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.
Preparing for an emergency is like packing for a long trip: Focus on the essentials first, and always consider the possibility of a worst-case scenario. Unfortunately, some communities and hospitals are making cost reductions their highest priority.
Three modes of operation, two of which might strain the trained EMS personnel resources immediately available but would not overwhelm them. Preparing for the third mode, a sudden mass-casualty scenario, must be done carefully and thoughtfully.
When it seems likely that explosives have been used in a mass-casualty incident or "event," the personnel responding must remember that additional, and bigger, explosions might soon follow and that they, the first responders, may be the target.
Several years have passed since the first H5N1 outbreak and there have been speeches, studies, and statistics galore - but few if any nations are even half-prepared to deal with the consequences of a major pandemic.
The U.S. private-sector health care system is probably the best in the world. But it is not prepared to deal with mass-casualty incidents, lacks the funding needed to expand beyond current capacity, and suffers from certain shortages.