1. Disaster Medicine in Korea
Gil Joon Suh, MD, PhD
Department of Emergency Medicine
Seoul National University College of Medicine
Good afternoon!, Ladies and Gentlemen
I am an Emergency Physician from Korea.
I am going to talk about Disaster Medicine in Korea, esp Emergency response and preparedness in Disaster

2. Disaster Management in Korea
No govenmental structure which is fully responsible for disaster
Separated approach to disaster
Natural disaster by Fire Department Service
Chemical disaster by Ministry of Environment
Biological disaster by Ministry of Health & welfare
Nuclear disaster by Ministry of Education & Science
Inefficacious in combined type of disaster
Administrative , not medical approach
There has been no govenmental structure which is fully responsible for disaster in Korea.
So, seperated approaches has been given by different governmental department according to the type of disaster, For example, Natural disaster by Fire Department Service; Chemical disaster by Ministry of Environment; Biological events by Ministry of Health and welfare; Nuclear events by Ministry of Education, Science and Technology.
The problems of the separated approach is that it is so inefficient in combined type of disaster, and it is mainly administrative approach, not medical approach.

3. Disaster Medicine in Korea
Not recognized as an established specialty science
Emergency Response and Preparedness developed by Emergency Medicine
Community-based Disaster Drill
Drill for Radiologic and Nuclear Disaster
Structural Education and Training Program
Disaster Medical Assistant Team (D-MAT) in designated Regional Emergency Centers
Disaster Medcine in Korea has not been recognize as specialty science.
The medical approach for disaster, especially emergency response and preparedness in Disaster was developed by Emergency Medicine.
This emergency response and preparedness system includes Community-based Disaster Drill, Disaster drill for Nuclear Disaster, Structural Education and Training Program, and Disaster Medical Assistant Team (D-MAT) in designated Regional Emergency Centers. However, this system also has weak points because it is mainly medically approached, not cooperated by other administrative structures.

4. I. Community-based Disaster Drill
Since 2005
From now, Let me briefly introduce Emergency response and preparedness system in Korea
First part is Community based disaster drill. It has been performed since 2005.

5. Community-based Disaster Drill
Supported by Seoul Metropolitan City Gov.
Joint drill
Participating organizations
Local emergency centers (level 2)
3 County Health authorities
Seoul Emergency Medical Information Center
Local fire department
Local police department
Coordinated by SNUH-Regional Emergency Center (level 1)
250 people/one drill x 4 /year
Community based disaster drill has been supported by Seoul Metropolitan City Government. This drill is joint drill.
Several organization such as Three County Health authority, Seoul Emergency Medical Information Center, Local emergency centers (level 2) , Local fire department, and Local police department participate this drill. SNUH-regional Emegency Center (Level 1) coordiantes the drill. About 250 people participate the drill. These drills are held 4 times a year.

7. Lessen from community-based Disaster Drill
Lessons
What is the disaster
What should be prepared
Who will collaborate with my party
Improve attitude & knowledge copying with disaster preparedness
Reduce time of performance but not to improve appropriateness of performance
Throught the community-based disaster drill, we learned following lessons;
What is the disaster
What should be prepared
Who will collaborate with my party
Attitude & knowledge improvement copying with disaster preparedness
The drill can reduce the time of performance but not to improve appropriateness of performance

8. II. Drill for Radiologic and Nuclear Disaster
Since 2005

9. Radiologic and Nuclear Disaster
Features
Difficult to detect in real situation
Acute catastrophic event : rare
The Masses and health providers : fear!
Translation of knowledge and skill is very important
Health provider-targeted education and training
As you know, it is difficult to detect nuclear and radiologic events in real situation, and acute catastrophic event is rare, and the Masses and health providers are usually scared and panic.
Therefore, it is very important to translate exact knowledge about radiologic disaster and skill to prepare and respond nuclear and radiologic events
The goal of this drill is health provider-targeted education and training.

10. Nuclear and radiologic Emergency Service Network
Primary Network (5 hospitals)
Prepare for the nuclear power plant events
Secondary Network (13 hospitals)
Prepare for the factory-oriented, downtown events, and inpatient care
Nuclear and radiologic Network Drill
Joint drill
Coordinated by NREMC
Once a year
We set up the emegency service network for the suspected case of nuclear and radiologic events.. Primary Network is to prepare for the nuclear plant events, and Secondary Network to prepare the factory-oriented, downtown events, and inpatient care.
Nuclear and radiologic emergency service network drill is held once a year.

11. decontamination area

16. National Disaster Life Support Course
Since 2008
Third part is National Disaster Life Support Course. This course has been held since 2008.

17. Preliminary NDLS course in 2007
We held preliminary NDLS course in This was a pilot training program. This program was 3 day course. It was similar to NDLS course.

18. NDLS Regional Training center
2008 Apply for the regional training site and approved by AMA-NDLS foundation
One-day Basic course (8 H)
Two-day Advanced Course (16 H)
A half-day instructor course (4 H)
Core NDLS course (4 H)
Monthly-based course in 2009
And then, we applied for the regional training site for NDLS course. Four key persons from NDLS foundation visited our training site, and supervised our program. This course was approved by AMA-NDLS foundation. The NDLS course is composed as follows: One-day Basic course (8 H), Two-day Advance Course (16 H), and A half-day instructor course (4 H). We also have Core NDLS course (4 H).
First NDLS cours was held by SNUH in From 2009, NDLS course has been held monthly based.

19. NDLS Regional Training center
Target
Emergency physicians/ emergency nurses/ EMTs/ and Health department officials
Supported by Seoul Metropolitan City Gov.
Didactic class
Skill class
Drill class
The Target persons of NDLS course are emergency physicians/ emergency nurses/ EMTs/ and Health department officials.
Seoul Metropolitan City GOV supports this course. We have Didactic class, Skill class, and Drill class in NDLS course.

20. National Disaster Life Course
Established Programs
These are programs of NDLS course. At the present, we don’t have eBDLS and eCDLS courses, but, we wll have a plan to hold these programs in the near future.

21. First NDLS course in 2008

22. Disaster Medical Assistant Team
Since 2004
Last part is Disaste medical assistant team (DMAT). Disater Medical Assistant team Has been made in 2004.

23. DMAT Baseline characteristics
Composed of 10 to 20 providers
Emergency physicians/ orthopedics/ pediatrics/ EMTs/ emergency nurses/ administrative assistants
Mobile ER (Field Emergency Care Center)
Equipped with emergency material and devices
Smaller than US surge capacity DMAT
Larger than Japan flying DMAT
DMAT is usually composed of 10 to 20 health care providers, who are Emergency physicians/ orthopedics/ pediatrics/ EMTs/ emergency nurses/ administrative assistants.
DMAT is similar to Mobile ER (Field Emergency Care Center) , and Equipped with emergency material and devices.
Korea DMAT is usuall Smaller than US surge capacity DMAT, but Larger than Japan flying DMAT. .

24. DMAT activation criteria
Less than 15 victims; do not consider
More than 43 victims: obligatory response to field
Should provide DMAT activity
within one-hour after a regional-call for DMAT
within six-hour after a nation-wide call for DMAT

25. DMAT training DMAT operation and training team
Monthly-based check up equipment and material for activation
Public support: not enough
16 Regional Emergency Center: responsibility to make and operate the DMAT
Not prepared with CBRNE events
Lack of PPE and Decon-unit
For DMAT traing, DMAT operation and training team monthly-based check up the equipment and material for activation, but public support is not enough. 16 Regional Emergency Centers have responsibilities to make and operate the DMAT. However,most of regional emergency center are not prepared with CBRNE events, and lack of PPE and Decon-unit.

26. Activities in Disaster Medicine
Korean Association of Disaster and Emergency Medicine (KADEM) since 2007
The 9th Asian-Pacific Conference on Disaster Medicine (2008)
Disaster Fellowship
SNUH since 2007
We founded the Korean Association of Disaster and Emergency Medicine (KADEM) in 2007, and held the 9th Asian-Pacific Conference on Disaster Medicine (2008).
Disaster Fellowship has been introduced in some hospital (SNUH since 2007).

27. To develop Disaster Medicine
Need for scientific infrastructure and research methodology
Expert evidence >> clinical evidence: current
Clinical evidence in the future
Surveillance system and analysis for disaster events to make clinical evidence
Syndrome surveillance for biologic events (Korea CDC, since 2007)
Mass casualty and disaster surveillance (Korea CDC, pending 2009)
To date, disaster medicine in Korea has been approached based on Expert evidence rather than clinical evidence.
For the development of clinical evidence based disaster medicine, we need scientic infrastructure and research methodology.
For the purpose, we have continued to set up Surveillance system and analysis for disaster events, Syndrome surveillance for biologic events (Korea CDC, since 2007), Mass casualty and disaster surveillance (Korea CDC, pending 2009), and so on. And this activity will be continued for the development of disaster medicine in Korea.

28. Only Disaster Preparedness, not Disaster Medicine Science
I think that Disater Medicine in Korea is a beginning stage.
In fact, we have few experiences in Disaster Medicine.
Therefore, Disaster Medicine in Korea is Only Disaster Preparedness, not Disaster Medicine Science.
To develop disaster medicine , we should organize the scientic societiy strongly and tightly, and make a strong network and cooperation with other societies and government organizations.

29. Thank you for your attention