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Conflict & Catastrophe Medicine > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Do disasters contribute a large amount to the overall global burden of injury?

A

No.

Disasters are a small contributor to the global burden of injury

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2
Q

What is the definition of a disaster?

A

A disruption of the human ecology, which the affected population cannot overcome within its own resources. Stricken community needs extraordinary effort to cope with it, often with outside help or international aid.

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3
Q

Are disaster natural or man-made?

A

All disasters are man-made.

As a result of where people live, how they live and factors such as poverty and poor access to healthcare/poor health.

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4
Q

What is the main threat to health as a result of disaster?

A

Mass movement of people.

Brings with it complications of epidemics.

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5
Q

How many deaths occurred between 1975-2000 as a result of disasters?

A

3 million

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6
Q

By 2100, out of 23 major cities globally (with 10 million+ inhabitants), how many will of them will be within at-risk zones?

A

17

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7
Q

Give 3 examples of Major Natural Disasters since 2003.

A

Indian Ocean Tsunami 2004
Pakistan Earthquake 2015
Haiti 2010

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8
Q

What is the name given to the region between Asia/Oceania and the Americas where the most Earthquakes take place?

A

Circum-Pacific Belt

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9
Q 
Rank the following from 1-4 with regards to which is the most important in disaster response:
Communcations
Transport
Power
Emergency Medical Aid
A
  1. Power
  2. Communications
  3. Transport
  4. Emergency Medical Aid

1-3 can be interchanged - emphasis on them being more important to restore/repair over emergency medical aid. Idea of limiting further loss of life and helping to save currently endangered lives.

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10
Q

Name 3 types of specifically man-made disasters.

A

War
Terrorism
Transport
Technological (Air pollution, chemical releases, fires and nuclear incidents)

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11
Q

What percentage of man-made disasters occur in the developing World?

A

95%

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12
Q

What is the definition of a complex emergency?

A

A humanitarian crisis in a country, region or society caused by conflict (internal/external) leading to a breakdown in effective authority requiring an international response that exceeds the capacity of any single agency.

Another definition is a complex emergency is a combination of: natural disaster, conflict, famine, mass population movement, social & political breakdown that occurs at the same time.

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13
Q

At an estimate how many people were killed and how many were injured in the Haiti Earthquake of 2010?

A

200,000 killed

300,000 injured

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14
Q

What were the macro-economic results of the Haiti Earthquake?

A 
Substantial Economic Losses
Debt
High Inflation
Unemployment
Insured Losses
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15
Q

How many people currently are at risk/exposed to disaster?

A

2 Billion

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16
Q

How many people are currently living in crisis conditions?

A

20 million

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17
Q

What is in place in most developed countries in order to deal with major disasters?

A

Disaster/Major incident plans that have been well practiced.

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18
Q

What region of the world suffers with a drastic shortfall in surgeons?

A

East Africa - 0.25 surgeons per 100,000 population.

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19
Q

What is the proportion of Orthopaedic surgeons in developed countries?

A

80%

26 out of 191 countries

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20
Q

How many wars/armed conflicts have occurred since 1945?

A

160

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21
Q

How many wars/armed conflicts are currently occurring?

A

50

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22
Q

Name 5 issues regarding the delivery of emergency disaster assistance that occurred in Haiti.

A
  1. Chaotic aftermath of natural disaster
  2. Local infrastrcuture and resource overwhelmed
  3. Delayed & inaccurate assessment
  4. Lack of coordination between agencies / govts
  5. Competition between NGOs
  6. Inefficiency, duplication
  7. Lack of accountability
  8. Short term volunteers, no continuity of care
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23
Q

How did the UN Cluster System come about?

A

As a recommendation from the 2005 UN review of global humanitarian system which stated:

  1. Coordination be strengthened
  2. Formation of a Central emergency response fund
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24
Q

What are the aims of the UN Cluster System?

A
  1. Increase capacity
  2. Leadership (WHO for health, UNHCR for IDPs, WFP in logistics))
  3. Agreed objectives
  4. Accountability
  5. Field-level coordination
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25
Q

Where was the UN Cluster System first implemented?

A

Pakistan Earthquake

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26
Q

Who is the UN Cluster System accountable to?

A

UN Emergency Relief Co-ordinator - Chair - Stephen O’Brien.

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27
Q

How many Global Clusters make up the Cluster System?

A

11

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28
Q

How many Global Clusters make up the Cluster System?

A

11

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29
Q

Name 1 Major Aid Organisation that does not participate/operate within the UN Cluster System

A

ICRC

MSF

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30
Q

What does DFID stand for?

A

Department For International Development

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31
Q

What is another name for DFID?

A

UKAID

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32
Q

How does DFID co-ordinate its aid delivery?

A

Through partners such as ECHO and ICRC.

Small donations to CHASE OT and UKISAR

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33
Q

What does DEC stand for?

A

Disasters and Emergencies Committee

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34
Q

Describe the structure of the DEC

A

Up to 15 charities working in the disaster field (14 currently)

Joint fundraising

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35
Q

Give 3 aims of the DEC

A

Co-operation
Co-ordination
Accountability
Effectiveness

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36
Q

State the requirements for membership of the DEC (3)

A
  1. Income > £4m / yr
  2. Emergency work > £10m / yr
  3. Good governance
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37
Q

What is the Crisp report?

A

A report as part of UK contribution to Global Health Partnership in Developing Countries

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38
Q

When was the CRISP report published?

A

February 2007

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39
Q

What did the Crisp Report recommend?

A
  1. Links between NHS & developing world (THET)
  2. Education & training
  3. Improved UK medical response to disasters ( database, coordination, release of staff)
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40
Q

How many organisations were operating in Haiti 1 month after the Earthquake in 2010 (and how many were in the health field)?

A

600

274 in health field

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41
Q

What is the UKIETR?

A

UK Emergency Trauma Register

Up to date register of accredited and trained volunteers hosted by UKAID

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42
Q

What is the Humanitarian Emergency Response Review (HERR)?

A

A report in 2011 chaired by Paddy Ashdown commissioned by the Secretary of State which provided recommendations about how to change and improve the UK’s response to Humanitarian crises.

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43
Q

Give 3 examples of recommendations by the HERR.

A 
Anticiptation
Leadership
Innovation
Accountability
Partnership
Resilience
44
Q

What does FMT stand for?

A

Foreign Medical Team

45
Q

What saves most lives; Local Healthcare provisions or FMT’s?

A

Local Healthcare Provision - available early, and immediately

FMT’s usually come in days later and tend to deal with longer term injuries, less urgent surgeries etc.

46
Q

What guideline dictates Military Involvement in Humanitarian Assistance?

A

Oslo Guidelines - OCHA

47
Q

Name 3 advantages of military assistance in Humanitarian situations.

A
  1. Strategic Planning
  2. Surge Deployment
  3. Logistics/Communications
48
Q

What does DRR stand for and what does it consist of?

A

Disaster Risk Reduction

  1. Identifies ‘at-risk’ areas
  2. Protection of vulnerable populations
  3. Investment in infrastructure as emergency preparedness
49
Q

What is the HYOGO Framework?

A

World conference in Japan 2005, idea of building nations resilience to disasters by 2015 - 168 signatories

50
Q

Name the 5 Priorities of the HYOGO Framework.

A
  1. DRR as a national/local priority
  2. Assess risks, enhance early warning
  3. Innovate/educate to build resilience
  4. Reduce risk factors
  5. Strengthen disaster preparedness
51
Q

Name the framework that has superceded the HYOGO framework.

A

Sendai Framework 2015-2030

52
Q

What is the main aim of Disaster Risk Reduction?

A

Mitigate the injury burden.

53
Q

What is a Typhoon?

A

A mature tropical cyclone

54
Q

Name 3 factors that a require for Typhoon formation.

A

Warm Sea Temperature
Atmospheric Instability
High Humidity
Coriolis Force

55
Q

Which country(ies) did Typhoon Haiyan affect?

A

6 countries, mainly The Philippines, but also, Micronesia, China, Taiwan, Palau and Vietnam.

56
Q

What is the definition of Epidemiology?

A

Epidemiology is the study and analysis of the patterns, causes, and effects of health and disease conditions in defined populations.

57
Q

Define Conflict

A

Force (implied or actual); process of organised violence of one group against another; thus involves injury and death- these are inherent

58
Q

What is the main aim of conflict?

A

– to defeat another human being(s) to change action and ULTIMATLEY alter perceptions

59
Q

What is the difference in the traditional idea of war compared to wars of late with regards to the parties involved and their statuses?

A

Wars traditionally between states/act by a sovereign state

Conflict often intra-state or undeclared wars nowadays.

60
Q

Name two key terror tools used in conflict.

A

Rape and Massacre.

61
Q

Name the 2 absolutes of war and describe what they are.

A

Pacifist - No violence/conflict can ever be justified

Holy War - Actions in the name of a supreme being permit the overriding of normal human conduct.

MUTUALLY EXCLUSIVE

62
Q

Describe ‘Jus In Bello’ and ‘Jus Ad Bellum’

A

Jus In Bello - regulates the conduct of parties engaged in an armed conflict - IHL is synonymous

Jus Ad Bellum - Right To War - is a set of criteria that are to be consulted before engaging in war in order to determine whether entering into war is permissible, that is, whether it is a just war.

63
Q

What are the 5 conditions that satisfy the concept of a Just War?

Describe them.

A
  1. Proper authority
    The principle of right authority suggests that a war is just only if waged by a legitimate authority. Such authority is rooted in the notion of state sovereignty.[2]
  2. Just cause / Right intention
    According to the principle of right intention, the aim of war must not be to pursue narrowly defined national interests, but rather to re-establish a just peace. This state of peace should be preferable to the conditions that would have prevailed had the war not occurred.
  3. Probability of Success
    According to this principle, there must be good grounds for concluding that aims of the just war are achievable.[2] This principle emphasizes that mass violence must not be undertaken if it is unlikely to secure the just cause.[3]
  4. Proportionality
    The principle of proportionality stipulates that the violence used in the war must be proportional to the attack suffered. For example, if one nation invades and seizes the land of another nation, this second nation has just cause for a counterattack in order to retrieve its land. However, if this second nation invades the first, reclaims its territory, and then also annexes the first nation, such military action is disproportional.
  5. Last resort
    The principle of last resort stipulates that all non-violent options must first be exhausted before the use of force can be justified.
64
Q

Name 2 War Ethical Viewpoints and their founders.

A
  1. Sun Tsu, The Art of War (China, 600 BC)
    - match and exploit enemy weakness (not strength)
    - manoeuvrist approach: avoid bloodshed
    - central psychological element
  2. Von Clausewitz (Prussia, 19th Century)
    - war an extension of politics
    - combat hardens perceptions
    - politicians required to stay dispassionate
  3. Mao & Giap
    - revolutionary: end justifies means
    - terror and intimidation with reward
65
Q

Name 4 traditional concepts of war and describe them.

A

Symmetrical – similar power, resources and strategies (varying execution); though there is always a cost of resources

Asymmetrical (Mack 1975)– imbalance in forces, and/or strategies eg established army and resistance (undermanned and underequipped) – insurgency/terrorist as well as counterinsurgency/terrorism

Protracted struggle – weaker party need to avoid strength of stronger appointment – thus draw it out to drive down enemy resources, perfected by Mao eg vietnam – Giap maintained the vietnamese could maintain being killed longer than Americans could maintain killing

Manoeuvrist Approach vs attrition (exploiting uncertainty)

Technocentric war – First seen in the gulf, reluctance to engage enemy directly, work at arms length through increased precision technology and acquisition/reconnaissance/
surveillance, platform will be aerial/air with change in military orthodoxy away from army and navy.

66
Q

Give 2 examples of conflicts involving ethic violence.

A

Rwanda, Croatia, Bosnia, Kosovo.

67
Q

Give 2 examples of conflicts involving civil violence.

A

East Timor, Sudan
Arab Spring:Egypt, Syria
Post-interstate war: Iraq, Afghanistan

68
Q

Give 2 examples of inter-state wars.

A

Iraq & Afghanistan

69
Q

What is the defining feature of Modern Era Warfare?

A

Terrorism - intra-state conflicts as a result of the emergence of non-state actors and international terrorist groups.

70
Q

What is the underlying cause of Modern Era warfare?

A

Globalisation

71
Q

Define Globalisation.

A

The process by which businesses or other organizations develop international influence or start operating on an international scale.

72
Q

Name 3 Threats to the ‘West’

A

Bombings including suicide bombings
CBRN threats including (Dirty bombs, Chemical 7, Biological attacks, Chimeras)
Cyber warfare
Hybrid warfare

73
Q

What are the issues with international law in legislating global conflict? (Name at least 2)

A

It is a blunt tool, used to attempt to solve complex states of warfare.

Rarely universal consensus on it.

No enforcement within a state.

Extra-state enforcement politically-dependent.

74
Q

Describe the spectrum of conflict and give examples with each.

A

LOWEST: Military Assistance (early Vietnam)
Humanitarian Operations (Early Balkans)
Peace Support Operations (Balkans later)
Low intensity Operations (Britain’s Colonial Wars)
Mid Intensity Operations (Falklands war – Limited use of available weapons)
HIGHEST: High Intensity Operations (Iraq 2003 - Full and Integrated use of full range of weapons)

75
Q

What is Lund’s curve used to describe?

A

Lund’s Curve of Conflict helps visualize how conflicts typically evolve over time and how different phases of conflict relate to one another.

76
Q

What are the main 5 parts of the Conflict Analysis Framework?

A
  1. Actors
  2. Root causes
  3. Issues, scope and stage
  4. Power, resources and relationships
  5. History of the Relationship
77
Q

Name 3 characteristics of a failed state.

A
  1. Failure of state sovereignty
  2. Loss of authority for enforcing legislature
  3. Loss of sole legimate use of force
  4. Non provision of public service
  5. Reduced interaction with international community.
78
Q

What are the consequences of a failed state?

A
  1. Corruption
  2. Intervention by non-state actors such as terrorist groups or militias
  3. IDP’s
  4. Economic Decline.
79
Q

What are the 8 Millenium Goals and who are they championed by?

A

UN

  1. Eradicate extreme poverty and hunger. …
  2. Achieve universal primary education. …
  3. Promote gender equality and empower women. …
  4. Reduce child mortality. …
  5. Improve maternal health. ..
  6. Combat HIV/AIDS, malaria and other diseases. …
  7. Ensure environmental sustainability. …
  8. Develop a global partnership for development.
80
Q

Give 4 alternative ways of dealing with conflict.

A
  1. Deal with world poverty
  2. Resolve civil conflicts before they inter-nationalise
  3. Interdicting terrorist & rogue state funding
  4. Focus on recruitment & radicalisation
  5. Pressuring totalitarian and authoritarian states
  6. Look at wider causes and consequences of conflict
81
Q

Name 4 characteristics of a leader.

A

Team builder

Self knowledge

Integrity

Life-long learner

Good communicator

Have clear vision

Have a clear strategy

Decision maker

Risk taker

Motivator

82
Q

What is Dwight D. Eisenhower’s definition of leadership?

A

“….the art of getting someone else to do something you want done because he (she) wants to do it”.

83
Q

What is the difference between leadership and management?

A

Management - concerend with the organisation of resources

Leadership - Concerned with organisation of people/

84
Q

Give an example of 5 leadership styles

A

Charismatic - personality driven ‘I’d follow him/her anywhere’

Participative - hands-on

Situational

Transactional - reward or punish

Transformational - redirect subordinates’ needs & thinking. Tend to challenge & inspire

Authoritarian - close control. Often have distinctive professional relationship alongside direct supervision

Democratic - share decision-making

Free rein aka laissez faire
delegate, but provide little or no direction ,or support

85
Q

Name the 3 styles of leadership which come together to form the ‘perfect leader’?

A

Authoritarian

Delegative

Participative

86
Q

What are the 3 roles that the RMA (Royal Marines Association) considers leadership to encompass?

A

Command - controlling directing

Organise - Whats to be done and doing it

Manage men - Look after your people.

87
Q

Name 3 practical issues with leadership and describe them

A

Mission analysis - Questioning, contigency preparation

Team Selection - Fit for task

Team Preparation - What ifs, so whats, rehearsal of contingency.

88
Q

Name the seven secrets of a successful leader.

A
  1. Sensitive to followers
  2. Positive and inspirational
  3. Treat followers with respect
  4. Meeting staff expectations
  5. Avoidance of arrogance
  6. Support staff
  7. A good listener
89
Q

What is meant by ABC?

A

BATLS - Resus

C - Catastrophic Haemorrhage
A - Airway
B - Breathing
C - Circulation

90
Q

What is meant by Right-Turn Resuscitation?

A

Afghanistan war - refers to Army camp hospital where patients in seriously bad conditions are taken down the corridor and to the right which was a hybrid resus/operating theatre.

91
Q

What is the trimodal death/life distribution?

A

A military BATLS concept:

KIA

Severe but potentially survivable injuries

Moderate to minor injuries

92
Q

What is the two main aims of the damage control resusciation continuum?

A

Aim to maximise tissue oxygenation

Minimise blood loss.

93
Q

Name 3 methods by which Damage control resuscitation is achieved?

A

BATLS

Advanced in-transit care

Haemostatic resuscitation

Consultant-based ED care

Tourniquet

Novel Haemostatics - Chitosan

94
Q

Describe the 4 types of treatment priorities.

A
  1. T1 Immediate treatment
    require emergency life-saving resus and/or surgery that is not time consuming & has a good chance of survival
  2. T2 Delayed treatment
    require major surgery/medical Rx but can wait after receiving sustaining Rx, e g, I V fluids, splintage, antibiotics. Examples: long bones; joint injury; burns.
  3. T3 Minimal treatment
    relatively minor injuries & longer delay is not life threatening. Can effectively take care of themselves or be helped by untrained people.
  4. T4 Expectant treatment
    multiply injuries, need time/materiel consuming Rx. Given supportive Rx
95
Q

Why are good leadership skills essential in an austere hospital environment with regards to conflicts in a team?

Give examples of the type of conflicts/incidents that occur and how they are solved.

A

These conflicts must be avoided for efficient workings of a team.

Examples:
Difficult colleagues - There is not the space for interpersonal conflicts - “You are an important component, but a replaceable component”

Patient safety incidents - NHS culture pervasive - Build staff trust
High visibility + openness, be prepared to tackle difficult problems, be fair and decisive.

96
Q

Name 5 potential issues to keep in mind regarding practising in a foreign environment

A

Culture

Language

Scope of practice

Guidelines

Governance

97
Q

Why is a shorter ‘power distance index’ good in practice?

A

Idea that colleagues are more equal, nurses questioning doctors etc.

98
Q

What 2 requirements should be taken into account when choosing a DMD?

A

Must have a deep knowledge of emerging trends and latest practices

Must have confidence to interdict in any area of system failure

99
Q

What is the triad of death?

A

Coagulopathy - Hypothermia and Metabolic Acidosis

100
Q

What is the idea for producing the weapon that causes the most damage?

A

Increasing the amount of energy it dumps in the body AKA high energy transfer weapons.

101
Q

What is the difference between low energy transfer and high energy transfer bullets?

A

Low energy transfer bullets pass through the body - less damage.

High energy transfer stay lodged in the body, increased retardation - more damage.

102
Q

What is the formula for Kinetic Energy, Mass and Velocity?

A

E = MV2/2

103
Q

What type of transfer results in a differing in the wound track from its trajectory?

A

High energy transfer

104
Q

What are the 2 element of a blast wave and what are their characteristics?

A

Shock Wave - Travels at >330m/s, high overpressures, short duration

Dynamic Overpressure - Moves objects due to gas flow, follows the shock wave - in the direction of the explosive products.

105
Q

What is an EFP?

A

Explosively Formed Projectile

106
Q

What is the relationship between Shock Wave Overpressure and Distance?

A

Shock wave overpressure decays rapidly with distance

107
Q

Describe the interation between blast waves and the body.

A

Accelerates the body wall

Propagates through tissues as a pressure (stress) wave

Loses energy at air or gas/tissue interfaces such as the lungs.

Conflict & Catastrophe Medicine (11 decks)

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