An earthquake measuring 6.5 on the Richter scale devastated Bam, Iran on the morning of 26 December 2003. Due to the great health demands and collapse of health facilities, international aid could have been a great resource in the area. Despite sufficient amounts and types of resources provided by international teams, the efficacy of international assistance was not supported in Bam, as has been experienced in similar events in other countries. Based on the observations in the region and collecting and analyzing documents about the disaster, this manuscript provides an overview of the medical needs during the disaster and describes the international medical response. The lessons learned include: (1) necessity of developing a national search and rescue strategy; (2) designing an alarm system; (3) establishing an international incident command system; (4) increasing the efficacy of the arrival and implementation of a foreign field hospital; and (5) developing a flowchart for deploying international assistance.

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Background Over 90 % of injury deaths occur in low-income countries. Evaluating the impact of focused trauma courses in these settings is challenging. We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization. Methods Two 3-day trauma education courses were conducted in the Rwandan capital over a one-month period (October–November, 2011). An ATLS provider demonstration course was delivered to 24 faculty surgeons and 15 Rwandan trauma nurse auditors, and a Canadian Network for International Surgery Trauma Team Training (TTT) course was delivered to 25 faculty, residents, and nurses. Trauma registry data over the 6 months prior to the courses were compared to the 6 months afterward with emergency department (ED) mortality as the primary endpoint. Secondary endpoints included radiology utilization and early procedural interventions. Univariate analyses were conducted using x2 and Fisher’s exact test. Results A total of 798 and 575 patients were prospectively studied during the pre-intervention and post-intervention periods, respectively. Overall mortality of injured patients decreased after education implementation from 8.8 to 6.3 %, but was not statistically significant (p = 0.09). Patients with an initial Glasgow Coma Score (GCS) of 3–8 had the highest injury-related mortality, which significantly decreased from 58.5 % (n = 55) to 37.1 % (n = 23), (p = 0.009, OR 0.42, 95 % CI 0.22–0.81). There was no statistical difference in the rates of early intubation, cervical collar use, imaging studies, or transfusion in the overall cohort or the head injury subset. When further stratified by GCS, patients with an initial GCS of 3–5 in the post-intervention period had higher utilization of head CT scans and chest X-rays. Conclusions The mortality of severely injured patients decreased after initiation of focused trauma education courses, but no significant increase in resource utilization was observed. The explanation may be complex and multifactorial. Long-term multidisciplinary efforts that pair training with changes in resources and mentorship may be needed to produce broad and lasting changes in the overall care system.

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Disaster management teams are critical to the mass casualty incident response given the complexity of today's disaster threats. Current disaster planning and response emphasizes the need for an all-hazards approach. Flexibility and mobility are the key assets required of all disaster management teams. Medical providers must respond to both these challenges if they are to be successful disaster team members.

Major earthquakes have the potential to be one of the most catastrophic natural disasters affecting mankind. Earthquakes of significant size threaten lives and damage property by setting off a chain of events that disrupts all aspects of the environment and significantly impacts the public health and medical infrastructures of the affected region. This article provides an overview of basic earthquake facts and relief protocol for medical personnel.

Background-Over 90 % of injury deaths occur in low-income countries. Evaluating the impact of focused trauma courses in these settings is challenging. We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization. Methods-Two 3-day trauma education courses were conducted in the Rwandan capital over a one-month period (October-November, 2011). An ATLS provider demonstration course was delivered to 24 faculty surgeons and 15 Rwandan trauma nurse auditors, and a Canadian Network for International Surgery Trauma Team Training (TTT) course was delivered to 25 faculty, residents, and nurses. Trauma registry data over the 6 months prior to the courses were compared to the 6 months afterward with emergency department (ED) mortality as the primary endpoint. Secondary endpoints included radiology utilization and early procedural interventions. Univariate analyses were conducted using x 2 and Fisher's exact test. Results-A total of 798 and 575 patients were prospectively studied during the pre-intervention and post-intervention periods, respectively. Overall mortality of injured patients decreased after education implementation from 8.8 to 6.3 %, but was not statistically significant (p = 0.09). Patients with an initial Glasgow Coma Score (GCS) of 3-8 had the highest injury-related mortality, which significantly decreased from 58.5 % (n = 55) to 37.1 % (n = 23), (p = 0.009, OR 0.42, 95 % CI 0.22-0.81). There was no statistical difference in the rates of early intubation, cervical collar use, imaging studies, or transfusion in the overall cohort or the head injury subset. When further stratified by GCS, patients with an initial GCS of 3-5 in the post-intervention period had higher utilization of head CT scans and chest X-rays. Conclusions-The mortality of severely injured patients decreased after initiation of focused trauma education courses, but no significant increase in resource utilization was observed. The explanation may be complex and multifactorial. Long-term multidisciplinary efforts that pair training with changes in resources and mentorship may be needed to produce broad and lasting changes in the overall care system.