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Civilian Weapons of Mass Destruction (WMD) training involves preparing for threats well-known to the military since World War II. Present and future developments in Chemical-Biological (CB) research have resulted in new potential agents, modes of action, and methods of delivery. Chemical-Biological defense training should include these new agents and anticipate contact with previously unknown ones. The natural response to an unknown threat is fear and panic, out of proportion to the actual threat. Specific training in management of new pathogens and toxidromes should be incorporated into existing preparedness regimes. Leadership skills that address uncertainty and inspire constructive responses will increase resiliency.
Methods
Literature Review
Results
Recent and Future CB Agents: (1) 4th Generation AchE inhibitors: Novichoks, Substance 33, etc.; (2) Genetically enhanced bacteria and engineered chimeric diseases; (3) Modified viral diseases: Variola, Influenza, filoviruses, flaviviruses, arenaviruses; (4) Bacteriophage induced diseases; (5) Agents targeting specific racial or genetic groups; (6) Mid-spectrum agents; (6) Bioregulators: Substance P, vasopressin, enkephalin, etc.; (7) Novel toxins: tetrodotoxin, SEB, saxitoxin, etc.; (8) Hallucinogens and incapacitants (LSD, DMT, carfentanyl, cis-fluoro-ohmefentanyl); (9) Prions and infectious nucleic acids Delivery: (1) New delivery methods: micro- and nano-robots modeled on insects (MEMS systems), microencapsulation; (2) Directed Energy Weapons Mitigation: (1) Development of systems for identifying and dealing with unknown agents and symptoms; (2) Hazard Identification, Risk Estimation, Risk Reduction Strategies, Residual Risk Evaluation and Monitoring, Mitigation and Recovery Leadership skills needed during uncertainty: Sense making, Visioning, Relating, Inventing.
Conclusions
Preparing for events without training for new and novel CB agents leaves us unprepared. Incorporating modern science with leadership skills will lessen the impact of future CB release and improve organizational resiliency. The main mistake people make is that they fear current problems more than future ones. Carl von Clausewitz Chance favors the prepared mind. Louis Pasteur.
Knowledge about disasters plays an essential role in managing and responding to disasters and emergencies, especially among a group of health care professionals who are actively or will potentially be involved in disaster and emergency settings. A set of training materials that aims to enhance understanding of disasters and their impact of health has been developed. This project aims to examine the effectiveness of the disaster knowledge training to improve technical knowledge and perceptions of health impact of disasters in health care professionals and responders.
Methods
“Understanding Disasters” training was provided to 300 health care professionals during May to October. Each of the participated attendees filled a pre- and immediate post-training survey that contains socio-demographic information and 20 items measuring various knowledge of disasters.
Results
287 individuals completed the questionnaires (95% response rate). Findings demonstrated that training may effectively enhance one's knowledge about disasters, especially by clarifying the myths and misunderstandings towards disasters. Respondents demonstrated an enhancement of knowledge in 70% of the questions (14/20). Of note, while the whole sample exhibited an enhancement in knowledge, non-clinical staff appeared to have more statistical significant gained in knowledge than clinical based trainee.
Implication
Although disasters cannot be controlled, human impacts of disaster can be mitigated if appropriate training might be offer. This study demonstrates that training program might be useful to enhance better understanding of health impact of disasters.
Analyses of causes and trends of traumatic brain injuries help to define public health policy priorities. There are not much TBI registries, thus making documentation of injuries inadequate and accessing these data problematic. This study is aimed at identifying the characteristics of TBI and determining the efficiency of documentation of patients' records in a tertiary hospital.
Patients and Methods
Based on WHO guidelines “Standards for Surveillance of Neurotrauma” we designed a proforma to collect data on traumatic brain injuries. A prospective data collection was done from January to June 2010. Data was collected on a paper form and then entered into the self-developed TBI registry database. Descriptive analysis was performed.
Results
Data for a total 414 patients were collected. Mean age was 33.00 years (SD ± 16.725, range 1–85 years), and 81% male. Most of the accidents took place on highways (57.2%), commonest being the road traffic accidents (55.1%), brought by relatives (74%). The mean duration for hospital stay was 5.42 days (SD ± 8.312 days, range 1-79 days). 10% patients required resuscitation at the time of admission. Details of Glasgow coma scale were available; details regarding CT scan findings were available for 300 patients. Good recovery was seen in 68.4% and the mortality was in 7.2%. Further details on vital parameters and investigations included in the study were also collected.
Conclusions
TBI related research in many developing countries is in the developmental stages with relatively few published data. Although early analysis of a TBI data can lead to useful information, there is further need for the development of a user-friendly secure web-based database system to continuously maintain and analyze the registry.
Efficiency of resuscitation has been fewly assessed. The aim of our study was to compare standard manual to automatic ventilation using a new device.
Methods
5 categories of healthcare professionals were included (paramedics, nurses, respiratory therapists, senior and junior emergency physicians; n = 10 in each group) and they evaluated 2 different apparatus: manual bag valve (BVM) and automated resuscitator (EasyCPR, Weinman). The experimental bench test consisted in an artificial test lung (ASL5000, IngmarMed), simulating 3 pathological status (COPD, ALI, ASA) and connected to a resuscitation-training manikin for the interface with the mask. Recorded parameters were: tidal volume (Vt), Peak Inspiratory Pressure (PIP), Residual Volume (Vr), overall distension (Vt + Vr), respiratory rate (RR). The ergonomy of the device was assessed at the end of each sequence (1–very uneasy à 5–very easy to use).
Results
Mean Vt reached the goal (400–600 ml) for only 26% [0, 6–45] of the cycles with BVM and 29% [0, 3–80] with the CPR. Within a same pathological status, PIP was higher with BVM (21 ± 17 cmH2O), as compared to CPR (11 ± 3 cmH2O; p < 0.001). Mean RR was 18 ± 6 C/minute with BVM and 10 ± 2 C/minute with CPR. Overall distension was significantly higher with BVM (491 ± 328 ml; up to 1750 ml), as compared to CPR (380 ± 168 ml; p < 0.001). Ergonomy of CPR was considered better for paramedics and nurses (p < 0.05).
Conclusion
BVM resuscitation does not allow reaching the standards in terms of Vt and RR, and may expose to overpressure (gastric distension) and thoracic overinflation. Automatic resuscitation (CPR) may standardize emergency ventilation, allowing a better fit to recommendations and an ergonomy enhancement.
The preparedness for mass casualty is needed in political event. We have the experience to build up the disaster medical system in G8 summit in Okinawa and Hokkaido. But these two areas were resort area which had little population. This time Japan hosted APEC JAPAN 2010 which held in Yokohama City. We reported disaster medical system for this event in big city.
Result
We mobilized DMAT from 21 hospitals whole Japan. We set 11 teams in Yokohama city, 10 teams in 2 Airports. DMAT inspected rerated disaster base hospitals. These hospitals made the plan for receive mass casualty included the victims by CBRNE event and had the exercise. They set up the decontamination system during APEC leader's week. We also have the contingency plan to coordinate with fire department. This contingency plan included transportation plan for hospitals and coordination plan in site. In transportation plan, sever casualty transported dispersal for hospital in Yokohama within 25. For over 25, sever casualty transported intensive for 4 hospitals in Yokohama. After stabilization treatment in these hospitals, the casualty transported dispersal from these hospitals to outside of Yokohama. In coordinate plan in site included job description in command and control, decontamination and medical relief post.
Discussion
We established disaster medical system for APEC JAPAN 2010. This event hold in Yokohama City had the big population. Compare with former G8 summit, medical system put importance in mass casualty event. As a result, non mass casualty event happened. But this preparedness will contribute not only future same kind events but also accidental mass casualty event such as train accident.
Caring for special-needs patients is challenging in disasters. They cannot be triaged, treated or discharged without consideration of their disabilities, including caregivers and social situations. The US Government's response to all hazards requires planning for challenges to communication, medical care, independence, and supervision (CMIST) for vulnerable populations. Vulnerable patients, by lack of any other plan or unavailability of an alternate caregiver, may converge on the emergency department, whether or not there is a medical problem. Language, hearing, seeing, and understanding must be included in patient care and discharge in an expedited manner during a disaster situation. Patients with powered devices and/or underlying medical problems may need access to services such as dialysis or electricity. Vulnerable populations have higher risk for injury and recovery from traumatic disasters. Patients with rotating caregivers, whether in an institution or independent, need alternative caregiver plans. Those patients with service animals will need to have animals included in their plans. Supervised nursing home patients, group home patients, psychiatric patients, minors, and high security patients cannot be released to shelters or other venues without adequate supervision. Before being released from medical care, one must ensure that supervision needs for vulnerable persons are met. Vulnerable casualties must also be protected from abuse and fraud. Individuals dependent on handicap access or public transportation or mobility aids will need plans for alternate transportation prior to a disaster. If the patient is not able to return to their normal community setting, discharge planning to alternate facilities will be part of the planning to prevent unnecessary admission to a hospital that may already be over capacity. Central repositories of information must be available to emergency department and social service personnel to allow caregivers and family to reconnect with patients, and to help with expedited care and discharge.
The World Health Organization Model Trauma System Policy suggests that Governments should undertake systematic reviews of the de facto prehospital transport systems for severely ill and injured persons. These systems, be they formal or informal, should be designed to optimize local resources with emphasis on standards of training, equipment, infrastructure and communications so as to assure delivery of prompt, quality, and equitable prehospital care. Scope of Review and Assessment a System Assessment and Gap Analysis (SAGA) tool has been developed to measure 127 key components of a high performance emergency transport system within the realms of Clinical, Organizational and Logistical functionality. The evaluation compares the current status of the specific components with those commonly expected to be seen in a formal international accredited EMS organization.
Methodology
The tool utilizes a thorough investigative process sufficient to produce credible and practical data which can be used to form a “System Improvement Plan.” While the scope of the project can be seen as relatively broad, the assessment process allows for adaptation to a wide variety of EMS system models which bring specific focus to the greatest areas of improvement opportunity with practical applications and alignment with those resources which are available to a given governmental entity.
Presentation
This abstract, (in both oral and poster presentation format), demonstrates a portional mock evaluation with focus on those components often overlooked by both evolving and mature formal system designs by the international EMS community. The SAGA approach is an invaluable tool for those responsible for integrating the functionality and needs of a broad range of stake holders into the overarching prehospital delivery system in building support for qualitative improvements.
Veterinary education provides a solid clinical and public health background that is applicable to several international development and humanitarian assistance sectors; however key skills and experiences that are required to be an effective Global Veterinary Medicine practitioner are not covered. In response to the US Department of Defense adopting Stability Operations as a core mission, the US Army Veterinary Corps has developed a Veterinary Stability Operations Practitioner Course intended to prepare Veterinary Corps officers to function effectively if tasked to conduct or support Stability Operations. The Veterinary Stability Operations Practitioner Course is a two part workshop series that provides a global veterinary perspective including knowledge, skills and experience necessary for Veterinarian to function in an international developing setting. Skills in assessment methodologies, program planning and evaluation are core to each workshop. Knowledge is based on production, market, and disease surveillance systems in the developing world. The intent is for the attendee after completing the course series to view their operational environment differently by understanding the social and cultural context that influences local population decisions and behaviors.
A 2006 survey showed that 27% of training institutions used computer-based training in disaster medicine and an additional 23% indicated that they will use it in the near feature(1). Victim descriptions are an important element of simulation exercises. Currently, the victim data utilized in computerized simulation exercises cannot be used in an interchangeable way.
Methods
The European Master in Disaster Medicine (EMDM) Academy, recognizing the need for access to reliable disaster victim data, initiated the Victim Base project in order to improve the availability and quality of disaster victim profiles for use in simulation, training and research. A standardized victim template was developed through a review of primary and secondary survey requirements with consultation from an international consortium of training experts in disaster medical management during two workshops.
Results
The victim template is composed of a description of the victim profile, a set of clinical conditions and triggers (time and interventions) to move from one clinical state to another. The parameters of a casualty condition are organized in sub-templates and arranged in the way the victim would most likely be assessed. Victim profiles can be delivered in different output formats on request of the users.
Conclusion
In order to evaluate the effectiveness or outcome of disaster response exercises or test operational plans, victim data must be robust, reliable and of high quality. Moreover, the data must be interchangeable in order to make comparisons between different response systems, regions or countries. VictimBase as an online library of disaster victims will contribute to achieve these objectives. 1. Delooz H, Debacker M, Moens G, Johannik K. and the ISEE Partnership. European survey on training objectives in disaster medicine. Eur J Emerg Med 2007;14:25-31.
The possibility of natural disasters and public health emergencies coupled with the possibility of terrorism clearly support the need to incorporate emergency preparedness and response material into the curricula for every health professional school in the nation.
Discussion
To date, the focus has been on the education of the existing healthcare workforce. Students' needs differ from those of practitioners in that there is a fundamental difference between educational competencies and occupational competencies. It is also important to recognize that to assure proper preparedness there must be a clear connection between departments of public health and all other healthcare entities. To this end we included public health students in the creation of competencies and have shown that non-clinical practitioners can, and indeed must, be included in this process.
Observations
We describe a process and present a list of emergency preparedness core competencies for health care professions and their applicability to Medical, Dental, Nursing and Public Health students. While we have designed this set of competencies using these disciplines, they may be easily adapted to other healthcare disciplines. The only variations would be in the assignment of proficiency levels and the decision of whether or not clinical competencies are appropriate. The core competencies have been divided into the following four categories which represent broad subject areas and the separation of the competencies related to direct patient care:
– Emergency Management Principles
– Terrorism and Public Health Emergency Preparedness
– Public Health Surveillance and Response
– Patient Care for Disasters, Terrorism and Public Heath Emergencies.
Sleep disturbances are common symptoms during the immediate and long-term aftermath of exposure of traumatic events. While stress affects sleep in all age groups, due to differences in physiological, psychological, and socio-behavorial risk factors, the clinical management of pediatric patients with sleep disturbances post-disaster might be different. This study aims to systematically review scientific literature on the clinical management of pediatric sleep disturbances post-disaster and its clinical implication in developing countries. Methods: A keyword-based, systematic review was conducted for scientific publication in academic and disaster literature databases (Medline, PUBMED, Academic Search Premier, Google Scholar, ELDIS, PsycINFO, PILOTS and RELIEFWEB) until October 2010. Abstracts of all the hits were inspected to remove non-relevant articles, and all relevant articles were reviewed and scored by two reviewers to determine relevancy before being included in the final study database. Quality, relevance, and applicability of the reported literature were examined critically with the EBM level of evidence and EPPHPPQ (2003) assessment tool.
Results and Discussion
The literature disproportionally emphasized the clinical effects and psychological impacts of traumatic events on pediatric patients, and most reported studies were reported as a subset within PTSD study literature. Management of younger children, gender differences, clinical effectiveness of cross-disciplinary management modalities, and experiences in middle- and low-income countries were extremely limited. While principles of sleep hygiene and clinical guidelines for management of adult sleep disturbance are available, the application of clinical effectiveness and appropriateness of these guidelines in pediatric population must be examined further.
Conclusion and Implications
Currently, there is limited literature on the acute management of pediatric sleep disturbances post-disaster in developing countries. Evidence-based studies are needed to identify the appropriate clinical approaches to support the pediatric population with sleep disturbances post-disaster.
Timely actions can facilitate the efficacy of Emergency Medical Services (EMS) response in disaster by understanding the scale of event and shifting of traditional tasks. A simple scaling system of earthquakes/disasters by ABC is proposed: Level A treated by the local EMS. One or more Multi Casualty Incident's (MCI) in a defined geographical area that can easily be Level B hours, by reinforcement of regional and national aid coordinated by automatic autonomic response. An earthquake/disaster where the EMS and medical community can complete their task within 48 Level C - An earthquake/disaster that even joint national forces cannot eliminate within 48 hours.
Methods
Information from medical systems around the world was gathered to help develop strategies to minimize the weaknesses whilst achieving the objectives of the EMS via adapting to shifting conditions.
Results
EMS goal is to provide treatment to those in need of urgent medical care and arrange for timely transfer of the patient to definitive care. EMS are not qualified or equipped to delay victims in the field for hours or days. However, many patients in earthquakes do not require definitive treatment or have an immediate lifethreatening.
Conclusion
By scaling the event by the ABC - a timely coordinated autonomic regional / national response can begin immediately. An area defined as level A will automatically back-up a level B/C area, in an event that the standard communication and activation systems collapse. Moreover, a clear shift in EMS roles will take place in a level B or C events. Available-Hours Busy-48-Hours Catastrophe-weeks Types of Levels area for delaying evacuation. Prioritizing, sorting and sending patients that require immediate attention to definitive care whilst considering availability of destination facilities and transportation resources. Patients that do not require immediate attention or cannot be saved shall await evacuation.
The new jumbo jets, such as the Airbus680, which can transport 600 to 800 passengers, need special consideration in case of a crash, especially if the crash occurs near the airport. Survival parameters depend on the effect of the brutal deceleration and the high probability of thermic effects due to fire, but also the toxicity of the smoke. These new jets requires a different approach to planning for crashes. The scale of the disaster will be totally new in terms of numbers of casualties, numbers of fatalities, and numbers of family members to for whom to provide psychological and technical information. In addition, the problem of identification of the victims will be heightened, and will require more forensic teams. There is, in fact, only one way to manage this kind of disaster: international cooperation and coordination.
The purpose of this presentation is to report the results from a series of standardized exercises administered to experienced, disaster-emergency-responders on their “operational readiness.” Based on original research with Olympic athletes, these results include: a frontline-perspective of challenges in a disaster; a quantitative definition of “readiness;” and the creation of related performance indicators. A growing body of literature has drawn attention to the significance of mental-readiness skills in attaining peak performance in challenging situations. For example, we know that top-level athletes have particularly well-honed mental-readiness skills and that this fact has often separated those who win a gold medal from those who do not. In recent years, this research has been extended to other occupations, including the field of surgery, policing, and now disaster-emergency-response, and similar results were found. For example, in the study entitled “Gold Medal Policing: Mental Readiness and Performance Excellence” (McDonald, 2006), peak-performing police officers demonstrated excellent technical and physical skills but excelled in mental readiness skills. Traditionally, the focus of most core-competencies has been on the technical and physical skills necessary to perform the duties. Given what we now know about the significance of mental-readiness skills, we can specifically develop and formally recognize these skills. That is, in addition to seeking the technical and physical skills required of a job, particular emphasis is places on refining the mental skills that ultimately makes the difference between satisfactory performance and peak performance. The goal of any field-training, is to produce a competent, independent, functioning frontline-responder. Such a responder will demonstrate concrete, observable “performance indicators.” Current research on peak performers has been integrated into developing comprehensive performance indicators. This outcome can benefit the recruitment, selection, training and evaluation of professions seeking to enter into the unique world of disaster emergency medicine.
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).
Objective
To design and implement a sustainable tool for the collection and storage of data describing trauma patients at JDWNRH.
Design and Methods
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.
Discussion
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.
Speed and accuracy are major considerations in triage in emergency field settings. Traditional physical examination techniques often are limited in detecting the true nature and full extent of internal visceral injuries, for which delayed recognition and treatment may lead to catastrophic results. Ultrasound has a well-established role in the rapid initial assessment of intra-abdominal pathologies, including trauma, and contemporary portable ultrasound machines are available for use in the field. This presentation will introduce the basic principles of diagnostic ultrasound and its use in emergency settings. Common clinical applications and pathologies and potential limitations and pitfalls also will be discussed with image illustrations.
Zürich is divided by a river and > 6 km lakeside labyrinth of small streets in the old city. Since 1992, Zürich hosts the street parade, which is the biggest event in Switzerland and one of the biggest in Europe. It is an event of techno parties, and nearly one million people gather along the lake and the old city. Medical assistance is provided by the emergency system of Zürich in cooperation with the fire department, police department, as well as the emergency systems of the neighborhoods, civil protection, and Volunteers. This mass gathering is unique because almost 16 km2 of the city and old city and four of the six bridges that connect the two sides of the city are closed and dedicated to the Streetparade, which complicates rescue operations. Since it is impossible for an ambulance to get to injured persons in the crowd, and very difficult to transfer patients to a hospital, many stationary medical units and two boats are used in the city, each with a combination of emergency doctors, paramedics, firefighters, and volunteers, who also can build mobile units and an advanced medical unit in a shelter that has rooms for 108 patients. Every mobile unit has a GPS system that permits the Operational Headquarters to have an overview. This system has been helpful in this particular event, permitting medical personnel to reach the injured persons in short time and to treat the majority of the patients in situ, minimizing the necessity of transport. In 2010, 680 patients were treated 680, of which, only 42 were transported to a hospital. No deaths due to panic attacks of lack of emergency response have occurred in the past 19 years.
Human-stampede events are emerging epidemics with large unplanned or impromptu mass gatherings. They are increasing in frequency worldwide, yet little is known of the epidemiology and other characteristics that would allow for communities to prepare, prevent and properly manage medical outcomes. We report a non-traditional methodology to identify a stampede's epidemiological characteristics using news reports, social networking, and systematic search of the internet. This hitherto unused technological dimension is a useful adjunct to obtain crucial data on mortality and morbidity, improve immediate understanding of the pathophysiology of the event, and provides opportunities to develop public education to remove potential bottlenecks and improve crowd control of these preventable tragedies.
Method
A LexisNexis search was followed by sequential searches of multiple internet-based English-language news agencies and the few research reports available in the scientific literature. Date, country, geographical region, time of occurrence, type of event, location, mechanism, number of participants, number injured, and number of deaths were recorded. Descriptive analysis was performed for deaths, injuries and location for this abstract.
Results
Following an extensive search of media accounts and research reports, a total of 263 human stampede events were identified worldwide between 1980 and 2011 resulting in 8,268 deaths and over 16,707 injuries. Major Religious assemblages, particularly in India and the Middle East, accounted for the highest number of fatalities. Precipitants of stampedes follow a geographical pattern; In Africa, sporting and political events and in Europe, entertainment venues sparked stampedes. This case series reports 7 incidents in China. All cases occurred in the recess hour of schools, when students formed a bottleneck at narrow staircases, resulting in 27 deaths and 168 injured.
Conclusion
Understanding the triggers in mass gatherings for a human stampede have been greatly aided by advances in social networking, internet and video mobile phones. Particularly in difficult environments which were previously difficult to document. The patterns identified in this study can appreciably add to community level preparedness, prevention and improved clinical understanding and management at prehospital and hospital levels.
Flood is one of the most common disasters and contributes to many-disaster related deaths worldwide. According to the EM-DAT database, floods account for 38.7% of all incidences, 6.2% of the deaths and every year 43% of world population is affected by flood. There are various factors which magnify the impact of flood to the community in the catchment area. The nature and extent of the flood is determined by the physical location and topography, and by the built environment. The built environment comprises of the existing political, social and economic structures inherent in a community. In the post-flood period, the risk of diarrhoea is significantly higher for those with lower educational level, living in a household with a non-concrete roof, drinking tube-well water (vs. tap water), using a distant water source and unsanitary toilets. The 1998 Bangladesh flood study confirms that low socio-economic groups and poor hygiene and sanitation groups are most vulnerable to flood-related diarrhoea (Annya et al., 2010). The Bihar flood of 2008 affected 100 villages out of which Supaul, Araria, Saharsa, Madhepura and Purnea were the most severly affected districts. Nearly 2.5 million people were affected by the floodwater. Various disease outbreaks are a common phenomenon in a post flood scenario. In Bihar, the population witnessed outbreaks of malaria, diarrhoea, measles and cholera. This paper examines the various factors causing diarrhoeal spread in the five flood affected districts of Bihar. Also, the paper analyses the above factors in terms of most contributing and least contributing factor towards diarrhoeal outbreak. The methodology used for the study is the statistical tool of Standard Multiple Regression Analyses where several independent variables will predict the dependent variable. The various independent variables have been taken all the five affected districts in Bihar floods. They are malnutrition, population density, awareness levels, socio-economic conditions, literacy, extent of flood and availability of health facilities. These independent variables will determine how much each predicts the dependent variable and as a result help in analysing the linear relationship between the dependent and independent variables.
The use and number of Foreign Field hospitals and Foreign Medical Teams being mobilized after sudden onset disasters in the past decade has increased significantly. Examples include Haiti (2010), China (2008) Pakistan (2005), and Iran (2003). Foreign medical teams do not just work in field hospitals anymore and new trends of how FMTs are engaged need to be taken into consideration. After sudden impact disasters, there is undoubtedly a high need for surgical response. The role of primary care, immediately after a disaster or emergency has sometimes been described as low priority and therefore not needed during the initial response to disasters and emergencies. This oral presentation will review trends in the primary care needs post disaster and the literature around it. Using the Health Resource Availability Mapping System (a model that is derived from the standard health cluster tool and used for collection, collation and analysis of health sector information) and modified to sudden onset disasters, which primary health services when will be reviewed. Discussion and brainstorming encouraged!