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September 4, 1991, Vol 266, No. 9 >
ARTICLE | September 4, 1991

National Medical Response to Mass Disasters in the United States: Title and subTitle BreakAre We Prepared? FREE

Ernesto A. Pretto, Jr, MD; Peter Safar, MD
[+] Author Affiliations

Presented in part at the Sixth Congress of the World Association for Emergency and Disaster Medicine (Club of Mainz), Hong Kong, September 12, 1989.

Reprint requests to University of Pittsburgh, International Resuscitation Research Center, 3434 Fifth Ave, Pittsburgh, PA 15260 (Dr Pretto).


JAMA. 1991;266(9):1259-1262. doi:10.1001/jama.1991.03470090093038
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Article
References

Preparing for a resuscitation response to mass disasters, such as major earthquakes or industrial disasters, requires revisions of present local, regional, and national disaster plans. These should include the following: (1) life-supporting first aid and basic rescue capability of the lay public; (2) advanced trauma life support and advanced (heavy) rescue capability brought quickly to the scene from local and surrounding (regional) emergency medical services systems; and (3) trauma hospitals sending medical resuscitation teams to, and receiving casualties from, the disaster scene for resuscitative surgery and definitive care. Local and regional everyday emergency medical services systems would respond first. The armed forces should help, at least for transport and security. We propose that the National Disaster Medical System replace its civil defense model with an emergency medical services model, designed to mobilize rapid support for local emergency medical services systems from regional, state, and national resources. Coordination should be by one federal agency, such as the Federal Emergency Management Agency, which, however, needs to focus more on resuscitation through physician input.

(JAMA. 1991;266:1259-1262)

REFERENCES

1 +
Safar P.  Resuscitation potentials in mass disasters. Prehosp Disaster Med . 1986;;12:34-47.
2 +
Klain M, Ricci E, Safar P, et al.  Disaster reanimatology potentials: a structured interview study in Armenia, I: methodology and preliminary results. Prehosp Disaster Med . 1989;;4:135-154.
3 +
Ricci EM, Pretto EA, Safar P, et al.  Disaster reanimatology potentials: a structured interview study in Armenia. Prehosp Disaster Med . 1991;;6:159-166.
4 +
Pretto E, Ricci E, Klain M, et al.  Disaster reanimatology potentials: a structured interview study in Armenia, III: results, conclusions, and recommendations. Prehosp Disaster Med . 1991;;6:245. Abstract.
5 +
Abrams J, Pretto E, Angus D, Safar P.  Basic extrication training of the lay public for disaster preparedness. Prehosp Disaster Med . 1991;;6:257. Abstract.
6 +
Safar P.  The pathophysiology of dying and reanimation.  In: Schwartz G, Safar P, Stone JH, Storey PB, Wagner DK, eds. Principles and Practice of Emergency Medicine . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1986;:2-41.
7 +
Leaning J, Lewis D.  The future of FEMA. J Emerg Med Services . 1991;;16:11-15.
8 +
Bisgard JC, Mullaly CF.  The Civilian-Military Contingency Hospital System (CMCHS) in the USA. Prehosp Disaster Med . 1985;;1:35-38.
9 +
Beary JF, Bisgard JC, Armstrong PC.  The Civilian-Military Contingency Hospital System (CMCHS): pro and con. N Engl J Med . 1982;;306:738-740.
10 +
World Health Organization.  Effects of nuclear war on health and health services. Prehosp Disaster Med . 1985;;1:17.
11 +
World Association for Emergency and Disaster Medicine.  Resolutions concerning disaster medicine and nuclear war. Prehosp Disaster Med . 1985;;1:15.
12 +
Silverstein ME.  The national disaster medical system planning for the USA. Prehosp Disaster Med . 1985;;1:39-42.
13 +
Moritsugu KT, Reutershan TP.  The National Disaster Medical System: a concept in large scale emergency care. Ann Emerg Med . 1986;;15:1496-1498.
14 +
Mahoney LE, Reutershan TP.  Catastrophic disasters and the design of disaster medical care systems. Ann Emerg Med . 1987;;16:1085-1091.
15 +
Mahoney LE, Whiteside DF, Belue HE, Moritsugu KP, Esch VH.  Disaster medical assistance teams. Ann Emerg Med . 1987;;16:354-358.
16 +
Reardon JD, Sandwall S.  National Disaster Medical System: medical manpower component establishment. Federal Register . (April 20) , 1988;;53:12994-12995.
17 +
Roth PB, Vogel A, Key G, Hall D, Stockhoff CT.  The St Croix disaster and the National Disaster Medical System. Ann Emerg Med . 1991;;20:391-395.
18 +
Safar P, Bircher NG. Cardiopulmonary Cerebral Resuscitation . 3rd ed. Philadelphia, Pa: WB Saunders Co; 1988;.
19 +
Safar P, Pretto E, Bircher N.  Disaster resuscitology including the management of severe trauma.  In: Baskett P, Weller R, eds. Medicine for Disasters . London, England: Wright-Butterworth Publishers; 1988;:36-86.
20 +
American College of Surgeons Committee on Trauma. Advanced Trauma Life Support Course for Physicians, 1989 . Chicago, Ill: American College of Surgeons; 1989;.
21 +
American Society of Anesthesiologists, Committee on Acute Medicine.  Community-wide emergency medical services. JAMA . 1968;;204:595-602.
22 +
Safar P, Ramos V, Mosquera J, et al.  Anecdotes on resuscitation potentials following the earthquake of 1970 in Peru. Prehosp Disaster Med . 1987;;3:124.
23 +
Safar P, Kirimli N, Agnes A, Magalini S. Anecdotes on resuscitation potentials following the earthquake of 1980 in Italy. In: Proceedings of Fourth World Congress on Emergency and Disaster Medicine. June 1985; Brighton, England. Abstract.
24 +
DeBruycker M, Greco D, Lechat MF.  The 1980 earthquake in southern Italy: morbidity and mortality. Int J Epidemiol . 1985;;14:113-117.
25 +
Molfese A.  1980 earthquake in Basilicata. Prehosp Disaster Med . 1987;;3:96-98.
26 +
Bozza-Marrubini M.  Three major disasters in Italy: experience of Niguarda Hospital of Milan as 'base hospital.' Prehosp Disaster Med . 1985;;1( (suppl I) ):414-419.
27 +
Manni C, Paderni S.  The earthquake in Italy in 1980. Prehosp Disaster Med . 1985;;1( (suppl 1) ):412-414.
28 +
Villazon-Sahagun A.  Mexico City earthquake medical response. Prehosp Disaster Med . 1986;;2:15-20.
29 +
Zeballos JL.  Health effects of the Mexico earthquake: 19th September 1985. Disasters . 1986;;10:141-149.
30 +
Romo CR.  The Mexico City earthquake, an international disaster: an overview. Prehosp Disaster Med . 1986;;2:4-8.
31 +
Comfort L.  International disaster assistance in the Mexico City earthquake. J Latin American Stud . 1986;;1:12-43.
32 +
Noji EK, Kelen GD, Armenian HK, Oganessian A, Jones NP, Sivertson KT.  The 1988 earthquake in Soviet Armenia: a case study. Ann Emerg Med . 1990;;19:891-897.
33 +
Ker RA.  How the Armenia quake became a killer. Science . 1989;;243:170.
34 +
Olson RS, Comfort LC, Pantelic J, et al.  Loma Prieta earthquake reconnaissance report: socioeconomic impacts and emergency response. Earthquake Spectra . 1990;;6( (suppl) ):393-451.
35 +
Boyd DR.  The Illinois Trauma Program: a systems approach to the care of the critically injured. J Trauma . 1973;;13:275-276.
36 +
Eisenberg MS, Horwood BT, Cummins RO, Reynolds-Haertle R, Hearne TR.  Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med . 1990;;19:179-186.
37 +
Alexander RH, Pons PT, Krischer J, Hunt P.  The effect of advanced life support and sophisticated hospital systems on motor vehicle mortality. J Trauma . 1984;;24:486-489.
38 +
Jacobs LM, Sinclair A, Beiser A, D'Agostino RB.  Prehospital advanced life support: benefits in trauma. J Trauma . 1984;;24:8-13.
39 +
Kraus JF.  Epidemiology of head injury.  In: Cooper PR, ed. Head Injury . 2nd ed. Baltimore, Md: Williams & Wilkins; 1987;:1-19.
40 +
Cowley RA, Baskett P, eds.  Focus on disasters. Prehosp Disaster Med . 1986;;2:1-234.
41 +
Siegelson HJ, Kaplan B.  Medical disaster management in the United States. N Engl J Med . 1989;;14:941-942.
42 +
Safar P, Berkebile P, Scott MA, et al.  Education research on life-supporting first aid (LSFA) and CPR self-training systems (STS). Crit Care Med . 1981;;9:403-404.
43 +
Bircher N, Safar P.  Life-supporting first aid (LSFA) and infant CPR (ICPR) self-training in children. Crit Care Med . 1983;;11:251. Abstract.
44 +
Star LD, Abelson LC, DelGuercio LRM, et al.  Mobilization of trauma teams for aircraft disasters. Aviation Space Environ Med . 1980;;51:1261.
45 +
Kvetan K.  Operation Desert Storm: task force on disaster and critical care. Crit Care Med . 1991;;19:854-856.
46 +
Cowley RA.  The total emergency medical system for the state of Maryland. Md Med J . 1975;;24:37.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Safar P.  Resuscitation potentials in mass disasters. Prehosp Disaster Med . 1986;;12:34-47.
2 +
Klain M, Ricci E, Safar P, et al.  Disaster reanimatology potentials: a structured interview study in Armenia, I: methodology and preliminary results. Prehosp Disaster Med . 1989;;4:135-154.
3 +
Ricci EM, Pretto EA, Safar P, et al.  Disaster reanimatology potentials: a structured interview study in Armenia. Prehosp Disaster Med . 1991;;6:159-166.
4 +
Pretto E, Ricci E, Klain M, et al.  Disaster reanimatology potentials: a structured interview study in Armenia, III: results, conclusions, and recommendations. Prehosp Disaster Med . 1991;;6:245. Abstract.
5 +
Abrams J, Pretto E, Angus D, Safar P.  Basic extrication training of the lay public for disaster preparedness. Prehosp Disaster Med . 1991;;6:257. Abstract.
6 +
Safar P.  The pathophysiology of dying and reanimation.  In: Schwartz G, Safar P, Stone JH, Storey PB, Wagner DK, eds. Principles and Practice of Emergency Medicine . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1986;:2-41.
7 +
Leaning J, Lewis D.  The future of FEMA. J Emerg Med Services . 1991;;16:11-15.
8 +
Bisgard JC, Mullaly CF.  The Civilian-Military Contingency Hospital System (CMCHS) in the USA. Prehosp Disaster Med . 1985;;1:35-38.
9 +
Beary JF, Bisgard JC, Armstrong PC.  The Civilian-Military Contingency Hospital System (CMCHS): pro and con. N Engl J Med . 1982;;306:738-740.
10 +
World Health Organization.  Effects of nuclear war on health and health services. Prehosp Disaster Med . 1985;;1:17.
11 +
World Association for Emergency and Disaster Medicine.  Resolutions concerning disaster medicine and nuclear war. Prehosp Disaster Med . 1985;;1:15.
12 +
Silverstein ME.  The national disaster medical system planning for the USA. Prehosp Disaster Med . 1985;;1:39-42.
13 +
Moritsugu KT, Reutershan TP.  The National Disaster Medical System: a concept in large scale emergency care. Ann Emerg Med . 1986;;15:1496-1498.
14 +
Mahoney LE, Reutershan TP.  Catastrophic disasters and the design of disaster medical care systems. Ann Emerg Med . 1987;;16:1085-1091.
15 +
Mahoney LE, Whiteside DF, Belue HE, Moritsugu KP, Esch VH.  Disaster medical assistance teams. Ann Emerg Med . 1987;;16:354-358.
16 +
Reardon JD, Sandwall S.  National Disaster Medical System: medical manpower component establishment. Federal Register . (April 20) , 1988;;53:12994-12995.
17 +
Roth PB, Vogel A, Key G, Hall D, Stockhoff CT.  The St Croix disaster and the National Disaster Medical System. Ann Emerg Med . 1991;;20:391-395.
18 +
Safar P, Bircher NG. Cardiopulmonary Cerebral Resuscitation . 3rd ed. Philadelphia, Pa: WB Saunders Co; 1988;.
19 +
Safar P, Pretto E, Bircher N.  Disaster resuscitology including the management of severe trauma.  In: Baskett P, Weller R, eds. Medicine for Disasters . London, England: Wright-Butterworth Publishers; 1988;:36-86.
20 +
American College of Surgeons Committee on Trauma. Advanced Trauma Life Support Course for Physicians, 1989 . Chicago, Ill: American College of Surgeons; 1989;.
21 +
American Society of Anesthesiologists, Committee on Acute Medicine.  Community-wide emergency medical services. JAMA . 1968;;204:595-602.
22 +
Safar P, Ramos V, Mosquera J, et al.  Anecdotes on resuscitation potentials following the earthquake of 1970 in Peru. Prehosp Disaster Med . 1987;;3:124.
23 +
Safar P, Kirimli N, Agnes A, Magalini S. Anecdotes on resuscitation potentials following the earthquake of 1980 in Italy. In: Proceedings of Fourth World Congress on Emergency and Disaster Medicine. June 1985; Brighton, England. Abstract.
24 +
DeBruycker M, Greco D, Lechat MF.  The 1980 earthquake in southern Italy: morbidity and mortality. Int J Epidemiol . 1985;;14:113-117.
25 +
Molfese A.  1980 earthquake in Basilicata. Prehosp Disaster Med . 1987;;3:96-98.
26 +
Bozza-Marrubini M.  Three major disasters in Italy: experience of Niguarda Hospital of Milan as 'base hospital.' Prehosp Disaster Med . 1985;;1( (suppl I) ):414-419.
27 +
Manni C, Paderni S.  The earthquake in Italy in 1980. Prehosp Disaster Med . 1985;;1( (suppl 1) ):412-414.
28 +
Villazon-Sahagun A.  Mexico City earthquake medical response. Prehosp Disaster Med . 1986;;2:15-20.
29 +
Zeballos JL.  Health effects of the Mexico earthquake: 19th September 1985. Disasters . 1986;;10:141-149.
30 +
Romo CR.  The Mexico City earthquake, an international disaster: an overview. Prehosp Disaster Med . 1986;;2:4-8.
31 +
Comfort L.  International disaster assistance in the Mexico City earthquake. J Latin American Stud . 1986;;1:12-43.
32 +
Noji EK, Kelen GD, Armenian HK, Oganessian A, Jones NP, Sivertson KT.  The 1988 earthquake in Soviet Armenia: a case study. Ann Emerg Med . 1990;;19:891-897.
33 +
Ker RA.  How the Armenia quake became a killer. Science . 1989;;243:170.
34 +
Olson RS, Comfort LC, Pantelic J, et al.  Loma Prieta earthquake reconnaissance report: socioeconomic impacts and emergency response. Earthquake Spectra . 1990;;6( (suppl) ):393-451.
35 +
Boyd DR.  The Illinois Trauma Program: a systems approach to the care of the critically injured. J Trauma . 1973;;13:275-276.
36 +
Eisenberg MS, Horwood BT, Cummins RO, Reynolds-Haertle R, Hearne TR.  Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med . 1990;;19:179-186.
37 +
Alexander RH, Pons PT, Krischer J, Hunt P.  The effect of advanced life support and sophisticated hospital systems on motor vehicle mortality. J Trauma . 1984;;24:486-489.
38 +
Jacobs LM, Sinclair A, Beiser A, D'Agostino RB.  Prehospital advanced life support: benefits in trauma. J Trauma . 1984;;24:8-13.
39 +
Kraus JF.  Epidemiology of head injury.  In: Cooper PR, ed. Head Injury . 2nd ed. Baltimore, Md: Williams & Wilkins; 1987;:1-19.
40 +
Cowley RA, Baskett P, eds.  Focus on disasters. Prehosp Disaster Med . 1986;;2:1-234.
41 +
Siegelson HJ, Kaplan B.  Medical disaster management in the United States. N Engl J Med . 1989;;14:941-942.
42 +
Safar P, Berkebile P, Scott MA, et al.  Education research on life-supporting first aid (LSFA) and CPR self-training systems (STS). Crit Care Med . 1981;;9:403-404.
43 +
Bircher N, Safar P.  Life-supporting first aid (LSFA) and infant CPR (ICPR) self-training in children. Crit Care Med . 1983;;11:251. Abstract.
44 +
Star LD, Abelson LC, DelGuercio LRM, et al.  Mobilization of trauma teams for aircraft disasters. Aviation Space Environ Med . 1980;;51:1261.
45 +
Kvetan K.  Operation Desert Storm: task force on disaster and critical care. Crit Care Med . 1991;;19:854-856.
46 +
Cowley RA.  The total emergency medical system for the state of Maryland. Md Med J . 1975;;24:37.

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