DISASTER PLANNING, PART I: Overview of Hospital and Emergency Department Planning for Internal and External Disasters

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PREPARING FOR DISASTER

The initial response of hospital personnel to an unexpected event must be based on awareness of the overall hospital disaster plan which has been acted out realistically during drills. As soon as possible, command and communication are established using incident command system (ICS) principles (see the article by Auf der Heide elsewhere in this issue). With a clear chain of command outlined for every department and a command post staffed with trained personnel, a sense of order should prevail

FEATURES OF THE DISASTER PLAN

Hospital disaster plans have several vital features (Table 3). First, each hospital must define the extent of its campus to be covered by the plan. If a hospital is affiliated with a research center, ambulatory care center of medical school, the plan must define precisely all areas covered by the plan and what would constitute a disaster for such a facility. A hospital's treatment capacity should be established but will vary depending on the resources available (power, water, structural

COMMAND CENTER

During all phases, a command post must be established. Command center function, location, and personnel should be clearly identified. In some hospitals the command center functions may be divided. A reporting center is separated from the command post to avoid confusion. In smaller facilities and during night shifts, the command center may need to be located near triage until sufficient personnel are available.

The command post should be staffed with key management personnel such as the hospital

FEATURES OF AN INTERNAL DISASTER PLAN

Internal disaster planning should be an extension of the hospital's external disaster plan with individual plans for a wide variety of potential internal calamities. The importance of planning for internal disasters has been highlighted by many recent hospital reports of disasters occurring within hospitals.1, 17, 26, 28, 38 Situations to be planned for include structural instability, hospital fire or flood, loss of power, loss of medical gases, elevator emergencies, loss of compressed air or

THE ROLE OF THE EMERGENCY DEPARTMENT DURING DISASTER

The emergency department plays a key role in any disaster plan. Acutely, it is the receiving area for all patients and must be responsible for ensuring that adequate decontamination has or will be carried out, as well as triage, stabilization, and initial treatment for all victims of the disaster. Unlike other areas of the hospital, in the weeks following a disaster, most emergency departments can expect increased patient visits. Many disasters have resulted in increased volumes for 2 to 3

LESSONS LEARNED

Experiences encountered during actual disaster situations form the basis for teaching disaster medicine and disaster planning. In "Disaster Planning, Part II," found elsewhere in this issue, Auf der Heide reviews events that have taught disaster planners much. An overview of these lessons learned is provided in this article. It serves to remind us that each disaster situation is unique, and any one type of disaster may be complicated by other events. For example, an earthquake near a nuclear or

CONCLUSION

Disasters are occurring more frequently and with greater impact because of the world's increasing population density. Hospitals are generally expected to provide for a community's health care needs in times of crisis. Yet, they too are vulnerable structures, highly dependent on technologic support to function. Because emergency physicians interface with EMS, the community, and the hospital, they must embrace their role as leaders in hospital disaster planning. Hospital disaster plans must

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References (45)

  • L.E. Mahoney et al.

    Catastrophic disasters and the design of disaster medical care systems

    Ann Emerg Med

    (1987)
  • E.K. Noji

    Progress in disaster management

    Lancet

    (1994)
  • E. Ricci et al.

    Assessment of prehospital and hospital response in disaster

    Crit Care Clin

    (1991)
  • C.M. Sheppa et al.

    The effect of a class IV hurricane on emergency department operations

    Am J Emerg Med

    (1993)
  • R.H. Welch et al.

    Anesthesia during total electrical failure, or what would you do if the lights went out?

    J Clin Anesth

    (1989)
  • R. Aghababian et al.

    Disasters within hospitals

    Ann Emerg Med

    (1994)
  • A. Arvesen et al.

    Contents and updating disaster plans

    Tidsskrift for Den Norske Laegeforening

    (1994)
  • C.S. Counts et al.

    Disaster preparedness: Is your unit ready?

    ANNA Journal

    (1994)
  • J. DeBoer

    Public health measures following a nuclear accident in the netherlands

    J Emerg Med

    (1994)
  • C. Doyl

    Mass casualty incident

    Emerg Med Clin

    (1990)
  • M. Edgell et al.

    Contaminated casualties: Are we ready to receive them?

    Journal of Accident and Emergency Medicine

    (1994)
  • M.L. Ever et al.

    Inpatient triage for out-of-hospital disasters

    NJ Med

    (1992)
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      The decision to implement “disaster triage” involves the additional component of resource allocation implicit in the meaning of the term “disaster.” A disaster can be defined as an event that results in injuries or loss of life and results in a demand for services that exceeds available resources.19 However, in terms of the health care response to an event, this binary concept of either being in a disaster or not is less helpful and likely impairs the response; thus, it is much more useful and common to consider the concepts of surge management.20–23

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    Address reprint requests to C. Phuli Lewis, MD, Department of Emergency Medicine, University of Massachusetts, Medical Center, 55 Lake Avenue North, Worcester, MA 01655

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    From the Division of Emergency Medicine, Department of Emergency Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts

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