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Hospital systems play a critical role in treating injuries during disaster emergency responses. Simultaneously, natural disasters hinder their ability to operate at full capacity. Thus, cities must develop strategies that enable hospitals' effective disaster operations. Here, we present a methodology to evaluate emergency response based on a model that assesses the loss of hospital functions and quantifies multiseverity injuries as a result of earthquake damage. The proposed methodology can design effective plans for patient transfers and allocation of ambulances and mobile operating rooms. This methodology is applied to Lima, Peru, subjected to a disaster scenario following a magnitude 8.0 earthquake. Our results show that the spatial distribution of healthcare demands mismatches the post-earthquake capacities of hospitals, leaving large zones on the periphery significantly underserved. This study demonstrates how plans that leverage hospital-system coordination can address this demand-capacity mismatch, reducing waiting times of critically injured patients by factors larger than two.

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OBJECTIVE: The aim of this study was to identify regulations that were established and implemented as an emergency disaster response to intense rain and floods generated by the El Niño coastal phenomenon. METHODS: A search was conducted for the legal norms approved and published between December 1, 2016 and December 31, 2017, in El Peruano, Peru's official newspaper. Twenty legal norms involved disaster emergency response, rehabilitation, and the reconstruction of the affected regions. RESULTS: Forty-six legal norms were identified, of which 41% were aimed at the declaration of emergencies and alerts, 22% to facilitate the management of economic resources, and 13% for coordination actions. Sixty-two percent of the approved standards were set for the regional level, 22% for the national level, 7% for the municipal level, and the remaining 10% corresponded with more than 1 level of government. CONCLUSIONS: The actions during and after the El Niño coastal phenomenon required the approval of standards included in the legal framework of Peru's disaster risk management, as well as a large number of unforeseen standards to address existing regulatory gaps and specific problems that occurred during this natural disaster.

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OBJECTIVE: The objective of the study was to research the basic seismic response capability (BSRC) of hospitals in Lima Metropolitana. A large number of wounded could be registered in case of an earthquake; therefore, operational hospitals are necessary to cure the injured. The study focused on the operational performance of the hospitals, autonomies of essential resources such as power, water, medical gases, and medicine, in addition to the availability of emergency communication system and ambulances. METHODS: Data by a probabilistic seismic risk analysis have been used to assess the operational level of the hospitals. Subsequently, availability of an essential resource has been combined with the immediately operational hospitals to evaluate the BSRC of the health facilities. RESULTS: Forty-one of Lima's hospitals have been analyzed for a seismic event with 72-100 years of a return period. Three hospitals (7.3%) were capable to work in a self-sufficient manner for 72 hours, another three (7.3%) for 24 hours, and one (2.4%) for 12 hours. CONCLUSION: Results showed a low performance of the hospitals in case of an earthquake. The issue is due to the high seismic vulnerability of the existing structures. Given the importance of Lima city in Peru, structural and nonstructural retrofitting plans should be implemented to improve the preparedness of the health system in case of an emergency. (Disaster Med Public Health Preparedness. 2019;13:138-143).

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Objetivos: Estimar el impacto ambiental del gas anestésico inhalatorio sevoflurano utilizado en los procedimientos quirúrgicos en un hospital público localizado en la provincia constitucional del Callao. Material y métodos: Estudio descriptivo y retrospectivo basado en la información sobre la utilización de tipos y cantidades de agentes anestésicos inhalatorios en un hospital seleccionado. La huella de carbono fue estimada con base en la cantidad de botellas del agente utilizado, volumen de cada botella, densidad del agente, y potencial de calentamiento global. Resultados: El gas anestésico utilizado en el hospital seleccionado fue el sevoflurano. El gas generó 18,13 CO2teq para el año 2015 y 17,64 en 2016. Conclusiones: El sevoflurano produce un impacto ambiental negativo pero menor al que hubiese ocurrido al utilizar otros gases como isoflurano o desflurano. (AU)

Objectives: Estimate the environmental impact of the inhaled anesthetic gas sevoflurano used in surgical procedures in a public hospital located in the province of Callao. Methods: A descriptive and retrospective study based on information about of the type and quantity of anesthetic agent used in the selected hospital. The carbon footprint was estimated based on the multiplication of the annual number of bottles used, volume of each bottle, density, and global warming potential. Results: Sevoflurane is the anesthetic gas used in the selected hospital. This gas generated 18.13 CO2teq for the year 2015 and 17.64 in 2016. Conclusions: The sevoflurano has a negative environmental impact but minor if other gases as isoflurano or desflurano would have been used. (AU)

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Peru has different legal mechanisms of emergency, one of which is the Public Health Emergency that is applicable when: there is high-risk for, or the existence of an outbreak, epidemic, or pandemic; the occurrence of cases of a disease classified as eliminated or eradicated; the occurrence of emerging or re-emerging infectious diseases with high epidemic potential; the occurrence of rapid disseminated epidemics that simultaneously affect more than one department; as well as the existence of an event that affects the continuity of health services. From July 2014 to December 2016, 23 Public Health Emergencies were declared, out of which 57% were in the high-risk or existence of epidemics, 30% were due to some natural or anthropic events that generate a sudden decrease in the operative capacity of health services, and 13% were due to the existence of a rapid spreading epidemic that could affect more than one department in the country. The risk or occurrence of epidemiological outbreaks, mainly of Dengue, was the main cause of emergency declaration. One-hundred and forty million US dollars were allocated to implement the action plans that were part of the declaration, of which 72% was used to keep the operational capacity of health services and 28% to vector and epidemiological control measures. Bambarén C , Alatrista MdS . A review of state public health emergency declarations in Peru: 2014-2016. Prehosp Disaster Med. 2018;33(2):197-200.

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Introduction A model prepared by National Civil Defense (INDECI; Lima, Peru) estimated that an earthquake with an intensity of 8.0 Mw in front of the central coast of Peru would result in 51,019 deaths and 686,105 injured in districts of Metropolitan Lima and Callao. Using this information as a base, a study was designed to determine the characteristics of the demand for treatment in public hospitals and to estimate gaps in care in the hours immediately after such an event. METHODS: A probabilistic model was designed that included the following variables: demand for hospital care; time of arrival at the hospitals; type of medical treatment; reason for hospital admission; and the need for specialized care like hemodialysis, blood transfusions, and surgical procedures. The values for these variables were obtained through a literature search of the databases of the MEDLINE medical bibliography, the Cochrane and SciELO libraries, and Google Scholar for information on earthquakes over the last 30 years of over magnitude 6.0 on the moment magnitude scale. RESULTS: If a high-magnitude earthquake were to occur in Lima, it was estimated that between 23,328 and 178,387 injured would go to hospitals, of which between 4,666 and 121,303 would require inpatient care, while between 18,662 and 57,084 could be treated as outpatients. It was estimated that there would be an average of 8,768 cases of crush syndrome and 54,217 cases of other health problems. Enough blood would be required for 8,761 wounded in the first 24 hours. Furthermore, it was expected that there would be a deficit of hospital beds and operating theaters due to the high demand. CONCLUSION: Sudden and violent disasters, such as earthquakes, represent significant challenges for health systems and services. This study shows the deficit of preparation and capacity to respond to a possible high-magnitude earthquake. The study also showed there are not enough resources to face mega-disasters, especially in large cities. Bambarén C , Uyen A , Rodriguez M . Estimation of the demand for hospital care after a possible high-magnitude earthquake in the City of Lima, Peru. Prehosp Disaster Med. 2017;32(1):106-111.

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The earthquake that struck the central coast of Peru on 15 August 2007 was a disaster that mobilized international humanitarian assistance to address the needs of the affected people in the regions of Huancavelica, Ica, and Lima. It also was an opportunity to prove the effectiveness of regulations and procedures to facilitate the entry and distribution of donations and medical goods during a major emergency. In the first month after the earthquake, the national government approved new regulations that aimed to reduce waiting time while reducing the number of requisites required by customs. More than 5,500 tons of international donations arrived in Peru in a short period of time. Many donated medicines arrived unsorted, without an international non-proprietary (generic) name on the label, and some medicines did not have any relationship with the diseases that would appear in the aftermath of the event.

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El objetivo de este estudio fue conocer algunos aspectos epidemiológicos de la artritis reumatoide (clásica) en el Servicio de Reumatología del Hospital Central de la Fuerza Aérea del Perú (HCFAP) entre los años 1976 y 1992. El estudio fue descriptivo, longitudinal y retrospectivo. Se estudió 206 casos, de pacientes con el diagnóstico de artritis reumatoidea clásica. La demora en el diagnóstico fue definida como el periódo de tiempo comprendido entre el inicio de los síntomas y el momento del diagnóstico. Se encontró 169 mujeres (82,03 por ciento) y 37 hombres (17,97 por ciento). La edad promedio fue 65ñ14,43 años (mediañDE) en los varones y 61ñ14,44 años en las mujeres. El grupo etáreo más comprometido fue el de 46-55 años (23,30 por ciento) y el menos comprometido el de 16-25 años. Al momento del ingreso al servicio, el 48,75 por ciento de los casos presentaba grado funcional II. El factor reumatoide (FR) fue positivo en el 70 por ciento de los pacientes (p<0,001). La mayor frecuencia de casos nuevos se registró en el año 1988 (11,65 por ciento) y la menor en el año 1978 (2,42 por ciento). El 52,38 por ciento evolucionó a la incapacidad en un intervalo de 0-5 años. Con relación a la ocupación, se observó que la mayor frecuencia correspondió a las amas de casa (71,21 por ciento). Se concluye que los resultados encontrados concuerdan con los datos referidos en la literatura nacional y extranjera, siendo posible que el mayor número de casos observados en 1988 esté relacionado a la modificación de los criterios diagnósticos de la Asociación Americana de Reumatología (ARA) en 1987.

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