National medical response to mass disasters in the United States. Are we prepared?
E. A. Pretto Jr and P. Safar
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, School of Medicine, PA 15260.
Preparing for a resuscitation response to mass disasters, such as major
earthquakes or industrial disasters, requires revisions of present local,
regional, and national disaster plans. These should include the following:
(1) life-supporting first aid and basic rescue capability of the lay
public; (2) advanced trauma life support and advanced (heavy) rescue
capability brought quickly to the scene from local and surrounding
(regional) emergency medical services systems; and (3) trauma hospitals
sending medical resuscitation teams to, and receiving casualties from, the
disaster scene for resuscitative surgery and definitive care. Local and
regional everyday emergency medical services systems would respond first.
The armed forces should help, at least for transport and security. We
propose that the National Disaster Medical System replace its civil defense
model with an emergency medical services model, designed to mobilize rapid
support for local emergency medical services systems from regional, state,
and national resources. Coordination should be by one federal agency, such
as the Federal Emergency Management Agency, which, however, needs to focus
more on resuscitation through physician input.
