The First Affiliated Hospital has treated 104 patients who tested positive for CoVID-19 in 50 days. It has achieved zero deaths in patients diagnosed, zero patients misdiagnosed, and zero infections in medical staff. Its experts documented real treatment experience when combating the virus, 24 hours a day, and quickly published this Handbook.
Public Health Emergencies often lead to Stigma, Discrimination and Abuse towards certain communities and social groups, or affected people. Within the context of CoVID-19, this has already happened … with the disease being recklessly associated with a specific population or nationality.
Established to facilitate on-line communication and collaboration internationally, as well as to provide Frontline Medical Teams around the world with the necessary communication channels to share practical experience about fighting, controlling and overcoming the pandemic.
The European Commission, together with several Partners, launched this Platform on 20 April 2020 … to enable the rapid collection and sharing of available Research Data. The Platform, part of the ERAvsCorona Action Plan (download PDF File, 153 Kb), is a significant effort to support Researchers in Europe and around the World in the fight against the CoronaVirus pandemic.
Vulnerable People, such as Those with Activity Limitations (#PwAL) or Disabilities (#PwD), are more impacted by #CoronaVirus/#CoVID19. These impacts can be mitigated if simple Self-Protection Measures are taken.
As Fire Departments and local Authorities Having Jurisdiction (AHJ’s) continue planning to respond to CoronaVirus/CoVID-19 occurrences in their communities, the IAFC Coronavirus Task Force has developed a guide to identify best practices … and key recommendations which are based largely on guidance from the U.S. Centers for Disease Control and Prevention (CDC – https://www.cdc.gov/) and the World Health Organization (WHO – https://www.who.int/emergencies/diseases/novel-coronavirus-2019). When planning for CoVID-19, Fire Chiefs must also be sure to collaborate with local Stakeholders, both individuals and organizations !
2014-04-13:Further to the Post, dated 2013-01-13 …
There are many essential qualities and features belonging to and representative of a Sustainable Human Environment (including the Social, Built, Virtual and Economic Environments).As discussed here many times before … Accessibility-for-All is one fundamental attribute, under Social and Legal Aspects of Sustainable Human and Social Development.
Another fundamental attribute … Urban Resilience … is now moving centre stage in the world of International Construction Research & Practice.WHEN, not if … this concept is fully elaborated and understood, it will have a profound impact on All Tasks, Activities and Types of Performance in the Human Environment … under All Aspects of Sustainable Human and Social Development.
After working for many years on Climate Change, particularly Adaptation … it was quite natural for me to encounter the concept of Resilience.But the aim of a newly established Core Task Group within CIB (International Council for Research & Innovation in Building & Construction) is to widen out this concept to also include Severe Natural Events (e.g. earthquakes, typhoons, tsunamis), ComplexHumanitarian Emergencies, (e.g. regional famines, mass human migrations), Extreme Man-Made Events (e.g. 2001 WTC 9-11 Attack, 2008 Mumbai ‘Hive’ Attacks), and Hybrid Disasters (e.g. 2011 Fukushima Nuclear Incident) … to set down Resilience Benchmarks … and to produce Resilience Performance Indicators. An imposing challenge !
AND … as Urbanization is proceeding at such a rapid pace in the BRICS Countries (Brazil, Russia, India, China & South Africa) and throughout the rest of the Southern Hemisphere … ‘practical’ and ‘easily assimilated’ trans-disciplinary output from this CIB Task Group is urgently required.In other words, the work of the Task Group must not be permitted to become an exercise in long drawn out pure academic research … the clear focus must be on ‘real’ implementation … As Soon As Is Practicable !!
A New and Updated Groundwork …
The ethical design response, in resilient built and/or wrought form, to the concept of Sustainable Human & Social Development.
SUSTAINABLE HUMAN & SOCIAL DEVELOPMENT
Development which meets the responsible needs, i.e. the human and social rights*, of this generation – without stealing the life and living resources from the next seven future generations.
*As defined in the 1948 Universal Declaration of Human Rights … and augmented by UN OHCHR Letter, dated 6 June 2013, on the Post-2015 Development Agenda.
The CITY (as Region)
A geographical region, with open and flexible boundaries, consisting of:
(b)A large resident population of more than 500,000 people (social environment) ;
(c)A supporting hinterland of lands, waters and other natural resources (cultivated landscape) ;
together functioning as …
(i)a complex living system (analogous to, yet different from, other living systems such as ecosystems and organisms) ;and
(ii)a synergetic community capable of providing a high level of individual welfare, and social wellbeing for all of its inhabitants.
A general condition – in a community, society or culture – of health, happiness, creativity, responsible fulfilment, and sustainable development.
A person’s general feeling of health, happiness and fulfilment.
A state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.[World Health Organization]
The complex network of real and virtual human interaction – at a communal or larger group level – which operates for reasons of tradition, culture, business, pleasure, information exchange, institutional organization, legal procedure, governance, human betterment, social progress and spiritual enlightenment, etc.
The social environment shapes, binds together, and directs the future development of the built and virtual environments.
Anywhere there is, or has been, a man-made or wrought (worked) intervention by humans in the natural environment, e.g. cities, towns, villages, rural settlements, service utilities, transport systems, roads, bridges, tunnels, and cultivated lands, lakes, rivers, coasts, seas, etc … including the virtual environment.
A designed environment, electronically generated from within the built environment, which may have the appearance, form, functionality and impact – to the person perceiving and actually experiencing it – of a real, imagined and/or utopian world.
The virtual and built environments continue to merge into a new augmented reality.
The intricate web of real and virtual human commercial activity – operating at micro and macro-economic levels – which facilitates, supports, but sometimes hampers or disrupts, human interaction in the social environment.
‘ For many Weak and Vulnerable People, today’s Complex Human Environment is inaccessible and unsafe … a hostile ‘reality’ which prevents independent functioning and participation in a local community; it is a blatant denial of their human rights.’
Relevant Human Environment (social – built – virtual – institutional) Factors … factors which are external, or extrinsic, to the context of a person’s life and living situation … include policies and standards, negative attitudes and stigma, lack of services, problems with service delivery, inadequate funding, lack of accessibility in the built environment and to electronic, information and communication technologies, lack of consultation and involvement, and an absence of reliable data and evidence.
Accessibility for All …
Take a really close look at the photograph below … and see a staircase which, in spite of all the legislation in the EU Member States, contravenes almost every accessibility-related design guideline. It is far from being an unusual scene in our European Built Environment …
Now, imagine the consequences of one, tiny slip …
Which is why our concern must be with Accessibility for All … which includes consciously thinking about children under the age of 5 years, women in the later stages of pregnancy, and frail older people (not all older people !) … and how they use and interact with their surroundings.
In addition, however … our attention must also turn to the large numbers of people, in all of our societies, with health conditions which result in serious impairments, activity limitations and participation restrictions. As a prime example, consider the Big-4 Non-Communicable Diseases (NCD’s): Cardiovascular Diseases (e.g. heart attacks and stroke), Cancers, Diabetes, and Chronic Lung Diseases.
These 4 NCD’s – targeted in a World Health Organization (WHO) Global NCD Campaign – share health risk factors (tobacco use, unhealthy diet, lack of physical activity, harmful alcohol use) … cause more than 36 million deaths annually (almost 80 % of deaths, from such diseases, occur in low and middle-income countries) … and result in a high proportion of disability (66.5 % of all years lived with disability in low and middle income countries).
NCD’s can limit one or more of a person’s major life and living activities … such as walking, eating, communicating, and caring-for-oneself. Examples of common NCD-related impairments include paralysis due to stroke, and amputation as a result of diabetic neuropathy.
When Easily Assimilated Signage IS Essential in Buildings …
Good Architectural Design IS ‘intuitive and obvious’ for building users … design characteristics which are critical in the case of Fire Engineering Design. However, what is intuitive and obvious in Ireland may not be so intuitive and obvious in Turkey … and what is intuitive and obvious in Europe will certainly not be intuitive and obvious in Africa, India, or China.
Architectural & Fire Engineering Design must, therefore, be adapted to Local conditions … culture, social need, etc., etc.
When a building is NOT ‘intuitive and obvious’ for the broad range of potential building users … easily assimilated signage IS essential …
International Standard ISO 21542: ‘Building Construction – Accessibility & Usability of the Built Environment’ was published in December 2011, as a full standard. In its Introduction, ISO 21542 is linked to the U.N. Convention on the Rights of Persons with Disabilities (CRPD) … almost like an umbilical cord.
The scope of ISO 21542 covers public buildings. The Accessibility Agenda in the U.N. Convention is very broad … so much standardization work remains to be completed at international level.
Concerning Accessibility Symbols and Signs … reference should be made to ISO 21542: Clause 41 – Graphical Symbols … and on Pages 106, 107, 108, and 109 … the following will be found:
Figure 66 – Accessible Facility or Entrance ;
Figure 67 – Sloped or Ramped Access ;
Figure 68 – Accessible Toilets (male & female) ;
Figure 69 – Accessible Toilets (female) ;
Figure 70 – Accessible Toilets (male) ;
Figure 71 – Accessible Lift / Elevator ;
Figure 72 – Accessible Emergency Exit Route.
I use the word ‘accessibility’, and not ‘access’ … because Accessibility has been defined in ISO 21542 as including … ‘access to buildings, circulation within buildings and their use, egress from buildings in the normal course of events, and evacuation in the event of an emergency’.
A note at the beginning of the standard also clarifies that Accessibility is an independent activity, i.e. assistance should not be necessary … and that there should be an assurance of individual health, safety and welfare during the course of those (accessibility-related) activities.
During the very long gestation of ISO 21542, an overwhelming consensus emerged in favour of using the term Accessibility for All … thereby sidestepping the thorny issue of different design philosophies which are described as being accessibility-related but, in practice, are limited and/or no longer fit-for-purpose.
The Accessibility Symbol used throughout ISO 21542 is shown above. I know that a small group of people from different countries worked very hard on this particular part of the standard. My only contribution was in relation to the inclusion of Figure 72, concerning Fire Evacuation.
This ‘accessibility’ symbol is an attractive, modern and, of course, abstract representation of a concept … a person with an activity limitation using a wheelchair. The symbol succeeds very well in communicating that concept.
However … as an Accessibility for All Symbol … encompassing people with other than functional impairments, e.g. hearing and visual impairments … and children under the age of 5 years, women in the later stages of pregnancy, frail older people … and people with the four main types of non-communicable disease discussed above … is this symbol, also, limited and no longer fit-for-purpose ??
Shown next, above, is the proposal for a new Area of Rescue Assistance Sign … which is contained in ISO 7010:2011 / FDAM 115 (2013). While it is nice to finally see this Safety Sign appear in the mainstream of safety signage … the title being proposed for the sign and the explanatory texts which accompany it are very problematic …
The technical term being proposed – Evacuation Temporary Refuge – is too long and too difficult to understand ;
The explanatory texts which accompany this Sign are very confusing and misleading.
This problem has arisen because the people who drafted ISO 7010:2011 / FDAM 115 (2013) hadn’t a bull’s notion that ISO 21542 even existed !
In ISO 21542, we use the term Area of Rescue Assistance … which is easy for everybody to understand, including building users, building managers and firefighters, etc., etc.
We also explained, in ISO 21542, that a Place of Safety is a remote distance from the building … not anywhere inside the building !
Mainstreaming Disability …
U.N. CRPD – Preamble
(g) Emphasizing the importance of mainstreaming disability issues as an integral part of relevant strategies of sustainable development,
As ‘disability’ moves closer towards … and is integrated and fully included in the ‘mainstream’ of sustainable community life and living … it is absolutely imperative that individuals and organizations who make up the Disability Sector become much more cohesive (far less fractious within) … that they begin to fully understand the practices and procedures of the mainstream … and actively and robustly engage with that mainstream.
It is ridiculous, for example, that a large amount of the Sector’s energy is still being diverted into meaningless meditations and endless tracts on whether it is ‘universal design’, or ‘design-for-all’, or ‘inclusive design’, or ‘facilitation design’, etc … when an entirely new design paradigm is being demanded by a world (our small planet when seen from the moon !), which is experiencing enormous levels of human poverty, natural resource shortages, human rights violations, and severe weather events. The overriding priority must be ‘real’ implementation … Effective Accessibility for All !
While the wider international design community is working hard on developing an array of Accessibility Symbols to facilitate different health condition and impairment categories, and to suit different environmental situations, e.g. a fire emergency in a building … I recently encountered another interesting contribution …
2009-11-25: In the midst of an economic, financial and fiscal crisis in Ireland … the country has recently been hit by a Major Flood Emergency in the West and South … extending inland almost to the centre. The emergency will continue over the next few days.
There appears to be no central co-ordination of the response to this National Emergency. No public guidance or other announcements have been published in the national media.
Further to the full page advertisement promoting the National Older & Bolder Campaign, which was printed on Page 7 of The Irish Times (2009-11-19) … the contents of World Health Organization (WHO) Fact Sheet: ‘Older Persons in Emergencies’, drafted following the 2006 Lebanon Humanitarian Crisis, are both appropriate and particularly relevant for Ireland now …
When dealing with older people in emergencies, a number of issues which might affect them will require special consideration. Apart from specific chronic disease and disability related issues, two major factors contribute to increased vulnerability of older people in emergencies: the ‘normal’ challenges of physical ageing and social loss, and the ‘environmental’ challenges. In a crisis, minor impairments which do not interfere with daily functioning in the normal environment can quickly become major handicaps that overwhelm an individual’s capacity to cope. For instance, an older person with arthritic knees and diminished vision, living alone in a high-rise apartment with no family members or friends nearby, can become incapable of getting food or water or of fleeing danger, and may be overlooked by neighbours.
There are several specific issues that affect older people, separately or in combination, and which can impact on their ability to respond or react in an emergency. Awareness of these specific issues by all those giving aid, or surrounding them, will improve interactions. Knowledge of the age profile in an affected community, as an emergency response is prepared, will help to ensure that older people at risk are identified and that appropriate supplies and services are provided on-site.
The specific issues affecting older people are:
1. Sensory Deficits (especially vision and hearing)
reduced awareness ;
difficulty accessing and comprehending visual and auditory information, and responding appropriately ;
reduced mobility and risk of disorientation.
2. Slower Comprehension and Retention of Information (especially new, complex or rapidly delivered information)
difficulty accessing information ;
difficulties in understanding and acting on risks, warnings, directions ;
reduced capacity for self-protection and avoidance of harm ;
disorientation in unfamiliar environments ;
greater risk for abuse and exploitation ;
provision of information in more accessible and structured formats.
3. Less Efficient Thermoregulation
greater susceptibility to hypothermia, hyperthermia and dehydration ;
appropriate shelter, clothing and food, as well as adequate fluid intake.
4. Reduced Functional Ability (poorer balance and reduced speed, psycho-motor co-ordination, strength and resistance)
reduced mobility and risk of being housebound ;
increased risk of falling ;
decreased capacity for self-protection and harm-avoidance ;
difficulty getting basic necessities and accessing health facilities, e.g. local clinics ;
increased vulnerability to abuse and exploitation.
5. Difficulties in Urinary Continence
need for adequate toilet facilities and continence supplies.
6. Oral Health & Dental Problems
easy-to-eat soft food and fluids may be necessary.
7. Changes to Patterns of Digestion
need for smaller, more frequent portions of easily-digestible, nutrient-dense food and adequate fluids.
8. Increased Body Fat Composition, with Decreased Muscle Mass and Metabolic Rates
greater sensitivity to certain medications with potential adverse effects on functional ability and cognition.
9. Greater Prevalence, and Co-Morbidity of Ageing-Related Chronic Disease and Disability (e.g. coronary heart disease, hypertension, stroke, cancers, diabetes, chronic obstructive pulmonary disease, osteoarthritis, osteoporosis, cognitive impairment)
need for condition-specific medications, treatments, medical device and assistance aids (oxygen, crutches, walkers, wheelchairs, glasses) ;
higher risk for adverse drug reactions.
10. Weaker and Smaller Social Networks (e.g. widowed, living alone, minimal contact with neighbours, dispersion of family)
reduced awareness and comprehension of the situation ;
greater risk of social isolation, neglect, abandonment, abuse and exploitation.
11. Heavy Reliance on Care and Support by Very Few Family Members
when essential family support is disrupted, physical and psychological functioning can deteriorate rapidly ;
reunification with family is particularly important.
12. Psycho-Social Issues
reactions to loss of home, family and possessions can be more acute for older people who cannot rebuild their lives ;
resistance to leaving, and grieving, may be strong.
13. Reliance of Other Family Members on Older People
older people often care for other dependent adults and children and may require resources for others as well as themselves.
Last but not least: Older People should not be considered solely as a Special Needs Group. From numerous accounts of natural disaster and armed conflict situations, it is known that their knowledge of the community, previous experiences with such events, and position of respect and influence within their families and communities are critical resources in dealing effectively with emergencies.
2009-10-07: As previously discussed … but deserving much repetition … the 2006 United Nations Convention on the Rights of Persons with Disabilities (CRPD) became an International Legal Instrument, i.e. entered into force, on 3rd May 2008.
This UN Convention simply aims to ensure that persons with disabilities are able to access human rights on the same basis as everyone else in society. And rights are no more than an elaboration of the responsible basic needs of all human beings.
It is worth recalling that the 1948 Universal Declaration of Human Rights was directly born out of the large-scale death, human misery and environmental destruction of the Second World War in Europe, North Africa, the Middle-East … and throughout Asia and the Pacific.
Human Rights must have – do have – ‘real’ meaning in a civilized society !
Israel signed the UN Disability Rights Convention on 30th March 2007. At the time of writing, it has not yet signed the Convention’s Optional Protocol. Israel has definitely not ratified the Convention or the Optional Protocol.
[To be fair, Ireland is in exactly the same position as Israel. Why am I not surprised ?!?]
With regard to Situations of Risk, e.g. a fire emergency in a building … or Humanitarian Emergencies, e.g. the Gaza Conflict from December 2008 to January 2009 … the language of Article 11 in the UN Convention is very clear and straightforward:
” States Parties shall take, in accordance with their obligations under international law, including international humanitarian law and international human rights law, all necessary measures to ensure the protection and safety of persons with disabilities in situations of risk, including situations of armed conflict, humanitarian emergencies and the occurrence of natural disasters.”
On 3rd April 2009, the President of the UN Human Rights Council established the United Nations Fact Finding Mission on the Gaza Conflict with the mandate “to investigate all violations of international human rights law and international humanitarian law that might have been committed at any time in the context of the military operations that were conducted in Gaza during the period from 27 December 2008 and 18 January 2009, whether before, during or after.”
The President appointed Justice Richard Goldstone, former judge of the Constitutional Court of South Africa and former Prosecutor of the International Criminal Tribunals for the former Yugoslavia and Rwanda, to head the Mission. The other three appointed members were:
Professor Christine Chinkin, Professor of International Law at the London School of Economics and Political Science, who was a member of the high-level fact finding mission to Beit Hanoun (2008) ;
Ms. Hina Jilani, Advocate of the Supreme Court of Pakistan and former Special Representative of the Secretary-General on the situation of human rights defenders, who was a member of the International Commission of Inquiry on Darfur (2004) ; and
Colonel Desmond Travers, a former Officer in Ireland’s Defence Forces and member of the Board of Directors of the Institute for International Criminal Investigations.
The Report of the Fact Finding Mission on the Gaza Conflict was presented to the Human Rights Council, in Geneva (Switzerland), on 29th September 2009.
The following is a short extract from that Report …
Section A – XVII The Impact of the Blockade and of the Military Operations on the People of Gaza and their Human Rights
I Persons with Disabilities (Paragraphs 1283-1291)
1283 Information provided to the Mission showed that many of those who were injured during the Israeli military operations sustained permanent disabilities owing to the severity of their injuries and/or the lack of adequate and timely medical attention and rehabilitation. Gaza hospitals reportedly had to discharge patients too early so as to handle incoming emergencies. Other cases resulted in amputations or disfigurement. About 30 per cent of patients were expected to have long-term disabilities.
1284 WHO reported that by mid-April 2009 the number of people with different types of permanent disability (e.g. brain injuries, amputations, spinal injuries, hearing deficiencies, mental health problems) as a result of the military operations was not yet known. It reported speculations that there might be some 1000 amputees; but information provided by the WHO office in Gaza and based on estimates by Handicap International indicated that around 200 persons underwent amputations.
1285 While the exact number of people who will suffer permanent disabilities is still unknown, the Mission understands that many persons who sustained traumatic injuries during the conflict still face the risk of permanent disability owing to complications and inadequate follow-up and physical rehabilitation.
1286 The Mission also heard moving accounts of families with disabled relatives whose disability had slowed their evacuation from a dangerous area or who lived with a constant fear that, in an emergency, their families would have to leave them behind because it would be too difficult to evacuate them.
1287 One testimony concerned a person whose electric wheelchair was lost after his house was targeted and destroyed. Since the residents were given very short notice of the impending attack, the wheelchair could not be salvaged and the person had to be taken to safety on a plastic chair carried by four people.
1288 The Mission also heard a testimony concerning a pregnant woman who was instructed by an Israeli soldier to evacuate her home with her children, but to leave behind a mentally disabled child, which she refused to do.
1289 Even in the relative safety of shelters, people with disabilities continued to be exposed to additional hardship, as these shelters were not equipped for their special needs. The Mission heard of the case of a person with a hearing disability who was sheltering in an UNRWA school, but was unable to communicate in sign language or understand what was happening and experienced sheer fear.
1290 Frequent disruptions in the power supply had a severe impact on the medical equipment needed by many people with disabilities. People using wheelchairs had to face additional hurdles when streets started piling up with the rubble from destroyed buildings and infrastructure.
1291 In addition, programmes for people with disabilities had to be closed down during the military operations and rehabilitation services stopped (for instance, organizations providing assistance were unable to access stocks of wheelchairs and other aids). Many social, educational, medical and psychological programmes have not yet fully resumed.