Trauma kills more people in the USA under 14 years of age than die of heart disease, cancer, pneumonia and intestinal disease combined. It is the leading cause of death in those under 38 years of age and it is the fourth commonest cause of death for the entire population. Advances in trauma emergency care are important from both the medical and economic standpoint since fatalities cost over twice the amount of non fatalities.

In May 1985, a cyclone from the Bay of Bengal struck the coastal islands of Bangladesh. In spite of early detection of atmospheric turbulance and the history of severe cyclones in the area, an estimated 11,000 people lost their lives.

In a natural experiment, cyclone death rates from the two severely affected islands, Urir Char and Sandwip, were analyzed to determine the risk factors of cyclone-associated mortality.

In Urir Char, in which no cyclone shelters existed, the study group lost 40 percent of the family members in contrast to 3.4 percent from Sandwip, where at least eight cyclone shelters existed. Individuals who did not seek shelter were at the highest risk. Barriers in seeking safety were physical as well as behavioral. Easy access to shelters was a significant factor in reducing the risk. Deaths could have been averted through improved timing and method of advance warning.

This report includes the preparations for and the medical impact of the missile attacks launched by Iraq on Israel. It includes the authorization language for the preparations, the preparations undertaken, the perceived threat to the civilian population of Israel, the operational plans activated, the attacks and the medical impact of these attacks, the number and types of casualties, the damage to property, and the initial and subsequent protection times. There occurred a total of 18 missile attacks with 40 conventional missiles launched against Israeli civilians. They resulted in an 4.4 times overall increase in the number of ambulance responses, 228 civilians injured; and two deaths. In addition, five persons died of myocardial infarction related to these attacks. Eight persons died of suffocation due to use of the gas masks.

There are over 25 active insurgencies in progress worldwide today. Terrorism is often part of these actions. But terrorism is also found worldwide in areas where no active insurgency exists. There has been a sharp rise in terrorist activities in the last five years, and there will continue to be an increase in such activities in the future.

Bombs, in various assortments, are the favorite weapons of terrorists. When guns are utilized, they are often of the military type and produce subsequent high velocity missile injuries which have entirely different characteristics than the normal type of handgun injury encountered in the civilian practice of medicine. The type of wounds produced by bombings include blast injuries, burns, multiple fragment injuries, blunt trauma, and major mutilation to include amputation. High velocity missile injuries produced by the use of various military rifles and submachine guns require treatment by a surgeon knowledgeable in the care of such wounds. Surgical lessons learned by military surgeons dating back to the time of Napoleon's surgeon Larrey are discussed in some detail in the article. Special considerations attending to medical care associated with terrorist activities are highlighted. Such consequences include multi-system trauma to an individual, trauma to large numbers of individuals at one time, massive trauma to individuals, and the difficulty in treating and evacuating victims who are trapped in rubble.

There is a rich mythology surrounding disasters and our response to them, which has built up over decades and hampers a scientific and objective response to the salvage of life and property. That mythology supports rationales for not dealing prospectively with the very real, but unpredictable, quirks of mankind, nature, and technology. Our response to disaster planning is all too often characterized by ignorance, with a fair share of parochialism, misinformation and unrealistic expectations.

Triage is the process of classifying injured patients according to a predetermined hierarchy. Triage typically involves the urgency prioritization of trauma patients in mass casualty circumstances. The triage process is also used daily in Emergency Medical Systems that incorporate trauma care systems to identify how severely a patient is injured and to channel the patient into the appropriate treatment echelon, i.e., to determine a threshold level of severity that merits a specific level of care.

In Jerusalem, the Emergency Medical Service is the sole prehospital provider for a population of 450,000 residents. Ambulances are dispatched from a centrally located first-aid center. Separate basic and advanced life support (MICU) ambulances are provided. Basic life support units are staffed by Emergency Medical Technicians (EMTs) trained to provide first aid and cardiopulmonary resuscitation (CPR). These units are dispatched to service persons in whom advanced life support (ALS) services are not likely to be required. The MICU is staffed by paramedical personnel plus a qualified physician. In order to maximize the efficiency of the service an attempt was made to use the MICU only for patients who may benefit from ALS interventions.

Selection of patients for whom the ALS unit may be required is accomplished by switchboard operators. These personnel routinely dispatch the MICU for definite emergencies such as unconsciousness or absence of breathing. All other cases have been reported first to an on-call physician who ultimately decides whether or not to dispatch the MICU. This method of determining priority for dispatch is called the Consultation-Dispatch System (CDS). This method of determining priority seemed inefficient, so an alternative system was implemented that did not require prior physician consultation. This brief report details the impact of this change on system operation and MICU activity.

Atrioesophageal fistula (AEF) is an important complication of radiofrequency ablation (RFA). Delayed diagnosis is associated with increased morbidity and mortality. Despite the name “atrioesophageal fistula,” fistulas functionally act esophageal to atrial, which accounts for the neurologic and infectious complications. This report presents the management of a 60-year-old male patient who was admitted to the emergency department (ED) with AEF-caused gastrointestinal bleeding. The patient was operated urgently, but he had serious comorbidities and died after the operation. The aim of this case was to evaluate patients who underwent RFA, within 10 days to two months, carefully in the ED and to know the possible complications.

I want to first talk about search and rescue as it occurred in Mexico City; secondly, about what we learned in Mexico City; where are we going from there; what are some of the things that are happening and should be happening in major disaster management, especially as it deals with search and rescue.

There are four main phases in search and rescue. Those four phases are: First, you have to locate the victims; second, you have to reach the victims; third, you need to stabilize those victims; and fourth, you need to evacuate them. I'm going to deal primarily with locating the victims because that was my main responsibility, coordinating the search aspect in Mexico City.

The Republic of Colombia is situated in the northern part of South America, with coasts to both the Atlantic and the Pacific Oceans. It has a long history of natural disasters: hurricanes from the Caribbean sea have lashed the eastern seaboard more than once, while the western part of the country belongs to the so called “Pacific Fire Belt.” Being in the zone of contact between the Nazca and the South American Techtonic Plates, where the former gets under the latter, it suffers from volcanic eruptions and earthquakes (Figures 1 and 2). The more recent major earthquakes were those in Tumaco in 1979 and Popayan in 1983. In Tumaco, the combined action of the earth movement (magnitude 7.9 in the Richter scale) and the subsequent Tsunami caused an estimated 500 deaths (Gueri et al). Popayan was almost totally destroyed by an earthquake of 5.3 magnitude in which over 100 people died (Gueri and Alzate).

When the infrastructure in a community is destroyed by manmade or natural disaster, even the simplest health services may be difficult to maintain. By the Alma Ata declaration, the World Health Organization (WHO) proclaimed, “Health for all by the year 2000.” The program is designed to cover the basic health needs as defined by the Primary Health Care (PHC) system. Therefore, a most important issue in a disaster, is to support, maintain, and rebuild the PHC system, to secure the population's basic health services.

Relevant and rapid aid is of great importance in disaster. The physical and psychological strain caused by disaster will increase the need for medical care compared to that during normal times. Child mortality and maternal complications will rise, Many of the 12 million children, who die every year, die as a result of war, refugee conditions, and/or other types of disaster.

The NorAid system is equipment composed to provide PHC, with special emphasis on vulnerable groups e.g., women and children. Provided the medical skills are available, it also may function as a hospital. The system already has been used in many countries, and has been found to be relevant, practical, and relatively cheap compared to the benefits achieved.