The study of a disaster which has occurred cannot be researched using the traditional techniques as it is not possible to conceive or conduct controlled, randomized experiments for such an event. Paper I of this series described non-experimental, scientific methodologies which were applied to study the detection-extrication-resuscitation activities which occurred following the devastating 1988 earthquake in the Republic of Armenia, USSR. This paper critically evaluates the methodologies used for the Armenia study and proposes modifications in these methods for application to the study of future disasters.

Approaches which could be applied to the study of future disasters are defined and critically evaluated from the view of reliability, validity, costs, and practicability. The revised set of protocols is discussed in terms of: 1) the structured interview process; 2) training of personnel to conduct, synthesize, and evaluate the interviews; 3) the time required to complete the interview process; 4) sampling techniques; 5) mechanisms for cross-checking the data; and 6) the addition of preliminary data collection immediately following or during the event. Use of this revised approach should assist in the collection and analysis of data associated with future disasters so that it is possible to: 1) further enhance life-saving and reduce mortality; 2) improve relief efforts; 3) reduce damage to communities; 4) evaluate the long-term effects of such events; and 5) assist in better preparation for future events.

This report from a member of the United Nations (UN) team of experts describes the investigations of the use of chemical weapons during the Iran-Iraq War. The UN-sponsored team of experts discovered evidence that clearly showed the use of three chemical weapon substances during that conflict—Yperite (Mustard Gas), Tabun (nerve gas), and Phosgene (respiratory irritant). The effects of these chemical agents and some means of treatment for victims are described.

There are limited data available and no recognized standards or guidelines for providing emergency medical care at large public event The organizational planning of emergency medical care for the 1987 San Antonio Papal Mass was reviewed. Medical care was provided using a multi-tiered system. The San Antonio EMS system played a leading role in the design, administration, and implementation of this medical care.

An analysis of the types and frequencies of emergency medical problems encountered by health care providers is detailed. The total attendance was approximately 100,000, 1.5% (1553) required medical attention, and 241 were evaluated on-site by physicians. The majority of medical problems encountered were managed by non-physician, health care providers.

Severe environmental conditions with a heat index exceeding 102°F were responsible for 174 cases (72%) of heat-related illness. A total of 55 patients required transport to local emergency department. There were no cardiopulmonary arrests, major injuries, or deaths.

Optimal, initial medical care given at the disaster site to victims of civil disasters requires an organized, pre-planned, disaster-site medical support system. Such a system has been developed in Singapore.

On notification of a serious civil disaster, the Coordinating Health Agency (CHA) initially dispatches up to three medical teams. Each team consists of two doctors, four nurses, and an allotment of pre-packaged medical supplies. A Disaster-site Medical Command (DSMC) head-quarters (HQ) is established, consisting of a Medical Commander (MC), a Deputy Medical Commander (Dy MC), three hospital staff, and a clerk. The MC conducts an initial assessment of the disaster site and then deploys medical teams and establishes the headquarters. The MC also informs the CHA (via cellular telephone) of the situation at the disaster site and when deemed necessary requests further medical assistance.

The MC has two-way radio contact with all medical teams. The medical teams relay information regarding the casualty situation, requirements for ambulances, stretchers, and medical supplies. Direct channel communication with the CHA enables the MC to direct ambulance transport of patients from the disaster site. The MC also has operational control over other paramedical teams from the Fire Service, the Singapore Red Cross, and the Singapore Armed Forces. Prior to transportation to the hospital, the medical teams only carry out trauma resuscitative procedures such as maintenance of airway, ventilation, and circulation.

This system is expected to provide a coordinated and rapid medical response to a civil disaster situation.

The study of disasters has become a new, applied science. The increasing global population is dependent on fragile links of communication and transportation, and the modern technology of weaponry has led to new forms of armed conflict. These combined factors have made our need to understand the process of disaster research ever more pressing. Similarly, workers and researchers in the field must reappraise their methodologies and their contributions to the literature of catastrophe. The end result of good research and its promulgation in journals, articles, and even press conferences should lead to the saving of lives, the protection of property, and the stability of our communities. Hastily performed research and misleading reporting can and does lead to unnecessary death and injury, and to the wasteful expenditure of scarce resources.

Since 1985, the state of Connecticut has been served by a hospital-based, advanced life support (ALS) helicopter air medical service. The service is stationed at a 1,000-bed, Level I, trauma center that is responsible for its operation. Connecticut statute requires the hospital to file operations reports with the Office of Emergency Medical Services, which reports to the Connecticut Department of Public Health. Operations include response to requests for transportation of severely ill or injured patients from the scene of an incident, and patient transport from one hospital to a higher level, definitive-care hospital.

This service also was charged to develop a disaster response plan to be integrated into the overall state plan for disaster responses. The helicopter disaster response involves all six New England states and the three hospital-based emergency medical helicopter programs that operate in the New England states.

This approach has allowed for joint planning and multi-agency, simulated drills. The helicopter emergency medical service has responded to 15 simulated emergencies (drills) and seven actual mass casualty incidents from May, 1985 to June, 1989. In Connecticut, the planning process conducted by the Department of Public Health and the Office of State EMS produced a coordinated, multi-jurisdictional, mass-casualty response plan.

The use of bronch odilators in the prehospital EMS setting is common. This study examined the safety of the administration of 2.5 mg albuterol using a hand-held nebulizer for the treatment of such patients.

A total of 55 patients were included. Following treatment, peak expiratory flow rates (PEFR) increased a mean of 27 L/min, ventilatory rate decreased four breaths/min, heart rate decreased slightly, and systolic blood pressure increased 10 mmHg. Five of the 53 patients in whom cardiac rhythm was monitored, had premature ventricular complexes prior to treatment; only one did following therapy. Breath sounds improved in 61% and were unchanged in 39%. Breathing was reported by the patient as improved in 51 of the 53 (93%) and only one felt worse. Adverse reactions were reported in 15%, but none were severe. This study shows that albuterol (2.5 mg) administration by hand-held nebulizer is both safe and efficacious in the prehospital setting.

Prehospital and hospital emergency medical care providers frequently rely on the electrocardiogram (ECG) to assist them in the differential diagnosis of complex patient problems and as such, the ECG often constitutes a major determinant of the definitive treatment selected. The purpose of this exercise is to review a small portion of the vast area of ECG interpretation: specifically, those rules that guide the practitioner in the diagnosis of Premature Ventricular Complexes (PVCs).

Premature ventricular complexes (PVCs) occur in multiple individuals in multiple settings. Due to these differences, the causes, implications, and treatment of PVCs must be individualized. Thus, the scope possible for this discussion is huge. Consequently, this exercise will focus only on helping the practitioner correctly identify PVCs.

Superpower military competition has abated, but the specter of nuclear weapons still adds a completely new dimension to warfare. The destructive capacity of so-called conventional bombs was made cruelly evident in the Second World War. Yet, today, a single, thermonuclear bomb has the explosive power of a million times the largest conventional device, with not only devastatingly immediate consequences but also extremely harmful long-term effects, both at the site of the attack and far away, in time and space (Figure 1).

In Figure 2, the small central circle with a radius of 1.4mm represents the combined area which would have been affected by the total of all the explosives used in the Second World War. The larger circle, with a radius of 100mm, represents the relative destructive power of the nuclear arsenals stockpiled today. This is a terrible and, hopefully, a sobering image.

Ongoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources. Data were not available for use in establishing policy.

In response, this community developed an on-line, computerized system known as Computerized Hospital On-Line Resources Allocation Link (CHORAL) that visually displays the resource status of all hospitals to the 911 center, base-station, and participating hospitals. A change of status requires simple keystrokes for entry into the computer which in turn is transmitted automatically to all other CHORAL computers.

Six patient care resources are monitored: Adult Ward (AW); Computerized Axial Tomography Scan (CT); Critical Care (CC); Labor and Delivery (LD); Pediatric (PEDS); and Psychiatric Secure Beds (PSB). Paramedics use protocol to determine if a particular patient fits one of these categories. Availability is relayed to paramedics by the 911 center and the base-station. During the first three months of system operation, there were 337 diversions representing 4,527 hours among 10 of the 12 participating hospitals. The most common resource resulting in diversion was PSB, which was unavailable for 2,195 hours (48.5%). Unavailability of CT resulted in the lowest number of diversions (1.3%, 60.3 hours). Using this system, the paramedics know the resource status of destination hospitals immediately, resource information monitored at base-stations and 911 centre is accurate, and data are available for use in establishing policy.