Disaster Medical Services

Eric K. Noji Definition.of Disaster

Effect.. of..Mass-Ca.sua!ty..E.ye.n.t.s., on, .an, .EmergencY., Department

Disaster.Pianning

Overview

Hazard. AnalYsis JCAHO, .Requirements

Hospital-communitY ..Cooperation, .in...D.isa.sie.r...P,!.a.nn„in9 The.. HospitalDisasterPlan Ba,sic..Requirements., of.Hospi.ta! ..Planning

Activating., .the..Disaster...Plan

Assessment of the Hospital's Capacity

Establishment .of.. Disaster..C.o.m.m.and

Communication supplies

Hospital. .Disaster.. .Administrative, .and ..Treatment.. Areas

Field.. DisasterOperations

Incident.. CommandSYstem

Communication from Disaster Site to Hospital

DistribMtion...of Casualties to.. Receiving. .Hospitals On-Site ..Disaster. .Medical ..T,eams...fro,m..,H,o,s,p.itals EmergencY ..Department

Initial ..Response

Personnel Notification

SecuritY, .and..Traffic ..Control

Reception., .o,f..Patie,nts

Medical ..C.a.re. ..during. . , D,!s,a,ste,r,,Si,t,uati,o,n?

Aftermath of Disaster

Major.. Disaster. . Response. Organizationsin. the.. United.. States FedeMEmergencY .Ma.nagement..AñencY

Disaster, .Medical ..Assistance., Teams Disaster.Medicine Chapter, References

Natural disasters, such as earthquakes, tornadoes, floods, and hurricanes, have claimed about 3 million lives worldwide during the past 25 years, adversely affecting the lives of at least 800 million more people, and have resulted in property damages exceeding $23 billion. While past disasters have produced their share of mass-casualty situations, the future appears to be even bleaker.1 Increasing population density in flood plains and earthquake- and hurricane-prone areas, the development of thousands of toxic and hazardous materials and their transportation on public roads, the potential risks from incidents at fixed-site industrial facilities, and the catastrophic possibilities of nuclear, biological, and chemical terrorism all suggest the probability of major emergencies in the future. Recent significant disasters include massive summer flooding in the Midwest (1993); earthquakes in Northridge, California (1994), and Kobe, Japan (1995); the bombing of a federal office building in Oklahoma City (1995); a sarin chemical weapon attack on a Tokyo subway (1995); a bombing during the Olympic Games in Atlanta (1996); severe El Nino-related flooding in California (1997); and Hurricane Mitch (1998). 23 and4

This chapter discusses disaster planning and operations with particular emphasis on the emergency department and the role of the emergency physician. Emergency physicians have extensive responsibilities for community disaster preparedness and other disaster medical services. In several position papers, the American College of Emergency Physicians (ACEP) has outlined the scope of emergency physicians' involvement in disaster medical services and stated its belief that "emergency physicians should assume a primary role in the medical aspects of disaster planning, management, and patient care ... [and that] emergency physicians should pursue training that will enable them to fulfill this responsibility." 56 and 7 Despite efficient field management of disaster victims, a rapid flow of victims from a disaster scene can quickly overwhelm a hospital emergency department. Emergency departments must have a specific set of protocols that direct the mobilization of personnel and equipment outside of the emergency department and permit rapid assessment, stabilization, and triage to definitive care of victims of a mass-casualty incident.8

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