On-site disaster medical teams dispatched from local hospitals may be of value if victims require prolonged extrication; transportation routes are blocked, preventing easy evacuation to hospitals; or the number of casualties exceeds transportation capacities. Such a team should be dispatched with great caution. Most physicians and nurses function well in an in-hospital setting, but few are prepared, either by training or experience, to work under austere field conditions. Such hospital-based teams should probably not come from the emergency department staff until backup staff has arrived to care for patients expected from the disaster site and those already in the emergency department. The resources for such teams should be carefully planned on a regional basis. The capability to send hospital teams to a disaster site can be developed in a number of ways. For example, an on-site triage team of physicians and nurses can come from teaching hospitals or be created from a pool of volunteer medical staff in office practice. Ideally, at least one institution from each region should maintain such a capability. The designated hospital should store disaster triage kits containing essential resuscitation and stabilization equipment in the emergency department for such circumstances.
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