Earthquake and other disasters of this year

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We have seen far too many challenges to our concepts of "disaster" this  
year.    Tsunami, London Subway, Baghdad and surrounds, car  bombings in 
Israel/Palestine, Katrina/Rita, Earthquakes in Kashmire,  Afghanistan, Pakistan, Wilma 
in Mexico, and others.   
 
Many, many categories of concerns and echonomic challenge  exist.    
 
Rescue, Evacuation, Triage, Communications,  Sanitation, Supply,  
Communication, Sterility, Record keeping, Imaging, Command, Authority,  Credentiallying, 
Volunteers, Communication, Control, Leadership, International  Borders, 
Safety, Immediate medical care, Post traumatic stress (among victims  and rescuers), 
relocation, housing, food, water, clothing, shelter  management.   security, 
communication,  regulations, outside  interference, Inside interference, 
unused supplies, supplies which are unusable,  etc. etc. etc. etc.   
 
Whether we debate top down or down up management, it is obvious that the  
challenges of terrorism, war, mass casualty, disaster, overwhelm,  
inaccessability, have many different and many similiar management  challenges.   Many on 
this list server have made significant  contributions to the many health issues 
of such disasters.   However,  one issue remains is that our collaborative 
networks are rudimentary.  It  is also obvious that governments have the 
management role in organization,  rescue, management and supervision.    
 
I have gone back to our disaster manuals, training, drills, and textbook  
chapters and find that organized medicine, organized surgery, and organized  
critical care are a long way from understanding just how disaster  management is 
structured.   It has also become very obvious to me  that much of the higher 
echelons of disaster policy (both governmental,  organizational, and regulatory 
agency) is politically and economically motivated  and does very little 
correlation at the LOCAL operational  level.     
 
We as physicians MUST insenuate ourselves into the public health planning  
and incident control of local disasters to optimize our integrated  
collaborative network efforts.   
 
I am extremely complimentary of the many efforts of individuals who have  
traveled far in order to help those in need.     However, I  do not believe that 
we have a good handle on how to optimize our efforts and  craft.  
 
k 

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