Towards resilient health systems: opportunities to align surgical and disaster planning

Abstract

Natural disasters significantly contribute to human death and suffering. Moreover, they exacerbate pre-existing health inequalities by imposing an additional burden on the most vulnerable populations. Robust local health systems can greatly mitigate this burden by absorbing the extraordinary patient volume and case complexity immediately after a disaster. This resilience is largely determined by the predisaster local surgical capacity, with trauma, neurosurgical, obstetrical and anaesthesia care of particular importance. Nevertheless, the disaster management and global surgery communities have not coordinated the development of surgical systems in low/middle-income countries (LMIC) with disaster resilience in mind. Herein, we argue that an appropriate peridisaster response requires coordinated surgical and disaster policy, as only local surgical systems can provide adequate disaster care in LMICs.We highlight three opportunities to help guide this policy collaboration. First, the Lancet Commission on Global Surgery and the Sendai Framework for Disaster Risk Reduction set forth independent roadmaps for global surgical care and disaster risk reduction; however, ultimately both advocate for health system strengthening in LMICs. Second, the integration of surgical and disaster planning is necessary. Disaster risk reduction plans could recognise the role of surgical systems in disaster preparedness more explicitly and pre-emptively identify deficiencies in surgical systems. Based on these insights, National Surgical, Obstetric, and Anesthesia Plans, in turn, can better address deficiencies in systems and ensure increased disaster resilience. Lastly, the recent momentum for national surgical planning in LMICs represents a political window for the integration of surgical policy and disaster risk reduction strategies.

Why do the impacts of coronavirus disease 2019 and the response surprise the world?

“…In a health context, for example, this extends to looking at why are vulnerable populations worst affected or affected differently and how can everyone have access to healthcare in such a setting. Taking an example from a different disaster, during the post-earthquake (2015) zones of Nepal in February 2019, it became evident how difficult it is to reach many areas, given the difficult terrain and landscape of the landlocked country (Pyda et al 2019 ; Rolsted & Raju 2020 ). Health is not a stand-alone sector and access to healthcare is influenced by many factors that arise from sociopolitical, economic and cultural dimensions.…”

“…This also means to stop the blame game of coordination and collaboration and move towards a truly coherent and integrated approach to address health in DRR. The recent article by Pyda et al ( 2019 ) accounts for important progress in the field of surgical planning and disaster preparedness, which could serve a useful strategy in emergencies globally. The co-chair’s summary from the GP highlights that ‘[ p ]lanning and action to manage biological hazards, including epidemics and pandemics needs to be strengthened, whilst enhancing investments in resilient health facilities’ (UNDRR 2019a ).…”

Climate change: challenges and opportunities to scale up surgical, obstetric, and anaesthesia care globally

“…13 Building resilient health systems that include the provision of emergency and essential SOA care will be crucial to ensure an adequate response to natural disasters. 15 However, cli mate change also presents a challenge to robust health systems, as seen in the summer of 2018, when all operating rooms were closed in Sollefteå, Sweden, during a severe heatwave as the increased humidity prevented adequate sterility. 16 Resilient health systems will be needed to respond to climate change.…”

Precision Augmentation of Medical Surge Capacity for Disaster Response

“…Based on the resilience of response, a local or regional response system releases endogenous surge capacity after launching an emergency response for a disaster. Endogenous augmentation of medical surge capacity refers to the increase in the medical surge capacity of a disaster response system through a self-buffer mechanism, which can also be called absorption capacity [10], which is inversely proportional to vulnerability and directly proportional to scalability. For example, in response to the Boston Marathon Bombing, due to the strong endogenous augmentation of medical surge capacity, the local medical response system had a favorable outcome with a low mortality rate of incident casualties [11].…”