The professional guidelines developed to help the nation's hospitals cope with a broad spectrum of emergencies have been so successful and so well-received that they have been expanded, revised, and refined to encompass non-emergency situations as well.
Forward-looking planners in Huntsville, Alabama, are seeking to determine the feasibility of using medical facilities as fallout shelters to cope with mass-casualty incidents involving a nuclear or "dirty" bomb.
"Full-scale" exercises sound like, and are, the ideal - but only in certain almost-perfect circumstances, and not without a firm foundation of individual and team training exercises to build on.
The good news is that the fallout shelters built during the Cold War never had to be used. The bad news is that they might have to be resurrected, refurbished and reconditioned, and made available as "just in case" protection facilities.
Standard operating procedures are by definition not enough when EMS responders are called to the scene of a mass-casualty incident. Extraordinary and/or non-standard procedures are not only permitted, therefore, but frequently mandatory.
With fire-prevention programs serving as an example, there is much that "everyday citizens" can learn about protecting themselves and their families in a variety of emergency situations. The most important lesson is learning one's own limitations.
The need for quarantine stations at U.S. borders was on the decline - until SARS & bioterrorism created a need for more stations on a continuing basis. Dulles International Airport (first one), has achieved much success & is a template for future use.
"Just in Case" has been trumped by "Just in Time." One result is that there is no surge capability that emergency managers can call on in times of major incidents. Unless, of course, an EMS Task Force is waiting in the wings.
Many first-responder agencies routinely use "4x4 volunteers" to help out in hazardous-weather situations and other emergencies. This solution to community problems must be handled with care and requires careful planning by state/local decision makers.
For most U.S. hospitals, planning for a mass-casualty disaster is an administrative afterthought. The result, frequently, is a counterproductive "game plan" based on rosy optimism and unproven assumptions.
