This paper is a report on an exercise designed to reveal the extent of belief in the common myths about disasters held by members of four groups of students from the University of Massachusetts and three groups of trainee emergency workers from Italy.

A questionnaire was administered in which students and trainees were asked to agree or disagree with 19 statements about disasters. These statements were based on common misconceptions about disasters and are at least statements untenable in statistical terms, if not downright wrong. In each case, a Likert scale was used to assess the strength of the students' and trainees' agreement or disagreement with the statements.

The results suggest that some of the misconceptions (for example, that panic and looting are widespread reactions to disaster) were strongly held, whereas others (for instance, that disasters cannot be managed) were less well-rooted. Despite years of refutation by experts, all groups firmly believed that dead bodies constitute a health hazard if they are not disposed of quickly. Attitudes to the proposition that technology offers a solution to the disaster problem were equivocal.

Though the results of the study by no means were homogeneous, students and emergency workers, on either side of the Atlantic, bring many of the same misconceptions that the mass media continually propagates. These beliefs represent a serious challenge for the instructor who wants to ensure that disasters and emergencies are not misconstrued.

Patients with soft tissue injuries caused by missile attacks during wartime have been treated with radical debridement and delayed closure. In a study in Gaza City, the rate of infection of missile injuries to the extremities when treated with minimal surgical intervention, was measured.

Patients with severe soft tissue damage, compound fractures, and injuries to major blood vessels and/or nerves were excluded from the study. One hundred fourteen patients were treated according to a standardized regime that included a superficial, minor surgery revision of the inlet and the outlet opening, and antibiotic treatment. Local soft tissue infection was defined as the presence of at least two signs of local infection.

A total of 109 out of 114 patients attended the first follow-up visit. Eleven (10%) of these patients had an infected wound. A total of 105 of the patients (92%) attended a second follow-up. None of these patients had an infected wound.

Under conditions with a high number of causalities, minimal surgical treatment followed by the administration of antibiotics is a safe procedure for patients with penetrating missile injuries and less severe soft tissue damage.

Although the international community currently is focused on Darfur, it is important that the status of other conflict-affected populations throughout Sudan are not overlooked. For the past decade, the Beja population, located along the Sudan-Eritrea border, has been affected by a conflict that has drawn little attention from the international community.

This study assessed crude mortality rates and other demographic characteristics using a mortality study nested within a nutrition assessment using cluster sampling methods.

The crude mortality rate among the Beja population in the National Democratic Alliance (NDA)-controlled territories between October 2003 and October 2004 was estimated at 1.4/10,000/day (95% confidence interval (CI): 1.2–1.6); the under five years of age mortality rate was estimated at 2.7/10,000/day (95% CI: 2.2–3.3). Both of these are elevated rates that exceed the accepted threshold to declare a humanitarian emergency.

When considered with recent reports of elevated malnutrition rates, the status of Beja is critical by international standards. Study findings suggest that: (1) nesting demographic objectives into other planned assessments (such as nutrition) are a feasible and cost-effective means for non-governmental organizations to characterize beneficiary populations; and (2) the Beja residing in the NDA-controlled territories are facing elevated mortality and are in urgent need of humanitarian assistance.

An incident involving the release of chlorine gas from the pump room at a local swimming pool resulted in 54 patients seeking treatment in the emergency departments (EDs) of two local, tertiary-level hospitals in Singapore. The hospital hazardous materials (HAZMAT) disaster plan was activated. This report describes how one of the EDs organized in response to the disaster.

Of the 54 people seeking treatment, 36 were treated in the ED at the Singapore General Hospital. The patients were decontaminated at shower facilities prior to entering the ED. The ED was reorganized to cope with existing patients, as well as the large influx of patients from the event site. A protocol was established in coordination with the local drug and poison information center to manage the patients who suffered from chlorine inhalation. Most patients were observed in the ED and subsequently discharged.Outpatient review appointments were scheduled.

Acute respiratory symptoms were the most common symptoms. Four children and four adults were admitted to the hospital, and the other patients were discharged from the ED after observation. All of the chest xrays were normal on the day of the chlorine inhalation. There were no mortalities or significant morbidities, even up to six months after the incident.

Although this chlorine HAZMAT incident did not cause severe injuries, and only a limited number of persons required admission to the hospital, some valuable lessons were learned.

During an infectious disease outbreak, the ability of a hospital to continue routine operations depends upon its ability to absorb expected losses in revenue when the routine charge base is replaced by infectious disease-related charges.

The purpose of this study was to determine the probable financial impact of a bioterrorism event or an infectious disease outbreak on an academic and a community hospital.

During the fiscal year 01 July 2002–30 June 2003, the average number of inpatient charges identified by the diagnosis-related-groups (DRGs) of an academic, tertiary care, Level-1 trauma center (PUH) and a community hospital (StM) were obtained retrospectively. Per diem charges were determined for patients with: (1) gastroenteritis; (2) sepsis; (3) meningitis; (4) tuberculosis (TB); and (5) pneumonia. These charges were used to simulate the financial coding of patients exposed to biological agents.

The total average PUH per diem charges per patient for all 31,530 discharges was (US)$10,516. Specifically, the average changes were $20,499 for patients with transplants, $14,406 for receiving critical care services, $12,650 for the provision of cardiac care, $11,576 for trauma/orthopedic care, and $8,259 for services for patients who suffered a stroke. For patients with infectious diseases, the average per diem charges per patient were: (1) $6,184 for patients with gastroenteritis; (2) $7,842 for patients with sepsis; (3) $10,831 for patients with meningitis; (4) $6,118 for patients with TB; and (5) $4,586 for patients with pneumonia. Per patient per day, PUH would generate a potential net on average loss of: (1) $4,332 for gastroenteritis; (2) $2,674 for sepsis; (3) $4,398 for TB; and (4) $5,930 for pneumonia replaced an admission. Patients with meningitis on average generated a net gain ($315) compared to the average, but would not compensate for the denial of transplant, cardiac, trauma/orthopedic, and some critical care services during the event. Total average StM per diem charges per patient for all 10,470 discharges equaled $3,008. Specifically, $4,965 for critical care, $3,022 for cardiac care, $4,397 for trauma/orthopedic care, and $3,037 for stroke services. For infectious diseases, the average per diem charge per patient was: (1) $2,273 (+$735) for gastroenteritis; (2) $3,047 (+$39) for sepsis; (3) $2,504 (-$504) for meningitis; (4) $2,887 ($120) for TB; and (5) $2,652 (-$356) for pneumonia (net loss/gain in parenthesis).

Through DRG analysis, the probable financial impact of a bioterrorist attack on a Health Care Delivery System is largely detrimental. Preparedness for a biological event must include an assessment of hospital capability and capacity to handle these types of patients, but also must consider the financial ability to absorb expected losses in charges or ways in which to recover the losses.