Beginning with the first World Trade Center bombing in 1993, the Oklahoma City bombing in 1995, the tragedies of September 11, 2001, and subsequent hurricanes, tornadoes, and manmade tragedies, many American physicians have been faced with responding to disasters equipped with only a general knowledge of emergency casualty care. The…
Objectives: In the aftermath of an environmental public health disaster (EPHD) a healthcare system may be the least equipped entity to respond. Preventable visits for ambulatory care–sensitive conditions (ACSCs) may be used as a population-based indicator to monitor health system access postdisaster. The objective of this study was to examine…
Rarely are hospitals forced to evacuate their nonambulatory patients; however, when a disaster occurs, evacuating nonambulatory patients, particularly from multilevel facilities, represents a major logistical hurdle. Hospital disaster plans often rely on outside agencies and limited equipment to perform vertical evacuations. This article describes a novel method using readily available…
Objectives: The need for healthcare systems and academic medical centers to be optimally prepared in the event of a disaster is well documented. Events such as Hurricane Katrina demonstrate a major gap in disaster preparedness for at-risk medical institutions. To address this gap, we outline the components of complete self-sufficiency…
Disasters with significant numbers of burn-injured patients create incredible challenges for disaster planners. Although not unique to burn care, high-intensity areas of speciality such as burns, pediatrics, and trauma quickly become scarce resources in a disaster. All disasters are local, but regional support is critical in burn disaster planning. On…
Objectives: This article details the development of the Center for Health Professional Training and Emergency Response (CHPTER), including its innovative, competency-based emergency preparedness training (EPT) curriculum, and the results of a regional preparedness workforce assessment. Methods: CHPTER was established in 2009 with the goal of enhancing regional health security and…
Catastrophic disaster planning and response have been impeded by the inability to better coordinate the many components of the emergency response system. Healthcare providers in particular have remained on the periphery of such planning because of a variety of real or perceived barriers. Although hospitals and healthcare systems have worked…
Disaster preparations and responses are incomplete without addressing the mental health aspects of disasters. Unpleasant mental states can be a natural and even adaptive human response following a disaster; however, disasters also can contribute to the development of mental illnesses and substance use disorders or exacerbate existing disorders for disaster…
Paraphrasing Sir Winston Churchill, to every person there comes in his or her lifetime that special moment when he or she is figuratively tapped on the shoulder and asked to do a special thing. What a tragedy if that moment finds him or her unprepared.
You are on call the weekend a category 5 hurricane made landfall and you, along with your colleagues, are trying to evacuate approximately 2000 people (approximately 200 patients) from the hospital which is now surrounded by 8 to 10 ft of floodwaters. Those trapped in the floodwaters are trying to…
So nigh is grandeur to our dust So near to God is man;When duty whispers low, “thou must.”The youth replies, “I can.”—Voluntaries, Ralph Waldo Emerson (1803–1882)1
The 2001 anthrax bioterrorism attacks demonstrated vulnerability for future similar attacks. This article describes mechanisms that can be used to prepare the medical community and healthcare facilities for the diagnosis and management of a subsequent bioterrorism attack should such an event occur and the fundamentals of medical simulation and its…
Objectives: To understand baseline inequities in appendiceal perforation rates and the impact of hurricane destruction on the healthcare system with respect to perforation rates and racial disparities. Methods: We used claims data extracted from Medicaid Analytic Extract files to identify appendicitis diagnoses in children and adolescents based on International Classification…
Objectives: Human-induced public health emergencies such as the anthrax bioterrorism event and the terrorism events of September 11, 2001 in the United States have increased awareness of the nation’s vulnerability to large-scale emergencies. Scant attention has been given to preparing physicians in sparsely populated areas for public health emergencies. This…
Objectives: Little is known about patient populations that remain during or after the mandatory evacuation of a city and use hospital services. This study sought to characterize the population that presented to an emergency department during Hurricane Gustav in 2008. Methods: This was a retrospective chart review of patients who…
On August 29, 2005, Hurricane Katrina made landfall on the US Gulf Coast, causing catastrophic damage to communities and the medical infrastructure throughout the lower half of Mississippi. Substantial power outages, widespread communication failures, and a sustained medical surge of patients provided a unique challenge for the medical care delivery…
Given the current geopolitical tensions, the risk of a terrorist attack on the United States is constant and increasing. Chemical terrorism, specifically the use of nerve agents, has occurred in other nations. Because of the ease of manufacture, the ability to conceal them, and the lethality of these agents, they…
There are an increasing amount and variety of disasters occurring throughout the United States. Many of these disasters require physicians to provide medical assistance. This article provides a brief introduction to disaster preparedness and its recent history and physicians’ obligations, role, education, preparation, and response. It is the intent of…
Elderly adults are faced with many unique health challenges during disasters and public health emergencies. The healthcare system can mitigate the risks to vulnerable elders by recognizing the variations in the environment in which they live and receive care and the likelihood of financial and social isolation and creating disaster…
The objective of this review is to stimulate the reader’s considerations for developing community disaster mitigation. Disaster mitigation begins long before impact and is defined as the actions taken by a community to eliminate or minimize the impact of a disaster. The assessment of vulnerabilities, the development of infrastructure, memoranda…
Medical care in resource-limited environments (austere settings) can occur in the context of a disaster, wilderness, or a tactical field operation. Regardless of the type of environment, there are common organizational themes in most successful humanitarian missions that occur in harsh natural or manmade environmental conditions. These principles prioritize the…
I live and practice in Joplin, Missouri. May 22, 2011 was a typical late spring–early summer day in the Midwest, with intermittent thunderstorms plaguing the day. I was home around 5:00 PM, when tornado warning sirens sounded for several minutes, an event not uncommon in the heart of Tornado Alley….
Current information systems for use in detecting bioterrorist attacks lack a consistent, overarching information architecture. An overview of the use of biological agents as weapons during a bioterrorist attack is presented. Proposed are the design, development, and implementation of a medical informatics system to mine pertinent databases, retrieve relevant data,…
Objective: To describe the injuries and illnesses treated by the American Red Cross (Red Cross) during Hurricanes Gustav and Ike disaster relief operations reported on a new Aggregate Morbidity Report Form. Methods: From August 28 to October 18, 2008, 119 Red Cross field service locations in Louisiana, Mississippi, Tennessee, and…
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