Ethical Discovery Paper Essay Example | Topics and Well Written Essays - 750 words

Ethical Discovery Paper - Essay Example I did not realize that lack of my understanding was hurting her, because she has always tried to make me happy. Recently I began to rethink the importance of parents in my life. This realization came to me after I was told a few real-life stories based on parental self-sacrifice. One of these amazing stories had a special impression on me. Despite doctors’ assurances that she will never be able to become pregnant, 41-year-old Stacy Krimm wanted to have children. Finally, her dream came true, but then she learned that she had cancer. She refused chemotherapy so her child could be born healthy. A few months after the pessimistic forecasts of her doctors, the woman learned that she was pregnant. However, in July she was diagnosed with cancer. Stacy had to choose between chemotherapy that could save or at least prolong her life and health of the unborn child. The woman chose the health of her future daughter. In August, after Stacy had had a seizure and her heart stopped, the doctors decided to make a Caesarean section and remove the child whose weight at that time was less than a kilogram. The girl was placed in the neonatal intensive care unit. The doctors told Stacy’s family and friends that she was dying. It was decided that a woman could see her child - for the first time. The girl who was named Dottie, was taken to hospital, where Stacy were laying, and put on the mothers breast. The mother and her child were looking at each other for a few minutes. The woman smiled. Three days after, Krimm Stacy died. Stacy’s brother, Ray Phillips, took a healthy baby girl to his home, and she lives with his family now. This story made me look at parental duty with different eyes. Firstly, now I understand that my parents are willing to give even their life for my salvation. Now I know that love is the main cause of the deepest anxiety of my parents for my future happiness and well-being in my future family. Parental love - this is what should be cherished.

France and its relationship to the United States Research Paper

France and its relationship to the United States - Research Paper Example America was later colonized by the British and after a series of rivalry disputes with the French, Britain and the French army engaged in a war that led to the defeat of the French. The French were pushed away from North America and they retaliated by providing the American’s army with weapons to fight for their independence. The two nations have been involved in close ties ever since. Just like any other international relationship, the relationship between France and the United States has been challenged by tension and suspicion. Historically, the United States was the one at the receiving end of the relationship. The benefits that France brought to the United States were vast in the initial period of the international relations. As time passed, the relationship became symbiotic and it has been this way to date. In this paper, I will focus on the history of France and its relationship to the United States. France relationship to the US Since early in the 16th century, the French businessmen were interested in the United States since it was a viable export region for raw materials and food stuff. French explorers in the western hemisphere of North America provided information on the best settling areas for the French people and they formed a colonial empire in this region. The French settlements in the United States were in Detroit, St. Louis, Biloxi, New Orleans, Green Bay, Baton Rouge and Mobile. During the colonial period, the French’s main rival in the region was the Great Britain. The two colonial powers engaged in a series of wars against each other to secure land. In the 18th Century, after the defeat of France by the Great Britain in North America, France opted to form an alliance with the United States freedom fighters. France provided the US army with heavy ammunition to fight against the British colonial army. This marked the beginning of the common interests between the two nations. Together they managed to push Great Britain out of North America. The French later sold Louisiana to the US and this strengthened the US economy (Davidson, 2003). During the seven years war between Britain and France, the French coveted the fertile Canadian land, which was controlled by the British. In helping the US defeat Britain, France was hoping that Britain would be weakened to leave Canada too. After the US gained independence on 4th July 1776, France continued supporting the new nation to grow into an economic giant in the region. During this time, France had already undergone an industrial revolution and it mentored the US to undergo a revolution in industrializing. The two nations became close business partners with the US exporting most of its raw materials to France in exchange for machinery that was needed for industrialization. The two nations’ relations were strengthened when the French gave their US counterparts with the statue of liberty. It symbolized their friendship an d it gave the French a gate pass to freely migrate to the US. The relationship between the two nations has grown over the years and they have become influential on each other’s economy, politics and culture (Lionel, 2004). In the 20th century, the relationship between the two nations maintained its positive growth. The US helped France to defeat the Nazis who were determined to take over the nation. The two nations were in the pioneering group of nations in many international diplomatic unions like the United Nations, WHO and NATO. As the US gained more power and influence in the world, France began to feel threatened and it formed the European

The Southern Pride Of The Civil War English Literature Essay

The Southern Pride Of The Civil War English Literature Essay The Civil War was from 1861-1865. The outcome of the war and the war itself impacted not only the people of that era, but also American literature. Authors infused the ways of the northern and southern people into their works like a baker folding food coloring into batter to make a delicious confetti cake. For example, in A Rose for Emily by William Faulkner, Faulkner writes and now miss Emily had gone to join the represtatives of those august names where they lay in the cedar-bunds cemetery among the ranked and anonymous graves of the union and confederate soldiers who fell at the battle of Jefferson.(89). In Faulkners short story the aftermath of the historical event, the civil war, is seen in the symbolism he uses throughout the short story, his character Emily, and his view of the south. In A Rose for Emily symbolism is used to show the effects of the civil war on the south and to lay a deeper meaning in the short story. At the beginning of this story the house is old, worn down, and out of style. It is described to have once been white, decorated with cupolas and spires and scrolled balconies in the lightsome style of  the seventies.(Faulkner 89). The house can symbolize the fall of the old south and the fallout of southern traditions since the civil war. The house also symbolizes the break down of miss Emily emotionally and physically over the years. Back when Emilys father died the house was still in good condition and kept up with, Emily also kept up with herself. She was young and considered a proper southern belle. When miss Emily dies she is old and her hair has turned gray. Just as Emily is stubborn so is the house. She refused to accept the modern ideas, when the town got free postal delivery miss Emily alone refused to let them fasten the metal numbers ab ove her door and attach a mailbox to it.(Faulkner 93), as it seems the house rejected updating with the new advances. A couple symbols to tell that time was passing are Miss Emilys pocket watch and her hair. The pocket watch is only mentioned once in the story. It was when the Board of Aldermen went to her house to collect taxes. They were in the living room and after the board was done talking, then thru could hear the invisible watch ticking at the end of the gold chain.(Faulkner 90). The ticking is a sign that time never stops and that southern ideals are changing. Emilys hair turned gray over the years, when we next saw muss Emily, she had grown hatband her hair was turning gray. During the next few years it grew grayer and grayer until it creased turning.(Faulkner 93). This showed time passing by. Homer Barron in this short story symbolizes a rat and the north. Homer symbolizes a rat to Emily when she found out he was not a marrying man(Faulkner 92). He most likely wouldnt hav e kept a promise to marry her so to Emily arsenic was a good choice of poison to kill him with. The druggist wrote a note of the box of arsenic For rats!'(Faulkner 92). Homer also symbolizes the north because he is from the north and has northern ideals. He portrays the northern ideals moving into the south. A rose from the title a rose for Emily symbolizes preservation. Homer is the rose when Emily kills him and keeps him in her room. The room has valance curtains of faded rose color, upon the rose-shaded lights(Faulkner 94), which is the perfect place to preserve a body. Emily preserved him like a rose to make him last. The rose is preservation of southern ideals as well. Also the rose is a remembrance of death. A lot of death occurred throughout this short story. The rose could also symbolize silence. With homer representing the north and a rose as silence, homers death is a way that Emily silenced the north or change in her life. Miss Emily symbolizes the old south. Emilys fathe r raised her on the southern ways, alive, miss Emily had been a tradition, a duty, and a card; a sort of heredity obligation upon the town, dating from that day in 1894(Faulkner 90). She was traditional, as in not paying taxes, like most southern people are. Death symbolizes Emilys life. She was alive but not really living the life she had. In a way she is death as in the grim reaper. Her father dies in her presence and she kills homer Barron. Emily herself dies in this short story, thus symbolizing the death of the old south. Faulkner uses symbolism in a rose fir Emily to help portray what kind of character Emily is. Faulkners character Emily is affected by the civil wars outcome. Emilys father settled in Jefferson, Mississippi after the war. Her father instilled strong southern beliefs into Emily. An effect of this is that Emily is stubborn and unwilling to change. Her refusal to pay taxes makes her more than just a stubborn town eccentric.(Smith 3). Miss Emily refused to conform to the ideals of the town when she wouldnt let the people put numbers on her house. Proof of Emily having southern beliefs is that her servant is black, a few of the ladies had the temerity to call, but were not received, and the only sign of life about the place was the Negro man -a young man then- going in and out with a market basket.(Faulkner 91). The black servant refers back to when slaves where allowed in the south. Miss Emilys father had repressed Emily from suitors,Mr. Grierson was a strict man who demanded high standards from hid daughter.(Black 4). The lacks of interaction with people lead her to have, the in ability to feel or demonstrate appropriate affect, or emotion, that is congruent to a particular situation.(Smith 2). Always being under her fathers control leads her to deny her fathers death. With her newly found freedom she cut off her hair as a sign of breaking away from her fathers control.(Fatima 3). Homer Barron started off as a fling; then became an obsession for Emily. The male presence was needed for her to function properly; homer was merely filling a vacancy(Bernardo 1). Emilys obsession over him made her never want to let him go. The fact that homer wasnt the marrying type pushed Emily over the edge to kill him, so she wouldnt ever have to let him go and keep him forever in her presence. Miss Emilys father presses southern ideals into Emily, which had a bad effect on her. Faulkner expresses the civil war affects through Emily. Emily is also a good expression on his views of the south. Faulkners vision of the south is seen through symbolism, the character of Emily and the events that take place in the short story. Homer represents the north. The north is inviting itself into the south and pushing away traditions that have been carried on for decades with the power the civil war has given it. When homer was supposively courting with miss Emily the town was appalled, at first we were glad that miss Emily would have an interest, because the ladies all said, of course a Grierson would not think seriously of a Northerner, a day laborer. (Faulkner 92). As the story goes on the south, represented by Emily, wins the battle. This is when she poisoned homer in fear of him leaving her. The town thinks that Emily has ran homer off, but instead she has killed him so she can keep him for herself. Emily silenced homer, thus preserving the integrity of the old southern ways. Faulkner has given the south a win in his short story since in the civil war the south lost to the north. A s the story unravels, in time so does Emily and the house. They both grow old and weathered. The southern ideals are dwindling away also as time goes on. Even though most of the south has forgotten Emily hasnt. She is the rose of preservation for southern ideals, traditions, and way of living. When Emily dies it means that all recollection of the old south is gone along with her. In William Faulkners A Rose for Emily, Faulkner wrote, à ¢Ã¢â€š ¬Ã‚ ¦-some in their brushed Confederate uniforms-à ¢Ã¢â€š ¬Ã‚ ¦(Faulkner 94). This was describing some veterans at Emilys funeral. IN this short story symbolism, the character Emily, and the view of the south show the consequences of the north winning in the Civil War. In American literature the Civil War shaped the works of many authors around that time era. Bernardo, Karen. William Faulkners A Rose for Emily'. 5/5/2010. Blank, Amanda. Short Story Reviews: A Rose for Emily, by William Faulkner. 5/5/2010. . Fatima. A Rose for Emily. 5/5/2010. Faulkner, William. A Rose for Emily. Trans. Thomas Gould. Literature: An Introduction to Reading and Writing. Ed. Edgar Roberts. New York: Longman, 2009. Print. Smith, Nicole. Psychological Character Analysis of Emily in A Rose for Emily by William Faulkner. 5/52010.

Romeo and Juliet by William Shakespeare :: Romeo and Juliet Essays

Romeo and Juliet by William Shakespeare Acts 3 scene 1 of the play is a turning point. How important are the events of this scene to the tragedy of Romeo and Juliet At the beginning of the play the audience already know the plot, from the prologue. The prologue describes the two lovers to be, quote: 'star-crossed lovers', luck will influence the events. Their love leads to death, quote: 'death marked love' this tells us that Romeo and Juliet are going to die, but in the first two acts, the actions of the play seem to be positive and encouraging because Romeo and Juliet first sight each other at the Capulet's ball, they fall in love, start to meet up secretly after the ball, get married without telling anyone and start planning their future together. In the space of twenty-four hours all these things have happened. In act 3 scene 1 the power of chance causes two deaths. The death of Mercutio, Romeo's best friend and Tybalt, a close relative of the Capulet's. This was caused because the Montague's gatecrashed the Capulet's ball and Tybalt wanted to teach Romeo a lesson for gate crashing the Capulet's ball. Tybalt didn't intend on killing anyone but he ended up killing Mercutio because Mercutio was defending Romeo's honour. When Romeo had realised that Tybalt had killed Mercutio from wounding him, he went after Tybalt and killed him. After this the audience know that Romeo and Juliet will not be able to be happy because Romeo will be banished from Verona which means he can never come back to Verona and the Capulet's will never let Romeo and Juliet be together because he killed Tybalt a close relative. At the beginning of act 3 scene 1 Benvolio wants to leave because the Capulet's are abroad and the prince said, quote: 'If ever you disturb these streets again, your lives shall pay the forfeit of the peace' this is said at the beginning of act 3 scene and is saying that if ever another fight is caused then they all will be banished from

Biography of Malcolm Knowles Essay

Introduction One cannot mention Adult Education without making reference to the internationally reputable adult educationist by the name of Malcolm Shepherd Knowles. Malcolm is renowned for leading both as an academician and practitioner who played a crucial role in the development and the application of adult learning across the globe (George, 2011). Background Malcolm Shepherded Knowles was born in August 24, 1913 in Livingstone, Montana. His parents were Dr. and Mrs. Dr. A. D. Knowles. He loved to participate in sports and outdoor activities from an early age. In addition to this, he was an avid scout during his youthful years. He was also an academically astute student. This was made evident when he graduated at the top of his class from the Palm Beach High School in 1930. Consequently, he was admitted to the distinguished Harvard University where he graduated with a Bachelor of Arts degree in 1934. During his stay at this prestigious institution, he took courses in philosophy, literature, history, political science, ethics and international law (George, 2011). He was also fascinated with extracurricular activities. This made him to be appointed the president of the Harvard Liberal Club, general secretary of the New England Model League of Nations, and President of the Phillips Brooks House. His involvement in voluntary service for the latter got him working with boys club and this formed a crucial platform for his fruitful career in adult education and social service. Career Malcolm Knowles went on to work with the National Youth Administration in Massachusetts where he was responsible for establishing the skills requirements for local employers and establish a course for the entire study body and teach those skills to the young people. In the course of this work he met Professor Eduard Lindeman who went on to become Malcolm’s mentor in adult education. As he continued in this work he married Hulda Fornell whom he had met at Harvard. In 1940, he assumed the role of Director of Adult Education. This enabled him to set up an association school for adults at the Boston YMCA. It is from this position that he was drafted into the Second World War in 1943. In 1946, he took the position of Director of Adult Education at the YMCA. He proceeded to pursue his Master’s degree in Arts at the University of Chicago and graduated in 1949. Under the mentorship of Cyril O. Houle he became executive director of the Adult Education Association of the USA which had been newly formed. He joined the Boston University in 1959 as an associate professor. During this time, he was very instrumental in launching a new graduate program in the field of adult education. He later joined the Fielding Graduate University in Massachusetts where he continued to teach until his retirement in 1979 (George, 2011). Despite the fact that he had retired, Knowles had already achieved his PhD continued to be involved in the field of Adult Education. During this time he became a Professor Emeritus at the North Carolina State University where he continued to write books and articles regarding adult education. Dr. Knowles passed away on Thanksgiving Day in 1997 at his home in Fayetteville, Arkansas due to stroke. Malcolm Knowles’s Contributions Malcolm’s contributions in education can never go unmentioned in especially in the field of adult education. He created a model which is still in use today in the field of adult education. This was the theory of andragogy. This theory was based on the differences in the learning styles between the children and the adults. This theory was developed after a thorough study of humanistic clinical psychology and the relationships which were derived from it. Thus, this theory was based on five basic assumptions about the features of adult learners (Malcolm, 1950). These features brought out a very different view from the features which were observed in children. These features included the following aspects (Malcolm, 1950); the self-concept; which is a person usually, matures over time from possessing a dependent personality towards one of being a self-directed one. Experience; this is the second feature which usually brings with it a huge amount of experience that an individual has gained over time. Readiness to learn; the primary motivation for a person’s readiness to earn may change from being one of eagerness of knowledge in his youth to one of eagerness to develop their social standing. Lastly, orientation to learning, as a person matures, his perspective of problems and urgencies shift to one of a frantic nature. Thus a person starts focusing more on his problems than the subject of his problems. Dr. Malcolm grounded the concept of adult education by bringing on board the principle of Adult Education. This came to the fore as part o his Master’s thesis as he was searching for a ‘coherent and comprehensive theory of adult learning’ when he hit upon the informal theory of adult education. He held the opinion that an organized course was usually better for new learning of an intensive nature while an informal association or club provided the best opportunity for practicing and refining the things which were taught (Malcolm, 1950). Dr. Malcolm spent a further fourteen years producing major texts in the field of adult education. His works include the Modern Practice of Adult Education (1970) and The Adult Learner (1973). These texts help to establish him as a central figure in adult education in the United States of America. Through them, the theory of andragogy was further popularized. He also recognized the value and the importance of learning communication skills. This is because he believed that humans have to interact with each other on a daily basis, therefore the knowledge of communication should be included as part of their curriculum. In order to aid an adult in the society, Dr. Malcolm believed that adult education should be able to enable the adults to develop a clear understanding of them through learning about their own needs and selves. Secondly, adults should cultivate a mindset of acceptance, love and respect towards others. This would help them to establish healthy relationships with others in the society. Adults should also possess an accepting attitude towards change. Adults should also figure out solutions to a general cause instead of fretting over the cause itself. This would help them to develop what he called an active and logical mind that would help them to make any situation and make it better. Adults should also have an understanding of the society and be proactive in instituting social change. This can be done by making every adult aware of the important issues such as political, economic, international affairs and the business aspects of life. Conclusion In conclusion, Dr. Malcolm Shepherd Knowles played a major role in the development and establishment of adult education. Despite the fact that he is no longer alive, his work, ideas and innovations still live on and inspire more strategies in adult learning. His efforts led to the development of the Theories of Andragogy and Self-Directed Learning (George, 2011). In addition to this, he was the first person to chart the rise and progress of the entire adult education movement which took center stage in the United States of America. This informed the process that led to the development of general theory and practice of informal adult education. Dr. Knowles remains to be a great inspiration to many academicians who have benefited from his ideas as well as the professionals in the field of adult education. References George, W. (2011). Malcolm Shepherd Knowles: A History of His Thought (Education in aCompetitive and Globalizing World). London: Nova Science . Malcolm, S. K. (1950). Informal Adult Education. Chicago: Association Press.

Natural Disasters and Health Care

Impact of Natural Disasters on Health Care Submitted by – Dalton Divakaran MS Health Care Management University of Texas at Dallas Index Introduction Types of Disasters Effects of Disaster on Economy Effect of Disaster on Health Care Organization * Sudden Influx * Damage to Facilities * Inadequately Prepared * Specialty Treatment Availability Effects on the Population * Immediate Health Impact * Long-Term Impacts Steps in Disaster Management * Mitigation * Preparedness * Response * Recovery Real Incident Study * Background: * Immediate Response Considerations: * Evacuation: Special Immediate Concerns: * Recovery Process: * Facility Considerations: * Lessons Learned at This Point in Response/Recovery: * Takeaways from this incident: Conclusion References Introduction According to dictionary. com Disasters means â€Å"a calamitous event, especially one occurring suddenly and causing great loss of life, damage, or hardship, as a flood†¦Ã¢â‚¬  Disasters such as Earthquakes, tsunamis, floods, hurricanes, tornados, epidemic disease outbreaks and more can damage any population and have a tremendous effect on the health care organizations that respond.Many health care organizations face major challenges during natural disasters. There are many different causes for those challenges. According to the International Federation of the Red Cross and Red Crescent Societies, in 2002, international disasters affected 608 million people and killed more than 24,000. The recent natural disaster in the United States for this year 2011(May 22, 2011) was the tornado Joplin in Missouri; 160 fatalities were reported in this natural disaster. Types of Disasters I. Natural disasters E. g. : Avalanches, Earthquakes, Volcanic eruptions. II. Hydrological disastersE. g. : Floods, Tsunamis. III. Meteorological disasters E. g. : Blizzards, Cyclonic storms, Droughts, Hailstorms, Heat waves, Tornadoes, Fires. IV. Health disasters E. g. : Epidemics, Famines V. Space disasters E. g. : Impact events, Solar flares, Gamma ray burst. VI. Technological disasters: E. g. : Chemical spills. VII. Complex emergencies: E. g. : Civil wars and conflicts. Effects of Disaster on Economy Developing countries suffer more economic losses than developed countries. The common factor is that, the poor are the ones who suffer the most, in both developed and developing nations.Although the total economic loss in dollars is greater in developed countries, the percentage of losses relative to the gross national product in developing countries far exceeds that of developed nations. Technological disasters and complex emergencies are not easily predictable. The major source of disasters in the 21st century may be due to rapid increase of Technological hazards, unregulated industrialization of developing countries and the globalization of the chemical industry. Effect of Disaster on Health Care Organization Sudden Influx * The biggest challenge after an aftermath is to provide emergency t reatment.The sudden influx of patients to a facility and the need for emergency responders in many places at the same time puts a strain on the health care organizations in the local area. Outside sources like the Red Cross would pitch-in for help in rescue and relief operations in the following days of the incident. However, the responsibility of handling the initial emergency care lies with the local health care departments. Damage to Facilities * The other effects of natural disaster are the lossdegrading of equipment and facility due to sudden spurt in the patients handled at the same time.The demand for all possible medical resources is the possibility that some of the resources may not be available because of direct damage from the natural disaster itself. For example floods may disrupt power supply required to run many equipments at the rescue center. Inadequately Prepared * Even though areas are more susceptible to certain natural disasters, such as earthquakes along a fault line or tornados in the South, they still strike with little or no warning. This throws the health care’s schedule out of the ordinary routine. The facility may not be completely prepared for what comes next.Emergency preparedness plans improve the chances that the organization will be able to respond effectively in the event of a natural disaster, whatever said and done it is never a guarantee that when and what magnitude a calamity occurs. Specialty Treatment Availability * Some disasters are not common like the storms, earthquakes and tsunamis. Epidemic outbreaks of infectious disease are something which needs utmost care to stop them from spreading to the others. It is not just to take care of emergency relief but also to quickly and efficiently protect the rest of the population.It is more challenging when there is no existing vaccine or known treatment. At this instance the role of health care organizations becomes even more important. These organizations must work to treat the patients and protect themselves while labs attempt to figure out a way to stop the infection from spreading. Effects on the Population A population’s vulnerability to all types of disasters depends on demographic growth, settlement in unsafe areas, environmental degradation, the pace of urbanization, unplanned development and climate change. Poverty thrives due to lack of access to healthy and safe environment.Poor education and awareness also poises risk to population. The effects of disaster on population can be broadly categorized into: 1. Immediate Health Impact 2. Long-Term Impacts These are explained below: Immediate Health Impact Short-term losses fall under three categories that have both direct and indirect effects: I. Disability, Illness, and Death; II. Direct losses in infrastructure; and III. Loss or disruption in health care delivery. Long-Term Impacts It is primarily a matter of building institutional ability and human resources, and includes: I.Identi fying vulnerability to natural hazards or other calamities; II. Building simple solutions for such occurrence in the future; III. Initiating a changedevelopment among the main factors to develop a basic plan that outlines the responsibilities of each factor in the health sector, identifying possible overlaps or gaps and building a consensus to create an effective healthcare system; IV. Maintaining close collaboration with these main factors; and V. Educating the first health responders and managers to face the special challenges of responding to disasters.Steps in Disaster Management * Mitigation – To minimize the effects of disaster. Examples: Zoning; Vulnerability analyses; Public education. * Preparedness – Planning how to respond. Examples: Preparedness plans; Emergency exercises/training; Warning systems. * Response – Efforts in minimizing the hazards created by a disaster. Examples: Search and rescue; Emergency relief, Finding alternative sources for relie f. * Recovery – Restore the community or organization to business as usual. Examples: Temporary housing; Grants; Medical care. Mitigation Preparedness Response RecoveryFig: Phases of Disaster Management Mitigation Mitigation is to reduce the intensity of a risk. Mitigation activity decreases the probably of the same disaster reoccurring. It includes vulnerability analyses updates; zoning and land use management; building use regulations and safety codes; preventive health care; and public education. Preparedness Preparedness is to have the health care crew on toes during an emergency situation. It is to achieve a level of readiness to handle any emergency situations. Preparedness can take form of education of rescue elief during emergencies.This may include rehearsals as well. Also it helps to ensure an optimum reserve of medicine, food, water, equipments and other essentials maintained for emergencies. Like mitigation activities, preparedness actions also depend on the appro priate measures in national and regional development plans. Response Response is to react to emergency situations to maintain life, sustain injuries and support the morale of the affected. It also includes providing transport, temporary shelter and food for the affected. Charitable organizations often play a major role in this phase of the disaster management cycle.Recovery Recovery is to bring back the affected population to normal life. Recovery measures both short and long term, include restoring life with minimum operating standard, temporary shelter, reconstruction and economic impact studies . This period brings many opportunities to boost prevention, increase vigilance and thus reducing helplessness. Real Incident Study August 2, 2011 Medical Response to Joplin Tornado May 22, 2011 Background: A tornado warning was issued by the National Weather Services on May 22, 2011 at 5:17 p. m. The tornado was rated an EF-5 with winds exceeding 200 mph.It traveled from west to east alon g 32nd street cutting a path ? to 1 mile wide over 13. 8 miles. The tornado eye was approximately 300 yards wide. Mercy St. Johns Hospital took a direct hit, initial and secondary, on the west facade with duration of approximately 45 seconds. There was a pause as the eye passed through the facility. * 160 deaths in the community resulted from this storm. * 8000 structures were destroyed. 400 businesses destroyed, * 8 school buildings destroyed, * 18,000 vehicles destroyed and * 4,500 jobs displaced. When St.Johns took the direct hit from the tornado initially the generators were destroyed, the roof was destroyed and most of which landed in the parking lots and on top of other facility equipment. All communications was immediately lost. The facility fire suppression sprinklers discharged and lines were broken. Several walls and floors were damaged. Doors were torn from their hinges, all of the glass was blown out of the building except the high impact shatter resistant glass in the p sychiatric ward, gas lines were broken, sewer lines were destroyed with raw sewage projected throughout the facility, and 86 medical offices were destroyed.The oxygen tank was severely damaged and discharged all of the liquid oxygen. There was a strong smell of natural gas throughout the building and all over the campus. Water discharged by the fire suppression system left the rooms and hallways with 3 to 6 inches of standing water. The air evacuation helicopter was destroyed. Typically the helicopter would have been moved to a local airport; however, the storm track did not predict impact to the hospital and there weather conditions prevented safe flight. All Hospital’s vehicles, except a John Deere tractor, were destroyed and the emergency trailer was found in pieces several blocks away.Everyone in the facility panicked that they were going to die, nurses evacuated patients to the hallways per their procedures and at the time of impact nurses covered patients with their bod ies to offer as much protection as possible. IV’s were ripped from patients’ arms, the IV poles became projectiles, and several patients were bleeding as a result. The ceilings collapsed, electrical, IT, and HVAC equipment dropped and littered the hallways. All emergency lights and exit signs were ripped from their mounts and were useless. Both incident command centers were destroyed and Emergency Operations Plans (EOP) lost in the debris.The facility was filled with hazardous waste and the radioactive material was unsecured. Outside debris was mixed and power lines were down. Note: If the tornado had moved just two blocks south Freeman would also have been destroyed. Freeman did suffer some physical damage that resulted in internal evacuation of at least 6 patient rooms. Immediate Response Considerations: There were many immediate considerations that had to be made. If the generators were started, then there was an extremely high probability of electrocution and possi ble explosion from natural gas.Various ways for communication should be arranged. Communications is not yet interoperable. Security forces and public safety could not communicate with each other due to variation is radio systems. Ambulance radios became the communication infrastructure during the initial response. Staff management is vital. Sufficient staff should be available for relief. Drug dispensing machines are useless in this type of a disaster. Staff had to break into the machines to gain access to life saving drugs. ID badges need to be backed up with wallet identification cards for employees.Several staff members lost their homes and automobiles and the badges went with them in many cases. National Guard troops refused to allow staff into the area because of no identification. Pharmacies need to be guarded with armed security. Have strong security so that people won’t run away with cars they do not own. The hospital needs access to several utility terrain vehicles ( UTV) for equipment and patient transport. Same uniform, common identification and common radio frequencies are required for the security team for easy identity. Remember that even the staffs require food, water and rest.Evacuation: Within a few hours St. Johns evacuated 183 patients, completed one surgical case while the storm was in progress, had 1 patient in the PACU, 24 ED patients and 28 critical care patients were among the evacuees. Evacuation was a tough job. This rescue team used what is described as the reverse START process found in our evacuation plan. The team discharged most of the patients they could. Some had no home to go to and opted to stay in the health care system as long as possible. Patient tracking was a nightmare. It took about 4 days to positively locate all of the evacuated patients.Many were sent to hospitals a great distance from St. Johns. The usage of heliport was not practicable and two temporary heliports were constructed in the parking lot. Anything that could be used to move a patient was used. Hospital evacuation sleds, mattresses, doors, wheelchairs, and mattresses were used to move patients down 9 flights of stairs that were dark and littered with debris. The Hospital had three predetermined collection points (muster stations) to evacuate to. This helped them to identify the patients and giving accountability for staff. Special Immediate Concerns:Staffs and physician homes were looted while they were trying to save other. There were attempts to loot property and drugs from the hospital and physicians’ offices. Hospitals need deployable incident command centers rather than fixed. Intra-operation communications was an immediate and continuing concern. Security forces could not be identified since they came in variety of uniforms. There was no common identification and no common radio frequency. Hospitals need the ability to install at least a 6’ steel chain link fence around the perimeter as soon as possible fol lowing the initial event.Know your staff was personally affected by the storm, many lost family members and homes. Many were not prepared to see the level of trauma and had difficulty dealing with the reality of this event. Nearly all required debriefing and employee support services. Special equipments are required for immediate rescue. Know whom your local, state, and federal response partners are and have an established relationship with them prior to any event. In an event of this magnitude, if you try to survive in your facility you cannot do it. You will need to evacuate the facility as soon as safe to do so.Everyone should be included during the planning process. It is important to acknowledge that although a given natural disaster may last for only a short period; survivors can be involved with the disaster aftermath for months or even years. Recovery Process: The first step is security of the facility and campus. The next morning after the event the mass evacuation was comp lete and the facility was cleared. As stated earlier, contracted security forces need to be in the same uniform and on the same radio frequencies as the Hospital security forces so that the recovery process goes smooth.Arrangement for vehicles and fuel should be done and agreements must be in place to have them delivered from locations outside the affected area. The types of vehicles needed should be predetermined. The delivery mechanism should be established very effectively to even work without any phone service. Tent operations became the first means of providing medical services followed by portable facilities. Facility Considerations: During Disasters even emergency power outlets may not operate. Assuming you can use a power generator, consider the following facilities: * Camera’s intended for security purpose should be on power generator. Lighting on emergency power needs to be evaluated. * Exit signs, stairs should be marked with photo luminescent tape or paint. * Know ledge on how to shut down utilities and medical gases quickly and establish a protocol for this procedure. * Proper lightning should be maintained in parking lots and facility areas during recovery phase. * The facility should be considered unstable until cleared by structural engineers. * Secure wiring, HVAC components, piping and light fixtures correctly above ceilings. * Plan for rapid deployment and connection trailer mounted equipment, portable buildings, and portable equipment. Debris removal is lengthy and complex. Lessons Learned at This Point in Response/Recovery: * Intra department communication is a must. If the Hospital and response partners are not on common frequencies then effective communication will not be possible. * Purchase solar charging stations for cellular phones and radio batteries. * Social networks or texting services may not be available during disaster. Effective alternative ways to communicate should be taught to the staffs. * Telephone landlines and su pport from IT are vital. Electronic Medical Records were essential to the continuum of patient care and for identification of practitioners who were in the facility at the time of impact. * Know that your reserve supplies will be inadequate or may be lost. A 96 hour cache of supplies may last as few as 4 hours because of the unanticipated demand. * If the generators operated the potential exists for several deaths by electrocution or explosion. * Stairwell lighting will be lost. JCMH egress lighting is all generator fed with no battery emergency lighting. * Manage staff and provide staff support, including mental health services.This will help them in taking quick decision. * Security of the building is critical. You have to protect your resources. * Badges will be lost during this type of event. Have wallet identification cards for your staff. Takeaways from this incident: * What you practice is what you do. * Knowledge of response partners, local, state, and federal. * Rehearsals with your community partners for rescue related activities. * Add patient slippers/shoes to your weather plan. Have on bed during Code Grey Level I. * Warehousing emergency supplies and to make it easily accessible even without transport facility. Have emergency kits throughout the facility with pens, pencils, paper, and medical record forms. Also include gloves, masks, flashlights, and batteries. * Develop a common triage tag and process. It is best to have a standard triage system. Share and follow it with all of the hospitals in your region. * You need to develop a rapid response team for security and a component of the security team will need to be armed. * Staff adequately during such events. * Efficient disbursement of supplies (Medicines, food etc) among staff for patient care and personal use. Consider staff physical and psychological needs – shift relief, food, rest, and debriefing. * Many storms usually have a follow- up storm and to be ready to minimize damage caus ed to structure and building (eg: Glass debris)during such events.. * The Joint Commission will arrive on site to assist with reestablishment of services and they proved to be a valuable resource. * Establish â€Å"Scrub Racks† with many sizes of scrubs to keep staff in suitable clothing. Conclusion Natural disasters are crisis situations. However, with planning, costly and ineffective interventions can be avoided.Improvisation and rush inevitably come with a high price, and there are many things health officials ought to avoid— preferential use of expatriate health professionals; emergency procurement and airlifting of food, water, and supplies that often are available locally or that remain in storage for long periods of time; the tendency to adopt dramatic measures— all contribute to making disaster relief one of the least cost effective health activities. . The occurrence of a major disaster can be the initial catalyst that helps health authorities recognize that disasters are a public health risk that must be addressed in an organized manner.Yet, preparedness cannot wait. A continual effort is needed to reduce possibility, by decreasing weakness through elimination and minimization and by increasing potential through ability methods. There needs to be a continuum between normal development, preparedness, and disaster response activities. Disasters are not likely to decrease in the foreseeable future. A sustained effort is needed to minimize risk, by reducing vulnerability through prevention and mitigation and by increasing capacity through preparedness measures.Disasters need to be addressed on a long-term and institutionalized basis through an established ministry of health program or department for prevention, mitigation, preparedness, and response for all types of disasters. References * Environmental health in emergencies and disasters: A practical guide. WHO, 2002. * Disaster Help, US Department of Homeland Security. * Green Pape r on Disaster Management, Department of Provincial and Local Government, South Africa * http://www. ehow. com/list_6847852_effects-disasters-health-care-organizations. tml#ixzz1epfIqgRL * Guide to Emergency Management Planning in Health CareBy Joint Commission Resources, Inc * http://www. scsrc. org/wp-content/uploads/2011/08/Joplin_Tornado_Trip_Report. pdf * http://www. himss. org/content/files/ambulatorydocs/BridgeheadWhitePaper_HealthcareDisasterRecovery. pdf * http://www. healthcaredisasterplanning. org/ * http://www. sans. org/reading_room/whitepapers/hipaa/disaster-recovery-healthcare-organizations-impact-hipaa-security_1336 * http://pandemic. wisconsin. gov/docview. asp? docid=14447 * http://www. dcp2. org/file/121/