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The first half decade of the 21 century has brought with it infectious outbreaks such as severe acute respiratory syndrome (SARS) [], bioterrorism attacks with anthrax [], and the spread of H5N1 influenza A in birds across Asia and Europe [, ] sparking concerns reminiscent of the days of the Black Plague. These events, in the context of an instantaneous global-media world, have placed an unprecedented emphasis on preparing for a human influenza pandemic [, ]. Although some argue that the media have exaggerated the threat, the warnings of an impending pandemic are not without foundation given the history of past influenza pandemics [], incidence of H5N1 infections among humans [], and the potential impact of a pandemic. Reports of the 1918 pandemic vary, but most suggested that approximately one third of the world’s population was infected with 50 to 100 million deaths []. Computer modeling of a moderate pandemic, less severe then in 1918, in the province of Ontario, Canada predicts 73,252 admissions of influenza patients to hospitals over a 6-week period utilizing 72% of the hospital capacity, 171% of intensive care unit (ICU) capacity, and 118% of current ventilator capacity. Pandemic modeling by the Australian and New Zealand Intensive Care Society also showed that critical care resources would be overwhelmed by even a moderate pandemic []. This chapter will provide intensivists with a review of the basic scientific and clinical aspects of influenza as well as an introduction to pandemic preparedness.

Injury due to explosive detonation has previously been isolated to industrial accidents and soldiers and civilians in areas of armed military action. Substantial data regarding blast-related patterns of injury has come from military reports and research, and there have been significant advances in protective vehicle and body armor, ‘far forward’ provision of medical care, and evacuation procedures. Despite this, explosive munitions and improvised explosive devices still comprise the majority of combat morbidity and mortality []–[]. There is also increased targeting of civilians in a global political environment where incendiary devices are a principle instrument of modern terrorism []–[]. Events in preceding decades indicate a critical need for both civilian and military emergency and intensive care providers to understand the pathophysiology and management of blast-related injuries.

The aftermath/response of a disaster can be divided into four phases. The importance of each depends on the length of time and the resources required. This in turn depends on the length of the disaster, the area involved, the number of the population affected, the re-supply available, the extent of the devastation, and the size of the evacuation. The four phases are discussed using Hurricane Katrina as an example. The phases are: