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A National Disaster Medical System (NDMS) has been planned to deal with medical care needs in disasters of great magnitude. NDMS is based on the concepts of the Civilian-Military Contingency Hospital System, in which civilian hospitals voluntarily commit a portion of their beds for military casualties. In the NDMS, the hospital beds will be augmented by medical teams and logistic support to enable the system to serve a large civilian disaster. The system is a cooperative effort of the Department of Health and Human Services, the Department of Defense, the Federal Emergency Management Agency, State and local governments, and the private sector. NDMS will comprise 150 disaster medical response teams to clear and stage civilian casualties, an evacuation system, and 100,000 pre-committed beds in hospitals throughout the Nation. The system will serve national needs in the event of a massive peace-time disaster or an overseas conventional military conflict.
The September 19, 1985, Mexico earthquake reminded scientists and engineers of the importance of considering soil amplification effects in earthquake-resistant design. The Mexico earthquake illustrated the “worst case”—the ground response and the building response occurring at approximately the same period, 2 seconds. This resonance phenomenon was predictable on the basis of similar experiences in past earthquakes. A number of areas in the United States also exhibit significant predictable soil amplification effects. Special steps are needed in these areas to mitigate the potential damage and losses that could occur in future earthquakes.
In 1978 an emergency medical system was established to provide extensive, on the spot treatment for medical emergencies and traffic accidents in Münster. It was designed, like other systems (17,21,23,25,31,34) to treat all types of medical emergencies, although it was initially thought that victims of traffic accidents would predominate. The system covers the city of Münster, which is the capital of Westphalia (see Figure 1) and has a population of 270,000 plus its neighboring communities. Thus, the service provides for 300,000 people over a 20 mile circle in diameter. This area has a low percentage of blue collar workers due to a lack of industry, as Münster is mainly an academic, administrative and business center.
For most civilized people terrorism is hard to imagine. Scenarios are concrete descriptions of events, case studies that help the imagination. Statistics inform, but are abstract. Planners and strategists, be they Colonels, Captains or Chiefs, need good scenarios, and they need to think and talk about them. Those who rely exclusively on statistics, to use a phrase popular in another decade or on another coast, don't get their consciousnesses raised; terrorism remains beyond the imagination.
I will present a process by which many of the prehospital providers in this country are trying to organize effective and efficient response plans for major medical incidents which could in fact include a disaster response.
Many people in the emergency medical services community, including myself, have been involved in a planning process for voluntary national EMS standards, the program being coordinated by the American Society of Testing & Materials (ASTM) F30 Emergency Medical Services Standards Committee. I chair a subtask group on Disaster Management. The committee has prepared a document containing elements, suggestions, processes and procedures from MCI/disaster response plans from EMS agencies around the country. These places include the cities of Los Angeles, New York, Chicago, Washington, D.C. area, Phoenix, Arizona and other urban places. The intent of this task group is not to prepare a document as a rigid standard to cover every detail on an individual task response plan. Instead, the intent of our task group is to provide an overview of expectations of what an individual mass casualty plan should include; focusing on such topical areas as Incident Command Management, communications, triage, transportation, logistical support issues, mutual aid and ancillary support services and many other topical areas that agency planners must address in developing their respective operational response plans.
In May 1985, a cyclone from the Bay of Bengal struck the coastal islands of Bangladesh. In spite of early detection of atmospheric turbulance and the history of severe cyclones in the area, an estimated 11,000 people lost their lives.
In a natural experiment, cyclone death rates from the two severely affected islands, Urir Char and Sandwip, were analyzed to determine the risk factors of cyclone-associated mortality.
In Urir Char, in which no cyclone shelters existed, the study group lost 40 percent of the family members in contrast to 3.4 percent from Sandwip, where at least eight cyclone shelters existed. Individuals who did not seek shelter were at the highest risk. Barriers in seeking safety were physical as well as behavioral. Easy access to shelters was a significant factor in reducing the risk. Deaths could have been averted through improved timing and method of advance warning.
In 1823, Sir William Hilary published a pamphlet entitled “An Appeal to the British Nation on the Humanity and Policy of forming a National Institution for the preservation of Lives and Property from Shipwreck” —and there is no doubt that his drive led to the formation of the Royal National Lifeboat Institution in 1824.
Two short quotations from his pamphlet read: “The succour and support of those persons who may be rescued, the promptly obtaining medical aid, food, clothing and shelter for those who may require such relief,” and “The assistance of medical men who would enrol themselves to be ready to attend, might frequently be of the utmost importance to succour and restore those who might have sustained severe injury or whose lives might be nearly extinct.”
War injury carries a high mortality, particularly for soldiers. In some individuals it may be necessary to recognize that the nature of the injury precludes any successful treatment. In the vast majority, life threatening situations can be averted by proper front-line management on the way to surgery and to the adherence by anesthetists and surgeons of the principles of war surgery which have slowly evolved over many years.
This presentation will discuss search dogs in general, their training, and the experience the dog teams had in the Mexico City earthquake. All of the search dogs in Mexico City, those from the U.S. and other countries, are trained similarly and have a similar job to do. What I will do is explain how the dogs are trained and what they can do.
It is my intention to discuss air scenting dogs, their use and training. You have to remember that the dog and the handler are a team and they train together, they live together, and they work together. The discussion will focus only on the dogs' training.
The object of this paper is to discuss the philosophy of the emergency medical system in Belgium.
In critical situations we should give the best possible treatment as early as possible. As a patient I would like to get the best doctor at the moment I am most in need of him and not when the doctor is badly in need of a patient. The anaesthesiologist is a most suitable practitioner for critical care, trained as he is by the surgeons to protect their patient against all sorts of manmade disasters, very often in distressing conditions.
In Belgium it has been possible to involve anesthesiologists in all aspects of emergency medicine. We are satisfied with this way of handling the problem, and we are not looking for another solution, although we are aware that in other circumstances other solutions may be requested. Nevertheless, we are all well aware that inside our system a further development is needed.
The events in Bhopal in December 1984 shook the world out of its sense of complacency about modern technology in general, and about the chemical industry in particular. This information was gathered from hundreds of interviews with doctors, Union Carbide officials, medical students, voluntary aid service workers and many others. There is a publication embargo on the medical establishment in Bhopal, but we need to plan in the light of their experience.
In Rotterdam with half a million inhabitants in 1974, we set up an integrated approach to pre-hospital coronary care consisting of ambulances equipped with monitoring and resuscitation equipment and staffed with specially trained nurses, who have a central role in cardiac emergencies (Figure 1). In 1979 we started a training program in cardiopulmonary resuscitation for the lay public, with training courses of three hours duration, following the Seattle model.
The establishment and maintenance of pre-hospital patient care delivery systems requires that special emphasis be placed on key areas. Those areas include post start-up activities beginning with a commitment from the business, government and medical communities in order to commission an investigative study aimed at gaining local medical authority and funding approval.
Additionally, once the system is established, there exists several challenges to program managers, including the provision of appropriate and timely leadership and medical education and the establishment of a quality data collection system which supports the expansion and reevaluative processes.
I will discuss the need for a viable pre-hospital contingency plan applicable to mass casualty or disaster mode situations.
It is my experience, during eighteen years in public safety and emergency services, that most organizations are highly competent and responsive to the daily expectations which are placed upon them. As most emergency services managers will tell you, they generally plan for the expected. After all, analysis in such areas as population growth, economic levels, unemployment and criminal trends are the lifeblood of any emergency service agency's personnel, equipment and budgetary allocations. Our level of sophistication today allows us to predict, with some degree of certainty, what demand will be placed on our organizations and how we will meet that demand. The point is this: we in emergency services have been extremely efficient and proficient in addressing the expected needs of the public we serve.
The earthquake that shook Mexico City could not have chosen a more vulnerable target. The capital city is located in the center of the world's most populated area. Some 18 million people, one fourth of the nation's inhabitants, are jammed into a mere 890 square miles, roughly 1% of the predominantly rural area. It is estimated that nearly one third of all families in Mexico City live huddled together in a single room and the average family has five members.
Besides being a densely populated area, Mexico City was founded on a shaky geological base that makes it specially susceptible to tremors. The first human settlements were made on the soft, humid clay of an old lake bed. The city has been constantly sinking through the years and some buildings are even tilted sideways, therefore having a greater risk in case of earth movements.
Most natural disasters that occur frequently may be classified into four main categories: floods, earthquakes, cyclones and famine. Other catastrophic events, such as land slides, avalanches, snow storms, fires occur at rarer occasions and threaten smaller proportions of the populated world. The destructive agents in the above categories are wind, water (a lack or excess thereof) and tectonic force. While all of these cause structural damage, their mortality and morbidity effects are varied both between them and over time. The disaster cycle can be differentiated into five main phases, extending from one disaster to the next. The phases are: the warning phase indicating the possible occurrence of a catastrophe and the threat period during which the disaster is pending; the impact phase when the disaster strikes; the emergency phase when rescue, treatment and salvage activities commence; the rehabilitation phase when essential services are provided on a temporary basis; the reconstruction phase when a permanent return to normality is achieved. The disaster-induced mortality and morbidity differ between these phases and are also a function of the prevailing health and socioeconomic conditions of the affected community. As a result of this, global statistics on disasters seem to indicate a significantly higher frequency of natural disasters in the developing countries than in the industrialized world.
Mass disasters are events which overwhelm, damage or destroy local Emergency Medical Services (EMS) systems, and therefore need the response of a State or National Disaster Medical System (NDMS). Natural mass disasters include major earthquakes, floods, hurricanes and fires. Manmade mass disasters include major fires, industrial accidents, wars, and nuclear accidents. Mass disasters must be distinguished from “multicasualty incidents” (MCI), such as major transportation accidents, which the local EMS system should be able to handle, if necessary, with the assistance of surrounding (regional) EMS systems. Endemic-epidemic disasters (e.g., droughts, famines, infectious diseases, and refugee problems) are catastrophes which deserve separate considerations, as they require ongoing political-economic solutions.