Although disasters have exacted a heavy toll of death and suffering, the future seems more frightening. Good disaster management must link data collection and analysis to the decision-making process. The overall objectives of disaster management from the viewpoint of public health are: 1) needs assessments; 2) matching available resources with defined needs; 3) prevention of further adverse health effects; 4) implementation of disease-control strategies; 5) evaluation of the effectiveness of the application of these strategies; and 6) improvement in contingency planning for future disasters.

The effects of sudden-onset, natural disasters on humans are quantifiable. Knowledge of the epidemiology of deaths, injuries, and illnesses is essential to determine effective responses; provide public education; establish priorities, planning, and training. In addition, the temporal patterns for the medical care required must be established so that the needs in future disasters can be anticipated.

This article discusses: 1) the nature of disasters due to sudden-onset, natural events; 2) the medical and health needs associated with such events and disasters; 3) practical issues of disaster responses; and 4) the advance organization and management of disasters. The discussion also includes: 1) discussions of past problems in disaster management including non-congruence between available supplies and the actual needs of the affected population; 2) information management; 3) needs assessments; 4) public health surveillance; and 5) linking information with decision-making. This discussion is followed by an analysis of what currently is known about the health-care needs during some specific types of sudden-onset, natural disasters: 1) floods; 2) tropical cyclones; 3) tornadoes; 4) volcanic eruptions; and 5) earthquakes. The article concludes with descriptions of some specific public-health problems associated with disasters including epidemics and disposition of corpses.

All natural disasters are unique in that the regions affected have different social, economic, and health backgrounds. But, many similarities exist, and knowledge about these can ensure that the health and emergency medical relief and limited resources are well-managed.

This paper provides an overview of disaster public health preparedness, response, and recovery activities with particular reference to examples that have occurred in California. It discusses the public health considerations from two aspects: 1) general public health effects; and 2) public and environmental health control measures. The latter discussion is divided into: 1) drinking water; 2) human wastes; 3) food; 4) personal hygiene; 5) mass care and shelter; 6) solid waste and debris; 7) hazardous materials; 8) injury prevention programs and public health information; 9) vector control; and 10) disease control and surveillance. Two tables summarize the disaster medical and health functions as they relate to public health.

Controversies regarding the mental health consequences of disasters are rooted both in disciplinary orientations and in the widely varied research strategies that have been employed in disaster mental health studies. However, despite a history of dissensus, there are also key issues on which researchers agree. Disasters constitute stressful and traumatic experiences. However, vulnerability to such experiences, as well as to more chronic Stressors, is socially structured, reflecting the influence of socio-economic status and other axes of stratification, including gender, race, and ethnicity. Disaster events differ in the extent to which they generate stress for victims. A holistic perspective on disaster mental health would take into account not only disaster event characteristics, but also social-systemic sources of both acute and chronic stress, secondary and cumulative Stressors, and victims internal and external coping capacities.

The media system controls information resources that public health agencies may wish to use to accomplish their goals, particularly in a crisis. The resources of the public health system sometimes are prized by the media system, and this provides opportunities for public health agencies to gain access to the media. This paper reviews the goals and resources of the media system as they relate to the mission of public health agencies in the periods before, during, and after a public health crisis. The various media are reviewed with attention to the role each can play for different purposes and at different stages of a crisis. The importance of presenting health information in the form of stories is emphasized, with specific advice regarding the attributes of an effective story.

Public health officials often are critical of the way television news covers disasters, while broadcast journalists complain of a lack of cooperation from the public health sector during disaster coverage. This article summarizes the issues discussed in a session on Televised Coverage of Disasters, presented in April 1999 at the UCLA Conference on Public Health and Disasters in Los Angeles. Public health officials were asked to “talk back to their television sets” in a dialog with television journalists. Concerns included: 1) the lack of balance in television coverage that is dominated by sensational images that may frighten rather than inform the public; 2) the potential for psychological damage to viewers when frightening images are shown repeatedly in the days and weeks of the disaster; and 3) the perception that TV reporters place too much emphasis on crime, property damage, and loss of life, giving relatively low priority to disaster preparedness and to public health issues in the aftermath of a disaster. Options for improving communication between television journalists and public health professionals also are discussed.

The following paper presents an argument for enhancing and encouraging the development of neighborhood-based disaster preparedness organizations, particularly as a potential medical triage and treatment resource following a disaster. First, theresearch context for the utility of non-institutional sources of post-disaster assistance is outlined, followed by the more specific instance of medical triage and treatment. An emerging model of community disaster preparedness training is described, noting the modules that address disaster medicine. Positive contributions and limitations are addressed looking to disaster and non-disaster experiences. While the potential for non-traditional resources to aid immediate post-disaster response is becoming both more common and more accepted, there are a number of recommendations that would improve the usefulness and value, including: 1) integration with existing emergency care infrastructure; 2) standardization of training; 3) use of coordinated drills between public safety organizations, hospitals, and voluntary sectors; and 4) dedication of more funding to assist in the creation and maintenance of programs. Because of the relative infancy of these community-based programs, and the infrequency of large-scale disasters, there is little, if any, pre-post research that can demonstrate a measured impact on response. More pre-disaster baseline data-gathering efforts are needed, combined with post-disaster evaluative research to understand the utility of these non-traditional resources in terms of overall response, and in particular the ability to assist in areas of disaster medicine practice. One also expects that under these kinds of [disaster] conditions, family members, fellow employees, and neighbors will spontaneously try to help each other. This was the case following the Mexico City earthquake where untrained, spontaneous volunteers saved 800 people. However, 100people lost their lives while attempting to save others. This is a high price to pay and is preventable through training.

Although the United States has been impacted by numerous devastating disasters over the last 10 years, there have been only limited efforts between the governmental and non-profit/voluntary organizations to meet the multiple disaster health and mental health needs of the community. Too often, responding organizations compete to provide services, duplicate efforts, and frequently under-estimate the need for services.

Recent efforts have been undertaken by The American Red Cross and other groups to resolve this issue. Governmental and community-based organizations have been invited to participate in planning sessions to pre-identify roles and responsibilities, as well as to exchange key information about the services each group can and does provide.

These efforts have lead to an increased awareness of the potential problems and the development of cohesive plans to provide medical and emotional support services to impacted communities. This has led to improved care for those with serious injuries or psychological crisis, while those with less critical problems have been managed appropriately without needing to be immediately referred to overcrowded emergency departments or physician's offices.

Multiple environmental, ecological, and socio-political forces are converging to increase the occurrence of both natural and technological disasters. Ten forces are of most concern in this regard. These are: 1) global warming, with its consequent weather extremes and climate changes; 2) continued rapid human population growth and concomitant increased urbanization; 3) decreased bio-diversity and consequent ecological fragility; 4) deforestation and loss of natural habitat for animal species, with resultant greater overlap of human and animal habitats, human exposure to animal pathogens, and other ecological perturbations; 5) increased technological development throughout the world (especially in developing countries with their typically immature safety programs) 6) globalization and increased population mobility; 7) sub-national religious and ethnic conflicts, and their potential for conflict escalation and large scale displacement of populations; 8) the collapse of several major countries and consequent unraveling of national identity and social order; 9) the rise of terrorism; and 10) dramatic advances in the science and technology of computing, communications, biotechnology, and genomics.

This paper describes 10 lessons learned relative to the public health aspects of emergency management, especially as they pertain to disasters. 1) Planning pays; 2) A bad situation can be made worse by inappropriate responses; 3) Most life saving interventions will occur before the disaster happens and immediately afterwards by local action; 4) Public health emergency management is not a democratic process; 5) Psychological impacts are usually greater than anticipated; 6) Communications and information management are vital, but often are the weak link in the response chain; 7) Collaboration and partnerships are essential; 8) Unsolicited volunteers and aid are inevitable and must be planned for and managed; 9) Never assume anything, and always expect the unexpected; and 10) Post-event evaluation is important, and must be coordinated.

The paramount lesson learned from past emergencies is that the untoward impact of these events can be anticipated and significantly ameliorated by appropriate planning and preparation. On the other hand, preparation for emergency events has deteriorated because of health-care financial constraints, and resources to support planning and needed infrastructure have diminished. Given these realities, the major unresolved challenge is how to ensure that planning for the common good is supported and, in fact, gets done.

Groups are assigned or formed to perform tasks that one person cannot accomplish alone. This lesson describes the classification of work groups, group unity, leadership, motivation, recognition, conflict resolution, and remediation associated with managing groups and their activities. Advantages associated with group process include 1) the generation of better ideas, 2) ability to assume greater risks; make fewer errors; 3) the capacity for greater knowledge and 4) information, and for some problems, production of better decisions. Groups may be formal or informal. Formal groups may be organic, task-directed, or committees. Informal groups arise when it becomes obvious that a group will work better or may be formed by a discipline within the organization or through friendships. The size of the group its status within the organization, the goals established, and the dependence of the members on the group all may affect the cohesiveness of the group. Leadership of the group must keep the group focused on the objectives and enhancement of the efficiency of its operation and the quality of the decisions made by the group. Motivation of a group often is more difficult than is that for individuals and generally positive inducements work better than do negative measures such as coercion and reprimands. Roles are often informal and conferred by the group collectively. Often norms are established within groups that help the group deal with conflict. Inadequate performance within a formal group may require changes in the leadership, removal of a member or clique within the group, reduction of group size, and/or dissolution of the group. Understanding the dynamics of groups is an essential skill required of good managers.