Children in a disaster: health protection and intervention

Children are disproportionately affected by disasters. They have greater physiological, psychological and sociological vulnerabilities, often exacerbated by the fact that their unique needs can be overlooked during relief efforts. This article provides an overview of disasters, including how they are categorised, and the factors that need to be considered by military and civilian healthcare teams that respond to them. Information is drawn from a variety of previous disasters, with the effects considered across a range of different populations and communities. The lessons learnt from previous disasters need to inform the ongoing discussions around how to best train and supply both individual healthcare workers and the wider teams that will be expected to respond to future disasters. The importance of role-specific training incorporating caring for children, consideration of paediatric casualties during planning exercises and teaching scenarios, and the requirement for paediatric equipment and medications cannot be overemphasised. While provision of paediatric care may not be the primary role of an individual healthcare worker or their broader team, it still remains their ethical and often legal duty to plan for and deliver care for children when responding to a disaster. This is a paper commissioned as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.

Plastic ‘Highways’ to the Sea: The Problem of Litter in English Inland Waterways

There is a conspicuous lacuna in the Environmental Protection Act (EPA) 1990 because it imposes no legal duty on statutory bodies to clear litter from aquatic environments (rivers, canals and lakes) in England and Wales. This paper identifies a significant gap in the law on aquatic environmental protection by undertaking doctrinal research, including contextual analysis of references to rivers in ‘soft’ law (e.g., policy documents such as the Conservative Government’s Litter Strategy) and ‘hard law’ (e.g., legislation including the EPA 1990); an examination of the problems with existing legal frameworks in this sphere and an exploration of legislative and practical measures which could protect our rivers and other inland waterways from litter. A legislative amendment to the EPA is proposed with discussion of whether imposing a duty on an existing body or a new, specialised body to clear litter from rivers will ameliorate these problems. The intention behind this paper is to initiate an informed debate on how to protect aquatic environments from the harmful effects of litter.

Candour and confidentiality

This chapter sets out the legal duty to preserve confidentiality and to promote candour. It explores the ethical basis for these obligations and the circumstances in which they can be breached. The recent emphasis on candour is designed to protect the position of whistle blowers. The chapter also outlines the law on data protection.

DELIKTUELE AANSPREEKLIKHEID WEENS ’N LATE: IS DIE ONDERNEMER SY KLANT SE HOEDER?

Dit is gevestigde reg dat ’n persoon wat versuim om te verhoed dat ’n ander skade ly, in die reël nie deliktueel onregmatig handel nie, of soos dit kripties in Saaiman v Minister of Safety and Security (2003 3 SA 496 (O) 503) gestel word: “The general rule of delict is that no one is held liable for doing nothing. This is trite law.” Positief gestel, is sodanige late dus prima facie regmatig. “Onderliggend aan dié uitgangspunt is die gedagte dat niemand sy broer se hoeder is nie”. Regsbeleidsoorwegings hiervoor is onder andere dat ’n algemene regsplig om benadeling van andere deur positiewe optrede te voorkom, ’n te swaar las op persone in die gemeenskap sou plaas, asook dat dit tot chaos kon lei “[i]f every individual were liable for failure to protect others against loss”, aangesien “each would be compelled, in order to avoid liability, to run around and busy himself with the affairs of his neighbours”. “Society is [dus] hesitant”, soos dit in Cape Town Municipality v Bakkerud (2000 3 SA 1049 (HHA) 1054) verwoord word, “to impose liability in law for, as it is sometimes put, ‘minding one’s own business’”. Daarom moet daar in elke besondere geval bepaal word of daar inderdaad ’n regsplig was om positief op te tree ten einde benadeling te vermy, en dit word beantwoord aan die hand van die redelikheids- of boni moresonregmatigheidsmaatstaf. In Van Eeden v Minister of Safety and Security (Women’s Legal Centre Trust, as amicus curiae) (2003 1 SA 389 (HHA) 395; sien ook Minister of Safety and Security v Hamilton 2004 2 SA 216 (HHA) 229) word dit so gestel: “The appropriate test for determining wrongfulness [of an omission] has been settled in a long line of decisions of this Court. An omission is wrongful if thedefendant is under a legal duty to act positively to prevent the harm suffered by the plaintiff. The test is one of reasonableness. A defendant is under a legal duty to act positively to prevent harm to the plaintiff if it is reasonable to expect of the defendant to have taken positive measures to prevent the harm.” In die onlangse tyd het daar ’n hele paar gevalle voor die howe gedien waar klante van ondernemers op sakepersele benadeel is. Drie sodanige gevalle verdien nadere beskouing, naamlik waar ’n klant op ’n gladdewinkelvloer gly en beseer word, waar ’n klant op ’n besigheidsperseel geskiet word, en waar ’n klant se motor op die parkeerterrein van ’n besigheid gesteel word. In al hierdie gevalle is die primêre vraag of die betrokke ondernemer sy klant se hoeder is, met ander woorde, of daar ’n regsplig op die ondernemer gerus het om die klant se benadeling te voorkom het. Sekondêr kom die vraag na die ondernemer se nalatigheid (en kousaliteit) ter sprake.

Death in worship places: Evaluating the roles of religious organisations and state governments in reducing the risks of religious disaster

The numbers of accidents and disasters resulting in injury and death of the faithful in religious buildings in many parts of the world are on the increase in recent years. Interestingly, the citizens of the countries where most of the cases are reported are overtly religious and manifest their religiosity by attending religious activities in religious buildings. This, therefore, heightens the impact of a disaster, such as where there is a religious building collapse or a stampede. The attendant social, legal and economic effects of such disasters on religious organisations, religious faithful and society thus necessitate the study. This article critically examines the roles of religious organisations and state governments in reducing the risks of avoidable disasters in religious buildings. It evaluates the reports of two instances of church building collapses in Nigeria as case studies. This article observes that many religious organisations do not have effective risk and safety policies to reduce their exposure to religious disasters. It also observes that the state is ineffective in enforcing building standards. It argues that religious organisations and the state owe a legal duty to protect the lives and guarantee the safety of the faithful against the tragedy that may occur in worship places, and where this duty is breached, and a victim suffers harm, a right to damages will accrue. It concludes that although a religious organisation may not be able to stop all such disasters, having an effective disaster risk policy can assist in reducing the occurrence of avoidable mishaps in religious buildings.

Understanding attention deficit/hyperactivity disorder in physicians: workplace implications and management strategies

Physicians with attention deficit/hyperactivity disorder (ADHD) may have unrecognized workplace difficulties because of inattention and impulsivity. If these behaviours interfere with patient care or organizational functioning, leaders may erroneously attribute the physician’s actions to unprofessionalism. As such, corrective efforts with punitive measures may be ineffective. ADHD is a neurodevelopmental disorder that responds to evidence-based treatments, including medications, accommodations, and supports. Physician leaders who understand the unique presentations of ADHD in physicians may better identify when this condition may be contributing to workplace behaviour. Furthermore, physician leaders may have a professional or legal duty to accommodate or support physicians with underlying medical and/or psychiatric conditions, such as ADHD. Using our own clinical experience, we provide a general overview of ADHD in physicians and guide physician leaders on how to help physicians who may be struggling with ADHD in the workplace. We hope that our clinical experience and observations of this hidden problem will spur discussion, awareness, and action for further research and support.

3. Enforceability of promises: consideration and promissory estoppel

Course-focused and comprehensive, Poole’s Textbook on Contract Law provides an accessible overview of the key areas on the law curriculum. Under English law, bargains and not gratuitous promises are enforced, thus a promise will not be enforceable if it is not contained in a deed (implying that any promise is taken seriously) or supported by consideration. Consideration refers to an act or a promise given in exchange for the promise (that is, the price for which the other’s promise was bought). The law does not recognize some acts or promises as good consideration, such as past consideration and performance of an existing legal duty. This chapter examines the general requirement in English law to provide consideration in order to enforce a contractual promise. The consideration requirement is relevant not only to the formation of a contract but also to the enforceability of promises altering the terms of an existing contract (alterations). An alteration promise that is not supported by consideration may still have some binding effect on the basis of the doctrine of promissory estoppel.

Quality improvement project: to improve adherence to DVLA (driving and vehicle liscensing agency) guidance in the tyrone & fermanagh hospital acute inpatients ward

AimsTo reach 80% adherence to DVANI (Driving and Vehicle Agency Northern Ireland) guidance in acute inpatients ward, T&F HospitalBackgroundThis is a scale-up of a previous successful QI project on driving and Attention Deficit Hyperactivity Disorder in Belfast Trust. According DVLA's guidance for medical practitioners on the current medical standards of fitness to drive, patients with certain mental health diagnosis are required to inform DVLA of their diagnoses and refrain from driving. Different factors are considered in order to determine patients’ fitness to drive. According to DVLA and GMC, it is medical professionals’ responsibility to advise patients to inform DVLA/DVANI of their mental health diagnosis. It is the patient's legal duty to notify DVLA/DVANI of their diagnosis. Patients can be fined up to £1000 if they failed to inform DVANI of their medical condition.MethodOutcome: Completeness of driving advice given to consecutive patients discharged from T&F hospital from April 2019 to early August 2019 in %Process: Document clearly in electronic and written notes on following - (1) has driving status been asked (2) has patient been advised to inform DVA if required (3) has patient been advised likely how long he/she is to refrain from driving forBalancing: increased the time of reviews, increased numbers of consultant reports requested from DVAResult4 cycles have been completed. Cycle 1 – baseline and review guidance; Cycle 2 – medical staff education and developed driving advice pathway and patient leaflet; Cycle 3 – admin staff was involved for putting driving advice pathway in admission pack; Cycle 4 – medical staff was educated again regarding importance of documenting electronically. Clear changes were seen after cycle 3 showing an increase of mean of 25% completeness of driving advice to over 90%.ConclusionIt is the legal duty of patients to notify DVANI of mental health diagnosis, however it is the responsibility of medical professionals to advise patients to do so. This QI project has shown improvement in the completeness of driving advice given. Further cycles are to be completed to obtain patient feedback.

Pierādīšanas nasta atbildības par vainojamu rīcību piemērošanā

In this article, the author analyses the burden of proof in determination of fault-based liability. The main focus is placed on the first prerequisite of civil liability – fault, which can be defined as non-compliance of the factual conduct with the required standard of care (in form of negligence or intent). Currently, the aspect of burden of proof regarding fault is quite unclear in Latvian private law. Therefore, in this article the author answers the fundamental question: which party has the legal duty to prove the prerequisite “fault” (or its absence) according to the Civil Law? Additionally, the author will also outline the peculiarities of burden of proof in both tort law and contract law.