Military participation in humanitarian operations, both in cases of armed conflict and in response to natural disasters, is a common phenomenon in several countries. In Brazil, the Armed Forces have a history in providing humanitarian assistance to victims of emergencies through their field hospitals, such as medical and dental care, laboratory and imaging diagnosis, and pharmaceutical services.

To verify pharmaceutical services preparedness of military units in an institution of Brazilian Armed Forces to disaster response and humanitarian aid.

A transversal study was carried out. The methodological approach was based on a logical model and indicators related to the preparedness of pharmaceutical services. Field research was carried out and good storage practices were investigated in loco. Key stakeholders were interviewed based on an open-ended questionnaire on the preparedness of pharmaceutical services. Interviews were transcribed and analyzed for overall content, according to analytical categories stemming from the literature and indicators prior defined.

Key stakeholders of three military units were interviewed, and official documents and guidelines were also analyzed. Some pronounced shortcomings were identified, such as the lack of a specific budget for medicines management, no surplus of health supplies, lack of appropriate transports, and need of capacity building of health professionals and support team. The existence of a disaster plan, selection of essential medicines for primary reaction, forecasting of medicines, field hospitals as mobile and adaptable health structures, and a system for military mobilization are some of the strengths identified. Two military units are better structured in the management of pharmaceutical service. The third unit still needs to mature its processes to fit the health purposes of its mission.

These findings can subsidize the improvement of pharmaceutical services’ efficiency and quality in means of providing better response in emergency situations supported by the Brazilian Armed Forces.

Providing patient care in a moving ambulance can be difficult due to various transport-related factors, (e.g., accelerations, lateral forces, and noise). Previous research has primarily focused on cardiopulmonary resuscitation (CPR) performance effects but has neglected to investigate other care interventions.

To test a range of different care interventions during different driving scenarios.

A workshop with ambulance practitioners was held to create a list of care interventions to be tested. Two ambulance practitioners were recruited to drive an ambulance on a closed test-track while performing care interventions on simulation models. Three driving scenarios of differing difficulty were used. Main outcome measures were estimates of workload using the NASA Task Load Index (TLX) and task difficulty. G-forces and video-data were also collected.

Estimated workload increased overall as the difficulty of the driving scenario increased, as did task difficulty estimates. However, some care scenarios and interventions were affected less. For example, placing intravenous access increased greatly in difficulty, whereas saturation and blood pressure measurements had more modest increases. TLX scores showed that the primarily estimated physical workload and effort that increased, but also mental and temporal demands for some care scenarios. The more difficult driving scenarios primarily increased the variability of measured G-forces but not necessarily the overall driving speed, indicating that force variability is an important factor to study further.

The study was intended as an initial pilot test of a wide range of care interventions. It will serve as input to future, larger studies of specific interventions and transport-related factors. Overall, this small pilot indicates that more interventions than only CPR should be studied in moving ambulances to investigate potential performance effects. This is important for traffic, patient, and work safety for ambulance workers and patients.

Seoul is the third most densely populated area in the world except for the city-state. However, a national disaster plan has not yet been established.

From September 2017, representatives of seven regional emergency medical centers in Seoul met monthly and decided to investigate basic data for the future establishment of surge capacity planning.

Staff, supply, space, and systems for surge capacity were surveyed in seven hospitals. The additional surveyed data were as follows: hospital incident command system and actual operational experience; performance of disaster drill; safety and security plan; estimation of surge capacity in normal operating conditions and extreme operating conditions; alternative therapeutic spaces; back-up plan to call non-duty medical staff; decontamination equipment; contingency plan for stuff shortage; etc.

All the hospitals reported they have hospital incident command systems and held disaster drills every year, however, the two hospitals (28.5%) had no real experience of hospital incident command system activation. Five hospitals (71.4%) did not have a safety and security plan. They replied they can treat average 7.7 emergency patients (Korean Triage and Acute scale (KTAS) ≤ 3), 10 non-emergent patients (KTAS>4), 0.9 surgical patients and 0.7 unstable patients simultaneously in normal operating conditions. In extreme operating conditions, they replied they can treat average 26.4 emergency patients (KTAS ≤ 3), 54.3 non-emergent patients (KTAS>4), 37 surgical patients and 2.3 unstable patients simultaneously. The two hospitals (28.5%) had no alternative therapeutic spaces, no back-up plan to call non-duty medical staff and no contingency plan for stuff shortage. Three hospitals (42.9%) did not have decontamination equipment.

The survey revealed the basic data for surge capacity planning in Seoul. Data from hospitals other than regional emergency medical centers should be collected for the completion of disaster plans.

A mass casualty incident presents a challenging situation in any health care setting. The value of preparation and planning for mass casualty incidents has been widely reported in the literature. The benefit of imaging, in particular, forensic radiography, in these situations is also reported. Despite this, the inclusion of detailed planning on the use of forensic radiography is an observed gap in disaster preparedness documentation.

To identify the role of forensic radiography in mass casualty incidents and to explore the degree of inclusion of forensic radiography in publicly available disaster planning documents.

An extended literature review was undertaken to identify examples of forensic radiography in mass casualty incidents, and to determine the degree of inclusion of forensic radiography in publicly available disaster planning documents. Where included, the activity undertaken by forensic radiography was reviewed in relation to the detail of the planning information.

Limited results were identified of disaster planning documents containing detail of the role or planned activity for forensic radiography.

While published accounts of situation debriefing and lessons learned from past mass casualty incidents provide evidence for integration into future planning activities, limited reports were identified with the inclusion of forensic radiography. This presentation provides an overview of the roles of forensic radiography in mass casualty incidents. The specific inclusion of planning for the use of imaging in mass fatality incidents is recommended.

During a mass casualty incident (MCI) seminar in Rome, Italy a survey was used to gauge the self-efficacy and confidence of the participants in managing an MCI. Following the course, a follow-up presentation was held by the Torino EMS Medical Director to evaluate and debrief the Torino Railway incident that occurred one day prior. Students partook in a seminar on MCI management, as well as a debriefing of the Turin Railway accident in which they evaluated the skills used by teams on the scene to manage the incident.

Medical students partook in a seminar to learn to manage an MCI scene, as well as a debriefing of the Turin Railway accident. Following both seminars, the students were given a survey to assess their sense of self-confidence in managing such a situation.

The mean level of self-efficacy prior to the MCI training (M=3.43, SD+0.42) increased after the training (M=3.71, SD+0.37) and remained at the same higher level (M=3.71, SD+0.51) after the medical students were exposed to the details of the Turin train accident. The overall difference between the mean self-efficacy scores in the three time frames was not found to be significant. The mean level of confidence in managing MCIs prior to the training (M=2.83; SD+0.89) increased after the training (M=3.56; SD+0.53) and remained higher following the presentation of the Turin train accident, despite a slight decrease (M=3.52, SD+0.63).

The participants’ surveys showed an increase in their self-efficacy and confidence following the course and follow-up presentation. It is our professional recommendation that real-life events be used in such seminars to increase self-efficacy and confidence. The topic will continue to be evaluated further.

Deploying an EMT to respond to a sudden onset disaster entails significant operational activities and support back home to deploy and support a responding team. These activities also include peacetime operations, exercising, innovation, engagement, training, and development of both team members and operational staff to further knowledge and experience.

To exhibit the operational activities and complexities of maintaining a deployable cache of equipment and consumables for deploying a self-sustaining Emergency Medical Team (EMT). This includes the elements of managing a high-performance team, human resource management ensuring the readiness of personnel to rapidly respond, maintaining World Health Organization (WHO) international standards for EMTs, and the operational aspects and support behind the scenes to deploy a team.

Analysis of operational activities and support for pre-deployment, deployment, and post-deployment phases including preparedness through innovation, collaboration, development, and maintenance of a high-performance team and cache.

The analysis of operational activities behind the scenes of deploying EMT maps the unique complexities of maintaining and deploying a high-performance team at all stages of deployment, demonstrating the success of a team in the field is attributed to the support and activities of the team back home to deploy them.

There is substantial preparation and behind the scenes operational activities that are undertaken to deploy and support a deployed EMT. Lessons learned from each deployment build on the operational capacity of staff deploying a team and on the future directions, innovations, and practices of a deployed team in the field.

Disasters are a major challenge for public health because of damage caused by death, injury, or illness that exceeds health services’ ability to respond. Health professionals and students require awareness and understanding of particular aspects of disaster planning, mitigation, response, or recovery. In Brazil, despite the increase in the number and intensity of disasters, there is no formal acceptance regarding the need to integrate disaster content into curriculum guidelines (1)

To develop and test referential and models for disaster management health professional education.

Competence-based education has been proposed. The methodology adopted was developed by the Association (2) and adapted to be used in the Brazilian context. An initial literature search was performed in MEDLINE via PubMed, Google Scholar, Lilacs, and Scielo databases using disaster and competencies as descriptors.

Articles and documents in Portuguese, Spanish, and English were identified for: public health (21), nursing (20), multi-professional (16), psychology (4), pharmacy (4), dentistry (2), medicine (1), veterinary (2), and nutrition (1). Data were organized according to a proposal from the literature (3) Selection of benchmarks for the preparation of education models identified 27 referential, three of them developed in Brazil.

Application and evaluation of the methodology developed with undergraduate students of the Federal University of Rio Grande do Sul consisted of an initiative to prepare health care professionals for disaster management.

Paramedicine is a rapidly evolving profession, growing from its initial role of providing emergency care and transportation of the sick and injured into a broad discipline providing a wide range of care in multiple practice settings, yet the field is relatively unexplored. Much of the research in the field centers on patient care, often from the perspective of emergency medicine. A growing body of literature describing the discipline itself is largely descriptive.

This interactive presentation describes and contributes to an applied research project that will define and describe Canadian paramedic practice. The research will develop frameworks, common taxonomy and designs, and evidence to support development of a national Canadian Paramedic Information System.

This two-year mixed methods study is gathering data from a literature review, stakeholder workshops, and key informant interviews. The project will develop “user cases” that explore the issues and challenges facing Canadian paramedic stakeholders and identify the information and data required to address those issues.

The presentation will present initial findings that describe core concepts, data/knowledge structures, and models that are foundational to understanding and informing current and emerging paramedic practice. It will explore this data in relation to operational needs of practitioners, operations, communities, and stakeholders to inform decision-making, guiding policy and direction, and advancing the profession. Lastly, it will develop explanatory principles, models, and relationships in a conceptual framework that describes paramedic practice.

The study will develop models and core data sets that guide research and support policy development at local and national levels, and inform operational and strategic decision-making. The presentation will provide an overview of the research and findings to date. Participants will engage in activities that explore the user-cases and selected findings, applying the results of the study through the lens of their own backgrounds and operational contexts.

Managing an MCI (Mass Casualty Incident) can be a daunting task for emergency responders. Effective management can be a matter of life and death but can be directly impacted by the feelings of the incident commander.

Students were trained to be incident commanders, then following the course were given a survey. In the days following the training, an MCI occurred involving a train full of passengers. The students were then given another survey to assess their readiness following the practical use of their studies.

Students were given a survey to determine their mean level of confidence in managing MCIs prior to training, and following the training. Following the training, there was an increase in confidence. After the training, there was an MCI in which their theoretical knowledge was put to the test.

The pre-training self-efficacy mean scores of younger students (M=3.5, SD+0.23) increased after the training (M=3.8, SD+0.28) and rose even more following the presentation of the Turin train accident (M=4, SD+0.26). While a similar increase in self-efficacy was found among the more mature students post-training compared to the level prior to the training (M=3.7, SD+0.44 versus M=3.4, SD+0.56), the mean self-efficacy score of the mature students decreased following the presentation of the Turin train accident to the pre-training level (M=3.4, SD+0.51).

Mean scores of self-efficacy and confidence in managing MCIs were found to be higher among medical students that were previously trained in coping with MCIs compared to medical students who participated in such a training program for the first time.

As more chronically ill people are living in the community and disasters are occurring frequently, the elderly and the medically frail vulnerable populations are experiencing significantly more disaster-related morbidity and mortality than the rest of the population. A failure to adequately address these vulnerabilities has been shown to have negative effects on the response to the disaster and the community as a whole.

The purpose of this research was to understand how older and/or medically frail adults have experienced disaster and how this experience impacts what they do now to prepare for disaster. A second purpose was the generation of theory regarding the process through which community members prepare for disasters.

This study employed a qualitative descriptive methodology, Situational Analysis, to explore the social processes of disaster preparedness in older and/or medically frail adults.

The core category was “Experience is the Best Teacher.” Based on the findings, it was theorized that these community members are generally considered unprepared for disaster. Their lack of preparedness is due in large part to a lack of education on how best to prepare. Once educated, motivation for self-responsibility of household emergency preparedness can be expected. Community interventions like distributing disaster supply kits and offering evacuation assistance help overcome their situational impediments to preparedness and provide the best chance for these community members to survive disasters without becoming ill or injured or experiencing a decline in their baseline functional status. If these community members are incidentally prepared, it is largely due to their past experience with disaster or their professional experience.

The results from this study could inform emergency plans and policy efforts to better meet the needs of elderly and medically frail community members during disaster.

The collapsed inferior vena cava (IVC) in computed tomography (CT) images can be found in patients with hypovolemic shock, making it an attractive diagnostic sign in early treatment of trauma patients. However, current research results are controversial.

To examine the dimensional change of IVC during acute hemorrhage through a volume controlled acute hemorrhagic shock model in swine.

Volume controlled hemorrhage was performed in 10 adult Bama minipigs. Enhanced CT scan and hemodynamic monitoring were performed when the cumulative blood loss volume reached 0%, 10%, 20%, 30%, and 40%. The transverse diameter (T) and anteroposterior diameter (AP) of IVC were measured in axial images. Hemodynamic parameters were obtained with a Pulse Contour Cardiac Output (PiCCO) hemodynamic monitor device. Arterial blood samples were also collected for artery blood gas analysis at each time point.

As the blood loss volume increased, the collapsibility (T/AP) and cross section area (CSA) of IVC significantly changed in hepatic level and pre-renal level. The significant decrease of the CSA of IVC (shrink) occurred early when the blood loss volume reached only 10%.

The IVC shrank early but collapsed late during acute hemorrhages in swine. The collapsed IVC on CT scans suggested a severe hypovolemic shock state but not an early indicator for shock.

In 2013, a multinational collaboration met to improve the global and nation-specific preparedness and response in managing casualties from nuclear and radiological disasters. From this meeting, a survey was developed and distributed in both Japanese and English. The results published four years later illustrate a lack of understanding about radiation and risks to the health care provider.

To dispel myths and increase understanding regarding trauma treatment and healthcare risks for healthcare providers during a radiologic event.

IRB approved survey and literature review

A total of 418 surveys were analyzed. Although 44% of participants acknowledged that they had taken at least one radiological training course, the majority of the respondents were still not comfortable with radiological emergencies.

Despite the plethora of both online and in-person radiological training availability, healthcare providers are not comfortable with the topic. Based on information from the survey, it is important to dispel myths and educate healthcare providers so that they have reasonable expectations regarding risks and to ensure that they are comfortable coming to work. By doing this, there will be an adequate healthcare presence to help take care of patients who are not only in need of immediate trauma and radiologic exposure care but also with non-affected patients coming for emergent and scheduled health care needs.

Besides being located on the Pacific Ring of Fire, Indonesia is the largest archipelago country in the world. Some parts of the country are not very accessible. It raises difficulties in controlling and monitoring a disaster response mission remotely in real-time. Muhammadiyah, the Indonesian non-governmental organization (NGO) that has been responding to disaster since 1919, used Geographic Information Systems (GIS) for Health Disaster Response (HDR) in the Lombok Earthquake 2018, in cooperation with ESRI Indonesia, as one alternative to disaster response controlling and monitoring.

To show the benefit of using real-time GIS for HDR in an archipelago country.

While responding to the disaster in Lombok, the Muhammadiyah Health Disaster Response Team was collecting data of patient, medication, problem, need, location, and resource with computers and smartphones, inputting the data that was forwarded to the ArcGIS platform. The Health Disaster Response Team coordinator and Muhammadiyah Board monitored and analyzed the health response through the GIS dashboard in Yogyakarta, 652km far from Lombok Island.

Using real-time GIS has been useful for disaster response. It was efficient by cutting flight and other transport costs, connected by the internet, and communicative by graphic and map dashboard. It was a green approach since it was paperless, and analysis-friendly by real-time data compilation and computation.

One of the big gaps in disaster response monitoring seems to be real-time data. Especially in an archipelago country, it is costly, time-consuming, and resource consuming. Daily big data may be frustrating and can become “white paper syndrome.” One of the good approaches to that is GIS Web services although it must be realized that the internet connection in a rural area can be another challenge. It can be solved by in-gadget data memory that can be delivered while the internet connection is available.

One of the key components in any effective disaster response is the capacity of local communities to respond in a timely and efficient manner. Over the last 3 years, the National Critical Care and Trauma Response Centre in Darwin has been involved in building regional capacity across the Asia-Pacific, supporting local leadership and building local skills and knowledge in order to develop a systematic approach to disaster medical management.

This presentation is to describe the Regional Engagement Program, its strengths, weaknesses, and outcomes.

We will describe the background to the program, the process for regional engagement and the Results of our evaluation. The program used the Major Incident Medical Management Systems (MIMMS) approach which was delivered in-country and included identifying and using local personnel to deliver the program. The program was conducted across the region in Myanmar, Fiji, Tonga, Vanuatu, Samoa, Timor, and Indonesia. Initially the courses were run by personnel from Australia but through engagement with local Ministries of Health and collaboration with identified key stakeholders, we have been able to build local faculty to ensure sustainability and local ownership.

Thirty-six personnel have been trained across four countries. Thirty-six candidates are now instructors, with a further 36 identified for future development as instructors. The evaluation illustrates the long-term partnerships that have been developed and the ongoing capacity development of key regional partners.

The Regional Engagement program demonstrates that prolonged engagement with key regional stakeholders and adequate and sustained mentoring will successfully build local capacity to the level needed to mount a successful response to a disaster. Personnel trained through this program helped guide the response to the Lombok earthquake and in Fiji, a MIMMS Team Member training program was conducted with minimal external support.

A trauma registry is a disease-specific data collection composed of a file of uniform data elements that describe the injury even, demographics, prehospital information, diagnosis, care, outcomes, and costs of treatment for injured patients.

To establish a trauma registry system on an electronic platform enabling data capturing through Android phones.

A software has been developed for the registry data collection for road traffic injury patients arriving at JPNATC, AIIMS, New Delhi. The software has been designed to use in the Emergency Department on Android phones/laptops with internet access.

A detailed registry data set has been prepared to enter prehospital, in-hospital, and post-discharge details of all the admitted patients. This includes demographic data, prehospital data, injury event data, vital signs within 24-hrs of arrival, ED disposition (date and time), operative procedures within 48 hours of arrival, chest x-ray (date and time), CT (date and time), ventilation days, ICU-stay days, hospital disposition (date and time), injury coding data (region, severity level, ISS, AIS, ICD-10) and Others, e.g., first neurosurgical consultation (date and time) and first blood transfusion (date and time). There are two panels for this software; one for user panel and another for the administrative panel. User panel is being used for data collection by the trained data collectors 24/7 at the emergency department on a rotation basis. The administrative panel is accessible to only the investigator or other authorized persons. The administrative panel and user panels are password protected. The entered data is being saved in a spreadsheet in the backend and can be used for periodic data quality check and data analysis.

There is no trauma registry in India so far for the road traffic injury patients. Present innovation would lay the foundation of national Trauma Registry in India.

A learning project was launched to prepare for natural disasters such as earthquakes and floods. Competencies were developed for clinical nurses in the Initial phase of disasters as an indicator to build a bridge between daily training and actions during crises. There are two predominant features of the competencies that differ from other works. First was to concentrate only on “the initial phase” of a crisis outbreak. The second was to associate each competence with services and roles of clinical nurses.

The development has been conducted in accordance with the ibstpi® competency development model. First, 50 outlining competencies from earlier studies were selected, like ICN Framework and Disaster Nursing Core Competency for undergraduates in Japan. Then a web-based questionnaire was carried out with a four-point scale of “able,” “probable,” “impossible,” and “cannot understand meaning” for incumbent nurses in order to gauge their adequacy.

There were 86 responses with an average of 14 years (1-40) of nursing experience. We compared them in three groups; those with a job post (G1), those with experience of longer than five years (G2), and those with experience of fewer than five years (G3). The average competency score (total 150 points) was 96.7 (67-129) in G1, 88.2 (53-145) in G2 and 80.2 (59-114) in G3.

The results imply, even in G1, the average score is low at 65/100 points. This may indicate most clinical nurses should make efforts to develop their skills and knowledge of disaster nursing through daily work. Only 32 competencies (G1), 14 (G2), and 5 (G3) were marked as “able” or “probable” by over 80% of responders. Thus with consideration, depending on the result and expert reviews, the competencies determined to be “required” for clinical nurses were finally refined down to 35 items including the premise of ten.

Major injury incidents in underground metalliferous and mineral mines are rare, but if, e.g., a major fire would occur, it is the emergency medical service (EMS) together with the mining company and rescue service who perform the rescue operation. Therefore it is important to develop safe and efficient rescue operation procedures for all the organizations involved, especially the EMS personnel.

To examine EMS personnel’s perceptions and experiences regarding underground mining incidents.

Individual interviews were performed with 13 Swedish EMS personnel. The interviews were transcribed verbatim and analyzed with qualitative content analysis.

The theme “providing the same care in a difficult environment” emerged. Depending on the type of incident, the EMS personnel considered if the injured mining workers could be cared for either outside or in the mine in order to access and care for the injured mining workers as quickly as possible. The EMS personnel mentioned that it was difficult to make the decision if they should enter the mine or not due to the uncertainty of their safety. They also considered that it could be harder to accomplish the same level of care as in other incidents due to the difficult environment. In some instances, they cannot drive their ambulance vehicles into the mine, so they have to prioritize which equipment to bring as well as consider how to transport the patients.

The results identify some of the difficulties the EMS find challenging. Therefore the results could be used in finding solutions and making the EMS prepared for an effective and timely response for injured in underground mines.

Currently, there is no uniform and standard disaster medicine course for students in medical school.

To design a disaster medicine course model based on knowledge structure, teaching and evaluation methods according to experts’ advice and interest of undergraduates majoring in clinical medicine.

The first and second level catalog defined as chapters and sections for the disaster medicine curriculum were drafted based on literature and summary of fragmentary experience. The teaching syllabus with methods of teaching and evaluation was initially outlined. The expert consultation form and student questionnaire were designed and validated. Experts in disaster medicine in China were consulted and students in our medical school were investigated. Delphi Methods was used and the chapters and sections were adjusted and weighed according to experts’ advice through the Analytic Hierarchy Process. The teaching and evaluation methods for each knowledge module were obtained based on suggestions from experts and students.

A total of 31 experts were consulted. 320 students were inquired. By two rounds of consultation with Kendall coordination coefficient W value 0.207, chi-square value 128.781(p=0.01), consensus about the knowledge structure for the curriculum were achieved, which consisted of 6 chapters (as Introduction to disaster medicine, incident command, medical knowledge and skills in disaster, public health, ethics in disaster, information management, with the weights of 0.1486, 0.1999, 0.4209, 0.0785, 0.0748, 0.0774 respectively)and 25 sections. Teaching methods for different knowledge module were determined, which included lecture, demonstration, case discussion, drill and sand table simulation. And the evaluation methods were affirmed as a quiz, written examination, skill test and teamwork test assessed by intra-group and inter-group evaluation.

Through scientific investigation of experts in disaster rescue and undergraduates majoring in clinical medicine, a disaster medicine course model for clinical medical students was established.

Resilience is often described as a desirable holistic approach to disaster preparedness. However, the term has a wide variety of meanings and is hard to operationalize and implement in disaster management. A goal for the EU H2020 project DARWIN was to operationalize resilience for incident management teams.

To test the resilience operationalization by analyzing command team behaviors in a major incident exercise and trace observations to resilience theory.

A regional medical command and control team (n=11) was observed when performing in a functional simulation exercise of a mass casualty incident (300 injured, 1800 uninjured) following the collision of a cruise ship and an oil tanker close to the Swedish coast. Audio and video recordings of behaviors and communications were reviewed for resilient behaviors based on the DARWIN guidelines using the “resilience markers for small teams” framework (Furniss et al., 2011).

A total of 121 observed instances of resilient behaviors were found in the material. In 95 cases (79%) the observed behaviors followed a priori hypothesized connections between resilient strategies and general markers. Certain marker-strategy combinations occurred frequently, such as 18 observations where the strategy “understand crucial assumptions” occurred together with the marker “adapting to expected and unexpected events.”

Resilience has the potential to contribute to a more holistic disaster management approach. The findings that the observations, in general, correspond to the expected relationship between theoretical concretization and contextualization supports the DARWIN effort to operationalize resilience theory. This is a prerequisite for developing observational protocols for training and further studies of resilient behaviors in disaster management teams.

HMIMMS (Major Incident Medical Management and Support: The Practical Approach in the Hospital) has been introduced by ALSG (Advanced Life Support Group, Manchester, UK) and developed for many countries for preparing to accept huge numbers of casualties at a hospital during major incidents. The original HMIMMS course has been held in Japan since 2007, produced over 1,200 providers. Japan has a crucial history of natural disasters, earthquakes, tsunamis, and typhoons often resulting in extensive damages to infrastructure and communications.

The MIMMS-JAPAN and the Japanese Association for Disaster Medicine have joined to plan to revise the original HMIMMS course from the point of view of the difference of the type of disaster.

By the permission of ALSG, two subjects were added “Hospital Evacuation” and “Business Continuity Plan” as lectures, workshops, and tabletops to the original HMIMMS course. Before attending the course, students were required to watch e-learning for deeper understanding and time-saving. Total program was organized into two days.

Main points of modification are to:

1. 1. Replace a system peculiar to the UK with a Japanese system.

2. 2. Add unique contents of a Japanese disaster.

3. 3. Add the important subjects especially in Japan.

4. 4. Modify the presentation slides to understand easily for Japanese students. But the fundamental concept that hospital functions upon ‘CSCATTT’ is strictly preserved.

Newly revised HMIMMS course will start in 2019 for Japanese learners. Many reflections must be accumulated and further revisions will continue.