Disaster Medicine

Conceptually, disaster medicine and emergency medicine are dissimilar. Disaster medicine requires planning and prevention activities before early intervention. It is anticipatory in nature, defining its mission as minimizing morbidity and mortality that result from acute environmental events such as earthquakes and tsunamis (Japan, March 2011); hurricanes and flooding (Hurricanes Katrina, August 2005, and Irene, August 2011); tornadoes (Joplin, Missouri, May 2011); forest wildfires (an annual event in the Western portion of the United States); and events of human origin such as chemical plant and oil refinery explosions, nuclear power plant meltdowns (Chernobyl, April 1986; Fukushima, March 2011), the periodic sinking of various water craft (usually ferry boats carrying hundreds of passengers), and sabotaged commercial airplane crashes (World Trade Center Disaster 2001). In contrast, emergency medicine is a reactive medical specialty, usually in a fixed location, that addresses individuals who come to the emergency department for medical assessment and treatment.

Disaster medicine, as noted below in a description of the U.S. Homeland Security's National Response Framework (NRF), relies on an understanding of the nature of the disaster, the extent of the disaster, and the allocation of prepositioned or repositioned assets that include, as noted in a description of the NRF, much more than only medical services.

Two fundamental concepts are often not well thought out by those in a potential disaster area. These were highlighted by Hurricane Katrina in 2005 and more recently by the effects of the Tohoku earthquake and tsunami that occurred on the eastern coast of Japan, on March 11, 2011, and the tornado that struck Joplin, Missouri, on May 22, 2011. First, the presence of a disaster plan and disaster-designated manpower and supplies does not necessarily ensure that immediate responses are possible owing to extensive damage to local infrastructure:

• 1.
  Communication systems, sanitation systems, and facilities for delivery of clean water are either destroyed or not functional because of a lack of electricity.
• 2.
  Transportation is disrupted because of damage to rail, roadways, and airports.
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• 3.
  Local law enforcement will have to balance their families’ needs versus those of the community.
• 4.
  Without transportation because of damage to roads and limited access to fuel, the effective radius is marginalized.

Many individuals, even with advance warning, will not take the necessary protective measures of stockpiling food, water, and chronic medications and relocating to safer shelters or arranging for transportation beyond the zone of danger (e.g., if they live in low-lying areas and extensive flooding is anticipated). Substance abusers can be anticipated to go into withdrawal and engage in drug-seeking behaviors if they have to relocate and/or their access to legitimate sources (from methadone maintenance programs or pain management clinics) or their access to illegitimate sources (from street drug pushers) is disrupted.