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Heart trauma is a severe form of thoracic trauma with an incidence of 7–14%. Heart trauma can be either open or blunt, with the latter more prevalent during a disaster. Possible open heart injuries include: (1) pericardial injuries; (2) superficial myocardial and coronary vessels injuries; and (3) penetrating cardiac wounds. The variants of blunt heart trauma include: (1) heart concussion and contusion; (2) rupture of the heart wall and intracardiac structures; (3) rupture of cusps and cords of the heart valves; and (4) cardiac septa (i.e., post-traumatic heart lesions). The latter are characteristic of injuries caused by a fall, and/or a crushing event. The course of heart trauma is severe, and is complicated by the development of shock and catastrophic hemodynamic disorders due to the sudden occurrence of post-traumatic heart lesions and infarction. Thus, verifying cardiac trauma can be complicated. Diagnosing and assessing the severity of heart trauma requires the measurement of intra-arterial and central venous pressures, chest radiography, electrocardiography, pericardial puncture, echocardiography, magnetic resonance imaging, cardioangiography, and measurement of heart enzymes. One-hundred twenty-seven patients ages 2 to 42 years with open (92.1%) and blunt (7.9%) cardiac trauma were treated. Of these patients, 16.5% were children and teenagers. The challenges of treating heart trauma include simultaneously carrying out anti-shock treatment, surgical operation, and resuscitation measures. If post-traumatic heart lesions are diagnosed, surgical correction should be performed despite cardiac decompression. The use of cardiopulmonary bypass is essential.
WHO Regional Office for Europe - Health Systems Crisis Preparedness Assessment Tool Bayer CP, Rockenschaub G.
Objectives
Health crises are often unpredictable and may occur at any place or time. Communities are particularly vulnerable when local and national systems, specifically health systems, are unable to cope with the consequences of a crisis, usually because they are overwhelmed by a sudden increase in demand or because the institutions that underpin them are fragile and cannot deliver what is required. The World Health Organization (WHO) Europe Health System Crisis Preparedness Assessment Tool aims to provide guidance to ministries of health and other relevant authorities on evaluation and strengthening of their health system's capacities for crisis management.
Methods
Based on an all hazard approach, an assessment tool was developed which comprises essential attributes considered vital for countries to meet the challenges of future health crises. The foundation of the tool derived from expert consultation workshops and pilot testing in eight countries in the WHO European Region.
Results
The tool lists essential attributes with respective indicators crucial for evaluating and identifying gaps in health system crisis preparedness. The assessment tool is structured according to the six building blocks of the WHO health system framework and is complemented by a user manual, allowing countries to apply a self–assessment approach. The tool is intended for use by ministries of health or other relevant institutions.
Conclusions
The tool may help determine the current status of health system crisis preparedness and facilitate the development of a prioritized plan of action that addresses any gaps identified. When used regularly the tool will help monitor progress.
In this study the cases occurred due to a direct effect of trauma and trauma-induced complications that might needed medical care and intervention in the field after the first 5 days of disaster were investigated. The cases in the field were determined by field screening and individual medical and surgical interventions have been conducted. The wounded that cannot be treated in the field were taken to the field hospital by the only available emergency ambulance, owned by Turkish Health Teams, to be treated by specialists. In the conclusion of the paper, the necessity and effectiveness of interventions provided to sick/wounded persons in the field who couldn't reach hospital was discussed.
La réalisation de gestes de secours adaptés par le premier témoin diminue la mortalité et réduit les séquelles pour les survivants après accident et détresse vitale. L'Académie Nationale de Médecine Française a souhaité, dans un rapport adopté en juin 2010 une systématisation des obligations de formation de la population au secourisme, soulignant le retard de la France en la matière. L'Automobile Club Médical de France (ACMF) souhaite rebondir sur la dynamique induite par ce travail afin de concevoir un programme spécifique de premiers secours aux accidentés de la route. Il souhaite une généralisation rapide de son enseignement à tous les candidats aux permis de conduire. L'objectif d'avoir lors de chaque accident du trafic un premier témoin capable de maintenir la survie des victimes en attendant l'arrivée des secours professionnels est clair. Le contenu de cet enseignement et les modalités pédagogiques sont en cours de réflexion par un groupe réuni à l'initiative de l'ACMF. Cette proposition sera soumise à l'observatoire national du secourisme en charge de la validation des contenus. La séquence de formation ainsi retenue aura vocation à devenir le module de base pour la formation des usagers de la route, à l'image du module “Alerter-Masser-Défibriller” dans le domaine de l'urgence cardiaque. Nous présenterons donc les principales causes et les statistiques estimées de morts évitables par l'intervention des premiers témoins.Puis nous décrirons les gestes réalisables par tout citoyen formé: alerte rapide et adaptée, prévention des sur-accidents, libération des voies aériennes supérieures, arrêt des saignements visibles. Ce programme sera une formation courte, pratique et gestuelle.
To describe results of experience in providing surgical aid to children in technological and natural disasters in various countries of the world: Haiti, Algeria, Armenia, Afganistan (three times), Georgia, Egypt, Russia, Indonesia (twice), Iran, Pakistan, India, Japan, Gaza strip, Chechnya, and Yugoslavia.
Materials and Methods
The Russian specialized team consisting of highly qualified pediatric specialists (traumatologists, neurosurgeons, plastic surgeons, specialists in wound treatment, anaesthesiologists-reanimatologists and others if necessary) work at local hospitals in the disaster zone. All of them work as volunteers. The most serious pediatric victims were concentrated in one or two regional hospitals. The volunteer specialists work on a twenty-four hour basis together with local doctors. Every day they examine patients, control wound bandaging, and perform surgeries. For long tubular bone fractures metalosteosynthesis is used. Modern techniques are used for Crush syndrome and for extended and purulent wounds (water-based ointments, early autoplasty). Currently, the main difficulty in many cases is primary treatment of extensive wounds with their complete closure and the many indications for amputations. Conservative and sparing techniques are not often used.
Conclusions
Pediatric victims in technologic and natural disasters must be helped by pediatric specialists. Our experience in the countries to which we have responded have revealed that there are not enough local specialists who can provide highly professional aid to children. There is no known coordinating structure in the world to efficiently organize specialized pediatric help to children in disasters and wars.
The Sichuan earthquake on 12 May 2008 with a magnitude of 8.0 killed > 87,000 people. The response of the Hong Kong Red Cross (HKRC) included a basic healthcare team to a small rural town called Yanmen three weeks after the earthquake. The objective of this study was to review HKRC's medical records to identify the disease pattern in the Chinese rural setting post earthquake.
Methods
A cross-sectional, record-based study of all patients treated by the HKRC basic healthcare team from 01 June to 19 June 2008. This retrospective study studied the medical records collected during the clinical consultations, and descriptive analysis was performed for the demographic and clinical information. Blood pressure measurement was classified according to the JNC-7 classification, and the age- and gender-specific prevalence of hypertension was sought.
Results
A total of 2,034 cases were seen during the 19-day period with daily attendance ranging from 73 to 153 cases. Musculoskeletal, respiratory, and gastrointestinal problems were the top three categories and accounted for 30.4, 17.4, and 12.7% respectively. Trauma accounted for 5.4% of the cases attended, and 26.0% of the injuries were related to the earthquake. A total of 38.7% of the consultations were for medical problems that existed before the earthquake. A total of 43.4% patients with blood pressure measurements were above the recognized cutoff for hypertension.
Conclusions
Due to the impact and time phase post disaster, trauma, and injuries directly resulting from the earthquake did not contribute to a large number of cases. However, the management of chronic illness was an important issue, especially with the excessive prevalence of high blood pressure found in this study. Further studies to investigate the relationship between chronic diseases including hypertension and post-earthquake conditions are needed.
Disasters and large-scale crises continue to increase in frequency. To mitigate the potential catastrophes that confront humanity in the new millennium, an evidence-based approach to disaster medicine is required urgently. This paper moves towards such an approach by identifying the current evidence-base for disaster medicine.
Methods
Using a search strategy developed by the Cochrane Prehospital and Emergency Health Field, three independent reviewers searched the electronically indexed database MEDLINE (January 2000 – August 2010) to identify peer-reviewed literature relevant to disaster medicine. Reviewers screened the titles and abstracts identified by the search strategy and applied predetermined criteria to classify the reported publications for date, source and study type and topic.
Results
A total of 8149 publications were identified. Of these, 8% focused on mitigation, 22% on preparedness, 19% on response and 51% on recovery. The publications were overwhelmingly anecdotal or descriptive (89%) while 5% were quantitative studies and 6% used qualitative methodologies. Only 66 of these publications were classified as being high level evidence. The publications were published in 928 journals, of which 34% were mental health related journals and 28% were public health journals. The journal “Prehospital and Disaster Medicine” had the greatest number of publications (5%) of all journals publishing on issues within the scope of disaster medicine. The events with the greatest numbers of publications were the 9/11 terrorist attacks, Hurricane Katrina, the Indian Ocean Tsunami, and the conflict in Iraq. Of note, this search highlights the lack of publications reporting on the application of evaluation tools or frameworks.
Conclusion
Given that the “science” of disaster medicine is spread across over 900 different journals, keeping on top of the evolving evidence-base of this emerging discipline will continue to be a challenge. Furthermore, the overall low quality of the evidence is an ongoing concern.
Trauma is one of the leading causes of morbidity and mortality across the world with traumatic brain injury (TBI) being an important cause of trauma related deaths. The aim of our study was to review the medical charts of patients who died within 24 hours of presentation to our Hospital after head injury.
Methods
We received approval from the institutional review board to conduct a retrospective review of patient charts at Acharaya Vinoba Bhave Rural Hospital, in Sawangi (M), Maharashtra (India). All patients who died within 24 hours of the presentation to the emergency department (ED) and had been diagnosed with TBI were included in the study. We collected data from 113 charts between January 2007 and December 2009.
Results
During this three year period, 113 patients died within 24 Hours of admission to the hospital. Of these, 37% (42/113) were diagnosed with (TBI). We conducted a chart review of these 42 patients. All our patients were brought to the ED by relatives or bystanders in non-ambulance vehicles. At the time of presentation to the ED, nearly all patients were normotensive, with only one patient with hypotension The Majority of our patients had a Glasgow Coma Scale of less than 5.
Conclusion
Our study brings to light various deficiencies in rural India, trauma care which include immediate rescue and transportation. Although patients were provided the optimum care in the ED, however it was not associated with favorable outcome. This highlights the need of a Trauma Registry to record real-time data which will help to improve care and systems.
“Facilitating disaster nursing research in Oceania Region” Natural disasters in the Oceania region and surrounds include for example earthquakes, volcanic eruptions (Rabaul, PNG, 1994, Merapi, Indonesia 2006), tsunamis, floods,(Indian Ocean 2004) fires, drought (Australia, 2009) and also pest plaques and pandemics which affected the broader international community. Between 1980 and 2008, there were 380 disaster events reported in the Oceania region in which 4,450 people died. That is approximately 154 deaths and 668,786 people affected at a cost of approximately $US 889 million per year. However despite this significant number of deaths and injuries, there is limited reporting on the nursing experience during such disasters or the impact of nursing on communities during response and recovery. This is due to the prioritised clinical focus of nursing resources of most countries during these events. A network of authors and researchers is being established in the area to support the reporting of nursing research in developing countries such as Papua New Guinea, Fiji, the Solomon Islands, Vanuatu, and Indonesia where nurses receive little post basic education, have limited opportunities to review the evidence for practice in disaster and emergency nursing, yet are regularly required to support the multidisciplinary disaster health team without essential support from the nursing research community. The network is essentially web-based and consists of a translational research approach via a network grid of researchers in response to a disaster event. Researchers from neighboring countries not clinically involved in the event respond by discovering and accessing data, analysing and reporting through a portal that enables timely reporting for discussion, publication, e-learning and dissemination of contemporary disaster nursing practices. This paper will report on the development of the network and its nexus with the WADEM Nursing Research Committee.
Appropriate triage shortens the delay in definitive care. this study examined whether the implementation of START triage criteria in emergency departments (ED) reduces over- and under-triage of patients. The purpose of this study was to examine the impact of START triage criteria on over and under-triage subjects.
Methods
The study was performed between 01 January to 15 September 2008. All patients presenting to the ED were recruited. A triage nurse tagged the patients with a red, yellow, and or green wristband, as per START triage protocol. Over-triage was defined as patients who were re-triaged from red (R) to yellow (Y) or Y to green (G) within 30 minutes of arrival. Under-triage was defined as patients re-triaged from Y to R or G to Y within 30 minutes of arrival.
Results
Of 25,928 patients, triage was performed for 25,468 (98.2%) subjects. A total of 8,303 were triaged during the morning shift, 6,994 during the evening shift, and 9,978 during the night shift. A total of 1,431 (5.6%) subjects were tagged as R, 10,634 (41.7%) with Y, and 13,424 (52.7%) were tagged as G. Four hundred seventy-four (1.9%) patients were over-triaged. Two hundred twenty (0.9%) were under-triaged.
Conclusions
The START triage criteria reduce over- and under-triage of patients.
Lessons learned from medical humanitarian mission during Somalia civilian war 1992–1994. Moroccan experience L. Safi. Chirurgical Intensive Unit Mohammed V Military Hospital Hay Riad Rabat Morocco Introduction Natural disasters and civilian war in Africa demonstrate a similar critical need for national preparedness. As one of a team of military physician who went on a medical mission, I would like to share glimpses of our experience and reflect our thought about humanitarian mission.
Objective
To report our experience during medical humanitarian mission.
Background
During Somalia civilian war Morocco deployed level 2 hospital to provide medical and social aid to soma liens during united Nations interventions UNISOM. The specific mission was to provide immediate relief to the affected population of Mogadishu, to minimize loss of life, and to mitigate human suffering. A team of 21 physicians specialists and 40 nurses were deployed in an university campus to provided medical assistance.
Methods
Data were collected from interviews, observations, field notes, memos, and retrospective study of medical statistique.
Results
80% of all patients we examined have infection disease in all fields: dermatology, ophthalmology, ORL, pneumology etc 90% of childs have denutrition Only the emergency surgery was involved.
Discussion and Conclusion
In doing so, the medical team learned many important lessons, including five of particular value to planners of similar relief operations in the future. A successful medical humanitarian mission will depend on accurate and relevant medical intelligence and socio-geographical mapping in advance of deployment.
This paper examines the coordination framework and interventions undertaken by the Sri Lankan health sector in providing essential health services to the displaced communities in the aftermath of the violent conflict in 2009. The narrative describes, in a chronological format, the strategies and actions undertaken by the health sector in response to a rapidly changing humanitarian crisis. The paper examines some of the key challenges faced by the health sector in the post-conflict recovery phases, the most pertinent being the human resources for health needs.
Methods
A review of Ministry of Health departmental meeting minutes/circulars, inter-agency health coordination meeting reports, weekly surveillance reports, inter-agency/agency assessments, media files, and donor and health cluster member reports were compiled and then analyzed in order to construct a narrative on how the Health Sector responded to the humanitarian crisis (from acute emergency phase to the post-conflict recovery and resettlement phase). The authors also were integrally involved in the planning, development, implementation, and monitoring of a spectrum of health sector interventions during the humanitarian crisis from within Government and the United Nations system.
Recommendations
A health systems strengthening approach, which places emphasis on human resources for health, can be effective in delivering high impact, sustained, high quality health care even in difficult and complex humanitarian emergencies such as civil war. The Sri Lankan experience has shown that harnessing effective human resource management stratergies in crisis also is vital for the post-conflict health system recovery phase that follows.The excuse that “the system may be too overwhelmed”; or health departments “too overstretched” to lead a coordinated effort can be mitigated with positive leadership and planning. The dividends of working in such an approach also ushers reconcilliation via a unified health workforce and promoting the idea of health as a bridge for peace.
This session offers an overview of the Strategic National Stockpile (SNS) and the Cities Readiness Initiative (CRI), including CHEM PACK. Managed by the US Department of Health and Human Services Centers for Disease Control and Prevention (CDC), “push-packs” of this critical federal cache of pharmaceuticals and medical materiel are at sites located throughout the country. The CDC's CRI is a federally funded program designed to compliment the SNS and enhance preparedness in the nation's largest cities and Metropolitan Statistical Areas (MSA) where more than 50% of the US population resides. Through CRI, state and large metropolitan public health departments continue refining plans to respond to a large-scale bioterrorism attack by dispensing antibiotics to the entire population of an identified MSA with 48 hours. The SNS Technical Assistance Review (TAR) will be reviewed, as well as best practices and lessons learned from successful public health emergency preparedness and response programs throughout the US.
Floods are among the most common hazards in the world and can result in a devastating impact on human life and property. The impact of floods on humans can be traced directly to factors such as the location and topography of the area, as well as demographics and characteristics of the existing environment. Pakistan is currently facing the worst humanitarian crisis in history. It is faced with daunting challenges of reviving and reconstructing almost one fourth of the population. Latest government figures indicate that over 14 million people have been affected by the floods. More than 1.5 million cases of diarrheal diseases have been reported so far. Over 235,000 people have been treated at the diarrhea treatment centers set up in the aftermath of the floods. Floods are unique in their nature since every region is characterized by diverse factors. This paper examines closely the diarrheal outbreak in the flood-ravaged provinces of Pakistan. The study looks at the extent of spread of diarrhea across different time periods through a comparative analysis of different provinces affected. There are many direct factors that affect the severity and scale of floods and, in turn, impact human health like contaminated water, cramped living conditions and lack of sanitation facilities. The paper explores the pre-existing indirect factors responsible for the spread of outbreak in the provinces. These range from geography, socio-economic conditions, demographic features, topography, and community infrastructure. These factors play an extremely pivotal role in determining the nature of response required to control the diarrheal outbreak.
According to the Belgian Hospital Disaster Planning Act, all hospitals are required to have written disaster plans and to routinely conduct annual disaster drills. In 2010, three neighboring hospitals organized independently from each other an evacuation exercise of a critical care department (CCD): two university hospitals of a Dialysis Center and a One-day Surgery Clinic respectively and the military hospital of a Burn Unit.
Aim
To compare these CCD's evacuation plans and drills and the overall hospital emergency incident response and command system.
Methods and Results
Conducting an evacuation exercise in a CCD, moving vulnerable highly dependent people towards an alternative shelter site is challenging, causing an important burden to ongoing medical specialist care, working staff and critical infrastructure. In all three CCD, it was decided to conduct a simulated evacuation exercise following an internal fire, thereby deploying fashioned simulated patients and visitors but bringing into action the regular attending medical, nursing and logistic staff. In each hospital a multidisciplinary design team was launched, consisting of the hospitals disaster preparedness coordinator, the EMS-staff, external emergency incident management and operational engineering experts. The appointed objectives for evaluation were the knowledge of the regular evacuation drills, especially the clearance of an intensive care or an operating room; access to evacuation routes; visibility of safety guidelines; need of specific evacuation equipment for the movement of patients; mission and tasks of the hospital's first response team and the medical incident manager; communication and information flow and the establishment of the hospital's coordination committee.
Conclusion
1. Simulated hospital evacuation exercises increased the hospital emergency preparedness, awareness and response to disasters within the hospital, in particular in a CCD, otherwise difficult to assess. 2. All three CCD experienced the same challenges and identified similar flaws. 3. A hospital disaster exercise manual might be of valuable help.
Critically ill patients in emergency department frequently require emergency airway management. This procedure in our ED is carried out by emergency medicine resident with rapid sequence intubation (RSI). This study investigates complications of tracheal intubation carried out in critically ill patients including: (1) hypoxemia and hypotension (2) aspiration and esophageal displacement (3) pneumothorax and right bronchus intubation.
Methods
Data were collected on consecutive intubations carried out by EM residents over a 29 months period. Between 195 patients only 100 patients had including criteria to enter this study. Also we compare the complications and success rate among three level of personnel carrying on the procedure.(first to third year of emergency medicine residency).
Results
109 consecutive intubations were carried on in 100 patients. Oral translaryngeal intubation was done in all patients. Three intubations required more than 2 attempts and hypoxia occurred in 34 cases. Aspiration was diagnosed by direct vision in 5 cases. Hypotension was found in 5 cases causing death in 3 of them during the intubation or in 30 minutes following the procedure. Esophageal displacement occurred in 10 of the attempts but all were recognized and reintubated. Success rate between three personnel levels are as follow: in first year residency 82% and in second year residency 94% and in third year residency is 100% (p = 0.014).There was not a statistically significant difference among these three groups considering the complications but the success rate should a difference between level 1 and 3 (p = 0.936). Multiple attempts did not increase the rate of complications. Mortality were dependent to hypotension (p = 0.019) and age (p = 0.001).
Conclusion
In our study we did not find the results of RSI to be operator dependent as long as it was done by emergency residents. It is recommended to compare the results of RSI and non- RSI methods in a future.
Recent reports have highlighted the health disparities that women and other vulnerable populations experience following disasters. Humanitarian groups have struggled to implement effective measures to mitigate such disparities during subsequent disasters.
Objectives
To analyze and provide practical solutions to mitigate barrier's to women's health encountered in Haiti following the 7.0 magnitude earthquake in January 2010.
Methods
In February 2010, a New York based team of emergency and international medicine specialists staffed the mobile emergency department in Port au Prince at L'Hôpital de l'Université d'Etat d'Haïti.
Results
Common presentations included infectious diseases, traumatic injuries, chronic disease exacerbations, and follow-up for earthquake-associated conditions. Female gender-specific problems included vaginal infections, breast pain or masses, pregnancy-related concerns, and the effects of gender-based violence. Identified barriers to effective gender-specific care included communication, camp geography, supply availability, and poor inter-organization communication.
Discussion
Recent disasters in Haiti, Pakistan, and elsewhere have challenged the international health community to provide gender-balanced healthcare in sub-optimal environments. Much room for improvement remains. Although our assessment team was gender-balanced, improved incorporation of Haitian personnel may have enhanced patient trust, and improved cultural sensitivity and communication. Camp geography should foster both patient privacy and security during sensitive examinations. This could have been improved upon by geographically separating men's and women's treatment areas and using a barrier screen to generate a more private examination environment. Women's health supplies must include an appropriate exam table, emergency obstetrical and midwifery supplies, urine dipsticks, and sanitary and reproductive health supplies. A referral system must be established for patients requiring a higher level-of-care. Lastly, improved inter-organization communication and promotion of resource pooling may improve treatment access and quality for select gender-based interventions.
Conclusion
Simple inexpensive modifications to organized post-disaster medical relief settings may dramatically reduce gender-based healthcare disparities.
The physicality of mass gatherings has been well described in the literature. The factors effecting the rate of illness and injury at mass gatherings have been well described and include the type and duration of the event, the type and age of crowd, and the availability of drugs and alcohol. In 2004 Arbon proposed a conceptual model that describes the relationship between the environmental, psychosocial and the biomedical domains of mass gatherings. However to date the science of mass gatherings has focussed on the environmental and biomedical domains. There is minimal evidence to support or describe the psychosocial domain. Current tools available to assess the psychosocial domain are scarce even though it is considered an integral part of a mass gathering event. Berlonghi (1995) and Zietz (2009) proposed two measurements, crowd type and crowd mood respectively. This paper reports on a pilot project undertaken to evaluate how effective these tools are to understand the psychosocial domain of a mass gathering event.
The treatment of victims with gunshot wounds has gained importance over the past 10–15 years due to continuous military conflicts and the increase in terrorist and criminal acts. Since 1992, a group of pediatric surgeons has been trained to treat gunshot wounds in both children and adults in field hospitals of the Russian Service of Disaster Medicine in Northern Caucasus.
Methods
Two working models of a Children's Field Hospital (ChFH) were reviewed. In the first model, a ChFH was implemented for 14 months (April 2001–July 2002) during a military conflict in the Chechen Republic. There were no other hospitals rendering medical aid to children in the area. In the second model, a field hospital was created for children following a terrorist act in Beslan, Northern Ossetia in 2004.
Results
Over the 14 month period, the Chechen Republic ChFH rendered medical aid to 102 adults and 20 (16.4%) children with gunshot wounds. Self-made explosives and unexpected munitions were blamed for explosive trauma in children. Two children died in the ChFH, and one child with amputated lower limbs was transported to Moscow for prosthetics placement. Three hundred eleven children presented to ChFH, including 55 children not requiring medical aid, and 256 wounded children, who were divided into 3 groups: 5 dying; 52 wounded and requiring emergency treatment; and 199 wounded who were transported to hospitals in Vladikavkaz after receiving initial medical aid at the ChFH. In total, 47 operations were performed, including seven abdominal and chest surgeries. Re-animation aid was provided at the Intensive Care Department of the ChFH for the stabilization of the critically wounded prior to their evacuation.
Conclusion
In the situation of mass admissions of wounded patients, the most important considerations are triage and the arrangement of operations according to urgent indications.
Reliable & easily accessible health information is needed before, during, and after disasters. The U.S. National Library of Medicine's Disaster Information Management Research Center has developed a portal linking to resources, guides, and tools for use by disaster/emergency personnel in preparing for, responding, to and recovering from disasters (http://disasterinfo.nlm.nih.gov). This session will introduce you to many of the disaster health information sources available on the Internet. Disaster information tools, such as the Wireless Information System for Emergency Responders (WISER) and the Radiation Emergency Medical Management (REMM) resource will be demonstrated. WISER assists responders in HazMat/CBRN incidents. Capabilities include support for substance identification, on-site incident management, and health management/guidance. The REMM tool provides guidance for health care personnel about clinical diagnosis & treatment of radiation injury during radiological & nuclear emergencies. WISER and REMM are available on the Web and as apps for a variety of mobile devices including the Blackberry and iPhone/iPod Touch/iPad. In addition how to access the disaster health literature from PubMed, the Resource Guide for Public Health Preparedness, and other sources will be discussed. Social medial tools for keeping up-to-date will be presented. Topics to be presented: NLM and other US resources for disaster health information. Other sources of disaster health information, including associations; non-governmental organizations, and international organizations. Databases and information aggregators. Disaster information tools and mobile applications Evaluating/assessing information on the web. How to stay up-to-date: listservs, RSS feeds, blogs, Twitter, etc.