Manmade disasters.

A disaster that produces a multitude of patients may severely stress a community's health-care system, from the EMS system to the hospitals. Physicians involved in such an event must realize that they will have to change their normal mode of delivering care, having to make decisions with less than the normal amount of information, and doing the most good for the most salvageable patients. Some understanding of and appreciation for the unique problems that face emergency personnel in the field are important for physicians who do not normally interact with fire and EMS personnel, because it will allow them to realize that they are not alone in the chaos of a disaster. Many manmade disasters produce patients with medical or surgical problems with which one is familiar, the only difference being the sheer number of patients. Other manmade disasters, however, most notably those involving hazardous materials and radioactive materials, are capable of producing patients who not only have unfamiliar medical problems but also have problems about which little information is readily available in the medical literature. Hospital physicians can do much to prepare themselves for these eventualities. Discussion and planning should be done among separate staffs (ICU, operating suite, emergency department), as well as among staff of the various disciplines so they can interact more effectively when a disaster occurs. Local disaster planners should receive input from hospital staffs so hospital capabilities are known and the field operation can mesh well with the hospital's operation.