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An earthquake measuring 6.6 Richter in 2003 devastated the historic Iranian city of Bam. During the response and recovery phases, considerable shortcomings were experienced. Flaws in the management of the various aspects of this disaster were identified to assess what was done or should be done to overcome these shortcomings during future disasters.
Methods:
A review of the management of the Bam disaster was performed by assessing files and data from 17 multi-center studies from 2003–2008. This assessment included data that related to the: (1) early warning phase; (2) time under rubble; (3) time to reach the scene and evacuate casualties; (4) assessment of rescue operations; (5) coordination of rescue teams; (6) triage; (7) trauma management; (8) transfer of equipment (resource mobilization); (9) rate of Disseminated Intravascular Coagulopathy (DIC), Acute Respiratory Distress Syndrome (ARDS), and Acute Renal Failure (ARF); (10) medical care provided; (11) efficacy of foreign field hospitals; (12) assistance of military forces; (13) rate of psychological distress among survivors; (14) provision of water, power, telephone, and healthcare services; and (15) social issues (opium abuse in survivors).
Results:
Data relevant to search-and-rescue operations and disaster management indicated shortcomings in human resources, patient transfer, availability of equipment and facilities, and trauma treatment. One percent of victims had compartment syndrome and needed a below-the-knee amputation, 11.6% were septic, 7.3% experienced DIC, 9.1% had ARDS, and 38.9% needed fasciotomy. The average time under rubble was 1.9 hours and the time from rescue to receipt of first aid time was 3.5 hours.
Conclusions:
Comprehensive disaster management must not be limited to the response phase but must include preparedness, recovery, and prevention, improvement of healthcare facilities, and provision of organized communication channels between organizations for running a command system and instituting coordination among relief workers. Continuous education, training of the general population and task forces involved in disaster management, and conducting periodic exercise drills also are important.
The World Association for Disaster and Emergency Medicine (WADEM) Education Committee recommends that all health professionals be exposed to a core program in disaster health. This paper describes the framework, implementation, and evaluation of a Graduate Certificate in Emergency Preparedness and Disaster Health designed for health professionals.
Methods:
Based on the WADEM Education Committee's framework for disaster health and the structure of the World Health Organization (WHO) Health Action in Crises Unit, a four-unit Graduate Certificate in Emergency Preparedness and Disaster Heath was developed, implemented and evaluated.
Results:
This Graduate Certificate evolved over diree years and includes four units: (1) an introduction to emergency preparedness and disaster health; (2) emergency preparedness; (3) response and major incident management, and (4) disaster recovery. Each unit has national and international perspectives.
Appropriate conceptual models provided the content and process of the course, although these have been difficult to locate. Delivery is largely on-campus with pre-reading and post-course assignments. A faculty of national and international leaders enriches delivery. Assessment largely has been assignment-based, with participation in one “Emergotrain” exercise required. Students may take the full Graduate Certificate or individual units only, either for credit or not-for-credit professional development.
Student feedback has been positive, with the introductory unit being rated as amongst the top 10% of units conducted in the faculty for two years in a row. The content, process, and assessments have been well supported with only few suggestions made for future modifications. An online option will now be offered in 2009, and a Graduate Diploma and Masters also will be available in 2009.
Conclusions:
This Graduate Certificate has been evaluated positively by participants. The conceptual modeling has been validated and the model may be of interest to other WADEM members.
The development of the [US] National Disaster Life Support (NDLS) programs (Advanced, Basic, and Core Disaster Life Support) began prior to 11 September 2001, but in its aftermath, the NDLS programs have become a leading all-hazards disaster medicine training program in the US. The NDLS programs are taught through a training center model. The curriculum is revised via the National Disaster Life Support Education Consortium (NDLSEC), a multi-disciplinary, multi-specialty consortium.
Methods:
The National Disaster Life Support Foundation (NDLSF) is a not-for-profit organization developed by the academic medical centers and partners that developed the NDLS programs. The founding institutions are the Medical College of Georgia, die University of Georgia, the University of Texas Southwestern, the University of Texas-Houston, and the American Medical Association. The NDLSF has die responsibility to oversee, certify, and monitor a network of training centers. The NDLSEC consist of individual members and 75 representative stakeholder organizations.
Results:
The training center network overseen by the NDLSF consists of 70 training centers in the US and 10 developing international training centers. The NDLSEC has >150 members with representatives from virtually every medical discipline and specialty. More than 70,000 individuals have been trained.
Conclusions:
The NDLS programs have employed a training center network model to deploy standardized, all-hazards disaster educational programs. The NDLS programs have been successful in bridging die gap in disaster medicine education programs in the US and may represent a useful model for other countries to provide disaster medicine education.
The aim of this project was to develop a Web-based, inter-professional education program on chemical, biological, radiological, or nuclear (CBRN) disasters, focusing on making cooperative, on-site efforts during the initial 15 minutes after the event more effective. The program should secure that intervening personnel from the police, health, medical, and rescue services have knowledge and understanding of the initial tasks and strategies of each respective organization in case of CBRN disasters.
Methods:
Using tabletop seminars based on five scenarios, the strengths and weaknesses regarding accomplishing tasks in case of the CBRN disaster were identified for each organization. Putting further strain on each scenario, the critical levels for satisfactory accomplishment were crystallized. Based on this vital information, all cooperating authorities have, in consensus, decided on the on-site organization.
Results:
The project has promoted the development of a profound national cooperation between the police, rescue, medical, and health services. The Web-based program has made the on-site efforts more efficient, focusing on personal and third-party security, on-site organization, zoning, levels of protection, and life-saving decontamination.
Conclusions:
This program provides an increased interprofessional understanding of the responsibilities, authority, and capacities of different sectors. This pedagogical program is cost-efficient, applicable at all levels within organizations, secures that everyone receives the same information, available whenever and wherever it is needed, and adjustable. When a participant passes a level, they attain a certificate, thus providing a secure evaluation system where die employer can appreciate the employee's competence.