Sharma B R
Department of Forensic Medicine and Toxicology, Government Medical College & Hospital, Chandigarh, India.
Am J Disaster Med. 2008 Mar-Apr;3(2):113-9.
Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism. These attacks are virtually always directed against the untrained and unsuspecting civilian population. Unlike the military, civilians are poorly equipped or prepared to handle the severe emotional, logistical, and medical burdens of a sudden large casualty load, and thus are completely vulnerable to terrorist aims. To address the problem to the maximum benefit of mass disaster victims, we must develop collective forethought and a broad-based consensus on triage and these decisions must reach beyond the hospital emergency department. It needs to be realized that physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply and for this reason, emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision-making.
爆炸和炸弹袭击仍然是造成大量人员伤亡的最常见蓄意灾难原因，尤其是作为恐怖主义手段。这些袭击几乎总是针对未经训练且毫无防备的平民。与军队不同，平民没有良好的装备或准备来应对突然大量伤亡带来的严重情感、后勤和医疗负担，因此完全易受恐怖主义目标的伤害。为了最大程度地造福大规模灾难受害者来解决这一问题，我们必须进行集体预先思考，并就伤员分类达成广泛共识，而且这些决策必须超越医院急诊科的范畴。需要认识到，在没有政策或规程指导的情况下，绝不应该让医生处于单独决定拒绝为患者治疗的境地。然而，急诊医生可能很容易发现自己处于资源需求明显超过供应的情况，因此，急诊护理人员、医院管理人员、宗教领袖和医学伦理委员会需要参与生物伦理决策。
