Emergency Management System In China

The Emergency Response Law of the People’s Republic of China stipulates that “the state shall establish an emergency response management system mainly featuring the uniform leadership, comprehensive coordination, categorized management, graded responsibility, and territorial management.” At the same time, China also established coverage of 2 aspects of the central and local emergency management agencies: hierarchy and clear responsibilities. After the Wenchuan earthquake, the Emergency Management System made a complete improvement in multiple aspects, including the following: (1) clarify government emergency management system: unified leadership, comprehensive coordination; classified management and graded responsibility; localization management-oriented; nongovernmental support and public participation; (2) set up a group of professional emergency rescue team; (3) establish and perfect an emergency management system of laws and regulations; and (4) establish and develop the emergency preparedness and response plans at all levels of government.

The Chinese emergency management system has its own advantages:

• ∙ Conducive to unified command, quick response and efficient linkage: under unified coordination and organization of central government, the whole nation copes with a catastrophe together.

• ∙ Conducive to the advantage of concentrating resources to accomplish large undertakings. China’s biggest advantage is that there is a strong central government, and in the entire government organization system, local governments are subordinate to the central government, and the central government can carry out effective command and coordination on local governments at all levels, focusing on integration of the different parts of the country’s power to deal with major events, to realize “when disaster struck, help came from all sides.” For example, for the Wenchuan earthquake, the central government took out 70 billion yuan as the post-disaster reconstruction fund and raised 1 trillion yuan as a reconstruction fund over the next 3 years through various channels, determining 19 provinces as counterpart support units; thus, a big performance for post-disaster reconstruction was achieved within less than 2 years.

• ∙ Efficiency advantage: Rapid and effective treatment for sudden events not only needs a strong organization and leadership system but also a sound and efficient mobilization, participation, and response mechanism. It has been found that under the framework of the current emergency management system in our country, response, mobilization, and response mechanism requires that the government is the main body, with army support and wide participation of the whole society being robust and efficient. It is helpful to exert the central and local enthusiasm: the central government unified leadership of the central government and localization management of governments at all levels cooperate with each other, with governments at all levels having their own responsibilities and authorities. After SARS, a national network-based infectious disease reporting system was quickly set up. By the end of 2008, it is basically universal at the township level. The system has been tested in treatment of emergencies in recent years, especially after Wenchuan earthquake in Sichuan in 2008 and the Yushu earthquake in Qinghai in 2010, with the central government organized to carry out efficient and rapid earthquake relief activities, winning the acceptance of many organizations at home and abroad.

Offices

The general office of the State Council set up the national Emergency Management Office (EMO), which is in charge of emergency duty, information collection, and comprehensive coordination. Moreover, the Chinese government established two types of EMOs: (1) comprehensive EMOs, which are supposed to support the Chief Executive at each level of government, such as the Premier, governors, mayors and county heads, in managing emergencies in their jurisdictions comprehensively; and (2) specialized EMOs, which are designed to support ministers or department heads at the national level and departments or bureaus in local governments to cope with the four categorized emergenciesReference Hong ¹³ (Figure 1). For example, on August 12, 2015, Tianjin port explosions required the national EMO to assign a functional department (EMOs of ministry/bureau) to take the lead in setting up an accident treatment team to investigate the cause of the accident, as well as coordinate the army, police, and public for emergency rescue and support in Tianjin. The Tianjin Municipal EMO is responsible for organization and leadership of onsite emergency rescue, organization of public security, civil affairs, health, and other industries in orderly participation in the disaster relief, and engaging in restoration and reconstruction as soon as possible, coordinating efficiently, and promoting relief work timely and scientifically.

Figure 1 Organization of Emergency Management Office (EMO) in China.

Education And Training For Disaster Medicine In China

Practices in Disaster Medicine

In recent years, to adapt to the international and domestic situation and keep up with the pace of development, some emergency preplans, policies, and forces have been established by the National Ministry of Health, the Army, and the Ministry of Civil Affairs. The Emergency Management Office, which has responsibility for the unified command of national disaster emergency management, was set up in 2005 under the General Office of the Chinese State Council. To date, 1 Chinese International Search and Rescue Team (CISAR) and 27 national medical rescue teams have been set up in 20 provinces. Moreover, PFPF corps are the main forces that respond to disasters. Rescue and relief works were classified as central works by PAP law in 2009. To date, the PAP corps have set up 152 emergency rescue teams, including 120 teams from the hydropower and traffic troops, 32 teams from the internal security forces, and 48 disaster medical rescue teams. These teams have built a nationwide network of emergency rescuers to perform emergency medical rescue missions.

The author (HS) co-established the CISAR in 2001 and led multiple international disaster medical rescues, including the Indonesia tsunami, Haiti earthquake, Wenchuan earthquake, Yushu earthquake, and other domestic and external large-scale disaster relief missions (Figure 2). Table 1 provides more detail on the disaster medical rescue experiences of CISAR in recent years. They have successfully completed rescue work and received recognition from the public, disaster victims, and affected countries, and have also provided valuable experience and reference for the development of disaster medicine and the construction of medical rescue teams.Reference Hou ^{15 –} Reference Fan, Hou and Zhang ¹⁷

Figure 2 Practices of Chinese International Search and Rescue Team (CISAR) in international disaster rescues. Tsunami rescue in Indonesia in 2004: (A) rescue critical patient & (B) combined transport of the injured patient with American army. Earthquake rescue in Haiti in 2010: (C) set up a tent hospital at the front of presidential palace & (D) treat patient with ocular trauma.

Table 1 Disaster Medical Rescue Experiences of China International Search and Rescue (CISAR) in Recent Years

Research In Disaster Medicine

Currently, especially after the Wenchuan earthquake, Chinese governments have increased budgets for the construction and improvement of emergency response systems. Each year, more universities, academic institutes, and enterprises join in the research efforts on disaster medicine and other aspects of the emergency response system.

Future Concern For Disaster Medicine In China

Basic knowledge of the type of injuries and illness caused by disasters is essential to determine the appropriate relief supplies, equipment, and personnel needed in these situations. In the past, data collected on damage following disasters were usually crude estimates based on superficial observations of limited technical and statistical validity. Disaster medicine researchers seek to provide more disciplined study into the exact nature of immediate disaster needs in terms of traumatic injuries, illness, mortality and their relationships to the demographic factors of the population. The results of such studies make significant contributions toward the development of cohesive disaster preparedness plans for communities, methods of rapid needs assessment for relief aid, and public worker training for disaster situations. Other important research priorities include the following: (1) development of earthquake casualty estimation models for improved preparedness and response, (2) determination of resuscitation potentials for improved methods of triage, and (3) operational analysis to determine which medical supplies are actually needed based on the number and nature of anticipated casualties and standard acceptable treatments. Additional studies should cover the effects on health care facilities, how evacuation decisions should be made and executed, and alternative methods of medical care delivery in situations where hospitals are rendered inoperative. Further studies of human behavior and ways to integrate existing data from the social science literature into disaster planning are critical. Finally, other areas that need to be examined include the actual risk of increased disease transmission following disasters, the cost-effectiveness of deploying field medical teams, the effectiveness or problems associated with the influx of large quantities of relief supplies and relief personnel into a disaster-affected community, and the development of a standard nomenclature for disaster-related activity.

There has been great financial investment and much professional interest within the academic community of the physical sciences (eg, geology, meteorology, engineering) regarding disasters. However, when research within these disciplines receives priority funding without commensurate emphasis on medical science, the preservation of a population’s health following a disaster may be at risk, while the survival of physical structures, such as bridges and roads, may be ensured. Consequently, our specialty must make a commitment to acquire adequate funding and provide professional education and mentoring to foster the necessary research that forms the foundation of disaster medicine. The viability of such scholarly activity depends on proper recognition of disaster medicine research through a committed forum for presentation and publication and opportunities for our physicians to receive ongoing scientific training. Finally, academic collaboration with nontraditional partners—such as engineers, geologists, social scientists, and government planners—is important if we are to further our knowledge in this multidisciplinary field.

The following recommendations are made:

• ∙ Explore the occurrence rules and injury characteristics of various disasters, carry out scientific and systematic fundamental research on disaster, and establish health emergency security plans combining traditional Chinese and Western medicine. Organize health care training of the simulated disaster field, optimize health emergency organization, and improve disaster medical emergency plans.

• ∙ Research, develop, and import the techniques combining traditional Chinese and Western medicine on disaster prevention. Reduce the number of casualties, decrease injuries, speed up casualty evacuation, and improve medical care capacity.

• ∙ Study medical equipment during casualty evacuation. Research and equip with small and highly portable emergency rescue equipment, which should be the most advanced, lightweight, compatible, modular, and standardized to achieve rapid exchange, rapid recharge, rapid maintenance, and joint training.

• ∙ Research and improve the forecasting model for the types, amount and distribution of casualties, provide a foundation for establishing a health care plan, predict the demand for treatment, evacuation and logistical support, and predict the working scale, operating environment, and geographical location of the rescue teams.

• ∙ Strengthen the fundamental research on disaster injury to include the body’s response to trauma, disaster severity injury assessment, the mechanism, prevention, and treatment of multiple organ dysfunction syndrome (MODS), trauma prevention research, mechanism of trauma cell molecular biology and cell molecular bioremediation biology, and research on tissue engineering. We should not only pay attention to the functional recovery of the body but also attach importance to the recovery from psychological trauma, develop functional recovery equipment, promote psychological treatment after disasters, reduce the rate and degree of disability, and improve social productivity.

• ∙ Rapidly create an efficient disaster medical network system. Ensure that the medical rescue, communication, and transportation networks run efficiently. Improve the disaster rescue content of medical science and technology.

• ∙ Set up portable ICUs and bring the emergent treatment to the field. This will play an important role in reducing the disability and death rates associated with disaster accidents and local warfare.

• ∙ Study disaster epidemiology. This research will promote the innovation and constant development of effective disaster medicine.

• ∙ View organization and management in disaster medicine as an integrated system. We must reinforce the organization and management of emergency medical services, build a strong command department to direct the work of emergency search-and-rescue, and improve the rescue medical system to guarantee successful rescue operations.

• ∙ To set up a triage system for disaster victims, build an elite rescue team, train a group of key members for self and mutual medical aid, strengthen onsite treatment, increase the efficiency of medical evacuation, shorten the time from trauma to surgery, and emphasize that the key to improving the efficiency of rescue is improving basic treatment technology.

• ∙ Medical and health departments and other disaster medical sections should be well prepared in theory, organization, equipment, and personnel—always ready to successfully implement rescue activities for disaster emergency incidents.

• ∙ Concentrate on the principles of scientific treatment. Organize a professional rescue team as soon as possible to provide early rescue and to enhance treatment and nursing care. Some severely wounded victims need timely surgical treatment, and if a hospital in good condition is available, they should be managed with surgery in the Emergency Department based on “fast, accurate, early, and effective” principles.Reference Li, Pei and Shen ²¹

• ∙ Pay attention to psychological impairment of the public. Sudden disaster events can induce psychological stress; statistics show that approximately three-fourths of people have so-called “terror syndrome” in varying degrees after trauma. Some suffer from mental disorders, show fear, or easily trust rumors. Psychological trauma is obvious, and we must employ proper tactics and measures.

• ∙ Attach importance to long-term effects on victims caused by disasters. Since the emergence of the psychological syndrome caused by the Gulf War in 1991, victims have attracted widespread attention and demonstrated that rescue treatment should be provided earlier and faster. Additionally, preventive care should be considered while the wounded receive overall treatment.

• ∙ According to the problems identified in many disasters, reformation and restructuring of related measures are necessary for improving emergency capacity to address a variety of disasters and sudden events to protect people’s health, life, and security. We should carry out research on disaster prevention and control to lower the incidence of disasters and the associated disability and fatality rates.

• ∙ Provide technical assistance, training and education programs, exercise support, and planning guidance for public health emergency preparedness and response activities.

In conclusion, Disaster Medicine is an emerging cross-discipline, but there are still many problems to be solved. Emergency rescue and disaster relief is one of the central tasks of Disaster Medicine, relying on the development of related clinical, research, and teaching efforts. We will do our best to contribute to the construction and development of the Rescue Medicine discipline in China.