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Wed, 6 Feb 2002 14:52:06 -0500

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Pret,

Our current hospital disaster plan assumes that the hospital alone can =
and should protect itself from nuclear, chemical, and biological =
cross-contamination from exposed patients.  It directs that victims =
should be decontaminated by hospital staff, using hospital-based =
facilities and equipment.  The challenge, of course, is figuring out how =
such a directive can be practically accomplished...
In our community and surrounding communities that encompass both Level 1 =
and Level 2 capable hospitals, the consensus has been that the HazMat =
teams would be tied up at the incident itself. =20

In a community with scores of thoroughly-trained, well-equipped =
municipal and military hazmat professionals, I'm wondering why =
protection of the hospital isn't a primary element of the community =
disaster plan: prophylactic triage on an industrial scale.   If even ten =
per cent of our regional hazmat personnel and resources were devoted to =
the hospital, it seems to me that we'd have a much cheaper, safer, and =
more effective decontamination process than a cluster of night shift =
nurses who haven't recerted in hazmat since their one-hour inservice =
last summer, and can barely remember how to tape their seams. =20
For this reason, if an incident occurs in the City, then the County =
HazMat Team would support the hospital and vice versa.  Of course in the =
infamous "perfect world" patients should not leave a HazMat Scene unless =
decontaminated.  However, we don't live in this "perfect world", and =
more often than not, the hospital must depend on some level of =
"protection" for it's staff and patients.=20

The other thing one must consider is turnover.  Many areas here utilize =
"travelers" or short term staff that once trained, often are lost in a =
move.

In the recent WMD seminars I have attended, there is not set guideline =
as to facilitate every situation.  In the course sponsored by the =
Department of Justice they encourage responding agencies to actively =
seek a role with, and establish themselves as a technical resource to =
local healthcare facilities.

Not to diminish the dedication or intelligence of my ED colleagues--but =
at what point do we admit that this is simply not a role that they can =
reasonably be expected to maintain competence in?  =20
Then, you must deal with the regulatory bodies that require healthcare =
facilities to maintain a degree of preparedness in dealing with HazMat =
incidents while OSHA requires employees "to be trained to perform their =
anticipated job duties without endangering themselves or others."  =
Furthermore the Joint Commission states that hospital personnel "...must =
have received at least the same degree of training as required for those =
who respond to HazMat incidents."  They further indicate that the =
training should address "hazard operation, identification, medical =
monitoring, environmental surveillance, selection, use and =
decontamination of PPE."  The level of training for PPE are most =
commonly recommended as level C or B, unless the agent is unknown, in =
witch case level A is recommended.  Then you must look at cost =
associated with the purchase and staff training (which is highlighted =
above).  OSHA currently requires training for levels A through D.

Please, somebody agree with me...?  It's so lonely being the only =
loud-mouthed imbecile on the Emergency Preparedness Committee.
In summary...and after running my mouth enough for the day...AGREED!

Michael W. Lewis
Education/QA Coordinator

Medshore Ambulance Service
PO Box 6
Anderson, South Carolina  29622

Main: 864.260.4600
Office: 864.260.4574
Fax: 864.260.4575
Email: mlewisemtp@earthlink.net
  ----- Original Message -----=20
  From: Bjorn, Pret=20
  To: 'trauma-list@trauma.org'=20
  Sent: Wednesday, February 06, 2002 2:09 PM
  Subject: Re: Disaster List?

  Rick,
  =20
  Your response in fact provides a perfect prologue for my question--and =
makes me wonder how you'll respond. =20
  =20
  My major hesitation was that my issues are hazmat-related: not trauma =
in the conventional sense.  Here 'goes anyway.
  =20
  Our current hospital disaster plan assumes that the hospital alone can =
and should protect itself from nuclear, chemical, and biological =
cross-contamination from exposed patients.  It directs that victims =
should be decontaminated by hospital staff, using hospital-based =
facilities and equipment.  The challenge, of course, is figuring out how =
such a directive can be practically accomplished...
  =20
  I'm aware that this is a common characteristic of hospital disaster =
plans.  I nonetheless think it's crazy. =20
  =20
  The practical upshot is that we're going to spend great heaps of money =
building a decontamination area, buying environment suits, and providing =
periodic hazmat training to any number of ED nurses and techs, with the =
understanding that some day five or six of them may be responsible for =
defending themselves, their colleagues, and a 400-bed hospital from =
secondary toxic exposure.  To me, this is like training them to treat =
burn victims AND put out the blaze, or dress the gunshot wounds while =
subduing the assailant: WAY beyond the scope of their training, =
experience, or ability to practice with any confidence.
  =20
  In a community with scores of thoroughly-trained, well-equipped =
municipal and military hazmat professionals, I'm wondering why =
protection of the hospital isn't a primary element of the community =
disaster plan: prophylactic triage on an industrial scale.   If even ten =
per cent of our regional hazmat personnel and resources were devoted to =
the hospital, it seems to me that we'd have a much cheaper, safer, and =
more effective decontamination process than a cluster of night shift =
nurses who haven't recerted in hazmat since their one-hour inservice =
last summer, and can barely remember how to tape their seams. =20
  =20
  Not to diminish the dedication or intelligence of my ED =
colleagues--but at what point do we admit that this is simply not a role =
that they can reasonably be expected to maintain competence in?  =20
  =20
  Please, somebody agree with me...?  It's so lonely being the only =
loud-mouthed imbecile on the Emergency Preparedness Committee.
  =20
  Pret
  =20
   -----Original Message-----
  From: DocRickFry@aol.com [mailto:DocRickFry@aol.com]
  Sent: Wednesday, February 06, 2002 8:20 AM
  To: trauma-list@trauma.org
  Subject: Re: Disaster-List?

    In a message dated 2/6/2002 7:45:54 AM Eastern Standard Time, =
pbjorn@emh.org writes:

      Anyone aware of a list server for the discussion of disaster =
management?

      Pret Bjorn

    What about right here on this list?????
    What do you want to talk about?
    Trauma physicians, nurses and prehospital workers are the natural =
leaders in this area, but in fact have largely abrogated this role--at =
least in the U.S.--to nonmedical agencies.  Disaster planning and =
command in most communities in this country is run by public health, =
city government and emergency management agencies, with the military =
planned to come in as backup along with other state and federal agencies =
(FEMA, OEP, etc). The docs and nurses are relegated to subservient roles =
to the administrators and bureaucrats. This is crazy, but largely our =
own fault.  Look at your own hospital disaster plan and see how little =
it relates to the reality of a true disaster--the literature makes very =
clear what kind of problems we will face in a true mass casualty event, =
but the planners clearly are not aware of this surprisingly abundant =
literature from past disasters.  Unlike most areas of trauma we normally =
discuss, which all of us are familiar with because we all deal with it =
daily, disasters are downright rare--that is why we are so ignorant =
about them--and the only way for us to learn about them is to read what =
others have encountered, and the only way for this to happen is that =
those involved in a disaster put together their experience and results =
in a coherent way to teach the rest of us what to expect.  This has been =
done, but I would bet money very few on this list are aware of this =
literature--who has read the JAMA study from 1996 on the Oklahoma City =
bombing, or the Arch Surg article in 1997 on the Olympics bombing in =
Atlanta, or the 4 papers published 1986-1989 on the bombing of the US =
Marine barracks in Beirut, the 1988 colllective review of terrorist =
bombings worldwide in Annals of Surgery, or of the Bologna train =
terminal bombing in 1980, or John Weigelt's review of the lessons he =
learned in disaster planning following 3 aircraft disasters in Dallas, =
or Len Jacobs' two papers in 1979 and 1983 on the role of trauma centers =
in mass casualty management and planning? =20
    We cannot handle a few hundred casualties all at once in the same =
way we handle the usual handful we see on a busy night--we must be aware =
of the basic change in approach and mindset such an event requires--a =
change from the greatest good for each individual (impossible in a true =
disaster) to the greatest good for the greatest number--from treating =
individuals to treating populations.  Doing away with lab test, x-rays, =
etc and developing a true understanding of what field and scene triage =
really is--something few of us know anymore.  What is an expectant =
injury?  If you don't know, you are not prepared to deal with a disaster
    There's a start for a discussion
    ERF=20

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<DIV><FONT face=3DArial size=3D2>Pret,</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><FONT face=3DArial size=3D2><FONT =
color=3D#800000=20
face=3DArial size=3D2><SPAN=20
class=3D890102313-06022002></SPAN></FONT></FONT></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2><FONT face=3DArial size=3D2><FONT =
color=3D#800000=20
face=3DArial size=3D2><SPAN class=3D890102313-06022002>Our current =
hospital disaster=20
plan assumes that the hospital alone can and should protect itself from =
nuclear,=20
chemical, and biological cross-contamination from exposed =
patients.&nbsp; It=20
directs that victims should be decontaminated by hospital staff, using=20
hospital-based facilities and equipment.&nbsp; The challenge, of course, =
is=20
figuring out how such a directive can be practically=20
accomplished...</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT face=3DArial size=3D2>In our community and surrounding =
communities that=20
encompass both Level 1 and Level 2 capable hospitals, the consensus has =
been=20
that the HazMat teams would be tied up at the incident itself.&nbsp;=20
</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><FONT color=3D#800000 face=3DArial =
size=3D2><SPAN=20
class=3D890102313-06022002></SPAN></FONT></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2><FONT color=3D#800000 face=3DArial =
size=3D2><SPAN=20
class=3D890102313-06022002>In a community with scores of =
thoroughly-trained,=20
well-equipped municipal and military hazmat professionals, I'm wondering =
why=20
protection of the hospital isn't a primary element of the =
<U>community</U>=20
disaster plan: prophylactic triage on an industrial scale.&nbsp;&nbsp; =
If even=20
ten per cent of our regional hazmat personnel and resources were devoted =
to the=20
hospital, it seems to me that we'd have a much cheaper, safer, and more=20
effective decontamination process than a cluster of night shift nurses =
who=20
haven't recerted in hazmat since their one-hour inservice last summer, =
and can=20
barely remember how to tape their seams.&nbsp; =
</SPAN></FONT></FONT></DIV>
<DIV><FONT face=3DArial size=3D2>For this reason, if an incident occurs =
in the City,=20
then the County HazMat Team would support the hospital and vice =
versa.&nbsp; Of=20
course in the infamous "perfect world" patients should not leave a =
HazMat Scene=20
unless decontaminated.&nbsp; However, we don't live in this "perfect =
world", and=20
more often than not, the hospital&nbsp;must depend on some level of =
"protection"=20
for it's staff and patients. </FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>The other thing one must consider is=20
turnover.&nbsp; Many areas here utilize "travelers" or short term staff =
that=20
once trained, often are lost in a move.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>In the recent WMD seminars I have =
attended, there=20
is not set guideline as to facilitate every situation.&nbsp; In the =
course=20
sponsored by the Department of Justice they encourage responding =
agencies to=20
actively seek a role with, and establish themselves as a technical =
resource to=20
local healthcare facilities.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><FONT color=3D#800000 face=3DArial =
size=3D2><SPAN=20
class=3D890102313-06022002></SPAN></FONT></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2><FONT color=3D#800000 face=3DArial =
size=3D2><SPAN=20
class=3D890102313-06022002>Not to diminish the dedication or =
intelligence of my ED=20
colleagues--but at what point do we admit that this is simply not a role =
that=20
they can reasonably be expected to maintain competence in?&nbsp;&nbsp;=20
</SPAN></FONT></FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Then, you must deal with the regulatory =
bodies that=20
require healthcare facilities to maintain a degree of preparedness in =
dealing=20
with HazMat incidents while OSHA requires employees "to be trained to =
perform=20
their anticipated job duties without endangering themselves or =
others."&nbsp;=20
Furthermore the Joint Commission states that hospital personnel "...must =
have=20
received at least the same degree of training as required for those who =
respond=20
to HazMat incidents."&nbsp; They further indicate that the training =
should=20
address "hazard operation, identification, medical monitoring, =
environmental=20
surveillance, selection, use and decontamination of PPE."&nbsp; The =
level of=20
training for PPE are most commonly recommended as level C or B, unless =
the agent=20
is unknown, in witch case level A is recommended.&nbsp; Then you must =
look at=20
cost associated with the purchase and staff training (which is =
highlighted=20
above).&nbsp; OSHA currently requires training for levels A through=20
D.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>
<DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
class=3D890102313-06022002>Please, somebody agree with me...?&nbsp; It's =
so lonely=20
being the only loud-mouthed imbecile on the Emergency Preparedness=20
Committee.</SPAN></FONT></DIV>
<DIV>In summary...and after running my mouth enough for the =
day...AGREED!</DIV>
<DIV>&nbsp;</DIV>
<DIV></FONT>Michael W. Lewis<BR>Education/QA Coordinator</DIV></DIV>
<DIV>&nbsp;</DIV>
<DIV>Medshore Ambulance Service<BR>PO Box 6<BR>Anderson, South =
Carolina&nbsp;=20
29622</DIV>
<DIV>&nbsp;</DIV>
<DIV>Main: 864.260.4600<BR>Office: 864.260.4574<BR>Fax: =
864.260.4575<BR>Email:=20
<A =
href=3D"mailto:mlewisemtp@earthlink.net">mlewisemtp@earthlink.net</A></DI=
V>
<BLOCKQUOTE=20
style=3D"BORDER-LEFT: #000000 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: =
0px; PADDING-LEFT: 5px; PADDING-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A href=3D"mailto:pbjorn@emh.org" title=3Dpbjorn@emh.org>Bjorn, =
Pret</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A=20
  href=3D"mailto:'trauma-list@trauma.org'"=20
  title=3Dtrauma-list@trauma.org>'trauma-list@trauma.org'</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Wednesday, February 06, =
2002 2:09=20
  PM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Re: Disaster =
List?</DIV>
  <DIV><BR></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002>Rick,</SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN =
class=3D890102313-06022002>Your=20
  response in fact provides a perfect prologue for my question--and =
makes me=20
  wonder how you'll respond.&nbsp; </SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN =
class=3D890102313-06022002>My=20
  major hesitation was that my issues are hazmat-related: not trauma in =
the=20
  conventional sense.&nbsp; </SPAN></FONT><FONT color=3D#800000 =
face=3DArial=20
  size=3D2><SPAN class=3D890102313-06022002>Here 'goes =
anyway.</SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT><FONT color=3D#800000 =
face=3DArial=20
  size=3D2><SPAN class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN =
class=3D890102313-06022002>Our=20
  current hospital disaster plan assumes that the hospital alone can and =
should=20
  protect itself from nuclear, chemical, and biological =
cross-contamination from=20
  exposed patients.&nbsp; It directs that victims should be =
decontaminated by=20
  hospital staff, using hospital-based facilities and equipment.&nbsp; =
The=20
  challenge, of course, is figuring out how such a directive can be =
practically=20
  accomplished...</SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT><FONT color=3D#800000 =
face=3DArial=20
  size=3D2><SPAN class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN =
class=3D890102313-06022002>I'm=20
  aware that this is a common characteristic of hospital disaster =
plans.&nbsp; I=20
  nonetheless think it's crazy.&nbsp; </SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT><FONT color=3D#800000 =
face=3DArial=20
  size=3D2><SPAN class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN =
class=3D890102313-06022002>The=20
  practical upshot is that we're going to spend great heaps of money=20
  building&nbsp;a decontamination area, buying environment suits, and =
providing=20
  periodic hazmat training to any number of ED nurses and techs, with =
the=20
  understanding that some day five or six of them may be responsible for =

  defending themselves, their colleagues, and a 400-bed hospital from =
secondary=20
  toxic exposure.&nbsp; </SPAN></FONT><FONT color=3D#800000 face=3DArial =

  size=3D2><SPAN class=3D890102313-06022002>To me, this is like training =
them to=20
  treat burn victims AND put out the blaze, or dress the gunshot wounds =
while=20
  subduing the assailant: WAY beyond the scope of their training, =
experience, or=20
  ability to practice with any confidence.</SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT><FONT color=3D#800000 =
face=3DArial=20
  size=3D2><SPAN class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN =
class=3D890102313-06022002>In a=20
  community with scores of thoroughly-trained, well-equipped municipal =
and=20
  military hazmat professionals, I'm wondering why protection of the =
hospital=20
  isn't a primary element of the <U>community</U> disaster plan: =
prophylactic=20
  triage on an industrial scale.&nbsp;&nbsp; If even ten per cent of our =

  regional hazmat personnel and resources were devoted to the hospital, =
it seems=20
  to me that we'd have a much cheaper, safer, and more effective =
decontamination=20
  process than a cluster of night shift nurses who haven't recerted in =
hazmat=20
  since their one-hour inservice last summer, and can barely remember =
how to=20
  tape their seams.&nbsp; </SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN =
class=3D890102313-06022002>Not=20
  to diminish the dedication or intelligence of my ED colleagues--but at =
what=20
  point do we admit that this is simply not a role that they can =
reasonably be=20
  expected to maintain competence in?&nbsp;&nbsp; </SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002>Please, somebody agree with me...?&nbsp; =
It's so=20
  lonely being the only loud-mouthed imbecile on the Emergency =
Preparedness=20
  Committee.</SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002>Pret</SPAN></FONT></DIV>
  <DIV><FONT color=3D#800000 face=3DArial size=3D2><SPAN=20
  class=3D890102313-06022002></SPAN></FONT><FONT color=3D#800000 =
face=3DArial=20
  size=3D2><SPAN class=3D890102313-06022002></SPAN></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DTahoma><FONT size=3D2><SPAN=20
  class=3D890102313-06022002>&nbsp;</SPAN>-----Original=20
  Message-----<BR><B>From:</B> DocRickFry@aol.com=20
  [mailto:DocRickFry@aol.com]<BR><B>Sent:</B> Wednesday, February 06, =
2002 8:20=20
  AM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Re:=20
  Disaster-List?<BR><BR></DIV></FONT>
  <BLOCKQUOTE></FONT><FONT face=3Darial,helvetica><FONT color=3D#0000ff=20
    face=3D"Comic Sans MS" lang=3D0 size=3D2 FAMILY=3D"SCRIPT"><B>In a =
message dated=20
    2/6/2002 7:45:54 AM Eastern Standard Time, pbjorn@emh.org=20
    writes:<BR><BR></FONT><FONT color=3D#000000 face=3DArial lang=3D0 =
size=3D2=20
    style=3D"BACKGROUND-COLOR: #ffffff" =
FAMILY=3D"SANSSERIF"></B><BR></FONT><FONT=20
    color=3D#800000 face=3DArial lang=3D0 size=3D2 =
style=3D"BACKGROUND-COLOR: #ffffff"=20
    FAMILY=3D"SANSSERIF">
    <BLOCKQUOTE=20
    style=3D"BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; =
MARGIN-RIGHT: 0px; PADDING-LEFT: 5px"=20
    TYPE=3D"CITE">Anyone aware of a list server for the discussion of =
disaster=20
      management?<BR><BR>Pret Bjorn<BR><BR></BLOCKQUOTE><BR></FONT><FONT =

    color=3D#0000ff face=3D"Comic Sans MS" lang=3D0 size=3D2=20
    style=3D"BACKGROUND-COLOR: #ffffff" FAMILY=3D"SCRIPT"><B><BR>What =
about right=20
    here on this list?????<BR>What do you want to talk about?<BR>Trauma=20
    physicians, nurses and prehospital workers are the natural leaders =
in this=20
    area, but in fact have largely abrogated this role--at least in the =
U.S.--to=20
    nonmedical agencies.&nbsp; Disaster planning and command in most =
communities=20
    in this country is run by public health, city government and =
emergency=20
    management agencies, with the military planned to come in as backup =
along=20
    with other state and federal agencies (FEMA, OEP, etc). The docs and =
nurses=20
    are relegated to subservient roles to the administrators and =
bureaucrats.=20
    This is crazy, but largely our own fault.&nbsp; Look at your own =
hospital=20
    disaster plan and see how little it relates to the reality of a true =

    disaster--the literature makes very clear what kind of problems we =
will face=20
    in a true mass casualty event, but the planners clearly are not =
aware of=20
    this surprisingly abundant literature from past disasters.&nbsp; =
Unlike most=20
    areas of trauma we normally discuss, which all of us are familiar =
with=20
    because we all deal with it daily, disasters are downright =
rare--that is why=20
    we are so ignorant about them--and the only way for us to learn =
about them=20
    is to read what others have encountered, and the only way for this =
to happen=20
    is that those involved in a disaster put together their experience =
and=20
    results in a coherent way to teach the rest of us what to =
expect.&nbsp; This=20
    has been done, but I would bet money very few on this list are aware =
of this=20
    literature--who has read the JAMA study from 1996 on the Oklahoma =
City=20
    bombing, or the Arch Surg article in 1997 on the Olympics bombing in =

    Atlanta, or the 4 papers published 1986-1989 on the bombing of the =
US Marine=20
    barracks in Beirut, the 1988 colllective review of terrorist =
bombings=20
    worldwide in Annals of Surgery, or of the Bologna train terminal =
bombing in=20
    1980, or John Weigelt's review of the lessons he learned in disaster =

    planning following 3 aircraft disasters in Dallas, or Len Jacobs' =
two papers=20
    in 1979 and 1983 on the role of trauma centers in mass casualty =
management=20
    and planning?&nbsp; <BR>We cannot handle a few hundred casualties =
all at=20
    once in the same way we handle the usual handful we see on a busy =
night--we=20
    must be aware of the basic change in approach and mindset such an =
event=20
    requires--a change from the greatest good for each individual =
(impossible in=20
    a true disaster) to the greatest good for the greatest number--from =
treating=20
    individuals to treating populations.&nbsp; Doing away with lab test, =
x-rays,=20
    etc and developing a true understanding of what field and scene =
triage=20
    really is--something few of us know anymore.&nbsp; What is an =
expectant=20
    injury?&nbsp; If you don't know, you are not prepared to deal with a =

    disaster<BR>There's a start for a discussion<BR>ERF</B></FONT>=20
  </FONT></BLOCKQUOTE></BLOCKQUOTE></BODY></HTML>

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