On February 22, 2011 at 12:51 pm an earthquake measuring 6.3 on the Richter scale struck the city of Christchurch, population 376,700 in the South Island of New Zealand. This followed a 7.3 magnitude earthquake in September 2010, but the shallowness (5km) and proximity of the February earthquake to the central city, resulted in far more devastation, with Modified Mercalli scores reaching ten in some areas and upward ground acceleration exceeding 2.4G. The application of the Coordinated Incident Management System (CIMS) routinely used by New Zealand Civil Defence agencies was swift, innovative and efficient, facilitating rapid deployment of local and international emergency teams and response resources. The effectiveness of this response was partially attributed to lessons learnt from the September earthquake which, with hindsight, was a practise for the more serious February event. The community response was equally remarkable, with standard approaches to measuring preparedness and resilience suggesting that community resilience in Canterbury was high. A number of initiatives by the New Zealand Ministry of Civil Defence and Emergency Management may have fostered some of this resilience,particularly community- based resilience-building projects initiated by the Regional Emergency Management Office on 2009 and 2010, supported by the Ministry of Civil Defence and Emergency Management. In addition, website education resources and media promotion (“Get Ready Get Thru”) and a travelling exhibition called “The Pandemic Roadshow” had been particularly well received and remembered by Canterbury residents. However, two key events provided an impetus for the Canterbury community to burnish its resilience. First, the Swine flu (AH1N1) pandemic in 2009 resulted in a greater awareness of public health in emergencies along with a doubling of neighbourhood support groups. Secondly, the September 2010 earthquake resulted in the establishment of the student army of volunteers and improvement of public information management. This presentation will describe the markers of community resilience following the Christchurch earthquake and discuss how such resilience can be fostered in communities where emergency preparedness is not recognised as a priority.

Speed and accuracy are major considerations in triage in emergency field settings. Traditional physical examination techniques often are limited in detecting the true nature and full extent of internal visceral injuries, for which delayed recognition and treatment may lead to catastrophic results. Ultrasound has a well-established role in the rapid initial assessment of intra-abdominal pathologies, including trauma, and contemporary portable ultrasound machines are available for use in the field. This presentation will introduce the basic principles of diagnostic ultrasound and its use in emergency settings. Common clinical applications and pathologies and potential limitations and pitfalls also will be discussed with image illustrations.

Medical disaster preparedness (MDP) of Rotterdam-Europort has been estimated by grading personnel, materials, and methods utilized in the chain of medical care, from the disaster site to the hospital. On a scale from 1 to 5, this MDP was set at 2.8: the disaster site is the weakest link, which determines the strength of the whole chain. This, in turn, was the result mainly of the methods utilized for which the personnel were not properly educated and trained.

By applying the methodology as described in an earlier paper, the MDP of cities, airports, harbors, industrial plants, etc. can be determined in a standardized way. This methodology should facilitate epidemiologic research in the public health aspects of disaster preparedness.

Emergency Medical Services (EMS) researchers face a variety of obstacles when conducting out-of-hospital investigations. This paper reviews some common problems and discusses practical solutions to facilitate the process and help avoid traps. This discussion focuses on prospective prehospital research.

One challenge to EMS research is to find new methods of improving the quality of care delivered in the field. There has been an emphasis placed on “exciting” topics, such as cardiac arrest and trauma resuscitation. Other events dominate the daily practice of prehospital medicine, but have not been well-studied. For example, what is the best way to immobilize the spine? What should be done for a patient with a suspected C-spine injury who is wearing a motorcycle helmet? No one has a scientifically proven approach to solve these common prehospital problems. There is a need to look at problems such as immobilization, asthma, overdose, and congestive heart failure to see what can be done differently in the field.

The growth and development of emergency medical services (EMS) has been both impressive and extensive since the late 1960s. Since that time, there has been much discussion and debate regarding the level and quality of care that patients receive from the EMS system. In the United States, this has resulted in a wide variety of emergency medical technician (EMT) certification levels that determine which personnel administer an extensive range of medications, procedures, and medical protocols. Because of these differences, the care a patient receives varies not only from state to state but from community to community. Even though there are many different EMS system configurations, EMS professionals generally believe die level of care they provide in their local community is effective. It is unfortunate that very often, opinions about EMS system effectiveness are not based on studies of EMS system performance or patient outcome data, but upon subjective assessments of ongoing activities by those individuals providing the services.

War injury carries a high mortality, particularly for soldiers. In some individuals it may be necessary to recognize that the nature of the injury precludes any successful treatment. In the vast majority, life threatening situations can be averted by proper front-line management on the way to surgery and to the adherence by anesthetists and surgeons of the principles of war surgery which have slowly evolved over many years.

The Falkland Islands conflict in the South Atlantic once again drew attention to the paramount importance of making adequate plans for the treatment of the sick and wounded, and their subsequent removal from the battle area. The pages of history are littered with accounts of battles, and in some cases wars, being lost because of the inadequate or non-existent plans made to give logistic medical support to the fighting units

Eugene Ionesco once remarked that an excess of politics and an exaggeration of sports are characteristics of our contemporary civilization. The excess of politization affects all parts of our public life, including medicine and its specialty Disaster Medicine. Political ideologies try to usurp a field that has solely humanitarian objectives, that depends on providing for and applying relief to many people in acute distress. There are already many relief organizations and ambulance services, physician staffed emergency medical services systems and first aid trained laymen. There are state and federal disaster relief authorities. Why then was it necessary to add another organization to this sometimes confusing manifold, the German Society on Disaster Medicine?

Emergency medicine is for the individual. It must provide optimal care for each single injured or sick person — except for the shortterm management of multiple casualties. Emergency medical missions are limited by time and locality. These missions are hospital services extended to the scene of the accident and work in connection with hospitals. Disaster medicine is for the masses. Its task is to do the best possible for the largest number of people at the right time and at the right place. This implies that in a disaster situation, optimal care for every single individual can and should not be the goal, but rather the best possible care for the largest number. Disaster medicine has to work in large areas, supraregional and long-term. It needs numerous treatment facilities and several steps or levels of treatment. Therefore it requires a firm medical coordination of lay help, primary professional help, transportation, and specialized hospital treatment with maximal efficiency.

Anesthesia in disaster medicine, especially as practiced in developing countries, is fundamentally different from the anesthesia that is practiced during normal situations. Anesthetic procedures suitable for disaster situations must often take place under minimal conditions of instrumental availability and in a setting of less than modern technology. Such conditions, of course, limit the use of inhalatory anesthetics.

The key factor present in disaster situations is the disturbed relationship between the number of injured, on the one hand, and the available resources to treat them, on the other. This includes medical personnel—both professional and para-professional. This has been substantiated by the earthquakes in Iran, Guatemala, China and Turkey. The earthquake which occurred in Tabas, Iran in December 1978, for example, lasted only thirty seconds, but left behind more than 20,000 dead and countless thousands of injured.