This presentation summarizes our ongoing hybrid sociological-geological field research into the May 12, 2008 Wenchuan earthquake. In this extreme geo-disaster, mortality was 69,226, with 274,643 injuries, and 17,923 missing. The human toll was accompanied by significant destruction of the natural environment and the economy, estimated at US$ 176 billion. A 300 km long surface rupture occurred in the Longmen Mountains along its margin with the Sichuan Basin.

This disaster was caused by the relationships among (1) towns built in on or in proximity to fault lines, (2) the low earthquake-resistance of residences, schools and hospitals, and other buildings, and (3) the concentration of population distributed along rivers lying below steep-sloped mountains. Mortality and devastation were compounded by post-earthquake landslides. The Chinese central government started a national-level response within 2 hours, upgrading it to the highest national emergency level within 10 hours. Most lives were saved by local people. Military rescue units were activated within minutes of the earthquake, and regional militia, local and provincial units such as the Sichuan Seismological Bureau self-activated immediately. By day-two, 20,000 rescue and engineering soldiers had been deployed. Over 15 large medical treatment, epidemic prevention, and psychological intervention teams responded and more than 10 million volunteers took part in relief activities. In spite of mobilization of the nation's resources, emergency relief was frustrated by formidable obstacles such as cloud cover, a destroyed ground transportation network, loss of communication, and continued geo-hazards in the form of landslide-dammed rivers which threatened large downstream urban centers. Expert national planning for recovery began five days post-earthquake; the plan was promulgated by national law in September, 2008. By the second anniversary of the Wenchuan earthquake, most school and residential construction was completed in earthquake-resistant areas.

The earthquake that struck Chile on February 27th, 2010 produced profound damage of hospital services with 4249 bed lost especially in the regions of Maule and Bio. The capacity of the health was critically reduced in ability to assure health access to affected people by the disaster.

The first strategy to maintain health services was the deployment of 18 field hospitals from Chilean organizations (Army and Air Force), international organizations and foreign governments. This measure allowed for 533 beds and 16 surgical blocks in the first weeks. There were 14 field hospitals until November. Taking into account the beginning of the winter season, the national government set up another sort of strategy to increase the capacity of the health care facilities: § Strengthening of hospitals without damage that were close to the disaster area. These hospitals were used as referral centers. § Purchasing of 708 beds from the private health sector. § Habilitation of free spaces to be used for inpatients. § Increasing the capacity of home care health programs to release beds. § Construction of some small temporary units to admit patients. § Small-scale interventions to repair damages in hospitals. § Extending the work time until 16 hours in the primary health care facilities. § Improving of the efficient of the using of human and physical resources. § Restructuration of the hospital network that allowed adding 300 new beds.

The ministry of health recovered more than 94% of loss beds and 92% of surgical blocks through July. However, it is necessary to identify US$ 2720 million for reconstruction program and to establish a national strategy of safe hospitals in order to reduce the future costs of the recovery of damaged health care facilities. *Based on information from PAHO – Chile.

On February 27, 2010, a 8,8 MW earthquake struck the central and southern coast of Chile, that was followed by a tsunami that destroyed some cities such as Constitution, Ilaco, Talcahuando and Dichato. The national authorities reported 512 dead and 81,444 homes were affected. It was the one of the five most powerful earthquakes in the human modern history. The most affected regions were Maule (VII) and Bio (VIII).

The impact of the quake in the health sector was enormous especially on the health care infrastructure. The preliminary evaluations showed that 18 hospitals were out of service due severe structural and no-structural damages, interruption of the provision of water or because they were at risk to landslides. Another 31 hospitals had moderate damage. The Ministry of Health lost 4249 beds including 297 (7%) in critical care units. Twenty-two percent of the total number of beds and thirty-nine surgical facilities available in the affected regions were lost in a few minutes due to quake. At least eight hospitals should be reconstructed and other hospitals will need complex repair.

The effect of the earthquake was significant on hospital services. It included damages to the infrastructure and the loss of furniture and biomedical equipment. The interruption of the cold chain caused loss of vaccines. National and foreign field hospitals, temporary facilities and the strengthening of the primary health care facilities had been important to assure the continuation of health care services. *Based on information from PAHO – Chile.

Search and rescue plays a major role in today's society. Whether lost at sea, stranded in a remote area, or trapped in a confined space, countless rescuers and volunteers will attempt to find you and get you to safety.

Rescue teams consist of highly trained professionals including firefighters, EMT's, paramedics and other local volunteers who are willing to risk their lives to help others. Special teams and robotics were sent into ground zero after 9/11, locating and providing immediate extrication to those who were injured. The U.S Coast Guard's search and rescue efforts during Katrina were crucial saving countless lives in New Orleans.

In the United States, animal search and rescue (ASAR) is becoming a recognized component of Search and Rescue (SAR).

Urban Search and Rescue (USAR) teams have long recognized the importance of having trained animal rescuers available to handle the animals that are often with humans seeking rescue. Animals are such an important part of most U.S. families, that in many cases, if the animal isn't included in the rescue efforts, the human will refuse to evacuate. The International Fund for Animal Welfare received a grant in 2010 to develop an ASAR curriculum and to train two Type II ASAR teams in Mississippi and Louisiana. This presentation will provide an overview of that curriculum and the courses that were developed for the unique tasks, skills, and equipment needs for animal search and rescue.

Following the Buizingen train-crash disaster on February 15, 2010, nineteen dead bodies were evacuated to the morgue of the Military Hospital. According to the hospital's emergency incident management system, the reception plan for the deceased was activated and an EM organized. Aim: To determine the psychological impact of exposure to current death and to evaluate the effect of proactive outreach in DRW deployed in an EM.

For five consecutive days 62 hospital staff personnel were involved in the daily activities of an EM: disaster victim identification, autopsies, care for the dead, logistic support and reception and mental relief of the families. Besides a critical incident debriefing on day 5, a postal questionnaire survey of these 62 DRW was conducted, including the Davidson Trauma Scale (DTS) – detecting acute post-traumatic stress reactions/symptoms (ASR/S) – and the Symptom Checklist SCL 90 self-report inventory – measuring primary symptoms and global distress – administered 2, 4 and 7 months following the train-crash. Out of these, 35 (56%) initially responded (informed consent), followed by a return rate of 80% (28/35) and 68% (19/28) respectively. Six out of the 35 participants were identified suffering from acute psychological distress according to DTS and SCL 90 and subsequently followed up in the hospital's dedicated Military Centre for Crisis Psychology. In five of them, normalization of symptoms had occurred by the second inquiry and persisted. Ten months post-event, only 1 patient still needs psychological counseling, whereas 34 demonstrated psychological resilience.

Prevalence of chronification is low (1/35) compared to literature (5 to 10%). Timely detection of acute distress and proactive outreach may effectively counterbalance chronification in tertiary victims following a critical incident. Education and training should help hospital staff deal with ASR/S and improve coping. Hospitals should support professionals in the most disturbing situations.

The first decade of the 2000s has advanced the field of mental health and psychosocial support (MHPSS) in disasters by providing expert consensus guidance. Nevertheless, MHPSS response to major disasters is frequently uncoordinated and rarely based on scientific evidence. Moreover, MHPSS response is not customized to the unique constellation of stressors and psychological risk factors that distinguish each disaster event. To address this lack of science and specificity, we have developed trauma signature (TSIG) analysis.

TSIG analysis consists of the following steps. Risk factors for disaster-related psychological distress and psychopathology (e.g., PTSD, depression) are continuously documented, updated, and refined. When disaster strikes, situation reports (sitreps) are issued in the early aftermath. We examine initial sitreps to determine the presence and intensity of evidence-based risk factors, subsumed under the headings of exposure to hazards, loss, and change. We estimate the size of the affected population. We rapidly create an initial TSIG and translate findings into actionable guidance regarding probable MHPSS needs for services and personnel.

We have constructed TSIGs for prominent 2010 disasters: Haiti earthquake, Deepwater Horizon oil spill, and Pakistan monsoonal flooding. Psychological risk factor profiles contrast sharply across these three salient events. Regarding exposure to hazards, numbers of persons experiencing physical injury and perceiving threat to life are highly divergent. Losses differ dramatically when quantified in terms of deaths, numbers bereaved, homes and livelihoods lost, and economic toll. The degree of lifestyle and societal change, including displacement, lack of survival needs, lack of security, and interpersonal violence, also differentiates the psychological impact of these disparate events.

TSIG analysis can be used to provide rapid post-impact/pre-deployment MHPSS response guidance based on risk factor assessment. Using TSIG analysis, MHPSS response can be tailored and timed to the defining features of the disaster event.

A multidisciplinary approach with Geographical information systems, Public health and Social science inputs was adopted to survey the fatal and non-fatal traffic crash events in the New Mumbai municipality region in Western India to identify the risky zones on the arterial highways.

A Standardized questionnaire was used to collect event data about the time, date, day of the week, location, type of injury, and vehicle type involved in the accidents, from the police station records. The data for the time period of January 2009 to July 2010 was merged into ESRI's ArcGIS software as attribute data. All the crash sites were georeferenced into the base map (with the major road networks of the region) by using a GPS receiver.

Analysis was done for Hot spot identification along the major highways, number of accidents, number of fatalities and injured, case-fatality ratio and number of accidents with only financial loss. Further, the role of environmental, geographical, sociological and constructional factors was highlighted on the locations of the RTC. These roadway factors, weather, population density, road conditions, profile of the injured and healthcare access was studied. Majority of RTCs occurred during normal weather and road conditions, during daylight and on dry roads. All the analyses and interpretations were done within the ArcGIS software environment and classifying RTCs according to the attributes on the Geodatabase gave significant results.

Spatial analysis using GIS for Road Traffic Accidents to identify hot spots to identify high risk zones in the region enables policy makers to design injury prevention strategies for RTCs. In India, further GIS-based research is needed for planning access to emergency health care, to determine environmental-related causes, developing Injury registries and design population-based educational interventions in a developing country setting.

Non-vehicular trauma (NVT) accounts for 8% of all calls to the GVK Emergency Management and Research Institute (EMRI), which provides prehospital emergency care to 85 million residents of Andhra Pradesh, India. This study describes the characteristics and outcomes of patients with NVT transported by GVK EMRI.

All patients with NVT were prospectively enrolled over 28 12-hour periods (equally distributed over each hour of the day and day of the week) during July/August 2010. Patients not found at the scene, refusing service, or reporting self-inflicted injuries were excluded. Real-time demographic and clinical data were collected from prehospital care providers using a standardized questionnaire. Follow-up patient information was collected at 48-hours and 30-days following injury.

A total of 1,569 patients were enrolled. Follow-up rates were 72% at 48 hours and 71% at 30 days. The mean patient age was 40 (SD = 18) and 67% were male. Adults (ages 18–64) accounted for most patients (80%), followed by elderly (age > 64, 12%) and children (age < 18, 8%). Of the patients, 71% were from rural/tribal areas and 89% from lower socioeconomic strata. Eighty-two percent called within 1 hour of injury. Median call-to-scene time was 19 minutes (SD = 15) and scene-to-hospital time was 25 minutes (SD = 21). Most patients suffered blunt injuries (85%) with falls accounting for 43% of all injuries. Of the injuries, 56% were accidents and 43% assaults. Most injuries involved head/neck (48%) and extremities (44%). Cumulative mortality rates prior to hospital arrival, at 48-hours and at 30-days were 1.1%, 3.2%, and 4.9% respectively. Falls accounted for 69% of all deaths. Falls and age > 65 were predictors of mortality (p < 0.0001). Of NVT survivors, 56% returned to baseline function and 28% were in significant pain or bed bound at 30-days post-injury.

This initial study of prehospital NVT patients in India reveals that falls and elderly age were highly associated with death.

3880 fracture patients are admitted in the Emergency Department of Saiful Anwar General Hospital from January to August 2009. It signifies to the second place of the cause of patients' admission. Most cases are motorcyclist victims from road traffic accident. Driving license is encouraged by the government to reduce the number of road traffic accident victims.

This study utilizes observational with cross sectional study and purposive sampling to correlate the relationship between status of motorcycle driving license ownership and the obedience of traffic law, the relationship between the patterns of motorcycle driving license ownership and the obedience of traffic law, and the relationship between the obedience towards traffic law and the gradation of open fractures among motorcyclist victims in accordance with Sardjito Scoring system.

Most patients have no driving license. And those who has driving license, mostly have never undergone driving license test. Patients with open fractures of cruris come with severe Sardjito scoring system, open fractures of antebrachii with moderate Sardjito scoring system, and open fractures of femur with moderate Sardjito scoring system.

It is strongly related between the ownership of driving license and road traffic accidents. The most road traffic accidents cases of are open fractures of cruris, open fractures of antebrachii, and open fractures of femur respectively. High obedience and strict use of personal protective equipment (safety helmet, glove, and jacket) would be effective in mitigating road traffic accident injuries.

The burden of traumatic injuries is increasing in Bhutan. Data from the Ministry of Health of Bhutan (MoH) indicates that the number of injuries has increased 37% from the years 2004 to 2008. Current data on demographics, cause, and outcome of injuries is not well documented, leaving the MoH with insufficient data to guide policy decisions. The MoH and the Bhutan Foundation have prioritized development of a national trauma registry in Bhutan, starting with a trauma registry at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH).

To design and implement a sustainable tool for the collection and storage of data describing trauma patients at JDWNRH.

The trauma team defined trauma as any injury that requires an evaluation, intervention, or admission to the hospital. A paper based tool was designed by consensus to collect data on demographics, injury type, injury location, injury severity, treatments and outcomes. A hospital based system to processes the data into Microsoft Access was established and data collection began in September 2010. Monitoring is ongoing to ensure the reliability of data.

During a four month period, with a team of physicians, government officials and public health staff developed a model trauma registry. The registry emphasized simplicity in design and execution and will serve as a stepping stone for a nation-wide trauma registry. Data collected from JDWNRH will provide the MoH with a detailed set of injury data to help with policy and resource utilization decisions. Logistical and technical challenges of developing a trauma registry are similar across health systems and this data collection tool and the lessons learned could be adapted to fit other institutions or health systems worldwide.

The objective of this study was to collect epidemiological injury data on patients presenting to the emergency department of a tertiary care hospital after the bombing on 29 December 2009.

This was a retrospective review of the medical records of the victims that were brought to a tertiary care hospital. Bombing victims were described as requiring acute care due to the direct effect of the bombing.

The results are derived from a sample size of 198 bomb blast victims, most of which were first transported to government hospitals by private cars rather than ambulances. After the government announced free treatment, there was a wave of patients, among which, most were stable and already had received some form of treatment. Approximately 5–6 patients who had life-threatening injuries were brought directly to the tertiary care facility and needed surgical intervention. The lack of security in the emergency department could have lead to another terrorist activity. There were no procedures done in the field as there is lack of emergency medical services training in Pakistan, but in the hospital most of the interventions included intravenous (IV) lines, wound care, and laceration repair. The most common treatments included the administration of IV fluids, antibiotics, and analgesia. Radiographs of specific sites and trauma series were used to rule out bone injuries. There was lack of documentation in most of the medical charts.

The emergency department was overwhelmed with the number of patients that it received. Therefore, an updated disaster plan and regular disaster drills are required. Rapid and accurate triage could minimize mortality among bombing survivors significantly. The majority of patients were discharged home.

Because of worldwide increase of catastrophes and recent terrorist attacks, hospitals and physicians are devoting increased attention to disaster and mass casualty incident (MCI) preparedness not only outside but also inside hospitals. In case of a terrorist attack physicians have to cope with injuries caused by conventional, biological, chemical, or radioactive weapons.

The aim of this study was to evaluate the current state of preparedness of German hospitals and physicians in case of an MCI or terrorist attack and to compare those results to the preparedness of hospitals and physicians from Austria, Switzerland, the United States of America and a worldwide collective.

Using an online questionnaire, we interviewed 1343 physicians in Germany, Austria, Switzerland, the US and a worldwide collective. The replies were analyzed statistically with the Shapiro-Walk test and the Mann-Whitney-U test.

in Germany physicians are less prepared than their colleagues worldwide for disasters inside and outside hospitals. 48,4% of German physicians (37% worldwide) did not know their area of responsibility as a physician in case of an “internal” emergency (fire, water pipe burst, power cut), even though 30,2% of German physicians (29,1% worldwide) have already had a real emergency in their hospital. Only 65,3% of physicians in Germany (75,5% worldwide) knew their area of responsibility in case of an MCI; MCI training was given less often in Germany (42,7%) than worldwide (64,3%). Most physicians in every country were unaware of injury patterns and treatment strategies in patients following bombings or nuclear, chemical and biological contamination.

Hospital Physicians are insufficiently prepared for internal emergencies and MCIs. There is a need for more drills in hospitals. In spite of the recent threat of terrorist attacks, the physicians' emergency training should be modified to accommodate the increased risk of catastrophes and terrorist attacks.

Natural disasters cannot be prevented but their human impact can be mitigated. Effective medical and public health mitigation and responses require multidisciplinary efforts and appropriate training. Whilst Asia is currently ranked as the most natural disaster prone area globally, limited disaster medical and public health response training opportunities are available in the region. Our paper reports efforts to identify the training gaps and ways to fill them to prepare frontline practitioners and academic researchers in disaster and medical humanitarian emergency relief efforts in Asia.

Grounded on the disciplinary principles of academic training in public health, emergency & disaster medicine and primary care, our paper reviews the current disaster related academic training offered in these disciplines and maps out the training and knowledge gaps in disaster mitigation and response for frontline practitioners and academic researchers. We suggest ways to fill such gaps.

A two-dimensional (clinical versus non-clinical), three-tier education training framework (Entrant level, Continuous medical education needs and Expertise level) is developed. Experiences and key training needs in Asia are highlighted.

The proposed framework identifies areas for comprehensive training for medical and public health practitioners who are interested to engage in medical disaster relief. The proposed framework also aims to strengthen mitigation and response capacities in health systems.