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 WisconsinUniversity of Wisconsin--MadisonMadisonPresident, World Association for Disaster and Emergency MedicinePresident, World Association for Disaster and Emergency Medicine (WADEM)(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

IssuesIssuesGlobal DirectionsGlobal DirectionsUN InitiativesUN InitiativesScienceScience

Major Recent EventsMajor Recent EventsINTERNATIONAL RESPONSESINTERNATIONAL RESPONSES

2004: SE Asia Earthquake & Tsunami2004: SE Asia Earthquake & Tsunami2005: Hurricanes Katrina & Rita2005: Hurricanes Katrina & Rita2006: Pakistan Earthquake2006: Pakistan Earthquake20022002--present: Afghan & Iraq Warspresent: Afghan & Iraq Wars20002000--present: present: DarfurDarfur2006: Lebanon2006: LebanonCivil unrest: East Timor, Sri Lanka, Ache Civil unrest: East Timor, Sri Lanka, Ache Indonesia, IsraelIndonesia, Israel--Palestine, Somalia, Palestine, Somalia, et alet al““War on TerrorWar on Terror””!!

WhatWhat’’s Happening Globally?s Happening Globally?NoNo Structured Research/Evaluations of Structured Research/Evaluations of InterventionsInterventionsNoNo Standards of PracticeStandards of PracticeNoNo Educational ObjectivesEducational ObjectivesNoNo CredentialsCredentialsNoNo RegulationRegulationNoNo Universal VisasUniversal VisasNoNo Control of EntryControl of EntryNoNo Single National/Regional/International Single National/Regional/International Coordination and Control Coordination and Control CenterCenter ConfusionConfusionPerpetuate MythsPerpetuate Myths

Key WordsKey Words

““DisasterDisaster’’““GapsGaps””

““AccountabilityAccountability””““Capacity buildingCapacity building””

““ProtectionProtection””““PartnershipsPartnerships””

““ScienceScience””

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!!!!!!!

ConvergenceConvergenceSelection of Disaster?Selection of Disaster?Who goes?Who goes?Why?Why?Needs assessmentsNeeds assessments——whose?whose?What is sent to sceneWhat is sent to scene——for relief?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 BosniaAccording to WHO According to WHO

Guidelines: Guidelines: inappropriateinappropriatefor settingfor setting (2(2--3%)3%)Required resources to sort Required resources to sort + repackage + repackage (28(28--36%)36%)Useless/unusable Useless/unusable (20(20--25%)25%)5050--60% of 34,000 tons = 60% of 34,000 tons = inappropriateinappropriateValue = $249,900,000 (not Value = $249,900,000 (not inclincltax break)tax break)Cost recipient country Cost recipient country $34,000,000 to dispose$34,000,000 to dispose

Ties for Balkan refugeesBerckmansBerckmans et al, N et al, N EnglEngl J Med 1997J Med 1997

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

HighHigh--heeled shoesheeled shoesEvening gownsEvening gownsSoccer shoesSoccer shoesBlanketsBlanketsPsychotherapy without credentialsPsychotherapy without credentialsLack of understanding of cultureLack of understanding of cultureNot selfNot self--supportingsupportingVisits by Visits by ““DignitariesDignitariesCoordination Coordination offeredoffered by UNby UN--OCHAOCHA

Credentialing/AccreditationCredentialing/Accreditation

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

No best practicesNo best practicesNo defined competenciesNo defined competenciesNo International/national licensingNo International/national licensingNo International No International Organization(sOrganization(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?leaves?”” ((UnivUniv Minnesota)Minnesota)•• MediaMedia•• Medical teamsMedical teams•• EquipmentEquipment•• Standard of careStandard of care

DisastersDisasterspresent present

““windows of opportunitywindows of opportunity””

WhatWhat’’s s HappeningHappening

At theAt theGlobal LevelGlobal Level

????????

Reorganization of UNReorganization of UNOrganization for Coordination of Organization for Coordination of Humanitarian Affairs (OCHA) Humanitarian Affairs (OCHA) (no health (no health component)component)

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

InterInter--Agency Steering Committee 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(WADEM) academic, science--buildingbuildingOther NonOther Non--Governmental Governmental Organizations (Organizations (NGOs)NGOs) responseresponse--orientedorientedPrivate SectorPrivate Sector

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

20052005--20152015

Develop matrix of roles and initiativesDevelop matrix of roles and initiativesFacilitate coordinationFacilitate coordinationConsult with stakeholdersConsult with stakeholdersEnsure support to national platformsEnsure support to national platformsSustainable development databaseSustainable development databaseInternational information clearing houseInternational information clearing housePeriodic 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

20052005--20152015

Develop matrix of roles and initiativesDevelop matrix of roles and initiativesFacilitate coordinationFacilitate coordinationConsult with stakeholdersConsult with stakeholdersEnsure support to national platformsEnsure support to national platformsSustainable development databaseSustainable development databaseInternational information clearing houseInternational information clearing housePeriodic reviews of progressPeriodic reviews of progressStimulate 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 technologies and programsprograms sciencescience??

ISDR: ISDR: ““Living with RiskLiving 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 CRIDCSW 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 FAOFEMAFEMA 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 ILO IMF IMF IOM ISDR ISO MSF NASA NATOIOM ISDR ISO MSF NASA NATO NEDIES NEDIES NEMA NOAANEMA NOAANRCNRC NSA NSA NSF OAS ODA ODI OFDA/USAID OHCHR PAHONSF OAS ODA ODI OFDA/USAID OHCHR PAHOPDC PTWS PWS RADIUS RDMP REIS PDC PTWS PWS RADIUS RDMP REIS SARSSARS SCFSCF--UK UK SEAGA SEI START TRM SEAGA SEI 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 UNUNHCR UN--HABITAT UNICEFHABITAT UNICEF UNIDO UNIFEM UNITAR UNIDO UNIFEM UNITAR UNUN--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 environmental disasters[hazardsdisasters[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 ComponentAssumed by WADEMAssumed by WADEM

InterInter--Agency Standing Committee Agency Standing Committee (IASC) (IASC)

Primary ObjectivesPrimary ObjectivesDevelop/Agree on systemDevelop/Agree on system--wide wide humanitarian policieshumanitarian policiesAllocate responsibilitiesAllocate responsibilitiesAdvocate for common humanitarian Advocate for common humanitarian principlesprinciplesDevelop/agree on common ethical Develop/agree on common ethical framework for all humanitarian activitiesframework for all humanitarian activitiesIdentify gaps in mandates/operational Identify gaps in mandates/operational capacitycapacityResolve disputes about/between Resolve disputes about/between humanitarian agencieshumanitarian agencies

IASC IASC ClusterCluster ApproachApproach

““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 leadershipAccountabilityAccountabilityInterInter--agency response (agency response (espesp IDP)IDP)CollaborationCollaborationEnhance partnerships/Enhance partnerships/complementaritycomplementarity

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 clustersEnsure required capacities/mechanisms Ensure required capacities/mechanisms existexistLongLong--term planning, standards, best term planning, standards, best practices, advocacy, resource mobilizationpractices, advocacy, resource mobilizationTraining + 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 clustersEnsure required capacities/mechanisms Ensure required capacities/mechanisms existexistLongLong--term planning, standards, best term planning, standards, best practices, advocacy, resource mobilizationpractices, advocacy, resource mobilizationTraining + 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 gapsgapsCommitments to respond to Commitments to respond to needsneedsand fill and fill gapsgapsProvider of last resortProvider of last resortMechanisms for performance Mechanisms for performance assessmentsassessments

IASC ClustersIASC ClustersService ProvisionService Provision•• Logistics (WFP)Logistics (WFP)•• Emergency telecommunications Emergency telecommunications

(OCHA/UNICEF/WFP)(OCHA/UNICEF/WFP)Relief and AssistanceRelief and Assistance•• Emergency shelter (UNHCR Emergency shelter (UNHCR espesp IDPsIDPs))•• Health (WHO)Health (WHO)•• Nutrition (UNICEF)Nutrition (UNICEF)•• Water, sanitation, hygiene (UNICEF)Water, sanitation, hygiene (UNICEF)CrossCross--cutting Issuescutting Issues•• Early recovery (UNDP)Early recovery (UNDP)•• Camp coordination and management (UNHCR)Camp coordination and management (UNHCR)•• Protection (UNHCR Protection (UNHCR espesp IDPsIDPs))

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 PointsLeadershipLeadership—— Roster Health Cluster Field CoordinatorsRoster Health Cluster Field Coordinators

Health expertiseHealth expertise—— system for training, practicesystem for training, practice

LogisticsLogisticsCoordinated responsesCoordinated responses——mechanismsmechanisms

Health Management Tool KitHealth Management Tool KitCountry Health Profile DatabaseCountry Health Profile DatabaseCommon Health Needs AssessmentsCommon Health Needs AssessmentsHealth & Nutrition Tracking ServiceHealth & Nutrition Tracking ServiceHealth Information SystemsHealth Information Systems Development Development Common Evaluation SystemCommon Evaluation SystemJoint Advocacy and Joint Advocacy and AppealsAppeals——communications communications with public, media, and policywith public, media, and policy--makers makers ––””Good humanitarian Good humanitarian donorshipdonorship””

Health ClusterHealth ClusterWHO (lead)WHO (lead)IOMIOMJtJt. Program HIV/AIDS. Program HIV/AIDSUNDPUNDPUNEPUNEPUNESCOUNESCOUNICEFUNICEFUNIDOUNIDOUNIFEMUNIFEMUNOPSUNOPSWFPWFP

Collaborating Collaborating PartnersPartnersMinistry of HealthMinistry of HealthOther MinistriesOther Ministries•• Higher EducationHigher Education•• EducationEducation•• EnvironmentEnvironment•• PlanningPlanning•• DevelopmentDevelopment

NGOs (NGOs (inclincl WADEM)WADEM)Other UN ClustersOther UN ClustersParent OrganizationsParent OrganizationsDonorsDonors

IASC Clusters IASC Clusters 2006 Appeal2006 Appeal

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

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

3,120,0003,120,000ProtectionProtection

5,440,2765,440,276NutritionNutrition

9,052,9809,052,980LogisticsLogistics

4,250,0004,250,000HealthHealth

6,700,0006,700,000EmergEmerg TelecommunicationsTelecommunications

1,691,0001,691,000EmergEmerg ShelterShelter

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

3,660,0003,660,000Camp Camp CoordCoord/mgmt/mgmt

Requirements (US$)Requirements (US$)ClusterCluster

IASC ClustersIASC ClustersCritiqueCritique

UN dominatedUN dominatedMost direct, external assistance by Most direct, external assistance by NGOsNGOs??SupercedeSupercede’’ss MoHMoH’’ss legal authoritylegal authority? Value added to all ? Value added to all partnerspartnersMust 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 MechanismsPreparedness and Capacity BuildingPreparedness and Capacity BuildingMass Casualty ManagementMass Casualty ManagementDisaster NursingDisaster NursingRole of Public Health (preparation for Role of Public Health (preparation for Expert Consultation)Expert Consultation)Consensus on TerminologyConsensus on TerminologyTraining of Regional CoordinatorsTraining of Regional Coordinators

WHO Regional OfficesWHO Regional Offices

1.1. PanPan--American Health OrganizationAmerican Health Organization(PAHO)(PAHO)——Washington, DC USAWashington, DC USA

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

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

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

The PhilippinesThe Philippines

Disaster Activities of SEARODisaster Activities of SEAROPostPost--earthquake and tsunamiearthquake and tsunami

•• PhuketPhuket Conference 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 PreparednessStrategies to reach benchmarksStrategies to reach benchmarksInventoried status of 11 countries relative to benchmarksInventoried status of 11 countries relative to benchmarks

•• FollowFollow--up, MoH, up, MoH, BaliBali 06/0606/06 (in preparation)(in preparation)

Validated benchmarksValidated benchmarksFollowFollow--up on Progressup on ProgressDiscuss Discuss JojakartaJojakarta Earthquake and smaller tsunamiEarthquake 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 HospitalsSafe Hospitals””——also ISDR 2008also ISDR 2008•• 22--day workshop on minimum standards and 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 EMS System Development in Latin America and the Caribbean America and the Caribbean (WADEM TF)(WADEM TF)

Uses of Field Hospitals Uses of Field Hospitals ((PDMPDM 2003;18(4 ):2782003;18(4 ):278––290)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

HACHAC--WHOWHODesignated February 2007Designated February 2007

as aas aWHO Cluster!!!!WHO Cluster!!!!

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

WhatWhat’’s Missings Missinginin

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. D. NebarroNebarro

Director, HACDirector, HAC--WHOWHOPrehospital and Disaster Medicine Prehospital and Disaster Medicine

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

The ProblemThe Problem

The same errors, inappropriate The same errors, inappropriate actions, delays are the same today actions, delays are the same today as they were 10 years ago.as they were 10 years ago.Many, many, many Many, many, many recommendations have been recommendations have been generated during analyses of generated during analyses of disastersdisasters——few have been few have been implemented.implemented.Many, many courses in Disaster Many, many courses in Disaster HealthHealth

Research/EvaluationResearch/Evaluation

ScienceScience

ScienceScience--based Standards/best practicesbased Standards/best practices

CurriculaCurricula

Education and TrainingEducation and Training

Credentialing + AccreditationCredentialing + Accreditation

CanCan’’t Havet HaveScienceScienceWithoutWithout

Standard TerminologyStandard Terminology

SE Asia Earthquake & Tsunami (2004)SE Asia Earthquake & Tsunami (2004)Kohl, Kohl, OfrinOfrin, , SalunkeSalunke, Birnbaum, Birnbaum (as of 16 Feb 02007)(as of 16 Feb 02007)

SE Asia Earthquake & Tsunami (n =167)

66

136 2 2 5 3

010203040506070

1 2 3 4 5 6-9 >9

Number Publications/Journal

Perc

ent o

f Sou

rces

SE Asia Earthquake & Tsunami (2004)SE Asia Earthquake & Tsunami (2004)Kohl, Kohl, OfrinOfrin, , SalunkeSalunke, Birnbaum, Birnbaum (in preparation)(in preparation)

Frequency (Top 5)Frequency (Top 5)

1515LancetLancet

2020NatureNature

2525ScienceScience

2828Intl Rev PsychiatryIntl Rev Psychiatry

4343Prehospital Disaster MedPrehospital Disaster Med

No. ArticlesNo. ArticlesPeerPeer--Reviewed JournalReviewed Journal

EventEvent--Specific Literature SearchSpecific Literature SearchArcher, Archer, BurkleBurkle, , et al et al (in preparation)(in preparation)

Frequency (Top 5)Frequency (Top 5)

55South Med JSouth Med J

1313Intl Rev PsychiatryIntl Rev Psychiatry

1717J Trauma StressJ Trauma Stress

2323MMWRMMWR

3333Prehospital Disaster MedPrehospital Disaster Med

No. PublicationsNo. PublicationsPeerPeer--Reviewed JournalReviewed Journal

Will not have aWill not have aRandomized, 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 eventsBuild validityBuild validityAdd valid findings to science Add valid findings to science (conceptual framework)(conceptual framework)Apply science to bestApply science to best--practicespractices•• 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 informationHard to build science and evidenceHard to build science and evidenceUnable to develop minimum standards of Unable to develop minimum standards of practicepracticeStandards determine EducationStandards determine EducationEducation results in Preparedness and Education results in Preparedness and Capacity BuildingCapacity BuildingDifficult 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 In order to benefit from lessons learned from lessons learned from past from past experiences, there experiences, there must be movement must be movement from just talk and from just talk and apparent 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 notenough, we must enough, we must DO.DO.””

Health Aspects of the Tsunami Health Aspects of the Tsunami Disaster in AsiaDisaster in Asia

MukeshMukesh KapillaKapilla, MD, MPH, MD, MPHScientific Director, EHA/WHO 2005Scientific Director, EHA/WHO 2005

Prehospital and Disaster MedicinePrehospital and Disaster Medicine2005;20(6):375.2005;20(6):375.

The Media The Media is driving is driving

disaster healthdisaster health!!!!!!!!!!

WADEM ActionsWADEM ActionsTerminologyTerminology

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

StructureStructure——building the Sciencebuilding 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 (Framework (UtsteinUtstein Template) (PDM, ongoing)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, PDMPDM2006;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 (onScience to Reality (on--thethe--ground)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. PanPan--American Health Organization (PAHO)American Health Organization (PAHO)3.3. South East Asia Regional Office of WHOSouth East Asia Regional Office of WHO4.4. AsiaAsia--Pacific Disaster Center (APDC)Pacific Disaster Center (APDC)5.5. Joint Commission Joint Commission 6.6. International Coalition of Nurses (WADEM Nursing International Coalition of Nurses (WADEM Nursing

Section)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 CommitteesProgrammeProgrammeInternational Law & International Law & EthicsEthicsPediatricsPediatricsEducation & TrainingEducation & TrainingPublicationsPublications

Task ForcesTask ForcesPublic HealthPublic HealthPsychosocialPsychosocialCBRNECBRNEEMS System EMS System DevelopmentDevelopmentSafe Healthcare Safe Healthcare FacilitiesFacilitiesTerrorismTerrorismTransportationTransportationCivilCivil--Military Military CooperationCooperationLandminesLandmines

Much RemainsMuch Remainsto be done!!!!to be done!!!!By Whom???By Whom???

ScienceScienceof of

Disaster HealthDisaster Health

““YouYou’’ve ve gottagotta accentuate the accentuate the positive,positive,

Eliminate the negative,Eliminate the negative,DonDon’’t mess with mister int mess with mister in--between.between.””

Johnny MercerJohnny Mercer

ISDR: ISDR: ““Living with RiskLiving 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 hazardand nations in our hazard--filled filled planet.planet.””

KofiKofi A. A. AnnanAnnanUN SecretaryUN Secretary--GeneralGeneral

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.eduhttp://www.wcdem2007.comhttp://www.wcdem2007.com