Disasters continue to increase in frequency and affect more and more citizens of the world community. Economic costs are increasing at an alarming rate. The death toll in the last 50 years has been in excess of 12 million persons, billions of people have been “affected”, and economic costs are estimated as high as US$4 trillion. Human and economic costs have been estimated for disasters caused by natural and manmade events. Manmade events are segregated into technological and inter-human conflicts. Defined human costs do not include those effects such as short- and long-term psychosocial problems that cannot be quantified. The lack of structure for the conduct of research and evaluation of interventions impairs our ability to learn from experiences. This Chapter introduces a structural framework for investigations into the medical and public health aspects of disasters including: (1) a standardized, universal set of definitions; (2) a conceptual model for disasters; (3) indicators and standards; (4) descriptions of 14 basic societal functions bound together by a coordination and control function; and (5) a disaster response template and two research templates. The templates are to be used in the design, conduct, analysis, and reporting of research and/or evaluations of interventions directed at preventing hazards from becoming a disaster-producing event, mitigating the effects of such an event on the affected society, and/or responses to a disaster.

The purpose of research is to discover or change laws and theory while the purpose for evaluations is to affix a value to the process or outcome. Research is used to define a cause:effect relationship between independent and dependent variable(s). Currently, such experimental studies either are impossible to conduct in the setting of a disaster or are considered unethical. Until recently, reports of disaster responses primarily have been anecdotal and descriptive with little or no structure. They have had little value in the elimination of hazards, reduction of risks, improvement in the absorbing and/or buffering capacities, reduction in vulnerability, and or enhancement of disaster preparedness. They have served to shape our perceptions of the medical and public-health needs associated with certain events. During the last two decades, methodologies used in the social sciences gradually have been adapted to the study of disasters. Such studies have contributed greatly to our understanding of the pathophysiology of disasters and the effects of specific interventions on the affected populations or populations at risk for an event. Not all aspects of such interventions can be measured, but most can be assessed using qualitative methodologies. The importance of using both qualitative and quantitative assessments of effects is discussed.

It is not possible for persons within and between the many disciplines involved in disasters to communicate with each other without clear definitions of the specific terms that are used. In many instances, the same terms have different meanings in different disciplines. Thus, a standardized set of definitions is provided in this chapter and in the associated Glossary of Terms. Some definitions discussed in this Chapter include: (1) disaster; (2) medical disaster; (3) hazard; (4) risk; (5) prevention; (6) modification; (7) event (including onset, duration, amplitude, intensity, scale, and magnitude); (8) impact; (9) mitigation; (10) preparedness; (11) damage; (12) vulnerability; (13) resilience; (14) absorbing capacity; (15) buffering capacity; (16) disaster management; (17) response; and (18) recovery. An annotated, comprehensive set of definitions is provided in the Glossary of Terms in these Guidelines.

The ultimate objective of disaster management is to bring the probability that damage will occur from an event as close to zero as is possible. A conceptual model is proposed that uses a generic, non-quantitative, mathematical expression (formula) for relating the probability that damage will occur with specific hazards and with the risk posed by the hazard and vulnerabilities. Actions are subdivided into those that are implemented before a hazard becomes an event and those provided as a response to an event that is occurring or has occurred. In the former category are those actions that either augment or mitigate vulnerability by increasing or decreasing the absorbing capacity and/or buffering capacity of the population/environment at risk for an event. Responses to an event either may be productive or counterproductive. Use of this “formula” in disaster planning and analysis should assist in identification of the essential elements that contribute to a disaster. For example, application of the formula should facilitate the development of understanding why the occurrence of similar events produce a disaster in one setting but not in another. Numerous examples of its application are provided.

This Chapter describes methods for defining the level of damage from an event, its impact on the functional status of the affected society, and for identifying the needs that result from the damage. The event may produce damage to the population (injuries, death), its constructions and societal functions, and/or to the environment. Societal functions are described as production functions with inputs, transformations, consumption of resources, and outputs. Distinction between available supplies, requirements, and needs is stressed. The differences between damage assessments and needs assessments are described. Needs for goods and services that are greater than the available level of supplies produces deficits. The concept of thresholds of available resources required to maintain the pre-event functional state, those necessary to sustain basic functional states, and those required for survival is developed. Surplus of available supplies is subdivided into those needed for contingencies and those that comprise luxuries. Indicators are required that define either the level of function or the level of available supplies.Distribution of available supplies (who receives them) impacts whether critical and functional requirements of a population, or part of the affected population, are satisfied.When critical requirements are not met, the crude mortality rate increases. Severity scoring of the damage sustained and the effects of responses is described. All damage and needs assessments and responses to them relate to the pre-event state of the affected society, and the objective of disaster responses is to return the affected society to its pre-event functional state.

Interventions are actions (processes) by humans to prevent, attenuate, create, or augment change(s). Resources (human, material) are consumed in the production of change. In disaster work, interventions are designed to: (1) affect the probability that damage will occur from an event; or (2) effect recovery. The definitions and implications of the terms: effects, outcomes, outputs, efficiency, effectiveness, efficacy, benefits, and costs (human, material, opportunity) as well as cost-effectiveness and cost-benefit are discussed. A new concept of Best Outcome Without Assistance (BOWA) is presented. Responses and interventions directed at prevention or mitigation of the damage produced must be evaluated from the perspective of their outcomes and to what extent they benefit the societies affected or at risk in relation to the goals and objectives defined prior to implementation of the intervention(s).

All damage requires some response. Responses are directed towards the mitigation of further damage once the impact of an event has begun and/or correcting the functional deficits created by the primary and secondary events, and restoring the functionality of the damaged elements to their respective pre-event state. Disaster responses are directed towards search and rescue, relief, recovery, and/or rehabilitation. Responses must be directed at satisfying all or part of defined needs. Implementation of responses must be coordinated through a Coordination and Control Center. Thus, all responses must be driven by clearly stated goals and objectives directed towards specific needs. The Disaster Critical Control Point (DCCP) is the time at which the available supplies balance all of the needs. Selection of appropriate indicators that reflect the severity of the damage and the effectiveness of the response in meeting its goals and objectives and the benefit to society that results is crucial. Use of appropriate indicators eventually will result in the evolution of minimum and optimum standards, and definition of functional and critical thresholds. Evolution of such standards and thresholds will lead to the development of critical pathways (process evaluation) and guidelines to be used in optimizing future responses. All of the steps from preparedness to recovery that are undertaken to minimize the damage and restore the pre-event status are the tasks of disaster management.

Ethical questions and dilemmas associated with disasters and their management are numerous and are compounded when international assistance is involved. This Chapter is intended to raise awareness and promote important and ever-relevant discussions; it is not a treatise on ethics. It discusses the issues associated with human rights and obligations and identifies important aspects of international law associated with such issues, hazard exportation, the right to know, needs assessments, as well as aid and assistance. Issues raised by the actions and policies of relief organizations, those associated with actions of the media, and those associated with the competence of the responding individuals and organizations also are examined. Triage and other forms of rationing of medical care create additional dilemmas that are discussed. Lastly, the problems associated with disaster research and application of the Helsinki Declaration are explored.

This is an extensive annotated list of definitions used in the Guidelines. It is not intended to be all-inclusive, nor is it a comprehensive dictionary. It seeks to define terms in ways that are applicable to all of the disciplines involved in disaster medicine and management. Terms included are to be used as defined for all research and evaluations using these Guidelines and Templates.