Chapter 8: Disaster and Mass Casualty

INTRODUCTION

No one can predict the time, location, or complexity of the next disaster. The management of the medical effects of contemporary disasters, whether natural or man-made, is one of the most significant challenges facing medical providers today. Disaster medical care, including trauma care, is not the same as conventional medical care. Disaster medical care requires a fundamental change (“crisis management care”) in the care of disaster victims in order to achieve the objective of providing the “greatest good for the greatest number of individuals.”^1,2,3,4,5 The demands of disaster medical care have changed over the past decade, both in the scope of medical care, the type of threats, and the field of operations (Fig. 8-1). Mass casualty incidents (MCI) are events causing numbers of casualties large enough to disrupt the health care services of the affected region. This is in contrast to multiple casualty events in which medical resources are strained (prehospital and/or hospital resources) but not overwhelmed. Demand for resources always exceeds the Supply of available resources in a disaster.

EPIDEMIOLOGY OF DISASTERS

Natural disasters may be classified as sudden-impact (acute) disasters or chronic-onset (slow) disasters.⁶ Sudden-impact natural disasters generally cause significant mortality and morbidity immediately as a direct result of the primary event (eg, traumatic injuries, crush injuries, drowning).⁷ Chronic-onset disasters cause mortality and morbidity through prolonged secondary effects (eg, infectious disease outbreaks, dehydration, and malnutrition). Earthquakes, tsunamis, landslides, and wildfires are examples of sudden-impact disasters. Chronic-onset disasters include famines, droughts, and infectious disease epidemics.

Man-made disasters may be unintentional or intentional (terrorism).^1,8,9,10 The spectrum of agents used by terrorists is limitless and includes conventional weapons, explosives, and weapons of mass destruction (biological, chemical, and radioactive agents). Over 70% of terrorist attacks involve the use of explosive weapons. Improvised explosive devices (IEDs) are a particular concern for trauma providers (Fig. 8-2). Such incidents present a significant challenge due to the complexity of injuries (primary, secondary, tertiary, and quaternary blast injuries).^{1,7,8,9,10,11} Responders must also be aware of the potential for secondary strikes directed at harming medical personnel. Terrorists do not have to kill people to achieve their goals. They just have to create a climate of fear and panic to overwhelm the health care system (examples: sarin/anthrax attacks).

PRINCIPLES OF DISASTER RESPONSE

Principle 1

Medical providers cannot utilize traditional command and control structures when participating in disaster response. The Incident Command/Management System is the accepted ...