The issues surrounding “life” continue to increase in number and complexity. Those of us in the health professions believe that once a life is established, we must do all that is possible to preserve it. For most of us, this is an absolute, regardless of circumstances and setting.

But, it is essential that we recognize that this value that we place on all life is not held universally. Members of some societies believe that the after-life is of greater value than is life in this earthly realm. For some, the “ultimate sacrifice” is relinquishing one's own life for a higher cause.

All of us hope that our life will make a difference. But, how and what we wish to accomplish is highly individual. Our goals may be personal, global, or a combination of both. If any portion of the “difference” you wish to accomplish is in the realm of humanitarianism, you are in the right place.

The 13th World Congress on Disaster and Emergency Medicine, convened in Melbourne, Australia in May 2003, requested the World Association for Disaster and Emergency Medicine (WADEM) to lead the development of “International Standards and Guidelines on Education and Training for “Disaster Medicine”. This Paper has been developed by a Working Group of the WADEM Education Committee (“the Working Group”) in response to that request from the international “Disaster Medicine” and emergency health community. The main focus of the Working Group is to develop standards and guidelines for education and training in the multi-disciplinary health response to major events that threaten the health status of a community. The contemporary view is that of a multi-disciplinary health response to major events which threaten the health status of a community, including the prevention and mitigation of future events, and taking account of the broader context in which these events occur.

It is the vision of the Working Group that evidence-based standards and guidelines for education and training must be developed in a broad sense, for all members of the healthcare community. Rather than purely describing isolated performance indicators, the Working Group agreed that priority be given to explaining the general approach, presenting the conceptual framework, clarifying important principles, and describing the educational needs and training requirements for situations for which there exist a major threat to the health status of a community.

It is not the intent to produce an updated educational curriculum for special courses in “Disaster Medicine” by listing levels of theoretical knowledge and clinical skills required for medical doctors, nurses, and paramedics. Nor, does the Working Group think it is useful to repeat requirements and learning outcomes that are part of the normal basic education and training for the various health professionals.

The purpose of this Issues Paper is to present an initial summary of current issues relating to an international perspective of “Disaster Medicine” education and training. This summary has been prepared following discussions within the Working Group of the WADEM Education Committee. The paper aims to stimulate debate and form the basis of further of discussion at an international meeting scheduled to be held in Brussels (Belgium) on 29–31 October 2004.

The Working Group has structured this Issues Paper into five parts and has identified several key issues for discussion.

Part 1: Understanding the contemporary interpretation of the multi-disciplinary health response to major events that threaten the health status of a community

Issue 1: Definitions and terminology in “Disaster Medicine”;

Issue 2: Getting to grips with the contemporary concepts and international trends in “Disaster Medicine”; and,

Issue 3: Valuing personal attributes in “Disaster Medicine” practitioners.

Part 2: Developing an underlying scientific framework for linking theory to practice in “Disaster Medicine”

Issue 4: Creating a scientific framework(s) for “Disaster Medicine”.

Part 3: Defining a conceptual framework and general principals to develop “International Standards and Guidelines on Education and Training for the Multi-disciplinary Health Response to Major Events that Threaten the Health Status of a Community”

Issue 5: Where are we now? Getting to grips with the contemporary concepts and international trends in “Disaster Medicine” education and training.

Issue 6: Where do we want to get to? Identifying contemporary, evidence-based education and training standards and guidelines for “Disaster Medicine” education and training programs.

Issue 7: How do we get there? Overcoming barriers to introducing the International Standards and Guidelines.

Part 4: Maintaining the momentum—improving international collaboration

Issue 8: Exploring the feasibility of an ongoing, international, collaborative network of “Centres of Excellence” in “Disaster Medicine” research and/or education.

Part 5: Additional input

Issue 9: What other issues would you like to bring to the attention of the Working Group?

A number of organized and universally publicized, large-scale events take place each year in many parts of the world that involve a population at greater risk. Large gatherings provide a theater of operations for public health and more thought now is being given to these issues. The Olympic Games is the largest, single event that is concentrated into one significant geographical space that unfolds over a period of weeks and involves a transient population. From Atlanta to Sydney, a growing awareness of public health issues has occurred, and there is a clear recognition that much more preparation is necessary for all future events. Therefore, it is mandatory that we recognize that the Olympic Games, Athens 2004 is a potential venue for accidents as well as for purposefully precipitated acts leading to suffering, disability, and death. The organization and management of public health is a major hurdle for Athens 2004. At a minimum, hospital and emergency medical services must be in an optimal state of readiness, a network of public health laboratory services must be deployed, and human resources must be retooled.

Introduction:No epidemiological data exist concerning the influence of an earthquake on the risk of stroke. Whether the incidence of cerebrovascular stroke increased after the 1995 Hanshin-Awaji earthquake (EQ) in Japan and whether seismic intensity affected stroke risk dose-dependently was examined.

Methods:A retrospective cohort study was conducted among residents, who were living in two towns on the island of Awaji and were participants of the National Health Insurance (NHI) program. The two towns were divided into 11 districts and their respective damage and socioeconomic states were investigated. Reviewing the NHI documents issued before and after the EQ, people who had strokes (9th International Classification of Diseases, codes 430–431 or 433–434.9) were identified. Risk of stroke in relation to the seismic intensities, was assessed with the Cox proportional hazard model.

Results:Among subjects aged 40 to 99 years, 45 of 8,758 (0.514%) had a stroke the year before the EQ, 72 of 8,893 (0.810%) had a stroke in the first year following the EQ, and 49 of 8,710 (0.566%) had a stroke in the second year following the EQ. In districts where the earthquake's intensity was ≤9.5 on the modified Mercalli intensity (MMI), compared with the year prior to the EQ, the relative risk (RR) of stroke was 2.4 (95% confidence interval (CI) 1.1, 5.0) in the first year following the EQ, after adjusting for age, gender, and income. In that year, compared with MMI of <8.5–9.0, RRs for 9.0–9.5 and ≥9.5 were 1.6 (CI 0.9, 2.1) and 2.0 (CI 1.1, 3.7), respectively (p for trend 0.02). No trend for the RR was observed in the year before the EQ or in the second year following the EQ.

Conclusion Stroke increased in the first year following the EQ. The increase was associated with seismic intensity in a dose-response manner. Results suggest a potential threshold for RR of >2.0 in areas near 9.5 on the MMI scale.

Numerous examples exist of the benefits of the timely access to information in emergencies and disasters. Information technology (IT) is playing an increasingly important role in information-sharing during emergencies and disasters.

The effective use of IT in out-of-hospital (OOH) disaster response is accompanied by numerous challenges at the human, applications, communication, and security levels.Most reports of IT applications to emergencies or disasters to date, concern applications that are hospital-based or occur during non-response phases of events (i.e., mitigation, planning and preparedness, or recovery phases). Few reports address the application of IT to OOH disaster response.

Wireless peer networks that involve ad hoc wireless routing networks and peer-to-peer application architectures offer a promising solution to the many challenges of information-sharing in OOH disaster response. These networks offer several services that are likely to improve information-sharing in OOH emergency response, including needs and capacity assessment databases, victim tracking, event logging, information retrieval, and overall incident management system support.