This presentation will demonstrate that the use of an “Operational Readiness Assessment” was successful in identifying high-performance strategies for frontline-responders, namely surgeons, air traffic controllers, police, and world-class athletes. This research-based approach confirms that best performers in high-risk situations prepare similarly to elite athlete, specifically relating to their emphasis on mental readiness. A framework (Orlick's “Model of Excellence”) developed by researchers who worked with Olympic athletes has a proven replication within very different high-risk disciplines. Both quantitative and qualitative analysis of mental readiness was provided based on in-depth interviews with exceptional professionals regarding their best and less-than-best performances. These findings were assessed to determine the presence of common success elements, including: (1) commitment; (2) confidence; (3) mental preparedness; (4) focus/refocus; and (5) seeking and accepting feedback. This refined assessment tool combines the methodological rigour of academic research with a highly readable and practical analysis of specific techniques that increase effectiveness. Challenges were defined from a frontline-perspective. The balance between technical, physical, and mental readiness were compared. Success skills, performance blocks and influencing factors for optimal performance were detailed. Ten practical recommendations are discussed relating how preparedness of frontline-operations strengthens performance, productivity, and morale. An “Operational Readiness Assessment” is a powerful tool with proven value in hospital, paramilitary, corporate, and industrial settings in which there is a need to be well prepared for, risks of injury or death, large equipment/financial expenditures, complacency, fatigue, and significant consequences of errors. It has been described as an indispensable addition to current work in recruitment, career development, e-learning, role-modeling and future research benchmarks. For example, new performance-indicators for mental readiness were incorporated into surgical-resident evaluations, national situational-awareness training was instituted for seasoned air-traffic controllers, and mental-survival e-modules now enhance police coach-officer programs. Ultimately, a “winning” strategy for managing risk is promoting a healthy, prepared workforce resulting in a safer community.

It is common knowledge that having an individual or family disaster plan is vital for saving lives and property before, during and after a disaster. First responders have the daunting task of helping many people during a disaster. It would make their jobs easier if people had disaster plans before a disaster. However, for a variety of reasons, few people have a disaster plan. People often do not develop disaster plans due to the time required to devise a plan, a lack of knowledge of the benefits of having a plan, or the effort required for the primarily manual process of developing a disaster plan. Wilberforce University has designed a solution called Wilberforce's Information Library Boosting Emergency Recovery (WILBER) which is a customized, online tool to quickly and automatically generate disaster plans to help save lives and property as well as mitigate the impacts of a potential disaster. WILBER utilizes an interdisciplinary approach to automatically generate a basic disaster preparedness plan. The system addresses a wide range of disasters but focuses on floods, earthquakes and technological disasters such as terrorism and nuclear disasters. WILBER automatically processes locally relevant data intelligently and combines mathematical analysis; distributed computing; individual and business risk management; current and historical information from a comprehensive Geographical Information Systems (GIS) that includes imagery, infrastructure, demographic, and environmental data; and wireless sensors for real time condition assessment. Not planning for a disaster only increases the potential magnitude of a disaster. WILBER allows citizens to quickly establish immediate procedures in the event of an emergency which in turn can lessen the burden on first responders and reduces the likelihood of loss of life. This research is funded by the Department of Energy's National Nuclear Security Administration and conducted by the Wilberforce University Disaster Recovery Center in Wilberforce, Ohio, USA.

This Level-1 Trauma Center, with a service area covering a population of approximately four million people, treats approximately 80,000 patients per year. In 2010 it is anticipated that > 23,000 patients will be admitted, and > 850,000 patient encounters will occur within the network. This year was especially fruitful with the World Series, Dallas Cowboys, and other large crowd events simultaneously. The disaster plan prepares the hospital for the Super Bowl in February 2011, and its anticipated 250,000 extra people. The emergency preparedness program is a unique hybrid model integrating hospital accreditation guidelines, governmental guidelines, and regulations with the daily experiences at the trauma center. Emergency Preparedness is a program of the Trauma Department; this relationship provides a direct connection between the emergency preparedness program and direct execution of the plan. The emergency preparedness coordinator is responsible for directing the hospital command center at the time of a disaster requiring activation of the plan. The four phases of emergency planning: (1) Mitigation; (2) Preparedness; (3) Response; and (4) Recovery comprise the core of the plan. However, memoranda of understanding with local, regional, and state emergency operation professionals and organizations are enacted so depleted resources can be replenished. This integration provides for a flexible web that allows sharing of expertise and resources. Trauma Research is available for conducting measurable assessments of emergency preparedness drills and exercises, as well as actual disasters and emergencies where a paucity of research exists. Compliance with all relative agencies is important. A successful emergency preparedness plan directly incorporates daily experiences. This model allows for the continued provision of standards of care and continuity of service during disasters and emergency situations on a daily basis.

Emergency Response Units (ERUs) were pioneered over a decade ago by the International Federation of Red Cross and Red Crescent Societies (IFRC), with the intention of providing a standardized, rapid global tool for response in disasters. Health ERUs are one example of several types of ERUs on stand-by in various countries around the world. Their tented infrastructure, basic medical equipment, and pre-trained personnel allow for the provision of surge medical capacity where it is needed. Commonly used set-ups include a Basic Health Care Unit and a Referral Hospital. The recently-introduced Rapid Deployment Emergency Hospital allows for a lighter, highly mobile infrastructure, with surgical and emergency medical capacity. The modular design of these ERUs allows for deployment with materials “tailored” to the disaster. Their flexibility has been demonstrated in public health emergencies such as the nation-wide cholera epidemic that occurred in Zimbabwe (2008) and more recently in earthquake-damaged Haiti (2010) and flood-affected Pakistan (2010). Health ERUs already on the ground in post-earthquake Haiti were able to re-organize equipment for use in cholera treatment units and centers, and additional ERUs were deployed specifically to set-up treatment centers. In Pakistan, a mobile clinic set-up was used to deliver primary health services to displaced populations, including psychosocial support initiatives and community health messages to minimize the emergence of communicable diseases. The Community Health module (CHM) is a new module in development since 2009. Experience has shown that disrupted health systems, combined with displaced populations can create a fertile environment for communicable disease outbreaks. The CHM addresses primary, secondary and tertiary prevention early in emergencies by engaging communities and more specifically National Society volunteers in epidemic control. The modular design of Health ERUs allow for a rapid and comprehensive approach to delivery of health care in a disaster, with a longitudinal perspective of population needs.

Cruising has become a major part of the tourist industry. In 2010, the total passengers carried worldwide was estimated at 18.4 million, on about 230 cruise ships. Large ships can hold up to 6,000 passengers and > 2,000 crew members. A large cruise ship is rather like an island, with two different communities: the well-trained crew, hopefully prepared for every eventuality and trying to make their guest's stay as pleasant as possible; and the guests, there to have fun. The guest population varies, with up to 40% under 21 years old during school breaks, and the average age is in the fifties or sixties on longer cruises to scenic places such as Alaska. Most of the time ships cannot be reached by helicopter and the medical teams need to cope with a wide range of emergencies from cardiopulmonary, trauma, and psychiatric issues. There are strict public health measures enforced and a range of legislation reducing the risks of cruising to a minimum. This paper reviews the training of the crew for medical emergencies, the incidence of disease, the incidence of medical disembarkation and major incidents on board, and the role of medical teams.

In the cycle of dealing with emergencies one can distinguish four periods, that is planning, diagnosing, responding and recovering. Contingency planning is a prerequisite for emergency management in general. The principles of this planning, for Veterinary Public Health (VPH), does not differ from other cases. However, here will be seen from the point of view of VPH. VPH emergencies include zoonotic diseases and food safety aspects. Emergencies in VPH appear suddenly or expand gradually. Need to define responsibilities for proclaiming an emergency by rating the severity and ranking the situation in steps before deciding that an emergency is in place. One can suggest that surveillance is significant in relation to zoonotic diseases. In food safety, preventative Food Safety Management Systems, in which crisis management and consequent possible product recall actions are part of it, serve the same purpose. In both activities VPH is related with other professionals, a reality expressed, also, in government administrations with different services and/or agencies. Therefore, partnerships and interoperability between veterinarians and physicians on the one hand and other food professionals on the other should be established, for the purpose of efficiently serving the general public. These actions should be developed, as appropriate, in business, region or country level. In order to effectively mobilise the appropriate personnel training and simulation exercises should be part of preparedness. In preparedness, planning for early warning and early reaction should be considered as part of the overall contingency planning. In the various steps in dealing with emergencies the key tool for decision making is risk analysis, served through its three components, that is risk assessment, risk management and risk communication. This last one is very important in relation to communicating with the general public, so that a balanced informing will allow for general public diligent actions without panic.

A trap gun (TG) is a locally manufactured, illegal barreled weapon with a simple trigger mechanism. Trap guns are frequent in agricultural areas of the country. Once the gun is set, it bursts automatically upon the triggering. Since there is no present person selecting the target, the gun injures both animals and humans. A retrospective study was carried out to identify geo-spatial distribution, seasonal variation and injury patterns of TG injuries brought to Teaching Hospital Anuradhapura during 2007 to 2009. A prospective study will identify those in a more detailed manner. The abstract discusses some findings of this ongoing study and the retrospective study. In 2007 there were 107 TG injuries, and 68 in 2008. In 2009 the number increased to 126. Of the victims, 97.5% were males. The mean age was 36.98 years (SD = 11.36), with an age range of 13–69 years and an Inter Quartile Range (IQR) of 29–43 years. The majority of the injuries were lower limb injuries. A significant percentage showed compound fractures and soft tissue injuries. Amputations due to vascular injuries were low (1.5%). Of the cases, 99.5% were from peripheral rural villages. Tap gun injuries are less common during the “Yala” farming season extending from May to September, during which Anuradhapura gets less rain. Yet number of TG victims steadily increases as the “Yala” progresses. This trend continues during the initial half of “Maha” season. It gradually deceases in the latter part of “Maha”. Trap gun injuries remain below average from February to July with the lowest number in April. The incidence of TG injuries is higher in Northwesterly administrative areas throughout the year, which share a common border with the “Wilpattu” game reserve. Further studies should be carried out to identify behavioral and socio-economical risks and economics of TG injuries.

The provision of mechanical ventilatory support for large numbers of casualties in disasters is a complex, controversial issue. Some experts consider this modality unsuitable for large disasters and a waste of resources better devoted to eminently salvageable victims. However, the reality has usually been that rescue teams bring with them some ventilatory capability, even if only for perioperative support. Also, there are many instances when the environment, the existing and potential capacities, allow for significant numbers of victims to be saved by providing artificial ventilation, that would otherwise have likely died. It is therefore important to discuss the issue, with all its complexity, so that the disaster preparedness and relief community fully understands its implications and makes informed, locally relevant decisions before and after disasters strike. The purpose of this presentation is to describe the ethical dilemmas, the technical and clinical considerations for such an endeavor. Ethical considerations: providing the most care to the most victims is the dictum of disaster medical management. Lowered standards of care are accepted and often the norm. However, in many moderate and even major disasters, the ability exists to save lives that will certainly be lost otherwise, by providing intensive care including mechanical ventilatory support, or may be provided if the managers so determine. Is it then ethical, to allow certain victims to die when such support may be available? What is the cost-benefit ratio of such a decision? Who should receive this limited resource? The young and healthy? The very sick? The salvageable? The postoperative? For how long? Until the international team leaves? Types of ventilator-dependency in disasters: (1) Primary ventilatory failure, normal lungs, prolonged ventilator dependency, e.g. botulinum toxin; (2) Combined ventilatory and hypoxemic failure, short to medium-term ventilator dependency, e.g. Sarin gas intoxication; (3) Primary hypoxemic failure, parenchymal lung injury, prolonged ventilator dependency, e.g. Anthrax, mustard gas, ricin; (4) Perioperative and prophylactic ventilatory support, short term but unpredictable. Ventilator supply versus demand: (1) Insufficient ventilators for first few hours only, then supplies come in; (2) Insufficient ventilators for days, then national or international relief expected; (3) Insufficient ventilators and no expected supplies. Care environment: (1) ICU, minority of casualties; (2) General floors: inexperienced nursing, medical staff; (3) Insufficient monitoring devices; (4) Insufficient numbers and quality of respiratory therapists; (5) Commercial companies normally providing technical support understaffed. Basic requirements from the ventilators: allows spontaneous ventilation, incorporates some alarms (ideally disconnect and minute volume), made by a reputable and stable company (will be there when the disaster strikes), low cost, user friendly, long shelf life, quick activation from storage, low weight and volume, few spares, few or generic disposables, little and simple maintenance, independent of compressed oxygen (i.e. electric, multiple voltages, long-life battery). The system: Mechanical ventilation is a complete patient care unit comprising: Bed and space, Oxygen supply, Vacuum, Cardiorespiratory monitor, Mechanical ventilator, Nursing staff, Medical staff, Expert consultatory staff, Logistic and technical support staff. Potential mechanical ventilators: (1) BVM or bag-valve-tube; (2) Transport-type, pneumatic or electrical ventilators; (3) Intermediate capability pneumatic, electrical or electronic ventilators; (4) Full capability intensive care ventilators; (5) Single patient use ventilators.

With increasing numbers of international flights and air travelers arriving in the US annually, the rapid spread of communicable diseases has grown. Epidemics of novel infectious diseases have emerged and rapidly spread globally in association with air travel, including the severe acute respiratory syndrome (SARS) outbreak in 2003 and H1N1 in 2009. In order to anticipate and mitigate the consequences of future rapid disease spread, the MITRE Corporation, in collaboration with the (US) Centers for Disease Control and Prevention, developed a risk assessment tool using a Susceptible-Exposed-Infectious-Recovered model and detailed flight and population data. The emergence and spread of prototypic pandemic influenza was simulated based on a theoretical geographical point of origin and its communicability. More than 50 international metropolitan areas were analyzed as potential points of origin to simulate the rapidity of spread to the US. The basic reproduction number (Ro), defined as the average number of persons to whom one infected individual transmits disease in an immune naive population, was varied from 1.4 to 1.9. The starting numbers of infectious persons at each origin also were varied (100 or 500 persons, 5% infectious may travel). Waves were computed as aggregate across metropolitan areas modeled in the US. The visualization of the first pandemic wave was most apparent in simulations of Ro = 1.9, resulting from 500 infectious persons at each origin. More than 50% of origins indicated that aggregate waves peaked around Day 125, while 30% of origins peaked around Day 90. Additionally, the time, in days, from its origin in six continents into the US was compared, and a two-week delay was found from South America compared with other continents. This simulation tool better equips policy makers and public health officials to quickly assess risk and leverage resources efficiently via targeted and scalable border mitigation measures during a rapid global outbreak.

Cooperation between veterinary and public health authorities in Bosnia and Herzegovina and their respective field services has historically been weak and inefficient. As is the case in many countries, animal health and public health fall under separate ministries with animal health the responsibility of the ministry of agriculture and public health the ministry of health. This model has promoted interagency competition for funding for disease surveillance and control. It has also resulted in poor information exchange, lack of efficient utilization of diagnostic resources, and poor harmonization of policies. Political decentralization, established in Bosnia after the Dayton peace agreement, resulted in the lack of a national-level responsibility for animal or public health. This was instead placed at mid-governmental levels. A state (national) veterinary office was created in 2000, but there still remains no national public health agency. The H5N1 Avian Influenza (AI) outbreak which began in Southeast Asia in 2003 and reached Europe in 2005 raised concerns about Bosnia and Herzegovina's (BiH) preparedness to combat pandemic disease. Accordingly, the state (national) veterinary service of Bosnia and Herzegovina (BiH) conducted exercises which resulted in increased monitoring of wild and domestic bird populations and the drafting and adoption of a contingency plan (CP) for AI. The activities prescribed by the CP were implemented in February 2006 when the H5N1 virus was diagnosed in wild swans. However, no cooperation was established with public health authorities during this incident, further underscoring the need for a one health approach to disease control activities. Adoption of the One Health concept is challenging, and there is no simple plan that can be applied across all cultures. To prevent it from simply existing as an idealistic theory, some revision is needed and practical guidelines must be developed. The authors will include suggestions as to how this might be achieved.