Typically, in the past, the hospital closest to the disaster site received an inordinately large number of disaster victims as well as the most critically injured. It is important that the casualty load be distributed among available hospitals so that the injured receive prompt and appropriate treatment and individual hospitals do not become overwhelmed.
However, such a situation may be unavoidable due to large numbers of critically injured patients, blocked transportation routes, or weather conditions. Nevertheless, such problems can be minimized by maintaining good communications between hospitals and on-site EMS command. The on-scene incident commander should be alerted immediately by a potentially overloaded hospital so that less injured and more stable patients can be sent to other hospitals. Secondary triage from one hospital to another may also be necessary if the hospital's capability to handle victims has been exceeded.
Casualties with special problems, such as major burns, carbon monoxide poisoning, and spinal cord injuries, may need to be transferred directly to specialized units, although it may not be possible for these units to accept a large number of injured.
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