A little over 20 years ago, a small number of highly respected and internationally known scientists and experts in prehospital and in-hospital emergency and disaster medicine met under the chairmanship of Professor Peter Safar and the late Professor Rudolf Frey to found the Club of Mainz, with the aim of creating an association comparable to the renowned Club of Rome.

The goals of the new club were primarily to foster and improve disaster medicine worldwide and to better prepare for future natural and manmade disasters. After little more than 20 years, the former Club of Mainz, later renamed the World Association for Disaster and Emergency Medicine (WADEM) celebrates its 20th anniversary and, at the same time, organizes the 10th World Congress on Emergency and Disaster Medicine. Over the past 10 years, the Congress has been held throughout the world, first in Mainz and later, e.g., Pittsburgh, London, Rio de Janeiro, Hong Kong, Stockholm, Jerusalem, to return in 1997 to its place of origin.

To celebrate these events, the Congress program consists of three Plenary Sessions dedicated to aspects that already were of concern 20 years ago to assess the developments and progress made during that period of time.

This is a descriptive study of the Emergency Medical Services response to a bombing of a United States Federal Building in Oklahoma City, Oklahoma on 19 April 1995. The explosion emanated from a rented truck parked in the front of the building. The force of the explosion destroyed three of the four support columns in the front of the building and resulted in a pancaking effect of the upper floors onto the lower floors.

There were three distinct phases of the medical response: 1) Immediately available local EMS ambulances and staff; 2) Additional ambulances staffed by recalled, off-duty personnel; and 3) mutual-aid ambulances and personnel from the surrounding communities. There were 361 persons in the building at the time of the explosion, 163 of these perished. Within the first hour of the explosion, 139 patients were transported to area hospitals. Of these, 32% were in critical condition. During the day of the explosion, 444 persons were treated for physical injuries: 410 of these were related to the explosion and 14, including one with fatal injuries, were sustained during search and rescue attempts. A total of 354 (80%) were treated and released from emergency departments, and 90 (20%) were admitted to hospitals. Six of the transported victims either were dead on arrival to the emergency department or died after admission to the hospital. Of those who died, 95% of the deaths were related to blunt trauma associated with the collapse of the structure. Only three persons were extricated alive after the first five hours following the explosion.

The scene became flooded with volunteers who, although their intentions were to provide help and aid to those injured, created a substantial logistical problem for Incident Command. Several other lessons were learned: 1) Telephone lines and cells became overloaded, but the Hospital Emergency Administrative Radio system was operational only in three of the 15 hospitals; 2) Volunteer personnel should have responded to the hospitals and not to the scene; and 3) Training was an essential for the success of such a response. Thus, the success of this operation was a function of the intense training, practice, and coordination between multiple agencies.

When the infrastructure in a community is destroyed by manmade or natural disaster, even the simplest health services may be difficult to maintain. By the Alma Ata declaration, the World Health Organization (WHO) proclaimed, “Health for all by the year 2000.” The program is designed to cover the basic health needs as defined by the Primary Health Care (PHC) system. Therefore, a most important issue in a disaster, is to support, maintain, and rebuild the PHC system, to secure the population's basic health services.

Relevant and rapid aid is of great importance in disaster. The physical and psychological strain caused by disaster will increase the need for medical care compared to that during normal times. Child mortality and maternal complications will rise, Many of the 12 million children, who die every year, die as a result of war, refugee conditions, and/or other types of disaster.

The NorAid system is equipment composed to provide PHC, with special emphasis on vulnerable groups e.g., women and children. Provided the medical skills are available, it also may function as a hospital. The system already has been used in many countries, and has been found to be relevant, practical, and relatively cheap compared to the benefits achieved.

A mass gathering always presents a challenge to the medical providers of a city since preparations must be made to cover any potential disasters, big or small. With a prediction of several hundred thousand people coming to the New York City area to participate in the Papal Masses, the New York City-Emergency Medical Services readied its forces of physicians, paramedics, and emergency medical technicians from throughout the region. Extensive multiagency planning involving a Total Quality Management process was integral to the success of covering the events.

Development of competence in exercising therapeutic judgment skills represents the goal of clinical education. Time (clock hours) is not a valid predictor of attainment of competence in paramedic clinical education. Quantity of patient contact experiences facilitates development of judgment skills, and offers a valid measure of progress toward competence. This project uses national survey data from accredited programs to describe the availability and accessibility of patient contact experiences within paramedic clinical education. Data from this local program supplements the national survey results. The components of clinical judgment are enumerated, and strategies to teach and evaluate clinical judgment skills are discussed.

When a disaster occurs, a major difficulty is knowing where to find accurate information, and how to help coordinate efforts to share accurate information in a quick and organized manner. The establishment of a global information network, that is in place before a disaster occurs, could link all the communication efforts for relief. We propose that a Global Health Unit for Disaster and Relief Coordination be set up as part of the Global Health Network, utilizing the Internet as its backbone. This Unit would establish the links for the disaster information mosaic.

Abstract: Recertification requirements and new curricula place increased importance on continuing education (CE) for emergency medical services (EMS) personnel. To be effective, continuing education not only must be accessible to EMS personnel, but it must be also acceptable. Journal-based continuing education was selected to improve accessibility, but questions were raised about its acceptance. Although there were some significant differences found between the feelings of basic and advanced EMS personnel, a study conducted on six articles showed that participants overall liked this method. The study also found that some articles significantly generated more reader response than others.

There is a huge need for access to information in the areas of disaster relief disaster medicine, and humanitarian assistance. The extraordinarily rapid increase in the literature in these subject areas attests to this need. However, use of the printed word has substantial limitations that are even more profound in the developing world.

Currently, the information available tends to be fragmented and sequestered by the specific interests of the organizations and governments involved. The evolving electronic methods for the storage, organization, and retrieval of information makes coordination between organizations concerned with disasters within our grasp.

This paper discusses the Center of Excellence in Disaster Management and Humanitarian Assistance and describes the World Wide Web and the implications it has in disaster management and medicine. It describes methods for obtaining user input to the techniques used for the development of the world wide web for the areas of disaster management and disaster medicine. The implementation of an on-line Internet reference desk that will provide: 1) a list of “experts;” 2) a searchable disaster database; and 3) on-line simulation courses and training exercises also is discussed.