There is a huge need for access to information in the areas of disaster relief disaster medicine, and humanitarian assistance. The extraordinarily rapid increase in the literature in these subject areas attests to this need. However, use of the printed word has substantial limitations that are even more profound in the developing world.

Currently, the information available tends to be fragmented and sequestered by the specific interests of the organizations and governments involved. The evolving electronic methods for the storage, organization, and retrieval of information makes coordination between organizations concerned with disasters within our grasp.

This paper discusses the Center of Excellence in Disaster Management and Humanitarian Assistance and describes the World Wide Web and the implications it has in disaster management and medicine. It describes methods for obtaining user input to the techniques used for the development of the world wide web for the areas of disaster management and disaster medicine. The implementation of an on-line Internet reference desk that will provide: 1) a list of “experts;” 2) a searchable disaster database; and 3) on-line simulation courses and training exercises also is discussed.

Medical emergencies occur in every country regardless of its level of socio-economic development. Little comparative data are available which define the characteristics of the system by which some emergencies are managed. Without such comparisons, it is difficult for countries to establish appropriate priorities within their geographic, cultural, and economic constraints. In an effort to gather some of these needed data, a survey was distributed to the participants in an International Conference on Emergency Health Care (EHC) Development convened in Washington, D. C, in August 1989. Each country participating was classified as Industrialized (INDUS), Developing (DC), or Least Developed (LDC) in accordance with World Health Organization definitions. Responses are expressed as proportion of total participants.

There were 450 participants from 74 countries. Only 17% of the surveys were returned. The sample included 78 participants from 40 (57%) countries. (INDUS: 30%; DC: 48%; LDC: 22%). All showed considerable dependence on ambulance services, but DC and LDC indicated substantial reliance on friends, neighbors, community health workers, and physician's offices. Prehospital EHC services were available to 93% of INDUS, 63% of DC, and possibly one-third of the LDC. Emergency Health Care is taken to the patients in the same proportions as noted above. The types of manpower dispatched varied widely with a great proportion of the respondents from DC and LDC indicating that care was delivered by non-professionally trained individuals. Interestingly, INDUS had the greatest proportion of volunteers. Response and transport times were shorter for INDUS than for DC. When no prehospital EHC services were available, patients reached the receiving facilities by alternate means such as walking (33%), private automobile (48%), or public transportation (33%). Central emergency access was available for 80%. Considerable variation exists as to the mechanisms by which such services are financed: poorer countries depend more on government support than do INDUS who rely heavily on donations and fee-for-service. Lastly, regardless of level of economic development, cardiovascular disease, trauma, and medical illness comprise the most important reasons for accessing the EHC systems.

This preliminary study points to the need for individualizing EHC systems in concert with the priorities of the country for which they are designed. Direct application of operational systems across countries does not seem an appropriate mechanism for the development of EHC. However, the delivery of EHC must be made an important element of overall health care in all the countries of the world.

While formal efforts have been made during the past quarter century in the United States to develop and coordinate emergency medical services (EMS) as a “system” of care, it was not until the past decade that we began to recognize and acknowledge the impact of stress on the lives of EMS and other public safety personnel, in both normal day-to-day response to emergencies as well as response to mass casualty incidents or disasters. The first significant writing on this complex issue, Emergency Response to Crisis, by Jeffrey T. Mitchell, PhD and H. L. P. Resnik, MD, provided a crisis intervention guidebook for emergency service personnel and early insight on crisis-worker stress and burnout. The most recent comprehensive discussion of this important area of concern can be found in Emergency Services Stress, by Mitchell and Grady Bray, PhD.

We believe the National Disaster Medical System is of benefit to each participant, to his community, and to the nation. The National Disaster Medical System will enhance local, State, and national ability to respond to emergencies. The system is now under development with the support of the health care professions and institutions of the country.

The efficiency of EMS, especially resuscitation of the severely wounded, depends upon speed and skills. This requires well-organized military-civilian collaboration, as shown during recent earthquakes in Ashkhabad and Tashkent. Reasons include the great mobility of military medical units, including field hospitals; communication facilities; specialized means of transportation; readiness of equipment and supplies; as well as skillled military medical personnel.

The Swiss Civil Defense system forms part of the national defense, has no combat tasks, and aims at the protection, rescue of, and care for the entire population of Switzerland. Horizontal evacuation is considered impractical and unrealistic. Vertical evacuation into special shelters in homes, public buildings, factories, etc., is the focus of CD. planning efforts. Shelters have increased air pressure, are artificially ventilated, are equipped with gas filters and are strong enough to give a relative protection against outside pressure, irradiation, chemical contamination and missile fragments of conventional weapons. The Swiss CD. system is to ameliorate the direct or indirect effects on the population of conventional, chemical, or nuclear war.

On 28 March 1982, El Chichon, a volcanic peak located in southern Mexico, began an eruptive phase of activity. Four major eruptions occurred within the next eight days, culminating in a cataclysmic eruption on 4 April. When the dust had settled, an estimated 200 million tons of ash blanketed more than 200 square kilometers of southern Mexico and neighboring Central American countries. Forty thousand villagers were left homeless and several thousand people may have lost their lives. Fifty thousand head of cattle were destroyed outright with many more succumbing to lack of water and pasture. Millions of hectares of crops were destroyed (Figure 1).