Arnold Jeffrey L
Yale New Haven Center for Emergency Preparedness and Disaster Response, 1 Church Street, 5th Floor New Haven, CT 06510, USA.
Prehosp Disaster Med. 2005 May-Jun;20(3):143-54. doi: 10.1017/s1049023x00002363.
This article considers the critical roles of risk and risk assessment in the management of health emergencies and disasters. The Task Force on Quality Control of Disaster Management (TFQCDM) has defined risk as the "objective (mathematical) or subjective (inductive) probability that something negative will occur (happen)". Risks with the greatest relevance to health emergency management include: (1) the probability that a health hazard exists or will occur; (2) the probability that the hazard will become an event; (3) the probability that the event will lead to health damage; and (4) the probability that the health damage will lead to a health disaster. The overall risk of a health disaster is the product of these four probabilities. Risk assessments are the tools that help systems at risk-healthcare organizations, communities, regions, states, and countries-transform their visceral reactions to threats into rational strategies for risk reduction. Type I errors in risk assessment occur when situations are predicted that do not occur (risk is overestimated). Type II errors in risk assessment occur when situations are not predicted that do occur (risk is underestimated). Both types of error may have serious, even lethal, consequences. Errors in risk assessment may be reduced through strategies that optimize risk assessment, including the: (1) adoption of the TFQCDM definition of risk and other terms; (2) specification of the system at risk and situations of interest (hazard, event, damage, and health disaster); (3) adoption of a best practice approach to risk assessment methodology; (4) assembly of the requisite range of expert participants and information; (5) adoption of an evidence-based approach to using information; (6) exclusion of biased, irrelevant, and obsolete information; and (7) complete characterizations of any underlying fault and event trees.
本文探讨了风险及风险评估在卫生突发事件和灾害管理中的关键作用。灾害管理质量控制特别工作组（TFQCDM）将风险定义为“某件负面事件将会发生的客观（数学）或主观（归纳）概率”。与卫生应急管理最相关的风险包括：（1）存在或将会出现健康危害的概率；（2）该危害演变为事件的概率；（3）该事件导致健康损害的概率；以及（4）健康损害引发卫生灾难的概率。卫生灾难的总体风险是这四个概率的乘积。风险评估是帮助处于风险中的系统——医疗保健组织、社区、地区、州和国家——将其对威胁的本能反应转变为降低风险的合理策略的工具。风险评估中的I类错误发生在预测的情况未出现时（风险被高估）。风险评估中的II类错误发生在未预测到实际发生的情况时（风险被低估）。这两种错误都可能产生严重甚至致命的后果。通过优化风险评估的策略可以减少风险评估中的错误，这些策略包括：（1）采用TFQCDM对风险及其他术语的定义；（2）明确处于风险中的系统以及感兴趣的情况（危害、事件、损害和卫生灾难）；（3）采用最佳实践方法进行风险评估；（4）召集必要范围的专家参与者并收集信息；（5）采用基于证据的方法使用信息；（6）排除有偏差、不相关和过时的信息；以及（7）完整描述任何潜在的故障和事件树。
