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  • The intensive care unit medical director should play an active role in each hospital's disaster planning.
  • The Joint Commission on Accreditation of Healthcare Organizations requires that each hospital develop, implement, and regularly test a disaster plan.
  • A hazard vulnerability analysis should be conducted by each hospital to identify threats to care of patients specific to its region.
  • Preparation should coordinate all community resources and not be focused on a single ICU or hospital.
  • Each ICU medical director should identify his or her role within the emergency command structure (typically the hospital emergency incident command system).
  • Back-up methods of communication such as walkie-talkies should be acquired and tested to ensure reliable communication between the ICU and the hospital command center.
  • A pool of potential volunteer ICU medical personnel should be identified prior to a disaster and mechanisms put into place to provide emergency credentialing.
  • An active disaster education program should be created to keep all ICU personnel up to date.
  • Participation in realistic disaster exercises is important to identify problems within each hospital's plan and to reinforce education.

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Hospitals today are faced with a daunting task: to prepare for community disasters that could bring a large number of injured or ill patients to their doorsteps. Since September 11, 2001, the threats to a community and its hospitals seem endless. In addition to the terrible events surrounding the World Trade Towers collapse, a more insidious attack occurred in the form of anthrax delivered through the mail. Health care workers have died as a result of severe acute respiratory syndrome (SARS), which represents an emerging, highly contagious infectious disease. Natural disasters have wreaked havoc on numerous health care facilities, and have jeopardized patient well-being.

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During a disaster, hospitals serve as a refuge for the injured and ill. Unfortunately, the ability of health care organizations to prepare for these would-be crises is jeopardized by current financial constraints. To many hospital administrators, maintaining facility solvency at their current rate of reimbursement is the real threat, while expending funds for disaster preparedness seems less essential. Hospitals must operate in a fiscally efficient manner, operating near full capacity. The ability of a typical hospital system to absorb large numbers of injured patients during an emergency either acutely, or over a more prolonged period of time, is extremely limited. More importantly, there has been little outside financial support to fund hospital disaster preparedness efforts.

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First responders (police, fire department, and EMS) remain the primary focus for most ongoing disaster preparedness efforts. However, as mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), all hospitals must have a functional disaster plan. As we learned during the recent SARS dilemma, the intensive care unit (ICU) is a key element of a hospital's response to large-scale incidents. In addition to emerging infectious diseases, trauma, bioterrorism, chemical attack, and radiation-induced injury are possible occurrences. Unfortunately, there is little written in the medical literature about the effects on structure ...

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