History of “Disaster Resuscitology.” The late Rudolf Frey, Professor of Anesthesiology at the Johannes Gutenberg University of Mainz, West Germany (see pages VIII-X), founded the “Club of Mainz” in September 1976, following initiating discussions with Peter Safar at the “International Symposium on Mobile Intensive Care and Advanced Emergency Medical Services (EMS) Delivery Systems” in September 1973 in Mainz (1), and the drafting of objectives and plans with the founding members in 1976 in Geneva and Mainz. Throughout the initiating discussions, Safar stressed the following: Presently active national and international disaster relief organizations are public health oriented. In mass disasters, such as major earthquakes, these organizations have been rendering effective aid to uninjured survivors, usually starting one day or later after the disaster event.

This new Journal, starting with volume 1, number 1, Spring 1985, is an official publication of the World Association for Emergency and Disaster Medicine (WAEDM), formerly called the Club of Mainz. The Journal is cosponsored by the League of Red Cross and Red Crescent Societies (LRCS). The Journal is owned and published by the WAEDM. There will be 4 Journal numbers per year.

This new Journal, starting with volume 1, number 1, Spring 1985, is an official publication of the World Association for Emergency and Disaster Medicine (WAEDM), formerly called the Club of Mainz. The Journal is cosponsored by the League of Red Cross and Red Crescent Societies (LRCS). The Journal is owned and published by the WAEDM. There will be 4 Journal numbers per year, plus an occasional supplement.

We initiated this Journal and its predecessor (see below) because existing journals on disasters focus on sociologic and epidemiologic topics, and more on aid to uninjured survivors and rehabilitation of disaster-stricken regions, than on the resuscitation and life support of severely injured victims. Disaster medicine is not yet a science, and thus based primarily on anecdotal reports. It is in need of international communication and the acquisition of quantifiable facts. The Journal will help meet these needs by examining the potentials of resuscitation, emergency medical care and critical care (intensive care) medicine for everyday Emergency Medical Services (EMS) and for disaster medicine. The disasters to consider range from multi-casualty incidents to mass disasters and endemic disasters. Other organizations emphasize response to mass disasters after days or weeks; the WAEDM emphasizes response within minutes to hours. This Journal will benefit medical and nonmedical members of the WAEDM and the LRCS, as well as non-member specialists in anesthesiology, critical care medicine, cardiology, emergency medicine, epidemiology, forensic medicine, government medicine, infectious diseases, military medicine, nuclear medicine, nutrition, pathology, public health, resuscitology, surgery, toxicology, and traumatology.

“The Club of Mainz for Improved Emergency and Disaster Medicine Worldwide” was founded in 1976 by ten concerned resuscitologists from seven countries under the leadership of the late Rudolf Frey, who then was Chairman of the Department of Anesthesiology at the Johannes Gutenberg University in Mainz, West Germany. The Club was founded because the potentials of modern resuscitation and life support are not realized in most everyday emergencies and natural and manmade disasters throughout the world. The idea was initiated in discussions between Frey and Safar during the International Symposium on Advanced Emergency Medical Services (EMS) Delivery Systems in Mainz in September 1973.

The “Club of Mainz” for Improved Emergency and Disaster Medicine Worldwide was conceived in 1973 and founded in 1976 by about 10 reanimatologists under the leadership of the late Rudolf Frey (Crit Care Med 6:389, 1978). Its objectives are: “(1) to foster optimal resuscitation and life support methodologies worldwide; (2) to concern itself with a range from everyday emergencies to mass disasters, with appropriate consideration for differences in populations, available resources and other factors; and (3) to informally pursue the objectives by combining the resources of scientific, social and related information and experiences, together with international communication and collaboration.”

The Club of Mainz recognizes the experiences and contributions of other organizations for public health related disaster relief, which particularly helps uninjured survivors and rehabilitates regions, but wishes to add the potentials of modern resuscitation (emergency and critical care medicine), focusing on the acutely ill or injured individual victim in distress.

The Club of Mainz was inspired by the Club of Rome, which was initiated in 1968 by the late Aurelio Peccei and some other concerned non-medical leaders and scientists. The 10 non-medical key problems identified by the Club of Rome have equivalents for disaster medicine: (1) overpopulation (starvation); (2) no long range planning; (3) destruction of the environment (destruction of people); (4) business crises; (5) competitive armament leading to wars; (6) poverty (starvation, epidemics); (7) chaotic development in science and technology; (8) antiquated institutions; (9) schisms between East and West and between North and South; and (10) lacking moral leadership.

The “Club of Mainz” for Improved Emergency and Disaster Medicine Worldwide was conceived in 1973 and founded in 1976 by about 10 reanimatologists under the leadership of the late Rudolf Frey (Crit Care Med 6:389, 1978). Its objectives are: “(1) to foster optimal resuscitation and life support methodologies worldwide; (2) to concern itself with a range from everyday emergencies to mass disasters, with appropriate consideration for differences in populations, available resources and other factors; and (3) to informally pursue the objectives by combining the resources of scientific, social and related information and experiences, together with international communication and collaboration.”

The League of Red Cross Societies is the international federation of the 130 National Red Cross and Red Crescent Societies, which together have a membership of more than 230,000,000. The League is one of the three components of the International Red Cross, the others being the International Committee of the Red Cross (ICRC) and the National Red Cross/Red Crescent Societies.

The ICRC acts as a neutral intermediary in humanitarian matters during international conflicts, civil wars and internal disturbances, providing protection and assistance to victims, prisoners of war and civilian detainees. The League objective is to facilitate, encourage and promote the humanitarian activities of its member societies and thus contribute to the promotion of peace in the world.

The “International Red Cross” is composed of: (1) The International Committee of the Red Cross (ICRC) which focuses on war victims; (2) the LRCS; and (3) the 130 National Red Cross and Red Crescent Societies worldwide which are federated by the LRCS. The LRCS was founded to facilitate, encourage and promote the humanitarian activities of its member societies and thus contribute to the promotion of peace in the world. The LRCS considers health as one of the keys to a better world for everyone. Red Cross programs include the training of nursing personnel, the provision of health care in rural areas, the organization of assistance to the sick, aged, and handicapped, and teaching first aid skills to lay people.

The “International Red Cross” is composed of: (1) The International Committee of the Red Cross (ICRC) which focuses on war victims; (2) the LRCS; and (3) the 130 National Red Cross and Red Crescent Societies worldwide which are federated by the LRCS. The LRCS was founded to facilitate, encourage and promote the humanitarian activities of its member societies and thus contribute to the promotion of peace in the world. The LRCS considers health as one of the keys to a better world for everyone. Red Cross programs include the training of nursing personnel, the provision of health care in rural areas, the organization of assistance to the sick, aged, and handicapped, and teaching first aid skills to lay people.

The Red Cross bases its actions on seven principles: (1) Humanity; (2) Impartiality; (3) Neutrality; (4) Independence; (5) Voluntary Service; (6) Unity; and (7) Universality.

The LRCS assists national societies in improving their disaster relief preparedness through the following functions: (1) to encourage, facilitate and assist in the establishment of a national disaster relief plan; (2) to give technical assistance to national Red Cross societies by sending delegates and equipment and/or by giving cash grants; (3) to convene seminars and conferences to help exchange opinions and share experiences; (4) to train qualified personnel; and (5) to maintain contact with other international governmental and non-governmental organizations. These include the United Nations Disaster Relief Organization (UNDRO); the World Health Organization (WHO); the International Children's Fund (UNICEF); the World Meteorological Organization (WMO); the Food and Agricultural Organization/World Food Program (FAO/WFP); the UN High Commissioner for Refugees (UNHR); and the United Nations Education Scientific and Cultural Organization (UNESCO).

In discussions of the pathogenesis of posttraumatic respiratory distress syndrome (adult respiratory distress syndrome, ARDS), thromboembolism or microembolism (6) is the most frequently suggested mechanism. Embolic material released from the site of injury and/or intravascularly formed aggregates of platelets and fibrin are thought to plug the pulmonary capillaries, giving rise to diffuse pulmonary damage. Pulmonary trapping of platelets and fibrin has been studied in various animal models in which intravascular aggregation was induced pharmacologically, without trauma (2). Studies in patients with ARDS are difficult to standardize, and the results therefore are often inconclusive. We have evolved an experimental model (5) by means of which changes identical to ARDS can be induced from reproducible musculoskeletal trauma in anesthetized pigs. The pigs are observed under anesthesia for three days after the trauma under standardized and carefully controlled conditions. The aim of the present study was to use this model for registration and monitoring of pulmonary trapping of platelets and fibrin in animals with ARDS following standardized trauma, without adding any pharmacologic substance that could influence platelet aggregation or fibrinolysis. Pulmonary trapping was determined by external detection of 51Cr-labeled homologous platelets and 125I-labeled human fibrinogen, intravenously administered before anesthesia and trauma.

There remains a challenge to improve worldwide, the medical response, and the ground safety response to the disaster of an aircraft crash. Statistically more survive all crashes than perish, and if an aircraft crashes with survivors, in most cases there will be more survivors than dead.

The challenge of survival is to ensure that if an aircraft does crash, the medical and rescue response to this disaster must be immediate, competent, technically skilled and adequately equipped to save the maximum number of lives possible, and to help preserve the quality of life for all who survive. Improving safety standards has been stimulated by the excellent work of the Flight Safety Foundation, the International Civil Aviation Organization (ICAO), the United States Air Line Pilots Association — in particular by Captain John Stefanski and by the World Association for Emergency and Disaster Medicine.

Many will recall that at the meeting of the Club of Mainz Association held in Monaco in 1979, a committee was appointed to investigate aircraft crash management at 100 international airports. The task of the Airport Disaster Workshop was to develop a model of emergency care for large and smaller airports, in order to produce a standard for the various groups of airports. The Club of Mainz Association has been concerned with the poor standard of medical response that has been shown at recent flight disasters. As a member of this consultant committee, it was obvious even from very early days of my research that the medical response to aircraft crash in some countries with high air traffic flows is incompetent, inadequate, and demonstrates little awareness of advances in resuscitation and on-site care of aircraft crash survivors.

This is an editorial comment for Volume 1, Number 1. Medical disasters are “events in which the number of acutely ill or injured persons exceeds the capacity of the local emergency medical services (EMS) system to provide basic and advanced medical care according to prevalent regional standards.” There are multi-casualty incidents, such as transportation accidents, in which the local EMS system is overwhelmed; mass disasters, such as major earthquakes and wars, in which the local EMS system is severely damaged; and endemic disasters, such as combinations of famine, epidemics and revolutions which often occur in world regions without EMS systems. Nuclear war has become recognized as the “ultimate disaster” which is beyond disaster medicine systems' capacities to save lives. Military medicine, however, which is organized for “conventional” war, offers the maximal life-saving potential for mass disasters in peace time.

Everyday humanity witnesses an opportunity to take a new step forward. Every morning millions of people enter a new day hoping for happiness and joys of life, and believing in a cloudless future. In everyday life with its troubles and problems, most people forget that their future wellbeing and happiness are endangered by thousands of missiles and nuclear warheads aimed at mankind itself. According to United Nations Reports, there are 50,000 nuclear warheads on Earth today. Their explosive energy is equal to over one million bombs of the kind dropped on Hiroshima in 1945. Unfortunately, some politicians and some members of the lay public do not know (or rather do not want to know) the simple truth that mankind has produced and keeps in store a power that can annihilate its creators. Let me recall Jolio Curie's words: “People should not allow the forces they have managed to discover and learned how to handle now be the cause of their destruction.”

Adult respiratory distress syndrome (ARDS) is the most fatal complication after severe trauma (1,3). ARDS is seen in multiple injured patients with fractures and the risk for ARDS increases with the number of fractures (9). One of the theories concerning the etiology in ARDS is, that tissue thromboplastine from the site of the fracture and surrounding soft tissue activates the coagulation system resulting in pulmonary microembolism (6). Riska (8) has noticed by clinical experience that increased frequency of early fracture stabilization by internal fixation in multiply injured patients has dramatically reduced the frequency of post-traumatic respiratory insufficiency. The aim of the present study was to investigate the effect of primary fracture immobilization on post-traumatic pulmonary changes in pigs. We used a model in which anesthetized pigs can be subjected to trauma and then observed for several days, while still under anesthesia, under careful respiratory and circulatory control, by means of repeated chest x-rays and postmortem macroscopic and microscopic examination of lung tissue.

Twenty-six pigs (Swedish Landrace), weight 17–23 kg were used. Chest x-rays were done in all animals before the experiment excluding those pigs with any pulmonary changes. The pigs were anesthetized with pentobarbital and pethidine, and tracheostomy, carotid artery cateterization and cystostomy were performed.

Endeavors to expand the flight safety programs into the ground safety response to an aircraft disaster have over the last decade involved many flight safety foundations, aviation organizations, pilot associations, and emergency medical societies. Much work has been done to upgrade airport emergency planning and many data from reports concerning airport disaster drills and crashes have been collected.

The goals of an airport disaster plan include the care, treatment and transportation of the wounded with a quality and quantity of care that minimizes the mortality and morbidity of the survivors of the crash. This simple but ambitious challenge is only accomplished by proper pre-planning and management which depends on the quality of the overall plan, the communication systems, the initial life support and resuscitation, the medical equipment, the patient handling and transportation, and the hospital system. According to a variety of reports from many parts of the world, this concept has, however, been difficult to teach, mainly because of insufficient co-ordination in planning, as well as at the scene of the accident.

At Copenhagen Airport — one of the major airports in the northern part of Europe — it was recently decided to have an airport disaster drill. But instead of a “push-button” test it was decided that an executive committee with members from the police, fire brigade, local airport authorities, flight safety council, pilots association, and the medical field should begin the drill by analyzing the topics which are known and expected to be at risk in the overall efficiency.

Rudolf Frey, known as “Rolf“ in Europe and “Rudi” in America — a leading star of anesthesiology, emergency medicine and disaster medicine — has ended his life's struggles. He influenced many lives positively. His years were rich with experiences and contributions.

Surgery and anesthesiology were his base specialties. Alone, these fields would have been too narrow for him. He initiated the first professorship of anesthesiology in Germany at the University of Heidelberg in the 1950's; the first autonomous university department of anesthesiology in Germany at the Gutenberg University of Mainz in 1960; the journal Der Anaesthesist, the first textbook of anesthesiology in German; one of the first physician-staffed advanced life support ambulance and ambulance helicopter services in Europe; numerous training programs, symposia and congresses; and the Club of Mainz and its associated monograph series Disaster Medicine, originally published by Springer-Verlag.