Some papers send more than just one message. And sometimes, the number of messages is unintentional or at least not explicitly debated in the article. Such papers have been produced before, but perhaps we should elaborate on these imbedded signals.

The primary messages brought forward by this paper include:

1. Non-doctors, if properly trained, but lacking pathophysiological insight, can provide acceptable surgical care and raise the standard of health care;

2. Training in science can be and should be dovetailed into capacity building as an integral part of quality control;

3. Scientific work can be performed outside the laboratory and the established, high-tech hospitals. Science/evidence can be produced where everyday activities occur; and

4. Large Level-1 Trauma Centers probably are cost-ineffective in most low-resource regions as they consume too many resources and most people do not have access to them.

A broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters.

During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam (2007), experts in the field of disaster epidemiology discussed important aspects of disaster health outcome assessment, such as: (1) what is meant by disaster health outcome assessment?; (2) why should one conduct a disaster health outcome assessment, and what are the objectives?, and (3) who benefits from the information obtained by a disaster health outcome assessment?

A disaster health outcome assessment can be defined as a systematic assessment of the current and potential health problems in a population affected by a disaster. Different methods can be used to examine these health problems such as: (1) rapid assessment of health needs; (2) (longitudinal) epidemiological studies using questionnaires; (3) continuous surveillance of health problems using existing registration systems; (4) assessment of the use and distribution of health services; and (5) research into the etiology of the health effects of disasters.

The public health impact of a disaster may not be immediately evident. Disaster health outcome assessment provides insight into the health related consequences of disasters. The information that is obtained by performing a disaster health outcome assessment can be used to initiate and adapt the provision of health care. Besides information for policy-makers, disaster health outcome assessments can contribute to the knowledge and evidence base of disaster health outcomes (scientific objective). Finally, disaster health outcome assessment might serve as a signal of recognition of the problems of the survivors.

Several stakeholders may benefit from the information obtained from a disaster health outcome assessment. Disaster decision-makers and the public health community benefit from performing a disaster health outcome assessment, since it provides information that is useful for the different aspects of disaster management. Also, by providing information about the nature, prevalence, and course of health problems, (mental) health care workers can anticipate the health needs and requirements in the affected population.

It is important to realize that the disaster is not over when the acute care has been provided. Instead, disasters will cause many other health problems and concerns such as infectious diseases and mental health problems. Disaster health outcome assessments provide insight into the public health impact of disasters.

Blood transfusion plays a critical role in the provision of medical care for disasters due to man-made and natural hazards. Although the short-term increase in blood donations following national disasters is well-documented, some aspects of blood transfusion during disasters remain under study. The 2003 earthquake in Bam, Iran resulted in the death of >29,000 people and injured 23,000. In total, 108,985 blood units were donated, but only 21,347 units (23%) actually were distributed to hospitals around the country. Kerman Province, the site of the disaster, received 1,231 (1.3%) of the donated units in the first four days after the disaster.The Bam experience revealed crucial missteps in the development of a post-event strategy for blood product management, and led to the development of a detailed disaster preparedness and response plan that addresses issues of donation, distribution, communication, transportation, and coordination. The current plan requires the Iranian Blood Transfusion Organization to convene a disaster task force immediately as the main coordinator of all disaster preparedness and response activities.

Introduction: Low education levels may limit community-based health worker (CHW) efforts in rural Afghanistan. In 2004, LeapFrog Enterprises and the United States Department of Health and Human Services developed the Afghan Family Health Book (AFHB), an interactive, electronic picture book, to communicate public health messages in rural Afghanistan. Changes in health knowledge among households exposed to the AFHB vs. CHWs were compared.

Methods: From January–June 2005, baseline and follow-up panel surveys were administered in Pashto-speaking Laghman and Dari-speaking Kabul provinces. Within each province, an AFHB and a CHW district were randomly sampled using a stratified, 2-staged cluster sample design (total 98 clusters and 3,372 households). Surveys tested knowledge of 17 health domains at baseline and on follow-up at three months. For each domain, multivariate logistic regression was used to assess the effect of the AFHB on follow-up pass rates, controlling for demographics and differences in baseline knowledge.

Results: Both AFHB and CHW resulted in statistically significant changes in pass rates on follow-up, although there were greater gains among AFHB users for five domains among Pashto-speakers (micronutrients, malaria, sexually transmitted diseases, postpartum care, and breast-feeding) and seven domains among Dari-speakers (diet, malaria, mental health, birth-spacing, and prenatal/neonatal/postpartum care). Community-based health workers effected greater knowledge gains only for the Dari breast-feeding module. Participants favored CHW over the AFHB, which they found poorly translated and difficult to use.

Conclusions: The AFHB has potential to improve public health knowledge among rural Afghans. Future efforts may benefit from involvement of local health agencies and the integration of interactive technology with traditional CHW approaches.

This keynote address will focus on the potential to reduce the increasing gap between rich and poor countries. This critical gap only can be bridged if we systematically replace the expensive and reactive international disaster post-hoc operations by systematic, long-term, proactive efforts to increase the local capacity to master everyday accidents and emergencies as well as empower the local preparedness for major events such as natural and technological events. If we really wish to strengthen local preparedness and competencies in remote communities in lowand middle-income countries (LMIC, “the South”), we must systematically share knowledge and skills through scientifically proven training programs aimed at such impoverished, still densely populated regions in the South. Such local training represents a sustainable, long-term action to build emergency medical capacity into the local population and the health workers, as opposed to only relying on expensive foreign relief that arrive too late, is cost ineffective, and most often responds to spectacular disasters. Building local competence also strengthens local resilience (Table 1).

Climate change is widely acknowledged as a key global challenge for the 21st century, and is projected to significantly affect population health and human well-being. All of the climate change-related changes in weather patterns will affect human health, from boosting mental well-being to mortality from largescale disasters. Human health can be affected both directly and indirectly.

For various reasons, the health sector has been slow in responding to the projected health impacts of climate change. To effectively prepare for and cope with climate change impacts, public health must move from a focus on surveillance and response to a greater emphasis on prediction and prevention.

The targeted agenda program dialogue identified three priorities for climate change related health actions: heat waves, vector-borne diseases; and malnutrition.

Introduction: Trauma is a leading cause of death and disability in Mexico. Unintentional injuries, along with diabetes and heart disease, contribute to >35% of the country's total mortality. Effective and efficient prehospital care of the conditions may improve outcomes.

Objective: The objective of this paper was to determine if prehospital field experience (PFE) correlated with higher passing rates among candidates for the paramedic registry in Mexico City.

Methods: This was a retrospective, cohort study using data from the Voluntary Registry of Prehospital Care Professionals (VRPHP) in Mexico City.

Results: The mean value for candidate age was 30.6 years and mean value for the years of PFE was 6.8 years (CI = 9–13 years). Most of the applicants were male and almost 90% were basic emergency medical services providers. Sixty-five percent of the candidates were from private, non-profit organizations, 73% were volunteers, and 19% had obtained a university degree. More than 57% had ≥5 years of PFE, but the experience level did not correlate significantly with higher passing rates for the registry evaluation (χ2 = 1.66, p = 0.43).The results differed between the two years that the examination was offered (χ2 = 32.98, df = 1, p <0.001, γ = 0.54), regardless of gender, education, and years of experience.

Conclusions: Previous field experience showed no correlation with passing rates, although the correlations improved between examination periods. The results may be used to support appropriate implementation of future health policies for prehospital emergency services.

Given the personal and societal costs associated with acute impairment and enduring post-traumatic stress disorder (PTSD), the mental health response to disasters is an integral component of disaster response planning. The purpose of this paper is to explore the compatibility between cognitive-behavioral psychology and the disaster mental health model, and explicate how cognitivebehavioral perspectives and intervention methods can enhance the effectiveness of disaster mental health services. It is argued that cognitive-behavioral methods, if matched to the contexts of the disaster and the needs of individuals, will improve efforts to prevent the development of PTSD and other trauma-related problems in survivors of disaster or terrorist events. First, the similarities between models of care underlying both disaster mental health services and cognitive-behavioral therapies are described. Second, examples of prior cognitive-behavioral therapy-informed work with persons exposed to disaster and terrorism are provided, potential cognitive-behavioral therapy applications to disaster and terrorism are explored, and implications of cognitive-behavioral therapy for common challenges in disaster mental health is discussed. Finally, steps that can be taken to integrate cognitive-behavioral therapy into disaster mental health are outlined. The aim is to prompt disaster mental health agencies and workers to consider using cognitive-behavioral therapy to improve services and training, and to motivate cognitive-behavioral researchers and practitioners to develop and support disaster mental health response.

In the aftermath of the magnitude 9 Sumatra-Andaman earthquake and Indian Ocean tsunami of 2004, a huge number of international responders launched rescue and relief missions in Aceh Province of Indonesia. Thousands of voluntary personnel came to help the wounded, assist with recovery, and rebuild damaged communities. As is often the case with disasters, the necessary disaster management manpower was not immediately athand. Consequently, rescue and relief missions did not coordinate with one another, and chaotic inefficiency prevailed.

Just a little over a year after the 2004 earthquake and tsunami, a second disaster occurred in Indonesia following a major earthquake that occurred in May 2006 on Indonesia's most populous island. The May 2006 earthquake killed 5,000 people in Yogyakarta Province, located in the central region of Java Island.

The main goal of this targeted agenda program (TAP) was the establishment of an international network that would be able to advise on how to improve education and training for chemical, biological, radiological, or nuclear (CBRN)) responders. By combining the members of the TAP group, the CBRN Task Force of the World Association for Disaster and Emergency Medicine (WADEM) and the European network of the Hesculaep Group, an enthusiastic and determined group has been established to achieve the defined goal. It was acknowledged that the bottlenecks for education and training for CBRN responders are mainly awareness and preparedness. For this reason, even basic education and training on CBRN is lacking. It was advised that the focus for the future should be on the development of internationally standardized protocols and standards. The face-to-face discussions of the TAP will be continued at future Hesculaep expert meetings. The intention is that during the 16WCDEM, the achievements of the established network will be presented.