, a man armed with a gun releases sarin gas into the ventilation system of a college building. Local police, firefighters, and chemical, biological, radiological, and nuclear (CBRN) teams respond to the scene. Before the teams arrive, those who are able, flee to the hospital across the street. The emergency department already is full when contaminated patients arrive. One hour later, a car bomb explodes in the hospital parking lot. A simulated hospital in a campus gymnasium was created by the University of Toronto Emergency Medicine Residency Program, Sunnybrook and Women's College Base Hospital Land Program, Toronto Emergency Medical Services, paramedic students, nurses, physicians, administrators, and social workers. The hospital received approximately 100 patients within two hours. To prepare for the exercise, a website was built, where a literature search on CBRN terrorist events was posted, local hospital disaster plans were evaluated, and new plans were created. Discussion: Hospitals are vulnerable in terrorist events and may need protection from police and CBRN teams. Online collaboration is a useful way to learn and modify disaster plans. Active testing using simulated, mass-casualty-producing events exposes weaknesses, which can be attenuated.

The earthquake in Bam, Iran, killed >40,000 people, injured >30,000, and left 75,000 homeless. The affected people also faced an increased risk of infectious diseases. Many were sleeping outdoors in the first few days following the earthquake, despite the cold temperatures of December and January. Other risk factors included the inadequate access to a water supply network and sanitation, and the past history of endemics of typhoid fever, cholera, malaria, and coetaneous leshmaniasis in the area.Using the records of Bam-area medical centers, the incidence of infectious diseases during a three-week period starting one week after the disaster have been assessed. The infectious diseases that were recorded include: acute severe watery diarrhea, dysentery, acute respiratory infection, suspicious malaria, suspicious measles, suspicious meningitis, suspicious hemorrhagic fever, acute icter, acute floppy paralysis, suspicious brucellosis, suspicious salmonellosis, anthrax, coetaneous leshmaniasis, tuberculosis, and animal bite.Over that three-week period, 6,241 patients suffering from acute respiratory infections were visited. Acute respiratory infections, with an incidence rate of 6.93%, were the most common reason for medical visits. The second most common infectious disease was enteric infections (incidence rate of 8.2%); 738 patients with enteric infection were seen during the period of study. The next most common diseases were cuetaneous leshmaniasis, suspicious malaria, and animal bite, with an incidence rate of 0.075%, 0.058%, and 0.023%, respectively. Cold temperatures, lack of shelter, lack of heating facilities, and the high number of people in the camps might have been factors contributing to the high incidence of respiratory infectious diseases. The high incidence of enteric infections may be linked to the collapse of the water supply network and lack of adequate access to sanitation and safe food. Keywords: Bam; earthquake; infectious disease; Iran; respiratory Objective: The purpose of this study was to establish a predictive scoring system and determine its effectiveness for severe acute respiratory syndrome (SARS) cases confirmed by Reverse Transcription Polymerase Chain Reaction (RT-PCR) from fever patients during the SARS outbreak of 2003. Methods:A prospective study was conducted in the emergency department of a tertiary care center during the SARS outbreak in Taiwan. The scoring system was divided into two stages: (1) triage: taking temperature, symptoms, and history using a structured questionnaire; and (2) screening station: measuring complete blood count (CBC) and chest x-ray (CXR). Data were analyzed with multivariable and logistic regression analysis. The confirmative diagnosis of SARS cases was made according to results of RT-PCR. Results: A total of 737 patients were presented to the emergency department for ruling out SARS from 29 March-30 June 2003. A total of 484 patients with a documented temperature >38.0°C (100.3'F) and an age older than 18 years (adult patient) were enrolled in the study...