The war in Kosovo in 1999 resulted in the displacement of up to 1.5 million persons from their homes. On the subsequent return of the refugees and internally displaced persons, one of the major challenges facing the local population and the international community, was the rehabilitation of Kosovo's public health infrastructure, which had sustained enormous damage as a result of the fighting. Of particular importance was the need to develop a system of epidemic prevention and preparedness. But no single agency had the resources or capacity to implement such a program. Therefore, a unique six-point model was developed as a collaboration between the Kosovo Institute of Public Health, the World Health Organization, and an international, nongovernmental organization. Important components of the program included a major Kosovo-wide baseline health survey, the development of a provincewide public health surveillance system, rehabilitation of microbiology laboratories, and the development of a local capacity for epidemic response. While all program objectives were met, important lessons were learned concerning the planning, design, and implementation of such a project. This program represents a model that potentially could be replicated in other post-conflict or development settings.

Since at least WWII, some open, contaminated wounds involving massive soft tissue injury and vascular damage have resulted in “irreversible shock,” despite prompt rescue, hemorrhage control, and blood and fluid replacement, without signs of clinical infection.

In animal studies, survival time was related statistically to the dosage of Clostridium perfringens in multicontaminated explosive wounds. Survival time was lengthened by the application of some topical antibacterial agents, but actual recovery was achieved only with topical mafenide hydrochloride solution aqueous spray, which resulted in negative clostridium. perfringens cultures. Although not related statistically to survival time, the mafenide hydrochloride spray also controlled the Pseudomonas aeruginosa in these wounds.

Mafenide hydrochloride had the American trade name of Sulfamylon from about 1942 until 1998, when another pharmaceutical company patented Sulfamylon as the trade name for mafenide acetate, a weaker antibacterial agent. However, mafenide hydrochloride still is available from chemical companies.

Mafenide hydrochloride solution spray has been used successfully in treatment of patients with severe by contaminated wounds and deep burns, and its use in initial care should be revisited.

This lesson discusses various structures for organizations that have functional roles in disaster responses, relief, and/or management activities. It distinguishes between pyramidal and matrix structures, and notes the advantages and disadvantages of each in relation to disasters. Span of control issues are dissected including the impact of the “P” factor on the performance of disaster managers and workers including its relationship to the coordination and control function. The development of a Table of Organization and how it relates to departmentalization within an organization also is provided.

Change in any organization is difficult. Relief organizations constantly are evolving and changing form to adapt to different needs, demands, and environment. As the phases of a disaster evolve, adjustments must be made by relief organizations to meet the changing needs. The sequential processes used to manage change include recognition and diagnosis of the problem, identification of alternatives, recognition of limiting conditions, selection of a strategy for change, and implementing and monitoring the change. The techniques used to effect change may be classified as structural, management, or technological. Changes can occur in division of labor, content of the work, relationships with other workers, supervisory and/or technical skills, operations, and decision-making hierarchy. Approaches can be mandated from the top, worked out jointly by management and personnel, or implemented by the affected personnel. Implementation of changes has two dimensions: timing and scope. Whenever changes are implemented, the impact of the changes must be monitored and the effects compared with what was expected.

Translation is a vital activity in Complex Emergencies (CEs) in which the responders and the affected populations do not share the same language or culture. This particularly applies to CEs in developing countries in which a lack of local resources usually results in the importation of foreign aid workers. This paper describes many of the common issues surrounding translation that can affect CE response effectiveness, issues that frequently are not appreciated by aid workers, including clinicians. The authors describe how these issues can arise, their effects, and outline approaches to addressing them.

The growth of the humanitarian aid industry has led to the proliferation of relief programs and the rapid rise in the number of relief personnel working in the field. One major necessity in developing successful international programs is appropriately trained field personnel. The purpose of this study was to evaluate the educational practice and training methods for field workers by non-government organizations (NGO).

Of the 53 organizations surveyed, 64% responded that they sent health care workers to acute human emergencies. A majority of organizations, 31/53 (59%), used manuals as the primary method of training for workers before going into the field. Eighty-five percent of organizations (45/53) supplied their workers with trip briefings from prior personnel before going into the field, and 91% (48/53) had an on-site coordinator. Only 34% (18/53) provided classroom teaching or orientation prior to departure. The average number of months spent by workers abroad was ≤1 for nearly half (49%) of the NGOs. Only 34% (18/53) of the NGOs required that personnel had previous international experience.

Training of humanitarian workers varies significantly between nongovernmental organizations. Lack of standardization in training programs and wide variation of provider preparedness indicates the need by NGOs for enhanced training for field personnel.

The United Nations Mission in Kosovo (UNMIK) designated that the World Health Organization (WHO) develop health policy to assist in the recovery and rehabilitation of the post-war health system of Kosovo. As a critical part of the pre-policy evaluation, an assessment of current prehospital medical services was performed. This assessment identified a basic healthcare infrastructure upon which additional prehospital capabilities can be built, especially in communications, staffing, equipment, and transport services. To serve Kosovo properly in the future, it is recommended that capacity building must include the parallel development of emergency departments and specialty-trained physicians.