Sweden has a long tradition in planning for disaster situations in which the National Board of Health and Welfare has a key responsibilty within the health sector. One important part of this disaster preparedness is education and training. Since 11 September 2001, much focus has been placed on the acts of terrorism with special reference to the effects of the use of chemical, biological, or nuclear/radiological (CBNR) agents. In the health sector, the preparedness for such situations is much the same as for other castastrophic events. The National Board of Health and Welfare of Sweden is a national authority under the government, and one of its responsibilities is planning and the provision of supplies for health and medical services, environmental health, and social services in case of war or crises. “Joint Central Disaster Committees” in each County Council/Region in the country are responsible for overseeing major incident planning for their respective counties/regions. The “Disaster Committee” is responsible for ensuring that: (1) plans are established and revised; (2) all personnel involved in planning receive adequate information and training; (3) equipment and supplies are available; and (4) maintenance arrangements are in place.Sweden adopts a “Total Defense” strategy, which means that it places a high value in preparing for peacetime and wartime major incidents. The Swedish Emergency Management Agency coordinates the civilian Total Defense strategy, and provides funding to the relevant responsible authority to this end. The National Board of Health and Welfare takes responsibility in this process. In this area, the main activities of the National Board of Health and Welfare are: (1) the establishment of national guidelines and supervision of standards in emergency and disaster medicine, social welfare, public health, and prevention of infectious diseases; (2) the introduction of new principles, standards, and equipment; (3) the conducting education and training programmes; and (4) the provision of financial support. The budget for National Board of Health and Welfare in this area is approximately 160 million SEK (US$18 million). The National Board of Health and Welfare also provides funding to the County Councils/Regions for the training of healthcare professionals in disaster medicine and crises management by arranging (and financing) courses primarily for teachers and by providing financial support to the County Councils/Regions for providing their own educational and training programmes. The National Board of Health and Welfare provides funding of approximately 20 million SEK (US$2.4 million) to the County Councils/Regions for this training of healthcare professionals in disaster medicine and crises.

Abstracts -13th World Congress on Disaster and Emergency Medicine had 96% sensitivity, 41% specificity, and 65% accuracy (in general physicians, respectively, 100%, 70%, and 85%). Conclusions: Considering limitations in the usage of more advanced resources in Iran for screening and earlier initiation of therapeutic measures -especially telecardiography -simultaneous use of the screening questionnaire and physicians attendance at the patient's bedside, not only results in lowering of EMS system expenses, unnecessary missions, and an increasing role of the EMS System in transportation of emergency patients, but also in comparison to present situation, do not produce meaningful differences in the rate of missed patients. The unprecedented damage to society resulting from this disaster was on the highest social, medical, psychological, and technical scales. The size of this human-made disaster required intensive and immediate efforts from the government, specialists, managers, operators still working at the nuclear power station, clean-up workers, and still others who arrived at the scene of the disaster to provide their services. Millions of people were affected, and some still are struggling with health problems as a consequence of this disaster. The strengths and weaknesses in the disaster management at Chernobyl were analyzed in order to gain a better understanding so that future calamities can be better managed. From a medical standpoint, there was a high level of contamination, difficult diagnosis and triage, and multifactoral health consequences, if any future disaster would have a component of contamination by isotopes, chemicals, or biological agents, the disaster scene would be dramatically changed and would require a significant correction of the management strategies at the scene. For such scenarios, it is crucial to identify common lessons and approaches for improving medical management in such circumstances.In this presentation, a number of the lessons learned from Chernobyl will be discussed that are fundamental for improving the medical management of individuals, reconnaissance teams, and the general population.

s31over civilian populations at risk. Qualitative and quantitative methods need to be developed for measuring quality and effectiveness in the educational and reporting processes proposed in this model. Sweden is known for its high standards of preparation for chemical incidents. Resources on chemical incidents were allocated from the preparedness during the Cold War. Two main parts of the system are the personal protective equipment (PPE) and the mobile units for decontamination. One part includes the stationary decontamination units in hospitals. Studies have been performed on these parts of the program. The results are under evaluation and will be presented. The PPE has been tested in different ways, was found to resist chemicals for a limited time, and is recommended to be used in combination with the charcoal garment. The test procedure and the results will be presented.The Swedish healthcare system and Swedish rescue services use both stationary and mobile decontamination units. The stationary units have been studied earlier with results pinpointing the need of strict regime while performing decontamination to obtain good results. In the case of mobile units, a corresponding study has been performed. The results indicate that those units have limitations: the time to assemble the unit, the flow of patients through the unit, the technical problems, and, most importantly, the results in terms of decontamination efficiency.In light of the above results, a new strategy to handle causalities contaminated by chemicals is being located. Strict rules will be developed for when and how decontamination should be done. Smaller units to perform a fast decontamination will be created, as well as techniques to transport still-contaminated patients to a hospital, and a final decontamination will be performed before entering the hospital, which will be of no risk to ambulance personnel.

Abstracts -14th World Congress on Disaster and Emergency Medicinesituation and evaluated their own performance. Job identification and responsibility are essential for both senior and junior staff morale and functioning. Organization (information flow, orderly work, and task allocation) is critical in coping with chaotic situations like that generated by the tsunami. Team cohesiveness makes them better able to withstand prolonged exposure to the stresses generated by severe disaster. Positive thinking and orientation towards the future gives people strength and motivation to keep working. Those who had volunteered for the disaster team were found to be more supportive and immunizing than those who had been asked to work with the team. Technical problems (such as the language barrier vis-a-vis the tourists were a cause of stress and the elimination of such problems (through the position of translators in healthcare facilities) alleviated that stress.