In the aftermath of a disaster the medical infrastructure of the affected zone is often significantly impacted or destroyed. Over the past several decades, telemedicine has been an effective tool used in disasters. Several years ago, the Emerging Security Challenges Division within NATO's Science for Peace and Security Program (SPS) initiated a program with Romania and Russia to develop a multinational telemedicine system (MnTS). Such a system can improve access to health services and increase survival rates in emergency situations that spans both geography and time zones. A MnTS can further the concept of cross border collaboration and meet the mission of the SPS Program.

The planning phase brought together subject matter experts from industry, government, and academia to discuss the integration of telemedicine into an effective system that could be deployed in a disaster. The initial planning involved a number of meetings in Bucharest and Moscow, to outline the approach to the MnTS. In 2014, the MnTS program was formally kicked off with Romania as the key partner country and Dr. Raed Arafat as the program director. Although Russia was involved initially, NATO decided to continue in an Alliance format and select partners only as active participants. Over the next several years, the MnTS program developed a Concept of Operations (CONOPS) document and built a system that included management, clinical and information technology (IT) infrastructure. Following a detailed and robust schedule, the MnTS and the assembled expertise participated in a simulated disaster scenario in the Ukraine in September 2015. In early 2016, the MnTS was expanded to include Finland, Moldova, and Ukraine as full partners.

The MnTS has a number of components and the participants are cognizant of the challenges that are faced in deploying telemedicine in a disaster. These include such areas as IT, language, culture, and legal issues. Each of these has been addressed by expertise in the MnTS program. This book has been assembled as a review of the NATO-funded MnTS and serves as an excellent reference on telemedicine and disasters. It is organized in 14 chapters that follow a thematic approach to the development of the MnTS.

Each chapter, written by subject matter experts, includes a vast array of experiences in MnTS. It includes an historical review of telemedicine and disasters in Chapter 1 and historical perspective of NATO's efforts in the field of telemedicine in Chapter 2. While these two chapters provide a foundation for telemedicine in disasters, Chapters 3–12 provide an excellent summary of how the MnTS was developed out of NATO's SPS Program. These chapters address the important and critical components of the MnTS such as the program's overall organizational structure, the integration of information technology, the legal and regulatory considerations, outreach and public awareness, and the culminating experience of evaluation of the MnTS in a field exercise. The book closes with final thoughts that summarizes the overall MnTS and provides a template for future work in bringing telemedicine as a tool for international disaster response.

Charles R. Doarn

Raed Arafat

Claudiu Zoicas

Rifat Latifi