When the Tsunami struck Asia on 26 December 2004, Aceh, Indonesia suffered more damage than did any other region. After the Tsunami, many humanitarian organizations provided aid in Aceh. For example, the International Committee of the Red Cross (ICRC), along with the Indonesian and Norwegian Red Cross opened a field hospital in Banda Aceh on 16 January 2005. This study describes the illnesses seen in the out-patient department/casualty department (OPD/CD) of the ICRC hospital nine weeks after the Tsunami. It describes the percentage of people seen for problems directly related to the Tsunami, and includes a basic screening for depression and post-traumatic stress disorder (PTSD).

A prospective, five-day study was performed from 01–05 March 2005. Patients registering in the ICRC field hospital in Banda Aceh were considered for the study. Data collected included: (1) age; (2) gender; (3) diagnosis in the OPD/CD; and (4) whether or not the problem was related directly to the Tsunami. Seven basic questions were asked to screen for depression and PTSD symptoms.

Twelve percent of the problems seen in the OPD/CD nine weeks after the Tsunami still were related directly to the Tsunami. Sixty-three percent of patients in the study were male. The medical problems included: (1) urological (19%); (2) digestive (16%); (3) respiratory (12%); and (4) musculoskeletal (12%). Although <2% of patients were diagnosed with a mental health problem, 24% had at least four or more of the seven depression/PTSD symptoms addressed in the study.

Post-earthquake and post-tsunami health problems and medical needs differ from those found in conflict zones. After the Tsunami, both surgical and primary healthcare teams were needed. Many problems were chronic medical problems, which may be indicative of the lack of healthcare infrastructure before the Tsunami. The findings suggest that mental health issues must be taken into consideration for future planning. The ethical issues of performing research in complex emergencies also need further development at the international level.

This Supplement is a Report of the Conference convened by the Regional Office for South East Asia (SEARO) of the World Health Organization (WHO). The Conference was a follow-up to the WHO Conference of May 2005 in Phuket, Thailand on the Earthquake and Tsunami of 26 December 2004. The invitational meeting brought together representatives of 11 countries impacted by the events. The goal of the Conference was to produce a plan of action that meets the specific needs of the countries and ensure that the countries of the Region will be better equipped to cope with any future event.

The objectives of the Conference were to: (1) identify gaps in the health needs of the affected and vulnerable populations for preparedness, responses, recovery, and rehabilitation; (2) determine the next steps in addressing these gaps; and (3) develop benchmarks and a corresponding framework for action that must be achieved to solidify the capacities and capabilities of the health sector to meet emergencies.

Presentations of background papers, panel discussions, and Working Groups were used. Based, in part, on the materials presented, the Working Groups drafted benchmarks that could mark the progress in achieving the overall goal and proposed strategies that could be used to reach the benchmarks. Representatives of the participating countries summarized the current status of their respective countries relative to each of the defined benchmarks.

The benchmarks relate to: (1) legal framework for preparedness and response; (2) national disaster plan for preparedness and response; (3) budget; (4) rules of engagement for external actors; (5) community plan based on risk identification and vulnerability assessment; (6)community-based capacities; (7) local capacity for provision of essential services and supplies; (8) awareness and advocacy programs; (9) identification of hazards, risks, and vulnerabilities; (10) education and training; (11) “safe” health facilities; and (12) surveillance and early warning systems.

There exists a wide range in the levels of preparedness at all levels in the affected countries particularly at the community level. The country representatives agreed that community-level preparedness, legal frameworks, local and national disaster plans, surveillance and early warning systems, and advocacy and awareness programs demand more attention.

The strategies and mechanisms that will facilitate achievement of the benchmarks were grouped into seven categories: (1) monitoring, evaluation, surveillance, and assessments; (2) education and training (human resource development); (3) information and communications; (4) legislation, policies, and authority; (5) funding; (6) planning and preparedness; and (7) coordination and control. Any or all of the strategies suggested could be implemented by the countries in the Region.

The Conference delivered an important set of benchmarks and strategies that, when implemented, will facilitate the countries and the communities within them reaching better levels of preparedness and response to future events. Attaining the benchmarks will decrease the number of lives lost and minimize the pain and suffering associated with such events.

During disasters, public health departments assume the role of maintaining the health of displaced persons. Displaced persons arrive with acute and chronic conditions as well as other risk factors. Descriptions of these conditions may aid future shelter planning efforts.

Approximately 4,000 individuals from New Orleans, displaced by Hurricane Katrina, were sheltered in Austin, Texas. A stratified random sample of the population was selected using individual beds as the primary sampling unit. Adults were interviewed about their acute symptoms, chronic diseases, and other risk factors.

The results indicate a substantial proportion of adults arrived with some symptoms of acute illness (49.8%). A majority of the adults reported living with a chronic condition (59.0%), and the prevalence of some chronic conditions was higher than that of the general population. Also, several factors that could complicate service delivery were prevalent.

Acute illnesses present transmission risks within the shelter. Furthermore, chronic diseases must be managed and may complicate care of acute illnesses. Risks like activity limitation or substance abuse may complicate shelter operations. Defining the potential scope of the illness burden may be used to help public health departments better plan the services they must deliver to displaced populations.

On 14 August 2003, New York City and a large portion of the northeastern United States experienced the largest blackout in the history of the country. An analysis of such a widespread disaster on emergency medical service (EMS) operations may assist in planning for and managing such disasters in the future.

A retrospective review of all EMS activity within New York City's 9-1-1 emergency telephone system during the 29 hours during which all or parts of the city were without power (16:11 hours (h) on 14 August 2003 until 21:03 h on 15 August 2003) was performed. Control periods were established utilizing identical time periods during the five weeks preceding the blackout.

Significant increases were identified in the overall EMS demand (7,844 incidents vs. 3,860 incidents; p<0.001) as well as in 20 of the 62 calltypes of the system, including ca rd i ac arrests (119 vs.76, p= 0.043).Significant decreases were found only among calls related to psychological emergencies (114 vs. 221; p= 0.006) and drugor alcohol-related emergencies (78 vs. 146; p = 0.009). Though median response times increased by only 60 seconds, median call-processing times within the 9-1-1 emergency telephone system EMS dispatch center of the city increased from 1.1 to 5.5 minutes.

The citywide blackout resulted in dramatic changes in the demands upon the EMS system of New York City, the types of patients for whom EMS providers were assigned to provide care, and the dispositions for those assignments. During this time of increased, system-wide demand, the use of cross-trained firefighter and first-responder engine companies resulted in improved response times to cardiac arrest patients. Finally, the ability of the EMS dispatch center to process the increased requests for EMS assistance proved to be the rate-limiting step in responding to these emergencies.These findings will prove useful in planning for future blackouts or any disaster that may broadly impact the infrastructure of a city.

In the aftermath of the Earthquake and Tsunami in Southeast Asia, many relief organizations sent medical aid to affected areas.

The aim of this paper is to examine the mix of healthcare workers resulting from an influx of aid to Meulaboh, Indonesia, and how they met local healthcare needs.

Data were collected from the registration center for relief organizations in Meulaboh and daily hospital meetings on healthcare needs and available workers.

Prior to the Tsunami, there were 14 doctors and 120 nurses in the hospital. By the third week after the Tsunami, there were 21 surgeons performing 10 surgeries daily, and >20 non-surgical doctors in the 90-bed hospital. There were <70 nurses available during the month after the Tsunami, which was insufficient for the needs of the hospital. In the town of Meulaboh, the number of doctors exceeded the number of nurses, while public health workers comprised <5% of the healthcare workers.

An initial disaster-coordinating agency, formed by the United Nations (United Nations) in conjunction with affected countries, should link actively with relief organizations. This will optimize help in meeting local needs, and direct relief to where it is needed most.

Massive earthquakes often cause structures to collapse, trapping victims under dense rubble for long periods of time. Commonly, this spurs resource intensive, dangerous, and frustrating attempts to find and extricate live victims. The search and rescue phase usually is maintained for many days beyond the last “save,” potentially diverting critical attention and resources away from the pressing needs of non-trapped survivors and the devastated community. This recurring phenomenon is driven by the often-unanswered question “Can anyone still be alive under there?” The maximum survival time in entrapment is an important issue for responders, yet little formal research has been conducted on this issue. Knowing the maximum survival time in entrapment helps responders: (1) decide whether or not they should continue to assign limited resources to search and rescue activities; (2) assess the safety risks versus the benefits; (3) determine when search and rescue activities no longer are indicated; and (4) time and pace the important transition to community recovery efforts.

The time period of 1985–2004 was selected for investigation. Medline and Lexis-Nexis databases were searched for earthquake events that occurred within this timeframe. Medical literature articles providing time-torescue data for victims of earthquakes were identified. Lexis-Nexis reports were scanned to select those with time-to-rescue data for victims of earthquakes. Reports from both databases were examined for information that might contribute to prolonged survival of entrapped individuals.

A total of 34 different earthquake events met study criteria. Fortyeight medical articles containing time-to-rescue data were identified. Of these, the longest time to rescue was “13–19 days” post-event (secondhand data and the author is not specific). The second longest time to rescue in the medical articles was 8.7 days (209 hours). Twenty-five medical articles report multiple rescues that occurred after two days (48 hours). Media reports describe rescues occurring beyond Day 2 in 18 of 34 earthquakes. Of these, the longest reliably reported survival is 14 days after impact, with the next closest having survived 13 days. The average maximum times reported from these 18 earthquakes was 6.8 days (median = 5.75 days). The event with the most media reports of distinct rescue events was the 1999 Marmara, Turkey earthquake (43 victims). Times range from 0.5 days (12 hours) to 6.2 days (146 hours) for this event. Both databases provide little formal data to develop detailed insight into factors affecting survivability during entrapment.

A thorough search of the English-language medical literature and media accounts provides a provocative picture of numerous survivors beyond 48 hours of entrapment under rubble, with a few successfully enduring entrapment of 13–14 days. These data are not necessarily applicable to non-earthquake collapsed-structure events. For incident managers and their medical advisors, the study findings and discussion may be useful for postimpact decision-making and in establishing and/or revising incident priorities as the response evolves.