Disaster management was the topic of the day as public health alumni gathered on June 7 for their annual reunion. Gilbert M. Burnham, M.D., Ph.D., an expert in relief operations at the Johns Hopkins Bloomberg School of Public Health, led a morning workshop in which he framed the issues surrounding responses to disasters, whether natural or man-made, with a single question: “How do we put things back together?”The United Nations, he said, defines disaster as a situation that “affects the community’s ability to cope.” The most vulnerable societies, he continued, are plagued by poverty, inequality and highly centralized governments. Human rights are often at risk when countries are in trouble, he said, and women and children are the most vulnerable. “Protection of women is a major, major issue,” he said, noting that a quarter of Sudanese refugee women report having been raped or sexually abused. In Kenya, collecting firewood is a major risk factor for rape among Somali refugees.While Burnham’s talk focused on developing countries in strife, other speakers at an afternoon panel described the lessons learned on September 11.Kelly Close, M.D., M.P.H. ’92, national coordinator of disaster volunteers for the American Red Cross Disaster program, saw problems firsthand at ground zero in Manhattan. She reported that unneeded volunteers showed up at the site, where there was no system for checking credentials. And families flocking to hospitals looking for loved ones needed some sort of “compassion center.”Michael D. Israel, M.P.H. ’80, former CEO of the Duke Medical Center, believed his staff was well prepared for a disaster—until September 11. “As good as we thought our plan was, it wasn’t anywhere near what it needs to be,” Israel told public health alumni.Duke’s plan had many strengths, said Israel, now COO for North Shore-Long Island Jewish Health System in New York. It established a clear chain of command, included a system for documenting care, set priorities for crisis response and created a common language for communicating during a disaster. But watching the events of September 11 and the disaster response made him aware of the Duke plan’s deficiencies. Duke had previously planned for the potential of mass casualties in the tens or hundreds, not thousands. With that many casualties, the planning would have to take into account mass hysteria and triaging patients in numbers well beyond anything ever conceived of in the past. “In addition, these potential numbers made us realize that we would have to work with local government to make sure the streets and highways leading to the medical center were kept open for essential vehicles,” Israel said after the panel discussion.Long before September 11, Scot Phelps, J.D., M.P.H. ’95, was already looking into disaster preparedness. Phelps, a paramedic and the manager of emergency life support programs at Phelps Memorial Hospital Center in Sleepy Hollow, N.Y., 12 miles from the Indian Point Nuclear Power plant and 20 miles north of Manhattan, was alarmed by the March 1995 nerve gas attack in Tokyo. A cult released the nerve agent sarin in the subway system, injuring 3,800 people and killing 12. Phelps said the Tokyo attack should alert hospitals that they need a plan for decontaminating large groups of people and for protecting health care workers in case of a chemical attack or spill. He said hospitals should recognize that most local ambulance crews are not trained in decontamination and that firefighters, who may have such training, will be at the site of an assault or attack and unavailable to help at the hospital.