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Koenig and Schultz's Disaster Medicine
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Book description

As societies become more complex and interconnected, the global risk for catastrophic disasters is increasing. Demand for expertise to mitigate the human suffering and damage these events cause is also high. A new field of disaster medicine is emerging, offering innovative approaches to optimize disaster management. Much of the information needed to create the foundation for this growing specialty is not objectively described or is scattered among multiple different sources. Now, for the first time, a coherent and comprehensive collection of scientific observations and evidence-based recommendations with expert contributors from around the globe is available in Koenig and Schultz's Disaster Medicine: Comprehensive Principles and Practices. This definitive work on disaster medicine identifies essential subject matter, clarifies nomenclature, and outlines necessary areas of proficiency for healthcare professionals handling mass casualty crises. It also describes in-depth strategies for the rapid diagnosis and treatment of victims suffering from blast injuries or exposure to chemical, biological, and radiological agents.

Reviews

'There are so many exceptional chapters in this text that it is almost unfair to single out selected ones for praise … Even those who consider themselves experienced will learn a lot in studying from this compilation … meticulously researched and exhaustive … Disaster Medicine: Comprehensive Principles and Practices is just that:comprehensive. Students, seasoned practitioners, health systems organizations, and academic institutions will find it a most welcome and invaluable addition to their reference libraries.'

Source: Annals of Emergency Medicine

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Contents

Page 1 of 2

Contents
  • 1 - Disaster Research and Epidemiology
    pp 3-20
  • View abstract

    Summary

    This chapter discusses research methods and findings in the context of the broader spectrum of processes involved in disasters. The discussion of the state of the art focuses on three aspects of disaster research: methodology, vulnerability, and estimates of morbidity and mortality. The study of disasters can occur in many different physical and temporal contexts. Disaster research, as with most other types of research, utilizes both qualitative and quantitative data. Surveys of individuals, healthcare providers, and healthcare organizations are heavily utilized in disaster epidemiology to obtain quantitative data about the health status of a population and possible associations between disaster exposure and health outcomes. The most commonly mentioned dimensions of vulnerability in disaster research are physical, economic, political, social, and psychological. The discussion of disaster morbidity and mortality describes how these estimates are derived, as well as the many factors that can influence their accuracy and introduce variability across studies.
  • 2 - Disaster Education and Training: Linking Individual and Organizational Learning and Performance
    pp 21-32
  • View abstract

    Summary

    Disaster education and training programs must be designed to reflect the interdisciplinary and intergovernmental nature of the emergency management, public health, public safety, and medical systems. This chapter explains the overall context for disaster health education efforts, describing the Instructional System Development (ISD) approach to developing education and training programs. It identifies examples of disaster health education and training programs for various audiences. The use of the ISD model can improve the efficacy of these programs, emphasizing the emergency management program development cycle. To improve operational level integration, the U.S. government has mandated the use of the Incident Command System (ICS). In the U.S. there are several programs that involve training the public to support formal response efforts in disasters. These include: the Citizens Corps, Medical Reserve Corps (MRC), and Community Emergency Response Team (CERT). Disaster education and training events are designed to improve individual and organizational performance during emergencies.
  • 3 - Surge Capacity
    pp 33-50
  • View abstract

    Summary

    A comprehensive surge system consists of well-balanced capacity and capability in personnel (staff), supplies and equipment (stuff), and physical structure and management infrastructure (structure). This chapter describes this 3S Surge System. The complexities surrounding surge capacity start with the myriad of definitions related to medical surge. The Metropolitan Medical Response System (MMRS) is a locally managed emergency preparedness and response system that is integrated into state and federal programs. Hospitals and other healthcare facilities must have plans to expand their capacity to manage a surge in the number of patients needing care during a disaster. An important source of surge response within the US is provided by formal State to State requests and offers of support. Evidence-based data on efficacy of interventions and best outcomes in surge capacity are limited. Further studies on the efficacy of interventions and their impact on individual-based versus population-based outcomes are needed.
  • 4 - International Perspectives on Disaster Management
    pp 51-61
  • View abstract

    Summary

    This chapter presents an international perspective that focuses on the evolution of the approach health specialists have used to reduce the health consequences linked to disasters. It highlights some of the main aspects of humanitarian disaster response training and disaster risk reduction. The chapter explores how disaster management has evolved to its present status. Both governmental and regional institutions have significantly improved their disaster management efforts over the last 30 years. The agency within the ministry of health is the designated entity for protecting health from the consequences of disasters. The rate at which disasters occur has a substantial impact on institutional development of these agencies. The humanitarian reform movement has generated the concept of dividing humanitarian assistance into several topic specific groups called clusters. Finally, the chapter explores avenues for future growth, and discusses examples of developments in emergency medicine education and research.
  • 5 - Ethical Issues in Disaster Medicine
    pp 62-74
  • View abstract

    Summary

    This chapter presents important ethical principles, codes of conduct, and cardinal virtues gleaned from history that may assist emergency managers and disaster response personnel who are confronted by ethical dilemmas encountered in disaster preparedness and response. One of the most common and arguably the most popular bioethical theories in developed western democratic societies is the application of ethical principles or Principlism. Under the influence of this theory, three bioethical principles have dominated clinical decision making within the confines of the doctor-patient relationship. Asserting virtue as an essential element to the practice of disaster medicine requires accepting as a starting premise that there is an ideal toward which emergency and disaster healthcare professionals should strive. Future empiric research in the field should help discern the feasibility of screening for, selecting, teaching, and modeling the cardinal virtues among provider candidates in advance of a disaster or multiple casualty incidents.
  • 6 - Emerging Infectious Diseases: Concepts in Preparing for and Responding to the Next Microbial Threat
    pp 75-102
  • View abstract

    Summary

    Factors such as increased global commerce and travel, and the threat of the intentional release of pathogens have set the stage for infectious disease disasters with large numbers of casualties. This chapter addresses the concepts and tools necessary to prepare better for and respond to infectious diseases disasters in general. Surveillance is an assessment tool for the general functioning of a public health system. Practice exercises and past disasters have demonstrated that the response and mitigation effort is improved by good working relationships between public health, public safety, and healthcare workers. Many aspects of successful management of an infectious disease disaster are dependent on timely and accurate communications between different stakeholders. The multidisciplinary focus of effort toward the fields of infectious diseases biology and epidemiology is a nascent application that holds promise for the future of both infectious diseases and disaster medicine.
  • 7 - Disaster Mental and Behavioral Health
    pp 103-112
  • View abstract

    Summary

    This chapter describes the range and timeline of typical reactions, approaches for screening, triage, and referral, preventing and managing psychological injuries, and integrated strategies to support disaster responders. Disasters and acts of terrorism produce a spectrum of common physiological, psychological, social, behavioral, emotional, cognitive, and spiritual reactions. An emerging incident management model for disaster mental and behavioral health is composed of three major components to enable a common operational picture for participating entities and jurisdictions. The components include community-based disaster systems of care, a common system for incident/event-specific rapid triage, and information technology for near-real-time data linkage. Psychological impact and resulting levels of psychiatric disorders may vary as a function of event characteristics, such as terrorism using weapons that can cause mass casualties and societal disruption. Using leadership, public messaging, and education greatly improves the mental and behavioral health of communities impacted by disasters and mass violence.
  • 8 - Special Needs Populations
    pp 113-130
  • View abstract

    Summary

    In studying the impact of disasters, concern has developed regarding populations that demonstrate a greater vulnerability to injury, death, and/or property loss. This chapter reviews populations at risk and identifies the special needs that each might experience. Personnel with responsibilities for managing disasters reflect on how each population might be present in their practices or jurisdictions. The chapter examines a number of the populations considered vulnerable by generally following the emergence of that literature as it has unfolded over the past few decades. Both emergency managers and disaster researchers tend to group the practice and knowledge relating to disasters into a life cycle of emergency management. In the U.S., the National Governor's Association organized the phases into preparedness, response, recovery, and mitigation activities. The chapter addresses special needs concerns within each phase. It concludes with a consideration of practical strategies and includes recommendations for future research and a resource section.
  • 9 - Public Health and Emergency Management Systems
    pp 133-150
  • View abstract

    Summary

    This chapter addresses concepts and issues that are essential for understanding how public health integrates with emergency management at all levels and in varying emergency circumstances. It presents a general overview of public health and emergency management systems and shows how they interface. One critical strategy to maintain public health in health-related emergencies is containment and prevention of disease. The chapter discusses the comprehensive emergency management, and outlines the incident command system (ICS), including the adoption within the United States of the National Incident Management System (NIMS). It explains the interconnectivity of healthcare systems as it relates to public health and emergency management systems and activities. The chapter describes the management of volunteers who spontaneously volunteer or are assigned to public health and deploy in support of emergencies. Finally, it examines the communications among public health and emergency management systems.
  • 10 - Legislative Authorities and Regulatory Issues
    pp 151-164
  • View abstract

    Summary

    This chapter reviews disaster legal issues primarily from the perspective of a person or institution, who collectively provide medical care to patients in the midst of catastrophic disaster or other public health emergency. It summarizes the key changes in the legal environment under which disaster medicine is practiced. Most medical providers use well-developed procedures to assure that any exchange of patient information complies with law. In the U.S., states regulate the practice of medicine. Thus, providers must be licensed in the state in which they are providing medical care. Medicare in the U.S. also promulgates federal hospital emergency management plan accreditation requirements. The U.S. Emergency Medical Treatment and Labor Act (EMTALA) requires Medicare participating hospitals to provide any individual presenting for care on hospital grounds with medical screening, stabilizing services, and appropriate transfer to a higher level of care if indicated.
  • 11 - Syndromic Surveillance
    pp 165-173
  • View abstract

    Summary

    The concept of syndromic surveillance is relatively straightforward, although the proof of concept and/or value is yet to be shown. There are multiple syndromic surveillance systems in use around the globe and even across the U.S. Syndromic surveillance contrasts with the "knowledgeable intermediary" the single clinician who, recognizing that a patient or group of patients arriving for care display an unusual set of signs or symptoms, activates public health authorities. This chapter gives a brief listing of several U.S. surveillance systems, past and present, using a variety of methodologies to achieve certain goals. To add value to any syndromic surveillance system, the addition of nonhuman data might also be useful. There are a variety of mathematical data analysis formulae in place in the extant syndromic surveillance systems. Syndromic surveillance is necessary because of difficulty establishing a diagnosis in a timely manner for human infectious diseases.
  • 12 - Triage
    pp 174-183
  • View abstract

    Summary

    This chapter presents a description of the triage systems. These systems include Simple Triage and Rapid Treatment (START), Homebush Triage Standard, CareFlight Triage, Triage Sieve, the Sacco Triage Method, the CESIRA Protocol, MASS Triage, and Military/NATO Triage. The chapter provides a brief discussion of the Sort, Assess, Lifesaving measures, Treat/Transport (SALT) system. SALT begins with a global sorting of patients to prioritize them for individual assessment. The chapter discusses the secondary triage systems SAVE and Triage Sort, as well as the pediatric specific systems, JumpSTART and the Pediatric Triage Tape. There are two categories of outcomes that could be used in assessing how triage affects patient outcome: patient-based scoring systems and resource based systems. Specific attention to chemical, biological, and radiological/nuclear (CBRN) events is a critical component of state of the art triage systems and must be considered when choosing a triage methodology.
  • 13 - Personal Protective Equipment
    pp 184-194
  • View abstract

    Summary

    Personal protective equipment (PPE) as a means to protect human beings from hazardous materials has been an evolving science throughout history. Discussion on PPE requires a brief historical review of biological, chemical, and nuclear warfare. In responding to disasters, healthcare providers may be exposed to toxic and infectious agents. Therefore, knowledge of PPE and why such equipment would be necessary is important. The selection of PPE is challenging and is based on several factors: the environment in which the hazardous agent is deployed, the concentration of the agent, the type of threat encountered, and the duration of an individual's exposure to the hazardous agent. Although research and development to further improve technologies and capabilities is required if healthcare personnel are to protect themselves and the healthcare infrastructure, it is also equally important that all healthcare personnel be trained and educated on the use of PPE and decontamination techniques.
  • 14 - Decontamination
    pp 195-202
  • View abstract

    Summary

    This chapter discusses the decontamination of humans after exposure to a hazardous substance. Much of the current knowledge surrounding decontamination and the management of the contaminated patient is based primarily on anecdotal evidence, personal experience, and common sense. Individuals who are able to walk into a shower and clean themselves receive a more thorough decontamination than non-ambulatory individuals. Historically, mass exposure to chemicals has been due to agents in the form of a vapor or gas. Clothing removal essentially completes the decontamination process. Recognizing that contaminated victims are present is the first critical step for a successful decontamination program. A basic tenet of emergency response is ensuring scene safety; failure to ensure the safety of responders and other nearby persons risks the creation of more victims. To assist with environmental protection, medical and health workers should dispose of contaminant and contaminated items in a fashion consistent with safe practices.
  • 15 - Quarantine
    pp 203-212
  • View abstract

    Summary

    Quarantine is an important tool in the armamentarium for protection of the public health from contagious infectious diseases. This chapter reviews the complexities of quarantine related to three separate but tightly linked perspectives: efficacy; legal authority; and ethical, as well as logistical, challenges in implementation. Quarantine has often been used interchangeably with isolation and civil commitment. In the United States, two model public health laws, the Model State Emergency Health Powers Act (MSEHPA) and the Turning Point Model State Public Health Act acknowledge that traditional public health powers such as surveillance, quarantine, and isolation are among the most outdated provisions in existing state laws The WHO addresses the legal issues of quarantine and outlines a collective defense strategy. It published legal guidance in the International Health Regulations 2005 (IHR-2005). The federal government also has the responsibility to assist states in the execution of their quarantine laws.
  • 16 - Mass Dispensing of Antibiotics and Vaccines
    pp 213-227
  • View abstract

    Summary

    The development of mass dispensing clinics and mass vaccination clinics should be incorporated into community disaster plans. Federal assistance in the event of a large-scale public health emergency requiring mass antibiotic prophylaxis or vaccination includes obtaining necessary medications from several sources. In the United States, the Strategic National Stockpile (SNS) is a federally managed supply of antibiotics, vaccines, antitoxins, antivirals, medical supplies, and equipment that is available to affected areas once local, state, or regional supplies are depleted or systems are overwhelmed. Points of dispensing (PODs) operation are the mechanisms available for dispensing medication or administering vaccines to large population after a catastrophic event. Medication-related adverse events may be seen in varying numbers in a mass dispensing or mass vaccination campaign. Each POD location should have the appropriate equipment such as forklifts or pallet jacks to move deliveries as well as sufficient equipment to provide cold chain storage as needed.
  • 17 - Management of Mass Gatherings
    pp 228-252
  • View abstract

    Summary

    The management of mass gatherings encompasses a wide range of activities because of varying types of events and baseline medical and health infrastructures. A classification system for mass gatherings can aid in the planning process internationally and also achieve a commonality of language for describing future events. This cycle of event, analysis, training, planning, and new event should be the goal for those involved in organizing mass gathering medical care. The event plan specifies the various training requirements, certifications, and indemnity/malpractice or insurance required of the medical director and deputy. Management of a mass gathering from the medical perspective requires human resources, medical equipment, pharmaceuticals, and medical facilities with sufficient examination rooms on site. As mass gatherings become more frequent, more experts need to be trained and more research performed to ensure continued reductions in morbidity and mortality among those attending or managing such events.
  • 18 - Transportation Disasters
    pp 253-274
  • View abstract

    Summary

    In this chapter, the author uses the Haddon Matrix to describe the disasters affecting each mode of transportation and the British Major Incident Medical Management System (MIMMS) to illustrate how these events are managed. The chapter deals with air disasters, sea (ship and ferry) disasters, rail (train/railway) disasters, and motor vehicle (bus/coach) disasters. Airport rescue resources must adapt to local circumstances. Implementation of a well-developed communication plan after an aviation incident facilitates transmission of information to all participating agencies. "Load and go" principles have been used in takeoff and landing crashes because the transport times are often quite short. The large losses in sea disasters have often been related to warfare. An incident at sea often happens far from land and from emergency and rescue resources. The chapter focuses on the most probable type of traffic mass casualty event that rescue forces encounter, that is, a bus or coach crash.
  • 19 - Emergency Medical Services Scene Management
    pp 275-284
  • View abstract

    Summary

    Effective emergency medical services (EMS) scene management contributes to the success of the response and mitigation phases. Management of large and sustained incidents is structured around command and general staff in association with geographical divisions, functional branches, and groups. Command and general staff consist of an incident commander or a unified command when multiple disciplines are needed to manage the incident. Reporting to the incident commander is the general staff: operations section chief, plans section chief, logistics section chief, and finance/administration section chief. To manage a multicasualty incident site, initial responders should establish an incident command system and appoint an incident commander and personnel to function as triage unit leader and medical communications coordinator. These essential three functions meet the initial needs of organizing resources, assessing the incident, reporting conditions and hazards (scene safety), requesting additional resources, initiating victim triage, and establishing communications with the EMS and healthcare infrastructure.
  • 20 - Healthcare Facility Disaster Management
    pp 285-311
  • View abstract

    Summary

    Disaster preparedness in healthcare facilities has historically been a low priority and is often viewed as a chore or unnecessary mandate. Researchers published numerous articles and manuals, and policy makers developed seminars devoted to medical surge capacity building. In January 2001, The Joint Commission made significant improvements to its emergency management accreditation standards that strengthened preparedness in hospitals. A central principle to these standards is the requirement that accredited hospitals have an emergency management committee (EMC). A surge capacity plan must consider all the hazards likely to create a sudden increase in healthcare demands. For many decades, hospitals and other healthcare facilities have included evacuation procedures in their emergency plans, but the emphasis was on a response to fire events. Research is needed to determine international, national, state, and local government priorities for funding hospital disaster preparedness as well as the perspective of the health insurance industry in this regard.
  • 21 - Mass Fatality Management
    pp 312-325
  • View abstract

    Summary

    This chapter examines current methods for addressing disaster fatality issues and discusses some of the complicating factors encountered during a mass fatality response. It discusses the current best practices for managing disaster fatalities. In most disasters, positive identification of disaster victims is based on the comparison of unique biological attributes observed in the remains with concurrent evidence of these features detailed in dental and medical records, radiographs, and other reliable documents. This method of comparing antemortem records with postmortem findings is routine in daily nondisaster forensic casework. DNA analysis is a powerful tool in disaster victim identification and offers a high degree of statistical confidence in its results. Mass fatality responders must provide a standard of care for the disaster dead and their families reflecting both the needs of the living and the complexities of managing the dead.

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