EDITOR’S CORNER (Volume 17, Number 4: October-December
2002)
More Giant Steps
Marvin L. Birnbaum,MD, PhD
Know then, whatever cheerful and serene
Supports the mind, supports the body too.
Hence, the most vital movement mortals feel
Is hope, the balm and lifeblood of the souls.
John Armstrong,
Art of Preserving Health, Bk. iv,1.310
There are two Supplements included with this issue of Prehospital and Disaster
Medicine (PDM). Both comprise major contributions to the advancement of
the SCIENCE of Disaster and Emergency Medicine/Management. The first (Supplement
2) is a compendium of the nearly 300 abstracts of the Scientific and Invited
Papers for the 13th World Congress on Disaster and Emergency Medicine to be
convened in Melbourne, Australia in May of 2003. Examination of these abstracts
leads to the conclusion that this SCIENCE has continued to improve since the
12th World Congress in Lyon in 2001. Yet, the greater significance and impact
of these abstracts is the manner in which the material has been put together
by the Organizing Committee for the Congress. The Committee has constructed
the Congress into distinct content areas that are consistent with the Task Force
structures that have been adopted by the World Association for Disaster and
Emergency Medicine (WADEM) in its efforts to address the challenges posed to
it by the 5th and 6th Asia-Pacific Conferences on Disaster Medicine, the World
Health Organization (WHO), and The Active Learning Network for Accountability
and Performance in Humanitarian Assistance (ALNAP). Each of the Standing Committees
and Task Forces of the WADEM will meet in Melbourne, and given the Programme,
should provide a kick-start for their respective quests to develop state-of-the
art white papers summarizing all we know about aspects of their specific charges.
The resulting activities of each of these Task Forces, including: (1) Public
Health in Disasters; (2) Communicable Disease Control in Disasters; (3) Disaster
Planning; (4) Civilian-Military Cooperation; (5) Co-ordination and Control;
(6) Medical Responses to Terrorism; (7) Nuclear-Biologic-Chemical Hazards; (8)
Refugees and Displaced Persons (9) Education and Training; and (10) Research,
should form the basis for the structure of WCDEM-14 to be convened in Edinburgh
in May 2005.
In addition, the Congress will focus on Public Health as related to disasters
and upon the structure for the conduct
and reporting of evaluation and research in Disaster Medicine/Management provided
in the Health Disaster
Management: Guidelines for Research and Evaluation in the Utstein Style, the
1st Volume of which is included with
this issue of PDM. In addition, the Melbourne Congress will offer the first
workshop on the use of the aforementioned Guidelines. Supplement 3 consists
of the first of four volumes (Chapters 1–8) of the Guidelines to be published.
This latest version of the Conceptual Framework and a Glossary of Terms should
provide the framework for future discussions relative to the evaluations of
interventions performed in disaster management, whether for prevention/mitigation
of the damage produced by potentially catastrophic events, and/or the responses
to such events. This dynamic document lays the foundation for future efforts.
Subsequent volumes will provide the remainder of the structure for research
and evaluation. Drafts of the remaining volumes can be accessed via the web
pages of both PDM (http://pdm.medicine.wisc.edu) and WADEM (http://wadem.medicine.wisc.edu).
As the process proceeds, PDM will place more and more emphasis on reports using
this structure. Without such a structured approach, investigations will continue
to be anecdotal. Only case reports will be allowed to use the anecdotal format.
All of the volumes of these Guidelines will be published prior to the Edinburgh
Congress.
Perhaps the most important contribution now accessible to you is the Glossary
of Terms included in this
Supplement. Correct use of terms is essential for all reports and communications
relative to disasters. All future reports will need to use these terms in accordance
with those used in the Glossary. The structure provided offers many new opportunities
for future research efforts both prospective and retrospective. For example,
there is a distinct need for researchers to take a new look into previously
published research papers and reports. Much can be learned by forcing such reports
into the structure provided by the Guidelines. Such efforts
will foster the categorization of findings into formats that should uncover
similar aspects of disasters produced by
similar as well as dissimilar events and the responses to them. Much of the
pathophysiology of why disasters occur
and the effectiveness, benefits, and costs of interventions used to prevent/mitigate
the effects of such events and for
the responses to them, stands to be learned from such efforts.
It is recognized that the process of implementation will be gradual and certainly
will not be possible before the
entire work is published. Further, given the lag time between identification
of the problem to be studied, implementation of data gathering, analysis of
the data, preparation and submission of the final work, it is not realistic
to expect strict adherence to the Guidelines for several years. However, the
process should begin now not only for work submitted to this Journal, but for
reporting all research and evaluations regarding Disaster Medicine regardless
of the medium used for presentation. Thus, you have in your hands two important
documents that will lead the way to better knowledge about and definition of
the value of interventions. Before we can go further, we must glean all that
we can from what already has been done. We must understand the current status
of our SCIENCE before we can proceed in an enlightened way into the future.
Omnibus in terries pauce dinoscere possunt
Vera bona atque illis multum diversa
Look round the habitable world! How few
Know their own good, or knowing it, pursue!
Juvenal, Satires. Sat x, 1.1. (Dryden, tr)