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KEY POINTS
The objective of disaster medical care is the “greatest good for the greatest number of victims.”
The Incident Command System/Incident Management System is the accepted disaster management system for all disasters, regardless of size or etiology.
Disaster management teams are based on functional capabilities, not titles.
The goal of disaster response is to reduce the number of survivors from the disaster who subsequently die (critical mortality rate).
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The prehospital and hospital management of the medical effects of contemporary disasters, whether natural or humanmade, is one of the most significant challenges facing trauma providers today. No one can predict the time, location, or complexity of the next disaster. The demands of disaster care have changed over the past decade in the types of threats, the scope of care, and the field of operations (Fig. 12-1). Many of today’s disasters occur or result in austere environments. Access, transport, resources, and other aspects of the physical, social, political, or economic environments may impose severe constraints on the adequacy of immediate care to victims of the disaster.1-3
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Trauma providers must be prepared to respond to both mass casualty incidents and multiple casualty events.1,4 Mass casualty incidents (MCIs) are events causing numbers of casualties large enough to disrupt the health care services in the affected community or region. Demand for resources always exceeds the supply of available resources in an MCI. This is in contrast to multiple casualty events (MCEs) in which medical resources are strained (prehospital and/or hospital resources) but not overwhelmed. Disasters involving weapons of mass destruction (WMD; biological, chemical, and radioactive), accidental or intentional (terrorism), are increasing in frequency and present unique challenges in the delivery of care to victims by trauma providers.1,5,6 Active shooter incidents resulting in multiple casualties have been on the rise throughout the world, significantly increasing the challenges for trauma providers and trauma centers.7-10
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Disaster trauma care is not the same as conventional trauma care. Disaster care requires a fundamental change (crisis management care) in the care of disaster victims to achieve the objective of providing the “greatest good for the greatest number of victims.”1-3
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EPIDEMIOLOGY OF DISASTERS
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Natural disasters may be classified as sudden-impact (acute) disasters or chronic-onset (slow) disasters.1,11 Sudden-impact natural disasters generally cause significant mortality and morbidity immediately as a direct result of the primary event (eg, earthquakes). Traumatic injuries such as crush injuries and burns are common injuries in sudden-impact disasters. Chronic-onset disasters (eg, droughts) cause mortality and morbidity through prolonged secondary effects such as infectious disease outbreaks, dehydration, and malnutrition.
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Disasters involving WMD, whether accidental or intentional ...