This Issues Paper is published with the permission of the President of the World Association for Disaster and Emergency Medicine. JEPHC thanks Dr. Knut Sundnes for allowing JEPHC to publish this paper of international significance.

Readers will note reference to an invitation for submissions in response to the Issues Paper and should not be distracted by the dates listed in the Issues Paper and are encouraged to forward any comments directly to Dr. Geert Seynaeve.

This issues paper is the result of an initiative launched by WADEM during the 13th WCDEM in Melbourne 2003. It is being concurrently published on the WADEM website at http://wadem.medicine.wisc.edu/ and in JEPHC. A short version is also available on the WADEM website and also published in WADEM's journal "Prehospital and Disaster Medicine" Volume 19, No. 2, 2004.