With the advent of the millennium era, the new war was proclaimed. The enemy in this war is neither Nazi troops with their panzers and submachine guns, nor the Arabic terrorists with their explosive belts. Monstrous and uncontrolled exploitation of the natural resources as well and the development of the nuclear technologies have made a tremendous negative impact on our natural ambience. Toxic and nuclear dumps are indeed the most devastating weapon that has ever been utilized by the mankind. However, the gravest repercussion of this war is the eradication and subsequent extinction of the number of fauna and flora species, the deterioration of the breathable atmospheric air and overall environmental degradation(Stepher-Hughes, 2005).
However, the nature now seems to launch a set of aggressive counter attacks. The most illustrative samples are the ruinous Chilean earthquake, 1960, with the death toll reaching the range between 2000 and 6000 people. 2004 was remarkable for the most destructive natural blow on the positions of the humankind. The Indian coastal area near Sumatra was virtually destroyed by the Tsunami, which magnitude was reported to be among 9 and 9, 4. Approximately 250, 000 people were found dead or permanently disappeared(Stepher-Hughes, 2005).
Moreover, the mankind is self-destructive. Recent explosions on the nuclear power stations in Fukusima, Japan and the 9/11 terrorist attacks are among the most notorious examples on how horrific the devastating force of the technology may be. Irrespective of the nature and the causes of the calamity, the consequences ensued are almost always of devastating
Considering the fact, that ideally emergency medical services have not been designed to work under disaster circumstances or shall be implicated as secondary or facultative workforce, practically they are always put to the frontline of the disaster management. Most importantly, nowadays, the professionals of medical emergency crews very often serve as definitive disaster fighters. Their disaster-tackling work can be classified into four paradigms: Disaster Mitigation Activities, Preparedness-Focused Disaster Activities, Response Disaster Actions and Recovery Activities (Philips, 2005). This research paper provides the aggregation of the international and domestic EU and USA experience with regard to those operations and analyzes the concepts of disaster, emergency medical services and emergency medical services management.
The Concept of Disaster
Before the operations and conducted by the emergency medical crews in the state of the disaster are analyzed, it is necessary to determine what shall be deemed as disaster. Outwardly, there is no need to provide a definition, but the practice clearly indicates that this task is of paramount importance. Determining whether some negative events are really disasters or not condition which workforce shall be applied to tackle the problem, what awards shall be endowed to the calamity liquidators and etc.
Although there is neither unified opinion of the scholars, nor the fixed and universally established legal definition on what shall be understood under the concept of disaster, commonly a disaster, or a calamity is considered to be a peril which brings substantial change to the natural environment, causes considerable human casualties or substantial physical destructions leading to heavy material and monetary losses. The origins of a disaster can be either natural or technological (also known as human-made). The most exemplary disaster generators are earthquakes, mass explosions, nuclear or other large-scale technological breakdowns. Some scholars consider that almost any natural or human-caused natural hazard can be eliminated or significantly minimized provided that proper disaster risk management is taken (Kromer, 2005). In other words, the peril may be annihilated if a recommended set of costly, but considerably effective measures is taken by the risk management and prevention agents.
The most important aspects which are relevant to both naturally and technologically generated calamities are human vulnerability aspect and inability of the reaction squads to do proper, prompt and effective emergency actions. Therefore, it is logical and coherent to assume that the global task of all the emergency services is to minimize the vulnerability of a population to a specific environmental or technological threat(Pons & Makrovchick, 2002). The second important objective is the organization of an effective and resultant emergency management.
The way disasters are coped with nowadays is far from ideal. A vast variety of versatile guidelines, recommendations and mandatory bylaws have been created to coordinate and manage the activities of the emergency crews(Philips, 2005). However, the practice precisely demonstrates that when a calamity occurs, chaotic, poorly organized and controlled activities are launched to tackle it.
Emergency Medical Services and Emergency Medical Management
The primary objective of emergency medical services is to provide expedient, out-of-hospital expedient and acute medical assistance and transportation services to the people affected by illnesses and injuries, who became incapable of transporting themselves as a result of those injuries and illnesses. The installation of these types of medical care facilities pursues two primary goals. Firstly, emergency medical services are charged with the task to provide basic treatment services to those, whose life, mental or physical health are endangered somehow(Stepher-Hughes, 2005). The second function which is vested to them is the obligation to deliver the affected patients to the closest medical stationed unit, where the treatment can be provided. In the majority of the civilized countries nowadays, these types of public servants are summoned by phone or other widely accepted means of common communication. The professional aspects of these crews are of paramount importance for the successful implementation of their tasks. First and foremost, the most professionally accomplished staff is hired to transport the patients due to the fact that basic medical assistance in the cases involving cardiovascular issues, like heart attacks, insults and myocardial infractions necessitate prompt, professional and experienced actions of the medical or paramedical worker. In the majority of jurisdictions, the first aid squad usually consists of emergency medical responder, ambulance medical care assistant, medical technical worker, emergency medical dispatcher and ambulance driver (Beck, 2006). More accomplished medical squads are usually reinforced by the presence of paramedics, critical care practitioners and emergency care staff and care assistant(Stepher-Hughes, 2005).
Emergency medical management is in its an interdisciplinary applied study which aim is to organize the cooperation and collaboration of the medical emergency and other taskforce practitioners with the intent to organize effective and definitive protection of the civil population from the dangerous repercussions of the natural and human activity based disasters(Pons & Makrovchick, 2002). The people who are actively engaged in the emergency medical management are practically responsible for the elaboration of the effective set and schedule of actions that are to be followed by the medical aid crews. These actions are closely connected with risk mitigation procedures, aspects connected with the preparedness of a specific medical unit in particular, and overall country medical system in general to cope with disaster when it happens. Other important aspects to be addressed in this research paper are the recovery and response actions taken by the emergency medical crews.
Emergency Medical Services Mitigation Activities
The concept of mitigation actions can be classified as a set of activities that are intended to anticipate, evaluate and avoid unnecessary risks. In particular, the task of the analysts in this paradigm of emergency medical services work is to prospectively analyze the detriment that can be done to the personal health and general healthcare situation of the targeted area. For some natural and technological disasters and calamities it is not evident for the ordinary citizens in advance that certain negative repercussions are likely to arise.
Considering the gravity of the anticipated circumstances, emergency medical units are often implicated to cooperate and to coordination mitigation efforts together with seismologist units, anti-terrorist centers and other stationed and mobile rescue teams (Philips, 2005). Very often the ecological and technological disasters are accompanied by the power-cuts that may hypothetically happen to be very prolonged. In such cases the installation of an autonomous power generator is regarded as a mitigation and prevention measure. The storm shelters are erected in the areas which are particularly vulnerable to seismologic vibrations of the earth. Seemingly, the emergency medical crews are not required to partake in emergency mitigation and prevention events. However, the practice has demonstrated that certain set of actions to ease the gravity of the ensued repercussions can be done by the emergency medical teams as well. To illustrate, the United States of America medical crews (the state of New York in particular) in the case of an announced “emergency state” are obliged to take additional medication, to be utilized if the number of the casualties in reality exceeds the one that has been anticipated (Beck, 2006). Another mitigation measure that is followed by the United States Medical crews is the presence of the autonomous tank station at the location of the medical department to which a medical crew is attributed. This tank stations must always be supplied with extra amount of gasoline, to provide for the contingency that crews may be expected to work extra shifts.
The last but not the least aspect connected with the possible mitigation actions followed by the healthcare emergency practitioners is the installed surgery equipment. Although the primary aims of the emergency medical crew is to make basic life-saving treatment, sometimes the need to make a basic surgery intervention remains as the only viable mean to save the life of an injured patient(Stepher-Hughes, 2005).
Emergency Medical Crews and Preparatory Actions
The concept of medical preparation to a disaster is closely and integrally connected with mitigation measures. Preparation stage involves the inventory management of the facilities and equipment. The appliances and medication which are outdated or can substitute for the ones which are more advanced technologically are replaced. Brand-new technological advancements are introduced to the medical sector in the first turn (Beck, 2006). Moreover, with regard to the difficulty of the conditions in which the rescue and lifesaving work can be conducted, the crews of the New York emergency medical service are usually equipped with the so-called reserve stockpile kits (Kromer, 2005). This type of package includes foodstuff, potable water, extra-supply of medications and flashlights. These kits have been elaborated for the needs of the medical crews that have been trained to work above normal conditions, such as landslide, floods and volcanic eruptions.
Another important aspect of the preparation paradigm is the need to organize a careful, meticulous planning of the scheduled rescue activities. In the event additional crews are to be urgently formed, the way the squads are formed (i.e. what professional namely are included and what actions they will be exercising) is prescribed by the internal regulations of the medical unit. When the state of emergency is proclaimed, the directives and orders of the medical superior authorities are automatically followed. No consultations or challenges of the decisions are permitted, since the expedient character of the provided services is the key factor to the success fulfillment of the rescue operation in general.
The logistic parlance of the preparatory actions is also of paramount importance (Kromer, 2005). The regions which can be the most harmed are to be identified, the roads shall always remain as clear as possible to ease the access of the crews. The trucks which are used by the crews has a durable, hardened bumper which is physically capable to remove the obstacles put on the way of the emergency medical rescue crews.
Responsive Actions of the Emergency Medical Crews
The proclamation of the emergency state on the affected territories (either the official one or the evident) necessitates that practical actions to be taken by the crews to diagnose the injured and wounded, to organize their delivery to the nearby hospital and others long-term care facilities and to provide the first aid to them. The practice manifests that the responsive actions taken by the medical crews of the United States of America, by their colleagues from the European Union and Far East (Japan and China) are almost similar in their scopes and natures and they are equal in terms of professionalism and effectiveness. Once the disaster occurs, the medical crews go to the locations which are reported to be the most devastated. Their appearance at the points of destruction are done both upon the telephone summons of the citizens and purposefully to the areas where the casualty tolls are reasonably predicted to be high (Beck, 2006). The nature of the actions conducted by the team greatly varies and depends primarily on the type of the disaster (Pons & Makrovchick, 2002). For instance when a disaster is aggravated by the epidemiological aspects the teams may be mandated to impose a state of quarantine over the area. With the spread of serious contagious contaminating diseases the medical emergency crews can be mobilized to work in the contaminated areas and to observe that the quarantine conditions and limitations are fully observed by the isolated people (Philips, 2005).
The disastrous situation aggravated by the big death and physical injury tolls usually involves the necessity to conduct and prompt basic treatment and diagnosis procedures. For instance, the most popular medical measure during the recent deluges of San Francisco was the administration of artificial respiration of the drowned people to restore their breathing ability and clear the lungs(Stepher-Hughes, 2005). Overall, the emergency medical crews are the most active partakers of the disaster recovery and the associated negative events. Their professionalism, experience and dedication conduce the efficiency of the overall operation and the reduction of the death and invalids list.
With the subsidization of the immediate perils to the health of the human beings, the recovery state is commenced. The obligation to arrange the recovery actions is upon the medical staff of the long-term healthcare centers. However, emergency medical crews can be implicated to this process in the understaffed areas, such as India. International experience although suggests that even highly developed medical infrastructures, such as Japanese one in the case of necessity (earthquakes and Fukusima nuclear stockpile emissions) the medical squads can be implicated to organize, supervise and process long-term care maintenance of affected people (Stepher-Hughes, 2005).
Moreover, contemporary international practice clearly suggests that although that is not their primary task, the vast majority of the emergency medical crews are routinely required to complete the tasks that exceed their core competence greatly. To illustrate, when the repercussions of the recent Haiti earthquake were being tackled, the EMS crews were expected to monitor the healthcare conditions of the affected citizens even when their major mission (the transportation and primary medical help was over). The deployment of the international rescue teams included the presence of the emergency medical crews from the USA and Russian Federation, since the staff responsible for the eradication of the consequences considered that these medical professionals are the most prepared to tackle such tasks.
However insignificant it may outwardly seem, the psychological aspect shall be nevertheless considered by the stakeholders. The people who have been rescued by the medical emergency crews do report to be connected subliminally with those, who saved them. The scientists in general fail to explain this phenomenon scholarly, but they routinely express the opinion that these intangible ties are conducive to the recuperation process in general. Therefore, aftereffect therapy often included verbal or written communication with those, who was directly involved in the rescue mission. Furthermore, the results fetched by this particular therapy are sometimes indeed spectacular.
Another form of recovery operations participation is the obligation if the crews to answer the summons of the former patients when the relapse of the negative symptoms occur. For instance when human being was traumatized as a result of a specific disaster, and the hidden effect of the traumas were revealed within a definite period of time, the medical crews are obliged to render assistance for that human being. To illustrate, some of the German and US emergency medical crews are still deployed on the affected areas (Haiti, Indian Coast) and help those who are in dire need of their urgent medical assistance.
Having summarized the main points of the research paper, it has become evident that the backbone of the effective emergency situation tackling is the effective and professional work of the emergency medical crews (Beck, 2006). The health and the lives of the affected population are fully dependent on the professionalism, expertise and dedication of the emergency medical service staff. Their emergency services are organizationally divided into four stages, i.e. mitigation, preparation, response and recovery. Each stage implicates the use of specific actions and all stages of actions are of equal importance and preponderance.
More exactly, when a disaster-related event occur, the emergency medical crews are summoned to evaluate the gravity of the situation, to participate in the rescue mission plan composition and to render rescue services practically. The practical aspect of the rescue operations in its turn involves the detection of the injured people (either selflessly or via their summons), the basic diagnosing and basic treatment and the transportation of the injured or ill people to the long-term care facilities or medical camps. When the way to them is inhibited, the crews can be expected to make surgeries and other types of treatment at the spot. Overall, it can be summarized that EMS do play a vital role in the course of almost any rescue operation, which can be classified as a disaster. Failure to carry out any of the aforementioned actions inevitably leads to the grave repercussions, including the deaths and heavy incurable post-traumatic injuries and illness aftereffects.
However effective the work of the emergency medical crews dealing with the disasters may seem to be, the area for improvement still remains. First and foremost, traditionally either specific medical services or even army detachments receive specific training procedures to be able to work under abnormal (i.e. disastrous) circumstances. However quite often (hurricane Catharine) the help of civil services is requested and these crews are not prepared to carry out their mission both psychologically and physically. Therefore, it does seem to be reasonable for them to get that type of professional enhancement courses.
Another implementable recommendation in that paradigm is the use of the EMS in the first turn. Contemporarily they are utilized when conventional rescue teams, especially the military ones cannot cope with their obligations. While the practice indicates that civil-oriented EMS are tackling the problems stemmed from a disaster considerably more effective way, it really seems advisable to use them more actively in the forefront of the arisen problems. However, their task shall be confined exclusively to the basis treatment and basic diagnosing functions and the functional responsibilities of other services shall not be shifted on them. Provided that all these recommendations are taken in to consideration it can be assumed that the overall professional performance of the EMS units will be greatly enhanced.