Basic emergency care at primary, secondary and tertiary health care level in India is in its infancy. Lack of training in emergency care is an important factor. We designed AIIMS basic emergency care course (AIIMS BECC) to address the issue.

To improve the knowledge, skill and attitude of healthcare workers and laypersons in basic emergency care and to identify and train instructors.

Prospective study conducted over a period of one and half years. The target groups were medical, police, fire fighter, paramilitary forces, teachers, school children of India. Provider AIIMS BECC is of one day duration. The contents of the course are cardio-pulmonary resuscitation, chocking and special scenarios like trauma, electrocution, drowning, hypothermia, pregnancy, etc. Course was disseminated via lectures, audio-visual and hands on training. The participants were evaluated by pre and post test questions. Subjects had to score 80% to be successful and those who scored more than 90% were eligible for instructor course. The confidence levels at baseline and at the end of the course were evaluated in policecourses were evaluated on course clarity, course delivery and trainers quality on a likert scale (1 = worst, 5 = excellent).

1614 subjects were trained. 99.81% became providers and 2.6% were trained as instructors. 83.1% were non-medical and16.9% were medical personals. 76.14% were police, paramilitary 0.8%, teachers 1.6%, students 2.1% and mixed groups were 2.6%. The average and modal increase in confidence level among police were 66.14% and 62.49%. Likert scale of ≥ 4 was observed in 90.7% in course clarity, 91.28% in course delivery and 95.26% in trainer quality.

Knowledge, skill and attitude of healthcare care and laypersons in providing basic emergency care improved by community emergency care initiative. Instructors were identified for further dissemination of the course. The confidence levels increased among police.

To receive trauma victims from site of incidence to the emergency department without mauling with adjuvant by first aid managers.

Poor dressing techniques practiced for first aid in industrial, domestic, traffic, calamity, etc. inflicted wounds. Dressing with copious amounts of cotton on traumatized parts that are open or exposed. Wrong wrapping, storage, transport of amputated parts for attempt of salvage / reimplantation.

Assessment of increased rate in sepsis and rise in rate of risk of complications or loss of traumatized body part or even life in cases of trauma in which primary / incident manager with poor awareness / skills, shortage of first aid material.

Need of training of general public on skills of first aid. Maintaining First Aid Kits for Emergencies as per stipulation and need based.

Improved results in management of trauma that were properly attended to from time of incidence to casualty.

Improved ratio of post traumatic sequel like sepsis, delayed amputations, revisions, graft rejections, co morbidities, expenditure, etc.

Involvement of local municipalities in promoting emergency preparedness has been recognized as a key factor to build a resilient community. As part of the efforts to build and maintain knowledge and capabilities, the Israeli Ministry of Health initiated a series of conferences aimed at capacity building of city councils to provide services to the population following disasters.

6 conferences have been planned for the years 2010-2011 in which 250 senior administrative employees from all municipalities, responsible for the health status in their communities are expected to participate. Each conference covers a variety of emergency scenarios, including biological events, regional hostilities and management of massive Acute Stress Reactions among the civilian population. Pre-post tests based on Multiple Choice Questions are conducted before and following each conference to identify impact of the training program.

Findings from the pre-post tests conducted up to date showed a significant increase in all elements included in the training program. The average knowledge scores of the pre-post tests were 33% and 79% respectively. The highest increases in level of knowledge were found in regard to deployment of community centers for light casualties in chemical warfare scenarios (48% and 100% respectively) and concerning population that requires evacuation during emergencies (68% to 100% respectively). Overall levels of knowledge regarding community treatment centers in biological events were relatively low both before and after the training (16% and 44% respectively).

Training local municipalities' personnel is crucial in order to promote emergency preparedness. Raising knowledge regarding response to newly emerging threats (such as deployment of exposure centers in biological events) was found to be more complex in comparison to well-recognized hazards (such as deployment of community treatment centers in chemical warfare). There is a need to conduct follow-up studies to determine the retention of knowledge over time.

Unusual biological events (UBEs) pose a distinct challenge for emergency preparedness. Not only are these events rare and difficult to detect, but they also pose clear hazards for both medical personnel and their families. Distinct skills include identifying UBEs and activating institutional and national response. Staff attendance and confidence in the health system play a vital role in effective management of UBEs. The Israeli Ministry of health conducts yearly drills on the personal, institutional, and national response to UBEs.

The aim of this study was to evaluate the effect of various educational tools and personnel characteristics on personnel skills, views, and compliance to participate in the management of UBEs.

As part of the preparations for an institutional drill in the Tel Aviv Medical Center, several educational methods were employed. These included e-mail notifications, computer-based self learning, publication of an institutional protocol, tabletop drills, personal briefings, and finally, a large scale exercise. Questionnaires regarding personnel characteristics, participation in pre-drill education, personal views, compliance, and familiarity of institutional protocols and selected diseases were distributed.

Age, family status, and years of experience had no significant influence on personal views. Confidence in the health system increased with experience. Intensity of training had significant positive effect on personal confidence and compliance to attend work during a UBE, however it did not appear to significantly influence personal views or medical knowledge.

Comprehensive education and exercise of personnel is beneficial effect in terms of personal confidence and work attendance during UBEs. Specific educational tools, such as self-learning software, increase proficiency.

Disaster risk reduction (DRR) has emerged as a core element of sustainable development. (UN/ISDR 2002). Reducing risk requires long-term engagement (O'Brien 2006), and the actual work of DRR is largely a task for local communities. (Schipper 2006). DRR shares some tenets with preventive medicine (Sidel 1992). As in preventive medicine, risk reduction calls for a basic attitude shift in the minds of many who traditionally get sick first and seek treatment later. The challenge for DRR, as applied to health, is to broaden the focus of disaster management from that of tertiary prevention, (response and recovery) to also emphasize primary and secondary prevention, (prevention, preparedness and mitigation).

The role of the health sector spans across the spectrum of DRR to include prevention, mitigation and preparedness activities. DRR, as applied to health, is intended to prevent and/or reduce the negative health consequences of disaster hazards. This is accomplished by two means: hazard avoidance and vulnerability reduction. Health and medical volunteers at the community level can play an important role in reducing human vulnerability to disasters by: (1) reducing susceptibility – “healthy people” (2) reducing exposure to disaster hazards – “healthy homes; (Srinivasan et al. 2003); and (3) increasing resilience – “healthy communities”. Volunteers help to reduce exposures to disaster hazards through participation in population protection measures such as shelter-in-place, evacuation and mass care. They work to reduce susceptibility by participating in health care, health promotion, and immunization programs. Finally, volunteers may build resilience by way of their participation in community-level preparedness, response and recovery efforts. (Keim 2008)

Nurses are leaders and primary health responder/providers in natural, anthropic and technological disasters. Preparation and education for nursing emergency and disaster response should begin before nursing program graduation and before disaster events occur. In Louisiana, 17 federally-declared disaster declarations were experienced from 2000 – 2009, ranging from the Space Shuttle “Columbia” to Hurricane “Katrina”. This presentation overviews Louisiana nursing programs' disaster preparedness and operational planning as demonstrated to Louisiana's Schools of Nursing Aligned for Emergency Responsiveness (SAFER) Conference, New Orleans, 2010. Co-sponsored by Dillard University, Division of Nursing, New Orleans, and Northwestern State University, College of Nursing, Shreveport, the invitational conference brought expert nurse and physician preparedness speakers from federal, state and local venues to review disaster planning, experiences, needs, and nurse preparedness competencies with nurse faculty leadership.

A multiple choice survey was developed, trialed and emailed to 42 Louisiana Nursing Programs. Programs surveyed included Associate degree, Bachelors and Graduate-level providers for Registered Nurses as well as Vocational Technical programs for the Licensed Practical Nurse. National Planning Scenario threat priorities; impacts of federally declared disasters on Louisiana nursing programs; nursing program roles in disaster; and awareness of nurse emergency preparedness competencies were queried.

34 of 42 surveys were returned. 20 were complete. Nursing programs were located state-wide and found in 7 of 9 Louisiana regions. Surveyed programs offered a Bachelors degree (45%); Graduate degree (35%); Associate degree (35%) and vocational or Licensed Practical Nursing (35%).

The majority of Louisiana nursing programs and their health communities have been impacted by federally declared disasters. Coordinated efforts to improve nursing program preparedness education, roles and responsibility are warranted as vulnerability increases.

This presentation summarizes our ongoing hybrid sociological-geological research into China's earthquake disaster management systems. Our methodology is a grounded research approach, based firstly on field observations related to the Wenchuan earthquake, including interviews with survivors and professionals responsible for disaster management; secondly on an extensive review of the English-language disaster management literature. China's earth scientists, frequently in collaboration with international scientists, have created a substantial English-language literature, but the social literature on disasters in China is scant. China's geographic variation is complex, with significant fault lines criss-crossing the nation.

Approximately half of the population lives in areas with a high risk of earthquakes. The two most-devastating of these since 1949 were the 1976 point-source Tangshan earthquake with mortality of 242,419, and the 2008 huge-area Wenchuan earthquake with mortality of 69,226. Our research has found that China's earthquake disaster management systems at the local, provincial, and national levels respond rapidly to earthquakes. National mobilization for rescue-relief after the Tangshan earthquake began within six hours, and within two hours for the Wenchuan earthquake. These systems are also characterized by reconstruction planning that functions in parallel to, and melds into, the relief effort streams. China's major infrastructure projects, such as hydro-electric power dams, are designed to resist extreme earthquake; however, rural mountain populations and the historic built-environment have low earthquake resistance, conditions which will endure for a long time.

As a result of the Wenchuan earthquake, China has undertaken ambitious three-dimensional monitoring and response programs. We recommend studies and action to reconnoiter, investigate, and prevent population exposure to geo-hazards, particularly in the Qinghai-Tibet Plateau. In summary, China excels at disaster response but has not yet entered a development era of preventing the population's exposure to earthquake hazards.

To be effective, disaster preparedness training should continually meet the needs of the trainees. Most military medical personnel undergo training focused on practicing in austere environments with little support. However, while located at their home station, disaster response is conducted in a different manner due to staffing and available resources. This survey attempts to identify areas of the military medical disaster response staff are most concerned with in order to better formulate future training for home station as well as contingency operations, ultimately increasing confidence and effectiveness.

An online survey service was utilized to anonymously poll 106 military medical personnel assigned to a joint Level 1 trauma center in Iraq using 38 forced Likert-scale questions. The training issue of most concern for both arenas is the patient surge. Military-civilian collaboration was a key point regarding the home station setting and supplies/equipment for the deployed setting.

Eighty-nine percent of responders rated disaster training as moderate to very important. However, there was a low perception of disaster exercises conducted in the manner of a real-world event. This was attributed to unrealistic participation and training methods. Computer-based training (CBT) was identified as an ineffective method of training; hands-on instruction clearly identified as the preferred method. Participants rated considerable confidence in Level C personal protective equipment, and the majority surveyed would report for duty despite exposure risk.

Current training methods may not optimally produce disaster response effectiveness. Management of the patient surge was a repeating training concern for both home and deployed settings. Future training efforts should focus on military-civilian collaboration for the home station, and management of the patient surge for both arenas.

During the past 12 years we have been developing our military medical unit through collaboration between the public health system and military system. We found that one system could not work separate without another. Experts from public health system are incorporated into the military structure which provides efficient technical support and logistics. Through such a system we can cooperate in international projects.

The objective of this study was to compare injuries and hospital utilization and outcomes from terror and war for civilians and soldiers.

Injuries from terrorism and war are not necessarily comparable, especially among civilians and soldiers. For example, civilians have less direct exposure to conflict and are unprepared for injury, whereas soldiers are psychologically and physically prepared for combat on battlefields that often are far from trauma centers. Evidence-based studies distinguishing and characterizing differences in injuries according to conflict type and population group are lacking.

A retrospective study was performed using hospitalization data from the Israel National Trauma Registry (10/2000–12/2006).

Terrorism and war accounted for trauma hospitalizations among 1,784 civilians and 802 soldiers. Most civilians (93%) were injured in terrorism and transferred to trauma centers by land, whereas soldiers were transferred by land and air. Critical injuries and injuries to multiple body regions were more likely due to terrorism than war. Soldiers tended to present with less severe injuries from war than from terrorism. Rates of first admission to orthopedic surgery were greater for all casualties with the exception of civilians injured in terrorism who were equally likely to be admitted to the intensive care unit. In-hospital mortality was higher among terrorism (7%) than war (2%) casualties, and particularly among civilians.

This study provides evidence that substantial differences exist in injury characteristics and hospital resources required to treat civilians and soldiers injured in terrorism and war.