Background There is no validated tool to identify gaps in emergency response systems of urban cities in low-and-middle income countries (LMIC). The objective is to develop a tool that (1) identifies the essential components of an urban emergency response system, (2) outlines methods for identifying gaps among components, (3) recommends best practices for addressing these gaps, and (4) recommends improvement strategies to policy makers.
Methods A systematic review of literature was conducted to identify existing tools, scoring systems and urban emergency response indices. Then, in-depth interviews (IDIs), and focus group discussions (FGDs) were held with key stakeholders to identify essential response components. This was followed by a modified Delphi process with 25 emergency response experts, to score each component on a scale of 1 to 4 (1 being least critical and 4 being most critical). The highest ranked components were included in the City Emergency-health Response Capability (CERC) tool.
Results The literature review yielded 20 articles defining components to an emergency response system. Then 25 IDIs and12 FGDs independently identified further components, which were subsequently ranked in the Delphi process. The highest ranked components were categorized into 5 domains: service delivery, safety and security, human resource, command and control, policy and procedures. The final CERC tool will use a set of scored questions and observations about these components in implementation.
Conclusion CERC aims to objectively identify gaps in LMIC urban emergency response systems. Using this tool, city officials can identify areas for improvement and resource allocation to increase their disaster-readiness
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