CONFERENCE REPORTS
HEALTH AND TECHNOLOGICAL DISASTERS

The First World Conference on Health Emergencies in Technological Disasters was organized by the Department of Civil Protection of Italy under the High Patronage of the President of the Republic. It was held in Rome, 5-7 May, 1992. There was a considerable presence of MBC members.
In preparing this Conference, the first dealing with technological disaster problems in health, the organizers had become convinced of five basic factors that apply intimately to all major disasters, as follows:

• that health problems cannot be dissociated from other major problems in a disaster;
• that technological, man-made disasters and natural catastrophes are closely interlinked;
• that effective management of disasters needs new techniques, with a solid scientific base;
• that collaborative international action and mechanisms are essential for proper preparedness and response to major emergencies; and
• that protection from disasters, natural and more so when caused by man, is the right of every citizen.

Until recently the more developed countries felt somewhat spared from disasters, but the spread of industrialization and of high technology has left flo corner safe and, indeed, has made these erstwhile "strong" countries more vulnerable, with catastrophic consequences to health and society. Man, who has had the imagination, the knowledge and the initiative to create complex technology, should also be in a position - and hopefully in the obligation - to prevent the ill effects of his creation.
The present Conference was an expression of that hope: a contribution to promoting safer management of the often lethal machinery of this technological world; to preparing industry to minimize the risks of its products; to organizing society to better respond to emergencies; to humanizing high technology; to ensuring the health and welfare of victims; and, above all, to preventing disasters.
Over 400 experts from the fields of disaster medicine, toxicology, industrial safety, nuclear protection, civil defence, communications, burns, armed forces, government, space exploration, nursing, education and the social sciences, representing, 40 countries, the European Community and all the relevant Agencies of the United Nations, attended.
Following three days of active participation, with scientific presentations, technical papers and dynamic discussions, the delegates reached conclusions on the main themes of the Conference, viz. fire disasters, toxicological emergencies, nuclear disasters and prevention, preparedness and response in these grave situations.
The following 18 recommendations were submitted to the Presidency of the Council of Ministers of the host country and to the national authorities of the participating delegates.

Recommendations
Considering the multiple aspects of the problems leading to or caused by technological disasters, the delegates submit the following recommendations to the First International Conference on Health Emergencies in Technological Disasters.
A. Legislation

1. Industry and Government should ensure in every way possible that technological advances minimize the risks or do not lead to technological disaster.
2. The cost-effectiveness not only in terms of finances but also, and mainly, in terms of health, social benefits and societal costs and eventual disasters must be conscientiously weighed.
3. National and international legislation in these matters must be firm and applicable.
4. Promote the understanding and collaboration of industrialized countries in the proper transfer of technology to developing countries.
5. Apply the principles of legal medicine to injuries, death and damage following disasters.

B. Education and training

1. Promote specialized establishments for disaster management. These could be in general facilities (like the European Centre for Disaster Medicine), specific toxicology departments (like the UniversitA del Sacro Cuore in Rome), specialist centres (like the Mediterranean Burns Club's Burn Centre in Palermo), or international, as the guidelines of the International Programme for Chemical Safety at the World Health Organization,
2. Promote training in the concepts , and techniques of disaster management. Foresee apparently minor incidents and prevent them from leading to disaster.
3. Encourage the inclusion of disaster medicine in medical and nursing school curricula, and the formation of national societies of disaster medicine.
4. Collaborate with such organizations as the World Association for Emergency and Disaster Medicine for worldwide collaboration.
5. Provide health education and public awareness of the community with audiovisual aids, school and family programmes and industrial accident safety to increase preparedness and reduce risk.

C. Organizational strengthening

1. Reinforce the safety measures of nuclear plants and, in particular, prepare governments, the media and especially the public about the real, acceptable and non-subjective hazards of radiation accidents. Collaborate with the International Atomic Energy Agency.
2. Apply the same measures to potentially toxic chemical plants and strengthen the involvement of the international community and legislation in this field. (There is, for example, stricter international surveillance of nuclear installations, like Chernobyl, than of chemical plants, like Bhopal).
3. Draw objective lessons from such major accidents as Chernobyl, Bhopal, Seveso and Schweizerhalle.
4. Collaborate with the International Programme on hernical Safety, the United Nations Industrial Development Organization and others.
5. Improve ambulance services and emergency medical systems available to all.
6. Strengthen the casualty/emergency departments of hospitals and establish specialized detoxication, poison control, burn therapy and industrial trauma care units.
7. Establish a clearing house for information on national and international patterns of emergency response and facilitate the exchange of experiences and advances. The patterns of Sweden, Italy, Japan and Germany are illustrative.

D. International Centre of Technological Disasters

1. The Conference strongly recommended the establishment of an authoritative international Centre for Technological Disasters, dedicated to research, study and response on major fires, toxic disasters and radiation catastrophes.

The optimal site of such a vital Centre would, the delegates believed, be Italy, the host country of this important First World Conference on Health Emergencies in Technological Disasters.

Developments
The success of this Conference was already evident from the usual indicators of congress organization, such as scientific level, international participation, authoritative presentations and the enthusiasm of the contributors. In this case, however, exceptional success must be noted in the speed with which the recommendations were put into application by the highest authorities. In fact, within six weeks the Government of Italy established, by law, the International Study Center for Major Health Emergencies and Technological Disasters, which will become operational very rapidly. Members of MBC will recognize its Steering Committee: Professors E. Melorio, Chairman; C. Manni, Vice-Chairman; S. Magalim, M. Masellis, G. Trenta, Members; S.W.A. Gunn, International Scientific Adviser.
The published Proceedings of the Conference can be obtained from Protezione Civile, Servizio Emergenza Sanitaria, Via Ulpiano 11, 00193 Rome, Italy'.

S.W.A. Gunn, MD (International Adviser to the Conference) and M. Masellis, MD