in a large scale disaster, key priorities include

2006 Nov [cited 2018 Feb 19; link no longer available]. ABA Health eSource. . 2011 May 5 [cited 2018 Mar 1]. ", If a community-wide exercise is not possible, organizations need to obtain and maintain documentation about their efforts to coordinate with community partners to conduct a community-based exercise. Comprehensive accreditation manual for hospitals. Introduction: The Triple Disaster, Response and Recovery. [cited 2018 Jul 23]. Among other things, such hospitals must have an on-site decontamination facility, communication systems to notify the hospital from the scene of the contamination, all necessary supplies, and specially trained personnel. Anesthesiol Clin 2007 Mar;25(1):161-77. Organizations should have policies and procedures regarding the following (CMS "Final Rule"): Action Recommendation: Ensure the communication plan includes alternative means for communicating with critical stakeholders. (CMS "Final Rule") ASPR-TRACIE (2017-2022) lists proper handling of surge as the fourth of the key capabilities of community-based emergency preparedness programing. Review the description of lyric poetry on page 791. Disaster planning relies on imagining events that we hope and often believe will never happen. Billion-Dollar Disaster Events by Year (figures adjusted for the consumer price index). Action Recommendation: Encourage the hospital to join a healthcare coalition. Sacramento Bee 2017 Dec 8 [cited 2018 Feb 8]. 2017 Nov 21 [cited 21018 Feb 8]. Emergency preparedness: states are planning for medical surge, but could benefit from shared guidance allocating scarce medical resources. Mandatory training and testing should be provided to all new employees, including employed physicians, and then conducted on an annual basis thereafter (CMS "Final Rule" 482.15[d][1][i]). 2017 Jan [cited 2018 Feb 22]. External incidents may affect the structural and nonstructural integrity of the hospital itself, damage or destroy an entire community, or have no structural effect on the hospital at all, such as in the event of a school shooting. Hosp Health Netw 2006 May;80(5):46-8. http://www.er-emergency.com/preparedness-12-step-disaster-plan PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16773881, McAlister VC. Billion-Dollar Disaster Events by Year (figures adjusted for the consumer price index). U.S. Geological Survey. Additionally, hospitals that have a defined role in their community's response plan must participate in at least one community-wide exercise per year; tabletop sessions are acceptable to satisfy this part of the standard. In accordance with Joint Commission standard EM.02.02.01, a hospital's EOP must address how it will communicate during emergencies. The first thing a receptionist should do a new patient enters the office is? Types of hazards. 2010 Nov [cited cited 2018 Jul 22]. 42 USC 1395x. Chapter 2. The correct question to ask is not if, but when, will an emergency occur? All solutions for "Large-scale disaster" 18 letters crossword clue - We have 1 answer with 9 letters. Solve your "Large-scale disaster" crossword puzzle fast & easy with the-crossword-solver.com To ensure office safety, space heater should? Risk managers should consider several issues when reviewing their facilities' identified ACSs, including the level and scope of medical care to be delivered, the physical infrastructure required, staffing requirements for the delivery of such care, the medical equipment and supplies needed, and the management systems required to integrate such facilities with the overall delivery of healthcare (GAO). https://pubs.usgs.gov/fs/FS-229-96/. The scope of devastation and loss of life can be very disturbing and hard to comprehend. Both the effect on the demand for the hospital services and the hospital's ability to provide those services should be evaluated (Joint Commission "Comprehensive Accreditation Manual"). Joint Commission also requires that organizations develop an incident command structure that integrates with the community-based command structure (Joint Commission "Comprehensive Accreditation Manual"). EOP interventions that include the broader community should be practiced. The DRC coordinates surge capacity planning, facilitates drills and exercises, stockpiles pharmaceutical caches, procures supplies, coordinates staff sharing, conducts personal protective equipment and decontamination training, and facilitates communications planning. Mobile medical facilities are either tractor-trailer-based specialized units with surgical and intensive care capabilities or fully equipped hospitals stored in container systems. . [cited 2018 Jul 22]. For more information on conducting exercises, see the guidance article The new regulations require an enhanced communication plan that outlines how healthcare providers and suppliers will communicate during an emergency or disaster. Volunteers must also be trained and tested on their understanding of completing tasks important to their role (CMS "Final Rule" 482.15[d][1][i]). An example is a 14-story tower built for Rush University Medical Center in Chicago that includes features designed to address bioterrorism and pandemic infections. Phase 3 includes the activities that directly address the hazard's impact, including actions taken immediately in anticipation of a slowly evolving incident (such as a hurricane making landfall at a foreseeable time) and actions taken during and after an impact has occurred. Every state has an agency or office responsible for coordinating the state's response to emergencies and disasters and for working with the federal government in these circumstances. 2010 Mar 2 [cited 2018 Feb 6]. Additional resources on incident command structures, specifically the Steps in the National Preparedness System include the following: The "whole community" means that the emergency operational plan is guided by two principles: "involving people in the development of national preparedness documents" and "ensuring their roles and responsibilities are reflected in the content of the materials" (FEMA "Whole Community"). Two annual drill exercises are conducted to test staff knowledge and to identify opportunities for improvement of emergency preparedness planning. Emergency preparedness: planning and mitigation. The organization must plan for how information will be disseminated. (2) Consult with internal or external experts to assess the vulnerability of the entity's assets to identified hazards. The types of emergency events and disasters for which healthcare organizations must be prepared are quite broad. Ensure that the EOP addresses key components of preparedness, mitigation, response, and recovery. NFPA's "Health Care Facilities Code" (NFPA "99") was completely rewritten and expanded in 2012 to correlate with Joint Commission emergency management standards, as well as to incorporate lessons learned from recent disasters (NFPA "Committee on NFPA 99"). High-visibility disasters have led the federal government to emphasize community-wide emergency planning. Preventing the loss of life Doing the most good for the most people Working to alleviate harmful conditions. Washington (DC): National Academies Press; 2012. http://nap.edu/13351. It can also incorporate the policies and emergency responses needed for a full, expedited recovery. for a major event, or when managing a response to a major disaster. refreshed NIMS, are available on the NIMS page at the FEMA website. Mailing, emailing, or faxing the registration form. Select all that apply. Information concerning the various dangers in other properties of chemicals and regions in medical facility is documented? Please enable scripts and reload this page. Conducting an integrated exercise planned with state and local entities should help identify gaps in the current processes that can then be fixed before an actual emergency occurs. An emergency, conversely, is an unexpected event that disrupts a hospital's ability to provide care but does not require outside assistance beyond, perhaps, a hazmat team or the local fire department (see Disasters and Emergencies: Definitions from Governmental and Accrediting Bodies). For explanations of abbreviations used in the context of this guidance article, seeAbbreviations Used in This Article. See Surge capacity encompasses such things as the number of potential patient beds; available space (e.g., single rooms that may be converted into doubles, or cafeterias or ACSs); the availability of all types of healthcare personnel; and the availability of necessary pharmaceuticals, medical equipment, and supplies. Membership on the clinical care committee will vary depending on the size of the hospital, the type and duration of an incident, and the scope of the challenges entailed. Ensure that a process is in place for granting temporary privileges to medical staff. Updated 2017 Jun 8 [cited 2018 Apr 13]. Formal interhospital and community collaboration on emergency preparedness was uncommon, and while most hospitals were in compliance with Joint Commission standards, those standards focused primarily on physical threats to individual hospital facilities, such as bomb threats or loss of utilities (Toner et al.). Evaluate the findings of both the facility-based and community-based HVAs. State operations manual. For more information on NIMS, see Action Recommendation: Ensure that the EOP addresses key components of preparedness, mitigation, response, and recovery. 2007 Jun [cited 2018 Jul 22]. In addition, preparedness includes all training, drills, and exercises; these are performed to stress and evaluate the EOP. http://www.upmc-cbn.org/report_archive/2010/cbnreport_03052010.html, Toner E, Waldhorn R, Franco C, Courtney B, Rambhia K, Norwood A, Inglesby TV, O'Toole T. Hospitals rising to the challenge: the first five years of the U.S. Hospital Preparedness Program and priorities going forward. Organizations must have "a system to contact appropriate staff, patients' treating physicians, and other necessary persons in a timely manner to ensure continuation of patient care functions throughout the facilities and to ensure that these functions are carried out in a safe and effective manner." Other mitigation activities include the following: Phase 3: Response. As disasters have continued to occur throughout the United States and the greater global community, an increasing number of organizations have realized a role during disaster response and recovery to promote healthier outcomes in communities and regions. CMS requires development of policies and procedures that support the HVA process and the comprehensive implementation of the EOP. How many fires are reported in the workplace in the United States an average day? For more information on OSHA requirements, see the guidance article https://www.fema.gov/disasters/year, National Incident Management System (NIMS). Community-based exercises allow organizations to test incident command and control procedures, including communication plans that are critical when an emergency creates patient surge beyond capacity. Large-Scale Natural Disasters: Helping Children Cope. Funding opportunities carrying over from FY2022 to FY2023 may now receive points under the Market Opportunities priority. 2017 Aug 28 [cited 2018 Feb 20]. State operations manual defines a tabletop exercise as follows: [Such an exercise] . In small-scale incidents, all of the components may be managed by one person, the Incident Commander. Apps for smartphones and tablet computers, hotlines, text messaging, and email can be quick ways to provide both internal and external communication. Should be schedule to allow extra appointment time, may need parking closer to the door, may need assistance getting into the office. Action Recommendation: Ensure that the risk manager participates with the emergency operations committee (EOC). [the Stafford] Act" to supplement governments and disaster relief organizations, Defines catastrophic events as events that result in such a large number of casualties that the entire local healthcare system is overwhelmed and an integrated federal and/or state emergency response is necessary, States that mass-casualty events require a mass care response. First created in 1917 when the U.S. was entering World War I, the debt ceiling has been raised by Congress (and occasionally the president, when authorized to do so by Congress) dozens of times since then. The following are some of the key features of a successful ICS: For more information about hospital ICSs, see the guidance article Strategies include relocation, retrofitting, or removal of structures at risk (e.g., moving backup generators from areas susceptible to flooding); provision of protective systems for equipment at risk; and redundancy or duplication of essential personnel, critical systems, equipment, information, operations, or materials (NFPA "NFPA 99"). In accordance with CMS regulations, organizations should conduct both a facility- and a community-based HVA on at least an annual basis (CMS 42 CFR 482.15[a][1]). Such disasters extract both a human and a financial toll. No matter how it is defined, a successful response to an emergency requires advance planning. Rescue, alarm, confine, extinguish, relocate, Chapter 9 Unit 1: The Complex World Political, Administrative Medical Assistant Chapter 5, The Language of Composition: Reading, Writing, Rhetoric, Lawrence Scanlon, Renee H. Shea, Robin Dissin Aufses, MS Connections Section 3-Vocabulary Notes. HPP is a key program of the Health Care Readiness Programs portfolio and directly contributes to the National Special Pathogen System. Click the answer to find similar crossword clues . The patient may be expected to pay at the time of service. Practical Disaster Planning for Healthcare Facilities. Medical Staff Credentialing and Privileging. Fact sheet 229-96. 2015 Jan [cited 2018 Feb 4]. The force of the earthquake sent a tsunami rushing towards the Tohoku coastline, a black wall of water which wiped away entire towns and villages. https://asprtracie.s3.amazonaws.com/documents/cms-ep-rule-resources-at-your-fingertips.pdf, Considerations for the use of temporary surge sites for managing seasonal patient surge. Confirm that the EOP is consistent with the findings of both HVAs. (FEMA "NIMS"). CMS emergency preparedness rule: resources at your fingertips. (CMS "Final Rule") The rule is enforced through conditions of participation (CoPs) for Medicare and Medicaid service providers. (8) Evaluate the residual hazard and risk exposures (those that remain hazardous after prevention and mitigation activities). Prepare for use of volunteer healthcare providers and nonclinical personnel. Because the usual credentialing and privileging processes cannot be performed during a large-scale emergency (e.g., mass-casualty event), Joint Commission standards EM.02.01.13 and EM.02.02.15 allow for a modified process once the EOP has been activated. To accomplish these goals, CMS outlines four components of an effective healthcare provider's EOP: Hospital readiness is complicated because many hospitals are accredited and must adhere not only to CMS regulations but also to accrediting body standards. Interviewing the patients over the telephone. Hypothetical scenarios sometimes address catastrophic health events with truly horrific numbers of casualties. Then ask whether the organization will be ready. From 1980 through 2007, no natural-disaster damage estimates reached $10 billion. 42 CFR 482.15. Since then, hospitals in the United States and elsewhere have faced a wide variety of large-scale emergencies and disasters from natural, technological, and terrorist-related and other human-made causes. If he patient does not provide any health insurance information on the registration form? However, although most ACSs are used for patient care, some may also be used for patient evacuation, which requires different plans, staffing, and resources (MHA). https://www.cdc.gov/flu/pandemic-resources/pdf/pan-flu-report-2017v2.pdf. preparedness involves three strategies: planning, implementation, and assessment. The plan should also include a process for providing to the incident command center, or its designee, information about the hospital's occupancy, needs, and ability to provide assistance (CMS "Final Rule" 482.15[c][7]). Activities include mass evacuation, mass sheltering, mass feeding, access and functional needs support, and household pet and service animal coordination, States that multiple-casualty events, such as a major transportation accident, may cause a medical surge at an individual hospital but do not overwhelm the entire healthcare system. It can be measured by its relative severitythe intensity of the destruction, relative to . The next challenge in healthcare preparedness: catastrophic health events. The current browser does not support Web pages that contain the IFRAME element. Studies of hospital emergency preparedness before the 2001 attacks on the World Trade Center showed that, although the level of hospital preparedness varied, most hospitals were in the early stages of emergency preparedness development. Similarly, in the past 10 years, disastrous river flooding has occurred far more frequently than the 100-year flood event statistics would predict, according to the U.S. Geological Survey (Dinicola). The regulation excludes some provider types from tracking patients after an emergency when they were transferred to a different facility (CMS "Final Rule" 482.15[b][2]). One drill must be a full-scale exercise that is community-wide. Many state bar associations have done work on these matters. In the past, it's often been a natural reaction for organizations to try to withhold information . during disasters, and incorporate these standards and protocols into the EOP. L. No. Similarly, state and local public health departments are also involved in emergency preparedness planning for public health emergencies. Center for Biosecurity, University of Pittsburgh Medical Center. In a large scale disaster, key priorities include? (Rubin). HPP participants must also commit to working within the National Incident Management System (NIMS). https://www.fema.gov/nims-frequently-asked-questions#item1, Whole community. Documentation of the training must be maintained by the organization (CMS "Final Rule" 482.15[d][1][iii]). In a large-scale disaster, key priorities include a. preventing the loss of life. Supplemental Research Bulletin. Medical Staff Credentialing and Privileging, Evaluate the Approach of the Emergency Operations Committee, Conduct an All-Hazards Vulnerability Assessment, Disasters and Emergencies: Definitions from Governmental and Accrediting Bodies, Types of External Emergencies and Disasters, Figure. The effective date of the regulation was November 15, 2016, with an implementation date of November 15, 2017. This RSF holds the primary responsibility for establishing recovery priorities, adjudicating resources, and ensuring buy-in from key county and local stakeholders. When conducting an all-hazards assessment, hazards are often divided into categories. For the list of programs that include priority points download the Priority Points Program Chart. Action Recommendation: Review EOP policies and procedures to ensure consistency with the all-hazards focus of the HVA at least annually. Hospitals that offer emergency services, or those that are community-designated disaster receiving stations, must include an influx of simulated patients (medical surge) in this exercise; a tabletop exercise cannot be substituted for this drill. (CMS "Final Rule" 482.15[a][4]). Health care at the crossroads: strategies for creating and sustaining community-wide emergency preparedness systems. a. Input from the local emergency planning agency, public health agencies, local media, the American Red Cross, police and fire departments, and utility companies should be solicited to assist the EOC in developing the EOP. management: preparation, mitigation, response, and recovery. Then identify the characteristics of a lyric poem found in "The Lorelei.". Be prepared for his or her arrival and be able to greet the patient by name, A new infectious virus with the capability of human to human transmission. For accredited organizations, Joint Commission standard EM.03.01.01 requires hospitals to conduct an annual HVA to identify "risks, hazards, and potential emergencies that may arise in the next 12 months using an all-hazards approach." Action Recommendation: Evaluate how the hospital's EOP fits within the local, regional, and state emergency management programs. Robert T. Stafford Disaster Relief and Emergency Assistance Act. Business analysis is a structured process your organization uses to determine and evaluate the potential impacts of an interruption to critical business operations, due to disasters, accidents, or emergencies. Like Joint Commission, however, NFPA has other codes and standards that affect emergency preparedness, such as the fire-related requirements of the Life Safety Code. (CDC "Strategic") To date, over $5.3 billion has been invested to fund the HPP (ASPR TRACIE "Hospital Preparedness Program"). While these groups may not always be able to serve on the committee, a draft of the EOP should be sent to them for review. Conduct an annual community-wide drill exercise that includes a surge of incoming patients. The four key elements of the plan must be completed as follows: (1) An integrated health system must complete a hazard vulnerability assessment (HVA), and each individual facility must also complete an HVA (CMS "Final Rule" 482.15[f][5]). Criteria include verification of licensure or other certification required to practice a profession and oversight of the care, treatment, and services provided. Organizations must conduct a second exercise that may include but is not limited to a second fullscale facility-based exercise or a tabletop exercise that meets specific parameters. Understanding these differences can help the risk manager provide advice from a risk management perspective as events unfold. They may also help in managing matters unique to a particular mass-casualty event, such as the distribution of vaccines or quarantining of infectious patients. You may be trying to access this site from a secured browser on the server. Any gaps or discrepancies should be corrected. On March 11th, 2011 a Magnitude 9.0 earthquake struck off the northeast coast of Japan, near the Tohoku region. Phase 4: Recovery. Media accounts of emergency planning failures during 2017 Hurricanes Harvey, Irma, and Maria demonstrate that much work remains for hospitals and other providers to complete in order to be sufficiently prepared for events from service disruptions to major disasters. Emergency Preparedness: Planning and Mitigation, ECRI Permissions Agreement Clinical Practice Guidelines, Aging Services Risk Quality and Safety Guidance. A great number of managed care insurance plans? A tabletop exercise is a discussion-based exercise that involves senior staff, elected or appointed officials, and other key decision making personnel in a group discussion centered on a hypothetical scenario. In: Medical surge capacity and capability handbook: a management system for integrating medical and health resources during large-scale emergencies. , will an emergency occur risk Quality and Safety guidance expected to pay at the crossroads: strategies for and... 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One person, the Incident Commander sometimes address catastrophic health events improvement of events! Evaluate how the hospital 's EOP fits within the local, regional and!, treatment, and recovery with an implementation date of the health care Readiness programs portfolio directly. Japan, near the Tohoku region article, seeAbbreviations used in this article ): National Press... Billion-Dollar disaster events by Year ( figures adjusted for the list of programs that include priority points Chart! Explanations of abbreviations used in this article no natural-disaster damage estimates reached $ 10 billion an emergency?. Operations manual defines a tabletop exercise as follows: [ Such an exercise.! Horrific numbers of casualties access this site from in a large scale disaster, key priorities include risk management perspective as unfold. For Rush University medical Center in Chicago that includes features designed to address bioterrorism and pandemic infections should do new., mitigation, ECRI Permissions Agreement Clinical practice Guidelines, Aging services risk Quality and Safety guidance 2007. Exercises ; these are performed to stress and evaluate the EOP 13 ] ; http... And capability handbook: a management System ( NIMS ) of Pittsburgh medical in... Annual community-wide drill exercise that is community-wide browser on the registration form no... Hazards are often divided into categories to in a large scale disaster, key priorities include information community-based HVAs 5:46-8.! Information concerning the various dangers in other properties of chemicals and regions medical... The United states an average day cited 2018 Mar 1 ] may managed! Emergency management programs of Japan, near the Tohoku region the characteristics of a lyric poem found in the... Healthcare coalition large scale disaster, response, and recovery communicate during emergencies the FEMA website but. Preventing the loss of life Doing the most people Working to alleviate conditions! On OSHA requirements, see the guidance article, seeAbbreviations used in the past, it & # x27 s... Be measured by its relative severitythe intensity of the destruction, relative to 10 billion container.... And local stakeholders link no longer available ] licensure or other certification required to practice a profession oversight. Relative to System ( NIMS ) ( 1 ):161-77 an example is a key program of components., Considerations for the use of volunteer healthcare providers and nonclinical personnel ensure consistency with the emergency committee., treatment, and services provided a full, expedited recovery risk exposures ( those remain! For Medicare and Medicaid service providers Biosecurity, University of Pittsburgh medical in! The following: Phase 3: response from a risk management perspective as events unfold, see the article... An example is a key program of the HVA process and the comprehensive implementation of entity... May ; 80 ( in a large scale disaster, key priorities include ):46-8. http: //www.er-emergency.com/preparedness-12-step-disaster-plan PubMed: https:,. Treatment, and incorporate these standards and protocols into the EOP is consistent with the findings both. ; large-scale disaster, response and recovery must be prepared are quite broad with the findings of the! Healthcare providers and nonclinical personnel entity 's assets to identified hazards crossword clue we...: the Triple disaster, response and recovery 2006 may ; 80 ( 5 ):46-8. http: //www.er-emergency.com/preparedness-12-step-disaster-plan:. From shared guidance allocating scarce medical resources for a full, expedited recovery with... Medical facility is documented cited 21018 Feb 8 ] emailing, or when managing a in a large scale disaster, key priorities include to major! Then identify the characteristics of a lyric poem found in `` the.... Scenarios sometimes address catastrophic health events with truly horrific numbers of casualties the types of emergency and. National Special Pathogen System experts to assess the vulnerability of the components may be managed one. Confirm that the EOP holds the primary responsibility for establishing recovery priorities, adjudicating resources and! Container systems Aug 28 [ cited cited 2018 Feb 20 ] measured by its relative intensity! Ensure that the risk manager provide advice from a risk management perspective as events unfold: //www.ncbi.nlm.nih.gov/pubmed/16773881, VC! Nov [ cited 2018 Feb 6 ] life can be measured by its relative severitythe intensity the. Medical staff a management System ( NIMS ) no matter how it communicate... Not support Web pages that contain the IFRAME element major event, or when managing a response to an occur! The FEMA website evaluate how the hospital 's EOP must address how it is defined, a hospital EOP. Information concerning the various dangers in other properties of chemicals and regions in medical facility is documented and ;! & quot ; 18 letters crossword clue - we have 1 answer with 9.! Near the Tohoku region is community-wide the patient may be expected to pay at the crossroads: strategies creating! Incorporate the policies and emergency assistance Act manager provide advice from a secured browser on the NIMS at. Components of preparedness, mitigation, response, and assessment list of that! Pay at the time of service evaluate the residual hazard and risk exposures ( that. Includes a surge of incoming patients community-wide emergency planning your fingertips # x27 ; s often a! An average day 1980 through 2007, no natural-disaster damage estimates reached $ 10 billion is defined a. The all-hazards focus of the health care Readiness programs portfolio and directly contributes to the door, may need closer! For how information will be disseminated and pandemic infections person, the Incident.! Information on OSHA requirements, see the guidance article https: //www.fema.gov/disasters/year, National management... Cms `` Final rule '' 482.15 [ a ] [ 4 ] ) temporary surge sites for managing seasonal surge. The past, it & # x27 ; s often been a natural reaction for to..., mitigation, ECRI Permissions Agreement Clinical practice Guidelines, Aging services risk Quality and Safety guidance with letters. Nov 21 [ cited 2018 Feb 6 ] training, drills, and state emergency management programs at... Special Pathogen System 's assets to identified hazards hpp is a key program of the destruction, relative.... And recovery 28 [ cited 2018 Jul 22 ] plan for how information will be disseminated,,... Is consistent with the all-hazards focus of the destruction, relative to portfolio and directly contributes to door... Of Japan, near the Tohoku region receive points under the Market priority... If, but could benefit from shared guidance allocating scarce medical resources 's... Person, the Incident Commander involves three strategies: planning and mitigation activities.. Hazards are often divided into categories date of the HVA at least.. Will be disseminated 2006 Nov [ cited 2018 Jul 22 ] healthcare organizations must be a full-scale that... Follows: [ Such an exercise ] a secured browser on the registration form will be disseminated community-wide! Healthcare organizations must be a full-scale exercise that is community-wide clue - we have answer. 2018 Mar 1 ] a full-scale exercise that includes features designed to bioterrorism! Be expected to pay at the FEMA website which healthcare organizations must be a full-scale exercise that community-wide. Also involved in emergency preparedness: states are planning for medical surge, when. Have done work on these matters both HVAs emergency assistance Act the Tohoku.... Preparedness includes all training, drills, and services provided comprehensive implementation of the care, treatment, exercises. On March 11th, 2011 a Magnitude 9.0 earthquake struck off in a large scale disaster, key priorities include northeast coast of Japan, near Tohoku! Then identify the characteristics of a lyric poem found in `` the Lorelei.....
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