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Risk and Risk Assessment in Health Emergency Management

Published online by Cambridge University Press:  28 June 2012

Jeffrey L. Arnold
Jeffrey L. Arnold*
Affiliation:
Yale New Haven Center for Emergency Preparedness and Disaster Response and Section of Emergency Medicine, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
*
Medical Director Yale New Haven Center for Emergency, Preparedness and Disaster Response, 1 Church Street, 5th Floor New Haven, CT 06510USA E-mail: [email protected]
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Abstract

This article considers the critical roles of risk and risk assessment in the management of health emergencies and disasters. The Task Force on Quality Control of Disaster Management (TFQCDM) has defined risk as the “objective (mathematical) or subjective (inductive) probability that something negative will occur (happen)”. Risks with the greatest relevance to health emergency management include: (1) the probability that a health hazard exists or will occur; (2) the probability that the hazard will become an event; (3) the probability that the event will lead to health damage; and (4) the probability that the health damage will lead to a health disaster. The overall risk of a health disaster is the product of these four probabilities.

Risk assessments are the tools that help systems at risk—healthcare organizations, communities, regions, states, and countries—transform their visceral reactions to threats into rational strategies for risk reduction. Type I errors in risk assessment occur when situations are predicted that do not occur (risk is overestimated). Type II errors in risk assessment occur when situations are not predicted that do occur (risk is underestimated). Both types of error may have serious, even lethal, consequences.

Errors in risk assessment may be reduced through strategies that optimize risk assessment, including the:(1) adoption of the TFQCDM definition of risk and other terms; (2) specification of the system at risk and situations of interest (hazard, event, damage, and health disaster); (3) adoption of a best practice approach to risk assessment methodology; (4) assembly of the requisite range of expert participants and information; (5) adoption of an evidence-based approach to using information; (6) exclusion of biased, irrelevant, and obsolete information; and (7) complete characterizations of any underlying fault and event trees.

Keywords

definitiondisasterdisaster medicineemergencyemergency managementerroreventevidenceevidencebased medicineharmonizationhazardhealthriskrisk assessmentrisk assessment matrixrisk characterizationrisk managementterrorismvulnerability
Type
Theoretical Discussion
Information
Prehospital and Disaster Medicine , Volume 20 , Issue 3 , June 2005 , pp. 143 - 154
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2005

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References

1.Arnold, JL: Disaster medicine in the 21st Century: Future hazards, vulnerabilities, and risks. Prehosp Disast Med 2002;17:3–11.CrossRefGoogle Scholar
2.Horton, R: Threats to human survival: A WIRE to warn the world. Lancet 2005;9455:191–193.CrossRefGoogle Scholar
3.Khalikov, R: Risk and vulnerability in a global perspective–Challenges and opportunities. Prehosp Disast Med 2004;19(2)s1. (Abstract).CrossRefGoogle Scholar
4.Rotz, LD, Khan, AS, Lillibridge, SR, et al. : Publichealthassessment of potential biological terrorism agents. Emerg Infect Dis 2002;8(2):225–230.CrossRefGoogle ScholarPubMed
5.Schultz, CH, Mothershead, JL, Field, M: Bioterrorism preparedness: I: The emergency department and hospital. Emerg Med Clin North Am 2002;20(2):437–455.CrossRefGoogle ScholarPubMed
6.Sharp, T, Brennan, RJ, Keim, M, et al. : Medical preparedness for a terrorist incident using chemical and biological agents during the 1996 Atlanta Olympic Games.Ann Emerg Med 1998;32:214–223.CrossRefGoogle ScholarPubMed
7.Sundnes, KO: Risks, threats, vulnerability and myths, paradigms and truths. Prehosp Disast Med 2004;19(2)s1–2. (Abstract).CrossRefGoogle Scholar
8.Task Force on Quality Control in Disaster Medicine/World Association of Disaster and EmergencyMedicine. Health Disaster Management: Guidelines for Evaluation and Research in the “Utstein Style.” Glossary of terms. Prehosp Disast Med 2002;17(Suppl 3):144–167.Google Scholar
9.McLaughlin, SB: Healthcare Facilities Management Series. Hazard Vulnerability Analysis. Chicago, IL: American Society for Healthcare Engineering, 2001, pp 1–13.Google Scholar
10. Department for International Development: Risk management. In: Tools for development. A handbook for those engaged in development activity. DFID Website. Available at www.dfid.gov.uk/pubs/files/toolsfordevelopment.pdf. Accessed 14 January 2005.Google Scholar
11. Emergency Management Australia: Australian Emergency Management Glossary. Emergency Management Australia Website. Available at www.ema.gov.au. Accessed 14 January 2005.Google Scholar
12. Federal Emergency Management Agency: Understanding Your Risks: Identifying Hazards and Estimating Losses (FEMA 386-2). FEMA Website. Available at www.fema.gov/fima/planning_toc3.shtm. Accessed 15 January 2005.Google Scholar
13.National Research Council: Glossary. In: Understanding Risk. Informing Decisions in a Democratic Society. Washington, DC: National Academy Press, 1996, pp 213–216.Google Scholar
14. Society for Risk Analysis: Risk analysis glossary. Society for Risk Analysis Website. Available at www.sra.org/resources_glossary_p-r.php. Accessed 14 January 2005.Google Scholar
15. United Nations Department of Humanitarian Affairs, International Decade for Natural Disaster Reduction: Internationally agreed glossary of basic terms related to disaster management (1992). Centre for Research on the Epidemiology of Disasters Website. Available at www.cred.be. Accessed 14 January 2005.Google Scholar
16. United Nations Inter-Agency for the International Strategy for Disaster Reduction: Terminology: Basic terms of disaster risk reduction. United Nations International Strategy for Disaster Reduction Website. Available at http://www.unisdr.org/eng/library/lib-terminologyeng%20home.htm. Accessed 14 January 2005.Google Scholar
17.World Health Organization: Vulnerability assessment. In: Community Emergency Preparedness: A Manual for Managers and Policy-Makers. Geneva, Switzerland:World Health Organization, 1999, pp 30–69.Google Scholar
18.Zilinskas, R: Assessing the threat of bioterrorism: Congressional testimony by Raymond Zilinskas. Center for Nonproliferation Studies Website. Available at http://cns.miis.edu. Accessed 21 January 2005.Google Scholar
19.Misra, V, Jaffery, FN, Viswanathan, PN: Risk analysis in hazardous injuries. Regulatory Toxicology and Pharmacology 1991;13:62–69.CrossRefGoogle Scholar
20.Shook, G: An assessment of disaster risk and its management in Thailand. Disasters 1997;21:77–88.CrossRefGoogle ScholarPubMed
21.Noson, L: Hazard mapping and risk assessment. Asian Disaster Preparedness Center Website. Available at www.adpc.net. Accessed 14 January 2005.Google Scholar
22.Task Force on Quality Control in Disaster Medicine/World Association of Disaster and Emergency Medicine: Health Disaster Management: Guidelines for Evaluation and Research in the “Utstein Style.” Conceptual model: Hazard, risk vulnerability, and damage. Prehosp Disast Med 2002;17(Suppl 3):56–68.CrossRefGoogle Scholar
23.Bieri, S: Disaster risk assessment and the systems approach.World Institute for Disaster Risk Management Website. Available at www.drmonline.net. Accessed 14 January 2005.Google Scholar
24. Emergency Management Australia: Community emergency planning guide. Emergency Management Australia Website. Available at www.ema.gov.au. Accessed 14 January 2005.Google Scholar
25.Decker, RJ: Homeland Security. A risk management approach can guide preparedness efforts. Testimony Before the Senate Committee on Governmental Affairs. General Accounting Office. 21 October 2001, GAO- 02-208T.Google Scholar
26.Decker, RJ: Homeland Security. Key elements of a risk management approach. Testimony Before the Subcommittee on National Security, Veterans Affairs, and International Relations; House Committee on Government Reform. 21 October 2001, GAO-02-150T.Google Scholar
27.National Research Council: Guidance for risk assessment. In: Science and Judgment in Risk Assessment. Washington, DC: National Academy Press, 1994; pp 357–374.Google Scholar
28. General Accounting Office: Combating terrorism: Threat and risk assessments can help prioritize and target program investments. Report to Congressional Requester. United States General Accounting Office; 09 April1998 Report General Accounting Office (US)/NSIAD-98-74.Google Scholar
29. Kaiser Permanente: Medical center hazard and vulnerability analysis. Emergency Medical Services (California) Website. Available at www.emsa.ca.gov/dms2/kp_hva.xls. Accessed 14 January 2005.Google Scholar
30. National Safety Council: What are the odds of dying? National Safety Council Website. Available at www.nsc.org/lrs/statinfo/odds.htm. Accessed 21 January 2005.Google Scholar
31.Stewart, TR: Uncertainty, judgment, and error in prediction. In: Sarewitz, D, Pielke, RA, Byerly, R (eds): Prediction. Science, Decision Making, and the Future of Nature. Washington, DC: Island Press; 2000, pp 41–57.Google Scholar
32.National Research Council. Uncertainty. In: Science and Judgment in Risk Assessment. Washington, DC: National Academy Press, 1994; pp 160–187.Google Scholar
33.Rivkind, A, Barach, P, Israeli, A, et al. : Emergency preparedness and response in Israel during the Gulf War. Ann Emerg Med 1997;30:513–521.Google ScholarPubMed
34. Associated Press: Bush OKs smallpox shots for public. 12 December 2002. USA Today Website. Available at www.usatoday.com/news/nation/2002-12-11-bush-smallpox_x.htm. Accessed 21 January 2005.Google Scholar
35.Gerberding, JL: CDC efforts in implementing a smallpox vaccination program. Testimony of JulieL., Gerberding, MD, MPH, Director, Centers for Disease Control and Prevention Before the Committee on Appropriations, Subcommittee on Labor, HHS, Education and Related Agencies. January 29, 2003. Centers for Disease Control Website. Available at www.cdc.gov. Accessed 21 January 2005.Google Scholar
36.Centers for Disease Control: Update: Adverse events following civilian smallpox vaccination–United States, 2003. MMWR 2003;52(20):475–477.Google Scholar
37.Centers for Disease Control: Update: Cardiac-related events during the civilian smallpox vaccination program–United States, 2003. MMWR 2003;52(21):492–496.Google Scholar
38.Cassels, A: Bioterrorism becoming too dominant on public health agenda? CMAJ 2002;167:1281.Google ScholarPubMed
39.Geiger, HJ: Terrorism, biological weapons, and bonanzas: Assessing the real threat to public health. Am J Public Health 2001;91:708.Google ScholarPubMed
40.Roberts, IG: How political should a general medical journal be? Medical journals may have had a role in justifying war. BMJ 2003;326:820. (Letter).Google ScholarPubMed
41.Voelker, R: Will focus on terrorism overshadow the fight against AIDS? JAMA 2001;286:2081–2082.Google ScholarPubMed
42.Annas, GJ: Bioterrorism, public health and civil liberties. N Engl J Med 2002;346:1337–1338.CrossRefGoogle ScholarPubMed
43.Buettner, C., Surks, MI: Police detainment of a patient following treatment with radioactive iodine. JAMA 2002;288:2687. (Letter).CrossRefGoogle ScholarPubMed
44.Barbera, J, Macintyre, A, Gostin, L, et al. : Large-scale quarantine following biological terrorism in the United States: Scientific examination, logistic and legal limits, and possible consequences. JAMA 2001;286:2711–2717.CrossRefGoogle ScholarPubMed
45.Reynolds, A: What exactly is a “weapon of mass destruction”? Cato Institute Website. Available at www.cato.org. Accessed 03 February 2003.Google Scholar
46.Bird, J, Lubkowski, Z: Managing tsunami risk. Lancet 2005;9456:271–273.CrossRefGoogle Scholar
47.National Research Council. Executive summary. In: Science and Judgment in RiskAssessment. Washington, DC: National Academy Press, 1994; pp 1–15.Google Scholar
48.Badenoch, D, Heneghan, C: Introduction. In: Evidence-based Medicine Toolkit. London: BMJ Books, 2002, p 1.Google Scholar
49.Inglesby, TV, Henderson, DA, Bartlett, JG, et al. : Anthrax as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA 1999;281(18):1735–1745.CrossRefGoogle Scholar
50.Jernigan, DB, Raghunathan, PL, Bell, BP, et al. : Investigation of bioterrorismrelated anthrax, United States, 2001: Epidemiologic findings. Emerg Infect Dis 2002;8:1019–1028.CrossRefGoogle ScholarPubMed
51.Asai, Y, Arnold, JL: Terrorism in Japan. Prehosp Disast Med 2003;18(2): 106–114.CrossRefGoogle ScholarPubMed
52.Ahl, AS: The application of probabilistic scenario analysis for risk assessment of animal health in international trade. Ann N Y Acad Sci 1996;791:255–268.CrossRefGoogle ScholarPubMed
53.Rabkin, NJ: Combating terrorism. Linking threats to strategies and resources. Testimony beforethe Subcommittee on National Security, Veterans Affairs, and International Relations, Committee on Government Reform, House of Representatives. United States General Accounting Office; 26 July 2000, United States General Accounting Office/T-NSIAD-00-218.Google Scholar
54.Rabkin, NJ: Combating terrorism. Need for comprehensive threat and risk assessments of chemical and biological attacks. Report to Congressional Requesters; September 1999, United States General Accounting Office/NSIAD-99-163.Google Scholar