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Disasters have claimed millions of lives and cost billions of dollars worldwide in the past few decades. Examples of large-scale disasters include the terrorist attacks of September 11, 2001; the 2004 Pacific Ocean tsunami; the 2010 earthquake in Haiti; the 2011 earthquake and tsunami in Japan; and Superstorm Sandy of 2012. Emergency physicians frequently have extensive responsibilities for community and hospital-level disaster preparedness and response. This chapter discusses the definition of a disaster, disaster preparedness and planning, the hospital emergency operations plan, field disaster response, and the ED disaster response.


The World Health Organization defines a disaster as a sudden ecologic phenomenon of sufficient magnitude to require external assistance. A disaster is an event that overwhelms the resources of the region or location in which it occurs. Furthermore, a hospital disaster may similarly be defined as an event that overwhelms the resources of the receiving hospital. A hospital disaster may be of any size and is not limited to mass casualty incidents. A single patient who ingested an organic phosphorous pesticide may overwhelm the resources of a hospital if that hospital is not prepared to decontaminate external to the ED. A single patient with suspected smallpox or a single influential patient (e.g., world leader or a celebrity) may use so many ED resources that it affects the care of other patients.

Whether an event is a disaster further depends on the time of day, nature of the injuries, type of event, and the amount of preparation time before the arrival of patients. The ED "surge capacity" (ability of the ED to care for more patients than is typical) may be severely limited by hospital overcrowding.

When it appears that the normal procedures of an ED may be interrupted by an event, there must be policies and procedures in place to activate a disaster response, direct the mobilization of personnel and equipment, and permit the rapid triage, assessment, stabilization, and definitive care of victims.


Disasters are subdivided into several categories (Table 5-1). External disasters occur at locations that are physically separate from the hospital (e.g., transportation accident, industrial accident). An internal disaster is an event that occurs within the confines of the hospital (e.g., bomb scare, laboratory accident involving radiologic agents, power failure). Disasters can be both internal and external (e.g., earthquake with mass casualties as well as damage to the internal hospital). Further discussions of disasters are provided in the following chapters: chapter 6, Natural Disasters; chapter 8, Chemical Disasters; and chapter 9, Bioterrorism.

TABLE 5-1Types of Disasters

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