1. Multiple Casualties

2. Multiple Causalities  Disaster: “a sudden ecologic phenomenon of sufficient magnitude to require external assistance” WHO  Disaster: when the number of patients presenting within a given time is such that the medical providers cannot provide care for them without external assistance.  Key concepts: It is independent of a specific number of victims The impact exceeds the available resources  The key principle of disaster medical care is to: DO THE GREATEST GOOD FOR THE GRATEST NUMBER OF PATIENTS

3. The Disaster Cycle  The quiescence level or the interdisaster period: the time during which risk assessment should be taken and plans for response to likely events developed, tested and implemented.  Prodrome phase or warning phase: specific events has been identified as inevitable going to occur.

4. Cont. The Disaster Cycle  The impact phase or the presentation of actual event; during which often little can be done to alter the actual impact.  The rescue phase: is the time immediately after impact during which response occurs.  The recovery phase or reconstruction phase.

5. Mass-Causality Incident Management  Medical concerns: Search and rescue Triage and initial stabilization Definitive medical care Evacuation  Public health concerns: Water Food Shelter Sanitation Security and safety Transportation Communication Endemic and epidemic diseases

6. Medical Response to Disaster – Initial Response  Notification and activation of EMS  An overall scene assessment to estimate the number of causalities, …  Communicate the assessment to the dispatch center  Identification appropriate location to perform triage  Notify the likely receiving hospitals

7. Medical Response to Disaster – Search and Rescue  The on-scene process of initiating patient care begin  The local community services respond to disaster  Specialized search and rescue teams as part of disaster plans  Local construction companies may provide search and rescue assets.

8. Cont. Medical Response to Disaster – Initial Response  The search and rescue units include: A cadre of medical specialists Technical specialists knowledgeable in hazardous materials, structural engineering, heavy equipments operations and technical search and rescue methods Trained canines and their handlers

9. Medical Response to Disaster – Triage  Ability to walk  Airway  Respiratory rate  Pulse rate or capillary return

10. Cont. Medical Response to Disaster – Triage

11.  Important features of triage area: Proximity to the disaster site Safety from hazards and upwind location from contaminated environment Protection from climatic conditions Easy visibility for disaster victims Convenient exit routes for air and land evacuation

12. Medical Response to Disaster – Transport  70 % - 80 % of causalities will get to a hospital without EMS hospital transport.  If the closest hospital is overwhelmed, the EMS should transport patients to more distance facilities.

13. Decontamination  It is an important part of all disasters involving hazardous materials.

14. Disaster Education and Training  Independent learning: is the foundation of disaster preparedness.  Group training is directed at a specific response teams with regard to disaster response  Simulations provide a training opportunity that brings together many individuals from varied and different background who are essential to implementation of disaster response