The problems of pre-hospital care and training in the developing world are very similar – resource limitations and training deficiencies. Humanitarian conditions in the Sudan have been among the worst in the world including both man-made and natural disasters. Effectively responding to emergencies is of paramount importance.

The information was collected by a group of Sudanese physicians working in the emergency department at a large urban public hospital in Khartoum, Sudan and in the U.S. for the purpose of establishing structured training programs for pre-hospital responders.

There are currently 37 registered state operated mini-van ambulances serving ∼8 million people in the capital city of Khartoum. There is 1 central dispatching command center operated by the state Ministry of Health (MOH) that serves 29 hospitals. Services are available by calling a central “999” emergency response number. There are no private ambulances in Khartoum; however, most patients are transported by private or public transportation. Ambulance transport teams consist of ∼2 ambulance emergency assistants with limited medical training. Ambulance transport costs are covered either by insurance for the insured; however, the majority of patients are self paid. Emergencies are also managed by the Department of Civil Defense, which is a branch of the Sudanese MOH that responds to natural and man-made disasters. There are 2 layers of this team; 420 physician with masters degrees in DM and emergency rescue workers. These emergency rescue workers do not have formalized training. Other important findings are: lack of training centers for first emergency responders, no standardized practice guide lines among pre-hospital care personnel.

Emergency response in the Sudan is a relatively new practice but has shown a promising trend for the continued development of a highly advanced and functional pre-hospital/emergency response system. More structured training through collaborative efforts and substantial resources are needed.

This project was designed to reduce secondary injury of road traffic accidents (RTA) victims in Hai Duong (HDRC) province in Vietnam in collaboration with the Red Cross with funding from Medical Teams International (MTI). The approximate number of beneficiaries was 601,820, including the 1,820 direct beneficiaries who received first responder training and emergency treatment. The 600,000 indirect beneficiaries is the population along a 45km corridor of National Highway #5 crossing Hai Duong province.

In late October 2009 an evaluation team from MTI reviewed the training of Vietnam Red Cross volunteers in Hai Duong province. The pre-evaluation activities (review of patient contact log books and patient interviews) were conducted by the MTI-Vietnam staff. 58 trained lead volunteers and 20 community members participated in this evaluation. Additionally 92 patients who had been treated by the volunteers were also interviewed.

Findings included: a) the volunteers who received training stated an increase in their confidence to respond to emergencies, b) a 65% increase of Red Cross volunteers, c) a increased awareness of EMS within the province, d) greater community engagement at emergency scenes, and e) broad respect from the community towards the HDRC volunteers.

Considerations for the future include: a) development of a continuing education program, b) increase of supplies to volunteers, c) more training involving multi casualty incidents, d) development of a communications protocol between volunteers and other healthcare providers and e) limit CPR training to drowning related events.

The outcomes exceeded the planned goals: knowledge and retention of course materials and skills is good, confidence levels of volunteers increased and those that are involved in emergency events in Hai Duong province are safer. The profile of EMS and first responders as a critical component of community health has been measurably raised among key stakeholders and the community.

Using a Computer Simulation (CS) to improve training and event management of paramedics for Mass Casualty Incidents (MCI). Eli Jaffe, Avi Dagan, Eyal Zahavi, Einat Aviel, Bruria Adini. The Department of Emergency Medicine, Ben-Gurion University of the Negev Magen David Adom (MDA) is the national emergency organization in Israel. Over the past few decades MDA personnel have been required to deal with MCIs involving large numbers of casualties. Recently, there have been fewer terrorist related MCIs, however, there is a continuing need for to maintain the knowledge and skills of paramedics to manage MCIs.

To examine performance of paramedics exposed to a CS compared to a control group exposed to a traditional lecture based learning experience.

An interactive CS based on the MDA standard operating procedure for managing MCIs was developed. The participants were randomly divided into two groups. Group 1 received the lecture format, and Group 2 the CS. Both groups were given a pre-test (Group 1 average score 56.3, Group 2 average score 53.1), and two post-tests. One immediately following completion of the intervention, and a second a month after completion of the course.

Average scores for the CS Group (n = 15) was significantly different on the first post-test (Group 1 average score 53.2, Group 2 average score 68.7), by 30% and on the second (Group 1 average score 71.9, Group 2 average score 80.8) by 12% compared to the Lecture Group (N = 17) (P = < 0.00).

CS allow for the use of multiple media formats based on real events, and are able to replicate reality using real media material. MDA has recommended that continuing education interventions for emergency medical personnel for maintaining knowledge and skills required for the management of MCIs utilize a CS based training methods.

Wildfires can injure animals both from burns and inhalation of smoke and particulates. In 2006 a rapidly moving grass wildfire burned 12 square miles in Yolo County. Approximately 1400 sheep on the range suffered variable degrees of burns. A coordinated effort of triage and individual treatment or humane euthanasia was performed by the UC Davis Veterinary Emergency Response Team.

Animals: Two sheep ranches with 1100 (ranch A) and 300 (ranch b) adult sheep of different breeds, ranging in age from 1-6 years of age. Initial owner evaluation: Both ranchers considered humane destruction of all sheep showing evidence of burned discoloration, estimated to be over 95% of 1400 sheep. Ranch B attempted shooting comprised sheep but stopped and requested aid from UC Davis as did ranch A. Veterinary initial evaluation and communications: Several burned sheep were visible from the roadway. Many sheep were standing with limited movement and some were recumbent. Triage was performed by bringing food and water sources to the sheep and those not eating and drinking were evaluated first. Gunshot euthanasia following AVMA guidelines based on veterinary determination of hopeless prognosis was used. Veterinary team members (N = 25) coordinated treatments, communications with public health, animal control, and press media, carcass disposal, volunteer management, and acquisition of office of emergency services resources.

Topical treatment of eyes and skin burns with silver sulfadiazine ointment, administration of systemic antibiotics (LA 200), pain relief (flunixine meglumine), wound debridement, and cesarean section of late term terminal sheep were performed.

Over 500 sheep were euthanized by gunshot and the remainder (approximately 900) recovered lasting from 1-42 days. Progression of burn injury to skin, udder, face, and hoofs persisted for 42 days.

A coordinated veterinary response provided humane care and triage of this mass casualty animal emergency.

Preparing for and responding to foreign animal diseases are critical missions to safeguard any nation's animal health and food supply. A specific challenge of foreign animal disease preparedness and response is the ability to rapidly incorporate and scale-up veterinary functions and countermeasures into emergency management operations during a disease outbreak. The United States Department of Agriculture, Animal and Plant Health Inspection Service, Veterinary Services has established a Foreign Animal Disease Preparedness and Response Plan (FAD PReP) which provides a framework for FAD preparedness and response. The FAD PReP goal is to integrate, synchronize, and de-conflict preparedness and response capabilities, as much as possible, before an outbreak by providing goals, guidelines, strategies, and procedures that are clear, comprehensive, easily readable, easily updated, and that comply with the National Incident Management System (NIMS). An overview of FAD PReP will be presented.

The APHIS FAD PReP incorporates and synchronizes the principles of the National Response Framework (NRF), the National Incident Management System (NIMS), and the National Animal Health Emergency Management System (NAHEMS). The FAD PReP contains general plans and disease specific plans that include incident goals, guidelines, strategies, procedures and timelines for local, State, Tribal and Federal responders. The FAD PReP helps raise awareness of the required veterinary functions and countermeasures, helps identify gaps or shortcomings in current response preparedness and planning, and helps to provide a framework to the States, Tribes, and Industry sectors in developing their individual response plans for specific diseases such as HPAI and FMD. The FAD PReP will also identify resources and personnel for potential zoonotic disease outbreaks and large-scale outbreaks, define stakeholder expectations for successful and timely outcomes, identify and resolve issues that may become competing interests during an outbreak and provide a systems approach to preparedness issues that need additional time, attention and collaboration.

Training Agricultural Emergency Responders by Paula L. Cowen, D.V.M., Director, Professional Development Staff, Veterinary Services, Animal Plant Health Inspection Service, United States Department of Agriculture

Background Emergency Response is a critical component of our Animal Agriculture infrastructure. The ability to deploy trained personnel to handle any kind of emergency is key to quickly containing any disaster and mitigating the effects. This training is provided by a number of federal agencies, universities as well as at the state and local level.

Several training strategies are employed by a number of different entities. Training is available on-line, in the classroom, with wet labs using live animals, through exercises and case studies. An overview of training and education of Agricultural Emergency Response personnel across the United States will be covered with a more in depth look at the training provided by the Animal Plant Health Inspection Service.

The Professional Development Staff provides technical training in disease identification and control, emergency response, import/export, and other topics as needed. Protecting and promoting American Animal Agriculture is our core mission. Veterinary Services provides leadership at the intersection of Animal and Public Health concerns.

Trauma is the leading cause of death in the age group 15–44 years in Nigeria. The burden of trauma has continued to increase in the subregion. It is estimated that a significant proportion of trauma deaths occur prehospital. The role of the EMT-Paramedics in trauma and emergency care is well established. However the profession has been absent in the West African subregion. There was no training centre for EMT Paramedic professionals until the UBTH established one in 2008.

To review the UBTH EMT-Paramedic training programme and the implications for trauma and emergency care.

The programme onset, implementation and challenges so far is reviewed in detail with illustrations.

The injection of the EMT-Paramedic professionals into our health system will surely improve our emergency care. The support of the Government at all levels as well support for the training from all Medical professionals is urgently neede.

From 2007, it is decided officially to provide and support mobile hospital team for Iraqi people to enhance access to quality healthcare not only for primary healthcare but also for religious mass gathering and mass casualty situation. Multiple special vehicles were donated to two provincial governments in Iraq and Iraqui experts were invited to Korea for mobile hospital team training including field simulation.

The simulation was based on computer aided initially, and table top simulation was done and real field drills were performed twice. This process was performed for 2 years to different teams from different province in Iraq. The arrangement of mobile hospital vehicles differed between the first and second year field simulation for finding more efficient arrangement. All the table top simulation and real field drills were recorded by writing and camcoders, after the simulations the video was analyzed and discussed with experts and participants.

Table top simulation has highest number of right decisions in individual simulation situation. The second field drill has more right decisions than the first field drill. The second year field simulation has less duration of drill, highest number of right decisions, and was more comfortable to trainees.

The necessity of mobile hospital team is increasing especially in some region and situation, however, the effort is not enough to seek the appropriate preparedness and method of operation academically. Specific knowledge and guideline for mobile hospital will be necessary as well as the up-to-date facilities and technologies.

History is replete with interoperability and resource reporting deficits during disaster that impact medical response and planning. Situational awareness for disaster and emergency medical response includes communicating health hazards as well as infrastructure and resource status, capability and GIS location. The need for actionable, real-time data is crucial to response. Awareness facilitates medical resource placement, response and recovery. A number of internet, web-based disaster resource and situational status reporting applications exist but may be limited or restricted by functional, jurisdictional, proprietary and/or financial requirements. Restrictions prohibit interoperability and inhibit information sharing that could affect health care delivery. Today multiple United States jurisdictions are engaged in infrastructure and resource situation status reporting via “virtual” states and regional projects considered components of “Virtual USA”.

This report introduces the United States' Department of Homeland Security's “Virtual USA” initiative and demonstrates a health application and interoperability via “Virtual Louisiana's” oil spill related exposure reporting during the 2010, British Petroleum Gulf Horizon catastrophe. Five weekly Louisiana Department of Health and Hospital summary reports from the Louisiana Poison Center; Hospital Surveillance Systems; Public Health Hotline; and Physician Clinic Offices were posted on the Louisiana Office of Homeland Security and Emergency Preparedness's “Virtual Louisiana”.

227 total spill-related, exposure cases from five reporting weeks were provided by five Louisiana source agencies and reported in Virtual Louisiana. Cases were reported weekly and classified as “workers” or “population”; associated with the parish exposure locations (8), offshore (1), or unknown (1); and shared with four other virtual states.

Real-time health and medical situation status, resource awareness, and incident impact could be facilitated through constructs demonstrated by “Virtual USA”.

The earthquake in January 2010 killed more than 250,000 Haitians and caused traumatic injury to tens of thousands of survivors. In the aftermath of the earthquake, Haitian civilians assisted in various medical roles. Many of the civilians requested training, and 8 months after the earthquake, a team of American clinicians, EMTs and health educators returned to Haiti to teach a course in basic lifesaving and emergency care.

Using a modified French-language EMS training curriculum, 60 community members with no previous medical experience were trained during an intense 2-month period. Trainings were held to teach basic lifesaving and stabilization skills. The Gwoup Ayisyen pou Ijans was formed and is preparing to take the French-language EMS exam. A follow-up study is being conducted to assess the capabilities of the students.

Preliminary challenges included securing safe places for training and teaching in both French and Kreyol. Successes were the willingness of trainers to volunteer time and equipment, and the high motivation of the students, despite the inability of the government to promise consistent work for an EMT force.

Social media (SM) are forms of information and communication technology disseminated through social interaction. SM rely upon peer-to-peer (P2P) networks that are collaborative, decentralized, and community-driven transforming people from content consumers into content producers. The role of SM in disaster management galvanized during the world response to the 2010 Haiti earthquake. (Pew 2010) During the immediate aftermath, much of what people around the world were learning about the earthquake originated from SM sources. (Nielsenwire 2010) During the first 2 weeks following the earthquake, “texting” mobile phone users donated over $25 million to the American Red Cross. (Sysomos 2010) Both public and private response agencies used Google Maps™. Millions joined MySpace™ and Facebook ™discussion groups to share information, donate money, and offer support. SM has also been described as “remarkably well organized, self correcting, accurate and concentrated”, calling into question the ingrained view of unidirectional, official-to-public information broadcasts. (Sutton, et al 2008) SM may also offer potential psychological benefit for vulnerable populations gained through participation as stakeholders in the response. (Sutton, et al 2008) (Laor 2003)

However, widespread use of SM also involves several important challenges for disaster management. Although SM is growing rapidly, it remains less widespread and accessible than traditional media. Also, public officials often view person to person communications as “backchannels” with potential to spread misinformation and rumor. (Akre 2010) In addition, in absence of the normal checks and balances that regulate traditional media, privacy rights violations can occur as people use SM to describe personal events and circumstances. (Palen 2007)

Telecommunications plays a critical enabling role in disaster response, both for the local population and for responses of external origin. However, it is common for telecommunications capacity to be reduced or disabled by the disaster or emergency. Meanwhile, the disaster stimulates demand for any remaining capacity, often resulting in total loss of telecommunications capability during the acute phase of a disaster and its response.

The Serval Project is addressing this through the implementation of a mesh mobile telephony system that is compatible with some existing mobile telephone handsets, and can be integrated into many more models without changing handset hardware designs or cost. This technology allows mobile telephones to directly communicate with one another, and allows telephone calls to be made without infrastructure beyond the telephones themselves. Our Distributed Numbering Architecture allows the telephones to use their existing telephone numbers, so that communications can continue immediately and without impediment when needed. The telephones self-organise, and relay calls for distant telephones, thus forming their own resilient telecommunications infrastructure that is able to remain operative during all phases of a disaster and its response, thus addressing an important vulnerability of the existing infrastructure-oriented approach to telecommunications. We see applications that include supporting communities in maintaining communication in order that medical and public health effects of emergencies can be responded to more effectively and potentially providing ready access to communications for distributed teams of emergency health and humanitarian workers in disasters. Our goal in creating this technology and removing all barriers to adoption is to facilitate its ubiquitous inclusion in new mobile telephones, so that we can leverage the mass production of consumer electronics to create a resilient telecommunications capacity that can be deployed anywhere without supporting infrastructure. This would enable the creation of, for example, networks consisting solely of used telephones.