The devastating Haiti earthquake of January 10, 2010 resulted in 250,000 dead, more than 300,000 wounded and at least 1.3 million displaced. As the poorest nation in the Western Hemisphere, life in Haiti was already fraught with poverty and one of the highest HIV rates in the world. After the earthquake, life in Haiti became intolerable. As Chief Medical Officer of Florida One DMAT, the author helped to coordinate medical relief operations at the US Embassy in Port-au-Prince beginning within 60 hours of the earthquake. The author and his FL1 DMAT team supported medical relief operations not only at the US Embassy but also at the Toussaint L'Ouverture International Airport for air evacuation of survivors to Miami and at Terminal Varreux for coordination of ingress/egress casualty operations for the USNS Comfort hospital ship.

Unique lessons were learned in this first ever deployment of US DMATs on foreign soil. The presentation will describe the medical operations, the triage process, the challenges of operating on foreign soil, and the results of the relief efforts. Recommendations will be offered to facilitate future international DMAT deployments including development of Standard Operating Procedures (SOPs) for DMAT international deployments and increased coordination between the US Department of State (who have jurisdiction over US assets on foreign soil) and the US Department of Health & Human Services (who are the coordinating governmental department for DMAT operations).

International collaboration for disaster response is an increasing phenomenon. Japan-United States joint field exercises have been conducted annually since 2004, triggered by an incident in which a US helicopter crashed into a university campus in Okinawa, Japan. The fifth Japan-US disaster field exercise was conducted testing the disaster response of the Okinawa government and US military.

The simulated exercise involved a US Navy aircraft that crashed into a city center in Okinawa, Japan. There were 16 simulated casualties that included US military members and Japanese citizens. The participants in this exercise were US military members, including the Disaster Assistance Response Team (DART) and local rescue and medical teams including the Okinawa Disaster Medical Assistance Team (DMAT). Data were gathered from the joint debriefing session held by both medical teams. Furthermore, interviews with team leaders from both nations were conducted and feedback obtained.

Lack of communication and inaccurate communication remained the root of most problems encountered. There were several miscommunications at the scene due to the language barrier and ignorance of different medical teams' capability and method of practice. Due to the unclear signage of the initial triage zone, another triage zone was developed later by a second medical team. Confusion regarding gathering information and order of transport also was witnessed. The capabilities of team members were not well known between teams, resulting in inappropriate expectations and difficulty in effective cooperation.

Understanding the systems and backgrounds of each medical team is essential. Signs or symbols of key elements including triage areas should be clear, universal, and multilingual. Communication remains the Achilles' heel of multi-national disaster response activities.

The Korean Disaster Relief Team (KDRT) medical team, mainly composed of graduates from first government certified international disaster support education course, deployed to Haiti after the earthquake in January 2010, and operated a medical relief mission. The present study was designed to evaluate the KDRT medical team mission in Haiti.

Data were collected via an anonymous questionnaire that was distributed one day after the completion of the mission in Haiti. Questionnaires were composed of four categories.

The response rate for this survey was 72% (18/25). The KDRT members were relatively young, with 72% of personnel.

Children frequently are the victims of disasters due to natural hazards or terrorist attacks. However, there is a lack of specific pediatric emergency preparedness planning worldwide. To address these gaps, the federal grant-funded New York City Pediatric Disaster Coalition (PDC) established guidelines for creating Pediatric Critical care (PCC) surge plans and assisted hospitals in creating their plans. To date, five hospitals completed plans, thereby adding 92 beds to surge capacity. On 01 May 2010, 18:00h, there was an attempt to detonate a car bomb in Times Square, a large urban attraction in the heart of New York City. The perpetrator was later convicted of the attempted use of a weapon of mass destruction. Had the bomb exploded, given the location and time of day, it is possible that many critically injured victims would have been children.

The unit director or a senior attending of nine major hospitals in the NYC area (five in close proximity and four at secondary sites) were surveyed for the number of their vacant pediatric critical care beds at the time of the event before activation of surge plans.

At the time the car bomb was discovered, the nine hospitals, which have a total of 141 PCC beds, had only 29 vacant approved pediatric critical care beds.

Had the event resulted in many pediatric casualties, the existing PCC vacant beds at these hospitals may not have satisfied the need. Activating surge plans at five of these hospitals would have added 92 to the 29 available PCC beds for a total of 121. In order to provide PCC to a large number of victims, it is crucial that hospitals prepare PCC surge plans.

Neurosurgical patients require frequent Computed Tomographies (CTs) of the head, usually at short notice. A mobile CT may prove to be invaluable for these patients.

To review the usefulness of mobile CT in intensive care unit (ICU).

This review was carried out over a 14 month period (18 July 2009 till 31 August 2010). Administrative and clinical data were reviewed and analyzed. For the first 6 months, only the number of CT's done was available. However, data were collected prospectively starting 01 Jan 2010 to include variables such as Glasgow Coma Scale (GSC) ventilator status and pressor support at the time of CT scan. The average time to do a CT was 150 minutes (range 60–240 minutes). The mean number of people required for shifting the patient was 4(range 3–6). For, mobile CT the average time to do a CT was 27.4 minutes (range 7.8–47 minutes) and mean for manpower was 3 (range 3–4).

The mobile CT was installed and became functional in the neurosurgery ICU on 18 July 2009. A total of 1,752 head CTs were performed during the study period, with an average of 4.8 CTs daily. Detailed prospective data were available (since 01 January 2010) on 1,023 patients. Of these patients, 75.9% (n = 776) were on ventilator, 72.3% (n = 740) were on sedation, and 5.6% (n = 57) were on pressor support at the time of CT. The mean GCS at the time of CT was 8.1 (range 3–15).

Mobile CT was found to be easy to use, with fast scanning time and excellent image quality. It proves to be beneficial for nurses as it requires less time, energy and manpower. The mobile CT is strongly recommended for any high volume neurosurgery department in the country.

On 11 December 2006, at 8:20h, five flats of a building containing 10 apartments collapsed due to a heater explosion. Four injured patients were transferred to a military hospital with the help of bystanders. Approximately 200 people gathered at the scene. People who were trapped in the building were rescued. The building was surrounded by safety tape. The first injured patient was discovered 4 hours after the collapse. The patinet was transferred by the National Medical Rescue Team. Rescue activities were terminated after 36 hours. A total of eight dead, including five children, and five injured people were recovered from the building. Six of the eight injured patients had superficial wounds. Two patients were monitored: one with head trauma and another with liver contusion and costa fracture.

The explosion occurred during working hours, which contributed to the low number of injuries and deaths. The top floor of the building had the highest survival rate. Bystanders entered the scene through the safety tape, and complicated the rescue efforts.

Rescue efforts during disasters require a high level of education. Otherwise, it becomes impossible to control the crowd and prevent chaos. Also, considering the direction of the building collapse during the rescue activities might enable reaching more people in a shorter time period. Coordination by the departments taking part in the rescue efforts is just one of the key issues affecting a successful response.

A destructive 7.9 magnitude earthquake struck the Sumatra Island of Indonesia on 30 September 2009. A Russian mobile hospital was implemented on 04 October in the village of Lupu-Alu, 20 km from the city of Padang.

The mobile hospital consisted of 20 pneumo modules equipped with technical systems. Personnel included 9 engineers and 25 medical specialists comprised of surgeons, therapists, traumatologists, children's surgeons, a pediatrician, and anesthesiologists. An air-mobile hospital was equipped with modern medical equipment (X-ray, ultrasonic diagnostics, etc.). Work at the hospital was complicated by almost daily tropical rains. The language barrier was addressed by using local translators who spoke Russian or English languages.

Medical aid was rendered to 479 patients. The intensive care department experienced the heaviest patient load (n = 11). Trauma (n = 54, 2%) and proinflammatory complications prevailed among surgical patients (n = 131). Treatment of bone fractures represented significant difficulties due to the late delivery of care. Of the 479 patients, 207 (43.2%) were children; among them, 49 (7%) had diseases of the upper airways, and 30 (4%) experienced trauma. Psychologists consulted with 52 children with post-traumatic stress syndrome. Telemedical consultations were conducted by the following specialists: (1) orthopedist (n = 2); (2) dermatologist (n = 2); (3) neurosurgeon (n = 1); and (4) plastic surgeon (n = 1).

Following the earthquake, medical personnel at the Russian mobile hospital in Indonesia experienced: (1) a large number of outpatients with various diseases who lacked medical care as a result of the non-functioning network of local public health services; (2) the admission of the patients with complications of trauma; (3) a significant number of children with inflammatory diseases of the upper airways; and (4) an opportunity of use telemedical consultations.

The January 2010 earthquake affected many services in Haiti, including health care. After the disaster, top-down response from international sources seemed like the only solution. While the existing health system was fragile, opportunities likely existed for incorporating bottom-up approaches in the capital and other cities, such as Cap Haitien in the North.

The study aims to: (1) identify available local health-related resources; (2) examine how these were, or were not, utilized in response efforts; and (3) evaluate the level of coordination among health delivery groups, particularly preparedness and recovery.

This case study included 11 key informant interviews at two hospitals (six at Justinian and five at Milot) and an organizational analysis of cooperation among 16 health-related organizations operating in northern Haiti. Disaster preparedness and recovery data for the health-sector organizations were obtained using a validated survey instrument and the Program to Analyze, Record, and Track Networks to Enhance Relationships (PARTNER) tool that uses the principles of Social Network Analysis (SNA) to elucidate the makeup of collaborative relationships.

During the response phase, command-and-control approaches from international healthcare organizations had a roll given the numbers of people affected and the overwhelmed local response capabilities. Pre-disaster vulnerabilities limited response capacity. Even during response, opportunities existed for integrating established groups. Generally, this was not a model utilized by international organizations, although some examples were present.

The external infusion of money, priorities, and forces potentially may harm the current system, rather than build upon it. International aid provides free health services beyond treatment of earthquake-related injuries, taking the place of some service functions of the Haitian system. Eventually, this could erode aspects of the Haitian health system. Alternative models of aid may better incorporate and integrate existing structures. Disaster planning is linked intrinsically to strengthening the health system as a whole.

The preparedness for mass casualty is needed in political event. We have the experience to build up the disaster medical system in G8 summit in Okinawa and Hokkaido. But these two areas were resort area which had little population. This time Japan hosted APEC JAPAN 2010 which held in Yokohama City. We reported disaster medical system for this event in big city.

We mobilized DMAT from 21 hospitals whole Japan. We set 11 teams in Yokohama city, 10 teams in 2 Airports. DMAT inspected rerated disaster base hospitals. These hospitals made the plan for receive mass casualty included the victims by CBRNE event and had the exercise. They set up the decontamination system during APEC leader's week. We also have the contingency plan to coordinate with fire department. This contingency plan included transportation plan for hospitals and coordination plan in site. In transportation plan, sever casualty transported dispersal for hospital in Yokohama within 25. For over 25, sever casualty transported intensive for 4 hospitals in Yokohama. After stabilization treatment in these hospitals, the casualty transported dispersal from these hospitals to outside of Yokohama. In coordinate plan in site included job description in command and control, decontamination and medical relief post.

We established disaster medical system for APEC JAPAN 2010. This event hold in Yokohama City had the big population. Compare with former G8 summit, medical system put importance in mass casualty event. As a result, non mass casualty event happened. But this preparedness will contribute not only future same kind events but also accidental mass casualty event such as train accident.

Recent reports have highlighted the health disparities that women and other vulnerable populations experience following disasters. Humanitarian groups have struggled to implement effective measures to mitigate such disparities during subsequent disasters.

To analyze and provide practical solutions to mitigate barrier's to women's health encountered in Haiti following the 7.0 magnitude earthquake in January 2010.

In February 2010, a New York based team of emergency and international medicine specialists staffed the mobile emergency department in Port au Prince at L'Hôpital de l'Université d'Etat d'Haïti.

Common presentations included infectious diseases, traumatic injuries, chronic disease exacerbations, and follow-up for earthquake-associated conditions. Female gender-specific problems included vaginal infections, breast pain or masses, pregnancy-related concerns, and the effects of gender-based violence. Identified barriers to effective gender-specific care included communication, camp geography, supply availability, and poor inter-organization communication.

Recent disasters in Haiti, Pakistan, and elsewhere have challenged the international health community to provide gender-balanced healthcare in sub-optimal environments. Much room for improvement remains. Although our assessment team was gender-balanced, improved incorporation of Haitian personnel may have enhanced patient trust, and improved cultural sensitivity and communication. Camp geography should foster both patient privacy and security during sensitive examinations. This could have been improved upon by geographically separating men's and women's treatment areas and using a barrier screen to generate a more private examination environment. Women's health supplies must include an appropriate exam table, emergency obstetrical and midwifery supplies, urine dipsticks, and sanitary and reproductive health supplies. A referral system must be established for patients requiring a higher level-of-care. Lastly, improved inter-organization communication and promotion of resource pooling may improve treatment access and quality for select gender-based interventions.

Simple inexpensive modifications to organized post-disaster medical relief settings may dramatically reduce gender-based healthcare disparities.

Tsunamis most commonly occur in the “Ring of fire” in the Pacific due to frequency of earthquakes and volcanic activity. Damaging tsunamis occur 1–2 times yearly. On September 29, 2009, an earthquake on the Pacific floor caused a tsunami that struck American Samoa, Samoa and Tonga, with only 20 minutes warning.

To evaluate the disaster response in American Samoa by emergency medical services (EMS), the territorial hospital, and the Department of Health.

A retrospective review of EMS logs, public health records, hospital emergency department charts, and key-informant interviews over a 2-week period. Descriptive statistics were used to evaluate data.

Three 5-meter waves struck the American Samoan islands, with land inundation as far as 700 meters. Many low- lying villages, including the capital city Pago Pago were affected. A total of 33 people (8 male, 23 female, including 3 children) were killed by the water, with approximately 150 significantly injured. EMS runs increased 250% from normal daily averages, with island-wide responses significantly delayed by flood damage. The hospital in Pago Pago, situated near the shore and only 10 meters above sea level, utilized 75 staff to evacuate 68 in-patients to high ground as soon as tremors were felt. This process was completed in 20 minutes with no associated morbidity or mortality. Patient injury patterns for the event are similar to recent literature reports. Mobile clinics and alternate care sites established at outlying dispensaries were used to decentralize healthcare from the hospital. DMAT/DMORT teams from Oregon and Hawaii supported local healthcare initiatives. Post-disaster public health surveillance focused on identifying and limiting food/water-borne illnesses, dengue fever, and influenza-like-illness outbreaks, as well as disaster related PTSD.

The disaster response to the tsunami in American Samoa was effective. Disaster planning was appropriate and rapidly implemented. Post-disaster public health emergencies were minimized.

To describe the Emergency Management Plan for H1N1 Major Epidemic Event to reduce the impact of the patients in a general emergency department.

Einstein hospital has a catastrophe management program which is regularly tested for several scenarios: accidents, fire, and biological attack among others. Special concern is given for pandemics since we need to keep employees' fit to keep the hospital running as usual.

On April 24, WHO issued an alert about the rising cases of influenza virus H1N1. Immediately we provided a plan of care for suspected or confirmed cases based on WHO and CDC guidelines. On April 29 increased level of alert to Phase 5 (pandemic imminent). The crisis management group created a multidisciplinary team with actions directed to Einstein's doctors and staff, 6,000 registered professionals, engineering, emergency care, laboratory, occupational medicine, hygiene, waste disposal, among others. Communication was maintained with government to update the official guidelines. Two specific drills were performed to train staff and support teams. Debriefings were made to all participants and lessons learnt were incorporated.

Official figures showed that in São Paulo until August 2 have been reported 6,383 cases, 11.8% (756 cases) of these were reported by HIAE. From 5 May 2009 to 05 December 2009, 1,324 cases were reported. There were only four deaths of patients with influenza A H1N1 and two acquired in hospital and the daily business were not compromised by the epidemic showing the importance of a crises management plan.

The methodology of realistic simulations has showed effectiveness in the planning of how to manage Major Epidemic Events and improvement actions from this exercise has been showing best results for the patient flow and safety whenever this kind of situation happens at Hospital Albert Eisntein.

Physical Medicine and Rehabilitation is a goal oriented and patient centered specialty which focuses on functional restoration and quality of life of persons with disability. The patterns of injuries among survivors of recent disasters have, range from mild (single limb fracture) to catastrophic (spinal cord injury, amputation, traumatic brain injury). Historically physiatrists have not participated the acute disaster management phase or in the emergent post disaster rehabilitation planning. This task is usually relegated to the trauma, orthopedic and general surgeons.

Authors had firsthand experience in the acute and emergent care and rehabilitation of trauma patients after Pakistan, China and Haiti earthquakes. An electronic literature search (English, 1965–2010, Key words: trauma, rehabilitation, disability, spinal cord injury, amputation, disaster, nerve injury) was carried out. Experience sharing through committees, online forum, and communications were conducted with physiatry colleagues internationally.

In these three recent earthquakes, Physiatrists provided direct patient care, including guidance in the evacuation of survivors with pre-existing disabilities, transport of persons with spinal trauma, treatment of wounds, fractures, pain, spinal trauma patients and persons with amputations. Physiatrists devised appropriate plans for conservative management of fractures. Education of local staff and coordination of rehabilitation was initiated. Monitoring, prevention and treatment of secondary complications including prolonged immobility, pressure ulcers, chronic pain, urinary, bowel and respiratory dysfunction was performed. Physiatrists helped in patient counseling and family education.

Physiatrists by virtue of their training and skills are in a better position to manage the disabilities, including direction of rehabilitation and community integration, prevention of complications, and education and training of health workers and teams. Timely rehabilitation interventions for Spinal cord injuries and lower limb amputations following the Pakistan, China and Haiti earthquakes resulted in reduction in morbidity and mortality among those with catastrophic injuries.

A report of black death, presumably pneumonic plague (Yersinia Pestis) occurred in the terrorist group Al Qaeda in the Land of Islamic Maghreb (AQLIM) in 2009. Up to 40 members of AQLIM are reported to have perished rapidly.

The event was managed by Algeria, but questions remain as to the nature of this event and the level of investigation that was applied. This paper is a discussion of the principle elements of a forensic epidemiology investigation that should have, but did not take place in Algeria. The need for improved forensic epidemiology investigation capability is illustrated in this event due the unique problems inherent in the investigation of intentional outbreaks.

Natural Disasters result in a sudden onslaught of huge numbers of catastrophic and disabling injuries including spinal cord injuries, traumatic brain injuries, limb amputations, long bone fractures and peripheral nerve injuries. In addition to these there are persons with pre-existing disabilities in the affected disaster zones. Oftentimes disasters overwhelm the available resources and rehabilitation services are usually underdeveloped in most parts of the disaster affected zones. Both challenges are frequently neglected and not included in disaster response planning. As a consequence, Physical and Rehabilitation Medicine (PRM) has traditionally played no or little role in the post disaster phase and disaster planning.

The data was derived from an English language literature search (1950–2010) using Pubmed, Google Scholar, Sciencedirect, Ovid, and Sagepub. Other sources of data included discussion with subject matter experts and the author's personal experience.

PRM has not historically become actively engaged in medical rehabilitation of injuries until 24-48 hours post-event. The emergence of the discipline of disaster rehabilitation however, advances PMR into the emergency response phase. This paper describes the disability pattern after disasters, shortcomings in the traditional disaster response with reference to PMR interventions and disabled populations and its negative consequences. It then explores the rehabilitation interventions offered in different disaster scenarios during the last decade and its positive impact in achieving a better outcome for the new onset and pre-existing disabled population.

This is the first paper in biomedical literature exploring the possible role of PRM in the post disaster phase. The paper offers recommendations to include PRM in the disaster response phase and possible plans of action for organizations working in the fields of disability and disaster management. It is expected that this paper will guide future research and establishment of the field of Disaster Rehabilitation.

Civilian Weapons of Mass Destruction (WMD) training involves preparing for threats well-known to the military since World War II. Present and future developments in Chemical-Biological (CB) research have resulted in new potential agents, modes of action, and methods of delivery. Chemical-Biological defense training should include these new agents and anticipate contact with previously unknown ones. The natural response to an unknown threat is fear and panic, out of proportion to the actual threat. Specific training in management of new pathogens and toxidromes should be incorporated into existing preparedness regimes. Leadership skills that address uncertainty and inspire constructive responses will increase resiliency.

Literature Review

Recent and Future CB Agents: (1) 4th Generation AchE inhibitors: Novichoks, Substance 33, etc.; (2) Genetically enhanced bacteria and engineered chimeric diseases; (3) Modified viral diseases: Variola, Influenza, filoviruses, flaviviruses, arenaviruses; (4) Bacteriophage induced diseases; (5) Agents targeting specific racial or genetic groups; (6) Mid-spectrum agents; (6) Bioregulators: Substance P, vasopressin, enkephalin, etc.; (7) Novel toxins: tetrodotoxin, SEB, saxitoxin, etc.; (8) Hallucinogens and incapacitants (LSD, DMT, carfentanyl, cis-fluoro-ohmefentanyl); (9) Prions and infectious nucleic acids Delivery: (1) New delivery methods: micro- and nano-robots modeled on insects (MEMS systems), microencapsulation; (2) Directed Energy Weapons Mitigation: (1) Development of systems for identifying and dealing with unknown agents and symptoms; (2) Hazard Identification, Risk Estimation, Risk Reduction Strategies, Residual Risk Evaluation and Monitoring, Mitigation and Recovery Leadership skills needed during uncertainty: Sense making, Visioning, Relating, Inventing.

Preparing for events without training for new and novel CB agents leaves us unprepared. Incorporating modern science with leadership skills will lessen the impact of future CB release and improve organizational resiliency. The main mistake people make is that they fear current problems more than future ones. Carl von Clausewitz Chance favors the prepared mind. Louis Pasteur.