Introduction: The 2009 Global Platform for Disaster Risk Reduction/Emergency Preparedness (DRR/EP) and the Hyogo Framework for Action 2005-2015 demonstrate increased international commitment to DRR/EP in addition to response and recovery. In addition, the World Health Report 2008 has re-focused the world's attention on the renewal of Primary Health Care (PHC) as a set of values/principles for all sectors. Evidence suggests that access to comprehensive PHC improves health outcomes and an integrated PHC approach may improve health in low income countries (LICs). Strong PHC health systems can provide stronger health emergency management, which reinforce each other for healthier communities.

Problem: The global re-emphasis of PHC recently necessitates the health sector and the broader disaster community to consider health emergency management from the perspective of PHC. How PHC is being described in the literature related to disasters and the quality of this literature is reviewed. Identifying which topics/lessons learned are being published helps to identify key lessons learned, gaps and future directions.

Methods: Fourteen major scientific and grey literature databases searched. Primary Health Care or Primary Care coupled with the term disaster was searched (title or abstract). The 2009 ISDR definition of disaster and the 1978 World Health Organization definition of Primary Health Care were used. 119 articles resulted.

Results: Literature characteristics; 16% research papers, only 29% target LICs, 8% of authors were from LICs, 7% clearly defined PHC, 50% used PHC to denote care provided by clinicians and 4% cited PHC values and principles. Most topics related to disaster response. Key topics; true need for PHC, mental health, chronic disease, models of PHC, importance of PHC soon after a natural disaster relative to acute care, methods of surge capacity, utilization patterns in recovery, access to vulnerable populations, rebuilding with the PHC approach and using current PHC infrastructure to build capacity for disasters.

Conclusions: Primary Health Care is very important for effective health emergency management during response and recovery, but also for risk reduction, including preparedness. There is need to; increase the quality of this research, clarify terminology, encourage paper authorship from LICs, develop and validate PHC- specific disaster indicators and to encourage organizations involved in PHC disaster activities to publish data. Lessons learned from high-income countries need contextual analysis about applicability in low-income countries.

Purpose: The 2007 Institute of Medicine report entitled Emergency Medical Services at the Crossroads identified a need for the establishment of physician subspecialty certification in emergency medical services (EMS). The purpose of this study was to identify and explore the evolution of publications that define the role of the physician in EMS systems in the United States.

Methods: Three comprehensive searches were undertaken to identify articles that define the physician's role in the leadership, clinical development, and practice of EMS. Independent reviewers then evaluated these articles to further determine whether the articles identified the physician's role in EMS. Then, identified articles were classified by the type of publication in order to evaluate the transition from a non-peer reviewed to peer-reviewed literature base and an analysis was performed on the differences in the growth between these two groups. In addition, for the peer-reviewed articles, an analysis was performed to identify the proportion of articles that were quantitative versus qualitative in nature.

Results: The comprehensive review identified 1,504 articles. Ninety articles were excluded due to lack of relevance to the US. The remaining 1,414 articles were reviewed, and 194 papers that address the physician's role within EMS systems were identified; 72 additional articles were identified by hand search of references for a total of 266 articles. The percentage of peer-reviewed articles has increased steadily over the past three decades. In addition, the percentage of quantitative articles increased from the first decade to the second and third decades.

Conclusions: This comprehensive review demonstrates that over the past 30 years an evidence base addressing the role of the physician in EMS has developed. This evidence base has steadily evolved to include a greater proportion of peer-reviewed, quantitative literature.

Introduction: Behavioral emergencies constitute an important component of emergencies worldwide. Yet, research on behavioral emergencies in India has been scarce. This article discusses the burden, types, and epidemiology of behavioral emergencies in India.

Methods: A computerized search of Medline, Psychinfo, and Cochrane from 1975 to 2009 was performed, and all articles were evaluated and collated. The results were summarized.

Results and Conclusions: There is an acute need for psychiatric emergency services in India. Suicides, acute psychoses, and substance-related problems form the major portion of behavioral emergencies, while current trends show a rise in disaster- and terrorism-related emergencies.

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.

Once again, the politically volatile Middle East and accompanying rhetoric has escalated the risk of a major nuclear exchange. Diplomatic efforts have failed to make the medical consequences of such an exchange a leading element in negotiations. The medical and academic communities share this denial. Without exaggeration, the harsh reality of the enormous consequences of an imminently conceivable nuclear war between Iran and Israel will encompass an unprecedented millions of dead and an unavoidable decline in public health and environmental devastation that would impact major populations in the Middle East for decades to come. Nuclear deterrence and the uncomfortable but real medical and public health consequences must become an integral part of a broader global health diplomacy that emphasizes health security along with poverty reduction and good governance.

Introduction: The State University of New York at Downstate (SUNY) conducted a web-based long-distance tabletop drill (LDTT) designed to identify vulnerabilities in safety, security, communications, supplies, incident management, and surge capacity for a number of hospitals preceding the 2010 FIFA World Cup. The tabletop drill simulated a stampede and crush-type disaster at the Green Point Stadium in Cape Town, South Africa in anticipation of 2010 FIFA World Cup. The LDTT, entitled “Western Cape-Abilities”, was conducted between May and September 2009, and encompassed nine hospitals in the Western Cape of South Africa. The main purpose of this drill was to identify strengths and weaknesses in disaster preparedness among nine state and private hospitals in Cape Town, South Africa. These hospitals were tasked to respond to the ill and injured during the 2010 World Cup.

Methods: This LDTT utilized e-mail to conduct a 10-week, scenario-based drill. Questions focused on areas of disaster preparedness previously identified as standards from the literature. After each scenario stimulus was sent, each hospital had three days to collect answers and submit responses to drill controllers via e-mail.

Results: Data collected from the nine participating hospitals met 72% (95%CI = 69%–75%) of the overall criteria examined. The highest scores were attained in areas such as equipment, with 78% (95%CI = 66%–86%) positive responses, and development of a major incident plan with 85% (95% CI = 77%–91%) of criteria met. The lowest scores appeared in the areas of public relations/risk communications; 64% positive responses (95% CI = 56%–72%), and safety, supplies, fire and security meeting also meeting 64% of the assessed criteria (95% CI = 57%–70%). Surge capacity and surge capacity revisited both met 76% (95% CI = 68%–83% and 68%–82%, respectively).

Conclusions: This assessment of disaster preparedness indicated an overall good performance in categories such as hospital equipment and development of major incident plans, but improvement is needed in hospital security, public relations, and communications ahead of the 2010 FIFA World Cup.

A disaster is a situation that overwhelms the local population’s capacity to respond, thus necessitating a request for assistance from outside the impacted area. In these circumstances, needs usually outweigh resources. The objective of response is to do the greatest good for the greatest number of people (the utilitarian principle). As such, some unique ethical considerations will arise that are not seen in day-to-day practice.

The adoption of medical ethics principles is important in such situations, but certain provisions must be accepted. In large-scale, complex disasters, it may be impossible to provide optimal care to each patient. This paper will discuss some of the challenges for healthcare personnel at “ground zero”, how training in preventive ethics may help, and what principles can be applied when working in disaster-affected areas or when responding to disasters.

Background: Trauma is a major health issue worldwide, but especially so in developing countries such as Nigeria, where no comprehensive, national, injury data exist. There is a need to better define the epidemiology of injury as a basis for formulation of violence and injury prevention strategy.

Methods: This is a systematic analysis of published data on the epidemiology of injuries.

Objectives: The objective of this study was to describe the prevalent causes of injury among adults and children, and the causes of injury mortality.

Results: The medical records of 15,694 patients from the age of two weeks to 95 years formed the analysed data set. The mean value of their ages was 27 ±13 years and the gender ratio (M:F) 2:1. The injury burden is 11.2/100,000 population. The prevalent causes of injury are: (1) road traffic crashes (RTCs) = 68.4 % of 9939 patients; (2) fall = 5.5%; (3) gunshot injury = 3.2%; and (4) burns = 2.4%. Among children, the leading causes are: (1) RTC = 33.9% of 2,199 patients; (2) fall = 29.1%; (3) foreign body related = 5.5%; (4) bites = 4.9%; and (5) burns = 4%. Mortality resulted mainly from head injury, 26.6% of 575, and hemorrhage 8.3%.

Conclusions: Road traffic incidents are the leading cause of injury among adults and children. Falls are six times more prevalent among children than for adults. Burns and firearm injuries are relatively uncommon. Injury mortality results mainly from head injury and hemorrhage.

Introduction: On 26 December 2004, a large earthquake in the Indian Ocean and the resulting tsunami created a disaster on a scale unprecedented in recorded history. Thousands of foreign tourists, predominantly Europeans, were affected. Their governments were required to organize rapid rescue responses for a catastrophe thousands of miles away, something for which they had little or no experience. The rescue operations at three international airports in Sweden, the UK, and Finland are analyzed with emphasis on “lessons learned” and recommendations for future similar rescue efforts.

Methods: This report is based on interviews with and unpublished reports from medical personnel involved in the rescue operations at the three airports, as well as selected references from an electronic literature search.

Results: In the period immediately following the tsunami, tens of thousands of Swedes, Britons, and Finns returned home from the affected areas in Southeast Asia. More than 7,800, 104, and approximately 3,700 casualties from Sweden, the UK, and Finland, respectively, received medical and/or psychological care at the temporary medical clinics organized at the home airports. Psychiatric presentations and soft tissue and orthopedic injuries predominated.

Conclusions: All three airport medical operations suffered from the lack of a national catastrophe plan that addressed the contingency of a natural or disaster due to a natural or man-made project occurring outside the country's borders involving a large number of its citizens. While the rescue operations at the three airports functioned variably well, much of the success could be attributed to individual initiative and impromptu problem-solving. Anticipation of the psychological and aftercare needs of all those involved contributed to the relative effectiveness of the Finnish and Swedish operations.

Gathering essential health data to provide rapid and effective medical relief to populations devastated by the effects of a disaster-producing event involves challenges. These challenges include response to environmental hazards, security of personnel and resources, political and economic issues, cultural barriers, and difficulties in communication, particularly between aid agencies. These barriers often impede the timely collection of key health data such as morbidity and mortality, rapid health and sheltering needs assessments, key infrastructure assessments, and nutritional needs assessments. Examples of these challenges following three recent events: (1) the Indian Ocean tsunami; (2) Hurricane Katrina; and (3) the 2010 earthquake in Haiti are reviewed. Some of the innovative and cutting-edge approaches for surmounting many of these challenges include: (1) the establishment of geographical information systems (GIS) mapping disaster databases; (2) establishing internet surveillance networks and data repositories; (3) utilization of personal digital assistant-based platforms for data collection; (4) involving key community stakeholders in the data collection process; (5) use of pre-established, local, collaborative networks to coordinate disaster efforts; and (6) exploring potential civil-military collaborative efforts. The application of these and other innovative techniques shows promise for surmounting formidable challenges to disaster data collection.

Introduction: Mass-casualty triage is implemented when available resources are insufficient to meet the needs of all patients in a disaster situation. The basic principle is to do the maximum good for the most casualties with the least amount of resources. There are limited data to support the applicability of this principle in massive disasters such as the January 2010 earthquake in Haiti, in which the number of patients seeking medical attention overwhelmed the local resources.

Objective: To analyze the application of a triage system developed for use in a mass-casualty setting with limited resources. The system was designed to admit only those patients who had medical conditions requiring urgent treatment that were within the capabilities of the hospital and had a good chance of survival after discharge. Priority was given to those whose treatment could be administered within a short hospital stay.

Method: A retrospective, observational review of computerized registration forms of Haitian earthquake victims who sought medical care at a 72-bed field hospital within four to 14 days after the event. An analysis of the efficacy of the triage protocol that was used followed, using length of hospital stay to measure consumption of resources.

Results: A total of 1,111 patients were triaged for treatment in the field hospital within 14 days of the earthquake. The median length of stay for all patients for whom data was available was 16 hours (mean = 29.7 hours). The majority of patients (n = 620, 65%) were discharged within 24 hours. Two hundred five patients underwent surgery and were discharged within a median of 39 hours (mean = 52.6 hours); of these, 124 (62%) were discharged within 48 hours. The total mortality of the treated patients was 1.5% (n = 17).

Conclusions: Currently accepted triage principles for the most part are appropriate for efficiently providing medical care in a disaster area with extremely limited resources, but require extensive adaptation to local conditions.