Emergency medicine's involvement in disaster medicine

Abstract

Disasters may be classified as 'simple' or 'compound'. A 'simple' disaster is one in which the usual arrangements for casualty management are overstretched but the infrastructure, such as roads, power, water supply, hospitals, etc., remains intact. A 'compound' disaster occurs when the infrastructure is also deranged and commonly is associated with natural disasters such as earthquakes, volcanic eruptions, floods and tsunami, military conflict and major chemical or nuclear accidents. Emergency medicine can make a most effective contribution to simple disasters such as major road, rail and air crashes, building collapse and fire. In these instances good disaster planning, communications, transportation and triage can enable the emergency physician and his colleagues in anaesthesia, surgery, radiology, pathology, nursing, etc. to rise to the occasion with organized help for the surrounding area. In compound disasters emergency medicine has a significant but less dominant role to play, depending on the nature of the catastrophe. In major famine or flood and bacteriological viral disease epidemics, the skills of emergency medicine are rarely appropriate. However, in traumatic events such as e.arthquakes and volcanic eruptions, experience has shown that emergency medicine and allied specialties can have a significant part to play (Safar, 1976; Klein et al, 1989). The success of their intervention will depend on a number of factors over and above their normal clinical skills. These factors include: