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While global migration to large cities has provided socio-economic opportunities to millions, it has also introduced new threats to urban populations, particularly marginalized communities. Large cities are increasingly vulnerable to manmade and natural calamities that can lead to injury, loss of life, and humanitarian crises.

Responding to this increasing vulnerability, 20 emergency medicine physicians, emergency medical services (EMS) personnel, and emergency management workers from NewYork-Presbyterian Hospital, in partnership with local and international agencies, are volunteering to conduct emergency management trainings and drills in Mumbai, India, and Colombo and Galle, Sri Lanka. The efforts, taking place Oct. 25 to Nov. 9, are aimed at improving local emergency preparedness and response by conducting trainings in pre-hospital and hospital emergency management, advanced trauma life support and public health evaluation and monitoring — and will also involve staging three large-scale disaster simulations.

"There is a tremendous need in many developing countries around the world for education and training in community-based and coordinated emergency management," says Dr. Robert Bristow, chair of the NewYork-Presbyterian Hospital's Emergency Management Committee and assistant clinical professor of medicine at Columbia University College of Physicians and Surgeons. "In 2006, Mumbai was the target of seven simultaneous bombings on its train system, killing 209 and injuring more than 700. Thousands have been killed and injured in the ongoing bombings by the separatist terrorist group in Sri Lanka. In 2004, Sri Lanka and India were hit with a deadly tsunami described as the worst disaster in its history, killing thousands. In 2005, the Maharashtra floods, the eighth heaviest ever-recorded 24-hour rainfall, crippled the city of Mumbai. We realized that much of what we have learned in emergency management post-9/11 at NewYork-Presbyterian, situated in New York City, could be beneficial in other parts of the world."

Disaster Drills

Emergency management drills have been validated in the medical literature as the single most important determinate of how well hospitals and communities respond after a disaster. As part of this two-week mission, the team is conducting large-scale emergency management drills in these two countries, simulating a mass-casualty incident. The drill will demonstrate a coordinated response between police, fire, emergency medical personnel, hospitals, clinics, government and non-governmental organizations, and other disaster responders. One hundred volunteers will act as victims and will be evaluated at the disaster site, medically triaged, and transported to hospitals where they will be evaluated and treated. At its conclusion, the drill will be evaluated for its effectiveness and used to create a road map for continued local development and coordination in emergency management.

In November of 2007, NewYork-Presbyterian's team led a similar emergency management training and drill in Ahmedabad, India, as part of a four-year grant to increase local emergency management capacity. This summer the city was struck by 17 terrorist blasts within 90 minutes. Two of the bombings involved Ahmedabad's Civil Hospital, which had participated in the drill. Government health officials reported in the Times of India that the disaster training provided by NewYork-Presbyterian's team helped improve emergency response to the attacks, expedite medical care for casualties, and armed the city with a plan that reduced panic and saved lives.

"This effort is unprecedented in its goals, its quality-control measures, and its scope. We are able to offer analysis using sophisticated bio-statistical tools, giving everyone a more detailed overview of the simulation's success," says Dr. Wallace A. Carter, director of the Emergency Medicine Residency Program at NewYork-Presbyterian Hospital and associate professor of clinical emergency medicine at Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. "The goal is to improve disaster planning and emergency medicine around the globe and to increase public awareness about emergency management."

One such initiative in Mumbai, India, currently led by Mumbai native Dr. Satchit Balsari of NewYork-Presbyterian Hospital/Columbia University Medical Center in partnership with All India Disaster Mitigation Institute, The Harvard Humanitarian Initiative, and local partners, is the development of MumbaiVoices, a citizen-driven analysis of the disaster response to the Mumbai train blasts of 2006. Last year, Dr. Balsari and others helped to organize the first emergency medicine conference in Mumbai, and is currently helping hospitals in Mumbai start their first four-year emergency medicine residency training program.

NewYork-Presbyterian's Emergency Medicine physicians have been involved in a number of multi-institutional, public-private and international humanitarian volunteer interventions in India, Germany, Montenegro, Darfur, Tanzania, Ghana, Dominican Republic, Guatemala and Myanmar. Among the collaborating institutions are the Harvard Humanitarian Initiative of Harvard University and AmeriCares, a disaster-response humanitarian organization based in Stamford, Conn. The Hospital Emergency Medicine physicians have also volunteered domestically — including on the Gulf Coast, following Hurricane Katrina.

For more information, patients may call 866-NYP-NEWS.

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,242 beds. The Hospital has nearly 2 million inpatient and outpatient visits in a year, including more than 230,000 visits to its emergency departments — more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health-care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth in U.S.News & World Report's guide to "America's Best Hospitals," ranks first on New York magazine's "Best Hospitals" survey, has the greatest number of physicians listed in New York magazine's "Best Doctors" issue, and is included among Solucient's top 15 major teaching hospitals. The Hospital's mortality rates are among the lowest for heart attack and heart failure in the country, according to a 2007 U.S. Department of Health and Human Services (HHS) report card. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons.