Creating order from chaos: part I: triage, initial care, and tactical considerations in mass casualty and disaster response

• Published in: Military medicine Vol. 172; no. 3; pp. 232 - 236
• Main Author: Baker, Michael S
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.03.2007
• Subjects: Accidents; Aircraft accidents & safety; Algorithms; Casualties; Chemical contaminants; Decision making; Disaster Planning - organization & administration; Disasters; Emergency medical care; Emergency Medical Services - methods; Emergency Medical Services - organization & administration; Emergency preparedness; Hazardous Substances; Hospitals, Military; Humans; Military Medicine - organization & administration; Patients; Skills; Triage - methods; Triage - organization & administration; United States; Warfare; Wounds and Injuries; United States
• ISSN: 0026-4075; 1930-613X
• DOI: 10.7205/MILMED.172.3.232

How do we train for the entire spectrum of potential emergency and crisis scenarios? Will we suddenly face large numbers of combat casualties, an earthquake, a plane crash, an industrial explosion, or a terrorist bombing? The daily routine can suddenly be complicated by large numbers of patients, exceeding the ability to treat in a routine fashion. Disaster events can result in patients with penetrating wounds, burns, blast injuries, chemical contamination, or all of these at once. Some events may disrupt infrastructure or result in loss of essential equipment or key personnel. The chaos of a catastrophic event impedes decision-making and effective treatment of patients. Disasters require a paradigm shift from the application of unlimited resources for the greatest good of each individual patient to the allocation of care, with limited resources, for the greatest good for the greatest number of patients. Training and preparation are essential to remain effective during crises and major catastrophic events. Disaster triage and crisis management represent a tactical art that incorporates clinical skills, didactic information, communication ability, leadership, and decision-making. Planning, rehearsing, and exercising various scenarios encourage the flexibility, adaptability, and innovation required in disaster settings. These skills can bring order to the chaos of overwhelming disaster events.