Download CLASSIFICATION OF EMERGENCIES AND THEIR CAUSES

CLASSIFICATION OF EMERGENCIES AND THEIR CAUSES
(EMERGENCIES OF NATURAL ORIGIN).
Scientific and technological progress not only improves the production,
improvement of working conditions and the welfare of the population, but also
increases the risk of accidents on facilities management. Huge regional burden of
industrial and energy facilities increases the likelihood of accidents and disasters,
losses from which can be compared with losses due to military conflicts.
Ensuring national security is an integral function of each state as a social
formation, designed to ensure favorable conditions for life and work of its citizens.
Assessment of the overall state of technogenic and ecological security is the
foundation on which a strategy of state policy in the field of population and
territories from emergency situations of Ukraine (HC).
Problems of prevention and elimination of health effects of anthropogenic
and natural origin in order to preserve life and health, is a component of national
security.
Almost a third of all industrial facilities are enterprises engaged in the
manufacture, processing and storage of highly toxic, explosive and flammable
substances. Given the economic crisis, lack of funds, very slowly and late is to
upgrade or replace obsolete fixed assets, the level of depreciation of equipment
which is close to critical. All this increases the likelihood of man-made hazards.
Man-made and natural processes can lead to accidents, disasters and, as a
result of them, to emergency facility or in a separate area.
Crash - out of order, destruction of facilities, buildings, equipment, vehicles
and breakdown of production or transport process in consequence of which the
object or a particular area a threat to life and health.
Catastrophe - a sudden, transient event caused by nature or human activity
that caused numerous casualties, inflicted injury or significant threat to the health
of people, caused the destruction or removal of facilities and other property in
significant amounts, and also caused damage to the environment .
Incident (NA) - violation of normal life and activity of people in a specific
area or object caused by accident, disaster, natural disaster or other dangerous
events, including epidemics, epizootics, fire that resulted or may result in failure to
stay population in the area or object of there business, loss of life and significant
material losses.
Emergency public health - a circumstance that has arisen suddenly, in which
the possibility of health care and the prevention and elimination of health effects of
NA actual potential and require additional medical capabilities outside or
substantial change everyday forms and methods.
The purpose of the classification of emergencies is an effective mechanism
for evaluation of events that has or may occur in the forecast period, and to
determine the degree of response at the appropriate management level. Common
signs of NS are: presence or threat of loss of life or significant breach of their life,
causing economic losses, significant environmental degradation. In order to create
a unified system of classification of the National Assembly and to determine their
levels to ensure prompt and adequate response to such situations by the Cabinet of
Ministers of Ukraine dated July 15, 1998 № 1009 approved the Regulations on the
classification of the National Assembly.
According to the causes of the origin of events that may lead to the
emergency situation in Ukraine differ:
Emergencies
anthropogenic origin
Natural origin
Socio-political origin
War origin
According to the territorial distribution
State level
Regional level
Local level
Site level
emergency situation anthropogenic origin - traffic accidents (accident), fires,
explosions or their unprovoked threat of an accident with the release of (the threat
of release) of hazardous chemical, radioactive, biological substances on objects the
economy on life-support systems, communication systems, telecommunications ,
power systems, waste water treatment facilities, the presence in the environment of
hazardous substances exceeding the MCL, the sudden destruction of buildings and,
hydrodynamic accident dams etc..
emergencies of natural origin - dangerous geological, meteorological,
hydrological (marine, freshwater), degradation of soil or subsoil, natural fires,
changing the state of air pollution, infectious diseases of people, human poisoning,
infectious disease or massive loss of livestock, damage crops and disease pests,
changing the state of water resources and the biosphere more.
emergency social and political issues related to the illegal actions of terrorist
and unconstitutional direction: exercise or a real threat of terrorist attack (armed
attacks, capture and retention of important facilities, nuclear facilities and
materials, communications and telecommunications, attempted managers state and
national deputies of Ukraine, assault or attempted crewmen air, sea and river
vessels), theft (attempted theft) or Destruction (attempt to destroy) such vessels
hostage crew members or passengers, setting an explosive device in a public place
institution, organization, business enterprise, residential, transportation, destruction
or theft of objects of different weapons, ammunition, armored vehicles, explosives,
radioactive substances, identification of obsolete munitions accident arsenals,
ammunition depots and other military installations with ejection of debris jet and
conventional ordnance.
PSD military character associated with the effects of weapons of mass
destruction or conventional weapons, during which there are secondary factors
affecting the population due to the destruction of nuclear and hydroelectric
stations, warehouses and storage of radioactive and toxic substances and waste,
petroleum products, explosives, transportation and utilities others.
level
spread
1
State
Regional
Local
Object
2
From more then 2
region – one
country and more
From more then 2
district
Number of
death
people
3
More then
5 people
Number of
injured people
Number of people with change
for the worse living condition
4
More then 100
people
5
More then 10000 people for a
long time (more then 3 day)
3-5 people
50-100 people
1000-10 000 people for a long
time (more then 3 day)
Spread out of
1-2 people
20-50 people
boundary of
potential
dangerous object ,
dangerous for
environment and
other settlement
Cant be determine according previously mentioned.
100-1000 people for a long
time (more then 3 day)
Medical consequences of natural character
Natural disasters (natural disasters) - a disastrous situations that occur
suddenly as a result of natural forces, leading to disruption of daily way of life of
large populations, in most cases involving loss of life, destruction of property,
destruction of housing, economic facilities and environmental pollution.
Implications many large destructive natural disasters are often catastrophic for
residents affected regions.
Peculiarities of the geographical position of Ukraine. scale geological
processes, the presence of mountain ranges, hills and lowlands, proximity warm
seas cause potential virtually the full range of natural hazards and processes of
geological, hydrogeological and meteorological origin and natural fires.
Most important for Ukraine dangerous among natural disasters are
earthquakes, floods, tornadoes, hurricanes, mud flows, landslides, landslides,
avalanches, forest fires.
Natural evil inherent in common: a large spatial scale, a significant impact
on the environment, a strong psychological impact on people.
Determined in 3 groups of natural disasters:
- Tectonic disasters (earthquakes, morehvylyuvannya, landslides, volcanic
eruptions)
- Topological disasters (floods, mudflows, avalanches, etc.)
- Meteorological disasters (storms, hurricanes, droughts, fires)
Earthquakes
Earthquakes - is tremors and vibrations of the earth's surface arising from
discontinuities in the crust and transmitted over a long distance in the form of
elastic waves. According to world statistics on the fate of earthquakes accounted
15.0% of all natural disasters, but the nature of the human and material losses they
occupy the first place. The intensity of earthquakes scored international Richter
scale.
Earthquake recorded only 1 point special devices (seismographs);
- 2-3 points - weak;
- 4 points - moderate;
- 5 points - powerful;
- 6.7 points - quite powerful;
- 8 points - destructive;
- 9-10 points - very destructive;
- 11-12 points - catastrophic.
Annually worldwide recorded more than 1 million aftershocks, of which 1
belongs to catastrophic, 10 - to severely disruptive and about 1000 - before
damaging.
In Ukraine earthquake-prone areas are zones of Crimea and the Carpathians
with an area of nearly 120 km2, with a population around 11 million. Power
aftershocks according to forecasts may be from 5 to 9 points.
Depending on the intensity of ground vibrations are 4 zones of destruction:
A - area of complete destruction - 100.0% damage (11-12 points);
B - an area badly damaged - 50,0-90,0% damage (9-10 points);
B - medium damage zone - 30,0-50,0% damage (7-8 points);
D - Zone weak destruction - 10,0-30,0% damage (5-6 points).
Earthquakes may be accompanied by fire, flood areas associated with the
destruction of dams and levees. Especially dangerous are the destruction of
chemical and radiation hazardous objects. The number of victims of the earthquake
can not be foreseen. It depends on the strength of the tremors and the degree of
destruction of various buildings. As a result of the earthquake, the following types
of injuries:
- Fractures of different locations;
- Traumatic amputation;
- Syndrome lasting compression or crushing;
- Head injury;
- Psychological disorders;
- Infectious disease.
Exploring the causes of injury and proves that in 10.0% of cases are
associated with collapses and the destruction of buildings, 35.0% - secondary
damaging factors (fragments of buildings, buildings), and 55.0% resulting from the
improper actions of the victims themselves caused fear and panic. Much of the
injured (adults and children) die from untimely medical care provided. More than
half the deaths falls on the first day. Mortality among infected with traumatic
shock is 12.0 - 15.0%.
Violation of the psyche (as in affected and among rescuers) in the
earthquake zone observed in 75.0%, and 10.0 - 15.0% expressed psycho-emotional
disorders. Such people need hospital treatment and isolation.
Due to damage to water supply and sanitation, lack of safe drinking water,
deteriorating sanitary living conditions of the population in the earthquake zone
may have massive infections.
Floods
Flood - a temporary inundation water significant terrain due to raise the
water level in rivers and other bodies of water, damage to hydraulic and stuff.
The main causes of flooding could become heavy downpours, intense
snowmelt, annual floods. Especially dangerous flooding arising from sudden
breakthrough hydro dams and dams, landslides or avalanches of rocks.
Among the flood disaster in Ukraine ranks first on the frequency, size
distribution, causing material damage. Very often these natural disasters occur in
the western parts of the country.
As the number of flood victims are second only to earthquakes. Depending
on the scale floods are distinguished:
- Low flood - there on the plains rivers are characterized by a relatively
small area of flooding, do not lead to casualties;
- High floods - accompanied by a significant rise of water, flooding large
areas, causing significant property damage, threatening human life and health;
- Significant flooding - accompanied by flooding river basins and
settlements, there is a real threat of losses among the population and the need for
its evacuation from the flood zone;
- Catastrophic flooding - flooding accompanied by very large areas,
worsening the livelihoods of the population, prevent economic activities in the
flooded areas, causing considerable damage and loss of health in the population.
When the catastrophic floods in flooded areas providing 4 flood zone
depending on the speed of water flow, wave height and the distance between the
dam and towns and travel time wave breaking.
The first zone - zone of catastrophic flooding is directly adjacent to the
water networks or the beginning of a natural phenomenon. Wave height can reach
several meters and speed of 30 km / h or more. The average length of this zone can
be 12.6 km. The time of the wave break to 30 minutes.
The second zone - zone of rapid flow. Current velocity of 15-20 km / h.
Length zone 15-25 km. Time passing wave to 1 hour.
The third zone - the zone of secondary flow. Current velocity of 10-15 km /
h, the length of 30-50 km. Time passing waves - 2-3 hours.
The fourth zone - the zone of weak flow (flood zone). Current velocity 5-10
km / h, length can be 35-70 km.
World statistics show that the proportion of floods up to 40.0% in total
disaster. Among the affected structure of sanitary losses formed by: drowning
(asphyxia), mechanical trauma, hypothermia, acute respiratory disorders and
cardiovascular activities, soft tissue injuries, concussions, pneumonia,
neuropsychiatric reactions, exacerbation of chronic diseases. Deteriorating sanitary
and epidemiological situation in the flooded areas that can lead to massive
outbreaks of infectious diseases.
When floods are important timely notification and evacuation of the
population, livestock and property from flooding probable region.
Sel
A variation is flooding the countryside. Village - a temporary stream of
water, sand, clay, rock fragments and boulders that suddenly formed in the basins
of the rivers. The cause mudslides are intense and prolonged torrential rains, heavy
snow and melting mountain glaciers and earthquakes.
Typically village some waves moving at speeds up to 10 m / s and more,
transferring large amounts of earth, gravel and large stones. Sel is characterized by
a sharp rise in the water level, wave motion, fugacious action (1-3 h) and
significant damaging effect. Selye flows are of great destructive power.
By selenebezpechnyh regions include areas in the Carpathians and Crimean
Mountains. Examples mudflow could be an event that happened in Kiev March 13,
1961, in the area of raw, when mud flow up to 4 meters mounted Kurenivka (Kyiv
region).
Landslides
Landslides - a moving mass of rock crawling down the slope under the force
of gravity. To account for 90.0% of landslides in the area are located at an altitude
of 100 to 1700 meters above sea level. They occur on slopes with slope more than
20 degrees, mostly along rivers in the Carpathians and Crimea.
Landslides like earthquakes, but the area of the disaster is much smaller.
Number of victims could be from a few to 50 people. Particularly active landslides
are active in the areas of economic activity (Carpathians, Crimea, Donbass,
Odessa, Dnipropetrovsk, Khmelnytsky region).
Important to determine the behavior and actions of people in mudslides and
landslides has timely detection and notification. On approximation Mudslides can
learn the nature of sound that give boulders or fragments stones. This sound like
thunder train approaching at high speed. About the beginning of the shift showed
the following characteristics: appearance of cracks on the buildings, exploding on
the roads, coastal fortifications and embankments, washing away the earth shifting
foundations of various tall structures.
The main causes of injuries and deaths in mudslides and landslides are:
- Collapse people soil, rocks, trees;
- Causing injuries objects that fall (stones, trees);
- Collapse people ruined buildings;
- Capture people turbulent flow of water or mudflow mass.
The winds of destructive force
Of the group of meteorological and agrometeorological phenomena of
natural origin are very dangerous storms are natural phenomena (storms),
hurricanes (typhoons), tornadoes (tornadoes), cyclones, which are very fast and
strong, often catastrophic movement of air that causes the destruction of buildings,
loss of life and animals.
The main cause of storms, hurricanes, tornadoes are cyclonic activity
atmosphere. The characteristics of these phenomena is the wind speed. Table 3
shows the Beaufort Scale, which allows you to imagine the destructive force of the
wind on his speed.
The Beaufort Scale is an empirical measure for describing wind speed based
mainly on observed sea conditions (on land it is categorised by the physical effects
it has on vegetation and structures). Its full name is the Beaufort Wind Force Scale.
N
0
1
2
3
4
5
6
7
Description
Wind speed
< 1 km/h
< 1 mph
Calm
< 1 kn
< 0.3 m/s
1.1–5.5 km/h
1–3 mph
Light air
1–2 kn
0.3–1.5 m/s
5.6–11 km/h
4–7 mph
Light breeze
3–6 kn
1.6–3.4 m/s
12–19 km/h
8–12 mph
Gentle breeze
7–10 kn
3.4–5.4 m/s
20–28 km/h
13–17 mph
Moderate
breeze
11–15 kn
5.5–7.9 m/s
29–38 km/h
18–24 mph
Fresh breeze
16–20 kn
8.0–10.7 m/s
39–49 km/h
25–30 mph
Strong breeze 21–26 kn
10.8–
13.8 m/s
50–61 km/h
High wind,
Moderate gale, 31–38 mph
Near gale
27–33 kn
Wave
height
Sea conditions
Land conditions
0m
Flat.
Calm. Smoke rises vertically.
Ripples without crests.
Smoke drift indicates wind direction
and wind vanes cease moving.
0 ft
0–0.2
m
0–1 ft
0.2–0.5
Small wavelets. Crests
m
Wind felt on exposed skin. Leaves
of glassy appearance, not
rustle and wind vanes begin to move.
1–2 ft breaking
0.5–1
m
2–
3.5 ft
Large wavelets. Crests
Leaves and small twigs constantly
begin to break; scattered
moving, light flags extended.
whitecaps
1–2 m Small
waves
with
Dust and loose paper raised. Small
breaking crests. Fairly
branches begin to move.
3.5–
frequent whitecaps.
6 ft
2–3 m Moderate waves of some
Branches of a moderate size move.
length. Many whitecaps.
Small trees in leaf begin to sway.
6–9 ft Small amounts of spray.
3–4 m Long waves begin to
form. White foam crests
are very frequent. Some
9–13 ft airborne spray is present.
4–5.5
m
13–
Large branches in motion. Whistling
heard in overhead wires. Umbrella
use becomes difficult. Empty plastic
garbage cans tip over.
Sea heaps up. Some
Whole trees in motion. Effort needed
foam from breaking
to walk against the wind.
waves is blown into
19 ft
13.9–
17.1 m/s
8
Gale,
Fresh gale
62–74 km/h 5.5–7.5
39–46 mph m
34–40 kn
18–
17.2–
25 ft
20.7 m/s
75–88 km/h 7–10
47–58 mph m
41–47 kn
9
Strong gale
20.8–
24.4 m/s
23–
32 ft
89–102 km/h 9–12.5
55–63 mph m
48–55 kn
Storm,
10 Whole gale
23.5–
28.4 m/s
11
103–
117 km/h
64–72 mph
Violent storm 56–63 kn
28.5–
32.6 m/s
Hurricane-
12 force
≥ 118 km/h
≥ 73 mph
≥ 64 kn
≥ 32.7 m/s
29–
41 ft
11.5–
16 m
37–
52 ft
≥ 14 m
≥ 46 ft
streaks
along
wind
direction.
Moderate
amounts of airborne
spray.
Moderately high waves
with breaking crests
forming spindrift. Wellmarked streaks of foam
are blown along wind
direction. Considerable
airborne spray.
High waves whose crests
sometimes roll over.
Dense foam is blown
along wind direction.
Large
amounts
of
airborne spray may
begin
to
reduce
visibility.
Very high waves with
overhanging
crests.
Large patches of foam
from wave crests give
the
sea
a
white
appearance.
Considerable tumbling
of waves with heavy
impact. Large amounts
of airborne spray reduce
visibility.
Exceptionally
high
waves.
Very
large
patches of foam, driven
before the wind, cover
much of the sea surface.
Very large amounts of
airborne spray severely
reduce visibility.
Huge waves. Sea is
completely white with
foam and spray. Air is
filled with driving spray,
greatly
reducing
visibility.
Some twigs broken from trees. Cars
veer on road. Progress on foot is
seriously impeded.
Some branches break off trees, and
some small trees blow over.
Construction/temporary signs and
barricades blow over.
Trees are broken off or uprooted,
saplings bent and deformed. Poorly
attached asphalt shingles and
shingles in poor condition peel off
roofs.
Widespread damage to vegetation.
Many roofing surfaces are damaged;
asphalt tiles that have curled p
and/or fractured due to age may
break away completely.
Very widespread damage to
vegetation. Some windows may
break; mobile homes and poorly
constructed sheds and barns are
damaged. Debris may be hurled
about.
Hurricane
The storm - very strong and prolonged wind, causing great destruction on
land and rough sea (storm). Depending on the time of year and in the air flow
distinguish different particle dust, without dust, snow and hail storms.
Dust (sand) storms accompanied by the transfer of large quantities of soil
and sand. They occur in deserts and semi-cultivated plains and able to move
millions of tons of dust for hundreds of kilometers and fill an area of several
thousand kilometers.
Without dust storms are characterized by the lack of involvement of dust in
the air flow and relatively smaller scale of destruction and loss.
Snowy winter storms occur and move through the air great masses of snow.
Their length from a few hours to several days. Have a relatively narrow strip
action.
Hail storms are characterized by almost sudden onset, rapid completion of
the same, little lasting and great destructive force.
Hurricanes
Hurricane - a long time a strong wind destructive force (12 points for
Beaufort scale). Wind speed exceeds 130 km / h. As a result of hurricanes
destroyed buildings on a large area, there are fires, people are dying, a large
number of people in need of care. The combination of hurricane winds and snow or
dust rise to strong blizzards or dust storms. During storms, hurricanes and
tornadoes medical and sanitary conditions will be determined primarily by the
nature of settlements, the size of the front passing wind flow, timely notification of
approaching disaster. In Ukraine, such disasters are more common in the southern
and western regions, but do not exclude the possibility of their occurrence in other
regions of the country.
Tornadoes
Tornadoes - air flow that looks like vortex that can lift and move
considerable distances humans, animals, tear roofs off buildings, uprooting trees
roots. This is the most destructive meteor. The air in the tornado rotates at a speed
of several tens of meters per second, while rising in spirals to a height of 800-1500
m Average speed its move 40-60 km / h. Consequences of hurricane winds and
tornadoes are characterized by the number of dead and injured, people were left
homeless, the number of destroyed and damaged houses, industrial and cultural
and service facilities, communications, power grids and communications and so
on.
Health Effects of Hurricane
During hurricane (tornado) to 50.0% of injuries occur from objects flying
and falling. Within injuries traumatic brain injury can range 50,0-70,0% (this is
18,0-20,0% severe traumatic brain injury), fractures of extremities, pelvis, spine about 15.0%. Combined injury can be 60,0-65,0%. Wounds are usually torn, soiled
with sand, earth, fragments of glass in great depth.
Wildfires
Fire - a spontaneous, uncontrollable combustion process, which is
accompanied by destruction of property and pose a threat to human health and life.
They are classified into natural fires (wood, peat, prairie, field) and fires in
settlements (single, massive, solid).
Depending on the nature of burning natural fires are divided into grassroots,
and upland soil. These global statistics indicate that the planet every year there is
about 3.3 million natural fires. Over the past 30 years the number of fires has
increased threefold, and the number of victims of them - 10 times.
Fires in settlements arising from the violation of the rules of fire safety
equipment, as a result of natural disasters. Fires may be the individual (off one or
more buildings), mass (burning buildings to 20.0%), solid (20.0% more burning
buildings). Fires causing major material damage and bring harm to people - there
are burns and trauma, carbon monoxide poisoning, nervous and mental disorders.
Fire is characterized by a large amount of heat and intense gas exchange of
products of combustion. Space, which captured fire, conventionally divided into
separate zones of active combustion, thermal effects and smoke. In the heat of the
fire zone of a mixture of air and gaseous products of combustion are between 60
and 9000S, and surface heat flux density exceeding 4 kW (60 kcal / (min • m2)).
In the area of smoke are Key factors affecting the combustion products,
many of which have high toxicity. Especially toxic substances formed during
combustion of polymers. In some cases, products of incomplete combustion with
oxygen can form flammable and explosive mixtures. In case of fire, people can get
thermal and mechanical damage of varying degrees of severity and possible carbon
monoxide intoxication.
Providing medical assistance to victims is different because the search is
complicated because of the smoke affected areas or buildings, and the emergence
of combined lesions.
Environmental Disaster
One of the basic concepts of ecology and the objects of its study is the
notion of "biosphere". During the biosphere understand thin layer of air, water and
soil throughout the globe where there are developing organisms. There are a
number of environmental factors, the most interesting of which is anthropogenic human activities associated with the development of civilization. Ecological
importance of this group of factors came in the second half of the 20th century, due
to intensive human impact on the biosphere. It led to:
1. Changes in the structure of the earth's surface (plowing of the steppes,
deforestation, violations of the surface water reclamation, creation of artificial
lakes and seas).
2. Changes in the composition of the biosphere (mining, emissions into the
atmosphere and water bodies of different chemicals).
3. Changes of thermal balance of certain areas of the globe.
4. Changes in the composition of living organisms of the biosphere (the
extinction of species, creation of new animal breeds and plant varieties, changing
their place of residence).
A characteristic feature of our time is the negative impact on the ecosystem,
increasing the number of accidents and disasters in the industry, including nuclear
power, chemical production and transport, increase in the number of natural
disasters. As a result of various human activities are polluting the biosphere, which
causes severe environmental problems.
The features of scientific and technological progress, leading to ecological
disasters are:
1. A significant increase in the volume of industrial production.
2. The emergence of new environmentally hazardous equipment and
technology.
3. Accumulation of chemical plants huge stocks of dangerous for the
environment and human health-acting poisons (SDYAV).
4. Consumption of non-renewable natural resources (oil, gas, coal).
5. Miscellaneous increasing complexity of technical systems that interact
man.
Particularly high growth in the last decade gained growth of chemical
production. Man-made emissions of chemicals into the atmosphere leading to
significant air pollution inorganic chemistry. As a result of burning fossil fuels in
the Earth's atmosphere ejected a large number of sulfur and nitrogen oxides and
carbon monoxide leads to the greenhouse effect and the threat of global climate
change. Extremely dangerous from an ecological point of view are products of
chlorine, namely compounds such as dioxin, which fall into the biosphere as a
result of accidents and violations of technological regimes especially in pulp and
paper industry. Even in low concentrations, they suppress the immune system
function, exercise mutagenic and carcinogenic effects.
Great danger are organophosphorus pesticides, heavy metals. In recent
years, marked accumulation in the environment toksykativ that the interaction
between them, as well as effects on the human body leading to new forms of
previously unregistered lesions and require new approaches to diagnosis and
treatment. This is clearly manifested in the following environmental emergencies,
such as "Chernivtsi disease", or alopecia and chemical damage unknown substance
residents Pervomaisky region Nikolaev region.
The development of science and technology has a negative side that could
lead to emergency situations of technogenic, natural and environmental problems,
which threaten the lives and health of people. Medical staff, in charge of public
health in these conditions should be adequately trained, not only from a specific
medical specialty but also for the organization of this process by implementing
these skills in extreme conditions.
Based on the needs guarantees the security of the population and territory of
Ukraine established an integrated system to prevent and respond to accidents,
disasters and other NA, part of which is a public service of Disaster Medicine
(DSMK), part of which may include physicians of all specialties. Preparation of
this activity and dedicated emergency medicine course.