Background:
There were several catastrophe in the last decades in the world. Make-up of systematic measuring and life-saving medical systems is urgent and essential issue. Our efforts for establishing disaster medicine, including ethical and philosophical points for surgeons are presented.

Material and Methods:
Mega-disasters or catastrophe are researched basically under our actual medical experience in sites: i.e., the 9-11 attack in 2001 in USA, sarin toxic gas attack in 1995 in Tokyo, Hurricane Katrina in 2005, in USA, Indian Ocean earthquake with tsunami in 2004 in South Asia, the Chernobyl Incident in 1986 in USSR or Ukraine, as well as the Higashinihon Earthquakes with tsunami, followed by the Fukushima nuclear plant disaster in 2011 in Japan.

Result:
Two different roles are demanded for surgeon: i.e., as a specialist with emergency surgical skills (micro-disaster field) and as triage officer and/or general control of medical teams(macro- disaster field). Moreover, we believe that knowledge and/or technic of treatment against special disasters, such as NBC or nuclear, biological and chemical hazards is necessary. Recently used sarin or other toxic gas in Syria supports.

Conclusion:
Therefore, the disaster medicine compendium is a matter of great urgency. We compiled the disaster medicine compendium Japanese version as of the year 2005. Although usually the utilitarianism, so-called “The greatest good for the greatest number” by Bentham and Mill are accepted widely, there are problems left for saving the vulnerable people during disaster. The ethical or philosophical points are also reviewed.