Mass-casualty incidents involving radiation are rare but potentially devastating events. Even incidents with a small number of casualties are challenging due to the specific nature of the information and decisions required, and the rate of decay of knowledge about radiation. A package of specific forms and guidelines could assist emergency department (ED) physicians with this process.

A seven-page tool was developed as part of a project (METER 2008) funded by the Canadian Chemical, Biological, Radiological, and Nuclear Research and Training Initiative (CRTI) to facilitate the ED management of radiation casualties. These forms cover triage, the history and physical examination, diagrams to mark areas of contamination, standing orders, and a means of estimating Acute Radiation Syndrome severity. The tool was piloted at a workshop in Quebec City in November 2007. Later, a questionnaire was distributed to participants to assess the usefulness. The tool will be further tested at other workshops across Canada during the winter.

Participants found the tool to be useful, Their comments and improvements will be presented.

The tool demonstrated in this presentation can be used to assist ED staff with the triage and management of casualties with exposure to radiation.

Although there is information about hazardous materials and related activity during hazardous material accidents, chemical disasters, or chemical terrorism, it is not comprehensive, cannot be accessed easily, and is not sufficient for the specific situation, as in a toxic accident in a household or chemical accident in industry. Additionally, the information is not prepared for the emergency medical response in general. The authors developed a comprehensive database system for medical hazardous materials and assessed the application of the system.

A questionnaire was answered by 534 persons who are hazardous materials-related workers, experts, or laypersons about the necessary contents of the database and the methods of application. Forty-six database fields were developed relating to chemical accidents and hazardous materials, the most important contents were extracted through a four-stage process. The database fields were prioritized in 19 classification groups based on an existing database and our survey.

There were 111 chemicals that were determined to be most necessary to include in the database. The final classification of database fields was eight groups. A Website was constructed of the resulting database for real application.

Although it has become possible to provide emergency information about chemical accidents, terrorism, or disaster, comprehensive information from the accident site to hospital still is needed for a quicker response, such as die identification of chemicals. The next step will be developing an information-providing system using mobile devices.

The study presents the generalized results of the long-term epidemiological, clinical, biochemical, cyto-genetic, and immunological studies dedicated to the mechanisms of the development of somatic pathology in the remote period in the victims of radiation accidents. The major accidents were included, i.e., Chernobyl nuclear power plant accident, radiation accidents on ships with nuclear energy devices, nuclear weapons tests, and other accidents.

The two databases were created at the Nikiforov Russian Center of Emergency and Radiation medicine (St. Petersburg) in order to monitor the health status of the victims of radiation accidents: (1) epidemiological database with sub-registries for leukosis, thyroid cancer and other cancers, (2) scientific clinical database.

The full range of all up-to-date and evidence-based clinical investigations was used including tomography, bio-and immunochemical methods, cancer markers and hormone levels assessment.

The epidemiological analysis showed that after five years following the exposure there is a significant rise in the incidence of somatic pathology across all age groups. After 10 years following the exposure 38% of clean-up workers already developed chronic diseases, while among those who were exposed to the dose of more than 25 cGy the incidence was more than 50%. Over 20 years of observation, the average number of diagnosed chronic diseases per clean-up worker increased from 1.4 to 10.6.

The most prevalent symptoms (>60%) are cardiovascular diseases, musculoskeletal and gastrointestinal diseases. From the results of cytogenetic and biochemical investigations the main pathological mechanism is the disturbance of microcirculation and endothelial dysfunction. In 60–80% of clean-up workers' muscular-skeletal diseases were diagnosed with the main manifestation and possible mechanism being an osteopenic syndrome.

The cytogenetic studies showed that across all age groups, the incidence of chromosome aberrations is significantly higher than in the control group. The assessment of cancer markers confirmed the elevated risk of developing cancer. This was accompanied by markedly elevated levels of hydrogen peroxide and other free-radical and lipid oxidation indicators in the blood.

The results of the complex epidemiological, clinical, biochemical, cytogenetic, and immunological investigation performed on the patients exposed to ionizing radiation due to a number of radiological accidents described the mechanisms of the development of somatic pathology due to radiation exposure.

People with disabilities largely have been excluded from emergency preparedness plans. Emergency Preparedness for Persons with Disabilities was developed to help assist such persons to deal with a variety of emergency situations.

Phase I focused on healthcare professionals who care for such persons. An eight-hour, basic, core course includes triage, transfer and transport, personal protection, patient decontamination, equipment decontamination, developing an office emergency plan, evacuation, communications, and emergency contacts. Modules for non-medical office staff include communications, staffing, personal protection, and Internet access to helpful sites.

Phase II focused on the person with disability and his/her caregivers—health professionals (visiting nurse or Home Health Aide) and families. Training modules include home preparations, preparedness kit development, and evacuation.

Methods of evacuation and transportation of patients in vertical and horizontal situations were tested. Training staff noted a lack of familiarization of triage methods, patient and staff accountability, and equipment that could be used in case of an evacuation. Training modules were modified following evaluation of the above.

Professionals and persons with disabilities can benefit from receiving emergency preparedness training. The experience and materials presented can accomplish this task. This training can serve as a model for rehabilitation professionals and the populations they serve.

Pregnant females are uniquely vulnerable to morbidity and mortality associated with trauma and from secondary exposure to environmental agents during and following a terrorist attack. For clinicians and emergency management planners, there are several specific considerations for pregnant victims of terrorist events in the planning and response phases of a terrorist event.

A review of scientific, medical, and academic literature pertaining to women and terrorist activities was performed. In addition, government reports and media accounts of terrorist attacks where women were direcdy or centrally involved as perpetrators were collected and reviewed. Common elements, themes, and similarities were analyzed by the investigator to determine trends in injury patterns, distribution of exposed individuals, and the acute and long-term health effects associated with the gravid female and her unborn child.

Several causes of morbidity and mortality among pregnant females and their unborn children as the result of terrorist attacks were discussed in the literature. Physical trauma, toxic inhalation effects, bioterrorism considerations, and psychosocial impacts were among those discussed most often. The disaster epidemiology associated with these health events is described, as well as the strategies for prevention and clinical management of this unique group of victims.

A greater understanding of the types of hazards and exposures which may affect a pregnant woman or her unborn child during or following a terrorist attack can assist in developing plans for medical counterterrorism. This epidemiological information can benefit both clinicians and emergency planners in anticipating the potential health and medical needs as well as planning for potential protective actions that can be implemented before or immediately following a terrorist incident.

Four experienced burn care providers participated as advisors in two mass casualty exercises in an area where access to a bum center is severely limited. The role of the advisors, lessons learned, and recommendations for future exercises will be presented.

Prior to the exercises, advisors provided a Justin-Time lecture orienting hospital workers to prehospital triage, emergent burn care, and burn center transfers. Exercise 1 consisted of a simulated train derailment with hazardous materials spill and involved 150 victims; many with burn injuries and associated trauma. An advisor was assigned to each car to provide guidance to victims and feedback to exercise evaluators on prehospital triage, victim management, and transfer decisions. Exercise two involved a terrorist attack at an oil refinery in a small community; 140 victims were moulaged, triaged, and transported to the hospital. A burn advisor was assigned to each of the following areas of the hospital: initial triage area, intensive care unit (ICU) for immediate/critical victims, rehabilitation area for patients triaged into delayed or minor injury categories, and the state Disaster Medical Assistance Team (DMAT) treatment area.

Overall, victims with injuries other than burns were more accurately triaged at the scene, assessed at the hospital, and managed. Although the state has provided burn courses to 150 nurses, physicians, and paramedics over the previous three years, there is a significant need for further burn training.

The presence of experienced burn advisors provided the opportunity for healthcare providers to receive training, ask questions during the exercise, and receive feedback following the exercise.

The Wenchuan earthquake, which measured at 8.0 Richter scale, occurred on 12 May 2008 in Sichuan Province, China. Official figures state that 69,197 were killed, 374,176 were injured, and 18,222 were listed as missing. The effectiveness of national emergency preparedness and disaster response system after the earthquake was analyzed. The experiences and lessons were gained for further improvements.

This paper describes what and how the search-and-rescue team and other facilities of different levels performed during disaster relief and reconstruction after the earthquake. The experience and lessons from the earthquake rescue are discussed.

There were well-organized contingency plans, but we were unable to follow the contingency plans due to the lack of practice. During huge disasters, too many departments were involved, and the collaboration became a problem. How can the precise, first-hand information to the government be provided to facilitate correct decision-making? The public doesn't know how to rescue themselves when facing a disaster. How to perform the disaster rescue more effectively? What to do to prevent epidemics? How to enhance international collaborations?

We should be familiar with the plans and follow them stricdy by practicing regularly. The public should be educated about what to do during a disaster. A National Disaster Assessment Team should be organized. The professional disaster medical staff should have an extensive knowledge in medicine; they should have the capability to deal with the condition of resource shortage, and to cooperate with different people with different backgrounds. The best way to have a disaster medical team is to establish education and training facilities. For enhancing international cooperation, we should have more communication and practice to be better organized, only in that way, can we deal effectively during real situations.

A newly designed, humanitarian logistic system called Disaster Inventory Management System (DIMA) has been developed by the Taiwan Society of Disaster Medicine according to the structure of the Humanitarian Supply Management System (SUMA). The applicability is to be investigated.

After the implementation of DIMA, standard education and training programs in six regional Emergency Operations Centers (rEOC) in Taiwan were organized. From July 2007 to April 2008 (Phase 1), a standardized, eight-hour logistics training program including DIMA application was completed among the staff of the six rEOCs in Taiwan. Four scenarios were provided to test the applicability of the DIMA system compared to the conventional logistics system of each rEOC. In Phase 2, the DIMA was applied to a rescue team from Taipei that was responding to the China Sichuan Earthquake that occurred on 12 May 2008.

The error rate of information for Phase 1 was approximately 3.5% (donor = 1%; consignment = 1%; ware houses = 1%; and central feedback = 0.5%), which was significandy lower than that of the information from the indi vidual logistics systems of the six rEOCs (12%, p <0.01). A five-point scoring system concerning the satisfaction obtained from 178 trainees revealed higher satisfaction of the DIMA in transparencies (92 ±10 points vs. 66 ±12 points, p <0.001) and accountability (93 ±8 points vs. 78 ±16 points; p <0.01) compared to the conventional methods. In phase 2, the error rate of information was about 2.4% (donor = 0.6%; consignment = 0.5%; warehouses = 0.8%; and central feedback 0.5%), which was significantly lower dian that of information by conventional logistics systems (8%, p <0.01).

The DIMA system is a transparent and efficient humanitarian management system. More practice may reduce the error rate in the future.

Mumbai is India's largest city and the financial capital of the country. Destruction of symbolic structures in large cities has been a worldwide strategy of terrorists for spreading hopelessness, fear, and panic. The recent Mumbai terror attacks were similar and included taking foreign nationals as hostages.

Victims profiles were studied for mode of injury (firearm, fire, blast, fall, or combination), the type of injury, and treatment. The level of hospital preparedness was described, especially for surge capacity. Terrorist events and conflict over the last five decades in Mumbai and India were analyzed. The Indian data was compared to global terrorism in order to suggest appropriate recommendations for countering terrorism in a developing country.

At least 173 people were killed and 308 were injured in the recent attacks. There were eight attack sites in downtown Mumbai, of which, three sites were patronized largely by western tourists and foreign delegates. Three were crowded public places, including a hospital. The most prevalent injuries were bullet wounds from automatic weapons, followed by blast, shrapnel, falls, and burns. All previous terrorist events in Mumbai are listed in the Table.

The attack of foreign nationals represents a proxy war, and the terrorists are looking for softer targets. Therefore, counter-terrorism initiatives must go beyond country-specific ' models. In developing countries where' public health infrastructure is an issue, adopting the “all-hazards” approach to disasters may be the direction required in order to build capacity for dealing with future events. While there is a push for top-end hospitals for “medical tourism”, India has realized that it is eventually the modest public hospital that responds to all disasters, including those caused by natural hazards or conflict. The financial capital of Mumbai has moved from low to moderate risk for terrorist activities over the past 15 years. The geopolitical reasons for this shift must be researched by social scientists.