National Emergency Management SummitNational Emergency Management Summit

Marv Birnbaum, MD, PhDMarv Birnbaum, MD, PhDEmeritus Professor of Medicine and PhysiologyEmeritus Professor of Medicine and Physiology

University of Wisconsin-MadisonUniversity of Wisconsin-MadisonPresident, World Association for Disaster and Emergency Medicine (WADEM)President, World Association for Disaster and Emergency Medicine (WADEM)

Editor, Editor, Prehospital and Disaster MedicinePrehospital and Disaster Medicine06 March 200706 March 2007New OrleansNew Orleans

The Leading Forum on Medical The Leading Forum on Medical Preparation and Responses to Disaster, Epidemics, and TerrorismPreparation and Responses to Disaster, Epidemics, and Terrorism

Worldwide Perspectives on Worldwide Perspectives on Emergency ManagementEmergency Management

Outline of ContentOutline of Content

IssuesIssues Global DirectionsGlobal Directions UN InitiativesUN Initiatives ScienceScience

Major Recent EventsMajor Recent EventsINTERNATIONAL RESPONSESINTERNATIONAL RESPONSES

2004: SE Asia Earthquake & Tsunami2004: SE Asia Earthquake & Tsunami 2005: Hurricanes Katrina & Rita2005: Hurricanes Katrina & Rita 2006: Pakistan Earthquake2006: Pakistan Earthquake 2002-present: Afghan & Iraq Wars2002-present: Afghan & Iraq Wars 2000-present: Darfur 2000-present: Darfur 2006: Lebanon2006: Lebanon Civil unrest: East Timor, Sri Lanka, Ache Civil unrest: East Timor, Sri Lanka, Ache

Indonesia, Israel-Palestine, Somalia, Indonesia, Israel-Palestine, Somalia, et alet al ““War on Terror”!War on Terror”!

What’s Happening Globally?What’s Happening Globally? NoNo Structured Research/Evaluations of Structured Research/Evaluations of

InterventionsInterventions NoNo Standards of Practice Standards of Practice NoNo Educational Objectives Educational Objectives NoNo Credentials Credentials NoNo Regulation Regulation NoNo Universal Visas Universal Visas NoNo Control of Entry Control of Entry NoNo Single National/Regional/International Single National/Regional/International

Coordination and Control CenterCoordination and Control CenterConfusionConfusion Perpetuate MythsPerpetuate Myths

Key WordsKey Words

““Disaster’Disaster’

““Gaps”Gaps”

““Accountability”Accountability”

““Capacity building”Capacity building”

““Protection”Protection”

““Partnerships”Partnerships”

““Science”Science”

Worldwide IssuesWorldwide Issues1.1. Convergence without needs assessments or Convergence without needs assessments or

credentialscredentials2.2. Inappropriate responses/interventionsInappropriate responses/interventions3.3. Credentials, accreditationCredentials, accreditation4.4. CoordinationCoordination5.5. Transition to recoveryTransition to recovery6.6. Role of WHORole of WHO7.7. Role of Public HealthRole of Public Health8.8. Responses supported; not PreparednessResponses supported; not Preparedness9.9. Lack of science Lack of science 10.10. BIG SURPRISE!!!!!!!BIG SURPRISE!!!!!!!

ConvergenceConvergence

Selection of Disaster?Selection of Disaster? Who goes?Who goes? Why?Why? Needs assessments—whose?Needs assessments—whose? What is sent to scene—for relief?What is sent to scene—for relief? Credentials?Credentials? Accreditation?Accreditation? Field hospitals? Alternative sites?Field hospitals? Alternative sites? Coordination and control?Coordination and control? Security?Security?

Donated Medical Supplies to BosniaDonated Medical Supplies to Bosnia According to WHO According to WHO

Guidelines: Guidelines: inappropriateinappropriate for settingfor setting (2-3%)(2-3%)

Required resources to sort Required resources to sort + repackage + repackage (28-36%)(28-36%)

Useless/unusable Useless/unusable (20-25%)(20-25%) 50-60% of 34,000 tons = 50-60% of 34,000 tons =

inappropriateinappropriate Value = $249,900,000 (not incl Value = $249,900,000 (not incl

tax break)tax break) Cost recipient country Cost recipient country

$34,000,000 to dispose$34,000,000 to dispose

Ties for Balkan refugeesBerckmans Berckmans et al, N Engl J Med 1997et al, N Engl J Med 1997

Earthquake/Tsunami (2004)Earthquake/Tsunami (2004)

High-heeled shoesHigh-heeled shoes Evening gownsEvening gowns Soccer shoesSoccer shoes BlanketsBlankets Psychotherapy without credentialsPsychotherapy without credentials Lack of understanding of cultureLack of understanding of culture Not self-supportingNot self-supporting Visits by “DignitariesVisits by “Dignitaries Coordination Coordination offeredoffered by UN-OCHA by UN-OCHA

Credentialing/AccreditationCredentialing/Accreditation

No Standards No Standards (except Sphere)(except Sphere)

No best practicesNo best practices No defined competenciesNo defined competencies No International/national licensingNo International/national licensing No International Organization(s) No International Organization(s)

willing to accept responsibility willing to accept responsibility ? Liability? Liability

Transition and RecoveryTransition and Recovery

““What happens after everybody What happens after everybody leaves?” (Univ Minnesota)leaves?” (Univ Minnesota)• MediaMedia• Medical teamsMedical teams• EquipmentEquipment• Standard of careStandard of care

DisastersDisasters

present present

““windows of opportunity”windows of opportunity”

What’s What’s

HappeningHappening

At theAt the

Global LevelGlobal Level

????????

Reorganization of UNReorganization of UN Organization for Coordination of Organization for Coordination of

Humanitarian Affairs (OCHA) Humanitarian Affairs (OCHA) (no (no health component)health component)

International Strategy for Disaster International Strategy for Disaster Reduction (ISDR) Reduction (ISDR) (no health component)(no health component)

Inter-Agency Steering Committee Inter-Agency Steering Committee (IASC)(IASC)ClustersClusters

Other Players/PartnersOther Players/Partners

World Association for Disaster and World Association for Disaster and Emergency Medicine (Health) Emergency Medicine (Health) (WADEM) academic, science-building(WADEM) academic, science-building

Other Non-Governmental Other Non-Governmental Organizations (NGOs)Organizations (NGOs)response-response-orientedoriented

Private SectorPrivate Sector

Hyogo Framework and StrategyHyogo Framework and StrategyBuilding Resilience of Nations and Communities to DisastersBuilding Resilience of Nations and Communities to Disasters

2005-20152005-2015 Develop matrix of roles and initiativesDevelop matrix of roles and initiatives Facilitate coordinationFacilitate coordination Consult with stakeholdersConsult with stakeholders Ensure support to national platformsEnsure support to national platforms Sustainable development databaseSustainable development database International information clearing houseInternational information clearing house Periodic reviews of progress Periodic reviews of progress Stimulate exchange, compilation, analysis, Stimulate exchange, compilation, analysis,

summary, and dissemination of best summary, and dissemination of best practices, lessons learned, available practices, lessons learned, available technologies and programstechnologies and programs

Hyogo Framework and StrategyHyogo Framework and StrategyBuilding Resilience of Nations and Communities to DisastersBuilding Resilience of Nations and Communities to Disasters

2005-20152005-2015 Develop matrix of roles and initiativesDevelop matrix of roles and initiatives Facilitate coordinationFacilitate coordination Consult with stakeholdersConsult with stakeholders Ensure support to national platformsEnsure support to national platforms Sustainable development databaseSustainable development database International information clearing houseInternational information clearing house Periodic reviews of progressPeriodic reviews of progress Stimulate exchange, compilation, analysis, Stimulate exchange, compilation, analysis,

summary, and dissemination of best summary, and dissemination of best practices, lessons learned, available practices, lessons learned, available technologies and programstechnologies and programsscience?science?

ISDR: “Living with Risk”ISDR: “Living with Risk”(2004)(2004) Acronyms = 685Acronyms = 685

ACC ACDS ADB ACC ACDS ADB ADPCADPC ADRC ADRRN AFEM ALIDES APEC ADRC ADRRN AFEM ALIDES APEC AU BCAS BCPR BPIEPC CAMI CATEX CCAD CDB CDERA AU BCAS BCPR BPIEPC CAMI CATEX CCAD CDB CDERA CDMP CDPC CEA CEDERI CEI CEMEC CEP CEPAL CEPR CDMP CDPC CEA CEDERI CEI CEMEC CEP CEPAL CEPR CEPRIS CIDA CIERRO CMEPC COEN COPUOS CEPRIS CIDA CIERRO CMEPC COEN COPUOS CRED CRIDCRED CRID CSW DAW DESA CSW DAW DESA DFID DHADFID DHA DMFC DMT DMTP DRRP DRM DMFC DMT DMTP DRRP DRM DSD DWS EAECEP EC ECHO DSD DWS EAECEP EC ECHO ECLAC ELSAECLAC ELSA ESCAP ESCAP EWS FAOEWS FAO FEMAFEMA FIVIMS GA GADR GEF GIS GOOS GPS GRID HAZUS FIVIMS GA GADR GEF GIS GOOS GPS GRID HAZUS HIV/AIDS IADB IAEA HIV/AIDS IADB IAEA IASC ICRCIASC ICRC IDA IDF IDA IDF IDNDR IFRCIDNDR IFRC ILO IMF ILO IMF IOM ISDR ISO MSF NASA NATOIOM ISDR ISO MSF NASA NATO NEDIES NEDIES NEMA NOAANEMA NOAA NRCNRC NSA NSA NSF OAS ODA ODI OFDA/USAID OHCHR PAHONSF OAS ODA ODI OFDA/USAID OHCHR PAHO PDC PDC PTWS PWS RADIUS RDMP REIS PTWS PWS RADIUS RDMP REIS SARSSARS SCF-UK SEAGA SEI SCF-UK SEAGA SEI START TRM START TRM UNAIDSUNAIDS UNCSD UNCHS UNCRD UNCSD UNCHS UNCRD UNCRD/DMPHO UNCTAD UNCRD/DMPHO UNCTAD UNDACUNDAC UNDAF UNDCP UNDG UNDAF UNDCP UNDG UNDP UNDRO UNEP UNESCO UNFCCCUNDP UNDRO UNEP UNESCO UNFCCC UNFIP UNFPA UNFIP UNFPA UNHCR UN-HABITAT UNICEFUNHCR UN-HABITAT UNICEF UNIDO UNIFEM UNITAR UNIDO UNIFEM UNITAR UN-UN-OCHA USAIDOCHA USAID USDE/OAS USDE/OAS USGSUSGS USTDA VAM VHF WB WCP USTDA VAM VHF WB WCP WFP WFP WHOWHO WMO WSSD WTO WVI WWRP WWW WMO WSSD WTO WVI WWRP WWW

International Strategy for International Strategy for Disaster Reduction (ISDR)Disaster Reduction (ISDR)

MissionMission““The ISDR aims at building disaster resilient The ISDR aims at building disaster resilient

communities by promoting increased communities by promoting increased awareness of the importance of disaster awareness of the importance of disaster reduction as an integral component of reduction as an integral component of sustainable development with goal of sustainable development with goal of reducing human, social, economic, and reducing human, social, economic, and environmental losses due to natural environmental losses due to natural hazards and related technological and hazards and related technological and environmental disasters[hazards].”environmental disasters[hazards].”

International Strategy for International Strategy for Disaster Reduction (ISDR)Disaster Reduction (ISDR)

No Health Component Included!!No Health Component Included!!

Assumed by WHO/WADEMAssumed by WHO/WADEM

No Science ComponentNo Science Component

Assumed by WADEMAssumed by WADEM

Inter-Agency Standing Committee Inter-Agency Standing Committee (IASC) (IASC)

Primary ObjectivesPrimary Objectives Develop/Agree on system-wide Develop/Agree on system-wide

humanitarian policieshumanitarian policies Allocate responsibilitiesAllocate responsibilities Advocate for common humanitarian Advocate for common humanitarian

principlesprinciples Develop/agree on common ethical Develop/agree on common ethical

framework for all humanitarian activitiesframework for all humanitarian activities Identify gaps in mandates/operational Identify gaps in mandates/operational

capacitycapacity Resolve disputes about/between Resolve disputes about/between

humanitarian agencieshumanitarian agencies

IASC IASC ClusterCluster Approach Approach

““aims to improve predictability, aims to improve predictability, timeliness, and effectiveness of timeliness, and effectiveness of humanitarian response, and pave the humanitarian response, and pave the way for recovery.”way for recovery.”

Strengthen leadershipStrengthen leadership AccountabilityAccountability Inter-agency response (esp IDP)Inter-agency response (esp IDP) CollaborationCollaboration Enhance partnerships/complementarityEnhance partnerships/complementarity

IASC Cluster Approach IASC Cluster Approach Global Leadership FunctionsGlobal Leadership Functions

Overall Needs Assessments Overall Needs Assessments Review available capacities Review available capacities Links with other clustersLinks with other clusters Ensure required capacities/mechanisms Ensure required capacities/mechanisms

existexist Long-term planning, standards, best Long-term planning, standards, best

practices, advocacy, resource mobilizationpractices, advocacy, resource mobilization Training + systems developmentTraining + systems development

• LocalLocal• NationalNational• RegionalRegional• InternationalInternational

IASC Cluster Approach IASC Cluster Approach Global Leadership FunctionsGlobal Leadership Functions

Overall Needs Assessments Overall Needs Assessments Review available capacities Review available capacities Links with other clustersLinks with other clusters Ensure required capacities/mechanisms Ensure required capacities/mechanisms

existexist Long-term planning, standards, best Long-term planning, standards, best

practices, advocacy, resource mobilizationpractices, advocacy, resource mobilization Training + systems developmentTraining + systems development

• LocalLocal• NationalNational• RegionalRegional• InternationalInternational

IASC Cluster Approach IASC Cluster Approach Field Leadership FunctionsField Leadership Functions

Analysis of Analysis of needsneeds, address priorities, , address priorities, identify identify gapsgaps

Commitments to respond to Commitments to respond to needsneeds and fill and fill gapsgaps

Provider of last resortProvider of last resort Mechanisms for performance Mechanisms for performance

assessmentsassessments

IASC ClustersIASC Clusters Service ProvisionService Provision

• Logistics (WFP)Logistics (WFP)• Emergency telecommunications Emergency telecommunications

(OCHA/UNICEF/WFP)(OCHA/UNICEF/WFP) Relief and AssistanceRelief and Assistance

• Emergency shelter (UNHCR esp IDPs)Emergency shelter (UNHCR esp IDPs)• Health (WHO)Health (WHO)• Nutrition (UNICEF)Nutrition (UNICEF)• Water, sanitation, hygiene (UNICEF)Water, sanitation, hygiene (UNICEF)

Cross-cutting IssuesCross-cutting Issues• Early recovery (UNDP)Early recovery (UNDP)• Camp coordination and management (UNHCR)Camp coordination and management (UNHCR)• Protection (UNHCR esp IDPs)Protection (UNHCR esp IDPs)

No mention of building the SCIENCE!!!!!!!!!No mention of building the SCIENCE!!!!!!!!!

Health ClusterHealth ClusterMission StatementMission Statement

““To support the Ministry of Health To support the Ministry of Health National Health Strategy in meeting National Health Strategy in meeting basic health needs as well as basic health needs as well as interventions aimed at addressing interventions aimed at addressing nutritional issues.”nutritional issues.”

Global Health Cluster Action PointsGlobal Health Cluster Action Points LeadershipLeadership— — Roster Health Cluster Field CoordinatorsRoster Health Cluster Field Coordinators Health expertise— Health expertise— system for training, practicesystem for training, practice LogisticsLogistics Coordinated responsesCoordinated responses——mechanismsmechanisms Health Management Tool KitHealth Management Tool Kit Country Health Profile DatabaseCountry Health Profile Database Common Health Needs AssessmentsCommon Health Needs Assessments Health & Nutrition Tracking ServiceHealth & Nutrition Tracking Service Health Information SystemsHealth Information Systems Development Development Common Evaluation SystemCommon Evaluation System Joint Advocacy and Joint Advocacy and Appeals—Appeals—communications communications

with public, media, and policy-makers –”Good humanitarian with public, media, and policy-makers –”Good humanitarian donorship”donorship”

Health ClusterHealth Cluster WHO (lead)WHO (lead) IOMIOM Jt. Program HIV/AIDSJt. Program HIV/AIDS UNDPUNDP UNEPUNEP UNESCOUNESCO UNICEFUNICEF UNIDOUNIDO UNIFEMUNIFEM UNOPSUNOPS WFPWFP

Collaborating Collaborating PartnersPartners Ministry of HealthMinistry of Health Other MinistriesOther Ministries

• Higher EducationHigher Education• EducationEducation• EnvironmentEnvironment• PlanningPlanning• DevelopmentDevelopment

NGOs (incl WADEM)NGOs (incl WADEM) Other UN ClustersOther UN Clusters Parent OrganizationsParent Organizations DonorsDonors

IASC Clusters IASC Clusters 2006 Appeal2006 Appeal

ClusterCluster Requirements (US$)Requirements (US$)Camp Coord/mgmtCamp Coord/mgmt 3,660,0003,660,000

Early RecoveryEarly Recovery 2,415,0002,415,000

Emerg ShelterEmerg Shelter 1,691,0001,691,000

Emerg TelecommunicationsEmerg Telecommunications 6,700,0006,700,000

HealthHealth 4,250,0004,250,000

LogisticsLogistics 9,052,9809,052,980

NutritionNutrition 5,440,2765,440,276

ProtectionProtection 3,120,0003,120,000

Water, Sanitation, HygieneWater, Sanitation, Hygiene 3,360,0003,360,000

Grand TotalGrand Total 39,689,25639,689,256

IASC ClustersIASC ClustersCritiqueCritique

UN dominatedUN dominated Most direct, external assistance by Most direct, external assistance by

NGOsNGOs ?Supercede’s MoH’s legal authority?Supercede’s MoH’s legal authority ? Value added to all ? Value added to all partnerspartners Must form Must form partnershipspartnerships

Reorganization of WHOReorganization of WHO

Emergency Humanitarian Actions (EHA)Emergency Humanitarian Actions (EHA)

Health Actions in Emergencies (HAC)Health Actions in Emergencies (HAC)

Emergency Preparedness and Capacity

Building

Response and Tracking

Transition and Recovery

WHO/WADEM Expert Consultations WHO/WADEM Expert Consultations since December 2005since December 2005

Tracking MechanismsTracking Mechanisms Preparedness and Capacity BuildingPreparedness and Capacity Building Mass Casualty ManagementMass Casualty Management Disaster NursingDisaster Nursing Role of Public Health (preparation for Role of Public Health (preparation for

Expert Consultation)Expert Consultation) Consensus on TerminologyConsensus on Terminology Training of Regional CoordinatorsTraining of Regional Coordinators

WHO Regional OfficesWHO Regional Offices

1.1. Pan-American Health OrganizationPan-American Health Organization (PAHO)—Washington, DC USA(PAHO)—Washington, DC USA

2.2. South East AsiaSouth East Asia (SEARO)—Dehli, (SEARO)—Dehli, IndiaIndia

3.3. AfricanAfrican (AFRO)— Brazzaville, Congo (AFRO)— Brazzaville, Congo4.4. EuropeEurope (EURO) — Copenhagen, (EURO) — Copenhagen,

DenmarkDenmark5.5. Western PacificWestern Pacific (WPRO) — Manila, (WPRO) — Manila,

The PhilippinesThe Philippines

Disaster Activities of SEARODisaster Activities of SEAROPost-earthquake and tsunamiPost-earthquake and tsunami

• Phuket Conference Phuket Conference (05/05)(05/05) ((PDMPDM 2005;20(6)) 2005;20(6))

• Meeting of Ministries of Health, Meeting of Ministries of Health, BangkokBangkok 11/0511/05 ((PDMPDM 2006;21(5)) 2006;21(5))

12 Benchmarks for Country Preparedness12 Benchmarks for Country Preparedness Strategies to reach benchmarksStrategies to reach benchmarks Inventoried status of 11 countries relative to benchmarksInventoried status of 11 countries relative to benchmarks

• Follow-up, MoH, Follow-up, MoH, BaliBali 06/0606/06 (in preparation)(in preparation) Validated benchmarksValidated benchmarks Follow-up on ProgressFollow-up on Progress Discuss Jojakarta Earthquake and smaller tsunamiDiscuss Jojakarta Earthquake and smaller tsunami

• Preparing definitive book on medical/public Preparing definitive book on medical/public health aspects of tsunami health aspects of tsunami (with WADEM)(with WADEM)

Disaster Activities of PAHODisaster Activities of PAHO

““Safe Hospitals”—also ISDR 2008Safe Hospitals”—also ISDR 2008• 2-day workshop on minimum standards and 2-day workshop on minimum standards and

benchmarks, 15WCDEM, May 2007, benchmarks, 15WCDEM, May 2007, Amsterdam (with Joint Commission Amsterdam (with Joint Commission International, Yale Center, WADEM)International, Yale Center, WADEM)

EMS System Development in Latin America EMS System Development in Latin America and the Caribbean and the Caribbean (WADEM TF)(WADEM TF)

Uses of Field Hospitals Uses of Field Hospitals ((PDMPDM 2003;18(4 ):278–290) 2003;18(4 ):278–290)

Management of the Dead Management of the Dead (new publication)(new publication)

Extensive disaster database (CRED)Extensive disaster database (CRED)

Big New MandateBig New Mandate

HAC-WHOHAC-WHO

Designated February 2007Designated February 2007

as aas a

WHO Cluster!!!!WHO Cluster!!!!

?? Authority + Resources???? Authority + Resources??

What’s MissingWhat’s Missing

inin

All of All of

This Stuff?This Stuff?

““Why have we Why have we not learned not learned

from what we from what we have have

learned?”learned?”D. NebarroD. Nebarro

Director, HAC-WHODirector, HAC-WHOPrehospital and Disaster Medicine Prehospital and Disaster Medicine

2005;20(6).2005;20(6).

The ProblemThe Problem

The same errors, inappropriate actions, The same errors, inappropriate actions, delays are the same today as they were delays are the same today as they were 10 years ago.10 years ago.

Many, many, many recommendations Many, many, many recommendations have been generated during analyses of have been generated during analyses of disastersdisasters——few have been implemented.few have been implemented.

Many, many courses in Disaster HealthMany, many courses in Disaster Health

Research/EvaluationResearch/Evaluation

ScienceScience

Science-based Standards/best practicesScience-based Standards/best practices

CurriculaCurricula

Education and TrainingEducation and Training

Credentialing + AccreditationCredentialing + Accreditation

Can’t HaveCan’t Have

ScienceScience

WithoutWithout

Standard TerminologyStandard Terminology

SE Asia Earthquake & Tsunami (2004)SE Asia Earthquake & Tsunami (2004)Kohl, Ofrin, Salunke, BirnbaumKohl, Ofrin, Salunke, Birnbaum (as of 16 Feb 02007)(as of 16 Feb 02007)

SE Asia Earthquake & Tsunami (n =167)

66

136 2 2 5 3

010

2030

4050

6070

1 2 3 4 5 6-9 >9

Number Publications/Journal

Perc

ent of S

ourc

es

SE Asia Earthquake & Tsunami (2004)SE Asia Earthquake & Tsunami (2004)Kohl, Ofrin, Salunke, BirnbaumKohl, Ofrin, Salunke, Birnbaum (in preparation)(in preparation)

Frequency (Top 5)Frequency (Top 5)

Peer-Reviewed JournalPeer-Reviewed Journal No. ArticlesNo. Articles

Prehospital Disaster MedPrehospital Disaster Med 4343

Intl Rev PsychiatryIntl Rev Psychiatry 2828

ScienceScience 2525

NatureNature 2020

LancetLancet 1515

Event-Specific Literature SearchEvent-Specific Literature SearchArcher, Burkle, Archer, Burkle, et al et al (in preparation)(in preparation)

Frequency (Top 5)Frequency (Top 5)

Peer-Reviewed JournalPeer-Reviewed Journal No. PublicationsNo. Publications

Prehospital Disaster MedPrehospital Disaster Med 3333

MMWRMMWR 2323

J Trauma StressJ Trauma Stress 1717

Intl Rev PsychiatryIntl Rev Psychiatry 1313

South Med JSouth Med J 55

Will not have aWill not have a

Randomized, Controlled Disaster!!Randomized, Controlled Disaster!!

Must use other techniquesMust use other techniques

Qualitative data collectionQualitative data collection(External validity increases with (External validity increases with

repeated findings in different settings)repeated findings in different settings)

Important IssuesImportant Issues

Compare eventsCompare events Build validityBuild validity Add valid findings to science Add valid findings to science

(conceptual framework)(conceptual framework) Apply science to best-practicesApply science to best-practices

• Management (coordination and control)Management (coordination and control)• Enhance responseEnhance response

Lack of StructureLack of Structure

Difficult/impossible to compare/collate Difficult/impossible to compare/collate data into useful informationdata into useful information

Hard to build science and evidenceHard to build science and evidence Unable to develop minimum standards of Unable to develop minimum standards of

practicepractice Standards determine EducationStandards determine Education Education results in Preparedness and Education results in Preparedness and

Capacity BuildingCapacity Building Difficult to obtain needed resourcesDifficult to obtain needed resources

““What Went Well?”What Went Well?”vs.vs.

“ What Could Have Been Done Better?”“ What Could Have Been Done Better?”

Standards/GuidelinesStandards/Guidelines

Obtain Consensus of StakeholdersObtain Consensus of Stakeholders

Curricula DevelopmentCurricula Development(Definition of Competencies)(Definition of Competencies)

Education & TrainingEducation & Training

Evaluation of CompetenceEvaluation of Competence

Credentialing (Individuals)Credentialing (Individuals)Accreditation (Organizations)Accreditation (Organizations)

““In order to benefit from In order to benefit from lessons learned from lessons learned from past experiences, past experiences, there must be there must be movement from just movement from just talk and apparent talk and apparent commitment to commitment to action. Knowledge is action. Knowledge is not enough; we must not enough; we must apply. Willing is notapply. Willing is not

enough, we must DO.”enough, we must DO.”Health Aspects of the Tsunami Health Aspects of the Tsunami

Disaster in AsiaDisaster in Asia

Mukesh Kapilla, MD, MPHMukesh Kapilla, MD, MPHScientific Director, EHA/WHO 2005Scientific Director, EHA/WHO 2005

Prehospital and Disaster MedicinePrehospital and Disaster Medicine 2005;20(6):375.2005;20(6):375.

The Media The Media

is driving is driving

disaster healthdisaster health

!!!!!!!!!!

WADEM ActionsWADEM Actions

TerminologyTerminologyCollating all glossariesCollating all glossariesConsensus Conference jointly with WHO (2007)Consensus Conference jointly with WHO (2007)

Structure—building the ScienceStructure—building the ScienceGuidelines for Research and EvaluationGuidelines for Research and Evaluation

Volume 1: Conceptual framework (2003)Volume 1: Conceptual framework (2003)Volume 2: Operational and Research Framework (May Volume 2: Operational and Research Framework (May

2007)2007)Volume 3: Research/evaluation methods (May 2007)Volume 3: Research/evaluation methods (May 2007)

Force published and new results into Research Force published and new results into Research Framework (Utstein Template) (PDM, ongoing)Framework (Utstein Template) (PDM, ongoing)

Prehospital and Disaster Medicine 2002;17 Suppl 3

WADEM Actions (2)WADEM Actions (2)

3.3. Standards and BenchmarksStandards and Benchmarks1.1. Abstracting several sources Abstracting several sources

(written and unwritten, May (written and unwritten, May 2007)2007)

2.2. SEARO Benchmarks SEARO Benchmarks (2005/2006, (2005/2006, PDMPDM 2006;21(5)) 2006;21(5))

3.3. Safe Hospitals Safe Hospitals

((JCI,YNHCDP,PAHO, WADEM) JCI,YNHCDP,PAHO, WADEM) 15WCDEM, May 2007, 15WCDEM, May 2007, Amsterdam)Amsterdam)

Standard

Benchmark n

Benchmark 1

Current Status

WADEM Actions (3)WADEM Actions (3)4.4. Education and TrainingEducation and Training

– Identified issues (Identified issues (PDMPDM 2004;19) 2004;19)– Standards determine educational objectivesStandards determine educational objectives– Publications (PDM, Insight, Nursing Insight)Publications (PDM, Insight, Nursing Insight)– WADEM Regional Training CentersWADEM Regional Training Centers

5.5. Science to Reality (on-the-ground)Science to Reality (on-the-ground)1.1. Liaison with operational organizations (IGO, NGO)Liaison with operational organizations (IGO, NGO)

1.1. World Health Organization (WHO)World Health Organization (WHO)2.2. Pan-American Health Organization (PAHO)Pan-American Health Organization (PAHO)3.3. South East Asia Regional Office of WHOSouth East Asia Regional Office of WHO4.4. Asia-Pacific Disaster Center (APDC)Asia-Pacific Disaster Center (APDC)5.5. Joint Commission Joint Commission 6.6. International Coalition of Nurses (WADEM Nursing Section)International Coalition of Nurses (WADEM Nursing Section)7.7. Emergency Nurses Association (WADEM Nursing Section)Emergency Nurses Association (WADEM Nursing Section)

2.2. Formation of WADEM National and Regional ChaptersFormation of WADEM National and Regional Chapters

WADEM Actions (4)WADEM Actions (4)ReorganizationReorganization

Standing CommitteesStanding Committees ProgrammeProgramme International Law & International Law &

EthicsEthics PediatricsPediatrics Education & TrainingEducation & Training PublicationsPublications

Task ForcesTask Forces Public HealthPublic Health PsychosocialPsychosocial CBRNECBRNE EMS System EMS System

DevelopmentDevelopment Safe Healthcare Safe Healthcare

FacilitiesFacilities TerrorismTerrorism TransportationTransportation Civil-Military Civil-Military

CooperationCooperation LandminesLandmines

Much RemainsMuch Remainsto be done!!!!to be done!!!!

By Whom???By Whom???

ScienceScience

of of

Disaster HealthDisaster Health

““You’ve gotta accentuate the You’ve gotta accentuate the positive,positive,

Eliminate the negative,Eliminate the negative,

Don’t mess with mister in-Don’t mess with mister in-between.”between.”

Johnny MercerJohnny Mercer

ISDR: “Living with Risk”ISDR: “Living with Risk”

““Disasters are a problem that we can Disasters are a problem that we can and must reduce. I commend this and must reduce. I commend this publication to all involved in the publication to all involved in the effort to build resilient communities effort to build resilient communities and nations in our hazard-filled and nations in our hazard-filled planet.”planet.”

Kofi A. AnnanKofi A. Annan

UN Secretary-GeneralUN Secretary-General

Thank YouThank You for your Attention and for your Attention and for your unequalled Commitment for your unequalled Commitment

to limit deaths and alleviate to limit deaths and alleviate unnecessary pain and suffering unnecessary pain and suffering

of our fellow human beingsof our fellow human beings

http://wadem.medicine.wisc.eduhttp://wadem.medicine.wisc.edu

http://www.wcdem2007.comhttp://www.wcdem2007.com