The human casualties and socio-economic damage associated with the Great Sumatra–Andaman Earthquake of 26 December 2004 and the resulting Indian Ocean tsunami are discussed. The Sumatra–Andaman earthquake was the largest earthquake to occur since the advent of global digital seismometry and it produced the most devastating tsunami in recorded history (and the largest humanitarian response). A reliable Indian Ocean Tsunami Warning and Mitigation System is shown to require an improved seismographic network, a real-time sea-level observing network covering the entire Indian Ocean basin, and the deployment of deep-ocean pressure sensors. It is concluded that Indian Ocean governments can achieve more tsunami-resilient communities by addressing poverty, promoting education, harnessing technological advances, investing in emergency medical and rescue services, and empowering stakeholders.

Natural variations in the global climate are governed by complex interactions among the atmosphere, oceans, and land cover. Modern climate models suggest that these variations will continue, but with larger magnitudes and greater variability due to human influences. This is expected to increase the risk of flood disaster events. To improve flood risk management, a flood decision support system architecture is proposed that capitalizes on the latest advances in remote sensing, geographic information systems, hydrologic models, numerical weather prediction, information technology, and decision theory. Specifically, the dynamic climate prediction system developed by the Institute of Atmospheric Physics, Chinese Academy of Sciences, is discussed in the context of flood management and planning in the Yangtze River valley, China.

Objectives The presence of critically ill patients may impact care for other ED patients. We sought to evaluate whether the presence of a critically ill child was associated with the time to (1) receipt of the first medication among other patients, and (2) administration of diagnosis-specific medications. Methods We performed a retrospective cohort study of all paediatric ED visits over 3 years. Patients were exposed if they arrived during the first hour of a critically ill patient's care. The primary outcome was the time from arrival to first medication administration. Secondary outcomes were time to corticosteroids in asthma and time to antibiotics for fever/neutropenia. We modelled times to medication using median regression, adjusting for demographics, arrival time and weekday, and census (number of patients in the ED). Results We analysed 170 112 visits. Median times to first medication for those exposed to 0, 1 and >1 simultaneous critically ill patients were 90 min (IQR 54–146), 96 min (IQR 58–157) and 113 min (IQR 72–166), respectively (p<0.001). The increase in time to corticosteroids among exposed patients versus unexposed was 6 min (IQR 2–14, p=0.11) and in time to antibiotic for fever/neutropenia was −4 min (IQR −4 to −11, p=0.13). Modelled time to first medication increased 3.1 min (95% CI 0.5 to 5.7) among all exposed patients (p=0.02). Time to first medication increased 15.3 min (95% CI 14.7 to 15.9) for each 10 patient increase in census. Conclusions The presence of critically ill patients was associated with a delay in medication administration to others. Census independently predicted medication delays.