Over the past two decades, the general public in affluent western societies has become vividly aware of major disasters from around the world through the improving technology of the news media. Each one of us can readily recall the instantaneous reports on earthquake ravaged Guatemala in 1976; war-torn Nicaragua and Cambodia in 1979; and devastating earthquakes in Italy and Algeria in 1980.

Once alerted to the magnitude of these disasters, private organizations (churches, foundations, civic clubs, etc.), some 300–400 in number, in dozens of countries mobilized public support through news reports, ads, public service announcements, speeches and circular letters. For example, the Pittsburgh area raised over one half million dollars for refugees in Southeast Asia in 1980 that was channeled through such groups as UNICEF, Catholic Relief Services, and the International Rescue Committee.

The objectives of the Second World Congress on Emergency and Disaster Medicine are closely aligned with those of the International Academy of Astronautics' Studies Committee. The fundamental concern that we share is that of reducing human suffering in the wake of life-threatening natural forces, man-made disasters, or emergencies experienced in the course of daily life. The overarching objective is to reduce to a minimum a population's vulnerability to disasterous occurrences by anticipating exposures accurately and setting in place wise precautionary systems.

The contribution made by space-borne systems is essentially that they can provide accurate information rapidly, clearly and dependably over wide areas.

The International Civil Defense Organization (ICDO) is helping a large proportion of the Third World Countries where Civil Protection is considered, promoted and organized as a State Service, an obligation of the Authorities toward the population to save it from the devastating effects of a natural or technological disaster or the after-effects of a serious accident. The absence of the industrialized countries within the ICDO has not prevented the poor countries from developing a protection and safety system within the Technical Cooperation Program of ICDO, by their own efforts and with their own resources. The system is based on intervention units, which although sometimes in their embryonic stages, are already capable, however, of administering emergency first aid. Hence the keen interest of those countries in resuscitation techniques.

In September 1980 at the International Aeromedical Evacuation Congress held in Munich, West Germany, the International Society of Emergency Medical Services (ISEMS) was formed. The purpose of this new society is to develop, promote, and improve EMS throughout the world. The founding members came from sixteen nations and represented such regions as Africa, the Americas, Europe, and the Middle East.

This new organization, ISEMS, provides a permanent, ongoing focal point for studies and serves as a global clearinghouse for EMS technical assistance, training, management, and evaluation. The Society remains on an international level, and its eligible membership consists of all persons who participate in EMS throughout the world. The publication of a scientific journal for all EMS personnel is planned. Through ISEMS, International Centers of Excellence will be established to provide technical assistance to countries for improvement of their EMS programs; training seminars and educational programs will also be sponsored. In addition, annually sponsored meetings in key cities in various countries of the world are planned.

The dangers of mass emergencies are greater today than ever before in the history of man. The reasons are:

1) The exponential growth of the world population from 2 billion in 1925 to 4 billion today and to an expected 8 billion in the year 2025. This growing population is badly in need of more and more food and energy to sustain itself.

2) The increasingly severe competition world-wide for the available supplies of food and energy will precipitate mass emergencies and even mass disasters. Some of these mass disasters, such as nuclear war, have the potential to destroy entire countries…or even the human race itself.

No matter how gloomy the outlook is, however, it is still the task of the medical profession to recognize this growing danger and to do everything possible to be prepared for and treat not only individual emergencies, but mass disasters as well.

Major risks to human health and life are, indeed, as old as life itself. Whether we think of epidemics, hunger and malnutrition, famines, wars, violations of human rights, crime, natural disasters and swarms of other dangers, we cannot but be struck by their pantemporality and ubiquitousness. Acute or chronic, periodic or sporadic, frequent or infrequent, these and other hazards are endemic to the very condition of human existence —unwanted but nonetheless real consequences of being alive and of being social.

It is indeed quite plausible to view some of the central strands and trajectories of human history as efforts to cope with the hazardous conditions of existence: to prevent risks from actualizing, or to mitigate the consequences of hazards which do actualize—those which we have not yet as developed the capability to prevent, and those which we cannot hope to prevent.

How can the results of computer modeling be used most effectively to serve the public policy decision-making process? In considering that question, I find it useful to keep two factors very clearly in mind:

First, simulation models never provide any final answers; they simply offer an accurate, rapid, and mathematically precise means of analyzing a number of complex variables and tracing their dynamic interactions over time.

Second, the use of computer modeling therefore presupposes—even demands—an ultimate higher level of decision —political, medical, or what have you—among the policy alternatives analyzed and compared in the model.

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.