Rapid innovations and improvements in communication technologies have opened many new channels for health education and delivery, as well as disaster management. Theme 2 examined the role and applicability of these technologies to Disaster Medicine and Management and the various issues involved in their use.

Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set Action Plans that then were reported to the collective group of all delegates.

Main points developed during the presentations and discussion included harnessing convergence, seeking interoperability, building partnerships and making it appropriate. This group identified four Principles of Action underlying its plan: (1) investigate possibilities, (2) identify stake-holders, (3) invite participation, and (4) involve discussants in activities.

Action plans were categorized into three areas that included “thinking globally, acting regionally”, forming a telehealth advisory group, and increasing corporate partnerships.

Technology is opening many opportunities that have applications in disaster management. To optimize benefits, goals and standards must be agreed upon and implemented.

To study the preparedness New York City for large scale medical disasters using the Year 2000 (Y2K) New Years Eve weekend as a model.

Surveys were sent to the directors of 51 of the 9-1-1-receiving hospitals in New York City before and after the Y2K weekend. Inquiries were made regarding hospital activities, contingencies, protocols, and confidence levels in the ability to manage critical incidents, including weapons of mass destruction (WMD) events. Additional information was collected from New York City governmental agencies regarding their coordination and preparedness.

The pre-Y2K survey identified that 97.8% had contingencies for loss of essential services, 87.0% instituted their disaster plan in advance, 90.0% utilized an Incident Command System, and 73.9% had a live, mock Y2K drill. Potential terrorism influenced Y2K preparedness in 84.8%. The post-Y2K survey indicated that the threat of terrorism influenced future preparedness in 73.3%; 73.3% had specific protocols for chemical; 62.2% for biological events; 51.1% were not or only slightly confident in their ability to manage any potential WMD incidents; and 62.2% felt very or moderately confident in their ability to manage victims of a chemical event, but only 35.6% felt similarly about victims of a biological incident. Moreover, 80% felt there should be government standards for hospital preparedness for events involving WMD, and 84% felt there should be government standards for personal protective and DECON equipment. In addition, 82.2% would require a moderate to significant amount of funding to effect the standards. Citywide disaster management was coordinated through the Mayor's Office of Emergency Management.

Although hospitals were on a heightened state of alert, emergency department directors were not confident in their ability to evaluate and manage victims of WMD incidents, especially biological exposures. The New York City experience is an example for the rest of the nation to underscore the need for further training and education of preparedness plans for WMD events. Federally supported education and training is available and is essential to improve the response to WMD threats.

In treating accident victims, actions by the Emergency Medical Personnel (EMP) at the scene may be the difference between life or death, full recovery or permanent disability. Development of selected profiles based on locale of services, tenure, and paramedic certification will provide valuable insight into the diversity within the Emergency Medical Services (EMS) profession. Not only will these profiles enable administrators to improve their recruitment, training, and retention of the emergency medical workforce, it potentially could enhance the quality of health care in the community.

Emergency medical personnel attending a statewide conference in Texas in late 1996 (n = 425).

1) There is no difference between the profiles of urban and rural emergency medical personnel; 2) There is no difference between the profiles of urban EMP with <9 years of experience and those with ≥9 years of experience; 3) There is no difference between the profiles of rural EMP with <9 years of experience and those with ≥9 years of experience. 4) There is no difference between the profiles of urban EMP with paramedic certification and those without certification; and 5) There is no difference between the profiles of rural EMP with paramedic certification and those without certification.

EMP attending the conference completed 425 survey instruments measuring five demographic features, five work-related features, and two psychological features. Survey instruments were included in each registrant's conference package. Completed surveys were deposited anonymously in labeled receptacles throughout the statewide conference site. Data collection ceased at the end of the conference. Discriminant analysis identified distinct profiles for the urban and rural EMP.

The urban EMP, more than rural subjects, was younger (mean = 36 years), more likely to be compensated 100% for their services, had a higher level of education (mean = 13.8 years), and reported a lower level of burnout. Urban EMP with <9 years of experience tended to be younger, male, married, and reported less burnout. Urban paramedics were more likely to be compensated 100% for their services, and had achieved a higher level of education. The rural EMP with <9 years of experience were less likely to be paramedic, reported lower burnout scores, and was younger. The rural EMP without paramedic certification was more likely to be a volunteer, and have had fewer years of service.

In Texas, locale of service (urban or rural), length of tenure as an EMP (>9 years), and paramedic certification appear to be significant factors that define the EMP population in Texas.

Hurricane Mitch was an event described as one of the most damaging recent natural disasters in our hemisphere. This study examined its effects on a community of 5,000 residents in northern Honduras.

Survey responses of 110 attendants at an ambulatory clinic 4 months after the event were analyzed. Correlates were established between demographic and housing characteristics and morbidity and mortality.

The availability of food, water, and medical care decreased significantly immediately after the hurricane, but by four months afterward returned to baseline values. Residents reported emotional distress correlated with the loss of a house or intrafamilial illness or mortality. Diarrheal illnesses more commonly were found in households with poor, chronic access to medical care. The use of cement block housing correlated with availability of food or running water, with access to medical care and vaccinations, and with a reduced frequency of diarrhea or headaches in the immediate post-hurricane phase.

Improvements in housing construction appear to be the most effective preventive measure for withstanding the effects of future hurricanes in tropical regions similar to northern Honduras.

The discussions in this theme provided an opportunity to address the unique hazards facing the Pacific Rim.

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 3 and Theme 7 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates.

The main points developed during the presentations and discussion included: (1) communication, (2) coordination, (3) advance planning and risk assessment, and (4) resources and knowledge.

Action plans were summarized in the following ideas: (1) plan disaster responses including the different types, identification of hazards, focusing training based on experiences, and provision of public education; (2) improve coordination and control; (3) maintain communications, assuming infrastructure breakdown; (4) maximize mitigation through standardized evaluations, the creation of a legal framework, and recognition of advocacy and public participation; and (5) provide resources and knowledge through access to existing therapies, the media, and increasing and decentralizing hospital inventories.

The problems in the Asia-Pacific rim are little different from those encountered elsewhere in the world. They should be addressed in common with the rest of the world.

To effectively respond to this relatively new, complex mandate it is essential to find effective models of coordination to ensure that medical and health services can meet the standards now expected in a disaster situation. This theme explored various models, noting both the strengths that can be built on and the weaknesses that still need to be overcome.

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 1 and Theme 4 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates.

The main points developed during the presentations and discussion included: (1) preplanning (predisaster goals), (2) information collection (assessment), (3) communication (materials and methods); and (4) response centres and personnel. There exists a need for institutionalization of processes for learning from experiences obtained from disasters.

Action plans presented include: (1) creation of an information and data clearinghouse on disaster management, (2) identification of incentives and disincentives for readiness and develop strategies and interventions, and (3) action on lessons learned from evidence-based research and practical experience.

There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.

This study evaluates whether a continuing education program for paramedics, focusing on Children with Special Health Care Needs, improved paramedics' assessment and management.

Emergency Medical Services responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness, were identified. The responses before and after the specialized education program were reviewed by a multidisciplinary team to evaluate assessment and management of the children. Interreviewer agreement between the nurses on the team and between the physicians on the team was assessed. We also evaluated whether there was an improvement in assessment and care by paramedics completing our education program.

Significant improvement was seen in appropriate assessment and overall care by paramedics who completed our specialized education program. Reviewers also noted an appropriate rating for the initial assessment category more often for responses involving paramedics who had the training. Agreement on whether assessment and treatment was appropriate for all five reviewers varied considerably, ranging from 32% to 93%. Overall there was a high percentage of agreement (>70%) between the nurses and between the physicians on most items. However, kappa statistics did not generally reflect good agreement except for most of the focused assessment items and some treatment and procedure items.

Most of the documentation on the EMS records indicated appropriate assessment and treatment during all responses for Children with Special Health Care Needs. Nevertheless, the results indicate that paramedics may improve their assessment and management of these children after specialized continuing education.

The need for the application of international standards has been evolving over the last decade. Consistency is needed not just in how we respond, but in when we respond. The discussions in this theme reflected on the progress of standard setting both at the local level and internationally.

Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates.

Main points developed during the presentations and discussion included: (1) requirement of standards of care for ALL disasters and core parameters, (2) process and procedure is best when there is interagency collaboration and coordination, (3) problems in disasters are management-related, not skill-related, and (4) standards of care must encompass evolving emergencies (e.g., emerging diseases, landmines).

The action plans for Theme 5 included: (1) develop positions of standards for management, health and public health, education and training, research, psychosocial aspects, and disaster plans; (2) advocate for actions and task forces to deal with evolving and emerging disasters, terrorism, landmines, and emerging infections; (3) proactively work to advocate and facilitate the multidisciplinary and multiorganizational requirements for disaster management; and (4) develop a resource list of interdisciplinary institutions and activities organized by country and topic including the design and maintenance of a website.

There is a clear need for international standards for the management of disasters. Positions and advocacy for these positions are required to define and implement such standards.