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KEY POINTS
Major natural and manmade disasters have always occurred, but their increasing frequency over the past decade has elevated awareness of the importance of planning and preparing for catastrophic events.
The responses of different healthcare systems to major disasters in the past have demonstrated the continued need for a more clearly identified planning process in order to effectively respond to multi-hazard events.
The CCM physician should be prepared to provide triage, stabilization, clinical management, teamwork leadership and managing of hospital resources.
The goal in mass casualty scenarios is to minimize mortality and morbidity, but an effective response during a disaster situation depends on multiple variables: nature of the incident, number of victims, resources, and the coordination of efforts, among others.
Understanding the characteristics of different disasters and predicting their impact on the healthcare system, integrating the principles of the command center, and participating in the local disaster planning process will improve the appropriate response by the critical care physician to disaster situations.
Educational efforts are crucial before and after a disaster. Simulation sessions and mock outbreak/disaster exercises must be instituted on a regular base to understand our current level of preparedness, teach personnel how to respond appropriately to these unique situations, predict and be prepared for unexpected events.
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Major natural and manmade disasters have always occurred, but their increasing frequency over the past decade has elevated awareness of the importance of planning and preparing for catastrophic events. Over the past 2 decades, more than 3 million lives have been lost worldwide due to major disasters. In 2008 alone, the total number of deaths caused by disasters with a natural and/or technologic trigger was a staggering 242,662.1 As populations grow and occupy spaces that are vulnerable to different hazards, it is expected that disasters will increase in severity and impact. The New York City Panel on Climate Change 2013 states in its executive summary that “Climate change poses significant risks to New York City’s communities and infrastructure.”2 Analyses of the response of different healthcare systems to major disasters in the past have demonstrated the continued need for a more clearly identified planning process in order to effectively respond to multihazard events.3
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In general, the US Critical Care Medicine System receives massive resources in terms of gross national product expenditure when compared with other developed countries, giving it the capacity to provide care to critically ill patients resulting from these disasters. But the question is whether the US critical care system and the intensivists are ready to handle the challenges such events present.4 The expected percentage of critically injured can vary depending on the nature of the event, but it is estimated to be approximately 16% of the overall number of survivors (range 2.5%-34%).5,6 However, published experience has shown that in mass casualty situations, the ICU is also commonly utilized as an ...