HKJC DPRI E-NEWSLETTER (ISSUE 1)

The human stampede incident occurred in Shanghai on the New Year’s Eve 2014 can’t be more familiar for us in Hong Kong. While the tragedy occurred in Lan Kwai Fong in 1993 will never be forgotten, measures came into our attention in recent years as recommended by an independent incident report1 commissioned by the Hong Kong government especially during festivals, remind us how disastrous it could be when a lot of people come celebrating without a proper crowd management plan. Shanghai’s recent stampede tragedy with 36 deaths would be classified as class III (severe), according to the classification system proposed by a recent research study2: class I (mild): injuries, 0 deaths; class II (moderate): 1 to 10 deaths; class III (severe): 11 to 100 deaths; class IV (devastating): 101 to 1000 deaths; class V (catastrophic) : >1000 deaths. The first documented human crowd disasters occurred, as stated in the journal, on the eve of Russian Tsar Nicholas II’s coronation ceremony in 1896 at Khodynka Field near Moscow. More than 1000 people were crushed or trampled to death when the crowd surged in response to rumours that souvenirs were in short supply.

Another scientific research looking at 215 human stampede events from 1980 to 2007 concluded factors associated with number of human losses3. Events that occurred in developing countries, outdoors, in the context of sports, religious, music and political events, or that had a unidirectional mechanism (versus turbulent) increased the number of deaths. Due to the limitation of the methodology, most of these factors are however not modifiable. Importance of key preparedness measures were discussed but not immediately obvious from the results of the study.

Back to Hong Kong, you will be able to meet crowd control officers from Civil Aid Service and first aiders from Auxiliary Medical Services, Hong Kong St. John Ambulance or Hong Kong Red Cross, all the way down from Tsim Sha Tsui to Causeway Bay until you reach Central in the New Year’s Eve. These are the preparedness measures as a direct result from the Lan Kwai Fong incident. They are the key to protect lives of citizens. The recent Shanghai incident, which occurred 22 years after the 1993 Lan Kwai Fong incident, reminds us that lessons on disaster preparedness have to be continuously captured, and regularly reviewed and adjusted to apply in future major events given this ever-changing crowd gathering behavior and pattern. After all, new and evolving threats and risks will only surprise those unprepared.

The on-going Ebola crisis continues in West Africa, with cumulative Ebola cases reaching over 20,000, among which over 8220 deaths reported (likely under-reported) since March 20144. Local government especially the health sector have been working very hard to tackle the humanitarian crisis since then, with growing support from international communities. Médecins Sans Frontières (MSF), for example, has more than 4,000 staff working across the region. Among which over 300 are international aid workers5. In view of the ongoing evolvement of the crisis, The Hong Kong Medical Association and HKJC DPRI jointly organized an Ebola Preparedness Seminar on 23 November 2014. Supported by the Centre for Health Protection, Hong Kong Red Cross and MSF Hong Kong, the seminar featured a scientific session and a practice session focusing on donning and doffing of personal protective equipment (PPE).

The seminar aimed to provide practical knowledge and training to Hong Kong healthcare professionals in the public and private outpatient setting, who may become the first responders to potential and suspected Ebola patients not only in Hong Kong, but also in the region and the affected countries. It attracted the participation of more than 150 healthcare practitioners.

Professional aid and healthcare practitioners who had responded to the Ebola crisis at the frontline in Liberia, shared in the seminar their knowledge and experience on both the medical and psychosocial interventions. One of the key highlights was how the crisis has often been referred as “a disease of fear”, due to the fear and stigmatization as well as the isolation resulted. Such a fearful atmosphere does no help to the situation at all, when mistrust and conflicts emerge leading many to resist earlier measures to prevent a major outbreak. Psychological support as an integral part of the response plan against the epidemic has been emphasized.

Demonstration of PPE and discussion of suitable level of protection among community health workers were another highlight at the seminar. Facilitated by video clips recorded at the HKJC Innovative Learning Centre for Medicine (ILCM)6 and the panel discussion by experts, it was concluded that the most important points included the use of TOCC (Travel history, Occupation, Contact and Clustering) as an early detection tool, the mucosal protection and hand hygiene with the proper use of PPE, and the environmental cleansing.

The concluding remarks called participants for their support in this global humanitarian crisis as a responsible global citizen. Despite the risk and danger faced in fighting this highly fatal disease, local communities with the support flew from all over the world continue to work around the clock to save lives and ensure rights and dignity of those who are affected. Every little effort counts and deserves the support by all sectors across the society.

While some may find it alarmist when the Hong Kong Observatory said earlier that we might possibly be struck by tsunami, one might be interested to know when Indonesia was hit by the mega-tsunami on the merry boxing day in 2004, most people (including both tourists and local residents) had no idea what a tsunami was. With no warning system at all, the country was badly struck by waves up to 30 meters high triggered by the 9.1-magnitude Indian Ocean earthquake. While many were having the thought “a disaster like this won’t happened, not to me at least”, lives were lost by surprise as people went out along the shore to watch the sea receding instead of moving to higher ground. Sounds familiar of how people are fond of seeing the waves at the pier during Typhoon signal No.8, doesn’t it? The fact remains as Hong Kong isn’t free from the risk of tsunami. Quoted from a scientific journal published in 2007, the probability of a wave with a height of over 2 meters to hit Hong Kong and Macau is about 10% in the next century7. The risk mainly comes from regional hazards like earthquakes along the Manila Trench. The Hong Kong Observatory will issue tsunami warning or information bulletin according to the risk of a significant tsunami (i.e. a tsunami with a height of 0.5 metre above the normal tide level) in Hong Kong and the estimated time of arrival (ETA) of the tsunami at Hong Kong is within 3 hours8.

It is the regional and international collaboration and early warning in place that has and will continuously protect us from potential disasters. Located in Honolulu, Hawaii9, the International Tsunami Information Centre was established in 1965 by the Intergovernmental Oceanographic Commission (IOC) of the United Nations Educational, Scientific and Cultural Organization (UNESCO). International exercises are conducted according to the regions including the Indian, Caribbean, Mediterranean and Pacific. Hong Kong is part of the Pacific Tsunami Warning and Mitigation System (PTWS). Delegates from HKSAR have been actively participated in the biannual Pacific Wave Exercise. Table captured from the Hong Kong Observatory website

This year’s Pacific Wave exercise - PacWave15 was held on 2 – 6 February. PacWave15 will simulate Pacific countries receiving tsunami threat messages containing wave amplitude forecasts. Member states or participants, including Hong Kong, may then use the information to assess their national threat and make related response decisions. The Exercise will include multiple scenarios to allow use of a distant or regional event, and will be conducted in real time during the daytime10. During the exercise, the Contingency Plan for Natural Disasters hosted by the Security Bureau will be the basis for the response in Hong Kong11.

As one of the deadliest natural disasters in recorded history, the 2004 tsunami claimed more than 220,000 lives in Indonesia (which accounted more than 170,000 alone), Sri Lanka, India, Thailand and Maldives. The unfortunate disaster event highlighted the critical needs to develop public awareness of natural hazards and early warning systems. The 2004 tsunami switched the global focus from disaster response to disaster risk reduction, of which preparedness and community resilience remain key in build up a “prepared” community in managing any disaster event.

5-year-on when the International Federation of Red Cross and Red Crescent Societies (IFRC) published the World Disaster Report 200912- an annual report illustrating the global trend in disaster risks management, the importance of an early warning systems around the world as measures of disaster preparedness was highlighted and discussed in details.

Whether it’s in Hong Kong, Sri Lanka, Pacific Region or any other parts in the world, one must keep in mind that we are dealing with human lives and our responsibility is high. This would be a continuous process and a lot more needs to be done, but first of all as a responsible community member, let’s start by taking part in building a safer Hong Kong.

The Lamma Island Ferry tragedy that occurred in October 2012 reminds us how unexpectedly disasters would strike. That is where disaster preparedness measures come in crucially to reduce related risks (possibility of the event becoming a disaster) as well as the impacts (damage resulted from the disaster). Being one of the busiest shipping hubs in the region thanks to its advanced management and geographical advantage, Hong Kong is being exposed to high marine disaster. The disaster risks have however been neglected always, assuming that “all is good and safe”. In fact, government departments and other concerned agencies have been keeping an eye in every second on potential marine disasters in Hong Kong. More importantly, contingency response plan and coordination mechanism have been developed, disseminated and practiced so that no time will be wasted when it comes to the moment between life and death. Issues follow including rescue and search, victim identification and management, psychological support as well as society restoration are no stranger in marine disaster response.

Believing that practice does make perfect, a symposium was organized on 6 December 2014 by Hong Kong Disaster Medicine Association calling upon related government departments and concerned agencies to reflect on how well we have performed, and how could we perform better in future marine disasters. Experienced disaster responders from different units such as Hong Kong Police Force, Fire Services Department, Government Flying Service, Auxiliary Medical Service, etc were invited to share their insights.

1 Mr. Justice Bokhary: The Lan Kwai Fong Disaster on January 1, 1993: Final Report, 1993 (363.3497 INT)
2 Ngai KM, Burkle FM Jr, Hsu A, Hsu EB. Human stampedes: a systematic review of historical and peer-reviewed sources. Disaster Med Public Health Prep. 2009 Dec;3(4):191-5. doi: 10.1097/DMP.0b013e3181c5b494.
3 Hsieh YH, Ngai KM, Burkle FM Jr, Hsu EB. Epidemiological characteristics of human stampedes. Disaster Med Public Health Prep. 2009 Dec;3(4):217-23. doi: 10.1097/DMP.0b013e3181c5b4ba.
4 http://www.who.int/csr/disease/ebola/situation-reports/en/
5 http://www.msf.org/article/ebola-crisis-update-30-january-2015
6 ILCM dedicated to use innovative simulation learning and research to enable healthcare professionals to deliver safe and quality patient care. See http://hkjcilcm.hk for details.
7 Liu, Y. et al. Tsunami hazards along Chinese coast from potential earthquakes in South China. Sea, Phys. Earth Planet. Interiors (2007), doi:10.1016/j.pepi.2007.02.012
8 http://www.hko.gov.hk/gts/equake/tsunami_mon_e.htm
9 http://itic.ioc-unesco.org/index.php?option=com_content&view=category&layout=blog&id=1173&Itemid=1173
10 http://itic.ioc-unesco.org/index.php?option=com_content&view=article&id=1908:exercise-pacific-wave-15&catid=2151&Itemid=2597
11 http://www.sb.gov.hk/eng/emergency/cp.html
12 http://www.ifrc.org/en/publications-and-reports/world-disasters-report/wdr2009/