This new Journal, starting with volume 1, number 1, Spring 1985, is an official publication of the World Association for Emergency and Disaster Medicine (WAEDM), formerly called the Club of Mainz. The Journal is cosponsored by the League of Red Cross and Red Crescent Societies (LRCS). The Journal is owned and published by the WAEDM. There will be 4 Journal numbers per year.

The “Club of Mainz” for Improved Emergency and Disaster Medicine Worldwide was conceived in 1973 and founded in 1976 by about 10 reanimatologists under the leadership of the late Rudolf Frey (Crit Care Med 6:389, 1978). Its objectives are: “(1) to foster optimal resuscitation and life support methodologies worldwide; (2) to concern itself with a range from everyday emergencies to mass disasters, with appropriate consideration for differences in populations, available resources and other factors; and (3) to informally pursue the objectives by combining the resources of scientific, social and related information and experiences, together with international communication and collaboration.”

The “International Red Cross” is composed of: (1) The International Committee of the Red Cross (ICRC) which focuses on war victims; (2) the LRCS; and (3) the 130 National Red Cross and Red Crescent Societies worldwide which are federated by the LRCS. The LRCS was founded to facilitate, encourage and promote the humanitarian activities of its member societies and thus contribute to the promotion of peace in the world. The LRCS considers health as one of the keys to a better world for everyone. Red Cross programs include the training of nursing personnel, the provision of health care in rural areas, the organization of assistance to the sick, aged, and handicapped, and teaching first aid skills to lay people.

This is an editorial comment for Volume 1, Number 1. Medical disasters are “events in which the number of acutely ill or injured persons exceeds the capacity of the local emergency medical services (EMS) system to provide basic and advanced medical care according to prevalent regional standards.” There are multi-casualty incidents, such as transportation accidents, in which the local EMS system is overwhelmed; mass disasters, such as major earthquakes and wars, in which the local EMS system is severely damaged; and endemic disasters, such as combinations of famine, epidemics and revolutions which often occur in world regions without EMS systems. Nuclear war has become recognized as the “ultimate disaster” which is beyond disaster medicine systems' capacities to save lives. Military medicine, however, which is organized for “conventional” war, offers the maximal life-saving potential for mass disasters in peace time.

Everyday humanity witnesses an opportunity to take a new step forward. Every morning millions of people enter a new day hoping for happiness and joys of life, and believing in a cloudless future. In everyday life with its troubles and problems, most people forget that their future wellbeing and happiness are endangered by thousands of missiles and nuclear warheads aimed at mankind itself. According to United Nations Reports, there are 50,000 nuclear warheads on Earth today. Their explosive energy is equal to over one million bombs of the kind dropped on Hiroshima in 1945. Unfortunately, some politicians and some members of the lay public do not know (or rather do not want to know) the simple truth that mankind has produced and keeps in store a power that can annihilate its creators. Let me recall Jolio Curie's words: “People should not allow the forces they have managed to discover and learned how to handle now be the cause of their destruction.”

This is an age of unprecedented uncertainty. Life is now perilously posed at the precipice of history. Never before has man possessed the destructive resources to make this planet uninhabitable. Having unlocked the Pandora's box of the atom, a new dimension has been provided to our potential for self-annihilation.

An objective assessment indicates no vital national interest that would justify nuclear war. Nonetheless, the nuclear arms race is ever accelerating.

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.

The German Association for Disaster Medicine published the following declaration for physicians, citizens and governments (J. German Physicians, June 24, 1983, pg. 39): “Disaster medicine defines as the limit of its applicability situations in which violence and the dimension of destruction will make every systematic and organized aid impossible; this would be the case in a nuclear war.” This explanation would show the right way to act for those who reject disaster medicine, as they consider it an alleged preparation for nuclear war — i.e., some members of the peace movement. This declaration also addresses authorities, so that they will not cherish false expectations. Some of these allegations culminate in the statement that the physicians supporting disaster medicine would suggest to the political and military leaders that nuclear warfare could be risked. This is obvious nonsense.

The members of the World Association for Emergency and Disaster Medicine (WAEDM) (The Club of Mainz) have considered the medical consequences of a major nuclear war and would like to make the following recommendations to all relevant governments and powers, and their medical professions:

1. That disaster medical preparedness should be continued and developed for conventional wars, nuclear accidents and the single small nuclear bomb explosion (e.g., by accident or terrorism).

The above contributions by Professors Chazov and Lown, the comments by Dr. Rebentisch, and the Resolutions by the WAEDM, the Red Cross and the WHO indicate that disaster medicine planning for a response to and civil defense protection in case of nuclear war is senseless, wasteful of resources (which are needed for current vital social programs worldwide), and also dangerous, by giving national leaders the impression that some individuals' medical protection in a nuclear war is possible. Most people, including some national leaders and military experts, believe that limited use of nuclear weapons would escalate to a global nuclear holocaust, and that any medical planning for nuclear war might encourage the irrational belief that nuclear was is winnable. Even if it were “winnable” the resulting death and torture of millions of innocent people and the damage of our planet's ecologic balance, make any consideration of the military use of nuclear explosions morally and medically unacceptable.

Throughout the world, experience is growing in the development of plans for military-civilian collaboration in disaster preparedness. This involves the complex problems associated with the coordination of various components of military and civilian Emergency Medical Services (EMS) systems and organizational differences between countries.

EMS are dependent on relationships between hospitals, police-fire-ambulance services, and municipal, county and state governments. In an emergency, their integration is accomplished in: (1) detection and assessment; (2) call for ambulance and hospital; (3) organization; and (4) emergency medical treatments.

The United States Military Health Care System exists primarily to ensure the ready availability of medical support to U.S. Armed Forces at any level of conflict anywhere in the world. Many military medical units are therefore organized and equipped to permit their rapid deployment on short warning to relatively remote areas. They can provide life-saving services within hours and can operate almost independently in any climate, provided they have the means to evacuate patients and to receive supplies. The military mission demands that the medical personnel assigned to these units be trained in peacetime to do their jobs in wartime.

Latin American and Caribbean countries have been affected by many natural disasters in past decades. Earthquakes caused in Peru (1970) approximately 70,000 deaths, in Nicaragua (1972) 5,000 deaths while destroying the capital, Managua, and in Guatemala (1976) 22,000. Hurricanes also wreak havoc: hurricane Fifi in Honduras (1974) with 10,000 deaths, hurricane David (1979), and hurricane Allen in Saint Lucia, Haiti and Jamaica (1980), have amply demonstrated the high vulnerability of these countries to emergency situations. These catastrophes and many other smaller ones required that all resources of the nation, governmental or private, military or civilian, be mobilized in a coordinated manner to meet the emergency needs of the population.

Wars have contributed to the progress of emergency medicine. Napoleon's surgeon Larrey introduced a new era in surgical skills. During World War I, blood transfusions and anesthesia were introduced, and during World War II, penicillin. Neither in war nor in civilian disasters can one predict the number of casualties. Thus planning should be similar.

EMS in developing countries must be established as a high priority, since it is one of the key elements in making possible any realistic improvement in health care. In Egypt, the pre-hospital phase of EMS is a highly visible commitment to the welfare of the nation and is a catalyst for other health activities. Satisfying needs identified in rural health care, such as high-risk infants, trauma, and time-related health problems, will be facilitated by an effective EMS system. EMS must be adapted to fit the culture of the people and their specific needs.

A disaster may be defined, for this paper, as “a situation in which an urgent need arises for international assistance to relieve humansuffering.” Disasters are frequently divided into manmade and natural disasters. Many so-called natural disasters have, however, a considerable manmade component in their etiology. The number of people vulnerable to the effects of disasters is increasing, and in the future disasters affecting human beings are likely to occur with greater frequency and severity, Full account must also be taken of the effects of a rapidly expanding world population, of advances in science and technology, and of economic and ecological factors.

In war a large number of military and civilian wounded and injured patients, and patients with disease, will increase the strain on the system of medical care. The expected distribution of injured in a conventional war can be estimated on the basis of previous war experiences, especially from World War II (1), the Korean war (5), the Vietnam war (7, 8), and the Arab-Israel wars (3). Corresponding figures for the civilian population are less readily accessible. Statistical data from previous wars as well as expected weapon development can be compared with data from various peacetime accidents and disasters. Thus, the expected distribution of injuries can be estimated (Table 1) (7).

Trends in recent warfare show a movement in the proportion of wounded soldiers to wounded civilians from 20:1 in World War I to a conjectured 1:100 in the case of atomic, biological or chemical warfare. Modern methods of waging war mean that for every fighting man, a group is engaged in logistics, and that for every dead soldier, an increasing number are wounded. Furthermore, the number of severely wounded cases is proportionately increasing.