An emergency medical system approach to disaster planning.

The increasing prevalence of terrorist attacks and natural disasters has mandated that more emphasis be placed on emergency disaster planning. The report focuses on the 1976 Courthouse bombing in Boston, which generated 20 casualties. Ambulance response by Boston's Emergency Medical Service system was made in 2.5 minutes and all victims were transported from the scene within 20 minutes. Successful management of this incident employed several important principles of disaster planning. These include the initial medical response, staging at the scene, and hospital notification. Additionally, the concept of triage as an integral part of disaster planning is explained with examples of the on-site medical stabilization and treatment of casualties. The importance of these concepts in practice and the necessity of close coordination of ambulance response and the responses of other emergency agencies, i.e., Police and Fire, were clearly demonstrated in the disaster which resulted from the Courthouse bombing.