Iran is a country wim an area of 1,648,195 km2 with a population of >8,000,000 people. The devastating earthquake in the Bam District of Kerman Province struck on 26 December 2003 when the population was sleeping, and left a total of 29,878 dead and 22,628 injured. It had a magnitude of 7.4 on tbe Richter scale. The aim of this study was to determine the frequency of physical injuries.

The data of 206 patients were collected from the medical records.

The majority of patients were in the 20–29 year age group. The female/male ratio was 1.51. The overall mortality rate was 2%. Most frequent injuries were lower extremity, pelvic, and spinal fractures respectively. Of the extremity fractures, 4.9% had open fractures, 95.1% had closed, and 19 patients underwent fasiotomy due to compartment syndrome. Of the pelvic fractures, 7.9% were unstable. Of the cases, 32% with vertebral fractures had spinal cord injuries. Other injuries were less frequent and included pneumothorax, hemothorax, abdominal viscous injuries, rib fracture, and head injuries.

The main problems in the victims were orthopedic. Hospitals must prepare to treat these injuries.

Cyclone Nargis struck on 02 May 2008 and was the worst disaster due to natural hazards in the recorded history of Myanmar. It left > 146,000 people dead and thousands more homeless. More than 200 hospitals and 400 clinics were destroyed by the cyclone. Singapore was the first non-bordering country to send a medical team to help Myanmar with the disaster relief efforts and carried out operations using mobile teams.

Demographic and medical data from the medical records were collected and analyzed.

A total of 4,489 patients were seen in nine days at hospitals, eight camps/villages, an orphanage, and an elderly care facility. Of the patients, 65% were female. More than a quarter of the patients were <12 years of age and 16.5% were >60 years old. The pediatrie patients suffered mainly from respiratory (26%) and gastrointestinal infections (28%), whereas the adults had a significant number of mus-culoskeletal complaints (21%), non-specific diagnoses (19%), and chronic medical conditions (11%). Only (6%) of the conditions required surgical interventions. A significant number of complaints were related to post traumatic stress disorder (10%).

Mobile clinics were useful for treating patients who did not have access to medical care. The post disaster epidemics that were expected were not experienced. Given the patient load, it was useful to have a pediatrician, primary healthcare physician, and emergency physician to cope with the cyclone-related medical conditions.

There is a difference between prehospital providers' ability and willingness to respond to terrorist, public health emergencies, and disaster incidents.

A nationally representative sample of the 203,465 basic and paramedic emergency medical service providers in the United States was surveyed to assess their ability and willingness to respond to terrorist incidents.

Emergency medical technicians were appreciably (10–20%) less willing than able to respond to such potential terrorist-related incidents as smallpox outbreaks, chemical attacks, or radioactive dirty bombs (p <0.0001). Emergency medical technicians who received terrorism-related continuing medical education within the previous two years were nearly twice as likely (OR = 1.9, 95% CI 1.8, 2.0) to be willing to respond to a potential terrorist incident as those who indicated that they had not received such training.

Timely and appropriate training, attention to interpersonal concerns, and instilling a sense of duty may increase first medical provider response rates.

Terrorist attacks are exceptional events that place paramedics in high-risk situations. When terrorist events occur, paramedics play an integral role in the response to, and management of, these events. Given that responding to terrorist events places paramedics at a high risk for a variety of health problems and injuries, it is imperative to adequately prepare for such events through the use of appropriate teaching and educational programs. These programs should be based on the direct experiences of paramedics responding to previous terrorist events.

This research utilized a series of focus groups in New York and London to investigate how paramedics experienced working during 11 September 2001 and the London bombings. Specifically, this research focused on what concerned paramedics about responding to terrorist events, whether they would be willing to respond again, and what can be learned from these experiences in regard to disaster response training and education.

Paramedics reported a number of primary risks that concerned them during their responses to 9/11 and the London bombings. These included injury, death, potential contamination, and exposure to unknown hazards and agents. Personal protective equipment (PPE), communication networks, and reliabilty of information all were areas of concern that must be addressed by disaster planners. Paramedics reported that the most negative aspect of responding to these terrorist events was the inability to communicate with loved ones and the lack of timely and accurate information regarding updates on the situation. Personal protective equipment was not always available, and at times the wearing the PPE interfered with providing optimal patient care.

Key lessons can be taken away from paramedics experiences during 9/11 and the London bombings. These include the need for dedicated communication channels, accurate and timely information, suitable training and education (including an emphasis on infectious agents), and the provision of suitable PPE conducive to optimal working conditions.

Sri Lanka has experienced a 24-year civil war with monthly terrorist incidents. Disaster drills, as a method of teinforcing collaboration and improved communication, can enhance military and civil response coordination and ultimately benefit the community and the injured victim.

Two large-scale disaster drills occurred in Sri Lanka in 2008 with participation of military disaster response teams, civil hospitals, international non-governmental organizations (INGOs), the World Health Organization, American universities and hospitals, the local governments, Ministry of Health, non-governmental organizations, the Red Cross, and others. Training occurred in incident command, communication, clinical response, crowd control, evaluation, and the planning process. Civil and private prehospital care responders worked closely with the military during the drill. More than 400 participants gave active feedback and an educational video of the recorded drills was distributed for future training exercises.

Military and civil responders identified challenges and strengths and discussed improvements for future operations. In the days following the drill, participants responded to actual mass casualty incidents with improved skills, coordination and communication. Subsequent drills and task-force meetings were conducted. The INGOs supported follow-up activities and provided training materials. International partnerships were forged with military, civilian representatives, and disaster medicine specialists. Military and civil response teams had never performed a drill together before and felt it was invaluable for their coordination.

The promotion of drills involving military, civil society, and communities should be encouraged to improve response, especially in countries with ongoing civil conflict and high terrorist activity. Drills can help military and civil partners reach a broader understanding of the others' role and methodology of response, which may improve the outcome and timeliness of a disaster response.

The creation of a medical incident response plan for the treatment of injured victims contaminated during a chemical incident challenges more man one of me rescue services involved in civil emergency response. Our main objective the was to create an incident management plan compatible with existing rescue service logistics and resources.

Under the supervision of the Schutzkommission des Inneren and with delegates from emergency medical services, fire, technical rescue services, and the German Army, a consensus conference to investigate the general conditions necessary and the existing structure available for managing victims of chemical incidents, was created. Typical injury patterns and their treatment in respect to decontamination procedures were considered, the necessary structure for casualty treatment and decontamination areas were derived, and commercially available products were tested for their usefulness in this situation. Standard operating procedures and algorithms were developed to aid realization of the concept. The suitability of the personal protective equipment and the question, if under these conditions the procedures of advanced life support can be performed, was evaluated in a standardized simulator model. The necessary training for rescue personnel involved was defined. To validate the concept, an exercise was performed.

All persons present at a chemical incident are to be classified as being contaminated. Injured persons must be separated into triage categories, and life threatening conditions treated before being decontaminated. Decontamination at the incident scene is necessary to prevent the transportation of the contaminant away from the incident scene. The principles of the decontamination of injured persons are based on the following pillars: triage, early removal of clothing, management of personal belongings and valuables, basic life support, spot decontamination, management and sealing of open wounds, application of antidotes, and primary decontamination of ambulant and non-ambulant victims.

The cooperation and the definition of roles between fire services (decontamination) and emergency medical services (triage and treatment) are necessary.

The concept uses existing decontamination vehicles used for the decontamination of fire fighters, by expanding its inventory with medical equipment, and extra technical apparatus. Using a modular approach, the system can be easily augmented by further units to treat multiple numbers of victims. However, demands on all rescue services involved are high, and must be complemented with an equally high standard of training, especially where rescue services have to learn skills not akin to their standard duties. An implementation of the system covering all geographical areas with specialized units is not possible, therefore a risk analysis to optimally position limited resources has to be conducted. Legislative bodies must strive to allow for an uncomplicated integration and disposition of disaster management resources.

Accidental or voluntary chemical incidents create many health and environmental problems. According to the physico-chemical proprieties of the released agent, risks are present for all involved persons (victims, rescuers), either by primary contamination (contact with skin or mucosal surfaces, respiratory tract inhalation), or by secondary contamination from close contact with exposed victims. Recent descriptions of mass-chemical accidents with numerous spontaneous evacuations from the contaminated zone to nearby hospitals represent an important risk for secondary contamination to these hospitals.

The use of an easy-to-set-up decontamination gate to protect or preserve hospitals from contamination of their site and personnel following a massive influx of contaminated patients was evaluated. A multi-disciplinary team equipped six regional hospitals with mass-decontamination gates without mobilizing excessive human or material resources.

Basic formation of hospital personnel took two hours; attaching the gate to a local fire hydrant took <10 minutes.

This decontamination gate has several advantages and limitatins that will be discussed. However, it does have merit as an autonomous protection for non-specialized and equipped hospitals to prevent secondary contamination.

Disasters and emergencies involving radiation can produce numerous social and behavioral impacts, including shadow evacuations, seeking of medical attention by large numbers of people fearful of potential contamination, and stigmatizing of individuals, products and communities perceived to be associated with the incident. Indeed, these, and related impacts, can constitute some of the most important and challenging public health effects of a radiological-nuclear incident. At the present time, it is unclear whether or how such issues are being addressed in preparedness training exercises.

With support from the Radiation Studies Branch, Centers for Disease Control and Prevention (CDC), a study (2006–2008) was performed by researchers at the University of Alabama at Birmingham. The aim was to determine how social and behavioral issues are addressed in radiological-nuclear exercises. Radiological-nuclear exercise reports, guidance materials, and related items were gathered, and a systematic review and analysis of the documents was conducted.

Initial findings from the study suggest that only about half of radiological-nuclear exercises deal with key social and behavioral issues. Where such issues are included, they tend to receive relatively litde attention, components are typically small in scope, and the most difficult challenges often are “assumed away.”

Even though social-behavioral issues are central in radiological-nuclear incidents, opportunities to practice coping with them in training exercises are quite limited. If preparedness training is to be realistic and useful, this problem urgently needs to be addressed. The present study provides a series of recommendations toward this end.

The medical system has an important role in response to a radiological emergency. Although the Radiation Emergency Medical Preparedness and Assistance Network (REMPAN) exists, every country must provide elements of preparedness of a national medical system for managing radiological emergencies.

A research group consisting of experts reviewed the literature and related plans; International Atomic Energy Agency (IAEA) standards also were considered. Based on a three-level approach, preparedness elements of the national medical system were determined.

An emergency medical services (EMS) team for each district is to be trained. The competence of the team members, requisite equipment, procedures for rapidly preparing an ambulance, triage, and decontamination procedures were compiled. For each province, a prepared general hospital and its teams should develop: (1) radiological assessment capability; (2) triage; and (3) decontamination preparedness intervention. A radiation emergency receiving area, equipment list, personal protective equipment, and cooperation with specialized centers were considered. Each country must have a specialized hospital for medical management, training, and connection with REMPAN. All specialized departments, unique instruments, specific drugs, and'necessary procedures were defined. Also, tlie development of a mobile medical support team that could be accessed from the region.

Although radiological emergencies are rare, a national medical system must provide a comprehensive emergency management plan and be prepared for incidents.