Medical Aspects Of Disaster Management Health And Social Care Essay

Medical Aspects Of Disaster Management Health And Social Care Essay On December 26, 2004, a violent earthquake measuring 9 on the Richter scale struck off the western coast of northern Sumatra. It initiated several tsunamis (tidal waves) that took more than 200,000 lives. It was the deadliest natural disaster in the past quarter of a century. But as horrible as it was, it was but a ripple compared to some quakes in recorded history. In 1556, an earthquake in China took the lives of 830,000 people. In India, an earthquake in 1737 killed 300,000. Almost thirty years ago (1976), a massive quake in China left 655,000 dead. The Sumatra quake, which scientists have measured with modern instruments, was so powerful that it is believed to have moved some islands about 50 feet. In addition, seismologists think that it wobbled the earth on its axis, accelerating the rotation speed, thus shortening the length of our day by fractions of a second which is remarkable in view of the planets precision movements. The 2011 earthquake off the Pacific coast of TÃ…Â hoku (TÃ…Â hoku-chihÃ…Â  TaiheiyÃ…Â  Oki Jishin), often referred to in Japan as Higashi nihon daishin-sai was one of the five most powerful earthquakes in the world since modern record-keeping began in 1900.The earthquake triggered powerful tsunami waves that reached heights of up to 40.5 metres. The earthquake moved Honshu (the main island of Japan) 2.4 m east and shifted the Earth on its axis by estimates of between 10 cm and 25 cm. This earthquake claimed 15,878 lives, left 6,126 injured, and 2,713 people missing . The earthquake and tsunami also caused extensive and severe structural damage in north-eastern Japan . Japanese Prime Minister Naoto Kan said, In the 65 years after the end of World War II, this is the toughest and the most difficult crisis for Japan. Around 4.4 million households in northeastern Japan were left without electricity and 1.5 million without water. The tsunami caused nuclear accidents, p rimarily the level 7 meltdowns at three reactors in the Fukushima Daiichi Nuclear Power Plant complex, and the associated evacuation zones affecting hundreds of thousands of residents. The World Banks estimated economic cost was US$235 billion, making it the most costly natural disaster in world history. Besides these, there have been the super cyclone in Orissa, earthquakes in Latur and Gujarat all of which have caused massive loss of life, distress, discomfort, disease and disability. Inspite of all this, we still await the so called Diego Maradonnas Hand of God to bail us out of each natural crisis causing incident. DISASTER STATISTICS In the past fifty years more than 10000 natural disasters have been reported, more than five billion people have been affected, more than twelve million persons have been killed and the economic costs have been greater than US dollars four trillion. In India during the period 1990 to 2006 more than 23000 lives have been lost in six major earthquakes(Uttarkasi, 1991;Latur,1993;Jabalpur,1997; Chamoli,1999;Bhuj,2001;JK ,2005.) Enormous damage has been caused to property and public infrastructure. The twin super-cyclones that hit Orissa in Oct 1999 affected 24 Districts, 219 blocks and 18790 villages resulting in loss of 8495human lives, 450,000 lives of cattle and damaging two million homes and 23000 schools. The Bhuj earthquake was a terrible human tragedy in which13,805 lives were lost that included 1031 school children and around 167,000 persons suffered multiple injuries This was in the wake of two consecutive years of drought. Disaster defined At the cost of repetition in the text it is important for us to understand and comprehend the term disaster. Disaster is a term very often figuratively used in day to day parlance. For instance, if, as professionals, you are making a presentation on some of your work which you highly value and the response of the audience is not exactly as per your expectations despite your utilizing all available resources, you would generally refer to such a presentation as being a disaster. Thus disaster is an unexpected event in which there is a sudden and massive disproportion between the hostile elements of any kind and the survival resources that are available to counterbalance these in the shortest period of time. There is no generally accepted definition of disasters. A study by Debacker found greater than 100 definitions of disaster. The variations occurred with professional role. The commonalities in all definitions are that disaster is a sudden and an extraordinary event wherein the deman d for health care resources is greater than those that can be supplied, where outside help and resources are needed and which causes disruption of infrastructure, loss of life, material damage and distress. In short disaster is an event where the response needed is greater than the response available. One of the more professional definitions of disaster (Humberside County Council UK) would read as under:- Disaster is a major incident arising with little or no warning causing or threatening death or serious injury to or rendering homeless, such numbers of persons in excess of those which can be dealt with by the public services operating under normal procedures and which calls for the special mobilization and organization of these services. Natural Disasters As we are deliberating on natural disasters, it may be worthwhile bringing out the fact that the Indian subcontinent is amongst the worlds most disaster prone areas with approximately 60 % of land mass is prone to earthquakes of moderate to high intensity, 8% of land vulnerable to cyclones, 12% of land mass is vulnerable to floods and 68% of cultivable area is prone to drought. The hilly areas are constantly at risk from landslides and avalanches and flash floods. With its vast territory, large population and unique geoclimatic conditions, the Indian subcontinent is exposed to natural calamities and catastrophies. While the vulnerability varies from region to region, a large part of the country is exposed to natural hazards which often turn into disasters causing significant disruption of socio-economic life of communities and to loss of life and property. For the ease of understanding Natural disasters could be classified as depicted in the Figure. Classification of Natural Disasters (a) Natural phenomenon beneath the earths surface  Ã‚ ¬Earthquakes including Tsunamis  Ã‚ ¬Volcanic Eruptions (b) Natural phenomenon at the earths surface  Ã‚ ¬Landslides  Ã‚ ¬Avalanche (c) Meteorological/hydrological phenomenon  Ã‚ ¬Cyclones  Ã‚ ¬Typhoons  Ã‚ ¬Hurricanes  Ã‚ ¬Tornados  Ã‚ ¬Hailstorms  Ã‚ ¬Sandstorms  Ã‚ ¬Floods  Ã‚ ¬Sea-surge  Ã‚ ¬Droughts Characteristics of Disasters Before we proceed any further let us briefly enumerate the characteristic features of a disaster since these will help us subsequently in formulating an appropriate disaster management strategy. The overwhelming characteristic features of a natural or any other type of disaster are:- (a) Suddenness of Occurrence. (b) Vastness of Damage. (c) Loss of Life and Property. (d) Disruption of Communication. (e) Panic and Anxiety. First Day First Person Ground Zero Report From Military Hospital Bhuj GS Sandhu Masses of humanity, crushed and mutilated limbs dangling, heads split open, shattered bones, and people coming in endless streams, tugging at the doctors sleeves to leave the patients they were attending to come and see their near and dear ones, crying, sobbing, screaming. This is the lasting impression of 26th January 2001 which I will carry with me for the rest of my life.- Extract of authors interview in Indian Express dated 8th February 2001. 1. Though the Kutch district of Gujarat is located in Seismic zone V, there was a general lack of awareness of the seismic risk and its implications among all sections of the society. The earthquake struck without warning at 0846 hrs on 26 Jan 2001. The epicenter was located 30 km north-east of Bhuj and measured 6.9 on the Richter scale. The impact was sudden and devastating. The local community was overwhelmed by the magnitude of the disaster and its resources rendered non-functional. 2. Military Hospital Bhuj is a small peripheral hospital, providing medical cover in the basic specialties. In the aftermath of the earthquake, this hospital acted as the first and sole responder, despite having suffered severe structural damage and its personnel and their families also being victims of the natural calamity. The principal task was to ensure operational readiness of the hospital for mass casualty management. A number of concurrent activities were initiated. Multiple reception, triage and resuscitation stations were set up. Indoor patients were moved out because of recurring aftershocks. Salvage of equipment and stores from collapsed buildings was commenced. An improvised surgical zone with makeshift operation tables was set up on hard standing. Pre and post operative areas were marked adjacent to this zone. Patient holding and evacuation areas were demarcated. Doctors from the town came to help in looking after the sea of injured humanity pouring into this sole medica l facility functioning in the disaster zone. The local army formation provided generator sets, water tankers, tents and personnel for crowd control. 3. A simple standardized patient management protocol adapted to the locally available resources and skills was devised. The aim of this protocol was to standardize treatment, save lives, prevent major secondary complications and prepare casualties to withstand evacuation to hospitals outside the disaster zone. Graded assessment was carried out, to cope with the sudden massive influx of casualties. Paramedical personnel did the initial assessment by grading the casualties into major and minor injuries. All patients with major injuries were resuscitated with IV fluids and exhibited antibiotics and parenteral Diclofenac analgesia. The physician and medical officers carried out airway management. The gynaecologist, who was also the administrative leader of the team, triaged the patients into those whose injuries could be handled locally and those who would require definitive management at specialized facilities. The final decision as to the salvage of limbs was performed by the surgeons at the operating table itself. 4. An idea of the difficult circumstances in which this emergency humanitarian action was executed can be gauged by the following situation in the immediate aftermath of the earthquake a) Collapse of the civil command and control structure in face of the magnitude of the disaster b) Structural damage to Military Hospital Bhuj c) Suboptimal / Inadequate surgical conditions d) Lack of communications e) Lack of water and electricity supply 5. Despite these constraints approximately 3000 casualties were handled at MH Bhuj before the first relief teams arrived around 2300 hrs on 26 Jan 2001. The problems encountered in handling casualties in these large numbers related to a) Crowd control b) Documentation c) Shortages of essential supplies d) Biomedical waste disposal e) Monitoring of the seriously injured f) Disposal of dead bodies g) Evacuation to specialized facilities 6. No country or community can be fully prepared to deal with sudden impact disasters. During the first few hours or even days, the affected community is isolated and must cope up the best it can. In a disaster situation the functions of the armed forces closely parallel those of the emergency services. The armed forces are trained to develop quick response capabilities. Their management and administrative systems function in a self contained, self sufficient and coordinated manner. The armed forces medical services have contingency plans and training to cater to mass casualty management. These capabilities allowed a small peripheral hospital to act as a sole responder to a disaster of overwhelming magnitude. The author was commanding the military hospital at Bhuj, Gujarat on 26th January 2001 Medical Role and Organization As we can see the management of natural disasters involves a host of disciplines working together to combat the ills and adverse effects of the disaster incident .This text will, however, be restricted to the medical role and organization during disaster incidences. This, however, in no way, is meant to malign the importance of other public services and agencies which are equally essential and play a vital role in the management of natural disasters. In fact these agencies contribute immensely towards successful and effective implementation of any disaster management strategy and are complementary to the efforts of the medical organization. The medical role will depend upon :- (a) Nature of the Disaster (b) Medical organisation set up for combating the natural disaster (c) The degree of involvement of the elements of the medical organisation in the Disaster incidence ie whether a hospital providing relief and rescue assistance is involved or not involved in the disaster situation The primary element of any health care delivery system that comes into operation during a natural disaster is the hospital. The role of a hospital will vary, depending upon the prevailing scenario :- (a) The hospital itself is not involved in the disaster. (b) The hospital is directly involved in the disaster. (c) The hospital is indirectly involved in the disaster. (d) The disaster affects the hospital only. In case the hospital is not itself involved in the disaster situation it can be geared up fully to meet the demands of such an eventuality. In case the hospital is directly affected by the disaster situation it will then be affected in the same manner as the general population and will then have to reorganize itself to provide medical aid not only to the community but also its own inmates and staff. In situations where the hospital is indirectly affected by disruption in some of its facilities and services like water and electricity supply, communication facility it will have to appropriately modify its own plan of action. These aspects have to be built into the disaster plan of the hospital. Aims and Objectives of Medical Role and Organisation During Natural Disasters The aim of any medical organisation during a natural disaster is to provide prompt and effective medical care to the largest number of people needing that care in order to bring about early recovery and reduce the death and disability associated with the disaster incident. A paradigm shift is needed from traditional approach to a casualty under normal circumstances. The approach has to shift from the traditional ALL FOR ONE to ONE FOR ALL. The primary objectives of the medical organisation during natural disasters are :- (a) To prepare the staff and institutional resources for optimal performance in an emergency situation of certain magnitude. (b) To make the community and other counter disaster agencies aware of the capabilities, execution and benefits of the medical disaster plans. (c) To establish security, traffic control and public information arrangements. The medical role during a disaster incident includes (a) Sending Mobile Medical Teams / Quick Reaction Medical Teams / First aid teams to the site of the disaster. (b) Providing First Aid and Basic Life Support at the site of the incidence (Pre hospital stabilization) (c) Sorting out the afflicted victims into priorities for evacuation (Triage) (d) Safe and Speedy transportation from the site of incidence to the location of providing definitive care. (e) Providing Advance Life Support and definitive care at the hospitals (f) Provisioning of Rehabilitation Services to the affected individuals (g) Care of the dead and moribund individuals. (h) Prevention of Epidemics and other related health hazards (Environmental health management). (j) Epidemiological and Health-surveillance efforts (k) Setting up Communication Centres for providing relevant information to the public, community and other agencies. To carry out the above roles to perfection at the time of a disaster event it is mandatory that all concerned in the medical organization must be aware of their roles and responsibilities. Thus arises the necessity of having a well designed and integrated Disaster Plan. Failure to Plan is Planning to Fail when the event actually happens. Planning provides the opportunity to network and engage all participants prior to the event. It provides the opportunity to resolve issues outside of the heat of the battle. Experience tells us that thinking about and planning for disasters is not as painful as having to explain why we didnt. Principles of Natural Disaster Plan of a Medical Organisation The basic principles which form the template of a Natural Disaster Plan are :- (a) Simplicity It should be simple and operationally functional (b) Flexibility It should be executable for various forms and dimensions of different disasters (c) Clarity It should lay down a clear definition of authority and responsibilities and not use too many technical jargons (d) Concise It should be suitable for the type of hospital and not be so voluminous that nobody will read it (e) Adaptability Although the plan is intended to provide standardized procedures, it should have an inherent scope for adaptability to different situations that can emerge during disasters (f) Extension of normal hospital working It should be made in such a way that the plan merges with the normal functioning of the hospital (g) Practiced Regularly to make it work and to recognize and reduce and eliminate the shortcomings. (h) Permanent and periodically updated based upon the experiences gained from rehearsals and disaster situations faced (j) A part of a Regional Disaster Plan. The key issues involved in any disaster plan are Preplanning, Communications, Co-ordination, Training and Regular practice. Without these elements no amount of technical skills and modern technology can mitigate the sufferings of disaster victims. Pre-requisites for Disaster Planning There are certain pre -requisites that require to be deliberated before planning for and managing disaster events. These are briefly described as under :- (a) Hazard / Vulnerability Analysis: This is based on past experiences and the vulnerability status of the localities that are within the ambit of the administrative and clinical jurisdiction of the health care facility. For example if an area is prone to earthquakes it is important that the hospital building is earthquake proof and the Disaster Plan of the hospital is able to cater to the rescue and relief of the victims of the earthquake. It is also important to remember that Earthquakes, Accidents dont come with prior notice but Floods, Cyclones do. Pre disaster preparedness in later case can prove to be very useful. (b) The Role, Responsibilities and Work relationships amongst all the staff of the health care institution must be clarified. (c) Hospital Capability Analysis: It is also essential to be familiar with the hospital treatment capacity should mass casualties suddenly arrive without adequate prior notice. Generally as a thumb rule the Hospital Treatment Capacity is 3% of total Hospital Beds whereas the Hospital Surgical Capacity in an eight hourly shift can roughly be calculated as under:- No. of operating rooms x 7 x 0.25 (d) Hospital Community cooperation in Disaster Planning: This is also an essential precondition and the outside support must be kept on alert and must be signalled to move at appropriate time to be in position in affected area immediately before the arrival of the casualties. Who Should Make the Hospital Disaster Plan? This is the next obvious question as to who should be responsible for making a hospital disaster plan. More often than not it is felt that this is the responsibility of the Hospital Administrators only. Well, the hospital administrators do play a major role in framing, coordinating, rehearsing and implementing the disaster plan but no single individual can effectively make the disaster plan of any health care set up since making the plan is a multidisciplinary affair and all disciplines should be involved in framing a plan for the implementation and success of which they are ultimately responsible. Herein lies the importance of constituting the Hospital Disaster Management Committee (HDMC). The Suggested Membership of this committee is as under :- (a) Director/Executive Head of the Hospital. (b) Departmental Heads. (c) Nursing Supdt./CNO/SNO (d) Hospital Administrator (e) O I/C Casualty Services. (f) Maintenance and Engineering Staff. (g) Staff Representative. (h) Representatives from other support services and utility services as required. Functions of HDMC It has been commonly said that sitting on a committee is like sitting on a WC. One makes a lot of noise and ultimately drops the entire matter. Well, the function of HDMC goes much beyond this saying. For this committee to function effectively, its role and responsibilities and terms of reference must be clearly laid down. Broadly the role of HDMC is :- (a) To develop the Hospital Disaster Plan. (b) To develop Departmental Plans in support of the Hospital Plan. (c) To plan Allocation of Resources. (d) To allocate duties to Hospital Staff. (e) To establish standards for emergency care. (f) To conduct and supervise Training Programme. (g) To supervise Drill to Test the Hospital Plan. (h) To review and revise the Disaster Plan at regular intervals. Components of Hospital Disaster Plan The various components of a well thought out disaster plan are enumerated below. These components will vary from one health care institution to other depending upon the capability and capacity as well as the hazard and vulnerability analysis. Notwithstanding this, the components should focus on the following aspects (a) Efficient system of Alert and Staff assignments. (b) Unified Medical Command. (c) Mobilisation of Resources (i) Medical Nursing, Administrative Staff. (ii) Medical Stores Supply and Equipment. (iii) Conversion of useable space into clearly defined areas for Reception, Triage observations and immediate care. (d) Procedure for prompt movement of patients within the hospital. (e) Procedures for discharge/referral/transfer of patients including transportation. (f) Prior establishment of Public Information Centre. (g) Security arrangements for inpatients, casualties, property of patients and the hospital etc. (h) Evaluation of Hospital Autonomy in terms of water, electricity, food and medical supplies including gases. (j) OT utilization planning. (k) Planning for X-ray, Lab and Blood Bank. The HDMC is required to prepare a disaster manual which should be crisp, easily understood by all and should contain the details of the mode of execution of the Disaster Plan. The hospital disaster manual is a written statement of the disaster plan which is required to be activated during any type of disaster and is divided into five sections which though not sacrosanct and can be modified according to the needs and requirements but they form the template on which the hospital disaster plan can be prepared and executed. A prototype of the template is given below Section I :- Introduction (a) Disaster Alert Code. (b) General Principles of conduct. (c) Brief synopsis of total plan. Section-II :- Distribution of Responsibilities (a) Requirement and responsibilities of individuals and departments. (b) Action cards. Section-III :- Chronological Action Plan (a) Initial Alert. (b) Activate hospital Disaster Plan. (i) Notify key personnel. (ii) Activate key Depts. (iii) Give details of Resource Mobilisation. (iv) Pre-arranged wards/areas for casualties. (c) Formation of a command nucleus (i) Preferably near the casualty reception. (ii) Define roles of hospital controller. (iii) Senior Nursing Officer, Hospital Admin (iv) Clinical Principles of Management of Casualties. (v) Reception. (vi) Triage (vii) Admission of Patients. (viii) Utilization of supportive services. (ix) Principles of treatment of casualties.  Ã‚ ¬Basic Life Support  Ã‚ ¬Advance Life Support  Ã‚ ¬Definitive Treatment (d) Specific problems of Disaster Management. (i) Clinical Problems.  Ã‚ ¬Less, serious patients report first.  Ã‚ ¬Contaminated casualties. (ii) Administrative Problems.  Ã‚ ¬Documentation.  Ã‚ ¬Police Documentation Team.  Ã‚ ¬Communication.  Ã‚ ¬Friends and Relatives.  Ã‚ ¬Crowd control  ® Convergence   Ã‚  effect.  Ã‚ ¬Voluntary workers.  Ã‚ ¬Patients Property.  Ã‚ ¬Press and Media.  Ã‚ ¬Disposal of Dead. Section IV :- Check List Of Personnel And Items. (a) Designation of overall medical authority. (b) Establishment of communication network. (c) Notification rosters. (d) Triage centre with Triage Officer. (e) Personnel Assignments. (f) Designation of medical teams areas of operations. (g) Routes of disposal. (h) Criteria for patient categorization. (i) Rapid documentation cards (j) Security arrangements. (k) Plans for logistics and supplies. (l) Records. (m)Evacuation system. (n) Information booth / Help desk Section V :- Repeated Rehearsals. (a) To train (b) To test performance (c) To correct weaknesses and deviations. A brief explanation of the aforementioned template is given in the subsequent paragraphs for the ease of understanding Introduction The introduction should include disaster alert code, general principles of conduct and brief synopsis of total plan. When the alert is given all personnel must report to duty and takeover their assigned jobs. A sample synopsis is placed at the end of this chapter. Distribution of Responsibilities (a) Authority and Command Nucleus : A small disaster management committee consisting of (i) Executive Head of the hospital (ii) District Health Officer/Civil Surgeon (iii) Professor of Medicine/Surgery/Officer In Charge Accident and Emergency Services (iv) Matron (b) Action Cards : The duties of each individual and dept are clearly indicated on a Action Card. These cards describe in details the responsibilities and the actions to be taken by each and every member of hospital staff starting from hospital administration to stretcher bearers and ward boys. Action card can be carried at all times and/or kept at command centre. If the designated individual proceeds on leave / out of station, then it should be the responsibility of the stand in individual to be aware of his role as per the action card. Chronological Action Plan For efficient and effective implementation during a disaster episode the action plan must be listed in chronological order. The salient features of the Action Plan are briefly explained below (a) Initial Alert : (i) Source of Alert (aa) Accident and Emergency department itself (ab) Through telephones or (ac) Through authorities like police etc. (ii) Action to be undertaken. On receipt of information, the concerned person must gather information regarding the place, time and type of disaster incident , the estimated number and type of casualties and the source of communication. He should also have a callback number if possible to remain in constant contact with the reporting personnel. This would help in determining the time available to prepare (response time) for the emergency and the necessary reorganization of hospital services to cope up with the same. (b) Activate Hospital Action Plan : The designated hospital staff activates the disaster plan. All the departments and people involved get into readiness to attend to casualties and depending upon the nature and number of casualties, crisis expansion of hospital beds is undertaken, utilizing additional space, by discharge of minor /cold cases and transfer of cases to other hospitals/ health care centres. (c) Formulation of Command Nucleus : The command nucleus should be formed immediately and located either in or close to the Accident and Emergency department. (d) Management of Casualties : This deals with (i) Admission of patients (ii) Triage and (iii) Organization of clinical services. (iv) Further treatment (v) Collection of information for management and for relatives and media (e) Hospital Management ; Once a disaster call is made and the hospital control unit established, the mobilization of the hospital services may proceed at the speed required with the minimum loss of time. Usually a number of designated areas will need to be created. (i) Reception An initial reception area acts as the first point of triage in the hospital and distributes patients to appropriate treatment zones. In addition, the initial reception will involve the documentation for casualties. The most experienced surgeons available should be responsible for triage. If staffing permits, assign specific members to care of each patient needing urgent attention. Ambulatory patients and those needing less urgent care should go to a separate area to await treatment at a convenient time. (ii) Resuscitation A large well lit open space is needed for effective resuscitation. Patients are prepared for surgery if required or sent to the wards as soon as their condition stabilizes. A senior anaesthetist is the best choice to supervise resuscitation and to prepare, with surgical advice, the theatre schedules. (iii) Operation Theatres Strict sorting is necessary to avoid blocking theatre space with patients with trivial injuries and who happen to arrive first. They may be treated in a separate theatre (Minor O.T) or at convenient times when other major problems are dealt with. Treatment in wards or Intensive Care units will need to be organized to follow initial care in accident department and the theatres. (iv) Radiology Proper radiology assessment is needed for the correct management of many casualties. Strict triage for radiology should be practiced by staff to avoid bottleneck in radiology department and over use and failure of X-ray machines or shortage of X-ray films. Portable X-ray machines will be preferred in orthopedic O.T. and image intensifiers sh

North Korea Essay Essay

Imagine how life would be like if you lived in North Korea. A country so isolated and cut off from the rest of the world. Even after many decades from the war, North Korea and America have never truly been friends. North Korea holds America responsible for dividing their country into North and South. However there are many similarities and differences between America and North Korea. America is very different from North Korea. While we have a Constitution with a Bill of Rights, amendments and basic freedoms, they must follow whatever their leader says with no exceptions. Even though North Korea has a constitution and amendments, the leader still controls all of the country. American citizens are able to vote for their countries leader unlike North Korea, in which where the son of the leader takes his father’s place with ruling the country. So, only one man rules North Korea and all decisions are made by him. Distinct from North Korea, where people don’t have the due process of law, Americans have the right to try to prove that they are not guilty. North Koreans are brought up to love their leader and aren’t allowed to believe in anything else. For them, their leader is the greatest and he is always right. On the other hand, Americans are allowed to believe in whatever religion they choose is right for them. American citizens are all granted equal protection unlike North Korea where only high-ranking officials are provided with those same basic protections. Also, there is no Internet, and cell phones are banned from the country, which block the people from communicating with the rest of the world. Most Americans are provided with basic needs, but in North Korea, a lot of people (child or adult) go blind because they don’t have those basic needs. Lastly, because hospitals and medical care in North Korea is so bad, many people don’t get the treatment that they desperately need. Thankfully, in the U.S., we have good Medicare and trained doctors who are able to cure people every day. American rights also have many similarities to those of North Korean citizen. Both countries have very strong militaries. We similarly strive to become independent countries. The people in America and North Korea have responsibilities, duties, and limited rights. For example like paying taxes and respecting the leader/president. Even though the strictness of these  three elements may change in each country, people in both countries still have to do these things. Although America is a democratic country and North Korea is a theocracy, they both have a strong government system. North Korea is ruled by Kim Jon Sun, our government has three branches and a president. Citizens of America are required to have a passport to travel to other countries, which is a lot like how North Korean’s are needed to have documentation in order to go to different places in their country. There are certainly more differences than similarities between America and North Korea. Living in North Korea would most definitely not be easy. So many things are available to us in the U.S. that wouldn’t be available to us in North Korea. American citizens have fair rights and can believe in whatever they want. We are able to travel to other countries and live according to our rules. Over looking all of the pros and cons of both countries, America would undeniably be an easier and more unrestricted country to live in.

Management of Marketing Channels Assignment

Management Development Institute of Singapore in Tashkent Faculty of Business Marketing Management of Marketing Channels Assignment Name: Gafurov Nodirbek Batch#: B0900377 Table of Contents Executive Summary3 Introduction4 The Role of Supply Chain Management5 Flextronics Logistics Management7 Reverse Logistics9 Flextronics in Channel Management10 References:12 Executive Summary This assignment demonstrates the most key business areas of the given, Flextronics International Ltd.It analyzes the core businesses of the company as logistics and supply chain that is subjective for the development and business achievement of the company. All findings of the company examples are gained during whole study from a range of reliable sources; such as websites, textbooks, audio materials, and other consistent newspapers. Introduction The core purpose of this statement is to draw and to discuss the role of supply chain management is playing today and how the company has capitalized it and use of Fl extronics’s technology to place its self in logistics management.Also it includes a justification of Flextronics use of reverse logistics and its relation to marketing channel and last of all personal view of Flextronics’s role in Channel Management. The report will be organized as follows: Section 1: The role of Supply Chain Management Section 2: Flextronics’ Logistic Management Section 3: Reverse Logistics Section 4: Flextronics in Channel Management The Role of Supply Chain Management Business today is in a large-scale environment.This environment forces corporations, regardless of position or key market base, to judge the rest of the world in their competitive tactic analysis. Organization cannot separate them from or skip outside factors such as economic trends, competitive situations or technology innovation in other countries, if some of their competitors are rivals or are located in those countries. Companies are going truly worldwide with Supply-chain M anagement (SCM). A company can build up a product in the United States, produce in India and sell in Europe.Companies have changed the ways in which they handle their actions and logistics activities. Changes in trade, the increase and innovation of transport infrastructures and the increase of competition have elevated the importance of flow management to levels. Liberalization, Privatization and Globalization (LPG) of the economies and organizations has fuelled the competitiveness among company. A number of issues have lead to the growing globalization of the world economy and as a result the competitive environment faced by the company has changed radically since the last decade.The drivers of globalization include: decreasing tariffs, improved transportation, communications and information technology, global manufacturing of products and availability of services across markets. These changes have enabled the global competitors to make the products and services available to custo mers worldwide, and the results have been a proliferation of choices for consumers and a need for the companies to offer greater products and service quality at lower costs in order to remain competitive.Changes in technology and globalization of products and services have also resulted in increasingly dynamic markets and greater uncertainty in customer demand. SCM tools and techniques are mechanisms that can allow the companies to respond to these environmental changes. Hence the reason as to why supply chain management has become popular during the past decade is the phenomenon of globalization. Increased competition has made business look for core competencies for enhanced performance.If a particular organization in some country has the core competence for a certain product/component/service, it will get the business for that product/service. This is called global outsourcing. A supply chain is defined as a set of three or more companies directly linked by one or more of the upst ream and downstream flows of the products, services, finances and information from a source to a customer. It consists of all the stages involved, directly or indirectly, in fulfilling a customer’s demand. It not only includes the manufacturer and suppliers, but also transporters, warehouses, retailers and customers themselves.Within an organization, the supply chain includes all the functions involved in fulfilling a customer demand. These functions include, but are not limited to, new product development, marketing, operations, distribution, and finance and customer service. Flextronics International Ltd. (Flextronics), incorporated in May 1990, is a international supplier of straightly integrated complex design and electronics manufacturing services (EMS) to original equipment manufacturers (OEMs). The corporation designs, builds, ships and services for electronics products for its consumers throughout a network of services in 30 countries among four continents.Its set of clients consist of Alcatel-Lucent, Applied Materials, Cisco Systems, Dell, Ericsson, Hewlett-Packard, Huawei, Johnson and Johnson, Lenovo, Microsoft, Research in Motion and Xerox. The services the Company presents across all the marketplaces it serves consist of design and engineering services, original design manufacturing (ODM) services; components design and manufacturing, systems assembly and manufacturing, printed circuit board and flexible circuit fabrication, logistics and after sales services. In April 2012, it obtained Stellar Microelectronics. In June 2012, Tessera Technologies, Inc. s wholly owned subsidiary, Digital Optics Corporation (DOC), purchased certain assets of Vista Point Technologies from the Company. As of March 31, 2011, the Company’s whole manufacturing capability was about 25. 1 million square feet. Flextronics works directly with leading manufacturing and distribution companies and facilitates them address their business challenges. From our practic e working with key corporations in consumer products, high tech and industrial manufacturing, there are six key trends leading to significant impact and change to supply chain design and performance: Trend 1 – Demand planningTrend 2 – Globalization Trend 3 – Increased competition and price pressures Trend 4 – Outsourcing Trend 5 – Shortened and more complex product life cycles Trend 6 – Closer integration and collaboration with suppliers Moreover, our company must face corporate challenges that impact Supply Chain Management such as reengineering globalization and outsourcing. Why is it so important for the company to get products to their customers quickly? Faster product availability is a key to increasing sales, says R. Michael Donovan of Natick (Mass. 2002), a management consultant specializing in manufacturing and information systems. There's a substantial profit advantage for the extra time that you are in the market and your competito r is not,† he says. â€Å"If you can be there first, you are likely to get more orders and more market share. † The ability to deliver a product faster also can make or break a sale. â€Å"If two products appear to be equal and one is immediately available and the other will be available in a week, which would you choose? † Clearly, â€Å"Supply Chain Management has an important role to play in moving goods more quickly to their destination. † Flextronics Logistics ManagementInitially, the supply chain management was referred to the functions of logistics, transportation, purchasing and supplies. Though, the growth of the supply chain management has moved to focus on integration, visibility, cycle time reduction and streamlined channels. The new integration has a variety of activities that include: * Integrated Purchasing Strategy * Supplier Integration * Supply Base Management * Supply Chain Management Logistics activities continue living since the early 1900s. These tricks were first associated with the military as a branch of war that pertains to the movement and the supply for armies.Military forces all the time used to make use of logistics models to make sure the availability of the compulsory material at the right place and on right time. Logistics is being used by the military even today. After 1950, supply chain management got a boost with the production and manufacturing sector getting highest attention. The inventory became the responsibility of the marketing, accounting and production areas. Order processing was part of accounting and sales. Supply chain management became one of the most powerful engines of business transformation. It is the one area where operational efficiency can be gained.It reduces organizations costs and enhances customer service. The evolution led to an Internet-based application for Supply Chain Management. Within a firm’s supply chain management, logistics is the work required to move and geographically position inventory. As such, logistics is a subset of and occurs within the broader framework of a supply chain. Logistics is the process that creates value by timing and positioning inventory. Logistics is the combination of a firm’s order management, inventory, transportation, warehousing, materials handling, and packaging as integrated throughout a facility network.Integrated logistics serves to link and synchronize the overall supply chain as a continuous process and is essential for effective supply chain connectivity. While the purpose of logistical work has remained essentially the same over the decades, the way the work is performed continues to radically change. Flextronics Global Services is a supplier of aftermarket supply chain logistics services. Its set of services serve clients operating in the computing, customer digital, infrastructure, industrial, mobile and medical markets.It provides multiple logistics solutions, including supplier managed i nventory, inbound goods management, product postponement, build/configure to order, order performance and distribution, and supply chain network design. Too many of such companies will find themselves victims of the powerful new transactional systems they put in place. Unfortunately, many leading-edge information systems can capture reams of data but cannot easily translate it into actionable intelligence that can enhance real-world operations.As one logistics manager with a brand-new system said: â€Å"I've got three feet of reports with every detail imaginable, but it doesn't tell me how to run my business† This manager built an information technology system that integrates capabilities of three essential kinds. For the short term, the system enabled to handle day-to-day transactions and electronic commerce across the supply chain and thus helped align supply and demand by sharing information on orders and daily scheduling.From a mid-term perspective, the system facilitated planning and decision making, supporting the demand and shipment planning and master production scheduling needed to allocate resources efficiently. To add long-term value, the system enabled strategic analysis by providing tools, such as an integrated network model, that synthesize data for use in high-level â€Å"what-if† scenario planning to help managers evaluate plants, distribution centers, suppliers, and third-party service alternatives. Reverse LogisticsThe raise of efficiency and competitiveness of companies, as well as legal and environmental aspects, and the change in the consumption culture of consumers have stimulated the growth of reverse logistics. In many cases, the existence of a well managed reverse logistics system is essential in the decision of purchasing products or services. Clients prefer suppliers that can operate in a close relation with their teams, to improve products and processes, and that cooperate in the solving of problems which may come off. To those clients, the sale is just the beginning of a relationship. Reverse logistics is a rather wide area/function that involves all the operations related to the reuse of products and materials such as the logistics activities of collecting, dismantling and processing of products and/or materials and used pieces in order to assure a sustainable recuperation of those that do not harm the environment (Revlog, 2005). Reverse Logistics is a process whereby companies can become more environmentally efficient through recycling, reusing and reducing the amount of materials used. Viewed narrowly, it can be thought of as the reverse distribution of materials among channel members. A more holistic view of Reverse Logistics includes the reduction of materials in the forward system in such a way that fewer materials flow back, reuse of materials is possible and recycling is facilitated†. (Carter and Ellram, 1998, p. 85).The fact of reducing materials used in the processes is according to some authors (Rogers and Tibben-Lembke, 1998) considered as Green Logistics and not Reverse Logistics, although the same authors agree in that the bound line between both concepts is not always clear. On the other hand, Carter and Ellram seem to keep tight to the same channel in which the forward flow was generated, against the more broad view in which other companies outside the business chain could be favored from the returns flows.The Company offers a suite of integrated reverse logistics and repair solutions that are operated on globally consistent processes. With its suite of end-to-end solutions, the Company can manage its customers' reverse logistics requirements while also providing critical feedback of data to their supply chain constituents while delivering continuous improvement and efficiencies for both existing and new generation products. Its reverse logistics and repair solutions include returns management, exchange programs, complex repair, asset recovery, recycli ng and e-waste management.The Company provides repair expertise to multiple product lines, such as consumer and midrange products, printers, personal digital assistants (PDA), mobile phones, consumer medical devices, notebooks, PC's, set-top boxes, game consoles and infrastructure products. With its service parts logistics business, the Company manages all of the logistics and restocking processes essential to the operation of repair and refurbishment services. The integration of reverse logistics operations inside the logistics effort of the corporation should be the first step in the process of corporate-wide integration.In the case of Flextronics, create a center of attention senior management attention and support look like to be the hardest task concerning returns. Mapping out the reverse logistics program and identifying the various departments directly or indirectly concerned in returns handling can prove to be a valuable inventiveness. Clear tasks must be assigned to account ing, sales, finance, marketing, etc. regarding increasing the efficiency and effectiveness of the reverse logistics program. Flextronics in Channel Management The role of Flextronics in Channel Management has been considered as an important competitiveness factor of other companies.This is especially important for the electronics industry given the high perish ability of its products and the complexity of its distribution channel. These factors combined make critical the relation between the members of the distribution channel. The world economy is becoming borderless and integrated, driven by global market forces, global technological forces, global cost forces and political and macro-economic forces. The integrated world economy and global competitive arena is changing the way in which companies traditionally operated.There is also geographical, functional and sectored integration, which gives a truly global playing field to the companies and results in channel management. Therefo re Channel Management is playing vital role in Global competitiveness. To conclude the practical implications, channel management’s tasks and behavior seem, on the surface, to be similar to traditional management. However, the difference in the form of a SCO as a starting point for the management is considerable. To acquire a proper SCO, the SCM literature suggests that a major change in the mindset must be achieved.To become best practice in SCM performance is therefore not easily achieved. However, SCM seems to be a promising strategy for many companies when considering the best practice companies’ profitability and growth, and this dissertation can hopefully give practitioners some advice about improved SCM performance. References: Barry, J. Girard, G. ;amp; Perras, C. (1993), Logistics planning shifts into reverse. Journal of European Business, Vol. 5, No 1, pp. 34–38. Business Dictionary (2012) Definition-What is logistics management? And its role in the bu siness Available at: http://www. usinessdictionary. com/definition/logistics-management. html#ixzz2Ar3FkYOr [Accessed on: 1st November, 2012] Flextronics (2010-2011) Corporate Social and Environmental Responsibility Program Sustainability Report: Flextronics Supplier CSER Program Overview pp. 64-68 Hawks, Karen. VP Supply Chain Practice, Navesink. (2006) Reverse Logistics Magazine Available at: http://www. rlmagazine. com/edition01p12. php [Accessed on: 17th October, 2012] Melissen F. W. ;amp; A. J. de Ron (1999), Defining recovery practices – definitions and terminology, International Journal on Environmentally

Rise of Sexual Assault in the Army - Free Essay Example

Sample details Pages: 2 Words: 670 Downloads: 4 Date added: 2019/02/20 Category Law Essay Level High school Tags: Sexual Assault In The Military Essay Did you like this example? The United States Army is the strongest force in the world compromised of both male and female soldiers, and strenuously requires all soldiers to be educated about sexual assault annually. With all the information that is provided about sexual assault, why does it still continue to rise in the Army? In fiscal year 2017, the Army continued to see an increase in the number of sexual assaults reported: 4.7 reports of sexual assault per 1,000 Soldiers, an increase from the fiscal year 2016 rate of 4.4 per 1,000 soldiers (Ferrell, Fiscal Year 2017 Sexual Assault Report). Sexual Assault is an intentional sexual contact without the consent by the use of force, threat, intimidation, or abuse of one’s authority. It is a punishable act under Uniform Code of Military Justice (UCMJ). Over the years, the Army has been working to bring forward ways of preventing sexual assault with program like Sexual Harassment and Assault Response and Prevention (SHARP). Also, different ways of reporting the assault have been introduced to the soldiers that include restricted and unrestricted reporting; However, the actions taken for these reported cases are not always in favor of the victims. It is not guaranteed that even after the report has been made, the sexual perpetrator receives the appropriate punishment for the conviction. Don’t waste time! Our writers will create an original "Rise of Sexual Assault in the Army" essay for you Create order In many cases, due to lack of evidence against the accused or failure to identify the offender, the case gets dropped and never makes it to trial. According to the annual report released by Department of Defense, there were 4,779 subject case dispositions were reported to the department in fiscal year 2017 where the offender could not be identified (Ferdinando, 2018). The aftermath of the sexual assault and disposition of the case results in degrading physical and mental state of the victim. Many times, the victim face military separation due to mental health problems as not being fit enough to be in the Army. This not only makes other possible victim vulnerable but also creates a thought process that making a report could result in retaliation from coworkers, and the chain of command. 58% of women and 60% of men who reported sexual assault face retaliation (â€Å"Military Sexual Assault Fact Sheet†), hence, a lot of sexual case goes unreported. Not only female but also males are victim of sexual assault. However, males are less like to report sexual assault cases. According to the article â€Å"What we know about Sexual Assault of Military Men†, males often mistake sexual assault as bullying or hazing. Also, recent DoD report showed 24 percent of men, versus just 9 percent of women characterized the sexual assault incident as hazing, and 39 percent of men characterized the incident as bullying compared to 24 percent of women. Sexual assault not only affects the victim but also everyone around them. It affects the overall cohesion of the Army family. Hence, it is time that the sexual assault prevention program adopted by the Army come to full effect. Anything based on a strong foundation has a strong and lasting effect. Therefore, starting from the lower level, the junior leader, be it the team or platoon leader must be sincere and commit to help soldiers in need and commit to fight against any sexual assault or harassment incident. Accordingly, leaders at all other level must ensure a safe and respectful work environment. When incidents are reported, the leaders should take appropriate action on time and provide proper counseling to the victim. Leaders must ensure that the victim does get feeling of retaliation either form co-workers or from the chain of command. Citations Ferrell, M. Y., Ms. (Ed.). (n.d.). Fiscal Year 2017 Sexual Assault Report. Retrieved from https://sapr.mil/public/docs/reports/FY17_Annual/Enclosure_1_Department_of_the_Army.pdf Ferdinando, L. (2018, May 01). DoD Releases Annual Report on Sexual Assault in Military. DoD News. Retrieved May 01, 2018, from https://dod.defense.gov/News/Article/Article/1508127/dod-releases-annual-report-on-sexual-assault-in-military/ Military Sexual Assault Fact Sheet. (n.d.). Retrieved October 14, 2018, from https://www.protectourdefenders.com/factsheet/ What We Know About Sexual Assault of Military Men. (n.d.). Retrieved from https://www.sexualassault.army.mil/whatweknow_militarymen.aspx