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Communication is the exchange of information. Successful communication reaches the correct recipient in a timely manner and is interpreted accurately. In resource-poor situations, especially following disasters, difficulty with communication is usually the major problem faced by health care and other service/rescue providers.

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Multiple space-based satellite communication systems have been used internationally during disasters.1 Even in the best circumstances, this type of communication may not be available until several hours, or even days, after major disasters. However, good communication is needed immediately. Whichever makeshift methods are used depends upon what resources are still available.

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Relying on a predisaster or "normal" telecommunication system—such as landline telephones, cellular telephones, or pager systems—to work in austere circumstances is foolish. Communication systems fail during disasters due to (a) network/signal problems, (b) electrical power loss, (c) damage to infrastructure, (d) surviving infrastructure (telephone, cellular phones, etc.) overload, or (e) system damage that overwhelms repair crews.

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In disasters and other chaotic situations, successful control of the situation depends upon obtaining adequate information and distributing messages to those with "boots on the ground." This often takes ingenuity.

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For example, rather than being used for rescue or extraction, the first helicopter on the scene of a widespread disaster, such as a commercial airliner crash, may best be used as a command and control center for subsequently arriving ground rescue units. The relative positions of the victims and rescue units can be better seen from an elevated vantage point than from the ground. Experience has shown that directing rescue units from the air in these circumstances may save the lives of victims who may otherwise not have been found in a timely manner. This approach also ensures more efficient use of rescue units.

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Most ambulances now have large roof markings for identification from above. If ambulances do not have these, apply temporary markings using water-based paint or tape. Number and letter (alphanumeric) combinations should be used to minimize duplication. Symbols (star, box, tree) may also be used with or without an alphanumeric designation. Everything should be very large, so the controller can see it easily from the air.

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In chaotic situations, it is often difficult to keep track of contact information for the multiple teams, agencies, and individuals. Keep and carry a personal log with this information, as well as a record of important events, directions, methods of making/procuring equipment or supplies, and so forth. During the response to Hurricane Katrina, such a log proved invaluable for tracking the constantly changing satellite and cell phone numbers for key contacts from multiple agencies. Use a small spiral notebook that can fit in your pocket, or a hardback, bound notebook, as some military personnel use.

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During power outages and other crises, cell phones may often be used to bypass other failed systems. However, even with a functional system (i.e., the cell towers working), cell phones may not ...

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