The Swedish Disaster Medicine study organization, KAMEDO, was described in Prehospital and Disaster Medicine 1999; 14(1):18–26 and three reports, Numbers 69–71, were published there. An aim was then to publish the KAMEDO summaries on a regular basis. Since then, two more KAMEDO reports—No. 72: Terror Bombings in Jerusalem, Ashkelon and Tel-Aviv 1996 Summary and No. 73: Thirty-five Years of Disaster Medicine Studies—have been released and the summaries of these two reports are hereby published.

Disaster management plans of emergency departments (EDs) in four major public hospitals were reviewed. A comparison was made between these plans, and they were analyzed to gain an understanding of the differing objectives and doctrines behind the practices. These were summarized into five major management concepts, which are considered to be critical to the success of a disaster plan: 1) staff mobilization systems (cascading vs batch mobilization); 2) staff deployment systems; 3) team organization (surgeons vs residents); 4) area management (the role of the area manager); 5) casualty volume management (accommodation vs expansion vs extension concepts). The-concepts derived should serve as a useful guide to the development of an ED disaster plan and potentially influence how new ED facilities could be planned.

Although disasters have exacted a heavy toll of death and suffering, the future seems more frightening. Good disaster management must link data collection and analysis to the decision-making process. The overall objectives of disaster management from the viewpoint of public health are: 1) needs assessments; 2) matching available resources with defined needs; 3) prevention of further adverse health effects; 4) implementation of disease-control strategies; 5) evaluation of the effectiveness of the application of these strategies; and 6) improvement in contingency planning for future disasters.

The effects of sudden-onset, natural disasters on humans are quantifiable. Knowledge of the epidemiology of deaths, injuries, and illnesses is essential to determine effective responses; provide public education; establish priorities, planning, and training. In addition, the temporal patterns for the medical care required must be established so that the needs in future disasters can be anticipated.

This article discusses: 1) the nature of disasters due to sudden-onset, natural events; 2) the medical and health needs associated with such events and disasters; 3) practical issues of disaster responses; and 4) the advance organization and management of disasters. The discussion also includes: 1) discussions of past problems in disaster management including non-congruence between available supplies and the actual needs of the affected population; 2) information management; 3) needs assessments; 4) public health surveillance; and 5) linking information with decision-making. This discussion is followed by an analysis of what currently is known about the health-care needs during some specific types of sudden-onset, natural disasters: 1) floods; 2) tropical cyclones; 3) tornadoes; 4) volcanic eruptions; and 5) earthquakes. The article concludes with descriptions of some specific public-health problems associated with disasters including epidemics and disposition of corpses.

All natural disasters are unique in that the regions affected have different social, economic, and health backgrounds. But, many similarities exist, and knowledge about these can ensure that the health and emergency medical relief and limited resources are well-managed.

In complex human emergency (CHE)-aid situations, the international community responds to provide assistance to reduce morbidity and mortality related to environmental and civil disruptions. The political and social situation in Kosovo, in combination with the military activity from 23 March to 09 June, 1999, created a crisis associated with mass movement of the population of Kosovo into neighbouring provinces and nations. This forced migration of people seeking protection increased demands for -water, food, shelter, and health care in the refugee areas. The United Nations High Commission for Refugees (UNHCR) estimated that 771,900 ethnic Albanians, and 30,700 Serbians, Croatians, and Montenegrins had been displaced from Kosovo during this time period, and that 439,500 of these people had arrived in Albania. Given the limited health-care resources in Albania to respond to the increasing demands for health care, a field epidemiological study was conducted by the International Organization for Migration (IOM) to assess the need for a medical evacuation program from Albania related to the crisis in Kosovo. Outcome measurements in this assessment were: 1) health-care capacity and health-care utilization rates in Albania before the crisis and by the refugees during the crisis; 2) the frequency of war-related injuries; 3) the frequency of medical evacuation; 4) nature of medical conditions of the patients being evacuated; and 5) destination for medical evacuation (internal or international) during the crisis. The results of the field assessment, which gathered health outcome data during the first eight weeks of the conflict (23 March 1999 to 25 May 1999), indicated that there was a need for a specifically designed medical evacuation programme in Albania. The study demonstrated that the implementation of a medical evacuation programme must be integrated with the national health care objectives. It also was found that the magnitude of an evacuation programme could be reduced markedly by strategic support of existing medical programmes in Albania (haemodialysis, trauma and orthopaedics, blood banking). Implementation of this strategy could permit containment of the majority of cases within Albania or to regional, health-care facilities. The results of such targeted support for specific services could result in a national programme for internal medical evacuation, with limited dependence upon the international movement of patients.

The use of ionizing radiation and radioactive materials continues to increase worldwide in industry, medicine, agriculture, research, electrical power generation, and nuclear weaponry. The risk of terrorism using weapons of mass destruction or simple radiological devices also has increased, leading to heightened concerns. Radiation accidents occur as a consequence of errors in transportation ofradionuclides, use of radiation in medical diagnosis and therapy, industrial monitoring and sterilization procedures, and rarely, nuclear power generation. Compared to other industries, a small number of serious radiation accidents have occurred over the last six decades with recent cases in the Republic of Georgia, Peru, Japan, and Thailand. The medical, psychological, and political consequences of such accidents can be considerable. A number of programs designed to train medical responders in the techniques of radiation accident management have been developed and delivered in many countries. The low frequency of serious radiation accidents requires constant re-training, as skills are lost and medical staff turnover occurs. Not all of the training involves drills or exercises in which responders demonstrate learning or communication over the broad spectrum of medical response capabilities. Medical preparedness within the context of a total emergency response program is lacking in many parts of the world, particularly in Central and Eastern Europe and the Newly Independent States. This paper describes an effort to enhance medical preparedness in the context of a total program of international cooperation and conventions facilitated by the International Atomic Energy Agency. The paper concludes that novel application of telecommunications technology as part of a training activity in radiation accident preparedness can help address gaps in training in this field in which preparedness is essential but experience and practical field exercises are lacking.

Prior planning to meet the physical and mental needs of medical and emergency services responder, is a practical measure to reduce staff stress. This has the potential to improve both the operational efficiency of a disaster response and reduce the incidence of post-traumatic stress disorders in responders. Research is needed to define which interventions provide the greatest benefits to local responders.

Bogus doctors pose a threat to public health and safety, and they present a security threat at disaster and multi-casualty event sites. A “bogus doctor” is an individual who misrepresents him/herself as a registered medical practitioner by their demeanour, actions, dress, or surroundings, while not entitled to be on a register of medical practitioners. There are very few reports in the medical literature, but practitioners have encountered them at the site of a disaster or multi-casualty event. This paper examines the five cases identified in the literature. Secure systems that confirm a health professional's identity and qualifications are required to avoid unnecessary delays and to protect the victims and health professionals providing the care.