Addressing 5 questions led the panel to offer 33 suggestions. Because of the large number of suggestions, the results have been separated into two sections: part I, Infrastructure/Capacity in the accompanying article, and part II, Response/Recovery/ Research in this article.A lack of rudimentary ICU resources and capacity to enhance services plagues resource-poor or constrained settings. Capacity building therefore entails preventative strategies and strengthening of primary health services. Assistance from other countries and organizations is often needed to mount a surge response. Moreover, the disengagement of these responding groups and host country recovery require active planning.

Develop descriptions that characterize the context of work for area managersIdentified 25 individual information needs.Creation of a persona based on common participant characteristicsDevelop 25 scenarios of use designed to satisfy identified information needs. ( The design of the scenarios was guided by the persona description and a critical incident (snow storm context)

The exercises increased the head nurses’ general self-efficacy but not their specific self-efficacy. After completing the first two exercises they also exhibited improved management skills as indicated by shorter time to treatment for both trauma and in-hospital patients.

Simulation results from the demonstration indicate that occupant’s exit preferences, visual perception of the signage system, herding behavior, and social behavior among groups can lead to very different reactions to cues.The first test studies the effect of additional exit signs on evacuation performance. The total evacuation time is 165 s (averaged over 10 simulation runs). As highlighted in the figure, in this initial exit sign arrangement, agents take detours and explore the floor before find their way to exit. With additional exit signs posted, the agents travel with more direct routes and the evacuation time takes 119 s (a decrease of 28 % in time compared to that of initial layout of fewer exit signs).The second test illustrates how changing the exit orientation can help direct crowd flow. With the sign arrangement in the first test case, agents tend to exit through the main entrance and cause the congestions at the main entrance. With the proper exit orientation, more agents perceived the exit sign and its direction and evacuated through the near exit. Consequently, the evacuation time is 89 s, a further improvement of 25 %. During the simulation, the agents query the spatial model with the known exits and retrieve the shortest paths to the known exits. At the decision making stage, the agents choose to move to the visible navigation points along the shortest paths to get to their known exits.During evacuation, members belonging to a group, such as families and close friends, concerned the safety of their group members and often seek out and evacuate with the entire group even when evacuation is urgent. Often, as opposed to moving toward familiar exits, people may follow social cues and choose the exits preferred by the crowd as they observe others’ actions. We model the ‘‘following the crowd’’ behavior as follows: during the simulation, the herding agent (who is seeking to follow other agents) perceives the space and detects visible floor objects. At the decision-making stage, the herding agent assesses, for each visible floor object, the number of neighbors who are traveling toward the floor object. The herding agent chooses the visible floor object with the highest number of neighboring agents traveling toward because the agent considers the movement of its neighbors as a social cue to explore potential areas for exits. If there are no visible floor objects that other agents move to, the agent then will adopt other navigation strategies, such as referring to their known exits or following the visual cues.

Simulation results from our case studies indicate that occupants’ social behavior and initial delay to evacuate can lead to very different congestion patterns and evacuation times. This kind of analysis can be useful in many applications, for example, architects can design occupant-centric floor layouts and ensure that the egress design can handle a wide range of occupant behaviors. The simulation results can also help design and placement of signage to guide evacuation. Such analysis can be useful for facility management to plan evacuation strategies and design emergency training programs.

Advantages of using virtual worlds training were concluded to be: The exact layout and location of resources of specific EDs can be replicated.Trainees do not have to be present at the same location to play their avatar roles.Drills can be conducted at any time of day or night to accommodate trainees’ schedules.A variety of patient scenarios and conditions can be modeled to simulate individual patient cases or multiple victims in complex clinical situations.Dangerous and/or infrequently occurring situations can be presented.Scenarios can be run more than once during a short period of time, allowing trainees to learn from their mistakes.Trainees’ performance during the simulation can be captured for playback and assessment after the event

Involvement and consultations of real patients in the creation and implementation of scenarios can help to achieve a high level of fidelity. Simulations should reflect the multi-disciplinary nature of real life wards.

The result is that timely and accurate response from the regional medical command together with timely response from a national coordination function most likely had a positive impact on patient outcome in simulation II. In addition, the results indicate that a more precise distribution of casualties over short distances to regional hospitals and long distance with HEMS to university hospitals and burn centres can be an advantage. Thus, by timely and specific referrals, the on-scene time was also reduced. Second simulation has better outcome due to three reasons. First, despite the long transport distances, the early mobilization of resources from both the Swedish and Norwegian side of the border made it possible to start transportation to the nearest regional hospitals by ambulances after 45 min. Second, the early mobilization of ambulance helicopters from Norway with both anesthesia physicians and nurses was a factor that probably contributed to these results due to the possibility of performing life-saving airway interventions after 1 h. Third, measurable performance indicators used in simulation II were found by the participants to be applicable and probably stimulated the participants to perform more timely and effective management in simulation IIHowever, despite correct triage at the scene, four patients with blunt head trauma causing expanding intracranial hematoma were identified in the system as risk for preventable death in both simulations. These cases were prioritized as immediate  but did not receive airway intervention within the stipulated period of 1 h. To address this issue, it is important to note that it was the burn perspective that governed much of the simulation and burns were to some extent prioritized for long-distance helicopter transport to the burn centres. Furthermore, the present disaster scenario occurred in a rural area where the early medical needs exceeded the response capabilities. Under such circumstances, without aggressive treatment, severe head injuries can have a poor prognosis. Nevertheless, these patients were never triaged as expectants  and could perhaps have survived in the simulation if they had received a higher priority leading to early transportation by helicopter to a university hospital for neurosurgeryThe result of this study shows that a large part of the Swedish health care system would be involved in this type of event, which might have displacement effects on regular health care in the long term. Furthermore, lessons learned from other burn disasters are that the national specialized intensive care resources can quickly become saturated for a long period. Therefore, the need for additional use of burn beds in Europe would probably arise in the longer term. National planning in case of such needs is called for.In these two simulations, we found that, in rural areas of Sweden, the major challenge in coping with a mass casualty incident with many burn cases is due to the long distances to specialized trauma and burn care units. A significant limitation in these settings is the possibility of achieving rapid patient evacuation based on the accessibility of transport resources (e.g. ambulances and helicopters). During these simulations, the extent of air transportation and coordination of helicopters were shown to be a bottleneck and were identified as significant risk factors for an unfavourable outcome. The absence of predefined organization and coordination routines concerning air transport in a mass casualty event must be addressed further at the national level. Unfortunately, it was not possible to fully test this function during these simulations.The rapid establishment of cooperation between the two county councils where the two national burn centres are located was of importance for the timely response seen in the simulations. This national coordinating function for burn care was established early and in accordance with the proposed national burn response plan. Furthermore, it was operational at an early stage and provided support to the regional management group by developing strategies for the distribution of burns.

Virtual globes can provide the geographic–social context that facilitates geo collaboration—or collaborative processes that are conducted and mediated through geographic information and knowledge.In addition to situation awareness of real world events, participants in any type of group work need to maintain awareness of collaborative activity. Examples of activity awareness include but are not limited to (a) a sense that other collaborators are ‘‘there’’ (social awareness) and (b) what relevant information is known by other collaborators. Activity awareness is important for overall situation awareness as it can influence the activity of collaborators in a given situation.Maps play a critical role as visual mediums to support development of situation awareness in humans. Virtual globes, as a next generation of mapping technology, provide an exciting new direction for supporting situation awareness in disaster management. In particular, virtual globes offer powerful visualization methods, interactivity, geographical context and ease of use that can be utilized for informed decision making tasks critical to effective disaster management. Results of these evaluations indicate the approaches presented offer a promising new direction on the use of virtual globes for situation awareness, disaster management and related research at the intersection of geographic information science and information retrieval.

Ability to track all units/groups participating in operation (belonging to different services and structures) and visualise their location on satellite map greatly enhances situational awareness. Ability to access exactly the same data indifferent locations results in a common operational picture for all actors involved both different services and authorities supervising them. Both above-mentioned factors allow for significantly better coordination of common operations. Automatic transmission of status information together with position information may provide for much clearer situational picture. Satellite support team physically present in headquarter is a very effective method to ensure efficient use of available space technologies. Geospatial products (satellite maps and analytical products) should use standardised marking (e.g. NATO standard symbols) to make them easily readable for users. Standards for such products made available electronically are also necessary. Users (commanding officers) require certain time (several hours) to get accustomed to new capabilities, understand them and use effectively. Operational demonstration is a very effective method to validate crisis management systems' concepts and to convince users about their usefulness.