh.com.au/national/nsw/floods-remind-us-the-plan-for-hawkesbury-floodplain-is-dangerously-irresponsible-20200210-p53zd2.html">double</a> over the next 30 years. At the same time, climate change will change rainfall patterns and make severe flooding <a href="https://www.infrastructure.nsw.gov.au/media/3262/interim-evaluation_december2021.pdf">more likely</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/one-of-the-most-extreme-disasters-in-colonial-australian-history-climate-scientists-on-the-floods-and-our-future-risk-178153">'One of the most extreme disasters in colonial Australian history': climate scientists on the floods and our future risk</a>
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<figure class="align-center ">
<img alt="new housing estate" src="https://images.theconversation.com/files/472165/original/file-20220703-25-z4xrve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472165/original/file-20220703-25-z4xrve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=241&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472165/original/file-20220703-25-z4xrve.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=241&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472165/original/file-20220703-25-z4xrve.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=241&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472165/original/file-20220703-25-z4xrve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=303&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472165/original/file-20220703-25-z4xrve.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=303&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472165/original/file-20220703-25-z4xrve.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=303&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Local governments in Western Sydney have been under pressure to build more homes.</span>
<span class="attribution"><span class="source">Ben Rushton/AAP</span></span>
</figcaption>
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<h2>Being prepared</h2>
<p>The third contributing factor to this flood disaster is a lack of preparedness.</p>
<p>The NSW government has a <a href="https://www.infrastructure.nsw.gov.au/media/3144/flood-strategy-frequently-asked-questions.pdf">strategy</a> to manage the flood risk in the Hawkesbury-Nepean. It includes improved flood warning and emergency response measures, upgraded evacuation routes, recovery planning and a regional floodplain management study.</p>
<p>But given the region’s big, growing population and massive flood exposure, these three bolder and more urgent measures are needed:</p>
<p><strong>1. Get better at urban planning</strong></p>
<p>Local governments, developers and communities must collaborate to agree on smarter land-use zoning – basically, deciding what infrastructure and activities go where. Because let’s be honest: some land just should not be built on. </p>
<p>This is a lesson Lismore has learned the hard way. There’s now a broad-ranging discussion underway about whether the town’s central business district should be <a href="https://www.lismorecitynews.com.au/story/7744990/moving-the-cbd-land-retreats-flood-ideas-up-for-discussion/?cs=27565">moved</a> entirely, and flood-prone riverside land turned over to <a href="https://theconversation.com/i-simply-havent-got-it-in-me-to-do-it-again-imagining-a-new-heart-for-flood-stricken-lismore-178982">other uses</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498464361974620160"}"></div></p>
<p>If we must build on flood-exposed land, better building codes and designs are needed. This may mean accepting <a href="https://theconversation.com/build-disaster-proof-homes-before-storms-strike-not-afterward-61947">higher</a> construction costs. It will certainly require tough rules requiring developers and homeowners to comply with planning measures.</p>
<p>And when building new suburbs in flood-prone areas, several best-practice building standards should be adopted. They include:</p>
<ul>
<li>raising floor heights above, say, a one in 500 year flood level</li>
<li>improving drainage</li>
<li>reducing hard surfaces that don’t absorb water.</li>
</ul>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/under-resourced-and-undermined-as-floods-hit-south-west-sydney-our-research-shows-councils-arent-prepared-178293">Under-resourced and undermined: as floods hit south-west Sydney, our research shows councils aren't prepared</a>
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</em>
</p>
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<p><strong>2. Prepare infrastructure and people</strong></p>
<p>All too often, flooding cuts off vital access roads and prevents or limits evacuations. <a href="https://www.theguardian.com/australia-news/2022/mar/15/screaming-for-something-to-be-done-nsw-town-repeatedly-cut-off-by-floods-demands-safe-evacuation-route">More emergency routes</a> in and out of flood-prone areas are needed. </p>
<p>More designated evacuation shelters – <a href="https://knowledge.aidr.org.au/resources/ajem-april-2019-experiences-of-individuals-with-disabilities-sheltering-during-natural-disasters-an-integrative-review/">accessible to all</a> – are also required.</p>
<p>And it’s crucial people living in flood-exposed areas are aware of, understand and prepare for the risk. This requires community education and engagement – undertaken regularly (such as once a year) and in multiple languages.</p>
<p>For those in the Hawkesbury-Nepean region who want to better understand the flood-risk, check out <a href="https://www.ses.nsw.gov.au/hawkesbury-nepean-floods/">this valuable resource</a> provided by the NSW State Emergency Service (SES).</p>
<p>Even for those who understand the risks, insuring themselves against the damage may be difficult or impossible. Rising premiums mean insurance is already <a href="https://theconversation.com/after-the-floods-comes-underinsurance-we-need-a-better-plan-178143">out of reach</a> for many Australians – and the problem is set to worsen.</p>
<figure class="align-center ">
<img alt="flooded road with cars parked and people standing" src="https://images.theconversation.com/files/472166/original/file-20220703-20-dznsfb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472166/original/file-20220703-20-dznsfb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472166/original/file-20220703-20-dznsfb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472166/original/file-20220703-20-dznsfb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472166/original/file-20220703-20-dznsfb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472166/original/file-20220703-20-dznsfb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472166/original/file-20220703-20-dznsfb.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">Floods frequently cut off major access roads.</span>
<span class="attribution"><span class="source">Mick Tsikas/AAP</span></span>
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</figure>
<p><strong>3. Equip the SES properly</strong></p>
<p>The SES is responsible for flood and storm response, and it does exceptional work. But like most government agencies, the SES is being asked to do more with ever tighter budgets. </p>
<p>The organisation is largely made up of <a href="https://www.abc.net.au/news/2022-03-14/mullumbimby-flood-response-over-reliance-volunteers-emergency/100903514">volunteers</a> – and that workforce is <a href="https://www.theguardian.com/australia-news/2021/nov/05/under-resourced-ses-leaves-large-stretches-of-nsw-far-west-with-no-local-rescue-services-ex-volunteers-say">very stretched</a>. </p>
<p>As a society, we must ask how the SES can be better funded and supported to do the job we ask of them. For example, is it still appropriate to rely on a mostly volunteer-run service to provide such a challenging disaster response – especially as climate change worsens? Or should the SES’s paid workforce be greatly expanded?</p>
<h2>Looking ahead</h2>
<p>Unfortunately, the wet conditions we’re now seeing may persist for some time. Recent climate modelling <a href="https://climateextremes.org.au/concerns-over-a-third-possible-la-nina-for-australian-spring-2022/">suggests</a> Australia may face a third consecutive La Nina this spring and summer. </p>
<p>This extra rain will fall on already soaked landscapes, further increasing the likelihood of flooding. And the ramifications will extend far beyond affected communities.</p>
<p>Disruptions will be felt in <a href="https://climateextremes.org.au/concerns-over-a-third-possible-la-nina-for-australian-spring-2022/">agriculture</a>, supply chains, <a href="https://www.infrastructure.nsw.gov.au/media/3262/interim-evaluation_december2021.pdf">transport routes</a> and broader state and national economies.</p>
<p>In the longer term, of course, climate change is projected to <a href="https://www.nature.com/articles/s41612-021-00202-w">bring</a> far worse extreme rain events than in the past. The current flood crisis will recede, but the need to plan for future flooding disasters has never been more pressing.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-simply-havent-got-it-in-me-to-do-it-again-imagining-a-new-heart-for-flood-stricken-lismore-178982">'I simply haven’t got it in me to do it again': imagining a new heart for flood-stricken Lismore</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/186285/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dale Dominey-Howes receives funding from the Australian Research Council and National Disaster Resilience Fund. </span></em></p>Again, thousands of residents in Western Sydney face a life-threatening flood disaster. Obviously, nature is a major culprit – but other drivers are also at play.Dale Dominey-Howes, Honorary Professor of Hazards and Disaster Risk Sciences, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1660332021-09-08T20:12:17Z2021-09-08T20:12:17Z20 years on, 9/11 responders are still sick and dying<figure><img src="https://images.theconversation.com/files/419188/original/file-20210903-23797-akqghk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2396%2C1595&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos.aap.com.au/search/world%20trade%20center%20attack">Shawn Baldwin/AP/AAP Image</a></span></figcaption></figure><p>Emergency workers and clean-up crew are among 9/11 responders still suffering significant health issues 20 years after the <a href="https://www.history.com/topics/21st-century/9-11-attacks">terrorist attacks</a>.</p>
<p>More than <a href="https://pubmed.ncbi.nlm.nih.gov/18500709/">91,000 workers and volunteers</a> <a href="https://www1.nyc.gov/site/911health/enrollees/rescue-recovery-workers.page">were exposed</a> to a range of hazards during the rescue, recovery and clean-up operations.</p>
<p>By March 2021, some 80,785 of these responders had enrolled in the <a href="https://www.cdc.gov/wtc/">World Trade Center Health Program</a>, which was set up after the attacks to monitor their health and treat them.</p>
<p>Now our <a href="https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/abs/health-trends-among-911-responders-from-20112021-a-review-of-world-trade-center-health-program-statistics/09B87521287B943402782DAADB47E0B9">published research</a>, which is based on examining these health records, shows the range of physical and mental health issues responders still face.</p>
<h2>Breathing problems, cancer, mental illness</h2>
<p>We found 45% of responders in the health program have aerodigestive illness (conditions that affect the airways and upper digestive tract). A total of 16% have cancer and another 16% have mental health illness. Just under 40% of responders with health issues are aged 45-64; 83% are male.</p>
<p>Our analysis shows 3,439 of responders in the health program are now dead — far more than the <a href="https://parade.com/1248604/jessicasager/9-11-facts/">412 first responders who died on the day</a> of the attacks.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1304362152757727238"}"></div></p>
<p>Respiratory and upper digestive tract disorders are the number one cause of death (34%), ahead of cancer (30%) and mental health issues (15%). </p>
<p>Deaths attributed to these three factors, as well as musculoskeletal and acute traumatic injuries, have increased six-fold since the start of 2016. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-pain-of-9-11-still-stays-with-a-generation-64725">How the pain of 9/11 still stays with a generation</a>
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</p>
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<h2>An ongoing battle</h2>
<p>The number of responders enrolling in the health program with emerging health issues rises each year. More than 16,000 responders have enrolled in the past five years. </p>
<p>Cancer is up 185% over the past five years, with leukaemia emerging as particularly common, overtaking colon and bladder cancer in the rankings.</p>
<p>This equates to an increase of 175% in leukaemia cases over a five-year period, which is not surprising. There is a <a href="https://pubmed.ncbi.nlm.nih.gov/32771228/">proven link</a> between benzene exposure and acute myeloid leukaemia. Benzene is found in jet fuel, one of the toxic exposures at the World Trade Center. And acute myeloid leukaemia is one of the main types of leukaemia reported not only by responders, but by <a href="https://www.wtc-illness.com/cancers/leukemia-blood-cancer">residents of lower Manhattan</a>, who also have higher-than-normal rates. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1217080882273701888"}"></div></p>
<p>Prostate cancer is also common, increasing 181% since 2016. Although this fits with the age profile of many of the health program’s participants, some responders are developing an <a href="https://pubmed.ncbi.nlm.nih.gov/31221798/">aggressive, fast-growing form</a> of prostate cancer. </p>
<p>Inhaling the toxic dust at the World Trade Center site may trigger a cascading series of cellular events, increasing the number of inflammatory T-cells (a type of immune cell) in some of the responders. This increased inflammation <a href="https://pubmed.ncbi.nlm.nih.gov/26816843/">may eventually lead to prostate cancer</a>.</p>
<p>There may also be a <a href="https://pubmed.ncbi.nlm.nih.gov/31490535/">significant link between</a> greater exposure at the World Trade Center and a higher risk of long-term cardiovascular disease (disease affecting the heart and blood vessels). Firefighters who responded to the World Trade Center on the morning of the attacks were 44% more likely to develop cardiovascular disease than those who arrived the next day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/air-pollution-causes-cancer-so-lets-do-something-about-it-19380">Air pollution causes cancer, so let's do something about it </a>
</strong>
</em>
</p>
<hr>
<h2>The mental health effects</h2>
<p>About <a href="https://pubmed.ncbi.nlm.nih.gov/31625489/">15-20%</a> of responders are estimated to be living with <a href="https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/ptsd">post-traumatic stress disorder</a> (PTSD) symptoms — roughly <a href="https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd">four times</a> the rate of the general population. </p>
<p>Despite 20 years having passed, PTSD <a href="https://pubmed.ncbi.nlm.nih.gov/28805168/">is a growing problem</a> for responders. Almost half of all responders <a href="https://pubmed.ncbi.nlm.nih.gov/31776767/">report</a> they need ongoing mental health care for a range of mental health issues including PTSD, anxiety, depression and <a href="https://www.medicalnewstoday.com/articles/325578">survivor guilt</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-11-anniversary-a-watershed-for-psychological-response-to-disasters-2975">9/11 anniversary: a watershed for psychological response to disasters</a>
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</p>
<hr>
<p>Researchers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364857/">have also found</a> brain scans of some responders indicate the onset of early-stage dementia. This is consistent with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364857/">previous work</a> noting cognitive impairment among responders occurs at about twice the rate of people 10-20 years older.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1432762034467311616"}"></div></p>
<h2>COVID-19 and other emerging threats</h2>
<p>Responders’ underlying health conditions, such as cancer and respiratory ailments, have also left them <a href="https://www.usatoday.com/in-depth/news/nation/2021/05/05/covid-risk-911-september-2001-ground-zero-responders-causes-concern/4961779001/">vulnerable to COVID-19</a>. By the end of August 2020, <a href="https://www.newsweek.com/how-many-people-died-911-thousands-perishing-september-11-related-illnesses-1531058">some 1,172 responders</a> had confirmed COVID-19.</p>
<p>Even among responders who have not been infected, the pandemic <a href="https://www.thecity.nyc/2020/9/10/21431746/how-many-9-11-survivors-have-died-of-covid-19">has exacerbated</a> one of the key conditions caused by search and rescue, and recovery after terrorist attacks — PTSD.</p>
<p><a href="https://www.nbcnews.com/news/us-news/covid-19-has-killed-dozens-9-11-first-responders-n1239885">More than 100 responders have died</a> due to complications from the virus, which has also exacerbated other responders’ PTSD symptoms.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1304566412325814274"}"></div></p>
<p>The number of responders with cancers associated with asbestos exposure at the World Trade Center is expected to rise in coming years. This is because mesothelioma (a type of cancer caused by asbestos) usually takes <a href="https://www.canceraustralia.gov.au/cancer-types/mesothelioma-cancer/awareness#:%7E:text=It%20usually%20takes%20a%20very,and%20roofing%2C%20and%20in%20insulation.">20-50 years to develop</a>. </p>
<p>As of 2016, at least 352 responders had been diagnosed with the lung condition <a href="https://www.mayoclinic.org/diseases-conditions/asbestosis/symptoms-causes/syc-20354637">asbestosis</a>, and at least 444 had been diagnosed with another lung condition, <a href="https://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/symptoms-causes/syc-20353690">pulmonary fibrosis</a>. Exposure to asbestos and other fibres in the toxic dust <a href="https://www.asbestos.com/world-trade-center/">may have contributed</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-harms-of-asbestos-wont-be-known-for-decades-14845">Health harms of asbestos won't be known for decades </a>
</strong>
</em>
</p>
<hr>
<h2>Lessons learned</h2>
<p>Our research involved analysing data from existing databases. So we cannot make direct links between exposure at the World Trade Center site, length of time there, and the risk of illness. </p>
<p>Differences in age, sex, ethnicity, smoking status and other factors between responders and non-responders should also be considered. </p>
<p>Increased rates of some cancers in some responders may also be associated with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2764101">heightened surveillance</a> rather than an increase in disease.</p>
<p>Nevertheless, we are now beginning to understand the long-term effects of responding to the 9/11 terrorist attacks. Exposure is still having both a physical and mental health impact and it’s likely responders are still developing illnesses related to their exposures.</p>
<p>Ongoing monitoring of responders’ health remains a priority, especially considering the looming threat of new asbestos-related cancers.</p><img src="https://counter.theconversation.com/content/166033/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>More 9/11 responders died from physical and mental health issues after the terrorist attacks than on the day itself. And survivors are still suffering 20 years later.Erin Smith, Associate Professor in Disaster and Emergency Response, School of Medical and Health Sciences, Edith Cowan UniversityBrigid Larkin, PhD candidate, Edith Cowan UniversityLisa Holmes, Lecturer, Paramedical Science, School of Medical and Health Sciences, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1383482020-05-27T12:52:12Z2020-05-27T12:52:12Z98% of emergency calls for strokes are made by someone else – so what if you’re alone in lockdown?<figure><img src="https://images.theconversation.com/files/337701/original/file-20200526-106836-1pnxk76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>During the COVID-19 pandemic, the UK government message has been to stay at home, protect the NHS and save lives. Unfortunately this necessary message has meant that many people with other life-threatening emergencies including strokes have stayed away from hospital when they need care. </p>
<p>Having a stroke is a medical emergency. This fact is not altered by COVID-19. But there is concern among stroke specialists worldwide about the dramatic fall in the number of admissions and referrals since the pandemic began. In the US, for example, the number of people going to hospital for strokes has <a href="https://www.sciencedaily.com/releases/2020/05/200508133808.htm">fallen by 40%</a>.</p>
<p>In the UK, GP surgeries and hospitals have made impressively swift changes to the way they work to minimise transmission of the virus between patients. But some people with non-COVID symptoms are still concerned that they might burden the NHS, while others are worried about contracting coronavirus if they go to hospital.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-may-be-increasing-risk-of-stroke-doctors-on-the-frontline-witness-new-pattern-138032">Coronavirus may be increasing risk of stroke – doctors on the frontline witness new pattern</a>
</strong>
</em>
</p>
<hr>
<p>Lockdown brings another problem for stroke patients. Each year <a href="https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2018.pdf">100,000 people in the UK have a stroke</a> – that’s one every five minutes. But most of those patients don’t call emergency services themselves. </p>
<p>In <a href="https://pubmed.ncbi.nlm.nih.gov/22335960/">our 2013 study</a> of 592 stroke patients, only 2% of 999 calls were made by the patient. Usually, it is a family member or other bystander who makes the call. If you are locked down alone, there may be no one with you who can recognise the signs and make the necessary call.</p>
<h2>The problem with isolation</h2>
<p>You may have seen the long-running stroke awareness campaign based on the FAST test: “<a href="https://www.stroke.org.uk/what-is-stroke/what-are-the-symptoms-of-stroke">Face, Arm, Speech, Time to dial 999</a>”. This is based on observing the main symptoms of stroke, which are facial weakness, arm weakness and speech problems. Despite public information campaigns about the FAST test for stroke and about the symptoms of heart attack, many people still delay, often with serious or even fatal consequences.</p>
<p>Our <a href="https://emj.bmj.com/content/29/6/502.long">research</a> shows that if patients are alone when stroke symptoms occur, they will often try to ignore it for a while, possibly even for several days, only seeking help when they talk to a family member or friend who takes further action. </p>
<p>Other patients report their symptoms only when they have tried to undertake an activity such as going shopping and found that they are unable to do so. Sometimes there are multiple steps taken before someone eventually phones for an emergency ambulance, with people consulting other members of the family or a neighbour, friend or their GP before finally making an emergency call. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/337699/original/file-20200526-106823-n44imh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/337699/original/file-20200526-106823-n44imh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/337699/original/file-20200526-106823-n44imh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=305&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337699/original/file-20200526-106823-n44imh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=305&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337699/original/file-20200526-106823-n44imh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=305&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337699/original/file-20200526-106823-n44imh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=383&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337699/original/file-20200526-106823-n44imh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=383&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337699/original/file-20200526-106823-n44imh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=383&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Know the signs.</span>
<span class="attribution"><a class="source" href="https://www.stroke.org.uk/what-is-stroke/what-are-the-symptoms-of-stroke">Stroke Association</a></span>
</figcaption>
</figure>
<p>Now that many people are limiting the number of times they leave their house, their normal social networks have been radically altered or have disappeared altogether, with limited or no contact with others. Self-isolation and shielding have changed the expected pathways by which people normally seek help.</p>
<p>For example, someone who lives close by to a relative who lives alone may normally pop in every day, but due to working remotely, home schooling, supermarket queuing and virtual catch-ups with friends, they now might only call in twice a week with essential shopping, delivered while adhering to social distancing guidelines. In these changed circumstances, relatives might not mention health concerns as soon as they might otherwise. </p>
<p>Even with regular phone or video conversations, lack of face-to-face contact might reduce the likelihood of someone’s symptoms being mentioned or noticed by another person. Although some stroke symptoms such as slurred speech or confusion might be detected in a phone call, other symptoms such as arm or leg weakness or loss of balance are less readily noticed. </p>
<p>While there have been reports of strokes in younger, previously healthy people <a href="https://www.washingtonpost.com/health/2020/04/24/strokes-coronavirus-young-patients/">related to COVID-19</a>, it is mostly older people and those with serious underlying conditions who are at higher risk of heart attack, strokes and other serious emergencies. This is much the same group of people who need to shield against COVID-19 and whose social networks are highly disrupted during this crisis.</p>
<h2>What we can do</h2>
<p>So what can be done to help? The public information campaign is vital – many more people will suffer preventable disability and lives will be lost if they do not seek help for non-COVID related health emergencies.</p>
<p>Routes to getting the medical attention you need might have changed (GP consultations are by phone in the first instance) but the care is the same. The NHS has made rapid changes to working practices for acute admissions to hospital and for investigations such as x-rays and blood tests to reduce the risk of transmission of COVID-19 as much as possible – after all, your doctor does not want you to get this disease any more than you do.</p>
<p>Knowing about the signs of stroke is not enough on its own. An action plan may be useful. If you know someone living alone, take the time to check in with them frequently. Make sure they know what to do if they have any concerns about any new or existing health problems – contact a pharmacist or GP for less urgent problems, NHS 111 for urgent problems and NHS 999 if you think someone is having a stroke.</p><img src="https://counter.theconversation.com/content/138348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steph Jones receives funding from the National Institute for Health Research. Research cited in this article was funded by the National Institute for Health Research (ref:RP-PG-0606-1066). The views expressed in this article are those of the authors and not necessarily those of the NIHR, NHS or Department of Health and Social Care</span></em></p><p class="fine-print"><em><span>Jo Gibson receives funding from the National Institute for Health Research. Research cited in this article was funded by the National Institute for Health Research (ref: RP-PG-0606-1066). The views expressed in this article are those of the authors and not necessarily those of the NIHR, NHS or Department of Health and Social Care. </span></em></p>Health services are seeing a drop in people seeing urgent care for stroke patients. Here’s how you can make sure your loved ones are safe.Steph Jones, Senior Research Fellow, University of Central LancashireJo Gibson, Reader in Health Services Research, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1349122020-04-30T20:09:25Z2020-04-30T20:09:25ZDisasters expose gaps in emergency services’ social media use<p>Australia has borne the brunt of several major disasters in recent years, including <a href="https://theconversation.com/entire-hillsides-of-trees-turned-brown-this-summer-is-it-the-start-of-ecosystem-collapse-126107">drought</a>, <a href="https://theconversation.com/with-costs-approaching-100-billion-the-fires-are-australias-costliest-natural-disaster-129433">bushfires</a>, <a href="https://theconversation.com/catastrophic-queensland-floods-killed-600-000-cattle-and-devastated-native-species-120753">floods</a> and <a href="https://theconversation.com/cyclone-debbie-we-can-design-cities-to-withstand-these-natural-disasters-75287">cyclones</a>. The increasing use of social media is changing how we prepare for and respond to these disasters. Not only emergency services but also their social media are now much-sought-after sources of disaster information and warnings. </p>
<p>We <a href="https://doi.org/10.1016/j.ijdrr.2020.101571">studied</a> Australian emergency services’ social media use in times of disaster. Social media can provide invaluable and time-critical information to both emergency services and communities at risk. But we also found problems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drought-fire-and-flood-how-outer-urban-areas-can-manage-the-emergency-while-reducing-future-risks-131560">Drought, fire and flood: how outer urban areas can manage the emergency while reducing future risks</a>
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</p>
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<h2>How do emergency services use social media?</h2>
<p>The <a href="https://disasterphilanthropy.org/disaster/2019-australian-wildfires/">2019-20 Australian bushfires</a> affected <a href="https://theconversation.com/nearly-80-of-australians-affected-in-some-way-by-the-bushfires-new-survey-shows-131672">80% of the population</a> directly or indirectly. Social media were widely used to spread awareness of the bushfire disaster and to raise funds – albeit <a href="https://theconversation.com/next-time-weve-got-to-handle-emergency-donations-better-132273">sometimes controversially</a> – to help people in need. </p>
<p>The escalating use and importance of social media in disaster management raises an important question: </p>
<blockquote>
<p>How effective are social media pages of Australian state emergency management organisations in meeting community expectations and needs? </p>
</blockquote>
<p>To answer this question, <a href="https://research.qut.edu.au/smartcity/home/people/urban-studies-lab/">QUT’s Urban Studies Lab</a> investigated the community engagement approaches of social media pages maintained by various Australian emergency services. We placed Facebook and Twitter pages of New South Wales State Emergency Services (NSW-SES), Victoria State Emergency Services (VIC-SES) and Queensland Fire and Emergency Services (QLD-FES) under the microscope. </p>
<p><a href="https://doi.org/10.1016/j.ijdrr.2020.101571">Our study</a> made four key findings.</p>
<p>First, emergency services’ social media pages are intended to:</p>
<ul>
<li>disseminate warnings</li>
<li>provide an alternative communication channel</li>
<li>receive rescue and recovery requests</li>
<li>collect information about the public’s experiences</li>
<li>raise disaster awareness</li>
<li>build collective intelligence</li>
<li>encourage volunteerism</li>
<li>express gratitude to emergency service staff and volunteers</li>
<li>raise funds for those in need.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/with-costs-approaching-100-billion-the-fires-are-australias-costliest-natural-disaster-129433">With costs approaching $100 billion, the fires are Australia's costliest natural disaster</a>
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<p>Examples of emergency services’ social media posts are shown below.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/325221/original/file-20200403-74206-5iy1q1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325221/original/file-20200403-74206-5iy1q1.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=755&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325221/original/file-20200403-74206-5iy1q1.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=755&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325221/original/file-20200403-74206-5iy1q1.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=755&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325221/original/file-20200403-74206-5iy1q1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=949&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325221/original/file-20200403-74206-5iy1q1.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=949&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325221/original/file-20200403-74206-5iy1q1.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=949&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">NSW-SES collecting data from the public through their posts.</span>
<span class="attribution"><span class="source">Facebook</span></span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/325222/original/file-20200403-74243-1hvqkob.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325222/original/file-20200403-74243-1hvqkob.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=623&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325222/original/file-20200403-74243-1hvqkob.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=623&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325222/original/file-20200403-74243-1hvqkob.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=623&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325222/original/file-20200403-74243-1hvqkob.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=783&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325222/original/file-20200403-74243-1hvqkob.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=783&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325222/original/file-20200403-74243-1hvqkob.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=783&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">VIC-SES sharing weather warnings to inform the public.</span>
<span class="attribution"><span class="source">Facebook</span></span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/325223/original/file-20200403-74243-12cthc2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325223/original/file-20200403-74243-12cthc2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325223/original/file-20200403-74243-12cthc2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325223/original/file-20200403-74243-12cthc2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325223/original/file-20200403-74243-12cthc2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325223/original/file-20200403-74243-12cthc2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325223/original/file-20200403-74243-12cthc2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">QLD-FES posting fire condition information to increase public awareness.</span>
<span class="attribution"><span class="source">Facebook</span></span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/325224/original/file-20200403-74212-1lcicso.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325224/original/file-20200403-74212-1lcicso.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=795&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325224/original/file-20200403-74212-1lcicso.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=795&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325224/original/file-20200403-74212-1lcicso.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=795&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325224/original/file-20200403-74212-1lcicso.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=999&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325224/original/file-20200403-74212-1lcicso.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=999&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325224/original/file-20200403-74212-1lcicso.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=999&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">QLD-FES showing the direction of a cyclone and warning the community.</span>
<span class="attribution"><span class="source">Facebook</span></span>
</figcaption>
</figure>
<p>Second, Facebook pages of emergency services attract more community attention than Twitter pages. Services need to make their Twitter pages more attractive as, unlike Facebook, Twitter allows streamlined data download for social media analytics. A widely used Twitter page of emergency service means more data for analysis and potentially more accurate policies and actions.</p>
<p>Third, Australia lacks a legal framework for the use of social media in emergency service operations. Developing these frameworks will help organisations maximise its use, especially in the case of financial matters such as donations.</p>
<p>Fourth, the credibility of public-generated information can sometimes be questionable. Authorities need to be able to respond rapidly to such information to avoid the spread of misinformation or “fake news” on social media.</p>
<h2>Services could do more with social media</h2>
<p>Our research highlighted that emergency services could use social media more effectively. We do not see these services analysing social media data to inform their activities before, during and after disasters.</p>
<p>In <a href="https://eprints.qut.edu.au/133703/">another study</a> on the use of social media analytics for disaster management, we developed a novel approach to show how emergency services can identify disaster-affected areas using real-time social media data. For that study, we collected Twitter data with location information on the <a href="https://theconversation.com/old-floods-show-brisbanes-next-big-wet-might-be-closer-than-we-think-70392">2010-11 Queensland floods</a>. We were able to identify disaster severity by analysing the emotional or sentiment values of tweets. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-the-internet-knows-if-youre-happy-or-sad-77401">Explainer: how the internet knows if you're happy or sad</a>
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<p>This work generated the disaster severity map show below. The map is over 90% accurate to actual figures in the report of the <a href="http://www.floodcommission.qld.gov.au/publications/final-report/">Queensland Floods Commission of Inquiry</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/323603/original/file-20200327-146695-3c9juy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/323603/original/file-20200327-146695-3c9juy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/323603/original/file-20200327-146695-3c9juy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=315&fit=crop&dpr=1 600w, https://images.theconversation.com/files/323603/original/file-20200327-146695-3c9juy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=315&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/323603/original/file-20200327-146695-3c9juy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=315&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/323603/original/file-20200327-146695-3c9juy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=395&fit=crop&dpr=1 754w, https://images.theconversation.com/files/323603/original/file-20200327-146695-3c9juy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=395&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/323603/original/file-20200327-146695-3c9juy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=395&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Disaster severity map created through Twitter analytics.</span>
<span class="attribution"><span class="source">Authors</span></span>
</figcaption>
</figure>
<h2>Concerns about using social media to manage disaster</h2>
<p>The first highly voiced concern about <a href="https://eprints.qut.edu.au/127136/">social media use in disaster management</a> is the <a href="https://theconversation.com/the-digital-divide-leaves-millions-at-a-disadvantage-during-the-coronavirus-pandemic-133608">digital divide</a>. While the issue of <a href="https://theconversation.com/online-tools-can-help-people-in-disasters-but-do-they-represent-everyone-116810">underrepresented people and communities</a> remains important, the use of technology is spreading widely. There were <a href="https://p.widencdn.net/kqy7ii/Digital2019-Report-en">3.4 billion social media users</a> worldwide in 2019, and the growth in numbers is accelerating. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/online-tools-can-help-people-in-disasters-but-do-they-represent-everyone-116810">Online tools can help people in disasters, but do they represent everyone?</a>
</strong>
</em>
</p>
<hr>
<p>Besides, many Australian cities and towns are investing in <a href="https://theconversation.com/smart-city-or-not-now-you-can-see-how-yours-compares-130881">smart city strategies</a> and infrastructures. These localities provide <a href="https://www.wiman.me/australia">free public Wi-Fi</a> connections. And almost <a href="https://www.consultancy.com.au/news/616/9-out-of-10-australian-citizens-now-own-a-smartphone">90% of Australians now own a smart phone</a>.</p>
<p>The second concern is information accuracy or <a href="https://edition.cnn.com/2020/03/02/politics/state-efforts-against-social-media-misinformation/index.html">“fake news” on social media</a>. Evidently, sharing false information and rumours compromises the information social media provides. Social media images and videos tagged with location information can provide more reliable, eye-witness information.</p>
<p>Another concern is difficulty in receiving social media messages from severely affected areas. For instance, the disaster might have brought down internet or 4G/5G coverage, or people might have been evacuated from areas at risk. This might lead to limited social media posts from the actual disaster zone, with increasing numbers of posts from the places people are relocated. </p>
<p>In such a scenario, alternative social media analytics are on offer. We can use <a href="https://theconversation.com/hide-your-location-on-twitter-we-can-still-find-you-and-thats-not-a-bad-thing-in-an-emergency-58649">content analysis</a> and <a href="https://theconversation.com/explainer-how-the-internet-knows-if-youre-happy-or-sad-77401">sentiment analysis</a> to determine the disaster location and impact.</p>
<h2>How to make the most of social media</h2>
<p>Social media and its applications are generating new and innovative ways to manage disasters and reduce their impacts. These include: </p>
<ul>
<li>increasing community trust in emergency services by social media profiling </li>
<li>crowd-sourcing the collection and sharing of disaster information</li>
<li>creating awareness by incorporating <a href="https://doi.org/10.1108/IJDRBE-08-2019-0054">gamification applications</a> in social media<br></li>
<li>using social media data to detect disaster intensity and hotspot locations</li>
<li>running <a href="https://doi.org/10.1016/j.ssci.2019.02.029">real-time data analytics</a>.</li>
</ul>
<p>In sum, social media could become a mainstream information provider for disaster management. The need is likely to become more pressing as human-induced <a href="https://eprints.qut.edu.au/132499/">climate change</a> <a href="https://www.aspistrategist.org.au/editors-picks-for-2019-preparing-for-the-era-of-disasters/">increases the severity and frequency of disasters</a>.</p>
<p>Today, as we confront the COVID-19 pandemic, social media analytics are helping to <a href="https://theconversation.com/coronavirus-how-twitter-could-more-effectively-ease-its-impact-132422">ease its impacts</a>. <a href="https://doi.org/10.3390/en13061473">Artificial intelligence (AI)</a> technologies are greatly reducing processing time for social media analytics. We believe the next-generation AI will enable us to undertake <a href="https://www.netbase.com/blog/the-2019-social-analytics-and-artificial-intelligence-report">real-time social media analytics</a> more accurately.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-how-twitter-could-more-effectively-ease-its-impact-132422">Coronavirus: How Twitter could more effectively ease its impact</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/134912/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tan Yigitcanlar receives funding from the Commonwealth and Queensland Governments for his current research on the planning of smart and sustainable cities and innovation districts. He is affiliated with the Brazilian Federal University of Santa Catarina as an honorary professor.</span></em></p><p class="fine-print"><em><span>Ashantha Goonetilleke receives funding from the Queensland and Commonwealth Government and Logan City Council for his current research. </span></em></p><p class="fine-print"><em><span>Nayomi Kankanamge is a PhD student of the Queensland University of Technology. She receives funding from the Queensland University of Technology Postgraduate Research Award. </span></em></p>Australian emergency services are using social media for a number of purposes during disasters. What they are not doing well is analysing social media data in real time to improve disaster management.Tan Yigitcanlar, Associate Professor of Urban Studies and Planning, Queensland University of TechnologyAshantha Goonetilleke, Professor, Queensland University of TechnologyNayomi Kankanamge, PhD Candidate, School of Built Environment, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1360062020-04-20T14:59:30Z2020-04-20T14:59:30ZEmergency service workers are already at high risk of burnout – coronavirus will make this worse<figure><img src="https://images.theconversation.com/files/328689/original/file-20200417-152585-4tkbot.jpg?ixlib=rb-1.1.0&rect=27%2C18%2C6162%2C3090&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/british-ambulance-responding-emergency-hazardous-bad-635231459">Brian A Jackson/Shutterstock</a></span></figcaption></figure><p>As the COVID-19 pandemic moves from weeks to months, the emergency services are coming under even more strain and pressure – whether they are operating in the police, fire brigade or the ambulance service</p>
<p>MIND, the mental health charity has found that nearly 90% of emergency service staff have experienced stress, <a href="https://www.mind.org.uk/news-campaigns/news/mind-research-finds-stress-affects-nine-in-ten-emergency-services-personnel/">low mood and poor mental health</a> at some point while working for the emergency services. </p>
<p>In my work, <a href="https://www.researchgate.net/publication/324018183_The_crisis_in_NHS_Ambulance_Services_in_the_UK_Let's_deal_with_the_'elephants_in_the_room'">I have highlighted</a> the growing instances of post traumatic stress disorder (PTSD) and other associated illness among emergency workers. This affects the <a href="https://www.kcl.ac.uk/kcmhr/publications/assetfiles/2015/Dunn2015.pdf">psychological wellbeing</a> of staff and significantly impacts their ability to function effectively while at work. It also affects the productivity of the emergency services while having a “ripple” effect on families. Cases of harassment and bullying of emergency service staff are also <a href="https://www.bbc.co.uk/news/uk-england-essex-51416677">fairly common</a>. </p>
<p><a href="https://emj.bmj.com/content/31/3/242">Evidence</a> from around the world suggests that paramedics are at risk of acute and chronic stress. And that this can lead to cardiovascular diseases, sleep problems and obesity along with mental health problems.</p>
<p>In my research, I have highlighted staff <a href="http://aace.org.uk/wp-content/uploads/2015/09/Ambulance-2020-and-beyond-the-AACE-vision.pdf">shortages and retention issues</a> in the NHS. My work has also shown how the highest <a href="https://www.emeraldinsight.com/doi/abs/10.1108/IJES-02-2016-0004">sickness absence rates</a> in the NHS are dominated by the ambulance workforce. </p>
<p>This helps to explain why <a href="https://www.itv.com/news/2020-03-27/covid-19-firefighters-to-deliver-food-drive-ambulances-and-retrieve-bodies/">firefighters</a> have agreed to deliver food and medicine, drive ambulances and retrieve bodies during the pandemic. And along with the call for <a href="https://news.sky.com/story/coronavirus-4-500-retired-doctors-and-nurses-sign-up-to-battle-covid-19-pandemic-11961685">retired doctors and nurses to return to work</a>, there have also been suggestions that former ambulance staff and police officers should come back to the frontline. This is seen as crucial to maintain operational resilience as demand grows on emergency services. </p>
<h2>Safety first?</h2>
<p>This all paints a fairly bleak picture of what life is like for an emergency service worker on the frontline – even without the current COVID-19 pandemic.</p>
<p>The safety of frontline emergency staff also remains a major issue.
The government has come under severe <a href="https://www.theguardian.com/politics/2020/apr/02/no-10-seeks-to-end-covid-19-lockdown-with-immunity-passports">criticism</a> for its tardy response towards mass testing for COVID-19 – both for frontline responders and the community. <a href="https://www.theguardian.com/commentisfree/2020/apr/02/doctors-nurses-lack-of-equipment-johnson-government">There has also been an increasing number</a> of healthcare staff dying due to lack of personal protective equipment (PPE), along with reports of staff “<a href="https://www.bbc.co.uk/news/uk-england-essex-52118437">limiting work</a>” due to such shortages.</p>
<p>The availability of PPE is fundamental to emergency first responders as the disease spreads. The Fire Brigade Union has already raised <a href="https://www.fbu.org.uk/circular/2020hoc0196mw/covid-19-testing-fire-service-personnel">concerns</a> for the safety of its members. It has highlighted the need for immediate testing to enable firefighters to “maintain resilience for the core functions of the service”. </p>
<p>Similar concerns about <a href="https://www.theboltonnews.co.uk/news/18353623.concerns-personal-protective-equipment-police-officers/">lack of testing</a> of frontline police staff and availability of <a href="https://www.swindonadvertiser.co.uk/news/18355886.wiltshire-police-federation-concerned-ppe-stocks-coronavirus-crisis-continues/">PPE stocks</a> have also been highlighted, along with reports of ambulance crews “<a href="https://www.bbc.co.uk/news/uk-england-suffolk-51914221">not being adequately protected</a>”. </p>
<p>The situation is further exacerbated by the mindless behaviour of some people – with reports of crowds coughing on police staff along with senseless attacks on <a href="https://www.kentonline.co.uk/thanet/news/holes-drilled-in-tyres-as-six-ambulances-attacked-224229/">ambulance crews</a>. Rightly, the Crown Prosecution Service has said that any such attacks on emergency workers will be punishable by up to two years <a href="https://www.theguardian.com/world/2020/mar/26/coronavirus-threats-are-crimes-says-cps-after-spate-of-cough-attacks">in prison</a>.</p>
<p>The crisis also demands constant monitoring to ensure emergency services are able to operate effectively without pushing individual services “<a href="https://www.theguardian.com/commentisfree/2020/mar/20/nhs-paramedic-coronavirus-service-ambulance-crews">over the edge</a>”. I have previously identified such pressures in the <a href="https://blogs.edgehill.ac.uk/comment/2018/11/12/winter-pressures-and-the-nhs-ambulance-services-doing-more-with-less-is-not-an-option/">NHS ambulance services</a>, which is grappling with an ever increasing demand even during “normal” times. </p>
<p>I have also identified existing <a href="https://www.palgrave.com/gb/book/9783030213282">governance challenges</a> and <a href="https://theconversation.com/grenfell-tower-inquiry-expert-explains-four-main-findings-and-how-emergency-services-must-improve-126163">coordination issues</a> between emergency services, something highlighted by the <a href="https://www.grenfelltowerinquiry.org.uk/phase-1-report">Grenfell Inquiry report</a> into the fire at the Grenfell Tower in London in June 2017.</p>
<h2>Staff morale</h2>
<p>The <a href="https://theconversation.com/coronavirus-why-clapping-for-carers-feels-so-strangely-uplifting-135092">professionalism and bravery</a> of emergency service workers, who <a href="https://theconversation.com/healthcare-workers-and-coronavirus-behind-the-stiff-upper-lip-we-are-highly-vulnerable-133864">risk their lives</a> to protect the community and keep us safe, has been particularly highlighted in the pandemic. But like many other sectors, emergency services are facing <a href="https://theconversation.com/coronavirus-to-avoid-major-humanitarian-fallout-uk-must-act-urgently-133968">big challenges</a> in dealing with the COVID-19 situation – and this is bound to impact upon their mental wellbeing.</p>
<p>The sheer complexity involved in dealing with a fast-moving pandemic necessitates good leadership, determination and honesty. This will be crucial to coordinate responses between various agencies to maximise resources, protect staff and maintain organisational resilience across the sector. This is far from easy, and as my analysis suggests, may prove a real test for leaders.</p>
<p>Ultimately the crisis demands <a href="https://www.kingsfund.org.uk/blog/2020/03/covid-19-crisis-compassionate-leadership">compassionate leadership</a> so that service chiefs can boost staff morale and motivate staff in responding to the COVID-19 crisis to help save lives.</p><img src="https://counter.theconversation.com/content/136006/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paresh Wankhade is affiliated with
Fellow, Institute of Civil Protection and Emergency Management
Trustee, Fire Service Research and Training Trust </span></em></p>Nearly 90% of emergency service staff have experienced stress, low mood and poor mental health.Paresh Wankhade, Professor of Leadership and Management, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1299002020-01-16T19:03:21Z2020-01-16T19:03:21ZTo improve firefighters’ mental health, we can’t wait for them to reach out – we need to ‘reach in’<p>Many firefighters will by now be exhausted, having been on the front line of Australia’s bushfire crisis for weeks or months. </p>
<p>This bushfire season has been unrelenting, and the hottest months of summer <a href="https://theconversation.com/the-bushfires-are-horrendous-but-expect-cyclones-floods-and-heatwaves-too-129328">may still lie ahead</a>.</p>
<p>In part, the toll is physical. The flames are high, they are intense, and they move fast. It’s hard to breathe because the air is so hot. </p>
<p>At the same time, first responders have witnessed widespread devastation. To land and livelihoods, to people and animals. Meanwhile, grief for the death of fellow firefighters feels raw, and the risk to their own lives very real.</p>
<p>We’re right to be concerned about firefighters’ mental health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-can-still-picture-the-faces-black-saturday-firefighters-want-you-to-listen-to-them-not-call-them-heroes-128632">'I can still picture the faces': Black Saturday firefighters want you to listen to them, not call them 'heroes'</a>
</strong>
</em>
</p>
<hr>
<h2>Emergency responders already have poorer mental health</h2>
<p>Every <a href="https://blackdoginstitute.org.au/get-involved/make-a-donation/PTSD">4.3 weeks</a>, a firefighter, paramedic or police officer dies by suicide – and that’s when it’s “business as usual”. </p>
<p>Research shows our first responders are <a href="http://resources.beyondblue.org.au/prism/file?token=BL/1898">more likely</a> to be diagnosed with a mental health condition than the overall Australian population. They are more than twice as likely to think about suicide, and three times as likely to have a suicide plan. </p>
<p>This paints a grim picture of the well-being of a population who dedicate their professional lives to helping others.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/as-bushfires-intensify-we-need-to-acknowledge-the-strain-on-our-volunteers-127517">As bushfires intensify, we need to acknowledge the strain on our volunteers</a>
</strong>
</em>
</p>
<hr>
<p>It’s likely responding to a disaster on the scale of the current bushfires could increase the risk of mental illness for some.</p>
<p>If firefighters are <a href="https://www.abc.net.au/radio/programs/pm/bushfire-volunteers-struggle-to-cope-with-post-traumatic-stress/11827760">not coping</a>, they may develop psychological disorders including post-traumatic stress disorder (PTSD), anxiety, depression, and substance abuse.</p>
<h2>PTSD</h2>
<p>PTSD develops when a person isn’t able to recover after experiencing a traumatic event.</p>
<p>Some firefighters may develop symptoms while they’re still fighting the fires. They may feel on edge, but push down their fears to get on with the job. However, it’s more likely symptoms will only appear weeks, months, even years down the track.</p>
<p>PTSD is associated with significant impairment in day-to-day functioning socially and at work. For firefighters and others with PTSD, <a href="https://theconversation.com/explainer-what-is-post-traumatic-stress-disorder-11135">typical symptoms or behaviours</a> will include:</p>
<ul>
<li><p>reliving the traumatic event. People with PTSD describe vivid images and terrifying nightmares of their experience</p></li>
<li><p>avoiding reminders of what happened. They may become emotionally numb and isolate themselves to avoid any triggers</p></li>
<li><p>being constantly tense and jumpy, always looking out for signs of danger.</p></li>
</ul>
<p>Volunteers in regional communities are particularly susceptible to trauma. They have often joined fire brigades to help protect their own communities, and then face trying to save their own homes or those of neighbours and friends.</p>
<p>We also need to be mindful of retired firefighters for whom these current bushfires will have triggered painful and disturbing memories. They may not currently be on the front lines, but they only need to turn on the television, open the newspaper, or look at social media to be taken straight back to Black Saturday or whatever particular event is distressing for them. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/paramedics-need-more-support-to-deal-with-daily-trauma-97315">Paramedics need more support to deal with daily trauma</a>
</strong>
</em>
</p>
<hr>
<h2>The problem with reaching out</h2>
<p>The increased prevalence of mental health issues among emergency responders suggests many existing emergency service well-being programs are failing those who need them the most. </p>
<p>In Australia, these programs are largely based on a what’s called a “resilience model” that focuses on people “reaching out” and seeking help when they need it. </p>
<p>First responders may be unlikely to take this initiative in the middle of a mental health crisis, when it’s often a struggle even to pick up the phone to a loved one, friend or colleague.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/310389/original/file-20200116-134784-6qyoue.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/310389/original/file-20200116-134784-6qyoue.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310389/original/file-20200116-134784-6qyoue.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310389/original/file-20200116-134784-6qyoue.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310389/original/file-20200116-134784-6qyoue.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310389/original/file-20200116-134784-6qyoue.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310389/original/file-20200116-134784-6qyoue.jpeg?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">
<figcaption>
<span class="caption">Some firefighters might not reach out for help when they need it.</span>
<span class="attribution"><span class="source">Jacob Carracher</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Instead, we need an approach to well-being that removes the onus on the individual. We need to shift our thinking from a model that requires the individual to “reach out”, to a model that also values others “reaching in” to identify those who may be struggling.</p>
<p>Ambulance Victoria’s <a href="https://www.ambulance.vic.gov.au/peer-dogs-take-the-lead/">Peer Support Dog Program</a>, which allows staff to bring in accredited dogs to create social interactions and conversations, is a good example of how “reaching in” helps with first responder well-being. This kind of approach empowers people through social connections and the appreciation they are also supporting others.</p>
<p>While employers need to do more in to facilitate “reach in” programs, anyone can create informal support networks. Whether friendship groups, community groups, sporting groups, or something else, the underlying thread should be a committment to each other’s well-being.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-rise-of-eco-anxiety-climate-change-affects-our-mental-health-too-123002">The rise of 'eco-anxiety': climate change affects our mental health, too</a>
</strong>
</em>
</p>
<hr>
<p>As we continue to contend with this crisis, ensuring firefighters feel supported can make a difference to their well-being. If you see a responder in the street, say thank you. If you see one in a cafe, shout them a cuppa. If you have kids, get them to write a letter or draw a picture and drop it off to the local emergency services station. </p>
<p>We can’t eliminate the risk firefighters will suffer with mental health problems after what they’ve been through, but these little acts of kindness can make a difference.</p>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/129900/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erin Smith is affiliated with The Code 9 Foundation and The Australian Red Cross.</span></em></p>Emergency service workers already have poorer mental health than the rest of us. In the wake of this bushfire crisis, we need to make the well-being of our first responders a top priority.Erin Smith, Associate Professor in Disaster and Emergency Response, School of Medical and Health Sciences, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1292982020-01-03T10:23:38Z2020-01-03T10:23:38ZHow to monitor the bushfires raging across Australia<p>As I write this, fires are consuming huge swathes of Australia and conditions are expected to worsen. The situation is attracting global interest, and reporting has been extensive. </p>
<p>But it isn’t always easy to find reliable information on how the situation is developing in specific areas that are home to your family and friends.</p>
<p>The following short guide draws on my experience covering bushfires as a reporter and my academic research. It may not be exhaustive but is intended to help Australians and their overseas family and friends source useful information and monitor the movement of fire fronts in real time.</p>
<hr>
<p><em>Editors note: The Conversation will add to this list as the situation develops, and publish extensive bushfire analysis – on what’s happened, why and what’s next for Australia – in the coming days and weeks. <a href="https://theconversation.com/au/newsletters">Sign up to our daily newsletter</a> to stay informed.</em></p>
<hr>
<h2>Australia-wide</h2>
<p>The Geoscience Australia <a href="https://sentinel.ga.gov.au/#/">Digital Earth Australia Hotspots</a> shows the national picture. (As noted <a href="https://twitter.com/EarthObserved/status/1213062431666126848">here</a>, it is being upgraded to the new and improved <a href="https://hotspots.dea.ga.gov.au/">Digital Earth Australia Hotspots</a> site.)</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/308400/original/file-20200103-11891-13vdve5.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/308400/original/file-20200103-11891-13vdve5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/308400/original/file-20200103-11891-13vdve5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=436&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308400/original/file-20200103-11891-13vdve5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=436&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308400/original/file-20200103-11891-13vdve5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=436&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308400/original/file-20200103-11891-13vdve5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=549&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308400/original/file-20200103-11891-13vdve5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=549&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308400/original/file-20200103-11891-13vdve5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=549&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 national fire situation as of January 3, 2020.</span>
<span class="attribution"><a class="source" href="https://sentinel.ga.gov.au/#/">Geoscience Australia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The latest fire weather warnings are also available on the Bureau’s <a href="http://www.bom.gov.au/australia/warnings/?ref=ftr">National Warnings</a> page.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-seeing-the-news-up-close-one-devastating-post-at-a-time-128774">Friday essay: seeing the news up close, one devastating post at a time</a>
</strong>
</em>
</p>
<hr>
<h2>Fast-breaking news and emergency broadcasts</h2>
<p>The latest warnings and news coverage are available for each state via the ABC emergency broadcaster in each state and territory. For current ABC emergency alerts, warnings and news coverage see: </p>
<ul>
<li><a href="https://www.abc.net.au/news/emergency/state/nsw/">ABC New South Wales and ACT</a> ; </li>
<li><a href="https://www.abc.net.au/news/emergency/state/vic/">ABC Victoria</a>; </li>
<li><a href="https://www.abc.net.au/news/emergency/state/qld/">ABC Queensland</a>; </li>
<li><a href="https://www.abc.net.au/news/emergency/state/wa/">ABC Western Australia</a>; </li>
<li><a href="https://www.abc.net.au/news/emergency/state/sa/">ABC South Australia</a> and </li>
<li><a href="https://www.abc.net.au/news/emergency/state/tas/">ABC Tasmania</a>.</li>
</ul>
<p>In fast-moving and emergency fire situations, ABC Radio posts directly to its Facebook page <a href="https://www.facebook.com/ABCemergency/">Bushfire Recovery Relief</a> page.</p>
<p>For fast-breaking news, follow the Twitter hashtags: <a href="https://twitter.com/hashtag/ausfires?src=hash">#ausfires</a>, <a href="https://twitter.com/hashtag/bushfiresaustralia?src=hash">#bushfiresaustralia</a>, <a href="https://twitter.com/hashtag/nswfires?src=hash">#nswfires</a>, <a href="https://twitter.com/hashtag/vicfires?src=hash">#vicfires</a>, <a href="https://twitter.com/hashtag/tasfires?src=hash">#tasfires</a>, and <a href="https://twitter.com/hashtag/wafires?src=hash">#wafires</a>.</p>
<h2>South eastern Australia</h2>
<p>As strong south-easterly winds arrive during Friday night and on Saturday, it will be too dangerous in some areas for ground crews to confront fast-moving fire-fronts.</p>
<p>Evacuation orders were issued early on Friday for <a href="http://emergency.vic.gov.au/respond/">East Gippsland areas</a> west of Kosciuszko National Park, south west of Canberra, in addition to evacuation orders issued for three other areas of south east NSW.</p>
<p>A fleet of aircraft monitors the movement of active fire fronts overnight using infrared cameras. During the day, waterbombing helicopters and fixed wing aircraft drop water and fire retardants to protect towns and houses where possible.</p>
<p>Aircraft movements over fire zones can be tracked in real time using <a href="https://www.flightradar24.com/-27.47,153.02/8">Flightradar24</a>.</p>
<p>Residents and visitors to south eastern Australia were asked to leave before the most severe weather conditions arrive on Saturday, with temperatures to soar to the mid to high 40s and for strong and changeable winds.</p>
<h2>Victoria</h2>
<p>In Victoria, a <a href="https://www.premier.vic.gov.au/victorian-government-declares-a-state-of-disaster/">State of Disaster</a> has been declared as dozens of new, active fires are burning across hundreds of square kilometres of inaccessible rugged and mountainous national parkland.</p>
<p>Residents of towns in East Gippsland were <a href="https://www.premier.vic.gov.au/victorian-government-declares-a-state-of-disaster/">ordered to evacuate</a> this week ahead of dangerous fire conditions.</p>
<p>To monitor active fires in Victoria, see <a href="https://www.cfa.vic.gov.au/home">Country Fire Authority</a> notifications, download the <a href="https://www.cfa.vic.gov.au/plan-prepare/vicemergency-app">VicEmergency App</a> (and follow the <a href="https://twitter.com/vicemergency">VicEmergency Twitter account</a>) and listen to the emergency broadcaster, <a href="https://www.abc.net.au/news/emergency/">ABC Radio</a>.</p>
<p>In Gippsland, listen to the local <a href="https://www.abc.net.au/radio/gippsland/live/">ABC Gippsland</a> station and connect with the local Gippsland community for the latest updates at <a href="https://www.facebook.com/ABCGippsland/">ABC Gippsland Facebook page</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hunter-hunted-when-the-world-catches-on-fire-how-do-predators-respond-126280">Hunter, hunted: when the world catches on fire, how do predators respond?</a>
</strong>
</em>
</p>
<hr>
<h2>New South Wales</h2>
<p>To monitor the whole NSW fire situation, see the <a href="https://www.rfs.nsw.gov.au/fire-information/fires-near-me">NSW Fires Near Me</a> website and app.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/308405/original/file-20200103-11909-stjlo0.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/308405/original/file-20200103-11909-stjlo0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/308405/original/file-20200103-11909-stjlo0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=164&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308405/original/file-20200103-11909-stjlo0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=164&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308405/original/file-20200103-11909-stjlo0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=164&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308405/original/file-20200103-11909-stjlo0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=206&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308405/original/file-20200103-11909-stjlo0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=206&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308405/original/file-20200103-11909-stjlo0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=206&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fires Near Me map icons.</span>
<span class="attribution"><a class="source" href="https://www.rfs.nsw.gov.au/fire-information/fires-near-me">NSW RURAL FIRE SERVICE</a></span>
</figcaption>
</figure>
<p>People in several parts of NSW have been advised to leave now. In some areas, people have been told it is already too late to leave. Key areas include:</p>
<ul>
<li>the <a href="https://www.rfs.nsw.gov.au/__data/assets/pdf_file/0008/146384/A3-tourist-leave-zones-South-Coast-flyer.pdf">south coast of NSW</a> from Bateman’s Bay to Wonboyn near the Victorian border. Thousands of people trapped in the danger zone since New Year’s Eve are leaving by car or boat ahead of the worsening conditions;</li>
<li>the <a href="https://www.rfs.nsw.gov.au/__data/assets/pdf_file/0005/147173/A3-leave-zones-Batlow-flyer.pdf">Batlow/Wondalga</a> area south west of the national capital, Canberra. Motorists have been told it is not safe to enter the area. People leaving were told to travel north towards Wagga Wagga but were later told it is too late to leave;</li>
<li>the <a href="https://www.rfs.nsw.gov.au/__data/assets/pdf_file/0009/147177/A3-leave-zones-Shoalhaven-flyer.pdf">Shoalhaven area near Sussex Inlet</a>. Firefighters expect extreme conditions worse than those on New Year’s Eve. It is likely that roads will be cut, potentially trapping people on beaches again;</li>
<li>the popular skiing resorts of the <a href="https://www.rfs.nsw.gov.au/__data/assets/pdf_file/0009/147186/A3-tourist-leave-zones-Snowy-Monaro-flyer.pdf">Snowy Monaro</a>. Evacuations have been ordered from Australia’s highest peak, Mount Kosciusko, in Kosciusko National Park, and the towns of Jindabyne, Berridale and Anglers Reach. Updates are available via the <a href="https://www.facebook.com/MonaroRFS/?__tn__=%2Cd%2CP-R&eid=ARD29w8xF9VJLax4GiZWCos0tbw_uMCXXVVQFYLVihEe3Rxx4Qi-jbCnOT3BJdHW8nP8GmHZbvj9zqgP">Monaro Team Rural Fire Service</a>;</li>
<li>the area of Khancoban and the large area west of the Kosciuszko National Park. Fire authorities warn that communities in this area would not be defendable on Saturday. </li>
</ul>
<p>The situation is rapidly changing so check local information (or stay in touch via the ABC emergency broadcasts) for the most up to date advice.</p>
<h2>Tasmania</h2>
<p>In Tasmania, follow the <a href="http://www.fire.tas.gov.au/Show?pageId=colGMapBushfires">Tasmanian Fire Service</a> website for the latest updates and warnings. To connect with the community in Tasmania, see the <a href="https://www.facebook.com/TasmaniaFireService/">Tasmania Fire Service</a> Facebook page.</p>
<h2>South Australia</h2>
<p>In South Australia follow the South Australian <a href="https://www.cfs.sa.gov.au/site/home.jsp">Country Fire Service</a> for updates. <a href="https://www.cfs.sa.gov.au/site/warnings_and_incidents.jsp">Current fires</a> are burning in the Mount Lofty Ranges, the West Coast and the Riverland districts.</p>
<p>A dangerous fire is burning on Kangaroo Island south of Adelaide. <a href="https://www.cfs.sa.gov.au/site/home/criimson/emergency_warning_message_ravine_issued_03_jan_16160004365.jsp">An emergency warning</a> was issued at 4.15pm Friday asking people to leave and warning the fire may pose a threat to lives directly in the path of the fire.</p>
<h2>Western Australia</h2>
<p>In Western Australia, follow <a href="https://www.emergency.wa.gov.au/">Emergency WA</a>. A total fire ban has been declared in Western Australia but there are no current emergency warnings. There are <a href="https://www.emergency.wa.gov.au/">bushfire advice notifications</a> for several fires burning in Western Australia.</p>
<h2>Queensland</h2>
<p>In Queensland, current bushfires can be monitored on the Queensland Government <a href="https://www.ruralfire.qld.gov.au/map/Pages/default.aspx">Rural Fire Service</a> website. To monitor fire advice, watch and act alerts and emergency alerts see the Current Bushfires page of the <a href="https://www.ruralfire.qld.gov.au/map/Pages/default.aspx">Rural Fire Service</a> website.</p>
<h2>Traffic updates</h2>
<p>Live traffic updates are available at <a href="https://www.livetraffic.com/desktop.html">Live Traffic NSW</a> and via the Live Traffic NSW App.</p>
<p>Motorists can create a free account so they can plan their journey and get updates on traffic hazards if roads along your planned route become impassable.</p>
<h2>Missing people</h2>
<p>People who are leaving home due to the bushfires are asked to register with the Red Cross <a href="https://register.redcross.org.au/">Register. Find. Reunite</a> registration service online or at evacuation centres. Family and friends can use this site to check on their loved ones.</p>
<h2>Connect with communities</h2>
<p>If there’s a key area of interest for you, search for the local fire brigade and community Facebook page.</p>
<p>Communities that are facing severe fire threat include <a href="https://www.facebook.com/groups/mallacoota/">Mallacoota</a>, <a href="https://www.facebook.com/batlowfirestation/">Batlow</a>; <a href="https://www.facebook.com/nswrfsshoalhaven/">Shoalhaven</a> and <a href="https://www.facebook.com/MonaroRFS/?__tn__=%2Cd%2CP-R&eid=ARD_g5LWPxKtM0yjZ56vshME3Q0Vu6YBvmHVmJwLYMzT3oU3jxv0nzGvFiG-3aoVlkkJzRXk2qfyh3_8">Snowy Monaro</a>.</p>
<h2>How you can help</h2>
<p>Information on how you can help can be found on the NSW Rural Fire Service website <a href="https://www.rfs.nsw.gov.au/news-and-media/general-news/how-you-can-help">here</a>.</p>
<p><em>UPDATED: This story has been updated to add more info on how to monitor fires, and to reflect changing advice of fire authorities.</em></p><img src="https://counter.theconversation.com/content/129298/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Gearing 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>Here’s how Australians and their overseas family and friends can monitor the movement of fire fronts in real time.Amanda Gearing, Journalist, author, broadcaster, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1275172019-11-26T18:41:34Z2019-11-26T18:41:34ZAs bushfires intensify, we need to acknowledge the strain on our volunteers<figure><img src="https://images.theconversation.com/files/303640/original/file-20191126-84213-lbhtnp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The vast majority of bushfire fighters in Australia are volunteers. And their job is only getting harder.</span> <span class="attribution"><span class="source">Dean Lewins/AAP</span></span></figcaption></figure><p>The early and ferocious start to the bushfire season in Australia this year has raised questions about the impact on those at the frontline – the tens of thousands of volunteers helping to put out the blazes.</p>
<p>In Australia, <a href="https://www.sbs.com.au/news/the-feed/why-do-australia-s-bushfire-defences-rely-on-tens-of-thousands-of-volunteers">the vast majority of bushfire fighters are volunteers</a>. In the Queensland Fire and Emergency Services, for instance, <a href="https://www.qfes.qld.gov.au/about/Documents/Volunteerism-Strategy.PDF">volunteers account for 89% of the workforce</a>. </p>
<p>And with fire seasons due to become longer and bushfires more intense due to the impacts of climate change, this will place even more demands on the men and women undertaking this vital and demanding work.</p>
<p>Given this, it’s important for us to understand how our worsening bushfires are affecting the mental and physical health of volunteers. Is this causing burnout? And if so, is that making it more difficult for fire and emergency services to recruit new volunteers and keep the ones they have?</p>
<h2>Challenges for volunteer recruitment and retention</h2>
<p>Of course, the impact of today’s bushfires needs to be viewed within the context of other challenges to volunteer recruitment and retention. </p>
<p>Two of the key factors are greater competition for people’s time – for example, due to <a href="https://www.sciencedirect.com/science/article/abs/pii/S1464286705000173">changes in the nature of paid work</a> – and the increasing difficulty of balancing work, family and volunteer commitments. </p>
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Read more:
<a href="https://theconversation.com/why-rural-australia-is-facing-a-volunteer-crisis-95937">Why rural Australia is facing a volunteer crisis</a>
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<p>The <a href="https://link.springer.com/article/10.1023%2FA%3A1023948027200">ways people choose to volunteer are also changing</a>. Many people are choosing more flexible, shorter-term and cause-driven ways of volunteering and eschewing the kind of structured, high-commitment volunteering that is common in the emergency services.</p>
<p>At the same time, rural communities <a href="https://theconversation.com/why-rural-australia-is-facing-a-volunteer-crisis-95937">are facing a shrinking volunteer base</a> as people either leave for better opportunities in cities or can no longer perform strenuous volunteering roles.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/303682/original/file-20191126-112489-1unzmwf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/303682/original/file-20191126-112489-1unzmwf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/303682/original/file-20191126-112489-1unzmwf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/303682/original/file-20191126-112489-1unzmwf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/303682/original/file-20191126-112489-1unzmwf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/303682/original/file-20191126-112489-1unzmwf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/303682/original/file-20191126-112489-1unzmwf.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">Father and son volunteers with the NSW Rural Fire Service.</span>
<span class="attribution"><span class="source">Dan Peled/AAP</span></span>
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</figure>
<p>Meanwhile, a lot has been said about younger generations being less motivated by altruistic values to volunteer. </p>
<p>However, <a href="https://theconversation.com/stop-calling-young-people-apathetic-for-many-volunteering-and-activism-go-hand-in-hand-123754">there is considerable evidence</a> that younger people are highly committed to making a positive contribution to society. They are just doing it differently than their parents – they are tapping into the power of social media and working outside of formal, structured organisations.</p>
<p>Changes to emergency management services are also at play. <a href="https://www.bnhcrc.com.au/publications/biblio/bnh-5415">One of the most significant shifts</a> has been the professionalisation, corporatisation and modernisation of volunteer-based emergency services in recent years. </p>
<p>While this has undeniably brought improvements to volunteer safety and the quality of service, it has also caused headaches for volunteers in the form of more bureaucracy and additional training requirements.</p>
<p>There is a risk <a href="https://apo.org.au/sites/default/files/resource-files/2019/06/apo-nid244761-1369896.pdf">this could drive a wedge</a> between the corporate goals of fire and emergency service agencies that focus on risk management and efficiency, for example, and their more traditional, community-based roots – the reason many people choose to volunteer in the first place.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/stop-calling-young-people-apathetic-for-many-volunteering-and-activism-go-hand-in-hand-123754">Stop calling young people apathetic. For many, volunteering and activism go hand-in-hand</a>
</strong>
</em>
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<h2>Improving support for volunteers</h2>
<p>This type of volunteering can be demanding. Bushfire volunteers face a range of significant stresses that can be <a href="https://search.informit.com.au/documentSummary;dn=943666236119043;res=IELHSS">physical</a>, <a href="https://www.beyondblue.org.au/about-us/about-our-work/workplace-mental-health/pes-program/national-mental-health-and-wellbeing-study-of-police-and-emergency-services">mental and emotional</a>. <a href="https://www.theguardian.com/australia-news/2019/apr/09/former-fire-chiefs-warn-australia-unprepared-for-escalating-climate-threat">Volunteer fatigue and burnout are real concerns</a>.</p>
<p>There are also economic burdens for both volunteers and their employers, as well as strains on their family members. </p>
<p>Additionally, with the likelihood of more intense bushfires in the future, volunteers will increasingly be asked to <a href="https://www.vfbv.com.au/index.php/champs/urban/results/item/739-cfa-assistance-to-nsw">travel outside their own communities</a> to fight fires in other regions, further complicating their lives.</p>
<p>Having said this, support for volunteers is available and improving. In <a href="https://www.bnhcrc.com.au/research/resilience-hazards/3533">my ongoing research</a> with other academics at the Bushfire and Natural Hazard Cooperative Research Centre, interviewees report improvements in operational equipment, technology and procedures that are enhancing volunteer safety. </p>
<p>Emergency services are also increasing mental health and well-being support for volunteers and developing <a href="https://www.ses.nsw.gov.au/media/2964/volunteering-reimagined-overview-paper.pdf">more diverse and flexible ways</a> for people to fit volunteering into their lives. </p>
<p>There is also a <a href="https://malechampionsofchange.com/groups/male-champions-change-fire-emergency/">strong commitment</a> to improving diversity and inclusion across the sector. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1197375914079731713"}"></div></p>
<h2>The reasons people want to help</h2>
<p>Even though fighting fires is obviously demanding work, it is also extremely fulfilling and rewarding. <a href="https://www.bnhcrc.com.au/publications/biblio/bnh-6012">Core reasons</a> that people choose to volunteer include helping the community, learning new skills, feeling useful and doing something worthwhile, and experiencing camaraderie with others.</p>
<p><a href="https://www.bnhcrc.com.au/research/resilience-hazards/3533">In our ongoing research</a>, we are consistently hearing that the personal fulfilment and rewards of volunteering are not being adequately communicated to the public. If they were, a lot more people would offer their services.</p>
<p>In addition, many volunteering roles <a href="https://www.miragenews.com/get-behind-frontline-to-help-our-emergency-services/">do not require people to be on the front lines</a> at all. There are a large number of <a href="https://www.mediastatements.wa.gov.au/Pages/McGowan/2019/11/Get-Behind-the-Frontline-to-help-our-emergency-services-.aspx">opportunities</a> to support fire prevention, response and recovery well beyond the fires themselves. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/303683/original/file-20191126-112517-5su839.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/303683/original/file-20191126-112517-5su839.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/303683/original/file-20191126-112517-5su839.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/303683/original/file-20191126-112517-5su839.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/303683/original/file-20191126-112517-5su839.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/303683/original/file-20191126-112517-5su839.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/303683/original/file-20191126-112517-5su839.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">A volunteer-run donation center in Taree, NSW.</span>
<span class="attribution"><span class="source">Dean Lewins/AAP</span></span>
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</figure>
<p><a href="https://www.sciencedirect.com/science/article/pii/S2212420915300388">We also know</a> that everyday people are deeply motivated to help others in the face of disaster. Indeed, NSW RFS and QFES are likely to see an upswing in people inquiring about volunteering in the aftermath of the current fires. </p>
<p>However, there is one important thing to note: the best time to approach emergency services about volunteering is before an event, rather than during one.</p>
<h2>Volunteering at a crossroads</h2>
<p>If we are fighting bushfires into the next decade with the same or declining numbers of volunteers, using the same approaches we use today, then clearly the job will be much harder and the demands on volunteers will become more extreme. </p>
<p>The key variable that will make the most difference for volunteers is the willingness and commitment of emergency services, governments, society and volunteers themselves to embrace change to current practices. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/70-years-before-black-saturday-the-birth-of-the-victorian-cfa-was-a-sad-tale-of-politics-as-usual-111080">70 years before Black Saturday, the birth of the Victorian CFA was a sad tale of politics as usual</a>
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<p>This includes a greater investment in risk reduction, new operational approaches and involving volunteers more in organisational decision making. Emergency services providers should also be working more closely with community organisations to better understand and target the particular needs of different communities.</p>
<p>Whatever choices we make, we cannot leave it to our front line volunteers to bear an increasing burden of fighting the bushfires of the future.</p><img src="https://counter.theconversation.com/content/127517/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Blythe McLennan receives funding from the Bushfire and Natural Hazards Cooperative Research Centre. </span></em></p>Volunteer numbers are shrinking in rural areas, leaving fewer people to battle bushfires. We need to change our thinking about volunteering to recruit more firefighters and keep the ones we have.Blythe McLennan, Research Fellow, Centre for Urban Research, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1036002018-11-06T23:09:27Z2018-11-06T23:09:27ZHow the opioid crisis is disrupting hospital care<figure><img src="https://images.theconversation.com/files/243587/original/file-20181101-83657-10wj72h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Few medical schools offer training in addictions medicine and most doctors feel they lack the specialist expertise to deal with the inpatient opioid crisis. </span> <span class="attribution"><span class="source">(THE CANADIAN PRESS/Andrew Vaughan)</span></span></figcaption></figure><blockquote>
<p>“… there is always soma, delicious soma, half a gramme for a half-holiday, a gramme for a week-end, two grammes for a trip to the gorgeous East, three for a dark eternity on the moon…” </p>
</blockquote>
<p>In Aldous Huxley’s 1932 novel <em>Brave New World</em>, citizens are trapped in a chemically induced state of docility and compliance. Their fictional drug of choice: Soma. Throughout North America and in some parts of Europe today, people are rendered into a diminished state (and killed) by an all too real version of soma: Opioids. </p>
<p>The misuse of these powerful narcotics is leading to an epidemic of addiction and death. As doctors and researchers, we want to highlight an often overlooked face of this epidemic — its emergence as a major disruptor within Canada’s hospitals. </p>
<p>Images of paramedics resuscitating people who have overdosed on the street are common within the news media. But the face of the inpatient opioid crisis is equally sinister and must be addressed simultaneously.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-fix-canadas-opioid-crisis-it-starts-with-pain-and-the-prescription-pad-78512">How to fix Canada's opioid crisis: It starts with pain and the prescription pad</a>
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<p>Some hospitalized patients are engaging in extreme behaviours — violence toward staff and other patients, theft and other antisocial actions — that disrupt the care of others and put patients and staff at risk. </p>
<p>We are initiating a program at the Kingston Health Sciences Centre (KHSC) called START (The Substance Treatment and Rehabilitation Team). Programs like START can perhaps better handle the inpatient crisis using a dedicated multidisciplinary team of practitioners. </p>
<p>Specialists from addictions, family, emergency and internal medicine, along with those from psychiatry, anaesthesia, social work, public health and nursing, work together — to competently manage care of patients with substance abuse disorders and coordinate care with outpatient services. </p>
<h2>A growing epidemic</h2>
<p>Let’s start with one person’s story. Crystal was a 29-year old patient who was frequently admitted to hospital due to her diabetes and its complications (kidney failure, blindness). She was prescribed opiates to relieve her pain but over time became dependent on them. </p>
<p>Crystal required dialysis and had multiple bouts of sepsis, a serious full-body infection. Her pain was poorly controlled and we believe she lost hope. She was found dead in her hospital bed after self-administering a lethal dose of narcotics. </p>
<p>Unfortunately this story is <a href="https://www.theglobeandmail.com/news/british-columbia/fire-hall-no-2-and-bcs-fentanyl-crisis-in-the-downtown-eastside/article32535637/">not unique or even unusual anymore</a>. Opioids are responsible for <a href="https://www.longwoods.com/content/24568">one in six deaths of young adults aged 24 to 35</a> in Ontario. Almost 4,000 people died in Canada in 2017 from opioid-related causes. And in the United States, <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm">accidental overdoses now claim more lives than car crashes</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/243533/original/file-20181101-83641-1aah4ih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/243533/original/file-20181101-83641-1aah4ih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/243533/original/file-20181101-83641-1aah4ih.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/243533/original/file-20181101-83641-1aah4ih.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/243533/original/file-20181101-83641-1aah4ih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/243533/original/file-20181101-83641-1aah4ih.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/243533/original/file-20181101-83641-1aah4ih.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 Cincinnati Fire Department medic nasally administers Naloxone to a man while responding to a possible overdose report at a gas station in downtown Cincinnati.</span>
<span class="attribution"><span class="source">(AP Photo/John Minchillo, File)</span></span>
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<p>Despite public attention, this number continues to grow. The problem is prevalent across the country. Rural and mid-size communities are affected as well as big cities like Vancouver and Toronto. </p>
<h2>Patients create a street supply</h2>
<p>The causes are complex but doctors over-prescribing opiates and the emergence of new potent forms of “street” opiates have contributed to the crisis. Drugs <a href="https://www.theglobeandmail.com/news/investigations/a-killer-high-how-canada-got-addicted-tofentanyl/article29570025/">laced with the potent opioid fentanyl, smuggled from China</a>, often cause sudden death due to a complete cessation of breathing. </p>
<p>Over-prescription of opioids by doctors fuels addictions in people that drives them to use these dangerous street drugs. Diversion of prescription drugs and theft or misappropriation of drugs from pharmacies creates a supply of narcotics on the street. <a href="https://www.cbc.ca/news/canada/missing-drugs-pharmacies-part1-1.4708041">More than half a million prescription drugs, mostly opioids, are stolen from pharmacies each year.</a></p>
<p>Within hospitals, patients addicted to substances — notably but not exclusively opioids — are often involved in this drug theft and diversion. Diversion means they move their own prescription narcotics prescribed to the street, often selling them right on hospital grounds. </p>
<p>It’s estimated that <a href="https://deptmed.queensu.ca/dept-blog/canadas-brave-new-world-overuse-prescription-narcotics">one third of all opioids on Canada’s streets result from diversion of prescription drugs</a>. Greed allows these diverted drugs to be <a href="https://www.theglobeandmail.com/opinion/editorials/globe-editorial-its-time-for-an-all-out-war-on-fentanyl-in-canada/article38005623/">laced with fentanyl (which is cheap and powerful) by criminals</a>, and people are dying. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/243536/original/file-20181101-83661-ml7ati.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/243536/original/file-20181101-83661-ml7ati.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/243536/original/file-20181101-83661-ml7ati.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/243536/original/file-20181101-83661-ml7ati.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/243536/original/file-20181101-83661-ml7ati.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/243536/original/file-20181101-83661-ml7ati.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/243536/original/file-20181101-83661-ml7ati.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&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">Wooden crosses representing the 1,265 Ontario residents who lost their lives in 2017 to overdoses are placed on the lawn as a sign of protest at Queen’s Park in Toronto in October 2018.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Frank Gunn)</span></span>
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<p>While many patients who come to hospital are addicted, health-care providers feel inadequately trained to deal with them. Indeed the medical profession has been slow to recognize that there is a <a href="https://www.longwoods.com/content/24568">direct relationship between our rate of opioid prescriptions and mortality</a>, even after adjusting for predictors of adverse outcomes, such as age.</p>
<p>The overuse of prescription narcotics is not accidental but reflects cynical marketing by certain pharmaceutical companies, notably Purdue Pharma, that claimed potent opioids like oxycontin were “less addictive.” </p>
<p>Canadian doctors have been <a href="https://deptmed.queensu.ca/dept-blog/canadas-brave-new-world-overuse-prescription-narcotics">slow to recognize this sinister side of pharmaceutical hype.</a></p>
<h2>Addictions specialists are needed</h2>
<p>Treating patients’ complications from their addictions, while neglecting the root of their problems, is frustrating for clinicians and often feels futile. </p>
<p>At the Kingston Health Sciences Centre, we address this issue by working with community partners such as Street Health to offer education and support to staff so they can better understand patients who suffer from addictions. KHSC is also looking at ways to provide additional funding and a more coordinated approach to address addictions. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/better-medical-education-one-solution-to-the-opioid-crisis-81019">Better medical education: One solution to the opioid crisis</a>
</strong>
</em>
</p>
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<p>The START team recently surveyed our hospital’s doctors and health-care professionals. For one month they collected reports of inpatient encounters where a substance-use problem was suspected (124 unique patients). </p>
<p>In 87 per cent of the reported cases, the physician felt managing the addiction was not within their scope of practice. In 98 per cent of cases, they felt the patient would benefit from an addictions specialist consultation. </p>
<p>Further complicating matters is that <a href="https://www.nytimes.com/2018/09/10/health/addiction-medical-schools-treatment.html?action=click&module=Discovery&pgtype=Homepage">few medical schools offer training in addictions medicine</a>, leaving a significant unmet societal need.</p>
<p>START’s goals include facilitating transitions of care from inpatient to outpatient, connecting patients with community treatment programs, providing specialized and consistent inpatient care plans including pain and withdrawal management, methadone or buprenorphine/naloxone treatment when appropriate and educating hospital staff and medical students. </p>
<p>These are all missing pieces from our current response to the unfolding crisis.</p>
<p>What has happened since Crystal’s death? At least two more patients have died from accidental overdoses in our hospital.</p><img src="https://counter.theconversation.com/content/103600/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>Canadian hospitals are ill-equipped to deal with the inpatient opioid crisis. Lack of specialist addictions care puts patients and staff at risk.Stephen L Archer, Professor, Head of Department of Medicine, Queen's University, OntarioChris Smith, Associate Professor of Medicine. Division Head, General Internal Medicine, Queen's University, OntarioRaistlin Majere, General Internal Medicine Physician, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/917512018-07-31T20:15:28Z2018-07-31T20:15:28ZWhen is it OK to call an ambulance?<p>When would you call 000 for an ambulance? When a fall results in a nasty fracture? Concern that labour is progressing so rapidly that you’ll give birth before you can get to hospital? Weakness from prolonged vomiting and diarrhoea? </p>
<p>If you take a look at some <a href="http://www.ambulance.nsw.gov.au/Calling-an-Ambulance/When-to-call-Triple-Zero-000.html">Australian ambulance websites</a>, none of these examples meet their definition of a “medical emergency” suitable for an ambulance response. But that doesn’t mean you shouldn’t call for an ambulance in these situations.</p>
<p>In <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2018/health/ambulance-services">2016-17</a>, Australian ambulance services attended 3.5 million incidents. These include cases categorised as urgent but not a “lights and sirens” response, as well as transport between hospitals and other health facilities. Only 1.1 million of the incidents, or approximately 37%, were classified as emergencies. </p>
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Read more:
<a href="https://theconversation.com/paramedics-need-more-support-to-deal-with-daily-trauma-97315">Paramedics need more support to deal with daily trauma</a>
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<h2>What happens when you call 000?</h2>
<p>When someone calls the emergency number and asks for an ambulance, the call-taker typically takes the caller through a computer-based script. They attempt to define the health problem, and determine the response required: lights and sirens, or not.</p>
<p>Call-takers are not medically trained, but use a call screening program to identify the health problem. This system includes non-urgent categories such as “sick person”, which includes complaints such as an earache, sore throat and hiccups.</p>
<p>People may find it easiest to call 000 for a broad range of health problems, particularly after hours. But the deployment of paramedics for non-urgent health problems reduces their availability to respond to medical emergencies and major incidents.</p>
<h2>Where are we going wrong?</h2>
<p>Media campaigns have been used to educate the public about when it’s appropriate to call an ambulance. Strategies such as the Ambulance Victoria <a href="https://www.ambulance.vic.gov.au/community-education/ambulances-are-for-emergencies/">Ambulances are for Emergencies</a> campaign includes stories of lives saved that may have been lost had ambulances been tied up with non-emergency calls.</p>
<p>Health promotion bodies have also highlighted the types of problems that should be considered health emergencies: chest pain, breathing difficulty, altered level of consciousness, sudden numbness, or paralysis of the face or limb.</p>
<p>But attempts to define a “health emergency” often fail to appreciate that the definition is dynamic and depends on context. A complaint of weakness associated with prolonged vomiting and diarrhoea may not be an emergency when you have family support and transport options. But it may be an emergency when the patient is an elderly person living alone without support. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/229929/original/file-20180731-176698-9fk08.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">Patients who arrive at hospital by ambulance are likely to believe their condition is more serious than if they got there themselves.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-team-working-on-patient-emergency-168769238?src=CRCnZ-2UKKWBIUb0mQBTmg-1-4">Shutterstock</a></span>
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<p>There is also a difference between the patient’s perception of a health emergency and a health professional’s definition. This has been investigated by an <a href="http://www.publish.csiro.au/ah/AH10922">Australian study</a> that found patients cannot be expected to accurately evaluate the urgency of a health event. Social and emotional cues are often used to identify medical urgency. Understandably, people may be poorly placed to make rational, informed decisions about care options during a health crisis.</p>
<p>Research on ambulance use in Queensland <a href="http://onlinelibrary.wiley.com/doi/10.1111/acem.12149/full">aimed to understand</a> why people use ambulance services for minor health problems. It found that people who arrived at an emergency department by ambulance had a higher self-reported perception of the seriousness or urgency of their problem than patients who self-presented to hospital emergency departments. </p>
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Read more:
<a href="https://theconversation.com/why-do-we-wait-so-long-in-hospital-emergency-departments-and-for-elective-surgery-54384">Why do we wait so long in hospital emergency departments and for elective surgery?</a>
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<p>The ambulance users were more likely to believe that ambulance services were for everyone to use, irrespective of the severity of their condition. They were also more likely to believe that arriving by ambulance would lead to priority treatment at the hospital.</p>
<p>One possible explanation for these findings relates to health literacy. Poor health literacy affects the person’s ability to interpret health advice and navigate the health system to identify options for unscheduled care. Low levels of health literacy also limit the effectiveness of interventions that are designed to change behaviour. </p>
<p>Research from the <a href="https://www.pc.gov.au/inquiries/completed/productivity-review/report">Productivity Commission</a> found the majority of Australians have inadequate health literacy. The proportion is greatest for those with chronic conditions. Even 40% of people with a health-related qualification have inadequate health literacy.</p>
<h2>Where can we improve?</h2>
<p>Taking into account the difficulties of making crucial decisions during a crisis situation, there are a number strategies which may facilitate more effective use of ambulance resources.</p>
<p>One alternative approach is to use experienced clinicians to screen emergency calls and direct the caller to the most appropriate health pathway.</p>
<p>Several Australian ambulance services have introduced such a system, and the outcome of this screening process may be to dispatch an ambulance, or initiate a home visit by a doctor, nurse or paramedic trained to manage non-urgent health problems. </p>
<p>These systems have been shown to provide <a href="http://www.publish.csiro.au/ah/ah15134">effective referral options</a> for cases that don’t represent medical emergencies. Instead of discouraging people to call 000, they use call screening systems to identify emergency cases, which may include those not explicitly listed on ambulance service websites.</p>
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Read more:
<a href="https://theconversation.com/in-the-future-your-ambulance-could-be-driverless-78974">In the future your ambulance could be driverless</a>
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<p>If you you’re confident navigating health information, you may find sites such as <a href="https://www.healthdirect.gov.au/">healthdirect</a> useful. This service uses a web-based algorithm to question the user about the nature of the health problem to direct the patient to local health services based on the nature of the complaint. It also provides a national phone number to contact a registered nurse about your health problem. </p>
<p>But if you’re unsure whether an ambulance is required, it’s OK to call 000 for advice. After all, delaying a call for a serious health problem can lead to a catastrophic outcome.</p><img src="https://counter.theconversation.com/content/91751/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Lord has received funding from the Office for Learning and Teaching Innovation and Development grant: Expert in my pocket: a mobile-enabled repository of learning resources for the development of clinical skills in student health professionals. (Ref: ID13-2962). $180,000.</span></em></p>If you’re unsure whether you need an ambulance, it’s OK to call 000 for advice.Bill Lord, Associate Professor in Paramedicine, University of the Sunshine CoastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/973152018-06-06T02:27:34Z2018-06-06T02:27:34ZParamedics need more support to deal with daily trauma<figure><img src="https://images.theconversation.com/files/221098/original/file-20180531-69484-jwq3kd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Paramedics have higher rates of mental health problems than other emergency services workers. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Among all emergency service workers, paramedics have the <a href="https://www.ncbi.nlm.nih.gov/pubmed/21681455">highest rate of PTSD</a>, with an estimated prevalence of 14.6%. This compares to 7.3% among firefighters and 4.7% for police.</p>
<p>While all emergency service personnel face catastrophic and stressful events, paramedics are exposed to these events on a daily basis. Most of them are resilient, most of the time, but traumatic events still take their toll, particularly when you consider the cumulative effect of repeated exposure.</p>
<p>Some cases will slip behind the professional guard and become personal. Paramedics working in small communities are more likely to know the people they attend, or know the patient’s family. And paramedics anywhere can be confronted with a scene or a patient that strikes a personal chord for some reason; the age of a child, the clothes someone is wearing, the colour and make of the vehicle. The <a href="http://www.abc.net.au/news/2018-05-17/vic-paramedic-assaulted-public-outcry-about-assaults/9772478">increasing incidence of assaults</a> on paramedics from members of the public adds to the trauma load.</p>
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Read more:
<a href="https://theconversation.com/a-soldier-and-a-sex-worker-walk-into-a-therapists-office-whos-more-likely-to-have-ptsd-71464">A soldier and a sex worker walk into a therapist’s office. Who's more likely to have PTSD?</a>
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<p>Paramedics’ mental health can also be compounded by the very nature of the job: shift work, fatigue and having to make critical decisions under time pressures. </p>
<p>In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726283/">international studies</a>, the rate of anxiety among paramedics has been estimated to be as high as 22%, depression 10%, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/18177497">suicidal ideation</a> 10%. This compares to <a href="https://www.ncbi.nlm.nih.gov/pubmed/21332432">rates in the general community</a> of 14.4% for anxiety, 6.2% for depression and 2.3% for <a href="https://www.ncbi.nlm.nih.gov/pubmed/19530020">suicidal ideation</a>. </p>
<p>Paramedics’ access to restricted medical drugs places them in a unique situation in this regard, and misuse of restricted medical drugs has also <a href="http://www.abc.net.au/news/2018-05-24/the-rise-of-narcotics-use-among-paramedics/9788134">recently hit the headlines</a>.</p>
<p>In yet unpublished research, we asked emergency service workers what they liked most about their job. Most said it was the satisfaction of knowing they were doing the job well, making a positive impact on their communities and helping people in their hour of need.</p>
<p>If you’ve encountered a paramedic on the job, you’ll likely have been reassured by their cool, calm and professional demeanour. Paramedics are well-trained to deal with medical emergencies and the horrific aftermath of accidents and disaster scenes. Focusing on the job at hand is an effective way of coping and keeping an emotional distance from the event. </p>
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<a href="https://images.theconversation.com/files/221100/original/file-20180531-69484-1ks5kdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/221100/original/file-20180531-69484-1ks5kdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/221100/original/file-20180531-69484-1ks5kdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221100/original/file-20180531-69484-1ks5kdg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221100/original/file-20180531-69484-1ks5kdg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221100/original/file-20180531-69484-1ks5kdg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221100/original/file-20180531-69484-1ks5kdg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221100/original/file-20180531-69484-1ks5kdg.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>
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<span class="caption">Focusing on the task at hand is an effective coping mechanism, but some cases will inevitably get under the skin of paramedics.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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Read more:
<a href="https://theconversation.com/explainer-what-is-post-traumatic-stress-disorder-11135">Explainer: what is post-traumatic stress disorder?</a>
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<h2>Who is at risk?</h2>
<p>But how can we predict who will be resilient and who will develop PTSD or other post-traumatic mental health problems? Those who have existing mental health problems may be more vulnerable, but this is only a small part of the answer. </p>
<p>The nature and severity of exposure to trauma is important. Intentional, interpersonal trauma such as physical or sexual assault is <a href="https://www.ncbi.nlm.nih.gov/pubmed/22154900">more likely to give rise to PTSD</a> than an accident or disaster. Prolonged or repeated trauma is <a href="https://link.springer.com/article/10.1007/BF00977235">more likely to lead to</a> more complex symptoms. </p>
<p>But the <a href="https://www.ncbi.nlm.nih.gov/pubmed/11068961">research</a> tells us this isn’t the <a href="https://www.ncbi.nlm.nih.gov/pubmed/12555794">full story</a>. The best predictor of recovery after trauma is the social support a person receives after the event, and whether they have other life stressors. </p>
<p>In the work context, this means a high level of organisational support can buffer the impact of trauma, while a high level of day-to-day operational and organisational stress can mean the person has fewer psychological resources in reserve to cope with a particularly traumatic experience. </p>
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Read more:
<a href="https://theconversation.com/one-in-five-police-officers-are-at-risk-of-ptsd-heres-how-we-need-to-respond-63272">One in five police officers are at risk of PTSD – here's how we need to respond</a>
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<h2>What needs to be done?</h2>
<p>Support from colleagues, as well as family and friends, is of critical importance after a traumatic event. </p>
<p>Organisations where staff have a predictable risk of exposure to trauma have a responsibility to build a supportive workplace culture, have policies and procedures in place to ensure support is provided in the immediate aftermath of trauma, and staff who need additional help have early access to best-practice, evidence-based care with specialist mental health practitioners. All emergency service organisations are working towards these goals. </p>
<p>At a community level, we need to remember our emergency service workers put their lives and wellbeing on the line for the sake of their communities. Respect and compassion is the least they should expect in return.</p><img src="https://counter.theconversation.com/content/97315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Phoenix Australia works with a range of emergency service organisations to improve outcomes for staff affected by trauma through research, policy and service development, and training initiatives. </span></em></p>Paramedics face traumatic situations every day. They need policies to ensure support is provided in the immediate aftermath of trauma, and early access to mental health care.Andrea Phelps, A/Director Policy and Service Development, Australian Centre for Posttraumatic Mental Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/968332018-05-22T10:52:48Z2018-05-22T10:52:48ZTerror attacks: how psychological research can help improve the emergency response<p>Western society is engaged in what has been referred to as an “<a href="https://theconversation.com/manchester-attack-we-are-in-an-arms-race-against-ever-adapting-terror-networks-78227">arms race</a>” against terrorism. Atrocities are increasingly characterised by novel and low-cost methods with the sole aim of causing as much death and destruction as possible. “The terrorist” is no longer a distinct enemy from a defined terrorist organisation, but is increasingly associated with <a href="https://theconversation.com/manchester-attack-we-are-in-an-arms-race-against-ever-adapting-terror-networks-78227">diverse and wide-ranging beliefs</a>.</p>
<p>So in this age of unpredictability, how can the emergency services prepare themselves to respond to a terror attack, like the one at <a href="https://theconversation.com/uk/topics/manchester-bomb-39032">the Ariana Grande concert</a> in Manchester in 2017? <a href="http://psycnet.apa.org/record/2017-03597-001">We’ve looked into</a> the psychology of decision making and how the key lessons from <a href="https://www.kerslakearenareview.co.uk/media/1022/kerslake_arena_review_printed_final.pdf">The Kerslake Report</a> – which evaluated the emergency response during the Manchester attack – could be applied on the ground.</p>
<h2>Design for the unpredictable</h2>
<p>Operational plans must be designed to reflect the unpredictable nature of terror attacks. One of the key lessons from the Kerslake Report related to the mismatch between current operational procedures and the nature of real-world attacks. It was noted that the agreed joint operational response to terror attacks – so-called Operation PLATO – did not fit Manchester.</p>
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<img alt="" src="https://images.theconversation.com/files/219925/original/file-20180522-51109-160ve30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/219925/original/file-20180522-51109-160ve30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=339&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219925/original/file-20180522-51109-160ve30.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=339&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219925/original/file-20180522-51109-160ve30.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=339&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219925/original/file-20180522-51109-160ve30.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=426&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219925/original/file-20180522-51109-160ve30.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=426&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219925/original/file-20180522-51109-160ve30.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=426&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">Lord Kerslake delivering his conclusions in Manchester in March 2018.</span>
<span class="attribution"><a class="source" href="https://www.paimages.co.uk/search-results/fluid/?q=manchester%20kerslake&amber_border=1&category=A,S,E&fields_0=all&fields_1=all&green_border=1&imagesonly=1&oldestfirst=1&orientation=both&red_border=1&words_0=all&words_1=all">Peter Byrne/PA Wire/PA Images</a></span>
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<p>Operation PLATO is based on an assumption of firearms being present, meaning that only specialist trained and protected responders can operate in the affected areas. However, the Manchester attack was the result of a bomb and no firearms were present. In fact, none of the most recent attacks in the UK, such as <a href="https://theconversation.com/uk/topics/finsbury-park-attack-39851">Finsbury Park</a>, <a href="https://theconversation.com/uk/topics/london-bridge-attack-39289">London Bridge</a> or <a href="https://theconversation.com/uk/topics/westminster-attack-37098">Westminster</a> involved firearms. This begs the question of how the emergency services can best prepare for terror attacks when modern day terrorism is becoming less and less predictable?</p>
<p>One way to cope with unpredictability during operational planning could be to shift focus away from the “type” of incident (for example, firearms) and focus on the dynamic risk currently faced at scene (threat to lives of responders). </p>
<p><a href="http://psycnet.apa.org/record/2017-03597-001">Our research found</a> an inherent conflict for incident commanders is the trade-off between saving public life while ensuring that this does not disregard the safety of responders. Operation PLATO did not fit the Manchester attack because the response was based on the assumption that a terror attack involved an active <a href="https://www.theguardian.com/uk-news/2018/mar/27/manchester-arena-bombing-fire-service-arrived-two-hours-late-says-report">threat to responder life</a>. As a result, fire crews played “no meaningful role”. However, there was no active threat. Developing operational procedures that focus on the actual risk to responders, rather than hypothetical assumptions about the type of risk involved during a terror attack, may make future operational planning more effective.</p>
<h2>Training and decision making</h2>
<p>There needs to be more training to develop skills in dynamic decision making. The Kerslake Report praised the work of Greater Manchester Police’s Force Duty Officer. They recognised that standard protocols did not fit the situation and allowed responders to operate in an area from which they should (according to PLATO) have been withdrawn. This decision to deviate from procedure was hailed as “one of the most crucial decisions taken” and the Force Duty Officer was congratulated for their dynamic “life or death” decision making.</p>
<p>But if this decision had gone wrong – for example a second explosive device was in the area – things would have turned out very differently. It is important therefore to consider how to best support commanders to know when and when not to break procedures, without putting the public at risk.</p>
<p><a href="https://books.google.co.uk/books?hl=en&lr=&id=F201DwAAQBAJ&oi=fnd&pg=PR7&dq=Klein,+G.+(1999).+Sources+of+power:+How+people+make+decisions.+Cambridge.+The+MIT+Press.&ots=d9A8m3jGMe&sig=C_ylCVNp8GckuhIvhuWTNGKzfA8#v=onepage&q&f=false">Psychology teaches us</a> that experienced people can make very fast and accurate decisions in their workplace. This is largely due to what has been termed <a href="http://journals.sagepub.com/doi/abs/10.1518/155534310X12844000801203">“recognition primed” decision making</a>, which enables them to quickly recognise subtle cues in the environment that trigger learned responses. Experts can also quickly identify when standard rules no longer fit and they need to develop innovative ways to solve the problem instead.</p>
<p><a href="http://journals.sagepub.com/doi/abs/10.1177/1555343416646684?journalCode=edma">Our research</a> with firearms police officers shows that more experienced officers use flexible thought processes allowing them to adapt their decisions to changing situations. Whereas less experienced officers used more rigid processing. Such adaptability is thought to be crucial under the uncertain and pressurised conditions of a critical incident. </p>
<h2>The importance of flexibility</h2>
<p>While emergency services train their staff in technical skills, the development of flexible decision making is often not a specified learning objective. It may occur as a by-product of training or “on the job” experience but it is rarely a core focus. </p>
<p>One way to expedite the development of flexible thinking is through systematically exposing emergency responders to a variety of simulated scenarios where, through guided practice and feedback, they can develop <a href="http://journals.sagepub.com/doi/abs/10.1177/1555343412468113">adaptive decision making</a>. By focusing on adaptive expertise specifically in training, (such as “worst case” scenarios that cannot be solved through standard operating procedures), the type of dynamic decision making that was so highly praised in Manchester may be more quickly developed in trainees.</p>
<p>One thing that shines through from our research is the importance of flexibility. Terrorist attacks are increasingly unpredictable, which can render previous response plans obsolete. Manchester provides a key lesson in identifying how the gap between hypothetical plans and the reality of incidents is widening. Taken together, it is hoped that the future of emergency training embeds these lessons, providing a greater focus on the need for flexible planning and dynamic decision making.</p><img src="https://counter.theconversation.com/content/96833/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>Terrorist attacks are increasingly unpredictable. Manchester provides a key lesson in identifying how the gap between hypothetical plans and the reality of incidents is widening.Nicola Power, Lecturer in Psychology, Lancaster UniversityLaura Boulton, Lecturer in Policing, University of Central LancashireOlivia Brown, PhD Researcher, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/938232018-04-10T13:04:19Z2018-04-10T13:04:19ZSore throats and false nails – the ambulance call-outs that cost millions<figure><img src="https://images.theconversation.com/files/213378/original/file-20180405-189816-16eq9co.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/635231459?src=LmNvxGpySO2Qgc38lOyJ4w-1-10&size=medium_jpg">Brian A Jackson/Shutterstock</a></span></figcaption></figure><p>Ambulance call-outs are increasing, resulting in services operating under enormous, and probably <a href="https://www.nao.org.uk/wp-content/uploads/2017/01/NHS-Ambulance-Services.pdf">unsustainable</a>, pressure. While most calls do need an emergency response, far too many don’t. A <a href="http://emj.bmj.com/content/15/6/368?ijkey=35f7564aa3963e4790e1e42e9f87404453ff9736&keytype2=tf_ipsecsha">study</a> of 300 consecutive emergency ambulance arrivals to an accident and emergency (A&E) department in London, England, found that only 54% of the patients legitimately needed an ambulance.</p>
<p>The tabloid press are fond of reporting daft ambulance call-outs, like one to revive a <a href="http://metro.co.uk/2017/12/30/these-are-some-of-the-most-ridiculous-calls-made-to-999-7110082/">dead pigeon</a>, and another to see if McDonald’s had run out of <a href="https://www.express.co.uk/entertainment/books/379058/999-numpties-The-daftest-calls-the-emergency-services-have-ever-had-revealed-in-new-book">chicken nuggets</a>. Funny though they are, these kinds of calls <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-258">put a strain on services</a> and take paramedics away from emergencies that are genuinely life threatening. </p>
<p>These calls can also be truly disheartening for paramedics who see themselves as health professionals who are there to treat people and save lives. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817967/pdf/policy-11-067.pdf">Research</a> has found this to be a common concern among paramedics who are obliged to respond to patients no matter how silly they perceive the call to be. In my ongoing study of the perceptions of patient safety in three English ambulance service NHS trusts, a call-taker in the emergency operations centre told me of their frustration:</p>
<blockquote>
<p>I have questioned one drunken man’s request for an ambulance because he had a sore throat, and this is when there were 23 calls waiting to get through, and I was angry about that.</p>
</blockquote>
<p>Their anger at situations like these is both understandable and common, with one paramedic involved in my study discussing his concern for other patients with legitimate emergencies, when having to respond to calls they find to be ridiculous:</p>
<blockquote>
<p>You laugh, but when I started I got a call-out to a girl because of false nails. She’d been playing with her boyfriend, bent her nail, bent back and the nail come off … And while I’m dealing with that, there could be a cardiac arrest somewhere, someone could be stuck under a lorry.</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/213395/original/file-20180405-189795-1cgr28n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/213395/original/file-20180405-189795-1cgr28n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/213395/original/file-20180405-189795-1cgr28n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/213395/original/file-20180405-189795-1cgr28n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/213395/original/file-20180405-189795-1cgr28n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/213395/original/file-20180405-189795-1cgr28n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/213395/original/file-20180405-189795-1cgr28n.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">Not an emergency.</span>
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</figure>
<p>As well as tying up resources that could be used to treat genuine medical emergencies and increasing the waiting times at A&E departments, these calls can be expensive for the ambulance services. In the UK, <a href="https://www.gov.uk/government/publications/nhs-reference-costs-2014-to-2015">each call costs</a> about £7, £180 if an ambulance is sent to treat a patient and £233 if the patient is brought to the emergency department. Given that a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817967/pdf/policy-11-067.pdf">significant portion</a> of calls are seen as not requiring an emergency response, this can add up to millions of pounds every year. </p>
<h2>24/7 culture</h2>
<p>Although the rise in the rate of demand for ambulance services, at <a href="https://www.sheffield.ac.uk/polopoly_fs/1.366348!/file/Evidence_on_Access_and_Behaviour.pdf">6.5% each year</a>, is relatively recent in the UK, inappropriate call-outs have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1343207/pdf/jaccidem00027-0002.pdf">documented</a> in research going back at least two decades. <a href="http://emj.bmj.com/content/emermed/31/6/448.full.pdf">One study</a> proposed a couple of reasons why patients phone the emergency services for conditions that could be treated in primary care, including difficulty getting a GP appointment and a perception that they will be treated more quickly. </p>
<p>The high number of inappropriate calls could also be attributed to a <a href="https://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2015/jan/12/a-and-e-patients-dont-need-ambulance">24/7 culture</a>, where people expect immediate treatment for any condition, no matter the severity. A paramedic in my study considered it to be a generational problem, with millennials making the most of these calls:</p>
<blockquote>
<p>It’s a great generation, but young people today don’t understand what the services are for, and we didn’t have this problem as bad some decades ago. They will call us for just about anything.</p>
</blockquote>
<h2>Public awareness</h2>
<p>With <a href="https://www.nao.org.uk/wp-content/uploads/2017/01/NHS-Ambulance-Services.pdf">demand</a> projected to increase in coming years, it is clear that the ambulance services need to address the issue of inappropriate call-outs soon. Many things can be done to lessen the pressures of demand and to allocate the resources of the ambulance services more efficiently. However, to reduce the number of silly call-outs, it’s clear that public perception of what the ambulance service is for, needs to change. </p>
<p>Awareness could be spread through educational campaigns, using social media to reach the patients online, such as South Central Ambulance Service’s <a href="http://www.scas.nhs.uk/news/campaigns/misuse-costs-lives/">999 Misuse Costs Lives</a> campaign, which informed patients of when it’s appropriate to dial 999 and when it’s appropriate to use a different service, such as a GP clinic. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/0de4RQn91Cs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>Although changing people’s expectations is essential, a more holistic approach will also be necessary – one that gives patients appropriate access to alternative care settings, such as their GP or <a href="https://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/Walk-incentresSummary.aspx">walk-in centres</a>. Until this is done, some people will continue to rely on the ambulance service to treat minor ailments.</p><img src="https://counter.theconversation.com/content/93823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keegan Clay Shepard 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>Overstretched ambulance services are increasingly being called out for non-emergencies.Keegan Clay Shepard, PhD Student and Graduate Teaching Assistant, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/853502017-12-11T03:01:16Z2017-12-11T03:01:16ZHow to put data to work in your neighborhood<figure><img src="https://images.theconversation.com/files/191709/original/file-20171024-30571-1atucvx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many cities collect valuable data on themselves.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/residential-neighborhood-subdivision-skyline-aerial-shot-569669149?src=Gq6ws1eFmE60EV9-0_KrTw-1-0">TDKvisuals/shutterstock.com</a></span></figcaption></figure><p>Every day, city governments collect vast amounts of administrative data – local property tax assessments, 911 emergency response calls, social assistance recipients and more. </p>
<p>These data have huge potential to <a href="https://www.nature.com/nature/journal/v531/n7594_supp/full/531S64a.html">enhance residents’ quality of life</a> and <a href="https://www.cep.gov/news/sept6news.html">stimulate economic growth</a>. Many local governments have jumped to create so-called “smart cities” that harness these data to enhance livability, workability and sustainability.</p>
<p>But most cities still don’t use their own administrative data to inform their decisions. In many cases, they lack the technical capacity and have <a href="http://www.tandfonline.com/doi/full/10.1080/2330443X.2017.1374897">only limited resources</a>.</p>
<p>Our lab has worked with the city of Arlington, Virginia to strengthen their services, particularly through the demographic planning and fire and police departments. Our work, which we are now expanding across Virginia and Iowa, shows how cities across America can leverage the data they already have to improve residents’ lives. </p>
<h1>Start with existing data</h1>
<p>By overlooking their administrative data, local governments are missing out on innovative ways to address their most pressing problems. Data provide a valuable way to describe the nature of the problems, assess the likely impact of potential solutions and predict future outcomes. </p>
<p>For example, in 2015, Arlington demographers wanted to understand the <a href="https://www.bi.vt.edu/sdal/projects/assessing-new-data-sources-for-the-federal-census">demographic and economic diversity of housing in local neighborhoods</a>. Knowing this could help them better plan school enrollments and adjust future school boundaries. </p>
<p><a href="https://www.bi.vt.edu/sdal/projects/assessing-new-data-sources-for-the-federal-census">Housing value information</a> from local property data is an excellent proxy for diversity, as it represents the wealth of the household. Individual local property values provide more timely and detailed information than federal data sets. </p>
<p>We used these data to determine <a href="http://dx.doi.org/10.1038/163688a0">measures of diversity</a>, down to the census block level or even smaller. We calculated diversity by computing the probability that two housing values selected at random from the geographic area differ on home value. The higher the score, the more diverse the home values are in the region. </p>
<p>This information provided city demographers with a new lens to explore available housing opportunities and relate this information back to younger families with children, whose income is often lower than other families. Higher economic diversity is an indicator of more <a href="https://www.urban.org/research/publication/promoting-neighborhood-diversity-benefits-barriers-and-strategies">opportunities for all</a>. It also helped them plan for school age enrollments by age. </p>
<h1>Using all data</h1>
<p>Government decisions have even more impact when local officials can combine their own data with other easily accessible outside resources, such as social media and state or federal databases. These combined sources can provide a more holistic view of our neighborhoods. </p>
<p>The Arlington fire chief, for example, wanted to improve <a href="https://www.bi.vt.edu/sdal/content/generic_page/Arlington-County-911-Response-Time-Data-Science-Public-Good-2016.pdf">situational awareness of his fire department operations</a> by using his data on the current placement of equipment and personnel.</p>
<p>We looked at what time incidents were reported and responded to. The patterns for response time in relation to distance from the call appeared similar across stations. However, by plugging the data into a statistical model and controlling for several other variables – including month, hour of day and call type – we found that response times were highest for calls for hazardous materials investigations, highway calls and wires-down incidents.</p>
<p>These estimates helped the fire chief better anticipate when these incidents might occur and decide where to place fire or medic units and when to have more firefighters available.</p>
<h1>Scaling our work</h1>
<p>Today, there are many examples of cities using administrative data to advance the public good. In San Francisco, the <a href="https://www.sfdph.org/dph/comupg/aboutdph/insideDept/OPP/hia.asp">Department of Public Health</a> partners with the private sector to inform the public about potential health issues seen in public health data and local data – for example, by adding <a href="http://sfist.com/2015/11/05/yelp_now_explicitly_warning_you_off.php">city restaurant inspection ratings to Yelp restaurant ratings</a>. In Alburquerque, New Mexico, universities and local governments are working together to better understand the size, composition and behavior of <a href="https://vimeo.com/237118398#t=29m56s">those who have been arrested multiple times</a>. </p>
<p>Scaling and sustaining such an approach requires a new and bold agenda. The universities we work at are land grant institutions, meaning that they’re part of a class of universities founded to provide the working class with a practical education directly relevant to their daily lives. One of our primary roles is to translate evidence-based research for the public.</p>
<p>We believe that land grant universities like ours should build upon their current roles and bring data in service of the public good. By partnering more closely with local governments, researchers can help communities that are data-driven to govern more intelligently.</p><img src="https://counter.theconversation.com/content/85350/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie Shipp received funding from Laura and John Arnold Foundation and the U. S. Census Bureau. </span></em></p><p class="fine-print"><em><span>Catherine Woteki is affiliated with Global Open Data for Agriculture and Nutrition. </span></em></p><p class="fine-print"><em><span>Sallie Keller received funding from the Laura and John Arnold Foundation and the U. S. Census Bureau.</span></em></p><p class="fine-print"><em><span>Sarah M. Nusser 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>Many cities lack the resources to analyze their own vast troves of administrative data.Stephanie Shipp, Deputy Director and Research Professor at the Social and Decision Analytics Laboratory, Virginia TechCatherine Woteki, Professor of Food Science and Human Nutrition, Iowa State UniversitySallie Keller, Professor of Statistics, Virginia TechSarah M. Nusser, Vice President for Research, Iowa State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/885512017-12-04T19:22:33Z2017-12-04T19:22:33ZYou should never drive into floodwater – some roads are more deadly than others<p>The floods that <a href="http://www.abc.net.au/news/2017-12-02/victoria-storms-in-pictures-euroa-to-williamstown/9219646">deluged parts of Victoria</a> over the weekend are the latest in the state’s long history of flooding, following on from major floods in 2010, 2011, 2012 and 2016. In all such events, emergency services are on standby to rescue motorists who drive into floodwaters and get stuck or washed away – with potentially fatal consequences.</p>
<p>Most of the <a href="http://www.bnhcrc.com.au/publications/biblio/bnh-2735">178 flood-related deaths since 2000</a> have been a consequence of motorists driving into floodwaters.</p>
<p>Although there is a growing body of research on the decision-making of people who choose to enter floodwater, little research has been done before now on the factors that make some stretches of road more dangerous than others.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flood-deaths-are-avoidable-dont-go-in-the-water-60615">Flood deaths are avoidable: don't go in the water</a>
</strong>
</em>
</p>
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<p>Why do people drive into floodwater? Often they are trying to get to or from work, or carrying out work-related duties such as surveying farmland or driving trucks. It is hard to judge the depth and speed of water, or to tell if there is debris or damage below the surface. A simple error of judgement can prove fatal, which is why emergency services warn against driving through floods even when the conditions look benign.</p>
<p>Our <a href="https://www.sciencedirect.com/science/article/pii/S1462901117301818">research</a>, carried out by Risk Frontiers, Macquarie University and the Bushfire and Natural Hazards Cooperative Research Centre (CRC), is among the first to consider the influence of road characteristics on flood deaths.</p>
<p>We analysed the road characteristics at 21 sites in NSW, Victoria, Western Australia and Queensland where flood-related motoring deaths have occurred since 2010. We found that some roads are clearly more dangerous than others.</p>
<p>Several factors increase the danger of a particular stretch of road, including: </p>
<ul>
<li>small upstream catchment size</li>
<li>the absence of roadside barricades</li>
<li>the depth of flooding next to the roadway</li>
<li>absence of street lighting</li>
<li>dipping road grade</li>
<li>lack of kerbs and guttering</li>
<li>inability of motorists to easily turn around. </li>
</ul>
<p>Each of these factors was observed in at least half of the cases we studied. Yet these kinds of risk profiles largely not considered in emergency planning or flood-management approaches, which tend to focus on urban flood risk. The large number of flood-prone road sections means that we need to prioritise those roads that are most in need of safety improvements.</p>
<h2>Rapid threat</h2>
<p>At eight of the sites we studied, emergency services or passers-by were on the scene within several minutes, either to attempt rescue or to call for assistance. This suggests that road conditions in some locations are so dangerous that first responders will be unable to help if a vehicle is submerged or swept away.</p>
<p>At 12 of our study sites, roadside flood signage was probably present at the time of the incident. (As our assessments were done some time after the deaths occurred, we have to use the best available information, which presents a small degree of uncertainty that the signage may have changed.) </p>
<p>Depth markers were the most common, followed by “Road subject to flooding” signs. This suggests that some motorists ignore, misinterpret or fail to notice warning signs, or that signs can be damaged, lost or obscured after installation. We suggest that signage should be improved in areas identified as high-risk.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/natural-hazard-risk-is-it-just-going-to-get-worse-or-can-we-do-something-about-it-84286">Natural hazard risk: is it just going to get worse or can we do something about it?</a>
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<p>The difficulty of turning a vehicle around at many sites underlines the importance of encouraging motorists to plan ahead, rather than make a snap decision to enter floodwater. </p>
<p>When severe weather is forecast, motorists should plan journeys in advance, with the help of up-to-date road information from an authoritative source such as the <a href="https://www.vicroads.vic.gov.au/">VicRoads website</a>. </p>
<p>As many motorists enter floodwater for work-related purposes, employers also have a responsibility to promote safe driving behaviour.</p>
<p>Whatever the exact reasons, all of the deaths at our study sites ultimately happened because someone decided to drive into floodwater. Our study showed that roads vary widely in safety. The water might look shallow and easy to negotiate, but you can never be completely sure. For that reason, the safest option is always to stay well clear.</p><img src="https://counter.theconversation.com/content/88551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Gissing receives funding from the Bushfire and Natural Hazards Cooperative Research Centre. </span></em></p>You should never try to drive through floodwater, because you never know what’s beneath the surface. And new research shows some roads are more treacherous than others.Andrew Gissing, Adjunct Fellow, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/835212017-09-11T08:44:03Z2017-09-11T08:44:03ZEmbedded with medics in Afghanistan, I witnessed the fall out of war<figure><img src="https://images.theconversation.com/files/184926/original/file-20170906-9202-1ekes2c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/dvids/6790919089/in/photolist-bm6eDT-bmXw6Q-duHBZ9-5czH2u-6GH9r6-7NrUQT-84woGe-bumGGG-f6hyer-5cvrgp-b8noKr-dMiPDL-eYYaqj-f6wNvm-9qMcGy-7BrqXt-9qMcwN-5cvrjk-7NvTyj-a1Vtwd-7NvTwQ-f6wNEE-bAcEJJ-7BrpL6-7L6n9H-6JABEE-7i2emY-7BvdPE-7hXiFV-7Brq1R-azvsN5-6JAAmj-azsNMZ-7Brqpx-azsPDR-dr5yJy-azvxeU-7L6n8z-azsLEK-nZkkqr-9qMdym-VRErbh-azsMni-azvrNQ-azvw23-azsQTa-WfjtyB-V1tXec-5cvrWe-5czHHY">DVIDSHUB/Flickr</a></span></figcaption></figure><p>Donald Trump’s about-face diktat that America is to galvanise its gig in Afghanistan was met with derision by many but will have caused others to sit right up. These will have included troops about to be dispatched to Afghanistan for a second, third or fourth helping of wack-a-mole, and especially those to be deployed in medical roles. </p>
<p>“The killers need to know they have nowhere to hide, that no place is beyond the reach of American might and American arms,” Trump <a href="https://www.nytimes.com/2017/08/21/world/asia/afghanistan-troops-trump.html?mcubz=0">said</a>. “Retribution will be fast and powerful.” While numbers are yet to be confirmed, estimates suggest an <a href="http://www.independent.co.uk/news/world/americas/us-politics/trump-afghanistan-troops-increase-numbers-war-us-army-escalation-a7905841.html">additional 4,000 troops</a> are to be flown to central Asia, to add to the 8,400 US troops already there. It’s well short of the <a href="http://www.npr.org/2016/07/06/484979294/chart-how-the-u-s-troop-levels-in-afghanistan-have-changed-under-obama">estimated 100,000 troops</a> active in Afghanistan during Obama’s surge, but Trump’s decision to continue an expensive and — given that swathes of the country are back under Taliban control — futile war is likely to inflict significant casualties on civilians.</p>
<p>Launched by the US in 2001 as Operation Enduring Freedom, the war toll <a href="http://watson.brown.edu/costsofwar/costs/human/civilians/afghan">is estimated</a> at 104,000 Afghan deaths to date — among which 31,000 are civilian — with another 41,000 civilians wounded. These numbers exclude injuries and deaths among NATO military personnel, including 2,254 US soldiers (1,856 in hostile action) and 454 UK soldiers (405 in hostile action). </p>
<p>During the first of a six-week tour of duty with a surgical team at Camp Bastion’s field hospital, I witnessed 174 casualties taken into the emergency room. My embedded deployment, as an academic keen to understand how high-performing individuals solve problems collectively under difficult circumstances, took place in the summer of 2011, or one of the bloodiest periods of the war. </p>
<p>The opportunity to study, by observation, how it is these doctors come to develop ideas about their work and the war, fairness and cruelty, about themselves and the other, is unprecedented, and I was keen to try and reciprocate the hospitality and camaraderie I’d been extended. One such opportunity presented itself when I was asked (repeatedly) to help the public understand what war is really like from the medic’s point of view. Richard Hooker’s 1968 novel <a href="https://www.goodreads.com/book/show/82472.MASH">M.A.S.H</a> – a fictional account of a US army surgical hospital in Korea during the Korean War – had been the only book to do full justice to the surreality of their experience, the doctors said, and might I write a modern-day, nonfictional version of it? </p>
<p>One likes to think that writing a book is cathartic. Not so. Or at least not in this case. While the deployment ended in 2011, it took me another five years to write up the account: <a href="http://www.cornellpress.cornell.edu/book/?GCOI=80140100810940">Doctors at War: Life and Death in a Field Hospital</a>. Aside from an unpleasant (and ultimately unsuccessful) attempt by the UK’s Ministry of Defence to ban publication, what stalled the writing was a personal struggle to make sense of the experience. </p>
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<img alt="" src="https://images.theconversation.com/files/184925/original/file-20170906-9862-ycluh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184925/original/file-20170906-9862-ycluh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=481&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184925/original/file-20170906-9862-ycluh6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=481&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184925/original/file-20170906-9862-ycluh6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=481&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184925/original/file-20170906-9862-ycluh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=604&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184925/original/file-20170906-9862-ycluh6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=604&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184925/original/file-20170906-9862-ycluh6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=604&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Army nurse at Camp Bastion Hospital, Afghanistan.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/defenceimages/9183294751/in/photolist-eZuMA8-dvkAGD-VZ7piN-b4ohdi-ahKeak-dEZgyF-ejeBxY-cryvzJ-dcvjHw-cieHPm-eQdBSL-eZG9JG-VazxFf-dj2dJm-cieHXQ-cieJ3u-eZG9DA-cieHA5-de2VM8-9qMdFs-cieJ6u-eZG9JY-duHCQb-duC1Zg-57xFCd-anKSQ9-7jBkBk-czo89q-9oUZg3-bzRUga-dcvgxr-9qNWCr-dcvgvt-jXtiMZ-bL2gmk-V1ub3i-drteY9-b8nvqZ-7Brq96-dcvgzB-7BrpkF-7BrpsX-5cvs7e-3EfYT4-5cvrZ4-drt51P-7LakZA-7BveW1-7Bve6S-7MPFC3">Defence Images</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>I’ve no wish to claim I was more, or less, affected than anyone else by the goings-on in that field hospital. These things are hard enough to measure as is. We do know something about the incidence of post-traumatic stress syndrome (PTSD) among rear-located medics (or medical staff who operate in war zones but away from the frontline), the <a href="https://www.ncbi.nlm.nih.gov/pubmed/25694493">available data suggesting</a> that they suffer similar rates of PTSD to those on the frontline despite not typically being exposed to risk of death or injury. This comparison is relevant insofar as the definition of PTSD assumes it to be caused in no insignificant part to precisely such exposure. So how might we explain the incidence of PTSD among the doctors and nurses I deployed with? And how might this help me understand my own experience? </p>
<p>A careful reading of my field notes suggests that the specific cultural, professional, and organisational contexts in which people who work at war are embedded can play a central role in the experience of emotional distress, regardless of whether they are directly exposed to combat. This is because these contexts can trigger and amplify repeated experiences of senselessness (witnessing the needless cruelty that are part and parcel of war), futility (the many times protocol required doctors to turn over patients they had stabilised to ill-equipped local facilities), and surreality (the disorienting, dreamlike quality of war). When these experiences are sustained, they can dislocate people’s homegrown sense of the meaningful, the good, and the normal to the point where they experience a threat to their sense of being in the world. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/184927/original/file-20170906-7289-asqh82.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/184927/original/file-20170906-7289-asqh82.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=228&fit=crop&dpr=1 600w, https://images.theconversation.com/files/184927/original/file-20170906-7289-asqh82.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=228&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/184927/original/file-20170906-7289-asqh82.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=228&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/184927/original/file-20170906-7289-asqh82.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=286&fit=crop&dpr=1 754w, https://images.theconversation.com/files/184927/original/file-20170906-7289-asqh82.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=286&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/184927/original/file-20170906-7289-asqh82.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=286&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"></span>
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<p>And perhaps this helps explain some of my own difficulties? My own expectations of the meaningful, good, and normal might differ in certain respects from those I spent weeks observing — after all, we were prepared for different professions — but this is not to say that they contrasted sharply from the felt experience of senselessness, futility, and surreality that many of us will still have shared?</p>
<p>Occasionally, this contrast resulted not from any professional expectation, but merely from my own expectation of what it is to be good and noble and, well, human. For example, I clearly remember feeling annoyed when, midway through our Friday pizza night routine, learning that yet another amputee had been flown in. To provide emergency treatment meant that our pizzas would grow cold yet again, and I felt physically sick at discovering my ever so slight sense of relief upon hearing that the casualty had been dead on arrival. What had happened to me?</p>
<p>What helped me process my own experience were the firsthand accounts of those who’d been at the sharper ends of war. <a href="http://www.cornellpress.cornell.edu/book/?GCOI=80140100810940">In one of these</a>, a US Army soldier found himself laughing at a man whose leg had been shot clear off, and how the man kept crawling around until he could no more, and thinking to himself, “that was a fucking human being, you son of a bitch. You fucking crazy bastard, that was a human being you fucking killed”. And yet, he said he’d do the same thing again, for “it’s like an evil thing inside your body”. To a monster, everyone is a monster, John Steinbeck wrote, and when war veterans — medics included — don’t talk about war it isn’t just because we won’t appreciate its horrors but because we won’t understand its surreality and pleasures. </p>
<p>I was never exposed to the thrill of the fight — and nor were the doctors — yet we were willing spectators to all that war destroys. As I write in the book, ours were the best seats in the house to a massacre that repels and intoxicates, a spectacle that flaunts humanity’s best and worst in not quite equal measure.</p>
<p>As Lillian Smith <a href="https://books.google.co.uk/books/about/Killers_of_the_Dream.html?id=fvab8gnFH_kC&printsec=frontcover&source=kp_read_button&redir_esc=y#v=snippet&q=%22There%20is%20a%20return%20journey%20to%20anguish%20that%20few%20of%20us%20are%20released%20from%20making.%22&f=false">said</a>: </p>
<blockquote>
<p>The human heart dares not stay away too long from that which hurt it most. There is a return journey to anguish that few of us are released from making.</p>
</blockquote>
<p>And, as I worked my way through the account, and as I wrote at the time, I realised that I missed the surreal, adrenaline-fuelled world of war surgery, that the relevance of my scholarship paled in comparison, and that my fate was little different from that of the surgeon and soldier insofar as our pleasure is often proportionate to another’s pain.</p><img src="https://counter.theconversation.com/content/83521/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark de Rond is author of Doctors at War: Life and Death in a Field Hospital, published by Cornell University Press.</span></em></p>PTSD isn’t just reserved for those on the frontline – my experience alongside a surgical team at Camp Bastion showed how it could affect anyone dealing with the fall out of war.Mark de Rond, Professor of Organisational Ethnography, Cambridge Judge Business SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/822022017-08-17T01:27:38Z2017-08-17T01:27:38ZFirstNet for emergency communications: 6 questions answered<figure><img src="https://images.theconversation.com/files/181830/original/file-20170811-13459-zr7tw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">FirstNet could relieve emergency workers of having to carry multiple radios and other communications devices.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Associated-Press-Finance-amp-Business-Louisia-/4af76d8a48e1da11af9f0014c2589dfb/14/0">AP Photo/Ric Francis</a></span></figcaption></figure><p><em>Editor’s note: In the aftermath of 9/11, public safety officials in New York City and around the country realized that firefighters, police officers and ambulance workers needed to be able to <a href="https://supernet.isenberg.umass.edu/visuals/DOD-LSN-Final-2017.pdf">talk to each other at an emergency scene</a> – not just to their <a href="http://dx.doi.org/10.1111/j.1475-3995.2010.00785.x">supervisors and dispatchers</a>. The solution was nearly 16 years in coming, but on March 30, the First Responder Network Authority, or FirstNet, was created. It’s one of the largest public-private partnership agreements ever, between the National Telecommunications and Information Administration (part of the U.S. Department of Commerce) and a group of companies led by AT&T. AT&T and its partners will develop and manage a nationwide wireless broadband network for use by first responders. Each U.S. state and territory is in the process of deciding whether it wants to <a href="https://www.ntia.doc.gov/files/ntia/publications/sapp_opt_out_process_02162017_0.pdf">build its own towers and wired connections</a> or <a href="https://www.firstnet.gov/sites/default/files/factors-governor-decision.pdf">let the AT&T group do the construction</a>. Ladimer Nagurney and Anna Nagurney, scholars of communications and network systems, respectively, explain what this multi-billion-dollar effort is, and what it means.</em></p>
<h2>1. What is FirstNet?</h2>
<p>The system nicknamed FirstNet was created by Congress in the <a href="https://www.congress.gov/bill/112th-congress/house-bill/3630">Middle Class Tax Relief and Job Creation Act of 2012</a>. Under the contract with the government, the <a href="https://www.commerce.gov/news/press-releases/2017/03/firstnet-partners-att-build-465-billion-wireless-broadband-network">group led by AT&T</a> will build, operate and maintain a new nationwide communications network, providing high-speed wireless communications for public safety agencies and personnel. The network will be protected against unauthorized intrusion and <a href="https://theconversation.com/creating-a-high-speed-internet-lane-for-emergency-situations-79151">strong enough to withstand disasters</a> that might damage other communications systems. Emergency workers will be able to preempt other users’ traffic on the network, and will be able to send and receive as much data as they need to during their emergency work.</p>
<h2>2. Why do we need it?</h2>
<p>In the aftermath of the 9/11 attacks in 2001, public safety agencies found that the first responders had a hard time sharing critical information throughout their agencies, or between different responding organizations. In just one tragic instance, after the south tower of the World Trade Center collapsed, the Fire Department of New York ordered all firefighters to <a href="http://www.cbsnews.com/news/communication-breakdown-on-9-11/">evacuate the north tower</a>. But many firefighters didn’t hear the order over their radios – and city and Port Authority police officers didn’t communicate on the same frequencies, so they never had a chance to hear the warning.</p>
<p>Four years later, the <a href="https://m.csmonitor.com/2005/0915/p04s01-usmb.html">same problems weakened officials’ response</a> to Hurricane Katrina. Most of the early efforts to solve this problem focused on making sure emergency workers’ radios could communicate with each other properly. In the intervening years, though, first responders have increasingly used smartphones, tablets and computers. They need to do more than talk; they need to share data among those devices – such as building layouts, possible environmental hazards, information about who and where victims might be and even basic details like local weather conditions. </p>
<p>Another change over time is our understanding of who first responders are. It’s not just police, firefighters and emergency medical personnel. <a href="http://www.nfro.org/who.html">Other public agencies</a> also are involved from the very early stages of a crisis, including transit agencies and environmental protection workers. Private companies are needed too, handling <a href="https://www.epa.gov/waterutilityresponse">damage or interruptions to utilities services</a> such as electricity, water, gas, telephone, cable TV and cellular service. </p>
<p>All of those groups need wireless communications at or near a disaster site. At the moment, they must compete with the general public: People inside the disaster area are often trying to seek help by calling 911 or texting friends or relatives. They may even post videos and photos of what is happening to social media sites. Loved ones elsewhere also flood communications networks, checking in as “safe” and trying to contact people they know who might be affected, to make sure they’re OK too. After the 2013 Boston Marathon bombing, for example, <a href="https://www.fastcompany.com/3008458/why-your-phone-doesnt-work-during-disasters-and-how-fix-it">all the major cellular networks got overloaded</a> by the number of people trying to make calls and send texts at the same time. (This even happens during nonemergency situations, such as concerts and <a href="https://arstechnica.com/features/2012/08/why-your-smart-device-cant-get-wifi-in-the-home-teams-stadium/">sporting events</a>.)</p>
<p>What’s more, many mobile broadband companies <a href="https://www.cnet.com/g00/how-to/how-to-tell-if-your-wireless-carrier-is-throttling-data/">limit the amount of high-speed data</a> a user can consume in a given month, either cutting off traffic or slowing it down significantly. But a first responder using a camera-equipped drone to inspect, say, a dam that might be breached needs unlimited high-speed communications to get real-time information that can protect both first responders and the public. </p>
<h2>3. Who will pay for it?</h2>
<p>The Federal Communications Commission has been rearranging the frequencies television channels use to broadcast their signals, making room in the electromagnetic spectrum for additional wireless broadband services. The agency recently <a href="https://www.fcc.gov/about-fcc/fcc-initiatives/incentive-auctions">auctioned off the rights</a> to use some of those frequencies to <a href="http://www.commlawmonitor.com/2017/04/articles/internet/fcc-announces-the-results-of-the-19-8-billion-broadcast-incentive-auction/">50 winning bidders including T-Mobile, Dish and Comcast</a>, raising US$19.8 billion.</p>
<p>Of that, $6 billion will be paid to the AT&T group, which will spend that money, plus an <a href="http://www.reuters.com/article/us-firstnet-at-t-contract-idUSKBN171209">additional $40 billion</a>, to build and operate the network.</p>
<p>Money will also come from payments from emergency response agencies, which will have to <a href="https://www.firstnet.com/plans">buy a FirstNet service plan</a> for each device, at prices expected to be similar to today’s mobile pricing. That revenue will also help fund the network, cover the companies’ investments and help generate enough of a profit that the AT&T group has promised to repay the $6 billion to the U.S. Treasury after the FirstNet contract expires in 25 years.</p>
<h2>4. What will happen when there’s not an emergency?</h2>
<p>When there is no emergency in an area, the bandwidth on the FirstNet network in that area will be available to AT&T to sell to private or corporate customers. This revenue, in addition to that from the first responder users themselves, is expected to pay for FirstNet.</p>
<h2>5. What do other countries do about this problem?</h2>
<p>Because of the close relationship between the U.S. and Canadian broadband services, Canada is creating <a href="https://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/psbn-en.aspx">a Public Safety Broadband Network</a> using the same frequency spectrum and protocols as the U.S. so that agencies on both sides of the border can connect to each other easily.</p>
<p>The U.K. is building an Emergency Services Network, expected to <a href="https://www.ft.com/content/d7981bf4-5730-11e7-80b6-9bfa4c1f83d2">begin partial operation near the end of 2017</a>. South Korea expects to complete its public safety wireless network in time to be <a href="https://www.rrmediagroup.com/Features/FeaturesDetails/FID/482">used during the 2018 Winter Olympics</a>. Several other countries have networks that are in <a href="http://e.huawei.com/us/publications/global/ict_insights/201608271037/focus/201608271435">various stages of design and construction</a>.</p>
<h2>6. FirstNet is supposed to last 25 years. What does that mean, and how will it happen?</h2>
<p>As <a href="http://www.electronicdesign.com/4g/wireless-companies-follow-roadmap-past-4g-and-5g">broadband wireless technology improves</a>, our devices and networks will too, including FirstNet.</p>
<p>The effort is also expected to promote technological innovations. Already, some of the technical solutions that serve first responders, such as the ability for <a href="https://resources.ext.nokia.com/asset/200168">devices to connect directly to each other</a>, have been incorporated into LTE standards. Some <a href="https://www.firstnet.com/apps">apps developed for first responders</a> may also release versions useful to others.</p>
<p>It’s hard to know what we’ll need in 25 years – just as 25 years ago, it would have been very hard to envision the technical details of today’s interconnected world. But building FirstNet will help protect and serve both first responders and the public during emergencies – and it will enhance communications in times of peace and prosperity.</p><img src="https://counter.theconversation.com/content/82202/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ladimer Nagurney, in an inherited IRA, owns approximately $1200 of AT&T stock. </span></em></p><p class="fine-print"><em><span>Anna Nagurney 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>A multibillion-dollar effort is just beginning to build an all-new nationwide wireless broadband network for emergency responders. How will it work, why do we need it and how will it last 25 years?Ladimer Nagurney, Professor of Electrical, Computer and Biomedical Engineering, University of HartfordAnna Nagurney, John F. Smith Memorial Professor of Operations Management, UMass AmherstLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/795282017-07-13T13:42:52Z2017-07-13T13:42:52ZHow to reboot Britain’s fractured emergency services<figure><img src="https://images.theconversation.com/files/177868/original/file-20170712-19689-1a6enbq.jpg?ixlib=rb-1.1.0&rect=7%2C4%2C992%2C657&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="source">pixelaway/shutterstock</span></span></figcaption></figure><p>The <a href="https://theconversation.com/grenfell-tower-disaster-how-did-the-fire-spread-so-quickly-79445">Grenfell Tower fire</a> and recent terrorist attacks in Manchester and London have put the spotlight <a href="https://www.theguardian.com/uk-news/2017/jun/20/cressida-dick-calls-for-more-money-for-the-met-after-terrorist-attacks">on spending cuts</a> for emergency services. </p>
<p>In Manchester, <a href="http://www.bbc.co.uk/news/uk-england-manchester-40167454">an independent review</a> into the emergency response was ordered in the aftermath of the bombing to look into the “the strain of spending cuts” on police. The city mayor is also <a href="http://www.manchestereveningnews.co.uk/news/greater-manchester-news/firefighters-infuriated-after-were-stopped-13087703">investigating</a> the fire service after crews were apparentley “held back” from helping the victims. </p>
<p>Whatever the outcome of these investigations – and <a href="https://www.theguardian.com/uk-news/2017/jul/08/grenfell-mayor-orders-urgent-review-of-fire-brigade-kit-after-rescue-delays">others like them</a> – I believe the problems go far beyond staff numbers and resources. The only way forward is to engage in a full system “reboot” to get better results. </p>
<p>The problems are legion. For starters, the emergency services are far too fragmented. There are huge differences across the emergency services when it comes to size, funding and organisational structures with <a href="https://aace.org.uk/news/rusi-calls-for-single-emergency-services-body/">no overarching body for coordination</a>.</p>
<p>Disconnected ministerial oversight also creates uneven and localised outcomes in performance. And the government’s approach to the problem is vague and unclear. The <a href="https://www.gov.uk/government/collections/policing-and-crime-bill">Policing and Crime Act 2017</a> has brought important changes to the governance of the police and fire and rescue services – but ambulance services remain independent of these provisions. It places a duty on police, fire and ambulance services to work together which currently remains undefined. </p>
<p>Ambulance demand is growing at an <a href="https://www.nao.org.uk/wp-content/uploads/2017/01/NHS-Ambulance-Services.pdf">annual rate</a> of about 5.2%. Managing such levels of demand and maintaining the quality of patient care is unsustainable and it is no secret that ambulance services across the country are <a href="https://www.publications.parliament.uk/pa/cm201617/cmselect/cmpubacc/1035/1035.pdf">struggling to meet</a> their performance targets. The police are witnessing a <a href="http://www.college.police.uk/News/College-news/Documents/Demand%20Report%2023_1_15_noBleed.pdf">reduction in recorded crime</a> but are increasingly dealing with cases relating to cybercrime, child and sexual exploitation and mental illness. Meanwhile fire services have seen a <a href="http://www.nlgn.org.uk/public/wp-content/uploads/Fire-Works_Final1.pdf">massive reduction</a> in fire call-outs. But these organisations continue to be performance-managed and target-driven – and current models of service delivery do not reflect these changes. </p>
<p>The focus for the emergency services remains on <a href="http://www.emeraldinsight.com/doi/full/10.1108/09513551111147132">performance metrics</a> and stringent target regimes. Alongside this is the influence that staff associations and unions have on determining the <a href="https://www.gov.uk/government/news/government-response-to-25-september-industrial-action-by-the-fire-brigades-union">scale and pace of reforms</a>. Workforce issues <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.2044-8295.1996.tb02575.x/full">such as stress</a> remain largely neglected and recruitment and retention of black, Muslim and ethnic minorities (BME) <a href="http://journals.sagepub.com/doi/abs/10.1350/pojo.2007.80.3.191">continues to be a challenge</a>. </p>
<p>Issues around Post-Traumatic Stress Disorder (PTSD) and other illness – which are common among emergency workers – are <a href="http://www.tandfonline.com/doi/abs/10.3109/10903127.2011.621044">not being fully addressed</a> and ambulance staff sickness is <a href="http://www.emeraldinsight.com/doi/full/10.1108/IJES-02-2016-0004">highest within the NHS</a>. Media reports also increasingly highlight cases of <a href="http://www.dailymail.co.uk/news/article-3609247/Theresa-slams-fire-service-chiefs-allowing-bullying-harassment-flourish-unveils-sweeping-reforms.html.">harassment and bullying</a> within the emergency services.</p>
<p>There are no easy fixes for all these problems but emergency services do need a “road map” to help them navigate the shifting political landscape and the changes to training and performance regimes. Here are five ways to improve the emergency services and better equip them for the future. </p>
<p><strong>Leadership reform</strong></p>
<p>There needs to be a move from <a href="https://www.hsj.co.uk/topics/leadership/break-away-from-heroic-leadership/5053155.article">isolated chiefs</a> calling all the shots to a more collaborative culture. This is because front-line staff and managers should have confidence in their own leadership and decision-making skills while dealing with other 999 services during major incidents and during interactions with the public. </p>
<p><strong>Promote collaboration</strong></p>
<p>A top-down bureaucratic approach to force the merger of police and fire services is unlikely to work and should be abandoned if it proves costly and does not bring results. <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/200092/FINAL_Facing_the_Future__3_md.pdf">Proposals for merger</a> and reorganisation of the fire services need to be reconsidered, along with the feasibility of a national or regionally organised police force like in <a href="http://www.scotland.police.uk/">Scotland</a>.
Further reforms should allow pooling organisational and management oversight. </p>
<p>Similarly, the role of the ambulance services within the emergency architecture should be spelt out more clearly, since they derive their <a href="https://www.publications.parliament.uk/pa/cm201617/cmselect/cmpubacc/1035/1035.pdf">funding</a> from the National Health Service budget. They work more as the emergency arm of the health services rather than the health arm of the emergency services. </p>
<p><strong>Adapt to changing demands</strong></p>
<p>There is a clear need to understand how usage is changing – and to support staff to respond to new challenges. This will help to improve workforce motivation and reduce the cost of ill health by building a “<a href="https://hbr.org/2011/06/building-a-resilient-organizat">resilient</a>” organisational culture. </p>
<p><strong>Academic partnerships</strong></p>
<p>Developing partnerships with academia will be useful in building modern and professional organisations and to further improve the research base in the “Blue Light” services. </p>
<p><strong>New management skills</strong></p>
<p>Addressing staff morale and retention and setting performance criteria that make sense will be central to improving the services. The obsession with a <a href="https://www.gov.uk/government/news/police-targets-review-published">target-chasing culture</a> should give way to broader sets of measures to reflect the new challenges and changing organisational realities. We need a new set of collaborative leadership and management skills to inspire a shared purpose across a network of organisations to respond quickly to current and future problems. </p>
<p>This is an important moment for the emergency services. The steady rise in the 999 demand along with shrinking budgets are seen by many as two of the key challenges which are unlikely to go away in the near future. There is an urgent need to restart Britain’s limping emergency services and bring about real “transformational” change. But it requires determination, imagination and leadership – or the 999 services will be facing their own emergency situation.</p><img src="https://counter.theconversation.com/content/79528/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paresh Wankhade 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 UK’s blue light services need to adapt and modernise or they will face their own emergency.Paresh Wankhade, Professor of Leadership and Management with expertise in emergency service management, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/798132017-07-09T23:51:30Z2017-07-09T23:51:30ZLessons for first responders on the front lines of terrorism<figure><img src="https://images.theconversation.com/files/176110/original/file-20170628-3154-7e5e7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">After two terror attacks the prior week, police patrolled the Westminster Bridge on election day 2017 in London.</span> <span class="attribution"><span class="source">AP Photo/Markus Schreiber</span></span></figcaption></figure><p>Acts of terrorism are <a href="http://www.cnn.com/2016/11/16/world/global-terrorism-report/index.html">on the rise globally</a>. Over the past several weeks alone, the world has seen stabbings, shootings and bombings in Flint, Tehran, <a href="https://theconversation.com/us/topics/london-bridge-attack-39289">London</a>, Kabul and Bogota.</p>
<p>We’ve spent the past several years researching how communities can prepare to provide urgent medical care to the large numbers of victims these events produce. </p>
<p>Given the persistent risk of terrorist attacks and large-scale accidents, it’s more critical than ever to learn from past incidents. That will ensure that first responders can work together effectively during the chaotic but critical minutes and hours after an incident. </p>
<h1>Better coordination</h1>
<p>Televised images of attack or disaster scenes often show patients being treated and transported by paramedics. Hours later, hospital press conferences often recount the heroic efforts of emergency physicians, trauma surgeons and nurses to minimize loss of life and limb. </p>
<p>But equally important are the actions of nonmedical first responders. Police, firefighters and even bystanders compress wounds, apply tourniquets or drive casualties to hospitals.</p>
<p>In the <a href="http://jamanetwork.com/journals/jama/article-abstract/1684255">Boston marathon bombing</a>, for instance, 264 victims transported to local hospitals survived, despite many serious injuries. This was credited not only to excellent triage, transport and care by medically trained paramedics, EMS and hospital staff, but also to <a href="http://journals.lww.com/annalsofsurgery/Abstract/2014/12000/The_Initial_Response_to_the_Boston_Marathon.4.aspx">immediate lifesaving actions</a> by police and bystanders. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/176109/original/file-20170628-31297-1pafc77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176109/original/file-20170628-31297-1pafc77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176109/original/file-20170628-31297-1pafc77.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176109/original/file-20170628-31297-1pafc77.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176109/original/file-20170628-31297-1pafc77.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176109/original/file-20170628-31297-1pafc77.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176109/original/file-20170628-31297-1pafc77.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Responders help those injured after a bomb went off near the finish line of the Boston Marathon.</span>
<span class="attribution"><span class="source">AP Photo/Charles Krupa</span></span>
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</figure>
<p>However, things do not always go so well. In the often chaotic post-incident scene, it can be difficult to coordinate the efforts of multiple response agencies and bystanders. Even as EMS personnel triage and transfer victims, law enforcement needs to maintain security, preserve evidence and locate potential perpetrators. That makes it challenging to manage access to and traffic around the scene. </p>
<p>For instance, <a href="http://www.cbsnews.com/news/orlando-nightclub-shooting-report-reveals-new-details-inside-pulse/">an Orlando Police Department report on the Pulse nightclub attack</a> cited the need for improved communication and coordination between the police and fire departments responding to the incident. While such problems do not always affect how many lives are saved, they can slow down the overall response. </p>
<p>Even when well-coordinated, those not trained in post-disaster casualty triage can unintentionally cause problems. They might transfer patients to hospitals that lack the resources needed to treat them, or transfer them in vehicles that lack critical life-support equipment, such as IVs or oxygen.</p>
<p>What’s more, unforeseen events such as poor weather or volume-related cell tower outages can create additional challenges. </p>
<h1>Preparing for the next attack</h1>
<p>Our recent research looked at three mass casualty incidents in the U.S. between 2013 and 2015, examining both the health care system and community responses.</p>
<p>We identified several best practices that can help medical and nonmedical first responders handle these incidents more effectively. </p>
<p>First, we must provide co-training for medical and nonmedical first responders. Police and firefighters are already starting to be trained in basic lifesaving skills in non-mass casualty incident contexts. In some communities, such as Atlanta and Irvine, California, police patrols carry <a href="http://www.sca-aware.org/sca-news/law-enforcement-agencies-putting-aed-devices-in-patrol-cars">automated electronic defibrillator devices</a> as well as <a href="http://www.emsworld.com/news/12318404/police-departments-carrying-narcan-to-save-both-the-public-and-police">Narcan</a> to reverse opioid overdose. Other police departments, such as in Denver, provide staff training in <a href="https://www.policeone.com/police-trainers/articles/6150110-Saving-lives-in-the-tactical-space-Training-to-use-tourniquets/">tourniquet application</a>. These efforts should be continued. </p>
<p>Moreover, both medical and nonmedical responders should be trained in scene safety, bystander management, field triage and medical techniques such as effective application of tourniquets. Even many medical professionals lack sufficient training in these skills. </p>
<p>Second, we need to ensure open communication lines. A dedicated radio frequency can facilitate communication among the various responder disciplines, as well as guard against problems caused by cell tower outages. Also, responders can be trained to rely, when necessary, on text messaging, which worked when voice communication did not during the events we studied.</p>
<p>Third, interdisciplinary disaster drills are critical. Communities should conduct regular citywide disaster drills that include EMS, fire and police departments, as well as area hospitals and health care systems. Responders need to test their training and protocols under conditions that simulate some of the complexity and stress of real events. This could include adding components without notice, to <a href="https://www.phe.gov/Preparedness/planning/hpp/surge/Pages/default.aspx">simulate the sudden onset of terrorist events</a>. </p>
<p>Such drills will help each group understand how its actions contribute to an integrated multidisciplinary response. They can also promote more effective collaboration during response to an incident. </p>
<p>Finally, we need to build relationships in advance that can be leveraged during emergencies. Our research indicates that one of the most important ingredients of an effective multidisciplinary medical response is strong relationships and trust among key players. Regular exercises and drills can help, but they need to be supported by leaders and organizational cultures. </p>
<p>For example, in recent years, with support from the federal government, many communities across the U.S. have created health care coalitions that provide formal mechanisms – including regular multi-stakeholder meetings and agreements to share critical resources – for coordinating the preparedness and response efforts of first responders, health care providers and private sector partners. </p>
<p>Moreover, given the frequent role of bystanders, professional responders should reach out to community emergency response teams and other organizations. That can help raise citizen awareness of basic lifesaving techniques. </p>
<h1>Public support</h1>
<p>Effective medical response to terrorism and disasters requires sustained investment. That can be difficult to muster in an era marked by increasing skepticism about public investment and distrust in public institutions. </p>
<p>However, experience suggests that we need collaboration among medical and nonmedical response organizations – and civilians. Through supporting public investments in mass casualty incident preparedness and response, both policymakers and civilians should have the confidence that, even when attacks cannot be prevented, their communities are resilient enough to respond to and recover from them.</p><img src="https://counter.theconversation.com/content/79813/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mahshid Abir is an Affiliated Adjunct staff member at the RAND Corporation and received funding from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (HHS/ASPR) for the research discussed in this article. </span></em></p><p class="fine-print"><em><span>Christopher Nelson is Professor of Policy Analysis at the Pardee RAND Graduate School and Senior Political Scientist at RAND. He received funding from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (HHS/ASPR) for the research discussed in this article.</span></em></p>Given the persistent risk of terrorist attacks and large-scale accidents, it’s more critical than ever for EMTs, police, firefighters and others to learn from the past.Mahshid Abir, Assistant Professor, Department of Emergency Medicine, Director of the Acute Care Research Unit, Affiliated Adjunct and Natural Scientist, RAND Corporation, University of MichiganChristopher Nelson, Professor of Policy Analysis, Pardee RAND Graduate SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/789742017-06-13T15:07:17Z2017-06-13T15:07:17ZIn the future your ambulance could be driverless<figure><img src="https://images.theconversation.com/files/173582/original/file-20170613-25865-1w540l5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Driver not required.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/447792142?src=3ONzbL6SAZaQgTE27Yosvw-1-7&size=medium_jpg">Gervasio S. _ Eureka_89/Shutterstock</a></span></figcaption></figure><p>The revolution in driverless vehicles will make many jobs obsolete. In the US alone, it is estimated that driverless vehicles will wipe out <a href="http://www.businessinsider.com/driverless-cars-to-wipe-out-4-million-jobs-2016-9?IR=T">4.1m</a> jobs. Truck drivers, delivery drivers, taxi drivers and Uber drivers will be out of work, and sooner than you might think. But automation can be a force for good, doing jobs more cheaply, safely and efficiently. In fact, there’s one service that’s crying out for more automation: the ambulance service. </p>
<p>Demand for ambulance services is <a href="http://www.strategyr.com/MarketResearch/Ambulance_Services_Market_Trends.asp">growing rapidly</a> in developed countries due to a <a href="http://ems.sinaiem.org/wp-content/uploads/2015/02/The-future-of-the-ambulance-services-industry-whitepaper-large.pdf">combination</a> of a growing and ageing population, an increase of chronic diseases, and a scarcity of primary care clinics and providers. This leaves the emergency services overburdened, with a dismal outlook for the future. </p>
<p>With <a href="http://fortune.com/2017/03/10/california-driverless-car-testing/">driverless vehicles</a> already on the road, some governments are looking into the possibility of <a href="https://www.publications.parliament.uk/pa/ld201617/ldselect/ldsctech/115/11505.htm">driverless ambulances</a>. Driverless ambulances and other technology could take some of the strain off the emergency services, freeing paramedics to deal with high-risk patients where each minute waiting for treatment <a href="http://www.jems.com/articles/2008/08/golden-hour.html">significantly reduces</a> a patient’s chance of surviving. This would include cardiac arrest patients, where brain damage typically starts within <a href="https://www.ems1.com/ems-products/aeds/articles/396858-Seattle-EMS-remains-a-model-for-cardiac-arrest-response/">four to six minutes</a>.</p>
<p>Initially, health services could introduce a fleet of <a href="http://calhoun.nps.edu/bitstream/handle/10945/47928/15Dec_Davies_Josh.pdf?sequence=1&isAllowed=y">driverless ambulances</a> alongside their <a href="https://ajp.paramedics.org/index.php/ajp/article/view/242/524">current manned models</a> to deal with low-risk patients – essentially starting out as “medical taxis”. Low-risk patients would be picked up by a driverless ambulance and transported to the nearest hospital or clinic for treatment. With the introduction of these ambulances, the need for paramedics to respond to every call – regardless of severity – would be greatly reduced. </p>
<p>However, not everyone is in favour of automated ambulances. One survey of just over 1,000 people in the US found that <a href="http://www.jems.com/articles/ugc/2017/03/01/new-study-shows-skepticism-about-driverless-ambulances.html">around half</a> said they would be comfortable riding in one.</p>
<h2>Supported by drones</h2>
<p>As well as delivering <a href="https://www.amazon.com/Amazon-Prime-Air/b?node=8037720011">Amazon packages</a>, spying on neighbours and conducting military strikes, drones could also be used by health services to take the pressure off the ambulance service. They would be especially useful for delivering medical equipment to remote locations. In fact, a start-up called Zipline is already successfully delivering blood and medicine across <a href="https://www.theverge.com/2016/4/5/11367274/zipline-drone-delivery-rwanda-medicine-blood">Rwanda</a>. But these services could also be used in developed countries. For example, if a doctor in a remote rural location has to treat a patient with a rare condition, but she lacks the necessary medical supplies at her GP clinic or local hospital, a drone could deliver the supplies. Alternatively, drones could be used to deliver vital medical equipment to a drop point prior to the manned ambulance’s arrival. This would allow the patient to be treated as soon as the paramedics arrive. </p>
<p>Drones could also be used to transport specialised equipment, medication or even blood products between hospitals. This would reduce the need for ambulances to drive further distances to find somewhere that can treat their patient. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/173583/original/file-20170613-25865-gc65u1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/173583/original/file-20170613-25865-gc65u1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/173583/original/file-20170613-25865-gc65u1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/173583/original/file-20170613-25865-gc65u1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/173583/original/file-20170613-25865-gc65u1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/173583/original/file-20170613-25865-gc65u1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/173583/original/file-20170613-25865-gc65u1.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">
<figcaption>
<span class="caption">Drones could be used to drop essential medical supplies in remote or hard to reach areas.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/392492077?src=Up1PeraWV4d4t9IRn18rYg-1-3&size=medium_jpg">gualtiero boffi/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Predicting emergencies</h2>
<p>For several years, police forces around the world have been using <a href="http://edition.cnn.com/2012/07/09/tech/innovation/police-tech/index.html">sophisticated algorithms</a> to predict areas where crime is most likely to occur. This allows police departments to deploy officers to areas of “high demand”. While these <a href="http://www.telegraph.co.uk/news/uknews/crime/7908856/Minority-Report-technology-used-by-police-to-predict-crimes.html">Minority Report-style systems</a> have proven to be controversial, a similar system that predicts illness hotspots is less likely to raise eyebrows. </p>
<p>A similar system could be used by ambulance services. It would collect previous trip data from the ambulances (both manned and unmanned). The software would take into consideration the time of year, weather, public events (such as concerts and protests), populations (such as elderly or deprived) and past emergencies that ambulances have responded to. This would enable the driverless ambulances to locate themselves within high-risk areas when they are not in use, allowing them to respond much faster to calls. </p>
<p>As these systems log more and more information, they will become increasingly more accurate at predicting medical emergencies, in the same way that <a href="https://www.smartdatacollective.com/13-retail-companies-using-data-revolutionize-online-offline-shopping-experienc/">data mining</a> tools, used by social media and advertising companies, get better at figuring out what food, clothes, movies and so on you like best, and what you might like in the future. </p>
<p>These new methods may seem far off, but depending on how fast healthcare systems invest and adopt these technologies, they could be changing the way we receive medical treatment within decades. In the face of ever rising demand, technology is likely to be the saviour of ambulance services, making it faster, more effective and safer. However, it may take a while before the public are comfortable with the idea.</p><img src="https://counter.theconversation.com/content/78974/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keegan Clay Shepard 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>… and supported by a drone.Keegan Clay Shepard, PhD Candidate, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.