This is a report of the impact of the ice storm that struck eastern Canada on 04–09 January 1998. The storm deposited ice some 100 mm thick on the ground and on the electric power lines and eventually left 1.4 million households and much of the infrastructure without electrical power.Data were obtained through non-structured interviews of those involved. Most of the larger hospitals were equipped with emergency generating equipment and were able to provide most essential services. For most hospitals, non-emergency services were compromised. Many other medical facilities, including clinics had to be shut down, and smaller hospitals were forced to transfer some patients to larger institutions. In addition, hospitals experienced a marked increase in the number of emergency department visits including an increase in the number of persons with injuries, respiratory tract infections, or heart problems. A marked increase in carbon-monoxide intoxication was observed: 50 persons required the use of hyperbaric oxygen and six persons died of CO poisoning.Prehospital services not only experienced a marked increase in the number of emergency responses, but also were utilized to provide transportation of non-ill or injured persons, equipment, and supplies. Home care was interrupted and many patients dependent upon power had to be transported to hospitals. Many hospitals opened their buildings to provide shelter to the families of many of their employees and medical staff. This helped to keep staffing at a better level than if they had to find shelter and essential services elsewhere.The transmission and sharing of information was severely limited due in part to the loss of power and inability to access television. This led to the distribution of misleading or incorrect information.This storm was exemplary of our dependence upon electrical power and that we are not prepared to cope with the loss of electricity.

After decontamination, the imitation substances still were present and evaporating from the contaminated persons, blankets, and units. These results indicate a need for improvements in technical solutions, procedures, and training.

A fire developed in a facility being used as a discotheque that resulted in death for 63 young people. The rescue operations, ambulance responses, medical care provided at the scene, hospital operations, and psychosocial responses are described. Bodies blocked the exit and many survivors had to evacuate by leaping from windows. A total of 16 ambulances were used. Survivors and people not directly involved in the incident created disturbances and some even attacked responders. Many of those who escaped early suffered mild inhalation injuries and those who escaped later, sustained more severe inhalation injuries. High levels of both carbon-monoxide and cyanide were detected at autopsy. A total of 213 persons were transported to hospitals, 85 by ambulance. Most who died at the scene had severe burn injuries, were unconscious, or suffered from fire-gas injuries. A total of 150 victims were admitted to a hospital, of which 74 (49.3%) required intensive care. Only one of the four hospitals actuated a disaster alert. Psychosocial support was complicated due the multicultural characteristics of those involved. Support to the survivors and relatives of the victims was provided by representatives of various religious organization, non-profit organizations, and by the government of Gothenburg. Many recommendations are provided to better prepare for future events.

Extensive flooding occurred in Poland in 1997 and in Sweden in 2000. These events and their management are reviewed in this Report. The floods in Poland were more extensive than in Sweden as they covered some 10% of Poland's landmass. An estimated 55 persons died as a direct result of the floods in Poland and none were reported due to the flood in Sweden. No epidemics were encountered in either country, presumably related to the extensive use of bottled water and radio instructions to boil all water before its use. The water supply was interrupted and untreated water was taken into the water distribution systems. Chlorination of the water supplies was added in Sweden. Sewage and refuse management was problematic. The heathcare system was impacted profoundly in Poland both by direct damage to hospitals and/or loss of essential services such as electricity and water supplies. Government responses are described with the needs in Poland being extensive including the need for outside assistance. Some pathways used for obtaining aid were outside of government coordination. Comprehensive conclusions and recommendations derived from the observations are provided.