SPECIAL REPQR3&:\
Fostering Disaster Resilient Communities -
across the Globe through the Incorporation
of Safe and Resilient Hospitals for
Community-Integrated Disaster Responses
Joseph Albanese, PhD; 1 Marvin Birnbaum, MD, PhD; 2
Christopher Cannon, MPH, MSN, FACHE;3 Joseph Cappiello, MPH, RN;4
Elaine Chapman, MCP; James Paturas, CEM, EMTP, FACCP;6 Stewart Smith, MPH, FACCP7
1. Radiation Biodosimetrist, Yale New
Haven Center for Emergency
Preparedness and Disaster Response, New
Haven, Connecticut USA
2. President, World Association for Disaster
and Emergency Medicine, Madison,
Wisconsin USA; Emeritus Professor,
University of Wisconsin, Madison,
Wisconsin USA
3. National Director, Yale New Haven
Center for Emergency Preparedness and
Disaster Response, New Haven,
Connecticut USA
4. President, Simulation Education Services,
Oakbrook Terrace, Illinois USA
5. Special Projects and Grant Development
Manager, Yale New Haven Center for
Emergency Preparedness and Disaster
Response, New Haven, Connecticut USA
6. Deputy Director, Yale New Haven Center
for Emergency Preparedness and Disaster
Response, New Haven, Connecticut USA
7. President and CEO, Emergency
Preparedness and Response International,
LLC
Keywords: damage; disaster; disaster resilient
community; hospital; loss of function;
resilience; resilient hospital; response; safe
hospital; safety
Abbreviations:
DiMAG = Disaster Mitigation Advisory
Group
ISDR = International Strategy for Disaster
Reduction
PAHO = Pan-American Health Organization
SEARO = Southeast Asia Regional Office
WADEM = World Association for Disaster
and Emergency Medicine
W H O = World Health Organization
Web publication: 30 October 2008
September - October 2008
Background
Events due to natural and technological hazards result in damage to living
beings and the natural and built environment. The high urban population
density, level of development, and extent of poverty in many disaster-prone
areas further exacerbate the cumulative impact of such catastrophes. Also,
crises, including those created by earthquakes, hurricanes, landslides, and
tsunamis, have underscored the inability of hospitals to provide uninterrupt-
ed, urgently needed health services and maintain structural integrity.1 In many
instances, deaths of hospital occupants were the direct result of collapsing
physical infrastructure. In response and recognition of the need for collabora-
tive efforts to mitigate the damages and loss of function, international public
health, humanitarian, and relief organizations such as the Pan-American
Health Organization (WHO/PAHO), the International Strategy for Disaster
Reduction (ISDR) of the United Nations, the World Bank, the Joint
Commission International (JCI), and the World Association for Disaster and
Emergency Medicine (WADEM) have sponsored a series of global forums
intent on developing guidelines for designing, constructing, and evaluating
"safe and resilient" hospitals. The underlying goals of these guidelines are to
protect the lives of patients, staff, and other hospital occupants, and ensure that
hospitals continue to function during and after a catastrophic event.
Successful resolution of community- and region-wide crises is connected
intimately with the functional capacity of hospitals. One of the many precar-
ious consequences of a disaster on a community is the impact of compromised
hospital functionality secondary to structural damage to the hospital infrastruc-
ture, loss of equipment and supplies, loss of staff, and a limited or lack of abili-
ty to accommodate a sudden, large influx of patients. When hospitals cannot
continue to operate during a disaster, their ability to provide common, every-
day public health services, such as vaccinations, and treating everyday injuries
and illnesses, including obviating the progression of minor injuries to life-
threatening ones, is compromised.2 The inoperability of a hospital in a com-
munity imperils the health of its residents and hinders its ability to recover.
Appropriately, the model of "safe and resilient hospitals" was promoted as an
integral component of disaster risk reduction planning in the healthcare sec-
tor during the 2005 World Conference on Disaster Reduction (Kobe, Japan),
and has been used to endorse policies that ensure "that all new hospitals are
built with a level of resilience that strengthens their capacity to remain func-
tional in disaster situations".3'4 To date, no single, internationally adopted def-
inition as to what constitutes a "safe and resilient" hospital exists.
Resilient Hospitals: More than Infrastructure
What constitutes hospital resilience? While it is true that during normal
operations, hospitals are viewed primarily as health providers affording indi-
viduals and families timely medical care, during catastrophic situations, the
community role of a hospital extends beyond a structural entity that offers
healthcare services. In the wake of a disaster, an affected population no longer
converges at hospitals solely to seek healthcare services. Indeed, past events
indicate that the general public regards hospitals as centralized points of corn-
http://pdm.medicine.wisc.edu Prehospital and Disaster Medicine
386
munity support and assistance; crowds gather at hospitals
for air conditioning, electricity, food, water, and accurate
information (as the common sources of crisis information
such as radios, televisions, and the Internet require electricity
that no longer may be available). Furthermore, since hospi-
tals operate 24 hours-per-day, seven days-per-week and are
perceived as the hub for rescue workers and emergency per-
sonnel, relatives searching for missing loved ones turn to
hospitals in hopes of locating lost family members.5 For the
reason that people look to hospitals as a source of direction,
support, and a rallying point for assistance in times of
emergency, it is important that hospital responses be con-
gruent with these expectations. Particularly true in pro-
tracted events, these expectations become obligations that
should not be ignored in the overall community response to
disaster events. The continued operation of hospitals pro-
vides reassurance that the essential institutions of society
have not broken down, and allows community assistance to be
coordinated through recognized points of support, i.e., hospitals.
In this context, it is clear that the concept of "safe and
resilient" hospitals must encompass and address infrastruc-
ture and cross-cutting themes of hospital disaster prepared-
ness including institutional capacity building, education
and training, project implementation, facilitating local and
regional cooperation, information sharing, networking and
knowledge management, and the provision of subject mat-
ter expertise. Safe and resilient hospitals represent facilities:
(1) in which urgently needed medical care remains accessi-
ble and functioning at full capacity (or at minimum, oper-
ating as a sufficiency-of-care facility) during and after a
catastrophic event; (2) capable of providing the reassurance
and medical leadership needed by the general public in
times of crisis; and (3) with structured relationships that
establish an interface among local and regional entities
involved in a community-wide disaster response. Clearly,
the establishment of "safe and resilient" hospitals is needed
to validate the hospitals' importance as a community asset
and maximize their integration within a community-wide
disaster responses.
Although nations vary widely in their approach and
responses to disasters, common organizational models for
disaster preparedness often are adopted among groups of
countries (e.g., those in the European Union, South
America, and Africa). Through programs such as the
ISDR, the United Nations, and other humanitarian and
relief organizations, have contributed to the dispersion of
general modalities for disaster preparedness, while encour-
aging countries to adjust these policies to align with their
own realities. The PAHO and the Asian Disaster
Preparedness Center (ADPC) also have influenced the
progression of disaster preparedness across a wide variety of
nation-states. More recently, the South East Asia Regional
Office of the WHO (SEARO) has proposed benchmarks
that, when implemented, will permit nations and their
communities to better prepare and respond to disaster
events. Healthcare disaster preparedness is a critical com-
ponent of the overall community responses to a disaster.
These benchmarks also relate to the healthcare sector, par-
ticularly in the context of establishing institutional mea-
Prehospital and Disaster Medicine http://pdm.medicine.wisc.edu
Safe and Resilient Hospitals
sures and mechanisms for building new and retrofitting
existing hospitals to meet minimum standards of "safe and
resilient" hospitals. This includes terms of infrastructure
and the capacity to mount and sustain facility-oriented and
community-integrated disaster responses.
Of the 12 benchmarks set forth by SEARO, six were dis-
cussed at a recent workshop sponsored by the 15th World
Congress on Disaster and Emergency Medicine
(15WCDEM), in May 2007 (Appendix). Of these, SEARO
Benchmark #5 proposes to institute a capacity to identify
risks, assess vulnerability levels, and implement appropriate
measures to reduce these vulnerabilities.6'7
Benchmark 5
Capacity to identify risks and assess vulnerability levels has been
established. Appropriate measures have been implemented to
reduce the vulnerabilities.
The strategies that follow pertain to hospitals and other
medical facilities that meet this benchmark. These strate-
gies are the result of extensive discussions during the Safe
Hospitals Workshop that was part of the 15WCDEM.
Strategic Objectives
1. Establish tiers of standards (criteria) that define "safe
and resilient" hospitals in diverse regions of the world.
2. Develop a tool to assess the extent to which hospitals
in diverse regions of the world meet the criteria for
"safe and resilient" hospitals.
3. Apply the evidence derived from use of this tool to
promote the concept of "safe and resilient" hospitals as
an integral part of emergency preparedness, respons-
es, and recovery, and maximize the political commit-
ment from decision-makers within and outside the
healthcare sector to support, protect, and integrate the
initiative into a community-wide disaster response.
Goals
1. Short-TermProvide stakeholders within and out-
side the healthcare sector with a flexible, dynamic,
and comprehensive set of standards. These must be
aimed at establishing a capacity to identify risks and
vulnerabilities of healthcare systems through the use
of a yet-to-be established tool. This tool must employ
wide-ranging factors to measure and rate the "safe
and resilient" level of hospitals in terms of their infra-
structural, functional, and organizational potentials
to respond to disastrous events. This tool wOl assist in
evaluating local and regional progress and help build
on existing healthcare preparedness capabilities in
order to enhance disaster resilient communities.
2. Long-TermAdvance the establishment of "safe and
resilient" hospitals in communities throughout the
world through the establishment and employment of
acceptable and readily available metrics that docu-
ment progress toward the standard.
3. AccreditationEstablish a mechanism to accredit
hospitals as to their respective capacity to continue to
function during or following a destructive event.
Vol. 23, No. 5
Albanese, Birnbaum, Cannon, era/
Summary of Recommended Actions
1. Select SEARO Benchmark #5 as the basis for health-
care disaster preparedness and response.
2. Assemble a group of international stakeholders to cre-
ate baseline standards for national, regional, and com-
munity leaders throughout the world to rate levels of
risk and vulnerability of hospitals. The assessment tool
currently developed by PAHO for identifying risks to
hospital infrastructure would be used to assess the
integrity of the building structure. It provides a foun-
dation to build a more comprehensive tool that can be
used to assess all levels of risk and vulnerability.
3. Prioritize identified standards according to the needs
of specific communities, nations, and regions.
4. Provide forums for guided discussions, using consis-
tent facilitation questions, to build upon strategies
that expand regional awareness of the importance of
disaster risk and vulnerability reduction.
5. Direct the development of resources, tools, and plan-
ning mechanisms for the implementation of these
strategies in order to ensure founding of future hos-
pitals that adhere to criteria that characterize such
facilities as safe and resilient.
6. Identify "next steps" for publicizing processes and strate-
3. Collaborative VenuesProvideforumsfor guided dis-
gies for reducing disaster risks and vulnerabilities of
hospitals that are adopted by local, regional, and nation-
al governmental and non-governmental organizations
that will fund, promote and oversee the initiatives.
Basisfor Recommended Actions
1. OverallSelect Benchmark #5 as the basis for estab-
lishing healthcare disaster preparedness and response.
The cornerstone of effective and efficient disaster
preparedness and response requires the careful analy-
sis of underlying risks and vulnerabilities,8 followed
by the implementation of appropriate counterbal-
ances to identified threats and susceptibilities in a
community. Benchmark #5 addresses this essential
component of disaster preparedness.9
2. Identifying Key StakeholdersAssemble and task a
group of international stakeholders to create baseline
standards for national, regional, and community
leaders throughout the world to rate levels of risk and
vulnerability of hospitals.
The importance of international collaborations
has been emphasized at several recent global confer-
ences and key multilateral frameworks focusing on
disaster risk reduction, including the World
Conference on Disaster Reduction (WCDR), con-
vened by the United Nations' ISDR in Kobe (2005),
which endorsed the Hyogo Framework for Action.
This Framework, which promotes a systematic
approach to reducing vulnerabilities and risks to haz-
ards, underscores the need for international cooperation
in building the resilience of nations and communities
to disasters.
In line with the Hyogo Framework for Action,
this white paper proposes to pull together interna-
tional stakeholder consultants for the purpose of
September - October 2008 http://pdm.medicine.wisc.edu
387
developing global standards that will be employed to
conduct cross-national vulnerability and risk assess-
ments of hospitals. The availability of baseline stan-
dards, developed by international stakeholders, and
subsequent adoption of these standards ensure that
bordering nations, whose hospitals face similar haz-
ards, evaluate risks and vulnerabilities posed by these
hazards using a universal tool. As expected, disaster
risk reduction strategies adopted by neighboring
nations will harmonize the actions of individual
nations and make them more mutually supporting.
Moreover, international participation in promoting a
set of universal standards by which to assess risk and
vulnerability lends added credibility to the process. It
would elevate the establishment of community-inte-
grated safe and resilient hospitals (as a means for dis-
aster risk reduction) to a national policy priority.
Potentially, this would permit the allocation of neces-
sary resources, oversight for implementation, and
consignation of accountability for attainment. Lastly,
the use of international standards to develop a uni-
versal disaster risk and vulnerability assessment tool
will contribute to reduce inequalities when establish-
ing safe and resilient hospitals in bordering countries.
cussions, using facilitation questions, to build upon
strategies that expand regional awareness of the
importance of disaster risk and vulnerability reduction.
Direct the development of resources, tools, and plan-
ning mechanisms for their implementation in order to
ensure construction of safe and resilient hospitals.
A cohesive and complementary approach is
required to determine how best to secure safe and
resilient (as well as community-integrated) hospitals
capable of protected operability, expeditious response,
and effective recovery efforts which parallel the pro-
gression of disaster events. This is required in order
to build the necessary resiliency to address local,
national, and cross-cultural disasters. Consequently, there
must be interactive participation among:
a. International members/agencies (including, but
not limited to the UN (ISDR), PAHO/WHO,
SEARO/WHO, WADEM, JCI, and YNH-
CEPDR) that provide expertise in formulating
minimum standards for developing a universal
risk and vulnerability assessment tool for hos-
pitals around the world;
b. National and local governmental and non-gov-
ernmental organizations tasked with raising the
awareness of threats to and vulnerabilities of
hospitals, and overseeing the implementation
of corrective actions to ensure that all hospitals
meet the criteria of safe and resilient hospitals,
which includes their integration in the overall
disaster response of the communities they
serve; and
c. Local and national stakeholders together with,
but not limited to, individuals holding subject
matter expertise in: (1) clinical, engineering,
Prehospital and Disaster Medicine
388 Safe and Resilient Hospitals

work flow, hospital administration, emergency oping the Hospital Safety Index. This scorecard,
management and preparedness; (2) public released in 2006, is tailored for hospital directors or
health and humanitarian organizations; (3) eth- disaster managers to rapidly identify risks and vul-
ical and legal agencies; (4) funding agencies, nerabilities to hospitals through a qualitative assess-
including national and local governmental and ment of elements relating to geographical location,
non-governmental organizations and donors; structural and non-structural safety, hospital organi-
and (5) end-users, responsible for tailoring the zation, and preparedness. However, a comprehensive
risk and vulnerability assessment tool explicit vulnerability assessment tool that experienced engi-
to nations and local communities in order to neers and emergency planners at the hospital and
evaluate the extent to which hospitals meet community levels can use to assess these elements as
criteria for safe and resilient hospitals. well as the degree to which hospitals are fully inte-
The goal of these discussions is to: (1) eval- grated in the overall community response to a disas-
uate the effectiveness of the risk and vulnerabili- ter is not yet available. The development of such a
ty assessment tool, its adoptions by member tool builds on the work accomplished by the
states, and track the progress of its utilization DiMAG, and further advances efforts towards estab-
and effectiveness in promoting modifications lishing safe and resilient hospitals.
to existing hospitals; and (2) foster discussions 6. Next StepsIdentify "next steps" for publicizing
on improving the tool based on feedback by processes and strategies for reducing disaster risks and
local, national, and international stakeholders. vulnerabilities of hospitals in order to ensure that pro-
4. Establishing and Prioritizing StandardsEstablish and posed solutions to establish future safe and resilient
prioritize identified standards according to the needs of hospitals are adopted by local, regional and national
specific nations and regions. governmental and non-governmental organizations
Although neighboring countries share common that will fund, promote and oversee the initiatives.
hazards and vulnerabilities, the use of baseline stan-
dards will establish unifying guidelines for develop- Proposed Mini-Projects
ing a universal tool to measure the degree of risk and In 2004, following a series of preparatory meetings, the
vulnerability to hazards when applying these stan- WADEM initiated a process geared toward developing
dards. Nation-states are dissimilar in respect to issues international standards and benchmarks in emergency
and obstacles for implementing disaster risk and vul- health preparedness and disaster medicine related to Safe
nerability reduction strategies, including the estab- and Resilient Hospitals. In May 2007, this overarching
lishment of resilient communities that include the approach and conceptual framework was presented at the
integration of "safe and resilient" hospitals in an over- 1SWCDEM in Amsterdam, in order to develop consistent
all disaster response. Disparities among neighboring standards and benchmarks for hospitals and healthcare
countries also relate to: (1) national capacity to address organizations worldwide. The ensuing discussion among
disaster risk and vulnerability reduction; (2) priority Joint Commission (JC), JCI, PAHO, SEARO, YNH-
hazards within countries; (3) social and cultural fac- CEPDR and WADEM, identified gaps in healthcare pre-
tors and political systems that largely influence how paredness and brought about recommendations for building
communities perceive hazards, risks, and vulnerabili- safe and resilient hospitals. Based on these recommenda-
ties; and (4) quality of essential services prior to, dur- tions, four mini-projects are proposed to support an imple-
ing and after a disaster. Accordingly, the application mentation approach for Safe and Resilient Hospitals based
of standards in assessing risks and vulnerabilities of upon the position paper resulting from the 15WCDEM:
hospitals to hazards requires a prioritization of min- 1. Mini-Project IDevelopment of evaluation survey
imum standards in accordance with the realities of and standards;
individual nations, and yet, be sufficiently stringent as 2. Mini-Project IIDevelop consensus among stake-
to ensure that the impact of hazards on communities holders for International Standards in Safe and
is minimized according to the goals and plans of a Resilient Hospitals;
community-integrated disaster response. 3. Mini-Project IIIIntroducing and orienting the
5. Resource Development and ImplementationDirect pilot sites on the practicality of standards developed
the development of resources to include tools and for establishing community-integrated, safe and
planning mechanisms to implement strategies to resilient hospitals; and
evaluate risks and vulnerability levels of hospitals. 4. Mini-Project IV-Evaluation of international stan-
Direct the development of resources, tools, and dards for establishing community-integrated, Safe
planning mechanisms for implementation of these and Resilient Hospitals.
strategies in order to ensure founding of future hos-
pitals that adhere to criteria that characterize such Approach
facilities as safe and resilient. Sources of funding to support the Safe and Resilient
The PAHO/WHO Disaster Mitigation Advisory Hospital initiatives should be identified and secured.
Group (DiMAG), in concert with many internation- Funding sources under consideration include the World
al subject matter experts, was instrumental in devel- Bank, USAID, US Department of State, US Department

Prehospital and Disaster Medicine http://pdm.medicine.wisc.edu Vol. 23, No. 5

Albanese, Birnbaum, Cannon, era/
of Homeland Security, US Department of Health and
Human Services, and philanthropic organizations. The
proposed mini-projects would be administered by teams of
international partners and would focus on developing stan-
dards for human resources, facilities, and risk assessment.
Summary
The impact of catastrophic events on hospitals and com-
munities is huge and continues to hinder progress in devel-
oping nations and industrialized countries alike. Over the
last 10 years, the UN/ISDR has sponsored a series of glob-
al conferences to increase awareness of the importance of
risk and vulnerability reduction and the need to build dis-
aster resilient communities. In recognition that hospitals
contribute to the health and resiliency of a community,
ISDR has adopted the PAHO and WHO "Safe and
Resilient Hospital" initiative. The primary focus of the ini-
tiative is to ensure the physical and functional integrity of
hospitals during a disaster. Hospital resiliency also must
encompass the ability to fully integrate hospital facilities
and their services into an overall community response to
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September - October 2008 http://pdm.medicine.wisc.edu
389
prevent hospitals from becoming isolated from other
responding organizations.
In order to help promote the "safe and resilient hospital"
initiative, during the 15WCDEM, three strategic objectives
were identified for hospitals that meet SEARO Benchmark
#5. These are: (1) establish tiers of standards (criteria) that
define "safe and resilient" hospitals in diverse regions of the
world; (2) develop a tool to assess the extent to which hos-
pitals, meet the criteria for "safe and resilient" hospitals; and
(3) apply the evidence derived from use of this tool to pro-
mote the concept of "safe and resilient" hospitals as an inte-
gral part of emergency preparedness, responses, and recovery,
and maximize the political commitment from decision-mak-
ers within and outside the healthcare sector to support, pro-
tect, and integrate the initiative into a community-wide
disaster response.
Ultimately, attaining these objectives will protect the
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Prehospital and Disaster Medicine
390 Safe and Resilient Hospitals

AppendixList of participants

15th World Congress on Disaster and Emergency Medicine (WADEM) Workshop Team Presenters
Birnbaum, Marvin, MD, PhD, President, WADEM (USA)
Cannon, Christopher, MPH, MSN, FACHE, National Director, Yale New Haven Center for Emergency Preparedness and Disaster
Response (YNH-CEPDR) (USA)
Cappiello, Joseph, MPH, RN, Vice President, The Joint Commission (USA)
Chapman, Elaine, MCP, Special Projects and Grant Development Manager, YNH-CEPDR (USA)
Cruz Vera, Filipe, MD, Mexican Social Security Institute (Mexico)
Gougelet, Robert, MD, Dartmouth Medical School (USA)
O'Rourke, Ann, MD, MPH, WADEM (USA)
Ofrin, Roderico, MD, MPH, South-East Asia Regional Office (SEARO), World Health Organization (WHO) (India)
Paturas, James, CEM, EMTP, FACCP, Deputy Director, YNH-CEPDR (USA)
Poncelet, Jean-Luc, MD, MPH, Pan American Health Organization (PAHO) (USA)
Smith, Stewart, MPH, FACCP, DoD Program Manager, YNH-CEPDR (USA)

15th World Congress on Disaster and Emergency Medicine (WADEM) Workshop Participants
Ahmadi, Shirshah, MD, Deputy, Surgeon General, Afghanistan National Army Hospital (Afghanistan)
Aiken, Jim, MD, Medical Center of Louisiana (USA)
Andress, Knox, RN, FAEN, LSU Health Sciences Center-Shreveport (USA)
Baker, David, Prof., Chemical Hazard and Poisons Division (UK)
Baris, Enire, MD, Izmir 112 Emergency Medical Services (Turkey)
Bradt, David, MD, John Hopkins Medical Institution (USA)
Bristow, Robert, MD, Director, Disaster Medicine, New York Presbyterian Hospital (USA)
Chungath, Juni Jobson, MD, Emmanuel Hospital Association (India)
Cruz Flores, Priscila, La Salle de Veracruz High School (Mexico)
Drew, Christopher, National Health Service, London Region (UK)
Eckert, Susan, Washington Hospital Center (USA)
Emons, Marjolein, MD, University Medical Center (Netherlands)
Gillis, Marc, MD, Imecda Hospital (Belgium)
Higgins, Dawn, CPTN, Spangdahlem Air Base, DE (USA)
Holtermann, Keith, MD, George Washington University (USA)
Jawaid, Ahmad Parawaiz, MD, National Military Hospital (Afghanistan)
Johnson, Andrew, MD, Townsville Hospital (Australia)
Kearney, Marguerite, PhD, RN, FAAN, Assoc. Prof., John Hopkins School of Nursing (USA)
Kraay, JD, Safety Region Utrecht (Netherlands)
Kuipes, Hans, Zuwe Hofpoort Ziekenhuis (Netherlands)
Lampakis, Stelios, MD, National Emergency Medical Services (Greece)
Leledakis, Georgios, Anesthesiology Dept., Hospital Preparedness Task Force, Klinikum Krefeld (Germany)
Lord, Jennifer, New Canaan Public Health Emergency Response Team, Norwalk Hospital (USA)
Mangal, Sayeed Abbas, MD, Chief, Emergency Room, Central National Military Hospital (Afghanistan)
Marcom, David, MD, Duke University (USA)
Mazurik, Laurie, MD, Sunnybrook Health Science Centre (Canada)
McCaskill, Mary, MD, Children's Hospital at Westmead (Australia)
Mclsaac, Joseph, MD, University of Connecticut and Hartford Hospital (USA)
Odabasioglu, Hasan, MD, Izmer 112 Emergency Medical Services (Turkey)
Odekina, Daniel, MD, Comprehensive Health Center (Nigeria)
Oner, Koksal, Prof., Gulhane Military Medical Academy (Turkey)
Oryakhil, Ahmad Fahim, MD, CSTC-H (Afghanistan)
Oz, Ayfer, MD, Management of Health (Turkey)
Perez-Calderon, Lius Jorge, MD, Asian Disaster Preparedness Center (Thailand)
Pradeep, Vaidya, MD, Tribhuvan University Teaching Hospital (Nepal)
Robinson, Bruce, Prof., Sir Charles Gairdner Hospital (Australia)
Saenz, Rocio, MD, Costa Rica Universidad Nacional and PAHO (Costa Rica)
Shabah, Abdo, MD, Centre de Sante Tulattavik (Canada)
Slepski, Lynn H, CPTN. Dept. of Homeland Security (USA)
Smith, Stewart, MPH, FACCP, Emergency Preparedness and Response International, LLC
Topuzlar, Mehmet, MD, Gulhane Military Medical Academy (Turkey)
Ukai, Takashi, MD, Hyogo Emergency Medical Center (Japan)
Una, Marren, Mater Misericordiae University Hospital (Ireland)
Vaidya, Pradeep, MD, Tribhuvan University Teaching Hospital (Nepal)
Van Driel, APG, St. Elizabeth Hospital (Netherlands)
Weiss, Stuart, MD, Med Prep Consulting Group, (USA)
Yeo, Michel, MD, PhD, Regional Office for Africa (AFRO), WHO (Kenya)
Albanese 2008 Prehospital and Disaster Medicine

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