Adulthood is upon WADEM, and the Association is shouldering this distinction with vigor and enthusiasm. Preparations for our 20th Anniversary Congress are well advanced and the rich program arranged by Prof. Wolfgang Dick in Mainz is assured of success. Very wisely. I think, we shall cover exactly the same topics that were discussed twenty years ago, to see what has been achieved in the interim, what has to be corrected, and what remains t be done. All members and all the disaster medicine community will wish not to miss this important event and celebration.

Another sign of our coming of age is that from now WADEM will publish Prehospital and Disaster Medicine on its own, as its official journal. Eleven preceding volumes of solid science propels us to wider horizons and more international humanitarian health action, both individually and as a worldwide Association. With Marvin Birnbaum assuring continuity as Editor-in-Chief, PDM can look forward to many years of valid contribution to scientific emergency and disaster medicine literature.

Yet another enrichment added to Insight is WADEM's computer based Global Disasters Report, ably produced by Ernesto Pretto, MD, MPH at our administrative offices in the University of Pittsburgh. Do keep feeding information so that this endeavor will meet its truly global function.

But whatever the undertaking, its usefulness must never be taken for granted, and serious assessment is necessary. whatever the motive of the action. This is all the more pertinent to medical response in disasters, where the usual criteria are even more difficult to apply. WADEM is therefore proud to have initiated, with serious collaborators that include the Nordic Society of Disaster Medicine and the World Health Organization, an ongoing research project on Quality Assessment and Evaluation of Disaster Response, chaired by Knut Ole Sundnes. All experienced disaster workers are invited to provide feedback for what will surely become the standard assessment tool.

The columns of the newsletter you are reading give further evidence of WADEM's vitality and presence in many fields of emergency in many parts of the world. The Association is thus forging ahead resolutely, and I invite all members -- and the many who would like to join us -- to keep up the good work in favor of the disaster stricken and for the growth of our young science.

S. William A. Gunn, M.D.. President

Welcome to the Journal of the Japanese Association for Disaster Medicine. Its Editor-in-Chief is WADEM Board member Dr. Takashi Ukai, whose book we reported on in our last issue of insight, under the Book Corner. WADEM and PDM look forward to meaningful collaboration in the field of disaster and emergency literature!

An enthusiastic member of WADEM, Dr. Wahid Al Kharusi and the Civil Defense authorities of Oman organized a high-level technical conference on risk reduction in this Sultanate on the Gulf Coast. Besides the scientific validity of the discussions, it is noteworthy that the meeting's recommendations were officially received by the entire Government Cabinet, an example to some countries where the political will is often lacking while the scientific necessities are there.

Dr. William Gunn, President of WADEM, has been invited to join the Scientific Board of the international Centre for Migration Health. A joint undertaking of the international Organization of Migration, the University of Geneva and WHO. The Center is dedicated to research, study and health assistance to the ever-growing numbers of people who are forced to migrate. WADEM member Dr. Fabrizio Bassani is also on the Directorate of the Centre.

Last June, coinciding with the meteorological and social splendor of Sweden's midsummer festivities, the European Union held a significant Workshop on Civil Defense and Disasters. WADEM was specially invited to present the Association's work, while many of our members were involved in the organization of the event: Doctors Be Brismar, Boerje Hallen, Per Kulling, Sten Lennquist and Karl-Axel Norherg. WADEM's project on Quality Control and Evaluation of Disaster Response was presented for the first time in a public conference by William Gunn, and received much attention among participants who wish to contribute to the effort. Reprints of the PDM article on this project were distributed. and further details will be found elsewhere in this issue of Insight.

Academician Mark Klyachko, an active WADEM member in Russia, is Director of the Center on Earthquake Engineering and Disaster Reduction in Kamchatka and St. Petersburg. In February he organized a very important international conference on Seismic Safety in Urbnn Areas that took place in Petropavlovsk. This farthest eastern area of Russia is particularly prone to earthquakes, volcanic eruptions and tsunamis, on which research is highly advanced at the Center. Upon invitation. WADEM contributed particularly to the human element of problems that are primarily of physical origin.

ARGENTINA
Claudio E. Cioldini, MD

AUSTRALIA
Alison M. Holloway
Eric W. Williams

CHINA
Mr. Joannes W.H. Luk
Dr. Shao Xiaohong

DENMARK
Tom Steinov

GERMANY
Dr. Trutz-Hagen Legarth

IRELAND
Dr. E. Nevin Un

ITALY
Guiseppe D'Angelo. MD
Dr. Gabriele Germano

JAPAN
Yoichi Shirakawa
Katsuhiko Sugimolo, MD

SAUDI ARABIA
Abdulla F. Al-Madhari, PhD
Bassam Ibrahim Gholam
Dr. Wahid Mikhail

SOUTH KOREA
Joon Pil Cho, MD

SWEDEN
Karl A. Wallman-Cason, MD

THAILAND
Somchai Kanchanasut

TURKEY
Mehmet Haberal, MD

UNITED KINGDOM
Dr. Ian Greaves
Dr. Ian D. McNeil
Dr. Biddy Rotkirch-Pole

U.S.A.
Jerry Allison
Nicholas G. Birchrr, MD
Elaine D. Gorman
S. Marshal Isaacs, MD
Mark E Keim, MD
Samuel J. Stratton, MD
Charles E. Wiles, III

AFFILIATED SOCIETIES
Global Med-Net
American Academy on Veterinary Disaster

The European Centre for Disaster Medicine (CEMEC) has close ties with WADEM, whose President is also the Centre's Scientific Director. To celebrate its Tenth Anniversary, CEMEC is presenting a special high-level Scientific Symposium on the 'Health Aspects of Refugees and Mass Population Movements'.

Organized by Dr. William Gunn, the presentation will include papers by WADEM members Dr. Fabrizio Bassani on 'The work of WHO in refugee health'. Dr. Corrado Manni on 'The aims of CEMEC', Dr. Michele Masellis on 'A nation's efforts for civilian protection'. Dr. Jean-Marie Fonrouge on 'The rights of disaster victims'. Dr. Yasuhiro Yamamoto on 'Action of a national organization at the international level'. Dr. Elvio Melorio on 'Triage in population displacements'. Dr. Leonardo Cenci on 'A NGO's services for displaced populations', and Drs. Gabriele Germano and G. d'Angelo on 'Victims of conflict; what a voluntary organization can do', and other related topics.

Congratulations to CEMEC on the important anniversary.

India is a subcontinent that is subject to almost every kind of disaster. Laudable efforts are made by several professional institutions for preparedness, and in November 1995, a major Trauma, Critical Care and Disaster Conference was held in Delhi. The organization by the Sundar Lal Jain institute was of the highest order and the work of WADEM was particularly appreciated. Several Indian colleagues joined the Association on this occasion.

Indeed, at almost every conference WADEM participates, it produces such interest that invariably new members join the Association. It is worthwhile for existing members to use this avenue to recruit new forces for WADEM.

In our last issue we reported on the establishment of the international Relations Committee of WADEM. Our nourishing scientific and organizational relations at the national and international levels will be evident from the various reports in these columns. Its Chairman continues the efforts to strengthen disaster medicine on the one hand, and to strengthen WADEM's position in that field on the other. Intel aria, he was invited to the ceremonies of the 50th Anniversary of the United Nations, and attended the 49th Session of the World Health Assembly of the WHO.

As stated in A Note from the President. beginning with the January 1997 issue, WADEM independently publish Prehospifal and Disaster Medicine as its official joumal. We are proud of this only peer-reviewed journal in its field and already have plans to increase its scientific impact. PDM naturally belongs to its members, but its columns are wide open to meaningful contributions from all serious circles. Members are encouraged to promote outside subscriptions, both to enrich the journal and to strengthen WADEM.

Many distinguished specialists in EMS and Disaster Medicine are members of WADEM and have contributed significantly to the basic and growing literature of these two interrelated disciplines. Besides numerous articles and other publications, and the solidly established Journal of Prehospital and Dsiaster Medicine, several books have been written by our colleagues, a recent sampling of which is given below. We would appreciate being informed by our members of any books they have published or are planning to write. This listing of¥publications will appear in every edition of the Association's newsletter, so please forward your information to the Administrative office for publication.

Dr. Alfred Keller of WADEM and Director of the Bradlford University Disaster Preparedness Unit has been nominated overall Editor of a monumental 10-volume series of books to cover extensively each aspect of Disasters. Published by Routledge of London, this massive series is planned for the year 2000, to coincide with the termination or the IDNDR (Disaster Decade). Prof. William Gunn has been entrusted with the preparation of the volume on Health Disasters, to which several WADEM specialists will contribute specific chapters.

The Action that Saves is the English version of the excellent, educational videocassette on emergency and critical care that was reviewed here under its French title Le Geste Qui Sauve. WADEM teacher. Dr. Jean-Marie Fonrouge and his team are to be congratulated on their outstanding educational films. Obtainable from: Institut Electricite Sante, 151 Bld. Haussmann, 75008 Paris, France.

CD-ROM on Burns. This unique computerized hypertext covering all aspects of burns and fires h;ls been prepared hy WADEM's affiliate. Mediterranean Club for Burns and Fire Disasters, it has been selected by the European Union as an exemplary product within its Comett series of computerized educational texts on specific scientific subjects. Congratulations to the MBC on such a remarkable contribution to a difficult science. The CD-ROM is obtainable from: InforMed. 471 Via Roma, Palermo 90139, Italy.

Another major production from the MBC is the 600 page massive volume, The Management of Burns and fire disasters: Perspectives 2000, by M. Masellis and S.W.A. Gunn. This is a worthy sequel to the earlier Management of Mass Burn Casualties by the same editors and publisher. Among the numerous positive reviews, the University of Illinois has evaluated it as ". . . a superb contribution to this difficult field of medicine." and the Chinese Academy of Medical Sciences has pronounced it an ". . . excellent book." Although primarily dedicated to burn and fire problems, the many studies on emergency planning and management make this book relevant to all other disasters. Obtainable from Kluwer Academic Publishers.
Canada & U.S.A.: P.O. Pox 358. Accord Station, Hingham, Massachusetts, 02018. In other countries: PO Box 322. Dordrecht 3300. The Netherlands.

Worterbuch der Katastrophenmedizin und der Internationalen Hilfe, is the German version of the successful and much translated Dictionary of Disaster Medicine and International Relief, previously reviewed in these columns. The authors, S.W.A. Gunn, B. Domres, and E.R. Steiner have expanded this edition and included a foreword, written by WADEM's secretary- general, Prof. Wolfgang Dick. Despite its title. researchers and workers in the disaster field outside medicine will find the book and its standardized terminology most useful in all emergency work. Obtainable form: Stumpf and Kossenday Publishers, PO Box 1261, Edewecht 26183. Germany.

Contributed by : Petr Zelnicek, M.D. PhD, Director

Traumatological Hospital Brno, Czech Republic is the trauma center for a region with approximately 2 million beds. It has a 32 bed ICU and 18 bed Spinal Unit. Since 1987, the Czech Republic Medical Disaster Response Team has been housed at this center. This is a mobile trauma team made up of doctors, nurses and technicians with special expertise in surgical care ate disaster sites both in the Czech Rep. and abroad. The team was active during earthquakes in Armenia and Iran.

In 1993, the 'Information Center for Disaster Medicine' was established at the Traumatological Hospital Brno by the Czech Ministry of Health. The aim is to create a directory of organizations and experts interested in disaster medicine, develop a database of relevant articles and specialized materials on this theme, and to establish international contacts for information exchange.

In June 1996, we organized a workshop with the theme 'Disaster Medicine in the Netherlands' that was realized thanks to the help of Professor Jan de Boer, MD, Professor of Disaster Medicine of the Free University in Amsterdam. Participants were surgeons, emergency medical services (EMS) physicians, representatives of regional civil defense authorities, among others. Professor de Boer presented a paper n the activities of EMS at a disaster scene and on methods for the estimation of the number of ambulances needed at a disaster scene in the Netherlands. These methods can contribute to disaster preparedness planning in other places. In another aspect of the workshop, Prof. De Boer informed participants about the disaster plan worked out by the Ministry of Health in the Netherlands in case of nuclear disaster. This paper was very relevant for participants because the Czech nuclear power station is located near Brno. The workshop was very successful and contributed to the development of disaster medicine in the Czech Republic.

Contributed by: Muneo Ohta, MD, JADM Representative

It is my great pleasure to share with you the news that the Japanese Association for Disaster Medicine (JADM) was established on 29 January 1996. This new organization will be a multi-disciplinary one and will contribute to the development of disaster medicine as an independent new medical category in Japan. As you know, Japan lost more than six thousand lives in the 'Great Hanshin-Awaji Earthquake' of 17 January 1995, and just tow months later, we faced more than five thousand injured in the 'Sarin gas disaster' on 10 March 1995.

These tragedies strongly emphasized to Japanese medical professionals the importance of advanced and rapid medical response to natural and/or man-made disasters. Additionally, it was realized that it might be impossible to respond adequately to all medical needs in a disaster, even if advanced medical capacity factors is available, given that there exists so many non-medical factors that affect disaster response.

Based on this assumption, some colleagues last summer proposed the establishment of an exclusive organization with a scientific base and multi-faceted activities. As a result, a first meeting was held in Osaka on 29 January 1996, chaired by myself, which brought together three hundred medical and non-medical investigators.

The discussions at our first meeting focused on the future direction of research and future activities of the organization. The program was limited to a panel discussion of 'Death Case-studies', and three symposia on 'Hospital Disaster Vulnerability,' 'Medical Response in the Acute Phase', and 'Medical Response in the Subacute Phase.' In order to have the right direction JADM invited Professor Steven J. Rottman, MD, president-elect of WADEM to attend. Dr.Rottman concluded his impressive special lecture, titled 'Disaster Medicine: What is our mission?' as follows:

''In summary, then, while our mission in disaster medicine is very broad, we often become factionalized, looking at ours as the true critical activity needed most by the affected region. This is simply not the case. Relief organizations must look openly at all the stages of the problem. We must consider that our immediate care responses must necessarily give way to the more protracted phase of humanitarian assistance. There is plenty of work for everybody and, unfortunately, we can expect this to be the case for the foreseeable future.''

During June 24-30, 1996 members of the Task Force on Quality Control of Disaster Management (cosponsored by WADEM and the Nordic Society of Disaster Medicine, among others) met again to further the group's work. Task Force members were kindly hosted and actively supported by the Dean of the Nordic School of Public Health, Professor Gustav Magmesson in Gothenburg, Sweden, who made available meeting facilities at the School. The primary focus of the Task Force is to develop international guidelines for the evaluation of health and medical disaster response to facilitate improved quality in disaster management. The first meeting was held in Pittsburgh in May 1994, the second in Geneva, Switzerland in October 1994, and the third at Utstein Abbey, Stavanger, Norway in 1995. The first publication from this group appeared in volume 11 No. 2 (pp.82-89) of our Journal of Prehospital and Disaster Medicine. That paper established a template for the future development of an instrument to be used in the comprehensive evaluation of disaster response. The template was further expanded in Gothenburg with the following:

the identification of 12 key 'disaster management functions' (Figure 1);

the formulation of two new concepts: a 'disaster vulnerability index' tan extension of the framework's 'pre-event status') which takes into account the balance between human and societal infrastructure vulnerability and disaster preparedness, in an attempt to better and more precisely define risk; and the health disaster severity index: an attempt to classify disasters according to their impact on human populations and their health infrastructure.

No, of course not! Instead, they are increasingly becoming involved in disaster management. They demonstrated this in a remarkable way last April in Japan, where together with the Japan Surgical Association, the International Federation of Surgical Colleges mounted a Scientific Symposium on Surgical Management in Major Emergencies and Disasters. Organized by William Gunn, almost all the speakers were WADEM members: Takashi Ukai (Surgical and nonsurgical care after the Great Hanshin earthquake). Areono Pusponegoro (Surgical care in volcanic disasters). Yasuhiro Yamamoto(The role of surgeons in the early phase of catastrophe). Giuseppe d'Angelo (Surgical problems following conflict disaster in developing countries), and Muneo Ohta (International Surgical aid- the Japan Disaster Relief Organization). We believe this is the first major scientific conference dedicated entirely to the surgical aspects of disasters.

It is evident that WADEM's efforts to strengthen the expertise of various specialties in relevant disaster management are bearing fruit. Thus, another development in this respect is the round table discussion on "Planning and Management of Burn Care in Mass Casualty and Disaster Situations." that will take place during the International Surgical Week in Acapulco, Mexico, in August 1997. WADEM's affiliated society on these matters, the Mediterranean Club for Burn Disasters, is the co-organizer. Those interested can contact The International Federation of Surgical Colleges secretariat, Hospital of the University of Pennsylvania, 3400 Spruce St.. Philadelphia, PA 19104, USA.

Jakov Adler, M.D. long-time WADEM member and one of the original founders of the Club of Mainz, which preceeded WADEM, has been appointed Chief of the Medical Support Unit (MSU) in the Department of Peace-keeping Operations/United Nations Headquarters. New York. Dr. Adler a former military surgeon of the Israel Defense Forces will assume this role as of 1 October 1996. The MSU is responsible for providing medical care to UN troops during peacekeeping missions all over the world. Among the main functions of the MSU are: planning new missions, approving senior medical officers for missions, briefing medical and other mission personnel in medical support matters, centrally controlling and providing medical supplies to the medical units deployed in missions, and developing an epidemiological surveillance and medical data system for planning, budgeting and quality control and improvement. Dr. Adler was the organizer of our extremely successful 9th World Congress in Jerusalem and is also a member of WADEM's Task Force on Quality Control of Disaster Management. This appointment is a great tribute to Dr. Adler's life-long efforts to improve military and disaster medicine. We wish him the best in his new post.

10TH WORLD CONCRESS ON EMERCENCY AND DISASTER MEDICINE

On the occasion of
The 20th Anniversary of The World Association for
Disaster and Emergency Medicine

(Founded in 1976 as the Club of Mainz)

Under the Patronage of the Chancellor of Federal Republic of Germany