E-learning has become the most popular topic in medical education with the advance of medical informatics. Driven by the communication and information technologies there is structural change from all of the related fields. In the era of information, students have to face floods of data of which the relevant information has to be selected and applied. The internet and the new media are major players in this process. More and more physicians unravel e-learning as a new tool and as attractive adjunct to the traditional face-to-face teaching in medicine. Therefore, many people think that we are currently witnessed of another paradigm permutation in medicine: a paradigm which sets the internet and the new media in the center of interest. In some specific fields of application, as emergency and disaster medicine, where the interaction between the student and the teacher, even if of great importance, are difficult to obtain in a quiet setting and have a lot of organizing, technical and economic troubles, e-learning approach could be an excellent application.^1,2
How to share experience and resources among learners is becoming one of the hottest topics in the field of E-Learning collaborative techniques. In response to the need to standardize learning across multiple clinical sites, create a community environment for geographically disbursed learners and faculty, and provide opportunities for students to learn about and practice disaster medicine, Taiwan Society of Disaster Medicine has implemented e-learning program including continuing medical education (CME) into its official website in Jan 2004. A new on-line video teaching program has been implemented in June 2005.³ While a lot of research has been pursued to provide collaborative learning environments for geographically dispersed learner groups, such as web-based lectures allow instructors and learners to share information and ideas with the entire class, supplemented by multimedia resources, electronic mailing lists and digital video links, this teacher-centered learning mode bears inherent limitations such as learner passiveness and lack of interaction.^4,5
To understand the utilization of e-learning in disaster medicine, we designed the following study to survey the situation of utilization of e-learning and traditional education in disaster medicine in recent half year.

In response to the need to standardize learning across multiple clinical sites, create a community environment for geographically disbursed learners and faculty, and provide opportunities for students to learn about and practice disaster medicine, Taiwan Society of Disaster Medicine has implemented e-learning program including continuing medical education (CME) into its official website in Jan 2004. The initial program consisted of powerpoint slide teaching and post-learning on-line test. The powerpoint files included:
Basic disaster medicine training included
1. Introduction to National Disaster Medical System (NDMS)
2. Introduction of DMAT
3. Incident Command System (ICS)
4. Mass casualty incident (MCI) management
5. Principles of logistics
6. Field evaluation
7. Principles of public health
8. Refugee? care
Advanced disaster medicine training included:
1. Blast injury
2. Crushing syndrome
3. Compartment syndrome
4. Traumatic asphyxia
5. Particulate health problem
6. Post-traumatic stress disorder (PTSD)
7. Personal protective equipment (PPE) and decontamination
In June 2005, we have implemented a new on-line video learning module to promote the interactivity of e-learning.

E-learning should provide rapid correction and addition of teaching content; explorative learning; ubiquitous access, time and place independency; individual adaptation to foreknowledge of students; enrichment of traditional teaching modes by multimedia-based preparation of contents; and improved interaction possibilities compared to traditional distance learning media. We thus explored that if our official disaster medicine-related e-learning websites can provide such requirements.
The study period has been divided into two phases: the study period A was from July 1 2004 to October 31 2004, and the study period B was from July 1 2005 to October 31 2005. The participants and total attending times of training courses were recorded and compared. The relative distribution of web-based and non-web-based learning were also compared during two different study period. In addition, satisfaction feedback rate from the participants were also recorded and analyzed.
The satisfaction questionnaire was simply designed as follows:
1. How were you satisfied with our registration procedure?
2. Were these lessons important to your concern in the specialist field?
3. Were you satisfied with the time you waited for your certification to be confirmed?
4. Did you find training course interactive?
5. Would you recommend this course to your colleague?
The grading of each question has been categorized to 5 grades, from 5 for very important to 1 for least important. The highest total score would be 25 and the lowest score be 5.

This study demonstrated that the rate of completeness of PCRs from ambulance agencies were severely low even in a metropolitan area in Taiwan before the related administrative regulations have been implemented. We believe it would result in severe problems in patient safety during the process of emergency management and transportation. Implementation of administrative regulation and assurance of health policies were proven to improve such deficiencies.
As mentioned above, the PCR should be met with the following criteria:^3,4 1) Factual: The log should chronicle objective information reported by emergency medical technicians --what they observe about the scene, glean from their assessment, or treatments rendered to the patient. Resist the impulse to speculate, judge character, or to label behaviors by using slang or demeaning statements abbreviated as code initials. On the other hand, using appropriate medical abbreviations increases the amount of information that can be noted in a limited space and in the short time span taken by most telemetry calls. Charting generally should maintain a sense of profession detachment. 2) Accurate: Even factual records will be subject to scrutiny if they look inaccurate or unreliable. During the discovery period, attorneys from both sides will examine all charts or logs and compare the actual notations to written standards. Every word and time frame may be meaningful. Inaccurate or incomplete entries, without just cause, diminish the reliability of the record. 3) Complete: The communications log should stand alone as a chronologic recording of all out-of-hospital events. It is helpful if boxes are present that al low quick checkmarks noting either ?ithin normal limits?or other locally customized notations suggesting a pathologic condition (nausea, vomiting, cough, etc.) Equally helpful are check boxes for routine assessments, such as quantification of pain, pupil size and reactivity, breath sounds, skin color, temperature, moisture, level of consciousness, Glasgow Coma Scale scores and trauma scores. Forms constructed to facilitate quick notations of care rendered in the field, destination, and estimated time of arrival are also beneficial provided local protocols define the applicable standards of practice. 4) Timely: The EMT should document as much as possible during the run.⁵ If this cannot be done contemporaneously, jot down shorthand notes so that details remain fresh until the staff can finish the record. All vital signs, rhythm interpretations, assessments, and out-of-hospital interventions should be timed unless local protocols indicate otherwise.
Patient tracking is always an important issue in disaster medicine.^6,7 To provide direction for the development and use of patient tracking mechanisms at different levels in a disaster or mass casualty incidents, transport providers will record the total number of patients transported and each patient? triage tag number, triage category, field site of origin and destination. Receiving hospitals or receiving destinations will record the number of patients received by triage number, triage category and will attempt to further identify them as time and resources allow and as provided in the facility? disaster plan. Accurate tracking of numbers of patients is critical to the ability to project medical resource use and need at all levels of the system, the ability to provide information to concerned family members; and the ability to not ?ose?patients evacuated or transferred out of the area. However, we believe that patient records or PCRs are one of the important components that maintain good patient tracking. In other words, the role of PCRs is more important in chaotic circumstances such as disasters.
Inter-hospital patient transfer is a different issue from other pre-hospital transportation and care. It is related to the policies of hospitals and administrative agencies. In lack of uniform administrative regulations, the performance of inter-hospital transfer depends upon mainly the regulations of hospitals themselves and their related ambulance cooptation or agencies. Any deficiencies in these related policies are closely associated the problem of patient safety and disaster preparation. We are glad to find the implementation of administrative regulations that defined the obligations of ambulance during inter-hospital transportation and care certainly improved the completeness and quality of PCRs in this field. We believe that it is a small and definitely significant step in patient safety and disaster preparation.