The terms catastrophe and disaster have been frequently heard worldwide due to situations like earthquakes, floods and events provoked by man as the September 11th and Anthrax attack. Catastrophe means all situations where material and human resources available in a healthcare facility are not enough to assist a large number of victims admitted at the same time. Accreditation requires having a plan to manage effectively those situations, assessing safely as much victims as possible.

To describe the catastrophe plan and its management in a private hospital.

Hospital Albert Einstein is located close to a huge soccer game stadium and near to the State Government Hall. This was the reason to have a plan focusing on casualties with a large number of victims. The literature was revised to choose the triage methodology. Triage to identify the priority of patients' assessment based on their condition, possibility of treatment and determining discharge for those without visible risk. Simulation was implemented, followed by debriefing to register lessons learned.

An algorithm was developed with a crisis center and defining care and support areas in the organizations to manage the victims at Emergency Room and triage field. The plan was effectively deflagrated twice: 47 victims from a bus accident and 25 from a policeman strike. Debriefing was done in all opportunities and communication is the main issue; 15 simulations have been done for training purpose, with specific goals.

Hospital is a high risk environment itself for an internal or external incident depending on its localization. A disaster plan is necessary to improve everyone safety, to organize resources, to respond effectively to such situations and take the organization back to regular operation as soon as possible. Simulations are essential to guarantee staff competency and organization support and response to adverse situations.

The formal training for Emergency Medical Technician (EMT) in Taiwan was legislated by Emergency Medical Care Services Act in 1995. Very little research discusses the competency of EMTs. The purpose of this study was to assess the determinants of competency for the EMT-II in Taiwan.

In June 2005, a cross-sectional survey was targeted on firefighters with EMT-II certificate and having a minimum work experience of three months in central Taiwan. Kirkpatrick's (1994) four-level model guided the development of conceptual framework and questionnaire. Structural Equation Modeling (SEM) was adopted for the analysis.

One thousand and seventy-three EMT-IIs were included in the study. Majority of them were male (99.4%) with an average age of 34.46 years old. Among them, 96.5% were careered EMTs with 130.33 months of field experiences. The competency of EMT-II was measured by 4 indicators of error reduction, quality improvement, achievement orientation, and efficiency improvement. The construct of ‘Capability Enhancement’ dominated EMT-IIs' ‘Competency’, followed by ‘Length of Time for Field experience’, ‘Instructor Expertise’, ‘TA Expertise’, and ‘Willingness to Learn’. Both ‘Age’ and ‘Total Course Time’ had a negative effect on ‘Competency’. ‘Capability Enhancement’ was mainly influenced by ‘Practice Absorption’ and ‘Theory Absorption’, followed by “Willingness to Learn”, ‘Instructor Expertise’, ‘Total Course Time’, ‘TA Expertise’, ‘Self Confidence’ and ‘Practicum Time in Ambulance Station’. However, the construct of ‘Teaching Technique” imposed a negative effect on ‘Capability Enhancement’.

The SEM model explains 75.7% of the variances in competency for EMT-IIs. The ‘Competency’ is dominated by ‘Capability Enhancement’. Improving the quality of course, instead of time, and recruiting younger EMT-IIs may advance the competency. Modification of ‘Teaching Technique’ may enhance the capability of EMT-IIs.

This study aimed to assess the training needs of public health nurses (PHN) and compare the job performed by them with job descriptions.

A descriptive study was conducted by utilizing triangulation research method. It was conducted in Eastern and Central regions of Nepal with 13 PHNs (of 13 districts among 75 districts of Nepal) and their supervisors were included as the samples. Data was collected by using standardized tools.

The mean age of the PHNs was 43.69 ± 9.4 years. Near half (46%) had 10 to 20 years job experienced. Most of the respondents (85%) had done PCL Nursing. All most all (92%) subjects had undergone some in-service education. Most of them (57%) used to visit health posts. The majority of PHNs (85%) assisted in planning and implementation of program for a health post. The Majority (85%) were involved in educational activities. Most (85%) were used to supervise the staffs working at health post. The majority of PHNs (77%) were not involved in research activities. Most of them (85%) prioritized the needs of training on recent concepts to bridge the gap between traditional and recent concepts of public health.

PHNs have broad areas of nursing expertise and opportunities for work if needed in a sufficient manpower at the district level. Most of them completed PCL nursing a number of years previously and therefore need training on recent advances and need to recruit more PHNs to improve public health services in Nepal.

A well sounded education in a peaceful environment is a stepping stone to a good future of a society. Therefore, we can say the foundation and potentiality of economic and socioeconomic of any country is well defined by this.

Not everyone receives the reward of education that plays a vital part in their lives. The main reasons as to why this is the case, Is due to the environment the person/individual lives in. For example, when a child is living in conflict and poverty as a major crisis the need for education will be ignored. Children in war torn countries such as Afghanistan where children are constantly under physical and psychological stress due to their schools being destroyed by bombardment and also the killing of their educators. Furthermore, children in war torn countries have a high risk of concern for a pointless education as they don't get a chance to attend school regularly, but they will dapper with educational stress. In this situation all the educators and their students will be whirling in the storms and floods of psychological stress. Education is very emotional and traumatic as it is in Afghanistan, where they suffered through the unfair interference of outsiders in their home country as the Russian did by the name of democracy in 1979–1998. Unfortunately, following 09/11 a new time has set with a new kind of invasion which is going on. We now observe more tragic situation which again external powers are injecting their culture and foreign bodies in Afghanistan. It's obviously drying out the water of our culture.

Where the Culture itself is one of the most important and valuable aspect of life it is a tower of education. Without culture, education would never have been built and so never could be improved.

To identify attitudes and understanding of Chinese undergraduate nursing students towards disaster, therefore providing information for the development of a disaster nursing curriculum in the Chinese context.

A total 214 undergraduate nursing students (Year 1 to 4) in one medical university in China were surveyed in 2010.

The majority of undergraduate nursing students (94.9%) were concerned about disaster, 46.7% of them thought they were very knowledgeable about disaster, while 39.3% of them stated they were moderately knowledgeable about disaster. The most popular way for the students to get information about disaster was television (88.3%), followed by internet (67.8%) and newspaper (45.8%). Only 33.6% of them said they gained information from the university. Earthquake (93.7% of students) and flood (36.1% of students) were mentioned by the students as examples of disasters that have occurred in China. The majority of students said the Wenchuan earthquake (2008) was the disaster that had the greatest impression on them. Five aspects were identified from their description of disaster, which included the cause, category, characteristic, impact and type of disaster. 36.4% of students were certain that disaster would happen again in China. A further 50.9% felt disaster was likely. Flood and earthquake were considered the most likely future disasters. 71% of nursing students strongly agreed that being prepared for disaster was important. The main reasons were better preparedness could decrease the damage to property and the incidence of death and injury. However, the level of understanding of the effects of disaster and the exposure of students to education about disaster health response was limited.

Knowledge and skills for disaster preparedness of nursing students should be strengthened in the medical university.

Operation Smile International (OSI) is a Non-Government Organization (NGO) with experience providing surgical care throughout the world. OSI has vast logistical capacity, skilled and credential providers, and international relationships. Disaster response had been considered by OSI in the past, but never initiated. However, the magnitude of the Haiti disaster, coupled with request from Haitian OS Partners led to the initial disaster response of the OSI organization.

This presentation will: (1) Describe the considerations and rationale that led OSI to this intervention. (2) Discuss the process of developing a disaster response within a relatively short period of time. (3) The response itself, and (4) Present how the lessons learned will be adapted to future OSI capacity and planning.

The state of Western Australia has a remote population spread throughout an immense area. Remote health and retrieval is strained on a day-to-day basis, let alone in mass casualty incidents (MCIs). Anecdotally, remote medical staff has minimal training in MCI response. There is no research into how aware these staff is on principles of MCI response.

An online survey was devised to ascertain the awareness and knowledge of medical staff most likely to be involved in a disaster. Demographic as well as questions in scenario format were disseminated to rural general practitioners (GPs), nurses and paramedics. Data was collected over a 4-month period.

117 surveys were completed online. Analysis revealed an astute awareness of resources and environment in a potential MCI but triaging was poor and complex decision-making results were equivocal. Trained respondents handled scenarios better than experienced (MCI involvement or planning) respondents.

In general, remote medical staff is aware of only certain MCI principles. Further training is warranted. Voluntary feedback from these staff also strongly corroborated this view.

Over and undertriage in simulation exercises Introduction The first healthcare personnel arriving at the scene of an accident or major incident is often an ambulance crew. It is therefore of importance that they are familiar with, and can practice triage during situations were there is a lack of resources. Overtriage, when a casualty is given a priority higher than motivated, may lead to inadequate use of resources, while undertriage can be seen as a risk for medical errors. There is a consensus that up to 50% overtriage is accepted in order to have an undertriage, which is less than 5%. The aim of this study was to increase knowledge regarding prehospital personnel's triage during standardized simulation exercises.

76 standardized simulation exercises where the triage of casualties was evaluated. The exercises were part of a training program for medical command and control at scene. The students trained were all professional ambulance crew. The scenario was a fire at a football stand with 50 causalities. All in all 3800 (76 x 50) triages were performed. The simulation system used was Emergo Train System. Prior to the exercises an expert group had triaged the causalities according to the MIMMS system (sieve). Of the 50 patients 15 were triaged as T1 by the expert group and the rest were not.

Of the 3800 triages 37% (n = 410) were classified as undertriage and 13% (n = 134) as overtriage. The most frequently undertriage casualties had an airway and/or breathing problem that were not observed. The most frequently overtriage casualties had a burn injury involving 30% of body surface area or unconscious casualties.

Triage in this simulation setting did not meet acceptable standards. More triage training for ambulance crew may improve outcome. More studies are needed regarding simulation exercises as a tool for evaluating results of triage.

Japanese Disaster Medical Assistance Team (DMAT) has important duties to support and reinforce functionally insufficient key disaster hospitals in the large-scale disasters. However, it is difficult for Japanese DMAT to fulfill these duties in the current circumstances, because the DMAT consists of individual institutions and Teams have less experience to work in the other institutions. To resolve the issues, disaster drills for some DMATs which consist of several institutions have been held since 2008. We evaluated the effectiveness of the drills and educational system.

Investigation was performed by surveillance questionnaires to 129 participants in the drill (staffs from DMATs, Red Cross and local government, and sham patients). The questionnaires are: A. Was the cooperative medical practice performed smoothly? B. Was the support for hospitals conducted effectively?, C. Was the medical record for wide-area transportation completed? (for our staffs only), D. Was our activity enough? (for participants excluding us), and E. Was the drill beneficial?

85 participants including 30 staffs in our institution answered the questionnaires (65.9%). The number of participants who answered ‘Yes’ was as follows: A. 48 (56.5%), B. 64 (75.3%), C. 8 (26.7%), D. 44 (83.0%) and E. 81 (95.3%).

Although the cooperative medical practice was not so smooth, it was recognized that members in DMATs got mutual trust by their high knowledge and skills. And it was suggested that DMAT could not command and control the hospital staffs without their understanding the equipments and documentations used by DMAT. And it is ideal to change the mindset of hospital top managements towards the disaster medicine through the repeated drills.

The repeated disaster drills at the local area is essential to make DMAT function sufficiently.

Development of Hospital Triage Training at the Chris Hani Baragwanath Hospital F. Plani1, E Degiannis, P Lingham No disaster training had ever been carried out at the CHBH, the biggest hospital in the world with over 2900 beds and over 5000 staff members. The 2010 Disaster Plan required that all clinical staff undergo the appropriate training. Basic Interprofessional Training for Trauma Disasters 411 staff members attended a half day course during May/June 2010, presented and sponsored by CHBH Trauma Directorate consultants. The aims of the course were to disseminate the trauma disaster plan in interdisciplinary and interprofessional fashion, clarify hospital triage, familiarize staff with Trauma Unit equipment, and practice resuscitations in mass casualty incidents. The course started with presentations on CHBH Disaster Plans and Protocols and Principles of Triage and Standard of Care in Disasters. This was followed by 3 multiple patient scenarios with rotating groups, over a whole hospital floor with: 1) 50 mixed patients outside the hospital; 2) 10 serious patients in the ER; 3) 10 patients deteriorating later in a ward or ICU. Next were individual patient resuscitations, Primary, Secondary, Tertiary Survey and “hand-over”, patient resuscitations in a disaster, using the contents from “Disaster Bags” and questionnaires to assess confidence and suitable treatment areas (Red, Yellow, Green, OT) for allocation in a disaster. The course was wrapped up by a familiarization visit to ED and the colour coded areas.

Final questionnaires demonstrated that all participants were a lot more confident in the triage of patients and the initial resuscitation using the implements found in the resuscitation room and the “Disaster Bags”. The course has been adopted as part of staff orientation at all professional levels from 2011 onwards, and is in the process to be extended to secondary level hospitals in Gauteng, RSA.

Pericardiocentesis is rare but life saving procedure that all emergency physicians should be competent in performing. Improper technique can place patients at significant risk for iatrogenic injury. Proper training is needed to familiarize physicians with proper pericardiocentesis technique.

In order to facilitate training of this relatively rare procedure, a cadaveric pericardiocentesis model was developed. Described is a step by step procedure for creating a cadaveric model that can be used to train and evaluate providers in pericardiocentesis competency.

This unique teaching innovation can be utilized in a variety of settings to train providers, including those in resource limited environments. It has already been utilized in the training of emergency medicine residents in Thailand and in the United States.

Japan is one of the world's famous countries for natural disaster. Seven years ago, The Japanese government indicated the necessity of providing disaster prevention education in schools. However, such education has not yet been introduced.

The aim of this study was to evaluate the 90min triage program in senior high schools.

Sixty nine students attended the program. The effects of the program were evaluated using pre and post examination by paired t-test and McNemar's test.

Compare pre-test with post-test, the average score of the tests was a significant increased. Compare pre-questionnaire with post-questionnaire, the number of interested students in a regional disaster drill has increased.

The results showed that this program increased the interest in disaster prevention and provided students with a chance to participate in disaster drills in their own resident area.

Carrying out this program in senior high schools, would provide students with a chance to learn disaster prevention.

Disaster medicine is a young discipline and there is a need for the development of methods for evaluation and research. This includes full-scale disaster exercises that are quite costly. Within each organization these exercises are seldom conducted. If there was a standardized concept on how to conduct as well as evaluate these exercises, this could lead to better knowledge and cost effectiveness. The aim of this study was to increase awareness of the possibility to develop and conduct full-scale exercises in different settings using performance indicators combined with indicators related to patient outcome serving as a basis for comparison and evaluation process.

Two full-scale exercises in different organizations were studied. Identical panorama with the same number and type of casualties was used. Sets of performance indicators combined with indicators for unfavorable patient outcome, according to the Emergo Train System®, were recorded as well as all transportation times and the patient distribution to selected hospitals. Qualified observers scored the results on predetermined locations; on the scene, hospital and strategic command and control.

The lowest scored performance indicators were “first report to dispatch”, “second report from scene” and “first patient evacuated”. Due to insufficient response and evacuation times of victims to the receiving hospitals the unfavourable patient outcome, regarding preventable deaths and preventable complications were 28% (n = 18) and 41% (n = 17), respectively.

Standardized full-scale exercises where the same type of results is recorded can be conducted. This combination of performance indicators and Emergo Train System® leads to probabilities of development and better command and control response. Future use of the same concept may demonstrate important results that will lead to new and better knowledge that can be applied during real incidents.

Sri Lanka has learned, with contributions from a 30-year war and a tsunami, that disasters happen when and where least expected. Thus the Health Emergency and Disaster Management Training Centre (HEDMaTC) of the Faculty of Medicine, University of Peradeniya was established to prepare Sri Lankan healthcare workers for all forms of health disasters.

HEDMaTC conducts training programmes for health professionals, including medical doctors, nurses, emergency technical officers, ambulance drivers and porters. As these are adult training programmes practical methods of training such as drills, workstations, group work and hands on training have been used, in addition to lectures. Emergency care equipment, specific kits and techniques and desktop exercises are used to demonstrate protocols of emergency management and discuss principles of risk management, disaster management concepts, conceptual and technical challenges in measuring disasters and their impact on public health and its effective management. Participants prepare action plans for their individual institution based on the knowledge gained and are discussed in follow up programmes a month later.

HEDMaTC is the only institution in Sri Lanka that is accredited by the Ministry of Health, Sri Lanka to train their staff in disaster management. HEDMaTC has trained 200 personnel in Public Health Emergency and Disaster Management, 117 in Sexual and Reproductive Health Services in Crises and 1034 in pre-hospital emergency care. The trained personnel were mobilized to the North and East of the country to handle healthcare issues, ranging from administration to ground work, of almost 300,000 displaced civilians in 2009 with a very satisfactory outcome.

The training methods used in these programmes are especially beneficial in adult training and it is to be recommended. We also recommend that HEDMaTC to be developed as a regional training center for South Asia.

Evolving health systems frequently seek guidance with emergency medicine related topics. This has lead to countless international collaboration between organizations attempting to meet this need.

Paraiba, a state of 3.6 million, ranks near the bottom in Brazil for per capita income. The medical establishment has private, public and military systems without emergency medicine training and no disaster plans. HHI and Harvard International Emergency Medicine Fellowship are academic research and service oriented organizations with an emergency medicine and disaster preparedness focus. In 2009 a request for technical assistance was made to HHI from Paraiba, concerning disaster preparedness, clinical emergency medicine and pre-hospital training.

Exchange of correspondence surrounding needs and expectations of the partner organizations was conducted until the August 2010. During August a series of meetings was conducted among the civilian, military and federal representatives and a collaborating body was formed under the guidance of UFP consisting of SAMU (prehospital care), the medical school and the five main hospitals of the city. In September HHI staff conducted a series of meetings and assessments in Paraiba. Plan Evaluation, educational and programmatic steps were decided on to be conducted over the several year project. Space and resources for the training center at the UFP was allocated. Establishment of 8–12 teaching modules for practicing physicians and nurses, built and taught by local staff with HHI support will be implemented and become a requirement to work in emergency areas. An assessment of disaster risks and emergency metrics will be conducted concomitantly. Exchange of staff between Brazil and USA will occur throughout the project.

No standard model of collaboration exists regarding international emergency medicine and disaster planning but ours demonstrates that exchange of information can evolve to match the abilities and expectations of both parties.