The efficiency of EMS, especially resuscitation of the severely wounded, depends upon speed and skills. This requires well-organized military-civilian collaboration, as shown during recent earthquakes in Ashkhabad and Tashkent. Reasons include the great mobility of military medical units, including field hospitals; communication facilities; specialized means of transportation; readiness of equipment and supplies; as well as skillled military medical personnel.

The only organization presently capable of responding immediately to a mass casualty situation in peacetime in Israel would be the Israeli Defense Forces. They have available the necessary means, organization, trained manpower and equipment. If a state of emergency would be proclaimed in the state of Israel in case of a major earthquake or similar disaster, in any part of the country, the chief military commander would be in charge. His army would take command over that area. All the other civilian institutions concerned with the care of casualties, including fire fighting forces, police and hospitals, would come under his command. With the military in charge, the response would be much shorter. The chief military commander would proclaim a state of emergency if he feels that it is warranted.

Besides defense, a military organization can protect a country in two ways: (1) Ensure the integrity of a country despite internal disasters and disturbances; military aid can have a humanitarian role. (2) International responsibilities.

The Canadian Forces participate in peacekeeping and disaster relief all over the globe. This international military job results in increased prestige for Canada and security for Canadians.

The subject of disaster medicine may seem suspect to those who say that it means to prepare for war. Others maintain that in the FRG we need not concern ourselves with disaster medicine because “disasters in this country seem unlikely.” I consider those claims absurd. I will try to point out possibilities for medical support by the West German Bundeswehr (Federal Armed Forces) in the event of natural disasters (e.g., earthquakes, floods, forest fires) or in severe accidents (e.g., traffic, aircraft, railway) where suitable civilian helpers or equipment are unavailable or are available only in insufficient numbers or too late. The Federal Armed Forces' Medical Service, according to legislation, is part of the Armed Forces, organized for defense. The medical service has to provide free medical care for military personnel, and protect, maintain or restore as far as possible the health of military personnel. Moreover, it is a matter of course in our country to employ the medical service of the Bundeswehr for aid in natural disasters or major accidents. For this purpose, the Surgeon General, Federal Armed Forces, in March 1982, issued guidelines on which I will primarily base my remarks.

The Department of Defense (DOD) must be prepared to deal with the most likely contingency situations. In developing plans, certain medical factors must be considered. One of these is mobilization time. In prior conflicts, we had sufficient time to expand the military medical system to meet the needs of military operations. We did this by organizing medical units, building hospitals, and training personnel. But, given the high state of readiness and mobility of current combat forces, a future conventional conflict could begin with very little warning. If the USA were to be involved in this kind of a situation, our military forces would have to be supported with our present medical capabilities.

Magnitude and Configuration of Disasters. The increasing number of disasters and consequent casualties in an era of growing sophistication of care for the emergency patient mandates a systematized disaster response utilizing all of a nation's resources in optimum fashion. Life in the second half of this century has grown more complicated and in so doing has laid the basis for more complex disasters. Larger groups of people are vulnerable to individual catastrophic events. Population increases and sociopolitical alterations have accelerated the trend toward the establishment of residential and industrial centers in areas subject to natural disasters. Societal and political pressures are increasing tensions, producing ever more disasters along a broad spectrum, ranging from isolated terrorist events through low intensity conflict to limited conventional warfare. Perhaps most important, our increasingly technological society has not only contributed significantly to the menu of conflicts but has brought a variety of new transportation and industrial hazards to the ordinary course of life.

During the early summer of 1982, Her Majesty's Armed Forces embarked upon an operation to repossess the Falkland Islands. The campaign was fought over a difficult terrain and under hostile climatic conditions, 8,000 miles from home shores. Resupply was difficult, sometimes unreliable and, during the initial battles, medical practitioners supporting combat troops had to practice ingenuity and improvisation. During the battles, 225 British Soldiers were killed and 777 wounded. Of the wounded who presented at the British Advanced Surgical Centers, only 7 subsequently died (1%). 658 battle casualties were dealt with at the various land-based surgical facilities. About 270 general anesthetics were given.

Following the June 1982 war in South Lebanon, the Israel Ministry of Health sent a medical team to assess health conditions in the area, to assist in the restoration of local health services, and to provide additional medical assistance as needed in public health and specialized medical services. For the approximately 600,000 population of the area, public health sanitary conditions were restored by local authorities, with some external assistance. Sanitation and housing for the refugee camp populations were difficult to solve because of extensive damage in the camps; but United Nations activities, supported by international and Israeli sources, were effective. Epidemic conditions did not occur. Monitoring for specific infectious diseases showed increases not exceeding usual summer conditions. Child nutrition status was satisfactory. Medical needs for specialty services, not available in South Lebanon, were arranged through screening and referral to Israeli hospitals. Renal dialysis needs were met by establishing a dialysis unit using local personnel in a damaged and non-functioning government hospital. Private medical and hospital services, the bulk of health care in the area, functioned except for minor dislocations throughout the war and post-war period. Israeli medical aid, managed by a small multidisciplinary team, was designed to assist and, where necessary, augment rather than replace local health services.

The medical successes realized in Vietnam can be attributed to several factors: rapid evacuation of casualties by helicopter or ambulances; the availability of whole blood; well-equipped field hospitals; highly skilled and well-organized surgical teams; and improved medical management. Of these important factors, rapid evacuation by helicopter contributed the most to saving the lives of the wounded. Without effective helicopter evacuation, it would have been difficult to exploit the other factors and management of medical resources would have been less efficient.

At the beginning of many of its armed conflicts, the United States has found itself unprepared for large numbers of casualties. The Vietnam War was no exception. In August 1965, Marines landed at Chu Lai, just south of Danang in South Vietnam, for their first major unit combat effort. They suffered more casualties than anticipated. They were cared for by Navy physicians and corpsmen in the combat area and then flown by helicopter to the Danang airbase. There, they were further triaged in a small field hospital, which quickly became saturated with those casualties which could not be moved. Those less seriously wounded and those who could be made transportable were flown directly to Clark Airforce Base in the Philippines by C130 combat aircraft, a flight of approximately 3 hours. They arrived unwashed, in their combat gear, with weapons on the litters. A C130 aircraft carries 72 litter casualties when fully loaded. At Clark AFB, after word had been received of the combat action, all patients, who could be discharged, were sent out. All personnel at the base, including wives and dependents, were mobilized to help at the hospital. They washed and moved the casualties as they arrived.

One of the worst hotel fires in the USA occurred at the MGM Grand Hotel in Las Vegas, Nevada, on November 21, 1980. This tragedy claimed 84 lives and injured 300 others. The toll might have been higher were it not for Air Force assistance.

Nine U.S. Air Force helicopters responded swiftly to the scene in answer to the city of Las Vegas plea for help. The call came from the Metropolitan Police Department at 7:38 a.m. and got an immediate response from the Nellis Air Force Base (AFB) Consolidated Command Post. By 7:55 a.m., the first Huey helicopter was airborne. Less than 20 minutes later it was hovering over the MGM Grand Hotel. Evacuation of survivors began immediately, according to Major Larry B. Doege, commander of Detachment 1, 57th Fighter Weapons Wing.

In the county of Stockholm with 2 million inhabitants and an area of 6,500 km2 , a trial project with a helicopter ambulance, staffed by physicians, was carried out during the summer seasons of 1978 to 1980. A total of 507 missions were accomplished.

The Trial Project. During the summer a large number of tourists visit the Stockholm archipelago. For these people there is a problem in the event of acute illness or accident to get qualified medical care without delay. A Bell 206 Long Ranger was based at Barkarby airport just outside the city of Stockholm. This was manned by doctors, ambulance personnel and a pilot, and was supplied with an emergency kit, intubation equipment, a portable ECG apparatus and a defibrillator.

There are high mountains around Oslo, which is located at the foot of the Oslo Fjord. The winter is rough, with snowstorms and secondary roads often closed, and people often ski long distances. Avalanches have buried many people. We started a physician-staffed ambulance helicopter service on June 1, 1978 out of the Central Hospital of Akershus, Oslo, primarily to get a physician to the scene as soon as possible. The helicopter is on alert 24 h a day and can take off in 2 min in the daytime and 15 min at night. In 86% of the cases, the helicopter can land within 50 m of the patient. At night, the landing places have to be more secure. The helicopter is a Bolkow BO 105, which can carry 2 patients, 1 pilot, 1 rescuer or paramedic, and 1 physician. In case of an accident on a lake, the paramedic is a frogman and in case of an avalanche we take a specially trained dog along. The pilot has vase experience with helicopter duty, and the paramedic has good medical and rescue experience. The physician has to be a specialist in emergency medicine and is usually an anesthesiologist. The team is always on duty at the hospital where the helicopter is stationed, only 100 m from the emergency entrance of the hospital.

Air transportation missions of seriously ill or injured patients are subdivided into rescue missions and medical evacuation missions. In 1981, for rescue missions, 29 stationed rescue helicopters were available with an operation radius of 50 km. Their task consisted of securing the primary care for vital risk patients as soon as possible. Medical evacuation missions were realized by helicopter, ambulance aircraft, and airliner. Before take-off a medical briefing was held to diminish the transport-trauma. Patients with cardiopulmonary insufficiency are at risk as simultaneous appearance of acceleration, climbing rate, falling cabin pressure and emotional stress may produce serious complications. Additional education of the medical crew is required.

Approximately 200,000 emergency patients die annually in the Federal Republic of Germany (FRG) after a sudden illness or a serious accident. According to estimates, more than 20,000 die because effective first aid was not rendered soon enough. We know that two-thirds of all victims of fatal traffic accidents die within 25 minutes after the accident has occurred. In order to improve chances of survival, the therapy-free interval must be as brief as possible.

Data from many rescue missions can be made more comprehensible by computer processing. Exact and systematic processing of data is needed to evaluate the effectiveness of treatments. We put into practice a computer assisted recording system for the rescue helicopter Christoph 5 in Ludwigshafen-Oggersheim, dealing specifically with medical performance.

For over 100 years, Innsbruck, Austria had been a center for Alpine and winter sports. In 1896, it became necessary to found an Alpine rescue service to come to the help of mountain climbers and skiers who were injured or stranded in our mountains. The reason for today's accidents are the same as they were 50 years ago. On the one hand, Alpine accidents are a consequence of preventable dangers, such as inadequate equipment, carelessness, and too little Alpine experience. On the other hand, they are caused by objective dangers, e.g., falling rocks, weather, lightning and avalanches. The rescue methods, however, have undergone a fundamental change over the last 3 years.

In summer, mountain accidents may include falls, causing contusions and open wounds; fractures and torn ligaments; external bleeding;internal bleeding in the head, thorax and abdomen; injuries to the spinal column and extremities; falling rocks causing skull injuries; and falls into crevasses causing additional hypothermia, frostbite and drowning. In winter, there are skiing accidents with fractures and torn ligaments; and avalanches resulting in asphyxia, hypothermia and frostbite. In addition, there are mountain sickness; pulmonary edema of high altitude; snow blindness; heatstroke; sunstroke; heart attack; diarrhea and vomiting; pneumonia; snakebite; drowning in torrents or lakes; and burns, explosions and cuts acquired in huts. First aid, medical support and transport to hospital may vary widely.

In contrast to other European countries, Italy lacks a Civil Defense Organization. Air Rescue is a task for the Italian Air Force Search and Rescue (S.A.R.) organization. It may also draw, if necessary, on the cooperation of the other Armed Forces and State Corps, the Merchant Navy, civilian organizations, the Italian Red Cross (C.R.I.), and the Mountain Rescue Service of the Italian Alpine Club (C.A.I.). The S.A.R. units intervene at the request of civil, state, public and private, national and international organizations. The tasks currently performed by the S.A.R. in Italy include search and rescue of civilian and military air crews lost at sea or over land and of shipwrecked survivors; emergency transport of doctors and supplies to the seriously sick or injured patients from ships at sea; inaccessible localities, earthquakes, floods, and other disasters.

The rescue of victims of accidents during underwater activities, and the treatment of the pathology provoked by too rapid ascent in diving, are unfortunately problems which still remain relevant today. The concept of rapid artificial recompression is at the basis of the fundamental therapeutic techniques for the early treatment of all those involved in accidents of this type. Though numerous advances have been achieved in this field, many practical limitations still prevent their complete utilization.