Disasters have claimed millions of lives and
cost billions of dollars worldwide in the past few decades. Recent
examples of large-scale disasters include the terrorist attacks
of September 11, 2001, the intentional distribution of anthrax in
the U.S. in 2001, the 2004 Pacific Ocean tsunami, and the 2010 earthquake
in Haiti. Emergency physicians frequently have extensive responsibilities
for community and hospital-level disaster preparedness and response.
This chapter discusses the definition of a disaster, disaster preparedness
and planning, the hospital emergency operations plan, field disaster
response, and the ED disaster response.
The World Health Organization defines a disaster as a sudden
ecologic phenomenon of sufficient magnitude to require external
assistance. A disaster is an event that overwhelms the resources
of the region or location in which it occurs. Furthermore,
a hospital disaster may similarly be defined as an event that overwhelms
the resources of the receiving hospital. It is important to note
that a hospital disaster may be of any size and is not limited to
mass casualty incidents. A single patient who ingested an organic
phosphorous pesticide may overwhelm the resources of a hospital
if that hospital is not prepared to decontaminate external to the
ED. A single patient with suspected smallpox or a single special
patient (e.g., President of the U.S. or a celebrity) may draw so many
resources from the ED that it affects the care of other patients.
Whether an event is a disaster further depends on the time of
day, nature of the injuries, type of event, and the amount of preparation
time before the arrival of patients. The ED “surge capacity” (ability
of the ED to care for more patients than is typical) may be severely
limited by hospital overcrowding.
When it appears that the normal procedures of an ED may be interrupted by
an event, there must be policies and procedures in place to activate
a disaster response, direct the mobilization of personnel and equipment,
and permit the rapid triage, assessment, stabilization, and definitive
care of victims.
Disasters are subdivided into several categories (Table 6-1). External disasters occur at locations that are
physically separate from the hospital (e.g., transportation accident,
industrial accident). An internal disaster is an event that occurs
within the confines of the hospital (e.g., bomb scare, laboratory
accident involving radiologic agents, power failure, fire, etc.). Disasters can
be both internal and external (e.g., earthquake with mass casualties
as well as damage to the internal hospital). Natural disasters are
discussed in 6348648, Chemical Agents in Chapter 9, and bioterrorism in Chapter
Table 6-1 Types of
Disasters |Favorite Table|Download (.pdf)
Table 6-1 Types of
|Natural disaster||Disaster caused by a naturally occurring event||Earthquakes, tsunamis, tornadoes, hurricanes/typhoons,
volcanic eruption, pandemic influenza, etc.|
|Manmade disaster||Nonnatural events that are not ...|
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