During the last few decades, various global disasters have ren-dered nations helpless (such as Thailand's tsunami and earthquakes in Turkey, Pakistan, Iran, and India). A lack of knowledge and resources make it difficult to address such disasters. Preparedness for a national disaster is expensive, and in most cases, unachievable even for modern countries. International collabo-ration might be useful for coping with large-scale disasters. Preparedness for international collaboration includes drills. Two such drills held by the Israeli Home Front Command and other military and civilian bodies with the nations of Greece and Turkey are described in this article.

The data were gathered from formal debriefings of the Israeli teams collaborating in two separate drills with Greek and Turkish teams.

Preparations began four months before the drills were conducted and included three meetings between Israeli and foreign officials. The Israeli and foreign officials agreed upon the drill layout, logistics, communications, resi-dence, real-time medicine, hardware, and equipment. The drills took place in Greece and Turkey and lasted four days. The first day included meetings between the teams and logistics preparations. The second and third days were devoted to exercises. The drills included evacuating casualties from a demoli-tion zone and treating typical injuries such as crush syndrome. Every day ended with a formal debriefing by the teams' commanders. The fourth day included a ceremony and transportation back home. Members in both teams felt the drills improved their skills and had an important impact on creating common language that would enhance cooperation during a real disaster.

A key factor in the management of large-scale disasters is coor-dination between countries. International drills are important to create com-mon language within similar regulations.

The objectives of the study were to develop and evaluate an “all-hazards” hospital disaster preparedness training course that utilizes a combi-nation of classroom lectures, skills sessions, tabletop sessions, and disaster exercises to teach the principles of hospital disaster preparedness to hospital-based employees.

Participants attended a two-day, 16-hour course, entitled Hospital Disaster Life Support (HDLS). The course was designed to address seven core competencies of disaster training for healthcare workers. Specific disaster situations addressed during HDLS included: (1) biological; (2) conventional; (3) radiological; and (4) chemical mass-casualty incidents. The primary goal of HDLS was not only to teach patient care for a disaster, but more important-ly, to teach hospital personnel how to manage the disaster itself. Knowledge gained from the HDLS course was assessed by pre- and post-test evaluations. Additionally, participants completed a course evaluation survey at the conclu-sion of HDLS to assess their attitudes about the course.

Participants included 11 physicians, 40 nurses, 23 administrators/direc-tors, and 10 other personnel (n = 84). The average score on the pre-test was 69.1 ±12.8 for all positions, and the post-test score was 89.5 ±6.7, an improve-ment of 20.4 points (p <0.0001, 17.2–23.5).Participants felt HDLS was edu-cational (4.2/5), relevant (4.3/5) and organized (4.3/5).

Identifying an effective means of teaching hospital disaster pre-paredness to hospital-based employees is an important task. However, the opti-mal strategy for implementing such education still is under debate.The HDLS course was designed to utilize multiple teaching modalities to train hospital-based employees on the principles of disaster preparedness. Participants of HDLS showed an increase in knowledge gained and reported high satisfaction from their experiences at HDLS. These results suggest that HDLS is an effec-tive way to train hospital-based employees in the area of disaster preparedness.

Tension pneumothorax is the second leading cause of preventable combat death. Although relatively simple, the management of tension pneumothorax is considered an advanced life support skill set. The purpose of this study was to assess the ability of non-medical law enforcement personnel to learn this skill set and to determine long-term knowledge and skill retention.

After completing a pre-intervention questionnaire, a total of 22 tactical team operators completed a 90-minute-long training session in recognition and management of tension pneumothorax. Post-intervention testing was performed immediately post-training, and at one- and six-months post-training.

Initial training resulted in a significant increase in knowledge (pre: 1.3 ±1.35, max score 7; post: 6.8 ±0.62, p < 0.0001). Knowledge retention persisted at one- and six-months post-training, without significant decrement.

Non-medical law enforcement personnel are capable of learning needle decompression, and retain this knowledge without significant deterioration for at least six months.

Although most hospitals have an emergency department disas- ter plan, most never have been implemented in a true disaster or been tested objectively. Computer simulation may be a useful tool to predict emergency department patient flow during a disaster.

The aim of this study was to compare the accuracy of a computer simulation in predicting emergency department patient flow during a masscasualty incident with that of a real-time, virtual, live exercise.

History, physical examination findings, and laboratory results for 136 simulated patients were extracted from the disastermed.ca patient database as used as input into a computer simulation designed to represent the emergency department at the University of Alberta Hospital.The computer simulation was developed using a commercially available simulation software platform (2005, SimProcess, CACI Products, San Diego CA). Patient flow parameters were compared to a previous virtual, live exercise using the same data set.

Although results between the computer simulation and the live exercise appear similar, they differ statistically with respect to many patient benchmarks. There was a marked difference between the triage codes assigned during the live exercise and those from the patient database; however, this alone did not account for the differences between the patient groups. It is likely that novel approaches to patient care developed by the live exercise group, which are difficult to model by computer software, contributed to differences between the groups. Computer simulation was useful, however, in predicting how small changes to emergency department structure, such as adding staff or patient care areas, can influence patient flow.

Computer simulation is helpful in defining the effects of changes to a hospital disaster plan. However, it cannot fully replace participant exercises. Rather, computer simulation and live exercises are complementary, and both may be useful for disaster plan evaluation.

Among imaging techniques, computed tomography (CT) is a reliable method for detecting intracranial hematomas in patients with head trauma, but it is not generally available in special circumstances like prehospital situations and harsh conditions such as those following an earthquake.

The objective of this study is to determine if near-infrared spectroscopy (NIRS) is useful for performing CT scans on patients with closed head trauma that present to medical centers that do not have the ability to perform a CT scan or in prehospital or harsh situations. Near-infrared spectroscopy and CT scan were compared according to sensitivity and specificity.

This was an observational, prospective study. One hundred forty-eight patients admitted to Rasool Akram General Hospital in Tehran, Iran with head injuries during a one-month period were studied using NIRS and CT. The observational, prospective study was conducted and sensitivity, specificity, positive and negative predictive values of NIRS were calculated. Chi-square and Kappa analysis was performed, and a p-value <0.05 was considered significant.

According to the CT scan findings, 54 (36.5%) of the patients developed intracranial hematoma. The NIRS examination showed that 69 patients (46.6%) might have intracranial hematoma. The number of true negatives was 73 and the number of false negatives was six patients. The sensitivity and specificity of NIRS examination was 88.9% and 77.7%, respectively.

This study speculates that NIRS may be a useful screening tool to detect intracranial hematoma. This capability could be useful in special situations like in a deprived area, medical centers without CT scan capabilities, prehospital situations, and in harsh conditions like those after an earthquake or other disasters that causes increased numbers of victims with closed head trauma.

The number of accidents involving emergency vehicles is a major concern for emergency service providers.

This study assessed the effectiveness of adding a driving simulator to a traditional training program.

The sample consisted of students attending the National Emergency Medical Services Academy in Lafayette, Louisiana. Each participant self-scheduled two days in which he or she would attend the driving portion of the training class. A total of 52 participants were in the control group and 50 participants were in the treatment group. In addition to the classroom training, the treatment group used a driving simulator prior to driving on the competency course.

The treatment group took significantly less time to drive through the competency course on the first run than did the control group. It also acquired significantly fewer penalty points on the first run and required significantly fewer runs to complete the course.

Simulators can be effective training tools for teaching emergency vehicle drivers.

Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response phase of disasters. Chronic disease exacerbations (CDE) account for one of the largest patient populations during disasters, and patients are at increased risk for adverse outcomes.

The objective of this study was to assess the burden of chronic renal failure, diabetes, and cardiovascular disease during disasters due to natural hazards, identify impediments to care, and propose solutions to improve the disaster preparation and management of CDE.

A thorough search of the PubMed, Ovid, and Medline databases was performed. Dr. Miller's personal international experiences treating CDE after disasters due to natural hazards, such as the 2005 Kashmir earthquake, are included.

Chronic disease exacerbations comprise a sizable disease burden during disasters related to natural hazards. Surveys estimate that 25–40% of those living in the regions affected by hurricanes Katrina and Rita lived with at least one chronic disease. Chronic illness accounted for 33% of visits, peaking 10 days after hurricane landfall. The international nephrology community has responded to dialysis needs by forming a well-organized and effective organization called the Renal Disaster Relief Task Force (RDRTF). The response to the needs of diabetic and cardiac patients has been less vigorous.

Patients must be familiar with emergency diet and renal fluid restriction plans, possible modification of dialysis schedules and methods, and rescue treatments such as the administration of kayexalate. Facilities may consider investing in water-independent extracorporeal dialysis techniques as a rescue treatment. In addition to patient databases and medical alert identification, diabetics should maintain an emergency medical kit. Diabetic patients must be taught and practice the carbohydrate counting technique. In addition to improved planning, responding agencies and organizations must bring adequate supplies and medications to care for diabetic, cardiac, and renal patients during relief efforts.

By recognizing and addressing impediments to the care of chronic disease exacerbations after natural disasters, the quality, delivery, and effectiveness of the care provided to diabetic patients during relief efforts can be improved.