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On the brink of disruption: Applying Resilience Engineering to anticipate system performance under crisis
Oswaldo Cruz Foundation – FIOCRUZ. Av. Brasil, 4036/10° Andar, Prédio da Expansão, Manguinhos, Rio de Janeiro, 21040-361, Brazil.
Oswaldo Cruz Foundation – FIOCRUZ. Av. Brasil, 4036/10° Andar, Prédio da Expansão, Manguinhos, Rio de Janeiro, 21040-361, Brazil.
Production Engineering Program, Federal University of Rio de Janeiro – COPPE/UFRJ. Av. Horácio Macedo, 2030 - Bloco G - Sala 207 - Centro de Tecnologia, Cidade Universitária - Ilha do Fundão, Rio de Janeiro, 21941-914, Brazil.
Oswaldo Cruz Foundation – FIOCRUZ. Av. Brasil, 4036/10° Andar, Prédio da Expansão, Manguinhos, Rio de Janeiro, 21040-361, Brazil.
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2022 (English)In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 99, article id 103632Article in journal (Refereed) Published
Abstract [en]

As COVID-19 spread across Brazil, it quickly reached remote regions including Amazon's ultra-peripheral locations where patient transportation through rivers is added to the list of obstacles to overcome. This article analyses the pandemic's effects in the access of riverine communities to the prehospital emergency healthcare system in the Brazilian Upper Amazon River region. To do so, we present two studies that by using a Resilience Engineering approach aimed to predict the functioning of the Brazilian Mobile Emergency Medical Service (SAMU) for riverside and coastal areas during the COVID-19 pandemic, based on the normal system functioning. Study I, carried out before the pandemic, applied ethnographic methods for data collection and the Functional Resonance Analysis Method - FRAM for data analysis in order to develop a model of the mobile emergency care in the region during typical conditions of operation. Study II then estimated how changes in variability dynamics would alter system functioning during the pandemic, arriving at three trends that could lead the service to collapse. Finally, the accuracy of predictions is discussed after the pandemic first peaked in the region. Findings reveal that relatively small changes in variability dynamics can deliver strong implications to operating care and safety of expeditions aboard water ambulances. Also, important elements that add to the resilient capabilities of the system are extra-organizational, and thus during the pandemic safety became jeopardized as informal support networks grew fragile. Using FRAM for modelling regular operation enabled prospective scenario analysis that accurately predicted disruptions in providing emergency care to riverine population.

Place, publisher, year, edition, pages
Elsevier, 2022. Vol. 99, article id 103632
Keywords [en]
FRAM, Mobile emergency care, Resilience engineering, Risk assessment, Safety management, Emergency services, Ferroelectric RAM, Amazon river, Emergency care, Emergency healthcares, Healthcare systems, Remote regions, Resilience engineerings, Risks assessments, Systems performance
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:hj:diva-55082DOI: 10.1016/j.apergo.2021.103632ISI: 000720479600007PubMedID: 34740073Scopus ID: 2-s2.0-85118342683OAI: oai:DiVA.org:hj-55082DiVA, id: diva2:1611715
Available from: 2021-11-16 Created: 2021-11-16 Last updated: 2021-12-02Bibliographically approved

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Hollnagel, Erik

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The Jönköping Academy for Improvement of Health and Welfare
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