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The human species has endured plague, famine, and natural disaster since the beginning of written record and likely since the beginning of time. Global flooding, earthquakes, hurricanes, and tropical cyclones have killed millions and injured millions more in the 20th century alone. In addition to threats from nature, humanity faces man-made disasters that are becoming more common and complex. As technology increases, so does our ability to wreak havoc with environmental disasters and high-impact production accidents or engineering failures.

Developed countries routinely spend millions of man-hours and trillions of dollars on disaster response. In the United States this includes comprehensive disaster preparedness and response systems to mitigate disaster-related morbidity and mortality, including our US health care infrastructure. As key leaders in emergency and pre-hospital medicine worldwide, emergency physicians are poised to be providers with the knowledge and ability to respond to the multitude of patients who will present from disaster incidents. Accordingly, it is imperative that the emergency physician be educated and able to function in the disaster environment.

This chapter will mainly highlight the emergency response structure and systems for United States disaster responses. While some information is applicable to other countries, disaster response varies greatly in other parts of the world.


  • Disaster: The term disaster refers to a loss of infrastructure secondary to a natural or man-made event, such as a tornado, a wildfire, or flood. The term “state of disaster” refers to an ongoing need for outside resources past the initial “medical” surge of a disaster. A disaster often but not always includes a mass casualty incident as defined below.

  • Disaster medical assistance team (DMAT): A DMAT is a group of professional and paraprofessional medical personnel, supported by a cadre of logistical and administrative staff, designed to provide medical care during a disaster or other events.

  • Disaster response framework: A system-based approach to disaster preparedness, response, recovery, and mitigation in the United States. This falls under the Office of the Assistant Secretary for Preparedness and Response (OASPR).

  • Emergency Management Assistance Compact (EMAC): Administered by the National Emergency Management Association (NEMA), this is a mutual aid agreement among states for the provision of emergency aid to one another. EMAC assistance may precede federal assistance.

  • Emergency operation center (EOC): A preplanned location where key leaders will convene to direct emergency functions in a disaster. This location may be hardened or protected against threats and usually is equipped with computers, phones, and media equipment to allow for incident command systems (ICS) or hospital ICS (HICS) operations which are defined below.

  • Emergency support functions (ESF): Emergency support functions are groupings of governmental and private sector assets structured to provide resources and implementation of services needed to save life, protect property and the environment, restore essential services, and fix critical infrastructure. Health care functions including emergency medical services (EMS) ...

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