China is one of the countries most affected by disasters caused by natural hazards. Disasters comprise an important restricting factor for economic and social development.

Retrospective analysis was performed based on the epidemiological data of disasters caused by natural hazards in recent two decades.

The deadliest disaster that was reviewed was the Sichuan, Wenchuan earthquake on 12 May 2008 with a death toll of 88,928. Floods were the the primary natural hazard resulting in disaster in China. The economic loss caused by natural disasters was huge, the Sichuan earthquake alone resulted in an economic loss of 845.1 billion Chinese Yuan. However, psychosocial factors did not receive attention by Chinese Government and academics.

The characteristics and impact of disasters should be analyzed to scientifically provide useful information for natural disaster mitigation in China.

To assess the preparedness of hospitals with respect to protecting health care workers (HCWs) during a pandemic.

A self-administered questionnaire was performed between November 2009 and January 2010, and a scoring system was developed to provide a quantifiable measure of preparedness.

A total of 12 hospitals in NSW, Australia, were approached – six regional hospitals (RHs) and six tertiary referral centres (TRCs). The study was extended to assess three hospitals in England, allowing a limited comparison between the hospitals in Australia that had faced the initial wave of the H1N1 (“swine flu”) pandemic and the hospitals in the UK that had more time to prepare for the outbreak. Response rates were 66% from the TRCs, 33% from the RHs, and 100% from the English hospitals. The overall preparedness scores were relatively high, with a median TOTAL score (adjusted) of 50.75 out of 70. The demographic that scored the highest Total was tertiary referral centres in Sydney. All English hospitals scored below the median. However, the range of scores across hospitals was quite narrow (45.1 – 57.1 adjusted). Scores were generally high for the areas of Preparedness, Infection control, Education and Training. Scores for Vaccination were more variable. The category that consistently demonstrated the lowest scores was that of Psychosocial Welfare and Assistance, despite this being found in previous research to be an integral part of that which HCWs have identified as important.

Given their integral role in pandemic response, protecting HCWs must be a priority as part of any pandemic preparedness plan. This goes beyond protection from infection, extending into aspects of physical and psychological wellbeing. Identifying these issues and addressing them is the key to maximising staff support and morale, and minimising staff absenteeism at such a crucial time.

Psychosocial Tsunami Financial Crisis Tragedies produced by nature have patterns similar to psychosocial emergencies. The disruptive effects impact on Public Health. Unemployment covers society and doesn't allow personal aptitudes to emerge and sinks people in hopelessness. There is a perception of constant risk. People are in alert with all the effects of sharp and chronic stress and in some occasions Post Traumatic Stress.

To get an efficient answer to reality from this impoverished group with severe effects facing working uncertainty and unsatisfied basic needs. To avoid the social tragedy to be a big wave that sinks a big part of the population very quickly. To train people on the importance of work to get a better quality life for each participant, the family and community.

6200 people were trained in twenty months and motivated to work in a population of 95000 citizens approximately. They got a salary and social security financed by the government and articulated with the NGO. They were organized according to working experience and abilities and a supervisor was elected every ten people. Each participant had been polled to reach these conclusions. Industrial security, health care, and group work abilities were some of the syllabus topics. Some of the tasks performed were: painting, gardening, public places embellishment and fixing, administrative duties, river cleaning, etc.

90% of labour inclusion among unemployed people. Acknowledge from the participants of their working abilities. To generate hope in uncertainty diminishing violence. Generate space to diminish stress with impact in cardiology matters, addictions and pathologies. The disruptive effects of financial crisis are diminished considerably in these groups.

SAFETY FUNCTION ACTION for Disaster Responders (SFA) trains a framework for achieving and maintaining a high level of disaster health. Within SFA, disaster health is defined as, “maximal safety, optimal function, and effective action in preparedness for, and response to, emergencies, disasters, and extreme events.” A set of six strategies forms the backbone of the framework with two strategies each for SAFETY (safeguard and sustain), FUNCTION (comfort and connect), and ACTION (advise and activate).

During 2008, a total of 2,553 participants were trained throughout the State of Florida. Participants were drawn from public health, healthcare, mental health, and professional/volunteer emergency responder workforces. During 2009, an additional 861 participants were trained as “SFA facilitators.” Facilitators were provided with guidance and training materials to return to their worksites and train peers on the SFA modules. Facilitators were in direct contact with a team of 5 DEEP Center “coaches” who supported their training efforts. To assess the training's effectiveness, pre/post-assessment data on the 2,533 SFA participants and 861 SFA facilitators were collected.

Live-training evaluation data showed highly favorable quality ratings for the course, materials, presenters, and all individual course components. Pre/post comparisons of the data indicated consistent gains in self-reported confidence ratings for all 7 “facilitator skills” (recruiting, motivating, training colleagues; teaching SFA skills, working with coaches) and 15 SFA “strategies and response skills” (applying the six SFA strategies to responders (self, family, team) and disaster survivors). Consistent gains were evident for 12 scales asking facilitators to self-report their comfort in dealing with disaster survivors exhibiting distress or suffering trauma and loss.

SFA has been launched as an online training course and a cell phone “app” is in progress. SFA has recently been trained in South America and Europe. Experiential components of SFA are being refined and expanded.

Psychological First Aid (PFA) has become the choice of mental health intervention and integration with the current disaster relief protocols during emergencies by the Institute of Medicine, NIMH and the WHO. It can be used during or immediately after disaster. People without mental health specialized training, including public health practitioners and emergency responders can learn and apply to everyone in need. Whilst being used extensively, few studies have evaluated the effectiveness of PFA and its field applicability.

A prospective randomized controlled study. 800 emergency medical responders were recruited. Participants were randomly assigned to the control/intervention arms to receive a one-day training of PFA based on the protocol developed by the National Child Traumatic Stress Network (2006). A pilot study was conducted to evaluate the screening tools and training material and all training was provided by trained clinical psychologist. Repeated measures analysis of covariance was used to evaluate the efficacy of PFA program in changes in various outcome measures between PFA intervention and control group. All analyses were conducted on the intent-to-treat and completer groups. Ethical approval was approved by the CUHK-NTEC Clinical Research Ethics Committee.

Preliminary results from the post-training and 3 month follow-up data indicated participants in the training group have reported a significantly more substantial knowledge in disaster mental health, improve self-efficacy in delivering help in times of emergencies, high frequency of actual helping behavior as well as better self-reported psychological well-being when compared with waitlist control group.

This study examines and reports findings of clinical effectiveness of PFA 3 months post training in Chinese emergency responders. Preliminary results provided empirical evidences on the effectiveness of the approach.

Disaster could greatly affect physical, psychological and social health of people affected. However, current crisis intervention protocols after natural or man-made disasters often overlook the psychosocial impact of crisis on victims. In its executive board meeting in 2005, WHO has called for action in implementing programs that can repair the psychological damage of war, conflict and natural disasters. Currently there are three main post-disaster psychological interventions available in the field: Critical Incidence Stress Management developed by Mitchell and Everly in 1980's; Psychological First Aid developed by the National Child Traumatic Stress Network and National Center for PTSD after millennium; and Mental Health First Aid developed by the Kitchener and Jorm after millennium.

A comparative descriptive analysis among the three different interventions was performed. Specific objectives, target populations, content, training duration, empirical evidence, instructor training and various adaptations were compared. Public health implications for implementation in disaster settings are discussed.

The study is among the first that provided a detail comparison among the different protocols available in the field. More importantly it discussed the empirical evidence that support the use of the specific protocols at different scenarios. Implication the results of the study could be used as a guidance for choosing psychological interventions immediately post-disasters by emergency responders, public health practitioners and academic researchers.

During disaster relief, personnel's safety is very important. Mental well-being is a part of this safety issue. There is however a lack of objective mental well being monitoring tools, usable on scene, during disaster relief. This study covers the use of validated tools towards detection of psychological distress and monitoring of mental well being of disaster relief workers, during the Belgian First Aid and Support Team deployment after the Haiti earthquake in 2010.

The study was conducted using a demographic questionnaire combined with validated measuring instruments: Belbin Team Role, Compassion Fatigue and Satisfaction Self-Test for Helpers, DMAT PsySTART, K6 + Self Report. A baseline measurement was performed before departure on mission, and measurements were repeated at day 1 and day 7 of the mission, at the end of mission, and 7 days, 30 days and 90 days post mission.

The study proved the ability to monitor mental well being and detect psychological distress, by self administered validated tools, during a real disaster relief mission. For practical reasons however some tools should be adapted to the specific use in the field. This study opens a whole new research area within the mental well-being and monitoring field.

To improve quality of life among subjects with crush injuries of extremities as an outcome of traumata of various aetiology by salvage procedures. To prevent or minimize psycho-social derangement or implications by minimizing partial or total loss of traumatized body parts and restore useful function.

20 year study/observation in trauma of limbs, hands, feet, fingers, toes with partial to near total vascular compromise sustained in road traffic, industrial, domestic, suicidal, homicidal, war wounds, fire work blasts, etc. accidents.

Pre-operative/follow-up counselling of every patient, attendants and employer are of utmost importance. Primary debridement, stabilization, skin cover and serial paraffin-gauge dressings are followed with straps/splints, passive/active range of movement exercises and delayed suture removal. Antibiotic cover with sequential cultures are mandatory.

Sepsis is a challenge. Males, youth, hands, Grade II wounds and RTAs dominate incidence. Contamination, delayed presentation, poor compliance and follow-up, poor nutritional status, anaemia, etc., dread salvage. Initial poor tissue perfusion is no indication for early decision to amputate/terminalize.

Compromised vascular crushes in which primary closure was achieved, salvage of limb and appendages was surprisingly possible. Cosmesis in working class is never the priority, but restoration of function and more so the chance of livelihood are. Dexterity and confidence come with practice. Richer the patient, difficult to convince. Psycho-social depression is more with early amputations than in revisions and much less in salvaged groups, commoner in men and unmarried illiterate women. Women adapt better to salvaged parts.

Even a nail lost with its bed is lost for ever, leaving a painful defunct stump. No riches can truly compensate. If soft tissue cover on bony elements and neuro-vascular bundles is achievable, an entire limb may survive and regain near normal function. When crush wounds remain aseptic a decision to amputate can wait.

In emergency preparedness there is the need to prospectively develop an approach to which interventions can be provided with available resources and the maximal amount of clinical effectiveness which can be attained by staff.

A panel of pediatric emergency preparedness experts employed our previously validated evidence based consensus process with a modified Delphi process for topic selection and approval. Interventions were chosen such that resources and staff efficiency would not exceed previously published data for non-disaster emergency care but allowing for standard emergency preparedness planning alterations in standards of care such as the assumption that usual numbers of staff would care for a disaster surge of four times the usual number of patients.

Using standard emergency preparedness assumptions of limited resources and staff efficiency, the panel agreed upon both methodologies for resource allocation and feasible interventions. A number of standard interventions would not be feasible and included detailed recording of vital signs, administration of vasoactive agents, prolonged resuscitation and central venous access.

By employing this approach to resource utilization described combined with the unique aspects of pediatric care, we can improve our planning and responses. This can be accomplished by understanding the needs of the population being served, learning how to focus on both pediatric needs and the expectations of the community with regard to care of children, adopting what has been learned in prior events in the United States and abroad, and developing prospective recommendations regarding essential interventions which can be performed in a disaster.

There remains a lack of comprehensive pediatric emergency preparedness planning worldwide. A disaster or mass-casualty incident (MCI) involving pediatric patients could overwhelm existing pediatric resources within the New York City (NYC) metropolitan region. The NYC Department of Health and Mental Hygiene (DOHMH) recognizing the importance to plan for a MCI with a large number of pediatric victims, implemented a project (the Pediatric Disaster Coalition; PDC), to address gaps in the healthcare system to provide effective and timely pediatric care during a MCI.

The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from the NYC pediatric/children's hospitals, DOHMH, Office of Emergency Management, and Fire Department (FDNY). Two committees addressed pediatric prehospital triage, transport, and pediatric critical care (PCC) surge capacities. They developed guidelines and recommendations for pediatric field triage and transport, matching patients' needs to resources, and increasing PCC Surge Capacities.

Surge recommendations were formulated. The algorithm developed provides specific pediatric triage criteria that identify severity of illness using the traditional Red, Yellow, and Green categories plus an Orange designation for continual reassessments that has been adopted by FDNY that has trained > 3,000 FDNY EMS personnel in its use. Triaged patients can be transported to appropriate resources based on a tiered system that defines pediatric hospital capabilities. The Surge Committee has created PCC Surge Capacity Guideline that can be used by hospitals to create their individual PCC surge plans. 15 of 25 NYC hospitals with PCC capabilities are participating with PDC planning; 5 have completed surge plans, 3 are nea completion, and 7 are in development. The completed plans add 92 surge beds to 244 regularly available PICU beds. The goal is to increase the PCC surge bed capacity by 200 + beds.

The project is an effective, multidisciplinary group approach to planning for a regional, large-scale pediatric MCI. Regional lead agencies must emphasize pediatric emergency preparedness in their disaster plans.

The treatment of victims with gunshot wounds has gained importance over the past 10–15 years due to continuous military conflicts and the increase in terrorist and criminal acts. Since 1992, a group of pediatric surgeons has been trained to treat gunshot wounds in both children and adults in field hospitals of the Russian Service of Disaster Medicine in Northern Caucasus.

Two working models of a Children's Field Hospital (ChFH) were reviewed. In the first model, a ChFH was implemented for 14 months (April 2001–July 2002) during a military conflict in the Chechen Republic. There were no other hospitals rendering medical aid to children in the area. In the second model, a field hospital was created for children following a terrorist act in Beslan, Northern Ossetia in 2004.

Over the 14 month period, the Chechen Republic ChFH rendered medical aid to 102 adults and 20 (16.4%) children with gunshot wounds. Self-made explosives and unexpected munitions were blamed for explosive trauma in children. Two children died in the ChFH, and one child with amputated lower limbs was transported to Moscow for prosthetics placement. Three hundred eleven children presented to ChFH, including 55 children not requiring medical aid, and 256 wounded children, who were divided into 3 groups: 5 dying; 52 wounded and requiring emergency treatment; and 199 wounded who were transported to hospitals in Vladikavkaz after receiving initial medical aid at the ChFH. In total, 47 operations were performed, including seven abdominal and chest surgeries. Re-animation aid was provided at the Intensive Care Department of the ChFH for the stabilization of the critically wounded prior to their evacuation.

In the situation of mass admissions of wounded patients, the most important considerations are triage and the arrangement of operations according to urgent indications.