Although none of us likes to think of nuclear war as a possibility, a truly prepared society evaluates the unthinkable. This paper specifically addresses a model for evaluating the medical situation of an area after a nuclear attack.

Consider the situation shown in Table 1 [all Tables and Figures follow the text], which shows an estimation of casualties resulting from a nuclear attack on an area with a preattack population of 9.5 million. The table indicates over half of the population survives and more than half of the survivors (about 3.4 million people) have injuries. This large number of injuries requires medical attention, and, if the area is unable to get outside help (as would be the case for nuclear war), only resources already available within the area could be used.

Sudden illnesses, accidents, fire catastrophes, explosions, gas leakages and war damage constitute serious threats to industry and other production enterprises all over the world.

To counteract the hazards resulting from such emergencies the Federation of Norwegian Industries in 1948 decided to establish an industrial civil defense organization. The Federation also decided that the industry itself should cover the cost both for operation of a central staff and for organizing and running an industrial civil defense at each individual plant or facility.

In 1953, the organization was legalized through the Norwegian Civil Defense Act and a Royal Decree of 1965 decided that the Industrial Civil Defense central staff should organize and supervise self protection in all enterprises employing 40 or more persons engaged in industrial activity, manufacturing and skilled trades, etc. This applies irrespective of where the facility is situated or where the operation takes place.

There are two principal aspects of disaster preparedness. First the daily around the clock routine already existing in ambulance services, hospitals, police forces, firebrigade, voluntary humanitarian organizations, etc. These organizations are occupied daily with accidents, each within their own areas of responsibility, and often in cooperation with each other.

Where people are hurt, medical care will have priority over damage of materials and property. So resuscitation and transport are basic factors in most accidents.

Second, according to the definition of disaster, the problems created by accidents of various types will exceed these daily operating resources. The community must take extraordinary steps to provide rescue and first aid to the victims, and provide fire control, police control, transportation, etc.

The newspapers present almost daily reports on great accidents some place on earth. However, on a national basis, catastrophes occur at rare intervals. There is hardly anywhere a professional rescue personnel which is ready for major accidents with mass casualties because of underutilization and for financial reasons.

That means that at major accidents with mass casualties, the need for rescue personnel and equipment usually exceeds the daily professional readiness for rescue services, and the required manpower and equipment in sufficient numbers are seldom available to handle such big accidents. Voluntary lief organizations will then lend a hand, but they mostly consist of helpers who are neither educated nor trained for such difficult rescue work.

The title of my paper, Area Disaster Planning in the UK, is perhaps grandiose. However, while the need for disaster planning at hospital level is well-recognized, few studies have been published on the results of getting a number of hospitals in a metropolitan area to co-operate in planning on a larger scale.

Following a series of railway accidents, the Ministry of Health in the UK issued a memorandum in 1954 to hospitals in the National Health Service on the arrangements hospitals should make for dealing with major accidents. The main points of this memorandum were that ambulance authorities should be told which hospitals in an area were able to receive casualties; that suitable hospitals should send a senior doctor to the site together with mobile medical teams; and that one doctor at a hospital should be in charge of all the medical arrangements.

Although in Sweden the risk of natural catastrophes is small, several have occurred in recent years. Two examples are a storm disaster in 1970 and a landslide in 1978—both causing extensive personal and material damage.

Other disasters can be caused by human activity in different forms, for instance, fires, explosions and accidents involving public transport, and also—a subject of much concern today—accidents at nuclear power plants. Terrorist actions have also led to serious disaster situations in recent years.

Common to the different types of disasters from the viewpoint of medical care is the fact that locally available resources are often inadequate. Even with very good access to ambulances and other forms of medical transport the waiting time at the scene of the accident can be so long that many patients suffer from acute respiratory distress, major hemorrhages and shock. Under such circumstances qualified first aid can be expected to reduce the morbidity and mortality considerably.

The River Ogunpa flood disaster was an event which created difficulties from every conceivable angle and provided many of the problems to be experienced in disaster management generally. It should be emphasized that every state hospital should have a disaster plan so that one could assume that it is adequately prepared for major accidents. Some of the teaching hospitals in Nigeria have disaster plans. However, the mere presence of a paper plan did not guarantee that it was up to date, comprehensive and understood by all staff concerned, in some of the major disasters which recently occurred in Nigeria. This article highlights some of the major natural and man-made disasters in our country, the magnitude of the damage done, factors affecting the response of the nation to the disasters, as well as some of the major deficiencies in our disaster plans.

At the Second World Congress on Emergency and Disaster Medicine there were many presentations of drama and disaster from all over the world. This article is unusual in that no major disasters are discussed.

Australia is a huge island continent with many of its cities separated by over 3000 kilometres. The dense settlement is in the southeast, but the greatest disaster potential is in the sparsely populated northwest.

This country is fortunate to have been spared from calamities during the documented history of the 200 years of European settlement. Previous Aboriginal history is sketchy, due to the absence of a written language. A history of the disasters includes earthquakes, cyclone, floods and bushfires. There are no volcanoes in Australia. Earthquake fault lines do exist, but there have been no incidents accompanied by great loss of life and property. Cyclones are frequent, but they usually wear themselves out on sparsely populated northern coastlines.

The Prague Emergency Service brought help in many cases of mass accidents with 30 to 120 injured persons (explosions, train crashes, plane crashes, tram crashes, etc.) during the years 1955–1979. We have discovered facts from our own experience and by comparison with disasters in other parts of our country. Prague's mobile ICU-type ambulance service has provided advanced resuscitation and life-support by physicians, since the early 1960s, also for multicasualty incidents.

It is necessary to reduce the consequences of mass injuries to a minimum. Some principal questions are: who is to be treated immediately, who can wait, where is help unnecessary?

Our hospital which was initially devoted to deal with specialized branches of medicine, was rapidly transformed into a purely military one when mass casualties of war needed care. The design of the hospital was therefore changed. Operating theaters were shifted to safe underground floors. Intensive care units were placed near the operating theaters, and a large reception-identification area was prepared to receive victims brought by ambulance or helicopter. Quick-sorting of casualties according to priorities was dealt with in the reception area.

(1) Immediate group: This was dealt with on the spot by quick resuscitation measures. (2) Urgent group: These were immediately taken to the intensive care units or to the operating theaters. (3) Expectant group: These were taken to the wards.

Appreciation of reliable commuications might seem universal; yet when natural disasters strike, few communities are equipped to handle these essential needs. In many instances their ability to notify the rest of the world about their disaster is seriously impaired. Why this is so and why Amateur Radio Operators, or “hams”, always seem to play such a vital part in community survival is the topic of this article.

The best communication systems can fail from traffic overload. As an example, there may be little if any loss of telephone lines or commerical radio links; yet the local population can totally paralyze a system simply by picking up the phone and calling someone. An analogy to this stoppage of communications traffic is seen daily on our expressways as too many cars enter and exceed some critical density at which all traffic must stop.

An International Working Party on the Definition and Classification of Disasters, sponsored by the International Trauma Foundation, developed recommendations on the definition and classification of disasters. The party consisted of: WH Rutherford (Chairman), Royal Victoria Hospital, Belfast UK; Dr. Jacob Adler, Shaare Zedek Hospital, Jerusalem, Israel; Dr. Peter Baskett, Frenchay Hospital, Bristol UK; Dr. Jan De Boer, Het Nieve Spittal, Warnsveld, Netherlands; Professor Bo Brismar, Department of Surgery, Huddinge, Sweden; Dr. Rudolf Frey, Department of Anesthesiology, University of Mainz, West Germany; Dr. Olafur Jonson, Borgarspitalinn, Reykjavik, Iceland; Dr. Stanely Miles, International Trauma Foundation, Salsbury, UK; Dr. Ronald Stewart, University of Pittsburgh, USA; Dr. Henryk Zielinski, League of Red Cross Societies, Geneva, Switzerland.

On September 26, 1980, at 22:19, a bomb exploded at the main entrance to the Oktoberfest in Munich. The bomb, which had been put together by an apparently politically motivated individual, had planted at waist level in a litter bin. Reconstruction from the fragments found at the site and in the bodies of the victims indicated that the bomb was made from a British mortar projectile, manufactured in 1954, which had been modified to ensure particularly intensive fragmentation. The area affected by the explosion was the size of a soccer field. The effects of the explosion were extremely severe (Figures 1-3): 13 fatalities and approximately 225 nonfatal casualties, of which approximately 50 were severely injured.

Thanks to quick, accurate reporting of this major disaster to the Munich Emergency Control Center, which acts as the central coordinating point in case of emergencies, a contingency plan was put into action, which had proved to be effective for disasters involving more than 35 injured. This plan calls for the dispatching of 5 ambulances staffed with physicians, all other available ambulances and the alerting of all hospitals which may have to receive casualties.

During 4½ years, 24 terrorist explosions occurred in Jerusalem. of 511 casualties, 340 were evacuated to the Emergency Department of our hospital. of a total of 272 admissions graded by the Injury Severity Score (ISS), 87% were light injuries, 2.9% medium and 10% severe. The high proportion of light injuries may be explained by the evacuation of all casualties to the nearest hospital by the public. The distribution of injuries to body areas is discussed. Head and neck injuries comprised 19.3% and extremity injuries 39%. The most common primary blast effect was acoustic trauma encountered in 16.3%. Solutions to the most commonly encountered problems in the Emergency Department are discussed.

A widely attended, well-publicized annual event in San Antonio, Texas each spring is Fiesta Week. Fiesta Week begins with the Battle of Flowers parade. In April 1979, a deranged gunman began to fire upon parade participants and bystanders. The area-wide disaster plan was activated in order to deal with the many casualties resulting from his actions. This paper provides a description of the disaster situation and describes the implementation of the mass casualty plan.

Over 300,000 people lined the parade route as the parade began. Gunfire erupted shortly after the start of the parade in an area where approximately 4,000 people had moved to observe the festivities. The first casualties included police and several parade spectators. Instinctively, onlookers sought cover behind cars, barrels and other parade barricades. Authorities estimated that about 500 people were pinned down by the gunfire.

Since oil was found under the North Sea in the mid 1960's, oil production now plays an important part in Norwegian economy. A major oil field is Ekofisk, between Norway and Britain (Figure 1). The Alexander Kielland, one of the rigs at Ekofisk, was a mobile platform of the pentagon type, floating on 5 columns, 150 nautical miles of f the Norwegian coast. It was developed and built as a drilling rig, but was used as an accommodation platform since delivery in July 1976. OnMarch27,1980, the Alexander Kielland rig lay at anchor on the Ekofisk field, close to the production platform EDDA.

On the 28th of November 1979, the fourth largest air disaster in the world occurred on the icy slopes of Mount Erebus, deep in Antarctica and 50 km from Scott Base. The 237 passengers and 20 crew were all killed instantly on impact, and their bodies and the wreckage were spread over an area 500 m long and 100 m wide. It had started out as a scenic flight, the 14th to Antarctica, and it had ended in tragedy. It was suffered, too, by an airline company which had maintained the highest standards of aviation safety.

In an account of Scott's last Antartic expedition in 1910, Cherry Garrard wrote of the “worst journey in the world,” and he said, “I have seen Fuji, the most dainty and graceful of mountains—and also Kanchenjunga; only Mechelangelo among men could have conceived such grandeur.

A few minutes before 9:00 a.m. on Friday 28th February 1975, a call was made to London Ambulance from Moorgate Station, stating nothing more than a train driver had been injured. Some three minutes later, a second call came which indicated that there had in fact, been a major disaster with many casualties. The extent of the casualties and difficulties to be encountered were still not realized, and only when the first of the rescue services and a medical team entered the wreckage was, what was before them was apparent. Three cars containing commuters had been compressed and “concertinaed” into a a blind ending tunnel. Three cars having a combined total length of 150 feet, with a possible total capacity of 440 persons, had been crushed in a tunnel with a maximum length of some 67 feet. Fortunately, despite the time, the cars were not full to capacity, and the total number of injured was only 113.

On July 11, 1978, a truck with a tank loaded with liquid propylene crashed into a camping ground, Los Alfaques, on the Eastern coast of Spain, giving rise to a Boiling Liquid Expanding Vapour Explosion (BLEVE) with a large number of casualties. The Swedish Organizing Committee for Disaster Medicine initiated a study of the events by sending the authors to Spain to make all possible observations at the scene. We were in the camp 48 hours after the explosion.

The Camp

The camping ground Los Alfaques is situated about 190 kilometers south of Barcelona and 165 kilometers north of Valenica. There are hospitals of varying sizes on the route to these big cities, both of which have large hospitals equipped with burn units of high standards, Francisco Franco Hospital in Barcelona and La Fe Hospital in Valencia.

In order to better understand the conditions permitting a fire disaster to occur and to better postulate methods of fire prevention, an historic analysis of three fire disasters was performed. Journalistic accounts, official investigative studies and documents were examined concerning 3 fire disasters: (1) The General Slocum Ship Fire of 1904; (2) the Triangle Shirtwaist Factory Fire of 1911; and (3) the Coconut Grove Nightclub Fire in Boston of 1942. Although the fires occurred on a ship, in a factory, and in a nightclub, several striking similarities were found.

(1) On June 15, 1904, the ship General Slocum embarked on a voyage up New York's East River, that ended in death for 1031 people. The ship, which was constructed entirely of wood, had recently passed inspection. The ship's crew, mostly longshoremen with little sea experience, had never fought a fire at sea. The hatches and bulkheads were flammable, the fire hoses were old and rotten, the fire buckets were out of reach and empty.