Suchergebnisse

The Chakhama Valley, a remote area in Pakistan-administered Kashmir, was badly damaged by the 7.6-magnitude earthquake that struck India and Pakistan on 8 October 2005. More than 5% of the population lost their lives, and about 90% of the existing housing was irreparably damaged or completely destroyed. In early 2006, the Aga Khan Development Network (AKDN) initiated a multisector, community-driven reconstruction program in the Chakhama Valley on the premise that the scale of the disaster required a response that would address all aspects of people's lives. One important aspect covered the promotion of disaster risk management for sustainable recovery in a safe environment. Accordingly, prevailing hazards (rockfalls, landslides, and debris flow, in addition to earthquake hazards) and existing risks were thoroughly assessed, and the information was incorporated into the main planning processes. Hazard maps, detailed site investigations, and proposals for precautionary measures assisted engineers in supporting the reconstruction of private homes in safe locations to render investments disaster resilient. The information was also used for community-based land use decisions and disaster mitigation and preparedness. The work revealed three main problems: (1) thorough assessment of hazards and incorporation of this assessment into planning processes is time consuming and often little understood by the population directly affected, but it pays off in the long run; (2) relocating people out of dangerous places is a highly sensitive issue that requires the support of clear and forceful government policies; and (3) the involvement of local communities is essential for the success of mitigation and preparedness.

BACKGROUND AND OBJECTIVE: During the initial phase of the COVID-19 pandemic the government of the state of Bavaria, Germany, declared a state of emergency for its entire territory for the first time in history. Some areas in eastern Bavaria were among the most severely affected communities in Germany, prompting authorities and hospitals to build up capacities for a surge of COVID-19 patients. In some areas, intensive care unit (ICU) capacities were heavily engaged, which occasionally made a redistribution of patients necessary. MATERIAL AND METHODS: For managing COVID-19-related hospital capacities and patient allocation, crisis management squads in Bavaria were expanded by disaster task force medical officers ("Ärztlicher Leiter Führungsgruppe Katastrophenschutz" [MO]) with substantial executive authority. The authors report their experiences as MO concerning the superordinate patient allocation management in the district of Upper Palatinate (Oberpfalz) in eastern Bavaria. RESULTS: By abandoning routine patient care and building up additional ICU resources, surge capacity for the treatment of COVID-19 patients was generated in hospitals. In parts of the Oberpfalz, ICU capacities were almost entirely occupied by patients with corona virus infections, making reallocation to other hospitals within the district and beyond necessary. The MO managed patient pathways in an escalating manner by defining local (within the region of responsibility of a single MO), regional (within the district), and cross-regional (over district borders) reallocation lanes, as needed. When regional or cross-regional reallocation lanes had to be established, an additional management level located at the district government was involved. Within the determined reallocation lanes, emitting and receiving hospitals mutually agreed on any patient transfer without explicitly involving the MO, thereby maintaining the established interhospital routine transfer procedures. The number of patients and available treatment resources at each hospital ...

Die Verfasser fragen, in wie weit der Grundsatz "Jeder nach seinen Fähigkeiten, jedem nach seinen Bedürfnissen" in den Teilsystemen der Krankenversorgung und Gesundheitsförderung als gesellschaftliche Grundformel wirksam ist. An den Grenzen des Krankenversorgungssystems stehen - in Gestalt wissenschaftlicher Gutachter - Wärter, die darüber wachen, dass die generalisierte Bedürfnisnorm wirklich nur im Krankheitsfall in Anspruch genommen wird. Für ganz Deutschland nach 1989 und auch in den vergleichend herangezogenen Ländern Tschechien, Schweiz und Italien gilt der individualisierende Grundsatz dieser Norm als selbstverständliche gesetzliche Grundregel des Systems der Krankenversorgung. Wichtig zur Sicherung individueller Bedarfsgerechtigkeit ist die Strategie der Evidenzbasierung, die gesamtgesellschaftlich und individuell Fehl- und Überversorgung ausschließen und im Kontext der wirtschaftlichen und politischen Systeme der Gesellschaft Gerechtigkeit herstellen soll. Hier konnte nachgewiesen werden, dass eine organmedizinische Diagnose zuzüglich externer Therapieerfahrungen zwar notwendige, aber keinesfalls hinreichende Voraussetzungen sind, um individuellen Bedarf feststellen zu können. (ICE2)