First News Break on "Massive emergency care in urban settings"
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Newsletter Actualidad - October 2012



First News Break on "Massive emergency care in urban settings"


1st. informative note


The city is a complex and dynamic system that is continuously modifying and adjusting its structures and functions to the demands or relationships between individuals and their natural or built-up physical milieu. According to The Office for Disaster Risk Reduction (UNISDR), by 2020, 82% of Latin Americans will be living in urban areas (UNDP, 2009). On top of this we have to add that more than 50% of the population in the urban conglomerates is living in spaces with only informal development, characterised by high vulnerability to landslides, floods, seismic movements, fires, among other threats, to which must finally be added the potential for traffic accidents, structure collapse, riots and social disorder.


Within this urban context, we can identify a series of conditions propitious for increasing the risk of massive emergencies. PAHO/WHO has characterised this type of emergencies as any adverse event resulting in a number of victims such that it alters routine emergency response, whether or not it surpasses the capacity for response of the services involved. In addition, the term victim is considered to apply to any person or group of persons affected as a result of a specific extraordinary event that derives directly or indirectly in negative sequelae at the physical or psychological level, or on their milieu. These are classified as follows:

  1. Persons that suffer the direct impact.  
  2. Families and friends of the above.
  3. Teams of first responders and caregivers for the persons that suffered the direct impact.
  4. The community affected as a whole.
  5. Persons that learn of the events from the communications media and who are affected somehow by the events.
  6. Persons who were not at the site of the occurrences, but have a relationship to those affected and feel guilty about it.

Healthcare systems, on the other hand, are characterised by different levels of management, going from the primary level, with a heavy intervention at the community level; the secondary level, characterised by a service network of a municipal – regional nature; and the tertiary or reference level, with national-level coverages according to the corresponding service network.


The general framework for the “Making Cities Resilient: My City is Getting Ready” campaign challenges the national governments, local government associations, regional and international organisations and civil society, donors, the private sector, academic institutions and professional associations, as well as all citizens to participate, assuming their role and contribute to build disaster resistant cities. It allows a reflection on the importance of safe health institutions that function within a network. The community organisations, the municipalities and the ministries of health must work in an articulated and coordinated manner to prepare the health system to confront the impacts from emergencies with massive numbers of victims.


Within the framework for planning for massive emergencies, the levels of healthcare described comprise the hospital sub-system, which in practice is the last link on the chain. At the same management level, it corresponds to the extra-hospital sub-system (municipal aid-worker groups, Red Cross personnel, Fire Departments, Police, private services and volunteers in patient care and transfer) to carry out the first intervention, limiting and controlling risks and initial care of victims, that are later delivered to the hospital services.


In the hospital milieu (independent of the level of care) one must be clear that the health centre, clinic or hospital is the most important place for the victims of an emergency situation, so that just as PAHO/WHO has mentioned, hospitals must be safe, and that those facilities continuing to function at maximum capacity after a disaster are considered safe (PAHO/WHO, 2009).


The capacity for disaster response with massive numbers of victims will depend not only on the structural condition of the facility, but also on an adequate operation of the non-structural components and the functionality of the centre after the impact of the adverse event. When a massive disaster or emergency situation occurs and impacts a community, it is the responsibility of the health sector to consider the following principles for its response (Navarro & Machado, 2007).

  • The coherence of the alert process.
  • Active mobilisation and efficient management of available resources.
  • Effective management at the site of the adverse event.
  • Linkages between the hospital and extra-hospital organisations.
  • Management of the hospitalised patients and the flow of the victims.
  • How the primary and secondary evacuations are handled.
  • Updated information for the authorities and victims’ families.

Health System organisation in the face of massive emergencies presupposes a scaled response from the local level through the central level, which maintains lines of coordination, in order to achieve effectiveness, timeliness, control and thus a better response. According to the specialist Daniel Quesada Rodríguez*, the primordial objective after a disaster is to keep the health services functioning, so that each centre must be aware that:

  • There will be changes in almost every hospital activity, which could imply changes in functions, schedules and workspaces among others.
  • Added to this are the structural damages and loss of personnel for the hospital infrastructure, which will reduce the response capacity.
  • The hospital’s capacity for response must be measured and defined immediately after the event, by means of an analysis of the damage and current operating status.
  • This information evolves over time as new damage appears or some damage losses are restored.

The health system’s response to massive emergencies becomes a priority for any emergency management organisation, since it is not only limited to the medical management of physical injury; it must establish a close relationship between the physical impacts, the psychosocial ones and the economic ones, whose responses depend not only on installed hospital capacity, but also on coordination with the rest of the players in local disaster management, such as basic service suppliers, those responsible for the infrastructure and the persons that make the strategic political decisions for the country.


A collaboration of:
Alexander Solís Delgado. MSc.
Specialist in Risk Management and Disaster Handling


* Emergency Physician, National Coordinator for the Institutional Emergency Programme at the Costa Rican Social Security System, Sub-Director of the San Juan de Dios Hospital, Costa Rica.

Navarro Machado, Víctor René; Falcón Hernández, Arelys. Manual para la instrucción del socorrista. 2007.
Pan America Health Organisation. Safe Hospitals: A Collective Responsibility: A Global Measure of Disaster Reduction. 2009.

Related documents


Cómo desarrollar ciudades más resilientes: Un Manual para líderes de los gobiernos locales. (2012)



Making Cities Resilient Report 2012: My city is getting ready! A global snapshot of how local governments reduce disaster risk


Resilient Cities 2012: Congress Report


Oslo government district bombing and Utøya island shooting July 22, 2011: The immediate prehospital emergency medical service response. (2012)


Abastecimiento de sangre durante desastres: La experiencia de Chile en 2010. (2011)


Hospitales seguros y riesgo urbano en Centroamérica: Sistematización y lecciones aprendidas


Mass Casualties and Health Care Following the Release of Toxic Chemicals or Radioactive Material. (2011)


Mass casualty modelling: a spatial tool to support triage decision making. (2011)


Disaster preparedness of Canadian trauma centres: the perspective of medical directors of trauma. (2010)


One million safe schools and hospitals campaign: Advocacy guide. (2010)


Política Nacional de Hospitales Seguros frente a los desastres. (2010)


Safe hospitals in emergencies and disasters: structural, non-structural and functional indicators. (2010)


Determinants of Paramedic Response Readiness for CBRNE Threats. (2009)


Hospitales seguros : Una responsabilidad colectiva : Un indicador mundial de reducción de los desastres. (2009)


Para salvar vidas: Hagamos que los hospitales sean seguros en las situaciones de emergencia. (2009)


La seguridad del hospital, tarea de todos. (2008)