title: Evaluation of the Response of the Swedish Healthcare System to the Tsunami Disaster in South East Asia.
abstract: OBJECTIVE
  When the tsunami in South East Asia hit the coast of Thailand on December 26, 2004, approximately 20,000 Swedish tourists were in the disaster zone. Of these, 548 died or were lost and more than 1500 were injured. The aim of this study was to evaluate the response of the Swedish health care system to the disaster in terms of assessment and support in the disaster zone, evacuation back to Sweden and continued treatment in Sweden.
  
  
  METHODS
  The evaluation was carried out based on (1) structured questionnaires to the staff of Thai hospitals, injured Swedish citizens and Swedish voluntary workers in the disaster zone; (2) semi-structured interviews with representatives of involved authorities, regional health care centres in Thailand and Sweden, hospital command centres, individuals treated for injuries and volunteer workers involved with supporting the injured; (3) on-site visits in the disaster zone; (4) analysis of reports following the tsunami.
  
  
  RESULTS
  A total of 11,000 injured were treated during the first 3 days following the tsunami at the six major hospitals in the Phang Nga, Phuket and Krabi provinces where the majority of the Swedish citizens were primarily taken care of. Of these 11,000, 3000 required hospital admission against a total bed capacity of 1400. Almost 1500 surgical operations were performed during the first 3 days across 33 operating theatres. Thai health care representatives and staff confirmed the requirement for teams from countries with many tourists in the area for practical and psychological support, interpretation, assessment for evacuation and undertaking early evacuation to home nations to release local health care resources. This need was also supported by the injured. Sweden, having the highest number of injured citizens next to the host country, was very late compared to other countries in sending assessment teams to the area and in supplying the needed support.
  
  
  CONCLUSIONS
  With increased international travelling, many countries today have large numbers of their citizens in other parts of the world. For Sweden, this has been estimated to be 400,000 at any one time, often in areas known to be risk zones for natural disasters and terrorism. This fact of modern-day life demands welldesigned plans to support both citizens in the area and the local health care in several ways: non-medical support by mediating contact between injured and local medical staff, psychological and practical support, support in evacuating own citizens from the area to release local health care and (under specific conditions) medical support. This planning has to include prepared assessment teams that can be rapidly deployed to the scene and a command structure permitting rapid and accurate decisions on a governmental level.
authors.affiliation: Department of Surgery (Professor Emeritus), University Hospital, Linköping, Sweden. lennquist@telia.com.|, Ängslyckestigen 4, 614 32, Söderköping, Sweden. lennquist@telia.com.
authors.forename: Sten
authors.initials: S
authors.lastname: Lennquist
authors.affiliation: Academic Department of Military Emergency Medicine, Institute of Research and Development, Birmingham, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Hodgetts
keywords: Aeromedical evacuation; Assessment teams; Disaster planning; Mass-casualty incidents Natural disasters; Tsunami