To date, disaster medical response has predominantly focused on pre-hospital issues such as triage, evacuation, and transport of casualties, and has largely assumed that hospital management would occur as planned.

The intensive care unit (ICU) is an essential link in the chain of events that follow a disaster, write Farmer and colleagues. Hospitals across the world have limited bed capacity and staffs are often not prepared for critical situations. As recent events have shown, hospitals can quickly be overwhelmed in the event of a disaster. This is also the case in countries where hospital facilities are thought to be large, modern and sufficiently equipped. For example, after the terrorist bombing in Bali in 2002, 15 patients requiring mechanical ventilation were sent to an Australian hospital, which could only care for a maximum of 12 ventilated patients. Floods in Houston Texas in 2001 quickly led to unavailability of ICU beds. Innumerable examples of attacks and environmental disasters have reinforced that hospital capacity is the major rate-limiting factor during a disaster medical response.

In the paper, Farmer and colleagues suggest improved, hospital-focused training, more detailed co-operation between hospitals, and the dual use of hospital infrastructure and resources. For example, resources currently directed for hospital patient safety could be repurposed to improve training, planning, and effectiveness of the disaster medical response. They argue that critical care professionals should be offered better, more targeted disaster medical training that includes exercises in realistic disas
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Contact: Juliette Savin
juliette@biomedcentral.com
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BioMed Central
26-Jan-2005