What is the difference between a “disaster” and an “emergency”? One can safely say that for the victim of an event, it is always a disaster. But what about the first responders who are tasked with returning conditions to normal as quickly as possible? What about the executives who must direct the first responders, as well as coordinate resources? The difference is a “matter of degree” because it depends on the amount of resources that are required to respond to the incident. For example, an overturned gasoline tanker truck may only be an emergency for a major metropolitan area, but a disaster in a more rural region. American public safety is a mirror image of the government system of federalism that developed during the founding of the United States. Public safety entities are attached to the various local, state, and federal government agencies. There are almost 18,000 local law enforcement agencies across the US. Only 47 agencies have more than 1,000 sworn officers, while almost 90 percent have less than 50. There are more than 30,000 fire departments, yet only about one-quarter of all firefighters are full-time professionals. The rest are volunteers. The author, a 30-year law enforcement veteran, has developed a college-level course for public safety executives to help them understand the “matter of degree.” The intent of the course is to challenge executives to conduct a careful self-examination of their own public safety agencies to determine what they are capable of doing in an event. An executive only gets one chance to do it right, so being able to distinguish between a disaster and an emergency response will be critical to success. When the event occurs, a public safety executive will be better prepared to make key decisions.

Why did we predict Y2K, but not 911? Why did we predict dirty bombs for much of the past decade, but failed to predict the Asian Tsunami, Hurricane Katrina, and the Haiti Earthquake? Rational disaster preparedness depends on rational risk assessment – but does this really occur? This presentation will explore why risk assessment in disaster medicine is broken, including (1) type I and type II errors in risk assessment; (2) limitations of human neurophysiology; (3) cognitive biases in risk assessment; (4) impact of the media; (5) lack of harmonization of the language of risk; (6) deference to so-called risk experts; (7) risk innumeracy; (8) flaws in risk assessment matrices; (9) black swan events; and (10) managing risk based on extreme events. Concomitantly, this presentation will explore how we can fix risk assessment in disaster medicine, proffering practical solutions to each of these common yet surmountable barriers.

The Modular Emergency Medical System (MEMS) is a flexible and scalable model for community-based response to all catastrophic emergencies. This paper highlights the development of MEMS at the local and regional levels, including training exercises to demonstrate MEMS capabilities, implementation strategies, and its role in the H1N1 response and vaccination clinics. The MEMS was introduced in 2002 as a bioterrorism response by the US Army Edgewood Biological and Chemical Command (ECBC). All-hazards MEMS, as part of a Regional Response System (RRS), was developed by the New England Center for Emergency Preparedness (NECEP) working with state and federal partners. The MEMS presents a modular response framework to mobilize communities and local resources to meet the medical surge demands during a catastrophic event. The modular components of MEMS empower a community-based response to catastrophic emergencies. The Neighborhood Emergency Help Center (NEHC) provides triage and initial treatment, or can function as a point for dispensing prophylaxis medications or vaccinations. During a medical surge, the Acute Care Center (ACC) moves non-critical patients outside of the hospital setting, creating more space for critical care patients. The Community Outreach (CO) module supports casualties recovering in their own homes, under quarantine, and other home-care support. The Casualty Transportation System (CTS) operates between MEMS components, patients' homes and outside of the affected area, meeting all transfer needs. The Medical Control Center (MCC) and Multi-Agency Coordinating Entity (MACE) provide command, control, and coordination of community emergency medical services (EMS), hospital, and public health response assets. Local, regional, and statewide exercises have demonstrated the capabilities of MEMS in Northern New England. The MEMS system, specifically with the MACE concept, was used in New Hampshire during the 2009 H1N1 event. These proven implementation strategies will assist local communities in developing and refining all-hazards response plans.

Space technology plays important role during emergency as well as non-emergency situation to provide the information that is relevant for disaster preparedness and to the rescue and emergency medical teams. During emergency situation, first and immediate information rescue and medical teams like to have is the area impacted, severity of the disaster and the population at risk. Such information is of critical nature for emergency medical teams in order to plan and mobilize the medical personnel, resources and infrastructure needed to provide effective medical services. Space based observation is the most efficient way to provide this preliminary information. Often emergency maps generated based on the space based observations are useful to the medical and rescue teams during emergency situation while detailed information from the field is still awaited. UN-SPDIER offers the platform for providing such services effectively by connecting with the end users the international and regional mechanism that provides such information. During non-emergency phase, the space technology contributes in strengthening disaster risk reduction (DRR) efforts, especially through telemedicines and Global Positioning System (GPS) technologies. These tools integrated with Geographical Information System (GIS) provide effective mechanism for predicting risks (risk mapping) and early warning. It also ensures the rapid distribution of information during catastrophic events. In recognition of these needs the United Nations General Assembly established the United Nations Platform for Space-based Information for Disaster Management and Emergency Response (UN-SPIDER). The programme aims at providing universal access to all types of space-based information by: being a Gateway to space information for disaster management support; serving as a Bridge to connect the disaster management and space communities; and being a Facilitator of capacity-building and institutional strengthening.

Each year a report is prepared for the World Economic Forum on global risks. It outlines the issues most likely to impact on society, and makes recommendations on actions required. The 2010 report concludes that global risks are becoming more volatile, uncertain, complex and ambiguous; and it comments on the increased number of high-impact, hard to predict ‘black swan’ events over the past decade. Indeed, recent disasters such as the Haiti earthquake which killed over 250,000 people, the eruption of Mount Eyjafjallajökull in Iceland, the rapid onset of the 2008/09 global financial crisis, and terrorist attacks around the world have all contributed to a heightened awareness of personal risk and vulnerability. In less than a decade the term resilience has evolved from the disciplines of materials science and environmental studies to become a concept used enthusiastically by policy makers, practitioners and academics. The concept is attractive as it suggests an ability of something or someone to cope in the face of adversity – to recover and return to normality after confronting an abnormal, alarming and often unexpected threat. It is used alongside security to understand how governments, local authorities, the emergency services and health agencies can best address the threats from natural disasters, health pandemics, malicious attacks on a country's critical infrastructure, and other major disruptive events. The paper discusses the meaning and utility of the concept of resilience. It traces the origins of the term through to its current use in addressing contemporary threats facing individuals, communities, organisations and nations. It identifies and describes a number of characteristics which are common to the concept of resilience in its many contexts and manifestations. In conclusion, the paper supports a review of the language and thinking of emergency and disaster management, and promotes the emerging concept of disaster resilience.

A disaster creates disruption and threats to life and society, mental anguish, and leads to feelings of instability around such areas as security and safety. It causes suffering and requires assistance from experts within a structured and tested response framework. After 11 September 2001, the demarcation between disasters caused by natural hazards and terrorism virtually disappeared. The two now get treated concurrently, but there is a danger that anti-terrorism might hijack the agenda, overshadowing important work that must be done in the field of disasters caused by natural hazards. With this in mind, the Health Emergency Management Unit in South Australia was born. The unit was established for preparedness planning around the growing concerns of the potential for an impending pandemic caused by avian influenza. From those shaky beginnings, South Australia now has a dedicated and trained team. The unit provides a 24/7 health responses to planned events and unexpected incidents caused by natural or deliberate forces that may occur in the region. It also participates as part of the National Disaster Deployment Program. Currently, the unit is focused on risk reduction and increasing resilience by implementing a sound, comprehensive approach including all elements of prevention, as well as preparedness, response, and recovery strategies. The unit also provides an extensive education, training, and exercise program to health facilities across South Australia. This paper will describe the ongoing journey of the unit, how it works and interacts with all levels of health service staff and other emergency services, and some of the recent events and incidents in which it has been involved in within Australia and overseas.

In the present Swedish military medical organisation all medical personnel, including surgeons, have to be recruited from civilian hospitals. Even if there are many civilian surgeons well qualified to perform trauma surgery, the injury patterns seen in e.g. Afghanistan are quite different compared to what is generally seen in trauma patients arriving to the ED at a civilian hospital. In order to upgrade the major trauma skills of the civilian surgeons recruited to and trained for participating in international missions, the (extended) military version of the Definitive Surgical Trauma Care (DSTC) Course has been implemented. DSTC is given with the intention not to duplicate ATLS, nor to provide an in depth course in surgery, but rather to teach those techniques particularly applicable to the patient who requires surgery and intensive care for major trauma, in a setting where such care is not commonly practised or even necessarily available. The course, made up by a mix of lectures, case discussions and skill stations has been given at the Swedish Armed Forces Centre for Defence Medicine in Gothenburg since 2007. It has gradually evolved to incorporate also anaesthesiologists and nursing staff into an integrated team. The faculty during these courses has been made up by a mix of international and Swedish instructors. Course candidates have primarily been military health staff, but vacant slots have been offered clinicians working in civilian hospitals in the western part of Sweden. During the last course in September 2010 17/20 (85%) of the physicians and 13/17 (76%) of the nurses rated the course as very beneficial or indispensible. The Swedish Armed Forces Centre for Defence Medicine will continue to run the military version of the DSTC course. Due to a certain over-capacity, course participation can be offered the civilian health care system.

The Australian Government first started to deploy civilian medical teams internationally in the aftermath of the 2004 Tsunami to Banda Aceh, the Maldives, and Sri Lanka. Historically, Australia had relied upon the Australian Defence Force (ADF) to provide overseas medical assistance, but, in this instance, the volunteers deployed were civilian staff, predominantly from tertiary hospital environments. Civilian Australian Medical Assistance Teams (AUSMATs), particularly in Banda Aceh, interacted closely with the ADF after the tsunami and have had a close liaison with the ADF in subsequent disasters, particularly where ADF assistance was required for aeromedical evacuation of patients. This has included assistance after the 2005 Bali bombing, the 2009 Ashmore Reef explosion, the 2009 Samoa tsunami, and the 2010 Pakistan floods. In the latter, Australia deployed a joint military-civilian medical taskforce to provide care to the affected people in Kot Addu in central Pakistan. Having had extensive experience in both military and civilian disaster responses, the authors in this presentation will look at the lessons that can be shared between civilian and military teams in the Australian context. The military brings particular proficiency in command and control, information gathering, security, communications, general logistics, aeromedical evacuation and living in the field. The civilian AUSMATs bring specialized medical expertise, experience in operating in small teams in a range of disaster conditions, health logistics, surveillance, and public health measures in a disaster setting. Learning how to blend these skill sets will be critical in ensuring effective and collaborative international deployments in the future.

Reliable & easily accessible health information is needed before, during, and after disasters. The U.S. National Library of Medicine's Disaster Information Management Research Center has developed a portal linking to resources, guides, and tools for use by disaster/emergency personnel in preparing for, responding, to and recovering from disasters (http://disasterinfo.nlm.nih.gov). This session will introduce you to many of the disaster health information sources available on the Internet. Disaster information tools, such as the Wireless Information System for Emergency Responders (WISER) and the Radiation Emergency Medical Management (REMM) resource will be demonstrated. WISER assists responders in HazMat/CBRN incidents. Capabilities include support for substance identification, on-site incident management, and health management/guidance. The REMM tool provides guidance for health care personnel about clinical diagnosis & treatment of radiation injury during radiological & nuclear emergencies. WISER and REMM are available on the Web and as apps for a variety of mobile devices including the Blackberry and iPhone/iPod Touch/iPad. In addition how to access the disaster health literature from PubMed, the Resource Guide for Public Health Preparedness, and other sources will be discussed. Social medial tools for keeping up-to-date will be presented. Topics to be presented: NLM and other US resources for disaster health information. Other sources of disaster health information, including associations; non-governmental organizations, and international organizations. Databases and information aggregators. Disaster information tools and mobile applications Evaluating/assessing information on the web. How to stay up-to-date: listservs, RSS feeds, blogs, Twitter, etc.

The purpose of this presentation is to compare the lessons learned in acute nursing care in the post-disaster settings of Aceh Jaya, Indonesia (2004) and Port-au-Prince, Haiti (2010). The impact of such disasters disproportionally affects populations made vulnerable by poverty, marginalization, and structural violence. The recognition of these vulnerabilities heightens the role of the nurse as an advocate for the ill and injured. In addition, the lack of adequate human and material resources on all levels necessitates insisting on best practices for patient care despite the resource constraints. Consideration of best practices begins with rigorous personnel selection of nurses adequately trained in emergency/critical care, complex humanitarian emergencies, and disaster response. A proficient level of resource-specific triage knowledge is required to adequately provide the most effective care to patients. Not infrequently, disaster nursing care involves being tasked with a clinical skill or procedures that would be outside the scope of practice in the home country. While the expansion to such practices often is justified by need, an ethical framework demands consideration of the central tenet of “first do no harm”. A heavy burden of coordination among other caregivers, family, and the local staff is required by nurses in this environment. The substantial challenges include communication and continuity of care during the initial response phase among multiple partners with varied backgrounds and goals. Drawing from experiences in Haiti and Aceh, this presentation seeks to define the best practices in disaster nursing care and explore the ethical considerations that arise in such challenging environments.