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The earthquake in January 2010 killed more than 250,000 Haitians and caused traumatic injury to tens of thousands of survivors. In the aftermath of the earthquake, Haitian civilians assisted in various medical roles. Many of the civilians requested training, and 8 months after the earthquake, a team of American clinicians, EMTs and health educators returned to Haiti to teach a course in basic lifesaving and emergency care.
Methods
Using a modified French-language EMS training curriculum, 60 community members with no previous medical experience were trained during an intense 2-month period. Trainings were held to teach basic lifesaving and stabilization skills. The Gwoup Ayisyen pou Ijans was formed and is preparing to take the French-language EMS exam. A follow-up study is being conducted to assess the capabilities of the students.
Discussion
Preliminary challenges included securing safe places for training and teaching in both French and Kreyol. Successes were the willingness of trainers to volunteer time and equipment, and the high motivation of the students, despite the inability of the government to promise consistent work for an EMT force.
Chemical, biological, radiological and nuclear (CBRN) cases are seen as an increasing risk because of the increasing threat of international terrorism. Decontamination is one of the basic components of the intervention for CBRN exposure. The introduction portable decontamination unit in the hospital setting is described in this presentation.
Method
The general properties, facilities, and capabilities of the portable decontamination unit, which is present in the GATA CBRN Department of the Turkish Armed Force's Health Command, were evaluated.
Results
The portable decontamination unit in the hospital has a metal frame that is 54 m2 wide. It is composed of two tents that weigh about 300 kg. The metal frame, metal legs, and tent cloth are stored in carrying bags. Four people can construct the tents in 10 minutes. An educated squad of four people can prepare the decontamination system and instructions in 25–30 minutes. The unit consists of two lines: one for outpatients and another for inpatient decontamination, which includes a rail system. Each decontamination line contains an undressing, shower, and dressing section.
Discussion
Along with metal-framed decontamination tents, there also are inflatable tents. The inflatable decontamination units can be pitched in 5–7 minutes by an electrical air compressor. Metal-framed tents are easy to carry, as the frame, metal legs, and tent cloth are stored in carrying bags. By pitching the decontamination tent on a smooth ground in front of the hospital entrance, decontamination of patients can be completed before they reach the hospital. Another decontamination unit is in place next to the emergency department.
Conclusion
Terrorist attacks that result in mass casualties demonstrate the importance of CBRN preparedness. A decontamination unit and an appropriate CBRN preparedness plan should be constituted into the basic treatment system.
As in other branches of medicine, disaster medicine needs a scientific basis. A disaster medical response is only as good as the assumptions on which it is based. Many of these assumptions are incorrect and/or are not based on systematically collected evidence. Although guidelines for evaluation and research on health disaster management and guidelines for reports on health crises and critical health events have been published, no uniform template for collecting empirical data on medical care response in disaster situations have been published.
Method
An EMDM Academy Consensus Group was established representing several disaster medicine research centers, the disaster medicine section of the European Society for Emergency Medicine (EuSEM), the World Association for Disaster and Emergency Medicine (WADEM), and the World Health Organization WHO. The Consensus Group decided to limit the project to the acute medical care response. The project was organized around a series of workshops, which created a forum for the presentation, analysis, and listing of descriptors (variables) and their indicators relevant for the disaster medical response. An adapted Delphi method and the Utstein-style method were used to reach consensus on the descriptors and indicators.
Results
A uniform template of describing pre-event, event, medical response and outcome variables and their indicators relevant for evaluation and research on the disaster medical response have been developed, including the agreement on standard definitions.
Conclusion
A uniform reporting template and method are essential to gather empirical data on disaster medical response management in order to establish robust databases allowing disaster medical response investigators and researchers to collect evidence that will impact on response outcomes and provide best practice.
Emergency management education and large-scale disaster drills help to increase local capacity for dealing with a multitude of hazards. Video recordings of disaster drills offer participants with little exposure to fundamental emergency management principles an introduction to important topics and scenarios. Such resources allow ongoing training and education, thus maximizing the investment required to mount a large-scale exercise.
Methods
During emergency management exercises in Mumbai, India between 2008 and 2010, video recordings of prior exercises were used to augment training for clinicians, administrators and public health practitioners. During the exercises, videos depicting scenario-based disaster drills were produced for use as teaching and evaluation tools focused on pre-hospital care, trauma life support, and hospital operations. Videos are distributed digitally and online, extending the teaching impact of multi-day courses and serving as a benchmark for future exercises.
Results
During the 2010 exercise in Mumbai, approximately eight hours of video footage were recorded by professional producers, and by participants in the evaluation and monitoring track of the course. That footage was added to a library from exercises in Ahmedabad and Mumbai, India, in 2007 and 2008. Video was used as a tool for immediate feedback on participant performance as well as the foundation for ongoing instruction. Videos allowed students to be sensitized to important issues prior to taking part in a drill, and to participate in the post-drill evaluation process.
Conclusion
Video documents of disaster management exercises serve as a valuable addition to an ongoing program of emergency management education and preparedness. Short video pieces increase the effectiveness of a teaching program by providing re-usable, easily accessible, and setting-specific teaching tools.
Cerebrovascular disease include all disorders in which a part of brain is transiently or persistently damaged by ischemia or bleeding and/or where one or more blood vessels of brain are primarily damaged by pathological processes. The research confirmed the influence of risk factors.
Objective
The primary objective was to measure frequency of patients with cerebrovascular diseases in the Emergency Service during the period from September 1, 2008 to March 1, 2009. The secondary objective was to prove co-morbidity between the risk factors and cerebrovascular diseases.
Method
Numerical indicators for patients with cerebrovascular diseases are extracted retrospectively by statistical work-up for the six-month period. The data indicating the risk factors predisposing cerebrovascular diseases are obtained through the (hetero)anamnesis.
Results
From the overall number of 24,600 patients, 127 patients had a diagnosis of cerebrovascular diseases. The frequency of cerebrovascular diseases is linearly increasing with age; after the age of 50, frequency is doubled. The frequency of cerebrovascular diseases is higher in women than in men, the role of heredity is significant, and risk factors influenced development of cerebrovascular diseases as follows: 50.40% of patients had hypertension, 16.54% diabetes mellitus, 48.82% smoking cigarettes, 40.94% obesity, 20.47% alcohol abuse, 11.02% migraine-like headaches, 30.71% cardiovascular diseases and 22.05% hyperlipidemias.
Conclusion
Cerebrovascular diseases are increasing in developing countries. The main reason is poor control of risk factors. In the majority of cases it is possible to produce decrease of frequency of cerebrovascular diseases by elimination and reduction of risk factors through the change of life style. Pre-hospital urgent concept of therapy and improving of organization of emergency service will contribute to decreasing mortality and morbidity of cerebrovascular diseases.
Recently, the local governments in Japan implemented the measures for people requiring assistance during a disaster (PRAD). These measures aim to provide public assistance during a disaster for the citizens who registered themselves to the PRAD list in advance, by sharing their personal information among relevant local authorities. However, the needs for such assistance were not clear among chronic disease patients, and there are some concerns about privacy protection in relation to the PRAD list.
Objectives
The objective of this study is to describe the attitudes toward the registration to the PRAD list among rheumatoid arthritis (RA) patients.
Methods
Study subjects were the members of a nationwide RA patient group in Japan. Of about 20,000 members, 1,477 who lived in the municipalities affected by disasters from 2004 to 2006 were enrolled. Self-administered questionnaires were sent by mail. The subjects were asked their attitudes toward the registration to the PRAD list and categorized into three groups: (1) no need for assistance; (2) need assistance but will not register; and (3) need assistance and wish to register or already registered. Their concerns about privacy protection as well as socio-demographic and health status were also asked.
Results
Of 1,477, 664 (45%) responded validly, and 596 (40%) answered on their attitudes toward the PRAD list. Of these, 365 (61%) reported they need assistance, though 30% of them (108) did not wish to register. A majority of the subjects concerned about privacy protection among those did not wish to register (65%) as well as among those wished to register (55%). Patients who lived alone, and those with low income were more likely to wish to register.
Conclusions
There are substantial needs for public assistance during a disaster among RA patients although the privacy protection issue would be a barrier to be overcome for successful utilization of the list.
The prehospital management of a patient starts with a telephone call to and triage by the ambulance dispatcher centre followed by continuous evaluations by ambulance crews and staff at emergency departments.
Aim
The aim of this study was to find out if these units have the same triage systems and if the initial evaluation matches the outcome at the hospital emergency departments.
Method and Material
Over 27000 ambulance transports within Gothenburg were studied by evaluating the ambulance medical records with regards to initial triage performed by the ambulance dispatcher centre using a medical index and triage performed by ambulance crews and staff at the emergency departments.
Results
There was no common triage system between these units. We also found a discrepancy between the initial triage using the medical index and physiological-anatomical triage performed by ambulance crews and staff at the emergency departments. As an example 50% of all patients triaged as priority one by the ambulance dispatcher centre were down-graded to priority 2–4 by the other units involved.
Discussion and Conclusions
A mutual and standardized system for triage is needed. Although over-triaged by ambulance dispatcher centre may be medically motivated, the difference between priorities should be minimized to a medically accepted level (25–35%).
Paediatric asthma is a frequent presentation to Emergency departments. Early intervention may prevent progression of the acute phase to a severe or life threatening stage. Magnesium is a wonder molecule that has repeatedly undergone vigorous trials. Magnesium is used by intravenous and nebulized route in many guidelines across the world. Heliox keeps coming in and falling out of favour with conflicting literature reviews. Its simplicity of use makes it an effective tool in the treatment of exacerbations of asthma. Aminophylline is one of the earliest bronchodilator that has heaps of adverse effects. This presentations begins with a world tour of major guidelines with a special focus on Magnesium, Aminophylline and Heliox followed by an in depth literature search. Current literature and metanalysis for all the three drugs for pulmonary function test, hospitalisation and adverse effects are graphically illustrated. Based on the evidence so far, a guideline is proposed for the use of the above three drugs for Paediatric asthma.
Pre-decontamination triage aims to prioritize the use of decontamination facilities for casualties based on their severity of injuries. Pre-decontamination triage aims to: (1) ensure severe casualties undergo early decontamination, in order for them to receive early definitive medical treatment post-decontamination; (2) provide basic life support measures, e.g., stopping external hemorrhage, use of bag valve mask ventilation, even before decontamination; (3) early administration of antidotes for organophosphate poisoning (if present). Triage during the pre-decontamination takes place in the warm zone. Triage personnel must don personnel protective equipment (PPE) of level C or above. Donning PPE will decrease the visual, aural and tactile senses of triage personnel, adversely affecting their ability to carry out effective triage. With these limitations in mind, a pre-decontamination triage system was devised, modified from the Simple Triage and Rapid Treatment (START) protocol. Assessment will be based on the presence of airway, breathing, or circulatory compromises, or changes in mental status, similar to the START protocol. Recognition of organophosphate poisoning prior to decontamination is emphasized, as the toxidrome is recognizable and specific. Once organophosphate poisoning is diagnosed, the severity of the poisoning is graded and antidote administration is carried out using the Mark I Kits. The need to be certain of the diagnosis of organophosphate poisoning before administration of Mark I Kits is emphasized. The diagnosis may not be apparent initially to the triage personnel till a spectrum of patients with toxidromes suggestive of organophosphate poisoning has been seen.
Disaster risk reduction (DRR) has emerged as a core element of sustainable development. (UN/ISDR 2002). Reducing risk requires long-term engagement (O'Brien 2006), and the actual work of DRR is largely a task for local communities. (Schipper 2006). DRR shares some tenets with preventive medicine (Sidel 1992). As in preventive medicine, risk reduction calls for a basic attitude shift in the minds of many who traditionally get sick first and seek treatment later. The challenge for DRR, as applied to health, is to broaden the focus of disaster management from that of tertiary prevention, (response and recovery) to also emphasize primary and secondary prevention, (prevention, preparedness and mitigation).
Discussion
The role of the health sector spans across the spectrum of DRR to include prevention, mitigation and preparedness activities. DRR, as applied to health, is intended to prevent and/or reduce the negative health consequences of disaster hazards. This is accomplished by two means: hazard avoidance and vulnerability reduction. Health and medical volunteers at the community level can play an important role in reducing human vulnerability to disasters by: (1) reducing susceptibility – “healthy people” (2) reducing exposure to disaster hazards – “healthy homes; (Srinivasan et al. 2003); and (3) increasing resilience – “healthy communities”. Volunteers help to reduce exposures to disaster hazards through participation in population protection measures such as shelter-in-place, evacuation and mass care. They work to reduce susceptibility by participating in health care, health promotion, and immunization programs. Finally, volunteers may build resilience by way of their participation in community-level preparedness, response and recovery efforts. (Keim 2008)
The acute coronary syndrome is a leading cause of heart death among adults. The treatment of such patients begins during the first contact with the doctor who is in most cases neither an internist or cardiologist, but an emergency medicine specialist or general practitioner working in the emergency department. For that reason it is of great importance to educate doctors who will be able to establish a fast and precise diagnosis, start therapy and organize quick transport to the nearest catheterization room or coronary unit.
Objective
The primary objective was to measure frequency of patient's visits to the Emergency Department because of an acute coronary syndrome. The Secondary objective was to examine the choice of treatment in pre-hospital conditions.
Methodology
Through the statistical retrospective analysis we collected the data from the Emergency Department protocols for the period between June 1, 2008 and December 31, 2008.
Results
In 14,986 patients during the six-month period, 343 of them had acute coronary syndrome. Men were more affected ((59.5%) than women (40.5%). Most cases belonged to the age group from 65 to 80 years (39.6%) and prevalence after 50 years shows abrupt growth. According to the diagnoses, most patients had unstable pectoral angina (42%) and then followed stenocardia (31%) and AIM (27%). Other therapy included NTG (22%), antihypertensives (21%), acetyl-salicylic acid (20%), analgesics (13%), antiarrhythmics (4%). Fifty-seven percent of the patients had complications. STEMI was diagnosed in 69% of patients, and most often the anterior wall was involved (35%).
Conclusion
The diagnosis of acute coronary syndrome was established in 343 patients based on the clinical image, electrocardiographic changes and level of cardiospecific enzymes (troponin T).
The European Project SICMA (Simulation of Crisis Management Activities) provides a modeling of the behavior of the entire Health Service System during field emergency operations, as well as the rules it operates by. The first step toward chain procedure modelling in the management of major emergencies is the representation of a traumatized patient whose health status can be followed in time during simulation. Since management of the trauma patient follows criteria of stabilization of main physiological functions, a trauma patient model was developed based on fundamental pathophysiological functions independently of specific lesion characterization. Methods: Each patient's health status was modelled according to 5 parameters (ATLS): A(airway), B(breathing), C(circulatory), D(disability), E(Exposure). Patient samples are extracted from a 10.000.000 patient database, generated by considering real anatomical lesions compatible with type and severity of considered scenarios (explosion, building collapse, fire, gunfight). Simulated lesion characteristics were then converted to pathophysiological parameters. Each physiological compensation parameter was represented by: (1) baseline value expressed as percentage of altered function; (2) function reduction rate over time, obtained by a mathematical approximation of clinical worsening. From level of function, rate of worsening and function-specific death thresholds, estimated time-to-death according to sustained damage is computed.
Results
This model allows simulation of evolution of patient health status both in absence of medical care, but also under therapy, in terms of immediate increment of each single parameter (“temporary” treatment), and of reduction or zeroing of parameter dec14rement rate (“definitive” treatment).
Conclusion
This model, based on evaluation of physiological parameters, presents an advantage over the consideration of single lesions, because simulating logical procedures that guide treatment choice in real situations can provide a more accurate assessment of casualities for those actors assigned to management of major emergencies.
To describe the Emergency Management Plan for H1N1 Major Epidemic Event to reduce the impact of the patients in a general emergency department.
Method
Einstein hospital has a catastrophe management program which is regularly tested for several scenarios: accidents, fire, and biological attack among others. Special concern is given for pandemics since we need to keep employees' fit to keep the hospital running as usual.
Results
On April 24, WHO issued an alert about the rising cases of influenza virus H1N1. Immediately we provided a plan of care for suspected or confirmed cases based on WHO and CDC guidelines. On April 29 increased level of alert to Phase 5 (pandemic imminent). The crisis management group created a multidisciplinary team with actions directed to Einstein's doctors and staff, 6,000 registered professionals, engineering, emergency care, laboratory, occupational medicine, hygiene, waste disposal, among others. Communication was maintained with government to update the official guidelines. Two specific drills were performed to train staff and support teams. Debriefings were made to all participants and lessons learnt were incorporated.
Results
Official figures showed that in São Paulo until August 2 have been reported 6,383 cases, 11.8% (756 cases) of these were reported by HIAE. From 5 May 2009 to 05 December 2009, 1,324 cases were reported. There were only four deaths of patients with influenza A H1N1 and two acquired in hospital and the daily business were not compromised by the epidemic showing the importance of a crises management plan.
Conclusion
The methodology of realistic simulations has showed effectiveness in the planning of how to manage Major Epidemic Events and improvement actions from this exercise has been showing best results for the patient flow and safety whenever this kind of situation happens at Hospital Albert Eisntein.
In the Netherlands in 2010, the multidisciplinary guidelines for the psychosocial support of uniformed services organizations (USOs) were developed. These guidelines are accepted as a national standard for psychosocial support for police, firebrigade, ambulance services, the Ministry of Defence, and coast guard. This presentation will focus on the backgrounds, development, and status of these guidelines, and an outline of the contents will be given. Members of USOs consistently are exposed to potentially shocking events. It was recognized that there is a need in the field for clarity and unambiguity about the organization of psychosocial care to this group. The goal of the guidelines is to guarantee optimal psychosocial support and care after experiencing disasters and shocking events, so that stress-related health problems among members of the emergency services are prevented. The guidelines are evidence-based, i.e., they are based on the results of the latest scientific studies, knowledge from experience (best practices), and other considerations. Consensus was reached that the promotion of the existing means of recovery of the USO member, and the facilitation of these means by peer support structures, are the key to a successful psychosocial support system. The peer support system has an important role in recognizing those affected with psychological and/or serious clinical symptoms that require diagnosis and/or treatment. Diagnosis and treatment should be exercised by mental health professionals. Therefore, they must be readily available, but should only be deployed when necessary. Three phases in the psychosocial support for USO members are discerned: (1) preparation (selection, information and training); (2) peer support and monitoring, (3) and referral for professional care (if necessary). The guidelines provide recommendations for the USO for each of these phases. National guidelines such as these should be discussed internationally to see whether they can provide a basis for further (international) implementation and use.
Merapi, the most active volcano in the world, erupted on the 26th October 2010 at 17.02, and followed by several eruptions. The biggest eruption was on the 5th of November 2010. Damages were catastrophic: 386 people killed, and more than $400 million lost. A wide area of fertile lands and settlements were destroyed which resulted in more than 200.000 refugees. This disaster had impact to 2 provinces and 6 districts. At the emergency phase, a special task force was established by central government of Indonesia. This paper aims to evaluate the task force and the role of its management support during the acute phase in the disaster.
Method
an input and process evaluation of task force work was implemented.
Results
The input evaluation shows that the task force members for emergency response came from central, provincial, district government employees, universities and non government organisation members. The financial sources are from public and private funding. The activities process of task force in forms of health response command system, temporary information system, communication and telecommunication system, supporting the volunteer groups, managing the refugees camps, implementing surveillance system, and backed up the local district health officers. There were problems of programs coordination and channelling the budget from national treasury due to the multiple eruptions. Most of these problems were solved by a management support team for the task force.
Conclusion
The multiple strikes of Merapi eruption needs better human resources management and financial support. During Merapi eruption, it is proved that a management support for emergency response task force is important. This management support allowed better control and coordination of available resources.
Early involvement by health services in the planning, preparation, operations and post-event analysis of mass gatherings provides one of the best opportunities to engage with other agencies and to develop a real sense of your agency's capabilities. The establishment of the new ISO Standards on Risk Management provide the best opportunity in a decade to structure this work in a manner that will develop true capacity to manage the multitude of risks health services face this century.
Discussion
Rather than ad hoc and sometimes conflicting approaches we now have the “lingua franca” on which to build our policy, capacity development, budgets and response. The evolution of risk management standards has seen the release of ISO 31000: 2009, Risk management - Principles and guidelines and ISO 31010: 2009, Risk management – Risk assessment techniques. Largely based on the earlier Australian Standard 4360 and work of the IEC these standards have the potential to embed critical aspects of the responsibilities of health agencies worldwide into a universal singular policy framework. Translating this into other areas of health agencies work includes communicable disease management and emergency management, in general, which will allow other agencies to understand the “health” perspective and vice versa.
Conclusions
Drawing on personal experiences from mass gatherings since 1997, the author will demonstrate the utility of the ISO Standards as the framework for health emergency management including mass gatherings. Examples will include mass gatherings at the international level within the Asia- Pacific Region to the local level within Sydney, Australia from 1997 to 2010.
Most research into the outcomes of injury has focused on mortality rather than the physical, social, and psychological sequelae of non-fatal injuries. The health and long-term outcomes of a cohort of accidentally-injured patients were studied in order to assess the impact on quality of life.
Methods
The cohort of patients was derived from six previous studies spanning 1988–2003. Patients were followed-up with to ascertain if they were still alive, and survivors were sent a follow-up questionnaire in 2006. The questionnaire asked about current problems resulting from past injuries, use of health services, and measures of health related quality of life (the EQ-5D and SF-36 or Nottingham Health Profile (NHP)). A sample of 114 also received detailed face-to-face interviews.
Results
A total of 2,418 patients were followed-up on between 4–15 years post-injury, of whom 311 had died. There were 580 completed follow-up questionnaires, and of these 64% reported health problems related to past injuries. The mean EQ-5D score at follow-up was 0.132 tariff points below the mean for a normal age-sex matched population, and SF-36 scores were 5–15 points worse than population norms. At all ages, EQ-5D and SF-36 scores were similar to those of the normal population aged 75. Interviewed patients also reported substantially more disability than the general population. Increasing injury severity was associated with almost all aspects of worse health at follow-up, and severe lower extremity injuries were strongly associated with poorer outcomes.
Conclusions
Injured patients continue to experience significant reductions in health and health-related quality of life for many years after their injury.
Dr. Madigan will discuss the evolution of awareness of the need for emergency preparedness and response for the animal component in disasters and emergencies in the United States and internationally. Emergencies and disasters affect animals and those who own them, including companion animals, animals who's use is for sustainment or groups of animals which serve as a key component of individuals economic existence. Numerous studies have shown the public will delay or refuse evacuation from impending risks if they have to leave their animals behind. A significant component of the public will refuse use of non pet associated shelters which then affects public safety and wellbeing. Emergency responders can be put at risk because of rescues required of non-evacuated individuals staying with their animals. Emergency responders may be called to be involved in animal rescues or animal evacuation. Animals impacted by disasters may incur injury, entrapment, and lack of food and water. Veterinary triage, emergency rescue, treatment and humane euthanasia are driven by animal welfare concerns as well as legislation mandating care of animals in declared disasters in some countries. Dr. Madigan's presentation will provide discussion and video examples of organized response to small and large scale animal emergency and disasters associated with 15 years as Chief of the UC Davis Veterinary Emergency Response Team. Additionally the training components needed for effective and safe preparedness and response will be discussed.
In response to recent real world events impacting public health and medical services, The Yale New Have Center for Emergency Preparedness and Disaster Response (YNH-CEPDR) has developed a methodology for collection and analysis for after action reporting of response operation effectiveness. This process has been implemented to multiple real-world events including the 2009/2010 H1N1 response activities. This method utilizes the US Department of Homeland Security Exercise and Evaluation Program (HSEEP) doctrine for the collection of response information, analysis and development of After Action Reports.
Objectives
In this session, participants will be introduced to data collection methods that include a combination of onsite response evaluation by subject matter experts applying a set of established operational response objectives, targeted web-based surveys collecting both qualitative and quantitative data regarding public health and medical staff opinions regarding response operations and achievement of objectives. Also introduced will be focus group interviews to determine response successes, opportunities and recommendations for improvement. This session will also provide an overview on the utilization of additional data sources including situational status reports, press releases, incident action plans and meeting minutes. In additional to providing a framework for developing a comprehensive After Action Report for a real-world response, this process can yield data that can be used to enhance ongoing response operations as well as to support anticipated response operations, such as applying lessons from one pandemic wave to the next. During the session, participants will be provided an opportunity to discuss their process for evaluating real-world events and to identify how this methodology can be integrated into their organization's response evaluation activities.
India with 1.08 billion populations is vulnerable to earthquake (56%), floods (8%), cyclones (12%) and droughts (28%) every year. It is further compounded with refugees, riots, epidemic and endemic situations. Disaster psychosocial support and mental health services has consistently grown and standardized over the past three decades in India. The initial experiments' started in 1981 with a circus tragedy and documentation of prolonged grief reaction. In the Bhopal gas tragedy (1984) mental health services were integrated through primary care doctors. The Marathwada earthquake (1991) involved primary health care personnel in provision of mental health care to the survivors. The Orissa super cyclone (1999) saw the emergence of psychosocial support to the community using local resources like community level workers who were survivors by themselves. The feasibility study involving 40 such workers was expanded to a pilot model with 400 workers in the Gujarat earthquake (2001) and later to the level of a District model in the Gujarat riots (2002). These developments paved way for the State model when Tsunami struck the eastern coast of India affecting three States and two Union Territories in India. The experiences and experiments led to the development of standardized capacity building tools and intervention kits with level and limits of care being addressed. The Indian experiences has seen a striding change from psychiatry paradigm to public health model, to the development of a standardized psychosocial support models involving community at large. The lesson learnt has been helpful in developing the National Guidelines on Psychosocial Support and Mental Health Services by the National Disaster Management Authority of India. These service models could be adapted to the developing South East Asian countries where there is a paucity of trained professionals to attend the needs of the survivors.