Per Becker

Ebola: Improving the Design of Protective Clothing for Emergency Workers Allows Them to Better Cope with Heat Stress and Help to Contain the Epidemic

It is a complex task to find optimal protective clothing to prevent the spread of Ebola virus disease (Martin-Moreno et al., 2014; Ryschon, 2014). The fear of getting infected is an obstacle for recruiting healthcare workers. In addition, the current design of protective clothing might curtail their working capacity severely in the hot and humid climate of West Africa and, in addition, paradoxically increase the risk of infection. Emergency work in full protective clothing including respiratory mask may lead to extreme heat stress in the hot climates resulting in shortened work time, dehydration, reduced professional judgement, and exhaustion. This increases risk of infection of health stuff (WHO, 2014). In Monrovia, Liberia, daytime maximum temperatures in the end of the year often reach 30–31°C, and the temperatures will be higher January to May, the hot season (Kjellstrom et al., 2014; http://climatechip.org/). In order to manage this heat stress, the workers need breaks (Kjellstrom et al., 2009). This leads to a frequent need to remove the protective gear, which involves an increased risk of infection. The multiple steps to remove the suit can take up to 30min (Kitamura, 2014). The modified Predicted Heat Strain (ISO 7933, 2004) model was used to indicate the expected work times (Fig. 1). The estimation was made based on the following assumptions. Standard man was chosen for the model calculations. Medium heavy activity (300W) was taken as the average work rate. The core temperature limit to cease such emergency work was set to 38.5°C. Three clothing types with different moisture permeability (i m) were selected for comparison: an impermeable outer layer (i m = 0.00), a semipermeable outer layer (i m = 0.07), and a relatively tight but still permeable outer layer (i m = 0.20). The basic clothing insulation in all cases was theoretically taken as 1 clo (0.155 m2K W−1) for comparative purposes. In all air temperature conditions, the other environmental factors were kept constant. Ambient water vapour pressure was set to 3.0 kPa, air velocity/body motion was 1 m s−1, and there was assumed no radiation effect present (work indoors or in shade). 1 Continuous work times for a work rate of 300W at different air temperatures before reaching a core temperature limit at 38.5°C in clothing with different moisture permeability (i m). The chosen work load in impermeable and semipermeable clothing allows 40min or shorter exposure during the hottest periods (Fig. 1) until the core temperature exceeds the suggested safe limit for occupational exposure. Higher core temperature is associated with decreased mental performance and increased misjudgement and mistakes (O’Neal and Bishop, 2010). Maximizing the moisture permeability and minimizing the clothing layers worn beneath the protective gear, provided that it should be resistant to penetration by body fluids, is a simple way of preventing heat stress and increasing the time spent inside the gear. However, dehydration and water intake must also be considered during extended exposures. A heat stress management program including rehydration should be an essential part of the overall health and safety program in any case. A desirable addition would be personal cooling used inside the protective clothing, such as cooling vests with ice or phase change materials (PCMs; Gao, 2014) or filtered ventilated coveralls (Kuklane et al., 2012). This may prolong working time to about 2h and reduce the number of gear changes per day. With 2-h work time in protective gear, the number of required personnel could be halved with possible decrease in contaminated waste. The final choice of the cooling method depends on specific air temperature and humidity. Increasing air temperature and, especially, humidity do reduce the effectiveness of air cooling and increase the benefits of PCM products. The use of PCMs requires freezers or cool areas for solidification after use. Cooling vests with ice are the cheapest and electricity for freezers is required. Power is one of the basic resources to provide healthcare and to cope with epidemics. Otherwise, the other types of PCM, e.g. Glauber’s salt or organic hydrocarbons/wax, with melting/solidifying temperature at about 28°C are available. For workers’ recovery after heat exposure, a room with air temperature below 27°C is recommended. The room or connected facilities could be used for PCM solidification storage. If still unavailable, then the melted PCM can be solidified in a relatively cooler water bath (using underground/well water, etc.), in an underground cave or in a cooler area during night. The higher the melting temperatures are, the less effective cooling is. However, if the temperature gradient is about 6°C or greater, the PCM can still provide a cooling effect. Considering cooling effect in ventilated garments, the provided air flow should be above 100 l min−1. There are filtered fan systems available on the market that manage the flows up to and above 200 l min−1 with the battery power lasting at least 5–8h (recharging takes about 2h). Ventilated systems (positive pressure suits) may allow even drinking water in the suit and that may prolong the work time even more. Table 1 gives a rough cost comparison of the present and a possible future protective clothing system based on 1-day (8-h) shift. It takes into account only the equipment cost. Estimation is based on the work time predictions given in Fig. 1 for the hottest work periods, i.e. 30min for the impermeable set and 2h for the new system that prolongs work period by higher permeability or by use of a cooling device. In both cases, similar final core temperatures are expected to limit the exposure. Also, it is expected that both sets take 30min for dressing, 30min for undressing, and require 30min for recovery between the work periods. As it can be seen the equipment cost of a new, theoretically even a 10 times more expensive solution is almost 3 times higher for a day. Table 1. Comparison of the equipment cost of the present and a possible, 10 times more expensive protective clothing system based on 1-day (8-h) shift. Assumed work time is 30min for present and 2h for the new system. In both cases, expected donning, doffing, ... Simultaneously, there are also other benefits with an actively cooling clothing system. The personnel need to cover one workstation is halved. The personnel have even extra time (about 30min) between the shifts to help with any other tasks or for additional recovery. Due to fewer times of dressing–undressing (16 + 16 times 30min versus 4 + 4 times 30min for present respective new system), there is also less need for assistance and disinfection during these periods. There will be less contaminated waste or fewer amounts of products to be cleaned. The new systems are meant to be reusable (extra costs for decontamination procedures have to be considered) compared to present, supposedly disposable systems, and already 2.5 times reuse will even up the equipment costs at the estimated prices. Infection risks are diminished due to the reduced need for undressing and cleaning procedures. In conclusion, reducing the risk of infection among the front-line healthcare workers and allowing a doubling of their work capacity could be a critical factor to successfully contain the epidemic. Considering that this epidemic is not the last, and with warmer climate both the epidemics are expected becoming more frequent, and conditions to fight them more severe (IPCC, 2013), then the testing and evaluation for selection of the optimal equipment is required long before missions are set out.

Whose risks? Gender and the ranking of hazards

Purpose – The purpose of this paper is to examine if gendered differences in risk perception automatically mean that women and men rank the hazards of their community differently, focusing any risk reduction measures on the priority risks of only part of the population.Design/methodology/approach – The study applies survey research through structured personal interviews in three municipalities in El Salvador. The data are analysed using SPSS to find statistically significant associations.Findings – It was found that there are no significant differences between the ranking of hazards of women and men in the studied communities. However, several other parameters have significant associations with the ranking of hazards, indicating that there are more dividing lines than gender that may influence priorities of risk reduction initiatives.Research limitations/implications – A quantitative study can only indicate how gender and other parameters influence the ranking of hazards. In order to understand why, it mu...

Experiential Lock-In: Characterizing Avoidable Maladaptation in Infrastructure Systems

Facing the combined challenges of environmental, social, and technological change, long-lived infrastructure systems run the risk of getting locked into unsustainable, maladapted pathways. This is particularly challenging in the context of climate change, given projected climate impacts are characterized by high degrees of uncertainty (Hallegatte 2009). Lock-in is a concept developed by economic historians to describe how economies get tied into using inefficient technologies, and it is linked to the concept of path dependence (Arthur 1983; David 1985), which refers to the fact that infrastructure systems follow specific trajectories that are difficult and costly to change. As shown in Arthur (1989), these trajectories depend on historical circumstances, timing, and strategy as much as on optimality. In the 1990s, some investigations highlighted the need to approach the analysis of technological changes through coevolutionary approaches that recognize the technological systems influences and are influenced by the social, economic, and cultural setting in which they develop (Rip and Kemp 1998). Liebowitz and Margolis (1994) argued that the role of some elements of the system, such as network externalities, remains contested. Of particular interest is the extent to which favoring incumbent infrastructure systems limits the development capacity of socioeconomic groups such as communities, industries, or countries. While exploring the whole phase space of possible fundamental influences is impractical, the authors argue that it is still possible to avoid some lock-in by effectively utilizing existing anticipatory capacity. The paper elaborates on three ideas, firmly rooted in the scholarly literature and recent studies, which characterize one type of avoidable lock-in: (1) the observed dominance of experiential versus analytical anticipatory capacity of communities, industries, and countries in the governance of sociotechnical systems; (2) the existence of formal approaches to quantify the limits to adaptation in such systems; and (3) limitations of the impact and capacity approach to adaptation. The elements of an avoidable lock-in are then summarized and illustrated by an example. Finally, some conclusions are given on the implications of this type of avoidable lock-in and how it might increasingly affect policy decisions that have long-term implications, such as those related to long-lasting infrastructure systems and spatial planning.

What’s important? Making what is valuable and worth protecting explicit when performing risk and vulnerability analyses

Values and opinions about what is valuable, are of central importance in risk and vulnerability analyses. Yet what is considered valuable is seldom explicitly established. The aim of this study is to explore what groups of civil servants express as valuable and worth protecting when performing risk and vulnerability analyses in their organisations and to discuss the underlying reasons for their stipulations. A theoretical framework is elaborated and applied on the outcome of four seminars, in which participants from Swedish public organisations express what they consider valuable and worth protecting. The results show considerable variation in what is expressed as valuable and worth protecting. Possible explanations for the variation and the usefulness of the outcomes of the different seminars are discussed.

An Institutional Model for Collaborative Disaster Risk Management in the Southern African Development Community (SADC) Region

This article presents and argues for a collaborative model for disaster risk management in the Southern African Development Community (SADC). The research employed a qualitative study through a literature review and empirical research through focus group interviews to realize its objectives. As a key theory of multinational collaboration, neoliberal institutionalism—a subset of the international relations theory—was used to develop the SADC institutional collaborative model. The model combined the theoretical, political, and technical dimensions of collaboration to enhance buy-in for the disaster risk management and reduction function of governments. The model demonstrates the need for a multidisciplinary approach to achieving disaster risk management and reduction in the SADC and elsewhere, if the developmental objectives of disaster risk reduction are to be realized without interference in the domestic affairs of the member countries. This model is therefore grounded in seeking consensus and cooperation among cooperating states in a quest to ensure national implementation of the regional framework on disaster risk reduction.

The Importance of Explicit Discussions of What is Valuable in Efforts to Reduce Disaster Risk: A Case Study from Fiji

This article argues for the importance of explicit discussions of what is valuable as a foundation for any disaster risk reduction initiative to be effective. It does so by stating that it is impossible to talk about risk at all if not having some notion of uncertain potential impacts on something that humans value. What is assumed as valuable and important to protect is then determining what hazards that are relevant in this context etc. However, this is rarely explicitly debated in contemporary disaster risk reduction, indicating a common assumption that all stakeholders implicitly agree in this matter. Such assumption may hold with only a few involved individuals, but is shown in an empirical study in Fiji as unlikely to be valid in any more participatory approaches to disaster risk reduction. In order to facilitate effective disaster risk reduction in such contexts it is important to start by involving the stakeholders in an explicit discussion of what is valuable in their specific context. Without such discussion there is a risk that stakeholders unintentionally impede each other’s efforts by pursuing different goals.

Challenges of using air conditioning in an increasingly hot climate

At present, air conditioning (AC) is the most effective means for the cooling of indoor space. However, its increased global use is problematic for various reasons. This paper explores the challenges linked to increased AC use and discusses more sustainable alternatives. A literature review was conducted applying a transdisciplinary approach. It was further complemented by examples from cities in hot climates. To analyse the findings, an analytical framework was developed which considers four societal levels—individual, community, city, and national. The main challenges identified from the literature review are as follows: environmental, organisational, socio-economical, biophysical and behavioural. The paper also identifies several measures that could be taken to reduce the fast growth of AC use. However, due to the complex nature of the problem, there is no single solution to provide sustainable cooling. Alternative solutions were categorised in three broad categories: climate-sensitive urban planning and building design, alternative cooling technologies, and climate-sensitive attitudes and behaviour. The main findings concern the problems arising from leaving the responsibility to come up with cooling solutions entirely to the individual, and how different societal levels can work towards more sustainable cooling options. It is concluded that there is a need for a more holistic view both when it comes to combining various solutions as well as involving various levels in society.

Developing Sustainable Capacity for Disaster Risk Reduction in Southern Africa

Southern Africa suffers from an acute lack in skilled capacities for disaster risk reduction and climate change adaptation. The region, with its unique disaster risk profile, is mostly bound by its inability to effect change and transformation for sustainable development and resilience building. Reasons for these limitations are largely due to the lack of capacities in disaster risk reduction with the public, semiprivate, as well as private sectors. However, since the 1990s, some significant work in disaster risk governance in the region has led to some of the most forward thinking policies and acts in the world. Therefore, the disaster risk reduction communities in the various Southern African states have not been idle. The major constraint now faced is the translation of these policies and plans into action, and this is where the need for more capacities becomes strikingly obvious. Research and academic institutions in the region have outlived all of the regimes and regime changes. These institutions are ideally suited to address the policy/practice gap that exists within the disaster risk reduction domain. In this chapter, we argue for a focus shift in developing sustainable capacities for disaster risk reduction in Southern Africa by first acknowledging and second harnessing the existing skills base in the region. We believe that contemporary capacity development for disaster risk reduction is predominantly ad hoc, short term, project focused, and microsized, and should be changed from within the region, by building on existing institutions and networks that are driven by Southern African institutions.

Changing the Paradigm: A Requisite for Safe and Sustainable Coastal Societies

Human beings have settled along shores ever since we emerged as anatomically modern Homo Sapiens in Africa 200,000 years ago [1]. The coastal zone provides us with livelihood opportunities, facilitates flows of people, capital, goods and services, and is generally a place of beauty and recreation. About 10% of the population and 10% of the world’s GDP are concentrated within 10 meters above mean sea level [2]. However, the coastal zone is not only an area of opportunity, but also the riskiest place on earth [3]. It presents particular challenges to human settlements and activities, such as coastal floods, erosion, cyclones, saltwater intrusion, etc. The coastal zone is in other words drawing human beings to settle there, requiring us to address the challenges of living there.

Why People Live in Flood-Prone Areas in Akuressa, Sri Lanka

To investigate why people live in areas at high risk of floods, a qualitative case study was carried out in the areas around Akuressa, in southwest Sri Lanka. Data collection consisted mainly of semistructured interviews with local residents and government officials. The purpose was to study why people live in areas at high risk of floods, by looking beyond the purely physical aspects of living with hazards and exploring the underlying social factors. Four main factors were identified: an overall good living situation; a sense of place; difficulties relocating; and being well-adapted to the situation. The analysis also examined whether government officials shared the views of local residents. The findings highlighted both areas of consensus and discrepancies related to risk awareness, and the efficiency of risk reduction measures that had been implemented by the government. The case study identified and explored underlying social factors, such as risk normalization, risk trade-offs, and push-and-pull processes, which seem to influence the decision to live in a high-risk area.