Preparation for disaster

Standardization of county medical society plans for dealing with casualties in disasters would greatly facilitate integration with the state Civil Defense organization. Without such plans there can be no hope of coping with the great number of casualties that would come should this area be attacked. The plan of the Alameda-Contra Costa County Medical Association herein described, has been tested in actual emergency and has been found effective.     

Major disaster planning.

In 1983 a coach crash brought a hospital''s major disaster plan into operation. The surgical aspects of the plan were assessed to see how well they matched up to three major aims: saving life, relieving pain and distress, and completing primary treatment of open wounds within eight hours of the accident. The last goal was not met for most of the 21 victims, mainly children with multiple deep dirty abrasions and extensive tissue loss. Having determined that none of the victims were in immediate danger the surgeons reassessed the priorities--in several cases disturbing dressings for a third or fourth time. The total time spent in theatre (in five theatres) was 37 hours, as opposed to the original estimated 10-15 hours. The experience gained in this accident suggests that a disaster plan should indicate the number of patients a single hospital can admit and that a senior surgeon should act as a coordinator and get surgeons working as soon as patients arrive, keeping two theatres reserved for lifesaving surgery. In this way primary treatment of wounds may be completed within eight hours of injury and the risk of infection reduced.     

Manchester air disaster.

On 22 August 1985 a fire occurred on a Boeing 737 jet airliner at take off at Manchester Airport. One hundred and thirty seven passengers and crew were on board. Fifty two passengers died on the aircraft, 85 escaped. Most survivors had minor physical injuries, but 15 required admission to hospital because of smoke inhalation and two of these had severe burns. At presentation only one survivor required ventilation but within 12 hours a further five required ventilation. Although initially patients suffering from smoke inhalation may seem relatively well, lung function may deteriorate rapidly in the first 24 hours. Careful organisation and regular practice of procedures to deal with a major accident are essential to be able to respond adequately to such an event.