This is a summary of the presentations and discussion of Surveillance, Early Warning Alert and Response at the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO)in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to the surveillance, early warning alert, and response to communicable and vector-borne diseases as pertaining to the responses to the damage created bythe Tsunami. It is presented in the following major sections: (1) key questions; (2) needs assessment; (3) coordination(4) gap filling; and (5) capacity building. The key questions section is presented in six sub-sections: (1) communicable diseases; (2) early warning; (3) laboratory capacity and referral networking; (4) coordination of disease surveillance, early warning, and response; (5) health infrastructure rebuilding; and (6) using existing national surveillance plans toenhance disease surveillance and early warning systems.

The treatment of hunger strikers is always contentious, chaotic and complex. The management is particularly difficult for health professionals as it raises unprecedented clinical, ethical, moral, humanitarian, and legal questions. There are never any easy answers. The current situation of prisoners from the Iraq and Afghanistan Wars currently at the Guantanamo Bay Detention Center in Cuba demands unprecedented transparency, accountability and multilevel coordination to ensure that the rights of the strikers are properly met. There are scant references available in the scientific literature on the emergency management of these tragedies. This historical perspective documents the complex issues faced by emergency physicians in Hong Kong surrounding refugee camp asylum seekers from Vietnam in 1994 and is offered as a useful adjunct in understanding the complex issues faced by emergency health providers and managers.

BurkleFMJr., ChanJTS, YeungRSD. Hunger Strikers: Historical Perspectives from the Emergency Management of Refugee Camp Asylum Seekers. Prehosp Disaster Med. 2013:28(6);1-5.

Immersion of patients in a body bag filled with ice and water is recommended as prehospital management of severe hyperthermia. Experienced paramedics have raised a number of concerns about the use of this technique; particularly, whether cardiac monitoring equipment would remain functional once immersed. This test showed that monitoring equipment does remain functional and provides advice about safety considerations. The test should reassure practitioners that such an approach is feasible.

The new jumbo jets, such as the Airbus680, which can transport 600 to 800 passengers, need special consideration in case of a crash, especially if the crash occurs near the airport. Survival parameters depend on the effect of the brutal deceleration and the high probability of thermic effects due to fire, but also the toxicity of the smoke. These new jets requires a different approach to planning for crashes. The scale of the disaster will be totally new in terms of numbers of casualties, numbers of fatalities, and numbers of family members to for whom to provide psychological and technical information. In addition, the problem of identification of the victims will be heightened, and will require more forensic teams. There is, in fact, only one way to manage this kind of disaster: international cooperation and coordination.

The train crash that occurred in London in 1999 resulted in 31 dead and almost 300 injured persons. Mobilized resources allowed for the application of normal treatment principles. Available resources were in excess of what was needed. The procedures implemented were judged as adequate. Responses followed the management plan formulated over many years and experiences. The rotating command procedures used worked well. Multiple communications systems were used, including landline telephones, mobile telephones, and radios. Plans should include caring for both adults and children. Well-planned psychosocial services and functional compute services are essential components.

This lesson explores the use of different management leadership styles and methods that are applied to disaster management situations. Leadership and command are differentiated. Mechanisms that can be used to influence others developed include: 1) coercion; 2) reward; 3) position; 4) knowledge; and 5) admiration. Factors that affect leadership include: 1) individual characteristics; 2) competence; 3) experience; 4) self-confidence; 5) judgment; 6) decision-making; and 8) style. Experience and understanding the task are important factors for leadership. Four styles of leadership are developed: 1) directive; 2) supportive; 3) participative; and 4) achievement oriented. Application of each of these styles is discussed. The styles are discussed further as they relate to the various stages of a disaster. The effects of interpersonal relationships and the effects of the environment are stressed. Lastly, leadership does not just happen because a person is appointed as a manager – it must be earned.

Disaster management plans of emergency departments (EDs) in four major public hospitals were reviewed. A comparison was made between these plans, and they were analyzed to gain an understanding of the differing objectives and doctrines behind the practices. These were summarized into five major management concepts, which are considered to be critical to the success of a disaster plan: 1) staff mobilization systems (cascading vs batch mobilization); 2) staff deployment systems; 3) team organization (surgeons vs residents); 4) area management (the role of the area manager); 5) casualty volume management (accommodation vs expansion vs extension concepts). The-concepts derived should serve as a useful guide to the development of an ED disaster plan and potentially influence how new ED facilities could be planned.

Prolonged EMS response times are a significant problem in rural areas. In this study, VHF radios and personal medical kits were placed in the private vehicles of rescue squad members. By coordinating the responses using radios, higher level EMTs were sent directly to the scene to initiate patient assessment and other procedures while others proceeded to an unstaffed station to pick up the rescue truck.

Using this response system, EMTs arrived at the scene prior to the rescue vehicle on 30 of 35 calls (85.7%). In 25 of 35 calls (71.4%), the first person at the scene was at an advanced EMT level even though the majority of responses (56%) were made by Basic EMTs (p<0.001). The mean response time for EMTs using privately owned vehicles was 9±4 minutes (means±SD) compared with 16±9 minutes for the rescue truck (p<0.01). There also was a significant difference in response times between the privately owned vehicles and the rescue truck when the time between the receipt of the call and the initial acknowledgement of response was measured (1±1 minutes vs. 7±3 minutes; p<0.01).

An effective EMS response can be made in rural areas by sending EMTs directly to a scene in private vehicles. Providing EMTs with VHF radios and personal medical kits enhances this response.

Communicable diseases represent a public health problem in developing countries, especially in those affected by disasters, and necessitate an appropriate and coordinated response from national and international partners. The importance of rapid epidemiological assessment for public health planning and resources allocation is critical. This review assesses infectious disease outbreaks during and after disasters caused by natural hazards and describes comprehensive prevention and control measures. The natural hazard event that causes a disaster does not transmit infectious diseases in the immediate aftermath of the disaster, nor do dead bodies. During the impact phase, most of the deaths are associated to blunt trauma, crush-related injuries, burns, and drowning rather than from infectious diseases. Most pathogens cannot not continue to survive in a corpse. The remaining survivors are the ones from which infectious diseases can be transmitted under appropriate conditions created by the natural disasters. Among several diseases, diarrheal diseases, leptospirosis, viral hepatitis, typhoid fever, acute respiratory infections, measles, meningitides, tuberculosis, malaria, dengue fever, and West Nile Virus commonly were described days, weeks, or months after the disaster event in areas where they are endemic. Therefore, diseases can also be imported by healthy carriers among a susceptible population. The objective of the public health intervention is to prevent and control epidemics among the disaster-affected populations. The rapid implementation of control measures should be a public health priority especially in the absence of pre-disaster surveillance data, through the re-establishment and improvement of the delivery of primary health care and restoration of affected health services. Adequate shelter and sanitation, water and food safety, appropriate surveillance, immunization and management approaches, as well health education will be strongly required for the reduction of morbidity and mortality.

Due to the limited resources of specialized hospital departments, the allocation of patients to different hospitals according to severity is an extraordinarily complex and time-critical problem. The emergency capacity was determined for all medical centers (n = 135) in the State of Hessen, Germany, for patients of various triage categories (red, yellow, green) during normal working hours, and during weekends and nights and included logistic specifications of a potential helicopter landing. These data were entered into a state register. Using the data from the “acute-care-register”, a Ticket System was developed that allows operations management to assign patients according to the severity of their condition, urgency, and specialization requirements (e.g., neurosurgery, ophthalmology, pediatrics) to a hospital without exceeding the admission and/or treatment capacity of the hospital/facility. During a non-critical period, the order of allocations depending on the distance from the clinic is planned in advance so that no further modifications are necessary during the acute intervention phase of an emergency response. Additional notification of hospital capacities for severe casualties provided during the emergency response can be easily and immediately supplemented. Due to the relatively low frequency of such emergency responses, a cost-effective concept that is easily adaptable to the respective fields of application was decided upon. The system is a sticker set customized for the respective rescue teams. The sets will be carried permanently in the rescue equipment by the organization manager of the rescue service team. The equipment is not dependent on electronic components. The cost per sticker set is approximately US$50. Keeping track of the patient allocations is assured.

Editor’s Introductory Note

This section of Prehospital and Disaster Medicine (PDM) presents reports and summaries of the 19th World Congress on Disaster and Emergency Medicine (WCDEM) held in Cape Town, South Africa in April of 2015. Abstracts of Congress oral and poster presentations were published in April 2015 as a supplement to PDM (Volume 30, Supplement 1).

Linking Competency with Training Needs: Session Summary on Disaster Studies and Evaluation, Session BO-17. Prehosp Disaster Med. 2016;31(1):117–118.