The Targeted Agenda Program (TAP) has been introduced for the first time during the 15th World Congress on Disaster and Emergency Medicine (15WCDEM) in Amsterdam in 2007 to stimulate interaction between the participants before, during and after the congress. A TAP process consists of 11 steps, starting with defining a relevant issue and ending with the publication of a TAP report based on expert opinions. Seven TAP groups participated during the 15WCDEM. The TAP issues referred to: (1) the need for health impact assessment of disasters; (2) the golden standard for preparedness for a chemical, biological, radiological and nuclear disasters; (3) the role of acute psychosocial first aid; (4) the 10 most important issues for policy makers to minimize health effects of floods; (5) the search for a golden standard in the treatment of wounded combatants; (6) the preparedness of health organizations for consequences of extreme weather conditions; and (7) the health problems of high-vulnerability groups during disasters. This article describes the motivation and operational aspects of the TAP and advocates that this concept can play an important facilitating role in focus, networking and enhancement of knowledge in the field of disaster health.

Global warming has been hotly debated over the last two decades among scientists, economists, legal experts, philosophers, and politicians. Yet, the medical and public health communities are relative newcomers to understanding this global threat to humanity. As we celebrate Earth Day on 22 April 2008, there is an opportunity to educate physicians and other healthcare providers involved in mitigating, preparing for, responding to, and recovering from disasters about the medical and health implications of global warming.

The issue of basic psychosocial life support during and after disasters is important. People who are affected by disasters can experience severe distress and may need psychosocial support. However, there still are many questions about service design and effectiveness of psychosocial support.

During the process of the Targeted Agenda Program, “Prioritizing Care during the Acute Phase: The Prominent Role of Basic Psychosocial Life Support”, a team of experts reached consensus on some important issues concerning psychosocial first aid, civil participation, and risk communication.The experts come from many different backgrounds, which supports the notion that psychosocial care deserves special attention within disaster relief programs involving all disciplines and all responsibilities.

Events due to natural and technological hazards result in damage to living beings and the natural and built environment. The high urban population density, level of development, and extent of poverty in many disaster-prone areas further exacerbate the cumulative impact of such catastrophes. Also, crises, including those created by earthquakes, hurricanes, landslides, and tsunamis, have underscored the inability of hospitals to provide uninterrupted, urgently needed health services and maintain structural integrity. In many instances, deaths of hospital occupants were the direct result of collapsing physical infrastructure. In response and recognition of the need for collaborative efforts to mitigate the damages and loss of function, international public health, humanitarian, and relief organizations such as the Pan-American Health Organization (WHO/PAHO), the International Strategy for Disaster Reduction (ISDR) of the United Nations, the World Bank, the Joint Commission International (JCI), and the World Association for Disaster and Emergency Medicine (WADEM) have sponsored a series of global forums intent on developing guidelines for designing, constructing, and evaluating “safe and resilient” hospitals. The underlying goals of these guidelines are to protect the lives of patients, staff, and other hospital occupants, and ensure that hospitals continue to function during and after a catastrophic event.

In the last 35 years, the disaster and humanitarian communities have evolved rapidly in two parallel cohorts. The disaster enterprise in the US and Latin America grew up in the 1970s in response to a series of major earthquakes, hurricanes, and forest fires, culminating with the nuclear disaster at Three Mile Island and the formation of the Federal Emergency Management Agency (FEMA) in 1979/80. The Disaster Program at the Pan-American Health Organization also took form in the 1980s.

The humanitarian enterprise can be traced to the Biafran War of 1968/69, where a range of international, non-governmental organizations (NGOs) converged to respond to support a population that was fleeing a civil war and famine. In the years since, drawn to refugees and internally displaced persons in war circumstances as varied as Angola, Afghanistan, and Bosnia, the humanitarian community has expanded in numbers, reach, and budget.

Mass-casualty triage has developed from a wartime necessity to a civilian tool to ensure that constrained medical resources are directed at achieving the greatest good for the most number of people. Several primary and secondary triage tools have been developed, including Simple Treatment and Rapid Transport (START), JumpSTART, Care Flight Triage, Triage Sieve, Sacco Triage Method, Secondary Assessment of Victim Endpoint (SAVE), and Pediatric Triage Tape. Evidence to support the use of one triage algorithm over another is limited, and the development of effective triage protocols is an important research priority. The most widely recognized mass-casualty triage algorithms in use today are not evidence-based, and no studies directly address these issues in the mass-casualty setting. Furthermore, no studies have evaluated existing mass-casualty triage algorithms regarding ease of use, reliability, and validity when biological, chemical, or radiological agents are introduced. Currently, the lack of a standardized mass-casualty triage system that is well validated, reliable, and uniformly accepted, remains an important gap. Future research directed at triage is recognized as a necessity, and the development of a practical, universal, triage algorithm that incorporates requirements for decontamination or special precautions for infectious agents would facilitate a more organized mass-casualty medical response.

Background: In April 2004, the US Army Medical Department approved the use of the Army Knowledge Online (AKO) electronic e-mail system as a teleconsultation service for remote teledermatology consultations from healthcare providers in Iraq, Kuwait, and Afghanistan to medical subspecialists in the United States. The success of the system has resulted in expansion of the telemedicine program to include 11 additional clinical specialty services: (1) burn-trauma; (2) cardiology; (3) dermatology; (4) infectious disease; (5) nephrology; (6) ophthalmology; (7) pediatric intensive care; (8) preventive and occupational medicine; (9) neurology; (10) rheumatology; and (11) toxicology. The goal of the program is to provide a mechanism for enhanced diagnosis of remote cases resulting in a better evacuation system (i.e., only evacuation of appropriate cases). The service provides a standard practice for managing acute and emergent care requests between remote medical providers in austere environments and rear-based specialists in a timely and consistent manner.

Methods: Consults are generated using the AKO e-mail system routed through a contact group composed of volunteer, on-call consults. The project manager receives and monitors all teleconsultations to ensure Health Insurance Portability and Accountability Act compliance and consultant's recommendations are transmitted within a 24-hour mandated time period. A subspecialty “clinical champion” is responsible for recruiting consultants to answer teleconsultations and developing a call schedule for each specialty. Subspecialties may have individual consultants on call for specific days (e.g., dermatology and toxicology) or place entire groups on-call for a designated period of time (e.g., ophthalmology).

Results: As of May 2007, 2,337 consults were performed during 36 months, with an average reply time of five hours from receipt of the teleconsultation until a recommendation was sent to the referring physician. Most consultations have been for dermatology (66%), followed by infectious disease (10%). A total of 51 known evacuations were prevented from use of the program, while 63 known evacuations have resulted following receipt of the consultants' recommendation. A total of 313 teleconsultations also have been performed for non-US patients.

Conclusions: The teleconsultation program has proven to be a valuable resource for physicians deployed in austere and remote locations. Furthermore, use of such a system for physicians in austere environments may prevent unnecessary evacuations or result in appropriate evacuations for patients who initially may have been “underdiagnosed.”

When facing a situation involving mass casualties, we must consider the choices we have as individuals and as communities. The range of opportunity and privilege across the world is vast. Set against the background of natural and manmade disasters, how do we provide the right care at the right time for those in need? How can we share our collaborative knowledge?.

The recognition of the dignity of those in need is the first step.

Relationship building in the time of non-disaster leads to mutual understanding, facilitating care. Medicine brings science and experience into the art of clinical problem-solving. Disaster situations require rapid solutions based on prior planning, communicated with the understanding that optimal outcomes depend upon relationships based on respect, sharing knowledge of the local environmental resources, coupled with clinical care.