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Preparing for response to disaster events presents a unique challenge to emergency department (ED) leaders for a number of reasons. Most often it is assumed that disasters are something that happen “somewhere else.” The likelihood that any given ED will have to respond to a disaster event remains relatively low. Issues of overcrowding, staffing shortages,1,2 violence3 in the workplace, and financial constraints4 are all much more likely daily stresses that might be encountered by ED management. Yet the incidence of disaster events, whether due to natural causes such as extreme weather, or as a result of intentional acts of terrorism, has increased over the past decade.5 “Trends affecting the modern world are resulting in social changes that raise the probability of more and worse disasters in the 21st century… . and stem from ever-increasing industrialization and urbanization… .”6

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The notion that it “won't happen here” really does not apply any longer. Moreover, there are plenty of false assumptions often mistakenly held by ED leaders regarding disaster events (Box 49-1).7 So, it is important to understand the key elements related to disaster preparedness and response in the ED. Indeed, as an ED manager, the leader role in this arena is often very much sought after by hospital administrators, government leaders, and the general public (Figure 49-1). In the decade since the 9/11 attacks, the anthrax mailings, the failures of the levees in New Orleans, and the H1N1 pandemic, hospitals have come a long way in their efforts to prepare for disaster events.8

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Box 49-1 Key Misperceptions Regarding Disaster Events
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However, disaster planning alone does not guarantee successful management of an emergency. In particular: “It is very easy to assume that if there has been disaster planning, there will be successful … management. After all, that would seem to be the ultimate purpose of planning ahead of time. Unfortunately, however, research has shown that is far from being the case; there often is a big gap between what was planned and what actually happens in a major disaster crisis. …”9 But reviewing and implementing the key concepts delineated in this chapter will go a long way to ensuring that the ED is ready to face the multitude of requirements necessary for a successful disaster response.

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