Abstract
Disasters, or mass casualty incidents, occurring in modern history differ from those occurring in even the recent past. In previous times, disasters were mostly the result of natural causes such as earthquakes or floods. Currently, multiple casualty incidents are often the result of human actions such as vehicular accidents involving many vehicles with multiple operators, passengers and collateral victims, terror attacks and acts of war, radiation accidents, toxic chemical releases, and pandemic infectious agent exposures. Especially, events involving accidental and intentional exposures of chemical, biological, radiological/nuclear materials, often abbreviated as CBR or CBRN events present unique challenges to the healthcare system in caring for the victims. In these mass casualty incidents, a fully comprehensive, coordinated team response involving many different components of the community healthcare system need to be mobilized to effectively meet the modern challenge of CBRN events. Necessary components of a modern emergency response include training for prompt triage, decontamination, detoxification, emergency medical treatment, as well as providing appropriate transport to the proper medical treatment facility. Meeting these challenges requires maintaining ongoing communications between agencies charged with meeting the disaster to allow acquisition of information and location for the patients, transfer the information to both the Central Medical Emergency Response Center and the designated hospital. While sharing this information was problematic in the past, modern wireless communications and information technologies provide convenient means for the rapid sharing of important patient data and current situational details. Finally, improving modern disaster response requires the development of a disaster response plan, ongoing training in implementing the plan including disaster scenario simulation, and budgeting to acquire the necessary equipment involved for the emergency response personnel to meet the presenting crisis.
References
1. Guerdan BR. Disaster preparedness and disaster management. Am J Clin Med. 2009; 6:32–40.
2. Health Systems Research Inc. Altered standards of care in mass casualty events [Internet]. Rockvill (MD): Agency for Healthcare Research & Quality;c2005. cited 2015 June 10. Available from: http://archive.ahrq.gov/research/altstand/altstand.pdf/.
3. Frieden T, Ikeda R, Richard C. In a moment's notice: surge capacity for terrorist bombings [Internet]. Atlanta (GA): Centers for Disease Control & Prevention;c2010. cited 2015 June 10. Available from: http://www.acep.org/WorkArea/DownloadAsset.aspx?id=43054/.
5. Rho JC. The failure of national emergency management system, and its structural causes -focused on the SEWOL maritime disaster. Korean Rev Crisis Emerg Manage. 2015; 11:1–18.
6. Altevogt BM, Stroud C, Hanson SL, Hanfling D, Gostin LO. Guidance for establishing crisis standards of care for use in disaster situations: a letter report. Washington, DC: National Academies Press;2009. p. 10–150.
7. Asaeda G. The day that the START triage system came to a STOP: observations from the world trade center disaster. Acad Emerg Med. 2002; 9:255–256.
8. Heightman AJ. Assault on Columbine. EMS amid the chaos of our nation's most violent school incident. JEMS. 1999; 24:32–40. 42–43. 45–46 passim.
9. Cook L. The world trade center attack. The paramedic response: an insider's view. Crit Care. 2001; 5:301–303.
10. Schenker JD, Goldstein S, Braun J, Werner A, Buccellato F, Asaeda G, et al. Triage accuracy at a multiple casualty incident disaster drill: the emergency medical service, fire department of New York City experience. J Burn Care Res. 2006; 27:570–575.
11. Cone DC, Serra J, Burns K, MacMillan DS, Kurland L, Van Gelder C. Pilot test of the SALT mass casualty triage system. Prehosp Emerg Care. 2009; 13:536–540.
12. Lerner EB, Schwartz RB, Coule PL, Pirrallo RG. Use of SALT triage in a simulated mass-casualty incident. Prehosp Emerg Care. 2010; 14:21–25.
13. Zoraster RM, Chidester C, Koenig W. Field triage and patient maldistribution in a mass-casualty incident. Prehosp Disaster Med. 2007; 22:224–229.
14. Monteith RG, Pearce LD. Self-care decontamination within a chemical exposure mass-casualty incident. Prehosp Disaster Med. 2015; 30:288–296.
15. Edkins V, Carter H, Riddle L, Harrison C, Amlôt R. ORCHIDS Work Package 9: systematic review of the needs of vulnerable and minority groups in emergency decontamination. London: Health Protection Agency;2010.
16. Culley JM, Svendsen E. A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures. Am J Disaster Med. 2014; 9:137–150.
17. Cross KP, Petry MJ, Cicero MX. A better START for low-acuity victims: data-driven refinement of mass casualty triage. Prehosp Emerg Care. 2015; 19:272–278.
18. Schultz CH, Annas GJ. Altering the standard of care in disasters--unnecessary and dangerous. Ann Emerg Med. 2012; 59:191–195.
19. Ryu JH, Yeom SR, Jeong JW, Kim YI, Cho SJ. Characteristics and triage of a maritime disaster: an accidental passenger ship collision in Korea. Eur J Emerg Med. 2010; 17:177–180.
20. Tia G, Massey T, Selavo L, Crawford D, Bor-Rong C, Lorincz K, et al. The advanced health and disaster aid network: a light-weight wireless medical system for triage. IEEE Trans Biomed Circuits Syst. 2007; 1:203–216.
21. Gao T, White D. A next generation electronic triage to aid mass casualty emergency medical response. Engineering in Medicine and Biology Society, 2006. EMBS '06. 28th Annual International Conference of the IEEE. Conf Proc IEEE Eng Med Biol Soc. 2006; 6501–6504.
22. Lenert LA, Palmer DA, Chan TC, Rao R. An Intelligent 802.11 Triage Tag For Medical Response to Disasters. AMIA Annu Symp Proc. 2005; 440–444.
23. Sacco WJ, Navin DM, Fiedler KE, Waddell RK, Long WB, Buckman RF Jr. Precise formulation and evidence-based application of resource-constrained triage. Acad Emerg Med. 2005; 12:759–770.
24. Tian Y, Zhou TS, Wang Y, Zhang M, Li JS. Design and development of a mobile-based system for supporting emergency triage decision making. J Med Syst. 2014; 38:65.
25. Becker C. 'We have survived, and we're stronger'. During the year since America s trauma of Sept. 11, New York hospitals--and healthcare organizations nationwide--have taken the painful lessons to heart. Mod Healthc. 2002; 32:22–26.