8.5 x12.5 Doublelines - Cambridge University Pressassets.cambridge.org/97805218/73673/index/9780521873673_index… · decorporation therapy, 498–499 delayed effects, 492–493 explosive

Index

Abbreviated Injury Scale (AIS), 394Academy of Counter-Terrorist Education at

Louisiana State University, 27ACAM-2000 smallpox vaccine, 463–464accidental industrial explosions, 394accountability, 64, 329–330ACEP. See American College of Emergency

Physiciansacetylcholinesterase inhibition, 449acquired immunodeficiency syndrome

(AIDS), 77–81, 366–367ACS. Seeacute coronary syndromesacute coronary syndrome (ACS), 590acute cutaneous radiation injury, 491–492acute gastrointestinal (GI) syndrome, 491acute hematopoietic syndrome, 488–491acute management, 493–494acute medical conditions, stabilizing, 199acute neurovascular syndrome, 491acute radiation syndrome (ARS). See also

nuclear eventsacute cutaneous radiation injury,

491–492acute GI syndrome, 491acute hematopoietic syndrome, 488–491acute management, 493–494acute neurovascular syndrome, 491clinical progression, 488death, 488decorporation therapy, 498–499delayed effects, 492–493explosive events, 407general considerations, 487–488intermediate management, 494latent phase, 488, 489lymphocyte depletion kinetics, 491manifest (illness) phase, 488, 490medical countermeasures, 494–498medical management, 493medical treatments, 494–498mortality rates, 494

overview, 482–483prodromal phase, 488, 489radiation combined injury, 492radiation-induced malignancy, 493recovery, 488treatment, 493–495treatment guidelines, 494

acute renal failure (ARF), 570–571acute respiratory distress syndrome (ARDS),

397, 444administrative controller designation,

235–236Advanced HazMat Life Support (AHLS), 522adverse events, antibiotics, and vaccines,

224–225aerosol dissemination, 458age-related responses, 104Age/Total Body Surface Area (TBSA)

Survival Grid, 424AHLS. See Advanced Hazmat Life SupportAIDS. See acquired immunodeficiency

syndromeair conditioning, 619air disasters

Airbus 340, 256Airbus A300, 257assessment, 258Boeing aircraft, 254–257the British Comet, 255Chicago, Illinois, 255command, 257communication, 258the Concord, 256crash site, 257–258debris on runway, 256equipment, 257equipment failure, 255–256fog, 254–255future research, 272Haddon Matrix, 254hostile weather, 256

ice, 254incidence data, 253injury events, current, 254injury events, historical, 253–254intentional crashes, 257Iran, 257Irish Sea, 257jammed valve, 255–256Lockerbie, Scotland, 257Manchester, England, 255MD-81 aircraft, 256Milan, Italy, 255miraculous survival, 257Paris, France, 256pilot error, 256planning, 257preparation, 257Russia, 256–257safety, 257–258scene response, 257–258shootings, 256–257Stockholm, Sweden, 256Taipei, Taiwan, 255Tenerife, Spain, 254–255terrorist attacks, 256–257Toronto, Ontario, Canada, 256training, 257transport, 258treatment, 258triage, 258Washington, DC, 254

airborne transmission, 76Airbus aircraft, 256, 257air-purifying respirators (APRs), 189–190AIS. See Abbreviated Injury ScaleAl Salam Boccaccio 98, 259Alfred P. Murrah Federal building bombing,

176all-hazard approach, 58all-hazards emergency management

programs, 139–140

643

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644 ■ IN D E X

alpha particles, 483–484Alphabet Bomber, 433–434alternate care sites, 560alternative care system development, 40–41AMA. See American Medical Associationamateur radio networks, 357American College of Emergency Physicians

(ACEP), 68, 234American Medical Association (AMA) Code

of Medical Ethics, 67–68American Red Cross, 121, 124, 144–145American Red Cross Safe and Well web site,

378amputations, 394, 570–571, 596ancillary supplies, 225anesthesia, 410, 571anhydrous ammonia, 440–441antemortem data, 320–321anthrax

antibiotics and vaccines, 215–216, 224biological event, 456–461EIDs, 76, 78, 86–88PPE, 184

Anthrax Vaccine Adsorbed (AVA), 460–461antibiotics and vaccines. See also points of

dispensing; vaccinesadverse events, 224–225ancillary supplies, 225anthrax, 215–216, 224Canadian antiviral stockpile for

pandemic influenza, 214–215children, 223cold chain management, 225CRI, 216dispensing laws, 223–224DOD Appropriations Act of 2006,

216–217drug formulations, 223the elderly, 223EUA, 224federal assistance, examples, 215–216future directions, 225healthcare professional and volunteer

roles, 221historical perspectives, 213IND, 224influenza pandemic 1918, 213informed consent, 224international efforts, 214–215Israel smallpox vaccine stockpile, 214labeling regulations, 224Managed Inventory, 215MedWatch, 225overview, 213PODs, 215–223Project BioShield law, 224Public Health Service Act, 217, 224Public Readiness and Emergency

Preparedness Act, 216–217RSS location, 215smallpox, 213–214SNS, 215special considerations, 223Swine Flu vaccination program 1976, 213

12-Hour Push Packages, 215United Kingdom SMART teams, 214U.S. Homeland Security Presidential

Directive 8, the NationalPreparedness Goal, 216

Vaccine Adverse Event Reporting System,225

WHO Global Outbreak Alert andResponse Network, 215

WHO medication stockpiles, 215winter storms, 596

antidoteschemical events, 432, 437–438, 442–444,

446–449HazMat events, 518–522

anxiety, 332, 535Applied Public Health Team (APHT), 45APRs. See air-purifying respiratorsARDS. See acute respiratory distress

syndromearea command, 279ARF. See acute renal failureArmy Center for Health Promotion and

Preventive Medicine’s Technical Guiderecommendations, 189

ARS. See acute radiation syndromearsenic, 433arterial blood gas analysis, 409arthropod-borne diseases, 533–534ash, volcanic, 638–639asphyxiants, 522asynchronous telehealth, 347Atlanta Metropolitan Area Heat Profile, 618atmosphere-supplying respirators, 190Aum Shinrikyo, 437–438authorization to provide medical care,

158–159AVA. See Anthrax Vaccine Adsorbedaverage global surface temperature

anomalies, 610

Baader-Meinhof gang, 434–435Bacillus anthracis. See anthraxbacteria, 87, 191bad weather navigation, 259BAI. See blast auditory injuryballistic projectiles, 411Baltic Sea, 259Basic and Advanced Disaster Life Support

training courses (DISASTER),590–591

BASICS system. SeeBritish Association forImmediate Care System

behavioral health. See mental and behavioralhealth

Best Practices for Hospital-Based FirstReceivers of Victims from MassCasualty Incidents Involving theRelease of Hazardous Substances, 189

Best v. Bellevue Hospital New York, 156–157beta particles, 481–484Bhopal, India 1984 disaster, 441–442BII. See blast intestinal injury

bioagent distribution rating system, Russian,455

bioclimates, 618–619biodosimetry, 484–487Biodosimetry Assessment Tool, 485bioethics, 62–63biological event. See also chemical events

ACAM-2000, 463–464aerosol dissemination, 458anthrax, 456–461AVA, 460–461Bacillus anthracis, 458–461bioagent distribution rating system,

Russian, 455bioterrorism, 455–456BioThrax, 461bioweapons, 455botulism, 466–468bubonic plague, 464–466BWC, 454–455category A agents, 458–471category B agents, 458category C agents, 458CDC select agents and toxins, 456–457chloramphenicol, 466cidofovir, 463Clostridium botulinum, 466–468critical agents for public health

preparedness, 458cutaneous anthrax, 459definition, 76Dengue fever, 468doxycycline, 466Dryvax, 463–464Ebola fever, 468–469EIDs, 88–89erythematous, 465F. tularensis palearctica, 470–471F. tularensis tularensis, 470–471filoviral fevers, 468food-borne botulism, 467Francisella tularensis, 470–471gastrointestinal anthrax, 459gentamicin, 466hantaviruses, 468HHS select agents and toxins, 456–457infant botulism, 467inhalational anthrax, 459Lassa fever, 468Marburg fever, 468monkeypox, 462–463Orthopoxvirus PCR testing, nonspecific,

463overview, 454–456plague, 464–466pneumonic plague, 464–466PPE, 184, 186rabbit fever, 470–471ribavirin, 469septicemic plague, 464–466skin lesions, 462smallpox, 461–464streptomycin, 466terrorist threat, 456–458






IN D E X ■ 645

threat list, 454–455tularemia, 470–471U.S. biodefense research priorities, 473U.S. Biological Arsenal, 455U.S. Civilian Biological Warfare Medical

Countermeasures Research, 472–473U.S. Military Biological Warfare Medical

Countermeasures Research, 473–474vaccines, 463–464VHF, 468–470VHF pathogenesis, 469VIG, 464wound botulism, 467

Biological Weapons Convention (BWC),454–455

BioSense, 168bioterrorism, 88, 138, 455–456Bioterrorism Hospital Preparedness

Programemergency management systems, 141

BioThrax, 461bioweapons, 87, 455. See also biological

eventbirthmarks, 315black ice, 592blast auditory injury (BAI), 397–398, 410blast effects, 480blast injuries. See explosive eventsblast intestinal injury (BII), 399–400, 409blast lung injury (BLI), 397, 398–399, 409,

410blast waves, 395–396BLI. See blast lung injuryblind selective mainstem intubation

algorithm, 404blood products, 294body disposal, 573Boeing aircraft, 254–257bombs/bombings

Alfred P. Murrah Federal Buildingbombing, 176

Alphabet Bomber, 433–434chemical events, 433–434dirty bombs, 405–407explosive events, 405–407Oklahoma City, 116special needs populations, 116WTC bombing 1993, 435–436WTC bombing 2001, 118, 125–126, 176

Bordetella pertussis, 77botulism, 466–468bradycardia, 594British Association for Immediate Care

(BASICS) system, 231British Comet air disaster, 255bubonic plague, 367, 464–466burn patient management

assessment, 424–425chemical reaction to inhalation injury,

427disaster planning, 423–424electrical injury, 427–428escharotomy incisions, 425evacuation to burn center, 426–428

full thickness burns, 426future directions, 428inhalation injury, 426–427overview, 423partial burns, 426preliminary treatment, 424–426“Rule of Nines,” 425START system, 424TBSA Survival Grid, 424transfer form, Institute of Surgical

Research Burn Center, 427transportation guidelines, 426triage decision table (for burn victims),

423–424burn surge, 46–47bus disasters, 267–269business processes, 354BWC. See Biological Weapons Convention

C. difficile-associated disease, 77Caddo County, Oklahoma 2007 tropical

storm, 119California Medical Assistance Teams

(CAL-MAT), 43CAL-MAT. See California Medical

Assistance TeamsCanadian antiviral stockpile for pandemic

influenza, 214–215Capability Management System (CMS), 22carbon monoxide (CO) poisoning, 535–536,

590, 597, 601–602cardinal virtues of disaster response, 69–70care of relatives, 294CareFlight Triage, 176CAS#. See Chemical Abstracts Service

registry numberCAS of the American Chemical Society. See

Chemical Abstracts Service (CAS) ofthe American Chemical Society

casualty arrival, 291category A agents, 458–471category B agents, 458category C agents, 458CBRN events. See biological event; chemical

events; nuclear eventsCenter for Domestic Preparedness, 26Centers for Disease Control and Prevention

(CDC)biological event, 456–457Cooperative Agreement on Public Health

Preparedness and Response forBioterrorism, 138

disaster research, 4EIDs, 90emergency management systems,

137–139grant programs to improve public health

preparedness and response forbioterrorism, 139

Guidelines for Environmental InfectionControl in Healthcare Facilities, 2001,210

Public Health Emergency ResponseGuide, 90

select agents and toxins, 456–457syndromic surveillance, 167, 168

CERC. See crisis and emergency riskcommunication

CERT. See Community Emergency ResponseTeams

CESIRA protocol, 177charity, 71–72CHCs. See Community Health CentersChemical Abstracts Service (CAS) of the

American Chemical Society, 513Chemical Abstracts Service registry number

(CAS#), 513chemical, biological, radiological, and

nuclear (CBRN) events.See biologicalevent; chemical events; nuclear events

chemical contamination, 185–186chemical detection paper, 519chemical emergency response, 540chemical events. See also hazardous material

eventsacetylcholinesterase inhibition, 449Alphabet Bomber, 433–434anhydrous ammonia, 440–441antidotes, 432, 437–438, 442–444,

446–449ARDS, 444arsenic, 433Aum Shinrikyo, 437–438Baader-Meinhof gang, 434–435Bhopal, India 1984 disaster, 441–442chemical weapons, 434–435chlorine, 431–432, 440cortisone creams or lotions, topical, 448CPAP, 448CSA, 435CSEPP, 450–451cyanide treatment, 445–446cyanides, 432, 435–437, 445–447erythromycin, 448examples of intentional, 433–440examples of unintentional, 440–443FEMA, 450–451floods, 531FMEs, 450–451GA, 448–450GB, 448–450GD, 448–450GF, 448–450glucocorticoids, 448HazMat events, 513history, 431–433hydroxocobalamin, 446–447IEDs (as combined weapons), 439–440large scale, medical review of, 450Leukopenia, 448Lewisite, 448medical response, 443–444methemoglobin, 446MIC, 441–442Minot, North Dakota, 440–441Muharem Kurbegovic, 433–434mustard, 432, 434, 438–439, 448–448nerve agents, 433–434, 437–438, 448–450






646 ■ IN D E X

chemical events (cont.)organophosphates, 432oximes, 450PEEP, 448phosgene, 432principles, 430–431pulmonary intoxicants, 445SCBA, 436sodium thiosulfate, 446Stalag 13, 433sulfur mustard (See mustard)SVBIED, 439–440TICs, 432toxic chemicals, 438–439treatment recommendations, 444–4502-PAM, 450Union Carbide Bhopal, India 1984

disaster, 441–442Valery Borzov, 438–439vesicants, 447–448VX, 448–450World War I, 432WTC bombing 1993, 435–436

chemical reaction to inhalation injury, 427Chemical Stockpile Emergency Preparedness

Program (CSEPP), 450–451chemical triage, 520chemical warfare, 185–186chemical weapons, 434–435ChemiNet, 523ChemiTeam, 523Chernobyl nuclear power station, 477–478CHEs. See complex humanitarian

emergenciesChicago, Illinois air disasters, 255Chicago, Illinois Heat Wave of 1995,

614–618, 620, 622chilblains, 593–594child soldier, 370chloramphenicol, 466chlorine, 431–432, 440cholinergic, 522chronic country health profile, 365chronic country model, 365–367chronic disease exacerbations, 535chronic obstructive pulmonary disease,

573Cities Readiness Initiative (CRI), 45, 216Citizens Corps, 26civil confinement strategies, 207climate and weather, 79, 81climate change, 58clinical care networks, 354clinical disorders, 106clinical effectiveness research, 358clinical progression, 488clinical video conferencing system, 346clinician training, 30closed population, 315–316Clostridium botulinum. See biological event;

botulismClostridium difficile NAP1/027, 77clothing removal, 198CMS. See Capability Management System

CO poisoning. See carbon monoxidepoisoning

coastal floods, 529–530cocaine overdoses, 613codes of ethics, 65–68cold chain management, 225cold injuries, 593–594, 596, 601Cold War, 4, 287Collaborative Fusion’s Community

Response System’s Patient TrackingModule, 383

Collaborative Medical Readiness Initiative,27

collateral damage, 370Comcare’s Integrated Patient Tracking

Initiative, 386command

air disasters, 257motor vehicle disasters, 271rail disasters, 265scene management, Emergency Medical

Services, 277–278, 279sea disasters, 260

communicable diseasesCHEs, 367–369definition, 76floods, 532–533

COMMUNICATION mnemonic, 231communications

air disasters, 258EIDs, 95–96emergency management systems,

146–148failures, crisis and emergency risk

communication, 338–340healthcare facility disaster management,

291, 302motor vehicle disasters, 271rail disasters, 266requirements, mass gatherings, 248sea disasters, 261

communityalternate care site partners, 41earthquakes, 567–570EHEs, 620floods, 539hurricanes, cyclones, and typhoons, 546mental and behavioral health, 106–107prevention plans, 620special needs populations, 120tsunamis, 582–583

Community Emergency Response Teams(CERTs), 26, 145

Community Health Centers (CHCs), 142Community Response System’s Patient

Tracking Module by CollaborativeFusion, 383

compartment syndrome, 571complex humanitarian emergencies (CHEs)

achievement indicators, 364AIDS, 366–367bubonic plague, 367child soldier, 370chronic country model, 365–367

collateral damage, 370communicable diseases, 367–369cultural beliefs, 368–369definition, 361dehydration, 366developing country model, 364–365, 367diarrhea, 366direct indices, 363effectiveness, 374endemic infectious diseases, 367epidemiology, 364flea bite, 368food shortages, 369–371future directions, 375health profile, chronic country, 365health profile, developing country, 364health profile, smoldering country, 365HIV, 366–367IDPs, 362impetigo, 364indirect indicators, 363–364international response, 374–375interventions, 371–372malnutrition, 366, 369–371mental health problems, 371–374micronutrient diseases, 369–371NGOs, 365–366overview, 361–362Pott’s disease, 368psychiatric illness, disabling, 373–374psychological reactions to trauma,

372–373psychosocial problems, 371–374refugee camp conditions, northern Iraq,

362, 363rehydration salts, 366resupply, 366risk factors, 371scrofula lesion of the neck, 368scurvy, 365septic plague, 367smoldering country model, 365–367SPHERE, 363telemedicine and telehealth, 345, 349,

350tetanus, 368tuberculosis, 368urban aid, 364vaccine preventable diseases, 368vitamin C deficiency, 365

Composition C4, 395, 396Comprehensive Emergency Management,

290Concord air disaster, 256congregate facilities, 118–119consent, 158contact network modeling, 207contact transmission, 76containment strategy, 206contaminant

detectors, 199disposal, 200identification, 198removal, 199–200






IN D E X ■ 647

contamination, 198–199context-specific triage, 181–182continuity of care, 124–125continuous positive airway pressure (CPAP),

448controller designation, medical, 235–236core temperatures, 594corrosive materials, 522cortisone creams or lotions, topical, 448Corynebacterium diphtheriae, 77courage, 70The Covenant, the Sword, and the Arm of

the Lord (CSA), 435CPAP. See continuous positive airway

pressureCPT5 codes. SeeCurrent Procedural

Terminology codescrash site, 257–258credentialing, hospital, 158–159credentials, 237credibility, 328–329cremation, 313CRI. See Cities Readiness Initiativecrisis and emergency risk communication

(CERC)accountability, 329–330action steps, 341anxiety, 332beliefs, maintaining current, 332commitment, 329–330communication failures, 338–340competence, 329confusion, 332, 339credibility, 328–329crisis maintenance, 331definition, 327–328dread, 332empathy, 329evaluation, 331expertise, 329fear, 332fears, 333–334first impressions, 340future research, 343–344gas hood, child’s, 335helplessness, 332–333honesty, 329hopelessness, 332–333information, processing (by

stakeholders), 331–332information, timely release, 338information, withholding, 329initial message, 340–341initial phase, 330–331Israeli risk communication experience

case study, 335–338leaflets, 337–338life cycle, 330–331message crafting, 341message relevance and effectiveness, 328,

332message, things to avoid, 341mixed messages, 338multicultural settings, 343–344

news screencap, 336overview, 326panic, 333paternalistic attitudes, 338–339power struggles, public, 339precrisis phase, 330psychological reality, 340purposes, 326–327repetition, 341reputational risk management, 328–329resolution, 331risk, perception of, 334rumor management, 339simplifying, 332speed, 340spokesperson role, 334–335stakeholder concerns and identification,

339–340stakeholder needs, 341–342stigmatization, 334town hall meeting management, 342–343trust, 328uncertainty, 333vicarious rehearsal, 343WMD drill, 336

crisis maintenance, 331criticality accidents, 477, 501–504crop loss, 530–531cross-sectional study design, 11crush injuries, 570–571CSA. See The Covenant, the Sword, and the

Arm of the LordCSEPP. See Chemical Stockpile Emergency

Preparedness Programcultural beliefs, 368–369Current Procedural Terminology (CPT5)

codes, 166cutaneous anthrax, 459cyanide, 432, 435–437, 445–447cyclones. See hurricanes, cyclones, and

typhoonscyclosarin (GF), 448–450cytogenetic assays, 486cytogenetic biodosimetry, 484–485

damage control, 301data

analysis for syndromic surveillance, 169collection, 12, 378, 384entry, 378, 380–382field communication, 382–383field tools, 382–383integration for syndromic surveillance,

168–169portals, 381security, 379security and storage, legislative and

regulatory issues, 155–156DEARE. See delayed effects of acute

radiation exposuredebriefing, 237–238debris, 125–126, 256, 579–580Decision Instrument for the Assessment and

Notification of Events that May

Constitute a Public Health Emergencyof International Concern, 208

decontaminationacute medical conditions, stabilizing, 199

clothing removal, 198completeness, 196–197contaminant detectors, 199contaminant disposal, 200contaminant identification, 198contaminant removal, 199–200contamination, preventing further,

198–199definition, 195dry powder, 199effectiveness, 196–197events requiring, recognizing, 198evidence preservation, 199future directions, 200HazMat events, 517–518, 520healthcare facilities, 200healthcare facility disaster management,

292–293information resources, 197–198key steps, 198overview, 195–196PPE, 196–197, 199process, 196–197scene management, Emergency Medical

Services, 281–282soap and water, 196–197special populations, 200strip and shower, 199suit ensembles, levels A-D, 188water temperature, 197when to perform, 197who needs, 197who performs, 197

decorporation therapy, 498–499Defense Against Weapons of Mass Destruction

Act, 288Defense Civil Preparedness Agency, 4definitive care, 135dehydration, 366delayed effects, 492–493delayed effects of acute radiation exposure

(DEARE), 493, 496–497delayed rescue, 259demand surge management, 106Dengue fever, 468dental records, 315Department of Defense (DoD)

Appropriations Act of 2006, 216–217emergency management systems, 135Federal Coordinating Center (FCC) sites,

136–137surge capacity resources, 45–47

Department of Health and Human Services(HHS), 134

Department of Homeland Security (DHS),90, 160

Department of Veterans Affairs (VA),135–137

depression, 535dermatological conditions, 534






648 ■ IN D E X

detonation effects, 479–482developing country health profile, 364developing country model, 364–365, 367developing world, 622–623development process, 53–56DHS. See Department of Homeland Securitydiagnostic assays, 92diarrhea, 366, 533diphtheria, 77dirty bombs, 405–407disabilities, 117–118disaster

cycle, 9definition, 3health, 21, 52international medical journals, 55myths, international, 53, 57myths, mental and behavioral health, 105

realities, international, 53related behavioral health casualties,

108–109Disaster Medical Assistance Team (DMAT)

emergency management systems, 143explosive events, 413surge capacity, 44winter storms, 600–601

Disaster Mortuary Operational ResponseTeam (DMORT)

disaster morgues, 318emergency management systems, 143mass fatality management, 315, 319surge capacity, 44

disaster planning, 423–424Disaster Portable Morgue Units (DPMU),

318disaster research. See research, disasterDisaster Research Center (DRC), 4disaster response plans, 89–90disaster risk management. See risk

management“DISASTER” training courses. See Basic and

Advanced Disaster Life Supporttraining courses

disaster triage differentiation, 181Disaster Victim Identification (DVI),

313–315dispatch center, 276dispensing laws, 223–224disruption of tissue interfaces in

air-containing structures of the torso,398

distress reactions, 103–105DMAT. See Disaster Medical Assistance

TeamDMORT. See Disaster Mortuary Operational

Response TeamDNA, 315, 316–317doctor-patient relationship, 65DoD. See Department of Defensedome collapse, 634donations, 53, 57dose schedules, drugs or treatment

modalities, 500doxycycline, 466

DPMU. See Disaster Portable Morgue UnitsDRC. See Disaster Research Centerdroplet transmission, 76drowning, 537drug and vaccine development, 100drug formulations, 223dry powder, 199Dryvax, 463–464dual-use risk, 93duty to respond, 68DVI. See Disaster Victim Identification

E-911. See enhanced 911 (E-911)early information dissemination, 620earthquakes

amputations, 571anesthesia, 571ARF, 570–570body disposal, 573characteristics, 562–566chronic obstructive pulmonary disease,

573community response, 567–570compartment syndrome, 571crush injury, 570–571EOC, 566epicenter, 563, 569epidemics, 573faults, locations and types, 563future directions, 574–575HICS, 568hospital response, 567–570hypocenter, 563ICS, 566incident command, 566ketamine, 571Loma Prieta, California 1989, 117, 566MDR program, 568medical issues, 570–572MESS score, 571MMI scale, 565–566mortality, 562myocardial infarction, 572–573nontrauma-related medical conditions,

572–573Northridge, California 1994, 116, 566overview, 562PGA, 565–566PGV, 565–566prehospital response, 566–567prevention, 574psychological distress, 573RDRTF, 572renal disease, end-stage, 573Richter scale, 564–565SAVE, 570shock waves, 564special needs populations, 116–117START, 567, 570surge capacity, 569US&R, 567WIISARD, 567WISTA, 567

Ebola fever, 468–469

Ebola-Zaire virus, 85economic development and land use, 79, 81ED. See emergency departmenteducation and training, disaster

Academy of Counter-Terrorist Educationat Louisiana State University, 27

Center for Domestic Preparedness, 26CERT, 26Citizens Corps, 26clinician training, 30Collaborative Medical Readiness

Initiative, 27disaster health, 21Emergency Management Program

Development Cycle, 21–22emergency response and recovery,

sample competencies, 24EOPs, 21–22, 24ESF 8, 21–22family disaster plan, 28hazardous materials training, 25HIPAA, 21–22Hospital Incident Command System, 22hospitals and healthcare systems, 27–29ICS, 22, 28internal medical surge capacity and

capability, 28–29ISD, 23–26ISD analysis, 23–24ISD design, 24–25ISD development and implementation,

25–26job groups, 24MaHIM System, 22Master of Science in Disaster Medicine

and Management, 30masters-level curriculum in disaster

medicine and public health, 29Medical Surge Capacity and Capability,22Medical Surge Capacity and Capability

Management System, 22medical surge,resources and activities, 29mission critical systems, 28MRC, 26National Disaster Life Support Courses,

29National Domestic Preparedness

Consortium, 26National Energetic Materials Research

and Testing Center at the New MexicoInstitute of Mining and Technology,26

National Exercise, Test, and TrainingCenter at the U.S. Department ofEnergy’s Nevada Test Site, 27

National Response Framework, 21–22NIMS, 26occupant emergency procedures, 28occupant life safety, 28operational system, 21–22organizational resiliency, 28overview, 21personal and family preparedness, 27program development, 23–26






IN D E X ■ 649

program evaluation, 29–30program examples, 26–30public education and training programs,

26recommendations for future research, 30special needs populations, 121university programs, 29US&R, 27WMD sample hospital course, 25

EDXL. See Emergency Data ExchangeLanguage

EF Scale. See enhanced Fujita Scaleeffective response actions, 621effusive volcanoes, 633–634EHEs. See extreme heat eventsEHR. See electronic health recordEIDs. See emerging infectious diseaseselderly, 115, 120, 223Electric Picnic Festival, 249electrical injury, 427–428electrical system, 300electron paramagnetic resonance (EPR),

486–487electron spin resonance (ESR) spectroscopy,

486–487electronic health record (EHR), 351–352Electronic Surveillance System for the Early

Notification of Community-basedEpidemics, 168

EMAC. See Emergency ManagementAssistance Compact

EMC. See Emergency ManagementCommittee

Emergency Action Codes, 514emergency bag (“Go Kit”), 122Emergency Data Exchange Language

(EDXL), 386emergency department (ED)

EHEs, 613–615, 625–627explosive events, 394, 408winter storms, 589–590

Emergency Management AssistanceCompact (EMAC), 43

Emergency Management Committee(EMC), 288–289

emergency management life cycle, 120–127Emergency Management Program

Development Cycle, 21–22Emergency Management Reform Act of 2006,

155emergency management systems

all-hazard emergency managementprograms, 139–140

American Red Cross, 144–145bioterrorism, focus and funding, 138Bioterrorism Hospital Preparedness

Program, 141CDC, 137CDC grant programs to improve public

health preparedness and response forbioterrorism, 139

CDC Cooperative Agreement on PublicHealth Preparedness and Responsefor Bioterrorism, 138

CERT, 145CHCs, 142CMS, tiers within, 142communications, 146–148definitive care, 135DMAT, 143DMORT, 143DoD, 135DoD FCC sites, 136–137Emergency Planning and Community

Right to Know Act, 141ESAR-VHP, 146ESFs, 135, 141FCCs, 135–137FEMA, 135, 139, 144–145field medical response, 135four phases of, 139funding and support, 148future directions, 148global public health, 148–149Health Resources and Services

Administration NationalBioterrorism Hospital PreparednessProgram, 138

HHS, 134Homeland Security Act of 2002, 138Hurricane Katrina, 133, 135ICS, 140–141Integrated Emergency Management

System, 139–140legislative authorities and regulatory

issues, 160MaHIM, 142, 148medical surge capacity, tiers within, 142MMRS, 137MRC, 143–144National Voluntary Organizations Active

in Disaster, 145–146NDMS, 135, 143–144NDMS volunteers, 143NIMS, 140, 147–148NRF, 135–137, 141, 147–148NRP, 135–137, 141, 147–148overview, 133–139Pandemic and All-Hazards Preparedness

Act, 134patient transport, 135population groups, 148Public Health Security and Bioterrorism

Preparedness and Response Act, 135,138

SNS, 137standardization, 141–142VA, 135VA FCC sites, 136–137volunteer credential, 146volunteer initiatives, 145volunteer management, 143volunteerism, convergent, 146Weapons of Mass Destruction Act of 1996,

137–138WMD, 137

Emergency Medical Treatment and Labor Act(EMTALA), 160, 516

Emergency Operations Center (EOC), 91,566

emergency operations plans (EOPs), 21–22,24

Emergency Planning and Community Rightto Know Act, 141, 516

emergency powers over healthcare facilities,161

emergency risk communication. See crisisand emergency risk communication

Emergency Support Function (ESF), 21–22,135, 141

Emergency System for Advance Registrationof Volunteer Health Professionals(ESAR-VHP), 146

Emergency Use Authorization (EUA), 224emergency waiver of U.S. state laws, 161–162emerging infectious diseases (EIDs)

agent, 82–85, 88agent identification and characterization,

92AIDS, 77–81airborne transmission, definition, 76anthrax, 76, 78, 86–88bacteria, 87basic research, 99–100biological incident, 88–89biological incident, definition, 76bioterrorist attack, 88bioweapons, 87Bordetella pertussis, 77breakdown of public health

infrastructure, 80, 81C. difficile-associated disease, 77categories, 77causes, 75CDC Public Health Emergency Response

Guide, 90changing ecosystem, 79, 81climate and weather, 79, 81Clostridium difficile NAP1/027, 77communicable, definition, 76communications, 95–96contact transmission, definition, 76Corynebacterium diphtheriae, 77DHS NRF, 90diagnostic assays, 92diphtheria, 77disaster response plans, 89–90disease, 83driving factors, 79–80droplet transmission, definition, 76drug and vaccine development, 100dual-use risk, 93Ebola-Zaire virus, 85economic development and land use, 79,

81Emergency Operations Center, 91endemic, definition, 76environment, 88epidemic, definition, 76epidemic diarrheal disease, 77epidemiological triangle, 77ethics and law, 83, 87






650 ■ IN D E X

emerging infectious diseases (EIDs) (cont.)evaluation, 98–99fungi, 87future research, 99–100government incentives, 93H1N1 pandemic influenza (2009), 96–97hantavirus, 77hantavirus pulmonary syndrome, 77healthcare facility workforce, 95HIV, 77hospital emergency management

systems, 90–91host/environment, 88host-resistant, definition, 76host-susceptible, definition, 76human demographics and behavior, 79,

81human susceptibility, 79, 81Hurricane Katrina, 90ICS, 90–91influencing factors, 81–82influenza pandemic, 88influenza virus from birds or swine, 77intent to harm, 80, 82international travel and commerce, 79,

81international workforce, 95isolation, definition, 76lack of will, 80, 82local, state, and national response efforts,

90MDR-TB, 77mechanism of, 82–83microbes, 75microbial adaptation, 79, 81Microbial Threats to Health: Emergence,

Detection and Response, 78mode of transmission, definition, 76modeling, 98national disaster exercises, 97–98National Response Plan, 90Neisseria meningitidis, 82, 85, 86NIMS, 90outbreak, definition, 76overview, 75–78pandemic, definition, 76pathogens, 75personnel, 83poverty and social inequality, 80, 81PPE, 86preparedness, 88, 97–99the public, 83public health workforce, 94–95public safety workforce, 95quarantine, definition, 76reemerging infectious diseases, 78–82reservoir, definition, 77resource management, 96–97resources, 83, 85response personnel, 85SARS-Cov, 76, 77, 79, 84–86, 88science and technology, 92Sin Nombre virus, 77Staphylococcus aureus, 77surveillance, 93–94

surveillance research, 99–100syndromic surveillance, 170technology and industry, 79, 81terrorism, 83, 87therapeutics, 92toxic shock syndrome, 77toxins, 87transmission, 83–85transmission prevention, 91transmission rate (R0), definition, 77vaccines, 92–93vector, definition, 77Vibrio cholerae O139, 77viruses, 87war and famine, 80, 82West Nile virus encephalitis, 77whooping cough, 77workforce preparedness, 94zoonoses, definition, 77zoonotic diseases, 91

empathy, 72–73, 329EMTALA. See Emergency Medical Treatment

and Labor ActEMTrack, 381endemic, 76endemic infectious diseases, 367Enhanced 911 (E-911), 276enhanced Fujita Scale (EF Scale), 553–554environmental justice, 513, 523EOC. See Emergency Operations CenterEOPs. See emergency operations plansepicenter, 563, 569epidemic diarrheal disease, 77epidemics, 76, 573Epidemiologic Reviews, 7epidemiological triangle, 77epidemiology

disaster research, 7explosive events, 393–395HazMat events, 511–512tornadoes, 555tsunamis, 581

Epi-X, 168EPR. See electron paramagnetic resonanceequipment failure, 255–256erythematous, 465erythromycin, 448ESAR-VHP. See Emergency System for

Advance Registration of VolunteerHealth Professionals

escharotomy incisions, 425Eschede, Germany rail disaster, 264ESF. See Emergency Support FunctionESR spectroscopy. Seeelectron spin

resonance spectroscopyEstonia, 259, 501ethics

accountability, 67AMA Code of Medical Ethics, 67–68American College of Emergency

Physicians Code of Ethics, 68bioethics, 62–63cardinal virtues of disaster response,

69–70challenges, 64

charity, 71–72codes of ethics, 65–68codes of medical ethics, 67confirmation, 72–73courage, 70culture, 66disaster context, 63disaster research, 13doctor-patient relationship, three core

principles, 65duty to respond, 68EIDs, 83, 87empathy, 72–73humanitarian imperative, 66ICRC Code of Conduct, 66–67justice, 63, 70–71local capacities, 66–67mass fatality management, 321NGHAs, 66overview, 62publicity and advertising activities, 67quarantine, 210race, creed, or nationality, 66rationing, 63, 65recommendations for future research,

73relief aid, 67resilience, 71self-disclosure, 72self-effacement, 71–72shared power and control, 72social contract, 68stakeholders (in disaster ethics), 63stewardship, 71team leaders, 73triage, 63, 65utilitarianism, 63, 65vigilance, 71virtue, 68–69

ethnicity, 116–117EUA. See Emergency Use AuthorizationEuropean Heat Wave of 2003, 614evacuation

burn center, 426–428explosive events, 405HazMat events, 520–521healthcare facility disaster management,

303–307hurricanes, cyclones, and typhoons,

546–547receiving hospital checklist, 308–309special needs populations, 118–119,

123tsunamis, 582–583winter storms, 594–595

eventintelligence, 243planning, 233–238planning schedule, 235safety guides, 242–243setup, 237

evidence preservation, 199Excessive Heat Events Guidebook, 622excursions, 477experimental study design, 9–10






IN D E X ■ 651

explosion hazards, 636–637explosive events

accidental industrial explosions, 394AIS, 394amputations, 394anesthesia, 410ARDS, 397ARS, 407arterial blood gas analysis, 409BAI, 397–398, 410ballistic projectiles, 411BII, 399–400, 409blast waves, 395–396BLI, 397, 398–399, 409, 410BLI severity categories, 399blind selective mainstem intubation

algorithm, 404clinical care, 415Composition C4, 395, 396dirty bombs, 405–407disposition, 411–412disruption of tissue interfaces in

air-containing structures of the torso,398

DMAT, 413ED, 394, 408emergency care, 408–410epidemiology, 393–395evacuation, 405external response, 413FAST, 410fluid management, 409follow-up, 412future research, 414–416GI tract tissue tearing, 399–400Glasgow Coma Scale, 400HACE, 401hazard determination, 414–415healthcare systems, 412Hostile Action Casualty System, 394human access, 401individual impact, 393injury classification, 397inner ear injury, 397–398intensive care, 410–411internal force propagation, 396ISS, 394, 410local medical receivers, 408local medical responders, 401longitudinal studies, 415–416MACE, 400MASS, 402MDA Israeli National EMS system,

402–403Modular Emergency Medical System,

413The Northern Ireland Hostile Action

Casualty System, 397nuclear detonations, 407–408ocular injury, 397–398open wounds, 411out-of-hospital care, 403–405overpressure, 396overview, 393–395pathophysiology, 397

PBI, 398PEEP, 399, 409permanent facilities, 412physics, 395PICE, 393plain chest radiograph, 409power loss, 412PPE, 415PPV, 398, 399, 409, 410pressure, 395–396primary blast injuries, other, 400–401public information, 413–414radiological injuries, 407–408rapid needs assessment, 413RDDs, 405REAC/TS, 407response system preparedness, 414SAVE, 402scene security, 404–405societal impact, 395SOFA, 411specialized responses, 405spontaneous, negative-pressure

ventilation, 409START, 402, 410surge capacity, 412–413surgery, 410systemic arterial air embolism, 409tactical field care, 405TBI, 400, 410TCCC or TC3, 403, 406temporary facilities, 413thoracic CT scanning, 409thoracic dynamics, 396TM injury, 397–398, 410TNT, 395tornadoes, 558triage, additional, 411triage, field, 401–403Triage for Targeting, 401–402Triage for Transportation, 402–403Triage for Treatment, 402triage, primary, 408underpressure, 396undertriage, 402US&R, 401, 405

explosive volcanoes, 633–634extended response and incident

organization, 278Extensible Markup Language (XML),

386external response, 600–601extreme heat events (EHEs)

Atlanta Metropolitan Area Heat Profile,618

Australia, 614average global surface temperature

anomalies, 610bioclimates, 618–619Chicago Heat Wave of 1995, 614–618,

620, 622cocaine overdoses, 613community participation, 620community prevention plans, 620death rates, 617

definition, 609demographic factors, 616developing world, 622–623early information dissemination,

620ED, 613–615, 625–627effective response actions, 621European Heat Wave of 2003, 614evaluation, 621Excessive Heat Events Guidebook, 622future research, 627–628geographical factors, 616–617heat cramps, 611–612heat edema, 612heat exhaustion, 612–613heat monitoring, 620–621heat stress illness, 611–613heat stroke, 613heat syncope, 612heat-related deaths – Chicago, July, 1995,

617highest temperature extremes, 612high-risk populations, 620hospitals, 614–615, 625–627individual factors, 616indoor heat exposure, 619international endeavors, 626–627interventions, 621local governments, 626meteorological effects, 611mitigation plans, 620–622morbidity, 615–616mortality, 615–616, 617notification, 621overview, 609–611Philadelphia Extreme Heat Event

Response Plan, 622physics, 611physiological effects, 611planning, 619–622prediction, 621primary prevention, 619prolonged exposure, 612recommendations, 625–627regional governments, 626risk assessment, 621risk factors, health, 611–617secondary prevention, 619–620South America, 623–625southeast Asia, 623–625strenuous activity, 612surge capacity, 614–615tertiary prevention, 620treatment, 613urban heat islands, 618–619weather fatalities, 610world assessment reports, 622world temperature anomalies January

2007, 623extremity fractures, 590

F. tularensis tularensis. See tularemiafacilities of opportunity, 41falling objects, 590fallout, 480–482






652 ■ IN D E X

family assistance, 322–323family disaster plan, 28FAST. See focused assessment using

sonography for traumafatality

identification methods, 315management, 539tornadoes, 1940–2005, 558

faults, earthquake, 563FCCs. See Federal Coordinating Centersfederal assistance, examples, 215–216Federal Coordinating Centers (FCCs),

135–137federal disaster assistance programs, 161Federal Emergency Management Agency

(FEMA)chemical events, 450–451emergency management systems, 135,

139, 144–145healthcare facility disaster management,

299, 307Higher Education Project website, 121legislative authorities and regulatory

issues, 161research, disaster, 12special needs populations, 114, 127

Federal Manager’s/Decision MakersEmergency Guide, 187

Federal Medical Stations (FMS), 45Federal Volunteer Protection Act of 1997,

152–153federally managed exercises (FMEs),

450–451FEMA. See Federal Emergency Management

Agencyfield hospital supplies, 243–244field medical response, 135filoviral fevers, 468finance/administration section, 276, 279,

297, 299financial reimbursement issues, 159fingerprints/footprints, 315fire on board, 259–260first receivers, 189first responder, 189fission products, yield, 481fission-neutron, lethal dose in mice, 483five-level scale for hospital preparedness, 518flat-plain damage patterns from

ground-level detonation, 480flea bite, 368floodplain management strategies, 536floods

anxiety, 535arthropod-borne diseases, 533–534carbon monoxide poisonings, 535–536causes, 529chemical emergency response, 540chemical exposures, toxic, 531chronic disease, exacerbations, 535coastal, 529–530communicable diseases, 532–533community needs assessment, 539crop loss, 530–531

definition, 529depression, 535dermatological conditions, 534diarrheal illness, 533disaster risk management, 536disease risk assessment, 539drowning, 537environmental health services, 539fatality management, 539floodplain management strategies, 536fluvial, 529food distribution disruption, 530–531future research, 540–541healthcare services disruption, 531–532high-income nations, 533–534Hurricane Katrina, 535injuries, 534–535low-income nations, 533, 534mental health effects, 535mold exposures, toxic, 531morbidity, 532–533, 539–540mortality, 532, 539–540overview, 529population displacement, 531, 539postraumatic stress disorder, 535poverty, 532PPE, 538preparing for, 538–539public health impacts, 530–532,

537–540recovery from, 540respiratory infections, 533rodent-borne diseases, 534safe water loss, 530sanitation loss, 530shelter loss, 531social support, 540suicides, 535surveillance, 539–540sustainable development, 536sustainable flood risk management,

536–537vector-borne diseases, 533wound infections, 534

fluid management, 409FluSurge, 38fluvial floods, 529FMS. See Federal Medical Stations (FMS)focused assessment using sonography for

trauma (FAST), 410fog, 254–255follow-up, 412food distribution disruption, 530–531food shortages, 369–371food-borne botulism, 467football stadia deaths and injuries,

230–232Francisella tularensis, 470–471frostbite, 593–594, 596frostnip, 594Fujita, Dr. T. Theodore, 553Fujita tornado damage scale, 553–555full thickness burns, 426fungi, 87

future directionsantibiotics and vaccines, 225burn patient management, 428CHEs, 375decontamination, 200earthquakes, 574–575emergency management systems, 148HazMat events, 523–524mental and behavioral health, 110PPE, 192volcanoes, 640

future researchair disasters, 272crisis and emergency risk

communication, 343–344disaster, 16–17education and training, 30EHEs, 627–628EIDs, 99–100ethics, 73explosive events, 414–416floods, 540–541HazMat events, 523–524healthcare facility disaster management,

310hurricanes, cyclones, and typhoons, 551legislative authorities and regulatory

issues, 162mass fatality management, 323mass gatherings, 248–250motor vehicle disasters, 273nuclear events, 504–505patient identification and tracking,

386–387quarantine, 210–211rail disasters, 272–273scene management, EMS, 282–283sea disasters, 272special needs populations, 127–128surge capacity, 47–48syndromic surveillance, 170–171telemedicine and telehealth, 357–358tornadoes, 560transportation disasters, 272–273triage, 182tsunamis, 583–584winter storms, 603–604

GA. See tabungamma rays, 481–484gas hood, child’s, 335gases, volcanic, 639gastrointestinal anthrax, 459gastrointestinal (GI) tract tissue tearing,

399–400GB. See sarinGCS. See Glasgow Coma ScaleGD. See somanGeneva Conventions, 313gentamicin, 466geographical factors, 616–617Geographical Information Systems (GIS),

13GF. See cyclosarin






IN D E X ■ 653

GHS. See Globally Harmonized System forthe Classification and Labeling ofChemicals (GHS)

GI tract. Seegastrointestinal tractGIS. See Geographical Information SystemsGlasgow Coma Scale (GCS), 178, 180, 400global cluster leads, 56Global Outbreak Alert and Response

Network, 167, 523global public health, 148–149Global Public Health Information Network,

523Globally Harmonized System for the

Classification and Labeling ofChemicals (GHS), 513

glucocorticoids, 448“Go Kit.” See emergency bagGoiania, Brazil, 478, 501Good Samaritan legislation (state), 152–153

government incentives, 93The Guide to Health, Safety and Welfare at

Pop Concerts and Other Similar Eventsmass gatherings, 242

Guiding Principles on InternalDisplacement, 313

H1N1 pandemic influenza (2009), 96–97HACE. See human access, care, and

evacuationHaddon Matrix, 254Hajj, 229hantavirus pulmonary syndrome, 77hantaviruses, 77, 468HavBED project. See National Hospital

Available Beds for Emergencies andDisasters

Hazard and Vulnerability Analysis (HVA),290–295

Hazard Classification System, 514hazard determination, 414–415Hazard Identification Number, 514hazard vulnerability assessment (HVA), 516hazardous material (HazMat) events. See

also chemical eventsAHLS, 522antidotes, 518–522asphyxiant, 522CAS#, 513CAS of the American Chemical Society,

513chemical detection paper, 519chemical incidents, 513chemical triage, 520ChemiNet, 523ChemiTeam, 523cholinergic, 522classification, 513–514corrosive, 522decontamination, 517–518, 520education and training, 25Emergency Action Codes, 514Emergency Medical Treatment and

Active Labor Act, 516

Emergency Planning and CommunityRight-to-Know Act, 516

environmental justice, 513, 523epidemiology, 511–512evacuation, 520–521five-level scale for hospital preparedness,

518future directions, 523–524future research, 523–524GHS, 513Global Outbreak Alert and Response

Network, 523Global Public Health Information

Network, 523Hazard Classification System, 514Hazard Identification Number, 514hazardous wastes, 513hospital-based response, 521HSEES system, 511HVA, 516hydrocarbon and halogenated

hydrocarbon, 522ICSC, 514identification, 513–515IHR, 511Improved Chemical Agent Monitor, 519incident site control zones, 519industrial disaster, 512–513IPCS, 511, 523irritant gas, 522Kemmler Code, 514medical treatment, 521mitigation, 515–516MSDSs, 514National Fire Protection Association 704

system, 514online resources, identification, 515OSHA, 516overview, 511–513planning, 516–517PPE, 517–518, 520prehospital response, 519preparedness, 516–519prevention, 515–516public health response cycle, 514–515recovery, 521–523response, 519risk assessment, 516risk management, 515–516SARA Title III, 516staff, 517–519systems, 516–517transportation, 520–521trauma triage, 520TREMCARDS, 514triage, 519–520UN Number, 513UN SIN, 513Union Carbide Bhopal, India 1984

disaster, 512–513WHO/IPCS Global Chemical Incident

Alert and Response System, 523Hazardous Substances Emergency Events

Surveillance (HSEES) system, 511

hazardous wastes, 513HazMat events. Seehazardous material

eventshealth assessments, 581Health Emergency Response Data System

(HERDS), 385Health Insurance Portability and

Accountability Act (HIPAA), 21–22,154

Health Resources and ServicesAdministration NationalBioterrorism Hospital Preparedness,138

healthcare diagnostic coding, 166healthcare facilities

decontamination, 200EIDs workforce, 95legislative authorities and regulatory

issues, 159–160surge capacity, 40–41

healthcare facility disaster managementblood products, 294care of relatives, 294casualty arrival, 291the Cold War period, 287common factors, 291–294communications, 291, 302Comprehensive Emergency

Management, 290damage control, 301damaged hospitals, 294decontamination, 292–293Defense Against Weapons of Mass

Destruction Act, 288electrical system, 300EMC, 288–289evacuation, 303–307evacuation checklist, receiving hospital,

308–309FEMA, 299, 307finance/administration section, 297, 299future research, 310HICS, 296–299history, planning and preparedness,

285–288history, United Kingdom, 285–286history, U.S., 286–288HVA, 290–295HVAC, 300–301ICS, 296, 297laboratory support, 293logistics section, 298MACS, 296media relations, 293medical equipment, 294medical guidance, U.S., World War II,

286the modern era, 287–288morgue, 293NIMS, 299–300operations section, 297overview, 285patient care capacity, 291physical plant, 300–302






654 ■ IN D E X

healthcare facility disaster management (cont.)planning section, 298PPE, 289–290preparedness, 288prophylaxis, 293recovery phase, 307–310security, 294service deliveries, 294staffing, 291–292, 303standards for, 289–290supplies, 293, 301, 303surge capacity, 302–304surge program creation, 302–303uncertainty, 291utilities, 293water system, 301

healthcare professional and volunteer roles,221

healthcare services disruption, 531–532healthcare systems, 412, 598–600health-risk behavior changes, 105heat

cramps, 611–612edema, 612exhaustion, 612–613exposure, indoor, 619monitoring, 620–621related deaths – Chicago, July, 1995, 617stress illness, 611–613stroke, 613syncope, 612

heat events, extreme. See extreme heat eventsheating, ventilation, and air conditioning

(HVAC), 300–301HELP. See Humanitarian Emergency

Logistics & Preparednesshelplessness, 332–333HEPA filters. Seehigh efficiency particulate

air filtersHerald of Free Enterprise, 259HERDS. See Health Emergency Response

Data SystemHHS. See Department of Health and Human

ServicesHHS select agents and toxins. See U.S.

Department of Health and HumanServices select agents and toxins

HICS. See Hospital Incident CommandSystem

high efficiency particulate air (HEPA) filters,191

high-energy waves, 579highest temperature extremes, 612high-income nations, 533–534high-risk populations, 620HIPAA. See Health Insurance Portability and

Accountability ActHIV. See human immunodeficiency virushome telehealth applications, 356home telehealth device, 346Homebush Triage Standard, 176Homeland Security Act of 2002, 138honesty, 329hook (or hook echo), 553

hopelessness, 332–333hospital emergency management systems,

90–91hospital impact, 559–560Hospital Incident Command System (HICS)

earthquakes, 568education and training, disaster, 22healthcare facility disaster management,

296–299hospital needs, 549–551hospital response, 567–570Hospital Surge Model, 38hospital-based response, 521host/environment, 88Hostile Action Casualty System, 394hostile acts, 264hostile weather, 256host-resistant, 76host-susceptible, 76HRSA requirements for current and

accurate bed availability. See U.S.Health Resources and ServicesAdministration’s requirements forcurrent and accurate bed availability

HSEES system. SeeHazardous SubstancesEmergency Events Surveillancesystem

human access, care, and evacuation(HACE), 401, 603–604

human demographics and behavior, 79, 81human factors, 269–270human immunodeficiency virus (HIV), 77,

366–367human remains. See remainshuman susceptibility, 79, 81Humanitarian Charter and Minimum

Standards in Disaster Response(SPHERE), 363

Humanitarian Emergency Logistics &Preparedness (HELP), 355

humanitarian imperative, 66Hurricane Katrina

EIDs, 90emergency management systems, 133,

135floods, 535SNAKE, 118special needs populations, 115–117, 127telemedicine and telehealth, 350, 353

Hurricane Mitch, 117Hurricane Rita, 119hurricanes, cyclones, and typhoons

classifications, 543community impact, 546environmental diseases, 548evacuations, 546–547future research, 551hospital needs, 549–551Hurricane Katrina, 90, 115–117, 127,

133, 135, 350, 353, 535Hurricane Mitch, 117Hurricane Rita, 119impact phase, 549infectious diseases, 548

morbidity, 547–548mortality, 547overview, 543personal needs, 550pharmaceutical needs, 550–551postimpact phase, 549–550preimpact phase, 549progression, 544public health consequences, 545–549Saffir-Simpson Hurricane Scale, 545special needs populations, 548–549

HVA. See Hazard and Vulnerability Analysis;hazard vulnerability analysis

HVAC. See heating, ventilation, and airconditioning

hydrocarbon and halogenated hydrocarbon,522

hydroxocobalamin, 446–447hypocenter, 563hypothermia, 261, 593–594, 596–597

ICAO Manual of Aircraft AccidentInvestigation. SeeInternational CivilAviation Organization Manual ofAircraft Accident Investigation

ICD-10 codes. SeeInternationalClassification of Diseases codes

ice, 254ICRC Code of Conduct. SeeInternational

Committee of the Red Cross Code ofConduct

ICS. SeeIncident Command SystemICSC. See International Chemical Safety

CardsIDLH situations. Seeimmediately dangerous

to life and health situationsIDPs. See internally displaced populationsIEDs. See Improvised Explosive DevicesIHR. See International Health RegulationsIHR-2005. See International Health

Regulations 2005immediate danger, 155immediately dangerous to life and health

(IDLH) situations, 188immersion foot, 594immigrants, 119–120immunity, 153impact mitigation, 52–53impact phase, 549impetigo, 364implanted medical devices with serial

numbers, 315Improved Chemical Agent Monitor, 519Improvised Explosive Devices (IEDs),

439–440IMSuRT. See International Medical Surgical

Response Teamincidence data

air disasters, 253rail disasters, 261sea disasters, 258

incident command, 566Incident Command System (ICS)

earthquakes, 566






IN D E X ■ 655

education and training, 22, 28EIDs, 90–91emergency management systems,

140–141healthcare facility disaster management,

296, 297incident site control zones, 519IND. See investigational new drugsindemnity insurance, 236indemnity, medical, 245–246individual impact, 393individual liberty, 156indoor heat exposure, 619industrial disaster, 512–513industrial events. Seehazardous material

eventsindustrial radiography accidents, 479infant botulism, 467influenza, 77, 88, 213information

processing (by stakeholders), 331–332systems, 352timely release, 338withholding, 329

informed consent, 224inhalation injury, 426–427inhalational anthrax, 459injuries

air disasters, 253–254floods, 534–535mass casualty triage, 174mass gatherings, 230–231motor vehicle disasters, 267–269rail disasters, 261–264sea disasters, 258–259tornadoes, 555–557tsunamis, 580–581volcanoes, 633

injury classificationexplosive events, 397tornadoes, 560

Injury Severity Score (ISS), 180, 394, 410inner ear injury, 397–398Instructional System Development (ISD),

23–26Integrated Emergency Management System,

139–140Integrated Patient Tracking Initiative (IPTI),

386integrated services digital networks (ISDN),

352intensive care, 410–411intent to harm, 80, 82intentional air crashes, 257intentional chemical events, examples,

433–440interagency cooperation, 58intermediate management, 494internal force propagation, 396internal medical surge, 28–29internal radionuclide contamination

treatment, 495–499internally deposited radionuclides, 495–499internally displaced populations (IDPs), 362

internationalall-hazard approach, 58challenges, research and development,

56–59climate change, 58development process, 53–56disaster health and medicine curriculum

topics, 52disaster medicine journals, 55disaster myths, 53, 57disaster realities, 53donations, 53, 57efforts, antibiotics and vaccines, 214–215emergency medicine, 57endeavors, EHEs, 626–627global cluster leads, 56impact mitigation, 52–53institutional approach, 54–56interagency cooperation, 58knowledge discovery, 57national preparedness, 56–57OCHA, 54overview, 51PAHO, 51reconstruction, 59response, 56–57response, CHEs, 374–375scientific and professional approach,

58–59security, 58travel and commerce, EIDs, 79, 81UN Disaster Relief Organization, 54visitors, special needs populations,

119–120WHO, 51, 54WHO/PAHO Hospital Safety Index, 54workforce, EIDs, 95World Bank, 54

International Chemical Safety Cards (ICSC),514

International Civil Aviation Organization(ICAO) Manual of Aircraft AccidentInvestigation, 313

International Classification of Diseases(ICD-10) codes, 166

International Committee of the Red Cross(ICRC) Code of Conduct, 66–67

International Health Regulations 2005(IHR-2005), 203–204

International Health Regulations (IHR), 511International Medical Surgical Response

Team (IMSuRT), 44International Programme on Chemical

Safety (IPCS), 511, 523Internet resources, winter storms, 601intersected vulnerabilities, 120interventions, 108, 371–372, 621investigational new drugs (IND), 224IPCS. See International Programme on

Chemical SafetyIPTI. See Integrated Patient Tracking

InitiativeIranian air disasters, 257Irish Sea air disasters, 257

irritant gas, 522ISD. See Instructional System DevelopmentISDN. See integrated services digital

networksisland volcanoes, 639–640isolation, 76, 157, 203–205, 207Israel smallpox vaccine stockpile, 214Israeli risk communication experience case

study, 335–338ISS. See Injury Severity Score

jack-knifing, 263Jacobson v. Massachusetts, 156jammed valve, 255–256job groups, 24JumpSTART, 179, 180justice, 63, 70–71

Kemmler Code, 514ketamine, 571Killarney GAA Stadium, 233killer tornadoes, 555–557Kirk v. Wyman, 157knowledge discovery, 57

labeling regulations, 224laboratory support, 293lack of will, 80, 82lahars, 637–638land-based communications services, 355language, special needs populations, 118LANs. See local area networksLassa fever, 468latent phase, acute radiation syndrome

(ARS), 488, 489lateral buckling, 263lava flows, 637Law of The Hague, 313leaflets, 337–338legislative authorities and regulatory issues

authorization to provide medical care,158–159

Best v. Bellevue Hospital New York,156–157

consent, 158credentialing, hospital, 158–159data storage and security, 155–156DHS, 160emergency management (public health

systems), 160Emergency Management Reform Act of

2006, 155emergency powers over healthcare

facilities, 161emergency waiver of U.S. state laws,

161–162EMTALA, 160federal disaster assistance programs, 161Federal Volunteer Protection Act of 1997,

152–153FEMA, 161financial and reimbursement issues, 159Good Samaritan legislation (state),

152–153






656 ■ IN D E X

legislative authorities and regulatory (cont.)health status, 154–155healthcare facilities, 159–160HIPAA, 154immediate danger, 155immunity, 153individual liberty, 156isolation procedures, 157Jacobson v. Massachusetts, 156Kirk v. Wyman, 157legal authorities, 204–205legal concerns, 312–314legal framework, 153–154legal issues, 208–209liability, 151–153licensing, 158location, 154–155malpractice insurance, 152mandatory public health measures, legal

basis of, 156–158media, 155medical malpractice, 151–153Medicare Interpretative Guidelines, 159NIMS, 160–161OSHA, 159overview, 151patient rights, 154–158privacy, 154Procedural Due Process, 156protected health information, 154public health officials, 155public health powers, 153–154quarantine procedures, 157recommendations for future research,

162recordkeeping requirements, 155reporting requirements, 155restrictions of movement, 157Robert T. Stafford Disaster Relief and

Emergency Assistance Act (StaffordAct), 161

Leukopenia, 448level of care, 240Lewisite, 448liability, 151–153, 245–246licensing, 158lifesaving interventions (LSIs), 178Lilo, Georgia, 478local area networks (LANs), 352local level resources and tools, 41–43local medical receivers, 408, 595–598local medical responders, 401local planning authority, 234local surge planning and coordination,

39–41Lockerbie, Scotland, 257logistics section, 276, 279, 298longitudinal incident management, 107–108longitudinal studies, 415–416longitudinal study design, 11Los Alamos, 501–503, 502–503low-income nations, 533, 534LSIs. See lifesaving interventionslymphocyte depletion kinetics, 491

MACE. See Military Acute ConcussionEvaluation

MACS. See Multiagency CoordinationSystems

Magen David Adom (MDA) Israeli NationalEMS system, 402–403

magnitude, 634–635MaHIM. SeeMedical and Health Incident

Management Systemmalnutrition, 366, 369–371malpractice insurance, 152, 236, 245–246malpractice, medical, 151–153Managed Inventory, 215Manchester, England, 255mandatory public health measures, legal

basis of, 156–158Mangled Extremity Severity Score (MESS),

571manifest (illness) phase, acute radiation

syndrome (ARS), 488, 490Marburg fever, 468MASS. See Move, Assess, Sort, Send Triagemass casualty triage history, 174Mass Evacuation Transportation Model, 39mass fatality management

antemortem data, 320–321Australian Interpol DVI team, 314birthmarks, 315closed population, 315–316dental records, 315DMORT disaster morgues, 318DMORTs, 315, 319DNA, 315, 316–317DPMU, 318DVI Guide, 313ethical questions, 321family assistance, 322–323fatality identification methods, 315fingerprints/footprints, 315future development, 323future research, 323Geneva Convention, 313Guiding Principles on Internal

Displacement, 313ICAO Manual of Aircraft Accident

Investigation, 313implanted medical devices with serial

numbers, 315important questions, 315–316Interpol DVI teams, 314–315Law of The Hague, 313legal concerns, 312–314mass fatality response agencies, 314–315mass graves or cremations, 313morgue operations, 319–320morgue selection, 317–319morgue triage, 319–320open population, 315–316operations, 317overview, 312PAHO, 313, 319remains, condition of, 316remains, identification, 312–313response teams, 317

risks from handling human remains, 314scars, 315search and recovery, 317social concerns, 312–314tattoos, 315unique skeletal structures, 315victim assistance, 322–323worker care, 321–322

mass flow rate, 634–635mass gatherings

ACEP, 234administrative controller designation,

235–236audit, on-site medical care, 248BASICS system, 231classification, 230clothing procurement, 237COMMUNICATION mnemonic, 231communications requirements, 248controller designation, medical, 235–236credentials, 237debriefing, 237–238definition, 229–230Electric Picnic Festival, 249emergency physicians, 228EMS units, 236equipment procurement, medical, 237equipment requirements, medical,

243–245event intelligence, 243event planning, 233–238event planning schedule, 235event safety guides, 242–243event setup, 237field hospital supplies, 243–244football stadia deaths and injuries,

230–232future research, 248–250The Guide to Health, Safety and Welfare

at Pop Concerts and Other SimilarEvents, 242

the Hajj, 229indemnity insurance, 236indemnity, medical, 245–246injury events, historical, 230–231Killarney GAA Stadium, 233level of care, 240liability, 245–246local planning authority, 234malpractice insurance, 236, 245–246negotiations, 239–240ordinances regarding, 229oversight, medical, 240overview, 228–233Oxegen music festival 2007, 249papal gatherings, 229pharmaceutical requirements, 244–245pop festivals, 230pre-event briefing, 237pre-event visits, 238–239protocol development, medical, 237reconnaissance, medical, 238–239records, medical, 246–247resource estimation, medical, 241–243






IN D E X ■ 657

responsibility designation, 235site emergency plan development, 236site plans, 235Slane Castle, 232–233staff selection, medical, 240–241staff training, medical, 241staffing, 236–237transportation, 245trauma units, 236treatment facilities, 247–248triage, 241types and sites, 228, 231–233VIP care, 239–240

mass graves, 313MASS Triage. See Move, Assess, Sort, Send

TriageMaster of Science in Disaster Medicine and

Management, 30masters-level curriculum in disaster

medicine and public health, 29Material Safety Data Sheets (MSDSs), 514MD-81 aircraft, 256MDA Israeli National EMS system.

SeeMagen David Adom IsraeliNational EMS system

MDR program. SeeMedical DisasterResponse program

MDR-TB. See multidrug resistanttuberculosis

media relations, 293Medical and Health Incident Management

(MaHIM) System, 22, 142, 148medical considerations, immediate, 559–560medical countermeasures, 494–498, 496–498Medical Disaster Response (MDR) program,

568medical equipment

healthcare facility disaster management,294

procurement, 237requirements, 243–245

medical facilities, special needs populations,126–127

medical guidance, U.S., World War II, 286medical management, 280–281, 493Medical Reserve Corps (MRC), 26, 43,

143–144medical surge. See also surge capacity

internal medical, 28–29medical (illustration), 34resources and activities, 29tiers within, 142

Medical Surge Capacity and Capability, 22Medical Surge Capacity and Capability

Management System, 22Medicare Interpretative Guidelines, 159medication storage temperatures, 593MedTrax system by Salamander Technology,

383MedWatch, 225MEMS. See Modular Emergency Medical

Systemmental and behavioral health

age-related responses, 104

clinical disorders, 106common adult responses, 104community-based responses, 106–107demand surge management, 106disaster myths, 105disaster-related behavioral health

casualties, 108–109distress reactions, 103–105floods, 535future directions, 110health-risk behavior changes, 105intervention, 108longitudinal incident management,

107–108overview, 103preparedness for disaster responders,

109–110problems, CHEs, 371–374psychiatric dysfunction, 106psychological first aid, 108–109psychological injuries, prevention and

management of, 108–109PTSD, 103–106public health measures, adherence to,

105–106referral, 107–108responder resilience, 109–110screening, 107–108social support factors, 106–107triage, 107–108

Mental Health Team (MHT), 45mesocyclone, 553MESS score. See Mangled Extremity Severity

Scoremessage, crisis

crafting, 341mixed, 338relevance and effectiveness, 328, 332things to avoid, 341

meteorological effects, 611methemoglobin, 446methicillin-resistant Staphylococcus aureus,

170methyl isocyanate (MIC), 441–442Metropolitan Medical Response System

(MMRS), 39, 137MIC. See methyl isocyanatemicrobes, 75microbial adaptation, 79, 81Microbial Threats to Health: Emergence,

Detection and Response, 78micronutrient diseases, 369–371Milan, Italy, 255Military Acute Concussion Evaluation

(MACE), 400military triage, 177–178Minot, North Dakota, 440–441miraculous survival, 257mission critical systems, 28mitigation

HazMat events, 515–516plans, EHEs, 620–622special needs populations, 127

mixed method study design, 12–13, 16

MMI scale. Seemodified Mercalli intensityscale

MMRS. See Metropolitan Medical ResponseSystem

MMWR. See Morbidity and Mortality WeeklyReport

mobile medical and portable facilities, 41–42mode of transmission, 76Model State Emergency Health Powers Act

(MSEHPA), 203–206modeling, 98modified cluster sampling, 600modified Mercalli intensity (MMI) scale,

565–566Modular Emergency Medical System

(MEMS), 413, 599–600modular/phased immediate and sustained

capability, 40mold exposures, toxic, 531monkeypox, 462–463morbidity

disaster research, 15EHEs, 615–616floods, 532–533, 539–540hurricanes, cyclones, and typhoons,

547–548MMWR, 7research, disaster, 15winter storms, 589–590

Morbidity and Mortality Weekly Report(MMWR), 7

morgueDPMU, 318healthcare facility disaster management,

293mass fatality management, 317–320operations, 319–320selection, 317–319triage, 319–320

mortalityARS rates, 492disaster research, 15earthquakes, 562EHEs, 615–616, 617floods, 532, 539–540hurricanes, cyclones, and typhoons, 547winter storms, 588–589

motor vehicle collisions (MVCs), 590, 592motor vehicle disasters

assessment, 271bus disasters, 267–269command, 271communication, 271environmental factors, 270equipment, 270–271future research, 273human factors, 269–270injury events, current, 267–269injury events, historical, 267planning, 270preparation, 270–271regulation factors, 269rescue factors, 269–270safety, 271






658 ■ IN D E X

motor vehicle disasters (cont.)scene response, 271–272training, 271transportation, 271–272treatment, 271–272triage, 271vehicle factors, 269–270

Move, Assess, Sort, Send (MASS) Triage,177, 402

MRC. See Medical Reserve CorpsMSDSs. See Material Safety Data SheetsMSEHPA. See Model State Emergency Health

Powers Actmud flows, 637–638Muharem Kurbegovic, 433–434Multiagency Coordination Systems

(MACS), 296multicasualty incidents, 277–278multicultural settings, 343–344multidrug resistant tuberculosis (MDR-TB),

77multijurisdictional coordination, 282mustard, 432, 434, 438–439, 448–448MVCs. See motor vehicle collisionsmyocardial infarctions, 572–573

N95 respirators, NIOSH, 191national disaster exercises, 97–98National Disaster Life Support Courses, 29National Disaster Medical System (NDMS)

emergency management systems, 135,143–144

surge capacity, 43, 44volunteers, 143

National Domestic PreparednessConsortium, 26

National Electronic Disease SurveillanceSystem, 167

National Energetic Materials Research andTesting Center at the New MexicoInstitute of Mining, 26

National Exercise, Test, and Training Centerat the U.S. Department of Energy’sNevada Test Site, 27

National Fire Protection Association 704system, 514

National Fire Protection Association classes,188

National Hospital Available Beds forEmergencies and Disasters (HavBEDproject), 385–386

National Incident Management System(NIMS), 26

education and training, disaster, 26EIDs, 90emergency management systems, 140,

147–148healthcare facility disaster management,

299–300legislative authorities and regulatory

issues, 160–161National Institute for Occupational Safety

and Health (NIOSH) guidelines,190–193

National Institute for Occupational Safetyand Health respirator selection logic,190–192

National Medical Response Team (NMRT),44

National Opinion Research Center at theUniversity of Chicago (NORC), 4

National Organization on Disability (NOD)Emergency Preparedness Initiative,118, 121

National Response Framework (NRF)education and training, 21–22EIDs, 90emergency management systems,

135–137, 141, 147–148National Response Plan (NRP), 90,

135–137, 141, 147–148National Voluntary Organizations Active in

Disaster, 145–146National Weather Service (NWS), 591NATO. See North American Treaty

OrganizationNatural Hazards Research and Applications

Center (NHRAC), 4NDMS. See National Disaster Medical

SystemNeisseria meningitidis, 82, 85, 86nerve agents, 433–434, 437–438, 448–450network development, 348–349networks of networks, 358neural network, 168news screencap, 336NGHAs. See Non Governmental

Humanitarian AgenciesNGOs. See nongovernmental organizationsNHRAC. See Natural Hazards Research and

Applications CenterNIMS. See National Incident Management

System, 911, 276NIOSH guidelines. SeeNational Institute for

Occupational Safety and Healthguidelines

NOD Emergency Preparedness Initiative.SeeNational Organization on DisabilityEmergency Preparedness Initiative

Non Governmental Humanitarian Agencies(NGHAs), 66

nongovernmental organizations (NGOs),365–366

nontrauma-related medical conditions,572–573

NORC. See National Opinion ResearchCenter at the University of Chicago

North American Treaty Organization(NATO), 177–178

North Carolina Domestic Training Exercise,356

Northern Ireland Hostile Action CasualtySystem, 397

NRF. See National Response FrameworkNRP. See National Response Plannuclear events

alpha particles, 483–484ARS, 482–483, 487–495

behavioral consequences, 499–501beta particles, 481–484biodosimetry, 484–487Biodosimetry Assessment Tool, 485blast effects, 480case studies, 501–504Chernobyl nuclear power station,

477–478clinical course of criticality events,

502–504criticality accidents, 477, 501–504cytogenetic assays, acute phase, 486cytogenetic biodosimetry, 484–485DEARE, 493, 496–497decorporation therapy, 498–499detonation effects, 479–482detonations, 407–408dose schedules, drugs or treatment

modalities, 500EPR, 486–487ESR spectroscopy, 486–487Estonia, private home radiation accident,

501excursions, 477fallout, 480–482fission products, yield, 481fission-neutron, lethal dose in mice, 483flat-plain damage patterns from

ground-level detonation, 480future research, 504–505gamma rays, 481–484Goiania, Brazil, 478, 501industrial radiography accidents, 479internal radionuclide contamination

treatment, 495–499internally deposited radionuclides,

495–499Lilo, Georgia, 478Los Alamos liquid criticality event,

502–503Los Alamos plutonium sphere cases,

501–503medical countermeasures, 496–498nuclear terrorism, 479overview, 477physiological variables, 484power plant accidents, 477–478PPE, 185radiation biology, 482–485radiation, dose rates, 483radiation, prompt effects, 480radiation quality, 483–484radiological terrorism, 479radiological triage, 484–487radionuclide exposures, 478–479radiotherapy accidents, 479shelter, dose reduction factors, 482shielding, benefits of, 482Techa River, former Soviet Union,

478–479terrorist threat scenarios, 479thermal effects, 480–481Three Mile Island nuclear reactor, 478Tokai-Mura Event (1999), 486






IN D E X ■ 659

Windscale nuclear power plant, 478Wood River Junction liquid criticality

event, 502–504nuclear terrorism, 479nursing homes, 118–119NWS. See National Weather Service

observational study design, 10occupant emergency procedures, 28occupant life safety, 28Occupational Safety and Health

Administration (OSHA)HazMat events, 516legislative authorities and regulatory

issues, 159respiratory protection standards, 192

OCHA. See Office for the Coordination ofHumanitarian Affairs

ocular injury, 397–398ocular primary blast injury (PBI), 398Office for the Coordination of

Humanitarian Affairs (OCHA), 54online resources, identification, 515on-shore effects, 578–580open population, 315–316open wounds, 411, 595Operation Strong Angel, 356operations section, 276, 277, 279, 297optical character recognition, 382organizational resiliency, 28organophosphates, 432Orthopoxvirus PCR testing, nonspecific, 463

OSHA. See Occupational Safety and HealthAdministration

outbreak, 76outcomes-based planning, 36–37out-of-hospital care, 403–405overpressure, 396overriding, 263oversight, mass gatherings, 240Oxegen music festival 2007, 249oximes, 450

Pacific Tsunami Warning Center (PTWC),582

PAHO. See Pan American HealthOrganization

Pan American Health Organization(PAHO), 51, 313, 319

Pandemic and All-Hazards Preparedness Act,134

papal gatherings, 229PAPRs. See powered air-purifying respiratorsparenteral cidofovir, 463Paris, France air disasters, 256partial burns, 426paternalistic attitudes, 338–339pathogens, 75pathophysiology, 397patient care capacity, 291patient identification and tracking

American Red Cross Safe and Well website, 378

Collaborative Fusion’s CommunityResponse System’s Patient TrackingModule, 383

Comcare’s Integrated Patient TrackingInitiative, 386

data collection, 378, 384data entry, 378, 380–382data, field communication, 382–383data, field tools, 382–383data portals, 381data security, 379EDXL, 386EMTrack, 381essential elements, 379–381existing systems, 381future research, 386–387HavBED project, 385–386HERDS, 385HRSA requirements for current and

accurate bed availability, 385IPTI, 386optical character recognition, 382overview, 377–378patient selection (for tracking), 379–380Raytheon Patient Tracking System, 385ReddiNet, 381relational database considerations,

383–385RFID, 379, 382Salamander Technology’s MedTrax

system, 383“skimming,” 382system design considerations, 378–382systemization efforts, 385–386tagging, approaches to, 382TRAC2ES patient tracking system, 378triage tags, 379, 381–382vendor evaluation tool, 387–388WebPCR, 381WiFi, 382–383WIISARD, 387XML, 386

patient monitoring and management, 350patient rights, 154–158patient tracking. See patient identification

and trackingPBI. See primary blast injury (PBI)peak ground acceleration (PGA), 565–566peak ground velocity (PGV), 565–566pediatric triage systems, 179–180Pediatric Triage Tape, 179–180PEEP. See positive end-expiratory pressurepermanent facilities, 412, 598–599pernio, 593–594personal protective equipment (PPE)

anthrax, 184APRs, 189–190Army Center for Health Promotion and

Preventive Medicine’s Technical Guiderecommendations, 189

atmosphere-supplying respirators, 190bacteria, 191Best Practices for Hospital-Based First

Receivers of Victims from Mass

Casualty Incidents Involving theRelease of Hazardous Substances, 189

biological warfare, 184biological weapons, 186CBRN events, 190chemical contamination, 185–186chemical release, frequency by substance

categories, 186chemical warfare, 185–186considerations for use of, 187–192decontamination, 196–197, 199decontamination suit ensembles, levels

A-D, 188EIDs, 86explosive events, 415exposure, 185–187Federal Manager’s/Decision Makers

Emergency Guide, 187first receivers, 189first responder, 189floods, 538future directions, 192hazards, 185HazMat events, 517–518, 520healthcare facility disaster management,

289–290HEPA filters, 191IDLH situations, 188injuries or symptoms, frequency by type

of event, 187N95 respirators, NIOSH, 191National Fire Protection Association

classes, 188NIOSH guidelines, 190–193NIOSH respirator selection logic,

190–192nuclear warfare, 185OSHA respiratory protection standards,

192overview, 184PAPRs, 189–191radiation exposure, 186–187respirator training, 191respirators, 189–190SCBA, 190scene management, Emergency Medical

Services, 281terrorism, 185threats, 185viruses, 191

PGA. See peak ground accelerationPGV. See peak ground velocitypharmaceutical needs, hurricanes, cyclones,

and typhoons, 550–551pharmaceutical requirements, mass

gatherings, 244–245Philadelphia Extreme Heat Event Response

Plan, 622phosgene, 432physical vulnerability, 14physiological effects, 611physiological variables, 484PICE. See potential injury/illness-creating

event






660 ■ IN D E X

pilot error, 256plague, 464–466plain chest radiograph, 409planning

air disasters, 257EHEs, 619–622healthcare facility disaster management,

298motor vehicle disasters, 270rail disasters, 264–265sea disasters, 260section, 276, 279

pneumonic plague, 464–466PODs. See points of dispensingpoints of dispensing (PODs)

activation phases, 223deactivation, 223effective management guidelines, 222equipment and supplies, 217–218modeling software and programming,

222nonsegmented, 219operations, 217–220planning, 216public information, 223segmented, 218–219site selection, 216–217staffing and training, 220–223

political vulnerability, 14pop festivals, 230population displacement, floods, 531,

539population groups, emergency management

systems, 148population management, telemedicine and

telehealth, 351positive end-expiratory pressure (PEEP),

399, 409, 448positive-pressure ventilation (PPV), 398,

399, 409, 410posttraumatic stress disorder (PTSD),

103–106, 535potential injury/illness-creating event

(PICE), 393, 586, 588Pott’s disease, 368power loss, 412power plant accidents, 477–478power struggles, public, 339powered air-purifying respirators (PAPRs),

189–191PPE. See personal protective equipmentPPV. See positive-pressure ventilationpredicting

EHEs, 621tsunamis, 582

pre-event briefing, 237pre-event visits, 238–239prehospital impact, 559prehospital response, 519, 566–567preimpact phase, 549preparation

air disasters, 257motor vehicle disasters, 270–271rail disasters, 264–265sea disasters, 260

preparednessEIDs, 88, 97–99HazMat events, 516–519healthcare facility disaster management,

288international, 56–57mental and behavioral health, 109–110special needs populations, 120surge capacity, 36

Preparedness & Response On AdvancedCommunications Technology(PROACT), 355–356

pressure, 395–396primary blast injury (PBI), 398, 400–401primary prevention, 619Prince, Samuel, 4privacy, 154PROACT. See Preparedness & Response On

Advanced CommunicationsTechnology

procedural coding, 166Procedural Due Process, 156prodromal phase, acute radiation syndrome

(ARS), 488, 489Project BioShield law, 224Project Heartland, 116prolonged exposure, extreme heat events,

612prophylaxis, 293protected health information, 154protocol development, mass gatherings,

237PSAP. See public safety answering pointpsychiatric dysfunction, 106psychiatric illness, complex humanitarian

emergencies, 373–374psychological

distress from earthquakes, 573first aid, 108–109impact, 126injuries, prevention and management,

108–109reactions to trauma, 372–373reality, 340vulnerability, 14

psychosocial problems, 371–374PTSD. See posttraumatic stress disorderPTWC. See Pacific Tsunami Warning Centerpublic education and training programs, 26public education, special needs populations,

121–122public health

antibiotics and vaccines, 217, 224CDC grant programs to improve public

health preparedness and response forbioterrorism, 139

CDC Public Health Emergency ResponseGuide, 90

critical biological event agents, 458Decision Instrument for the Assessment

and Notification of Events that MayConstitute a Public HealthEmergency of International, 208

disaster research, 7education and training, disaster, 29

EIDs, 80, 81, 90, 94–95emergency management systems, 132,

135, 138–139, 148–149, 160, 217, 224flood impacts, 530–532, 537–540global, 148–149Global Public Health Information

Network, 523HazMat events, 514–515, 523hurricanes, cyclones, and typhoons,

545–549infrastructure breakdown, 80, 81legislative authorities and regulatory

issues, 153–155mandatory measures, legal basis,

156–158masters-level curriculum in disaster

medicine and public health, 29mental and behavioral health, 105–106officials, 155powers, 153–154Public Health Security and Bioterrorism

Preparedness and Response Act, 132,135

Public Health Service Act, 217, 224public health workforce, 94–95quarantine, 208response cycle, 514–515surge capacity, 45telemedicine and telehealth, 345, 349,

350Turning Point Model State Public Health

Act, 203–206USPHS, 45workforce, 94–95

public health and emergency managementsystems. See emergency managementsystems

public health emergency. See complexhumanitarian emergencies

Public Health Service Commissioned Corps(USPHS), 45

public information, 413–414, 601Public Readiness and Emergency Preparedness

Act, 216–217public safety answering point (PSAP), 276public safety workforce, 95public telephone systems, 357publicity and advertising activities, 67pulmonary intoxicants, 445pyroclastic flows, 635–636

quarantineCDC Guidelines for Environmental

Infection Control in HealthcareFacilities, 2001, 210

civil confinement strategies, efficacy, 207contact network modeling, 207containment strategy, 206Decision Instrument for the Assessment

and Notification of Events that MayConstitute a Public HealthEmergency of International, 208

definition, 76, 203–204diseases subject to (U.S.), 209empowering authority for, 210






IN D E X ■ 661

ethical issues, 210future research, 210–211global travel, 207International Health Regulations 2005

(IHR-2005), 203–204isolation, 203–205isolation, healthcare facilities, 207legal authorities, 204–205legal issues, 208–209legislative procedures, 157MSEHPA, 203–206overview, 203potential exposure within four hours of

arrival from Europe to NorthAmerica, 209

Quarantine Act, Canada, 209SARS, 207–208travel restrictions, 206Turning Point Model State Public Health

Act, 203–206U.S. Code: Title 42, 209–210

Quarantine Act, Canada, 209quasiexperiment design, 10

rabbit fever, 470–471race, 66, 116–117radiation

biology, 482–485combined injury, 492dose rates, 483exposure, 186–187prompt effects, 480quality, 483–484

Radiation Emergency AssistanceCenter/Training Site (REAC/TS), 407

radiation sickness. See acute radiationsyndrome

radiation-induced malignancy, 493radiofrequency identification (RFID), 379,

382radiological dispersion devices (RDDs), 405radiological events. See nuclear eventsradiological injuries, 407–408radiological terrorism, 479radionuclide exposures, 478–479radiotherapy accidents, 479rail disasters

assessment, 266command, 265communication, 266equipment, 265Eschede, Germany, 264future research, 272–273hostile acts, 264incidence data, 261injury events, current, 263–264injury events, historical, 261–262jack-knifing, 263lateral buckling, 263overriding, 263planning, 264–265preparation, 264–265safety, 265–266scene response, 265–267telescoping, 262

training, 265transport, 267treatment, 267triage, 266–267

Rapid Deployment Force (RDF), 45rapid needs assessments, 413, 600, 604Rapid Syndromic Validation Project, 167rationing, 63, 65Raytheon Patient Tracking System, 385RDDs. See radiological dispersion devicesRDF. See Rapid Deployment ForceRDRTF. See Renal Disaster Relief Task ForceREAC/TS. See Radiation Emergency

Assistance Center/Training SiteReal-time Outbreak and Disease

Surveillance (RODS), 167–168real-time synchronous simulations, 356real-time videoconferencing, 355Receipt, Storing, and Staging (RSS) location,

215recommendations for future research. See

future researchreconnaissance, medical, 238–239reconstruction, 59recordkeeping requirements, 155records, medical, 246–247recovery, 125, 307–310, 488Red Sea, 259ReddiNet, 381reemerging infectious diseases, 78–82referral for mental and behavioral health,

107–1refugee camp conditions, northern Iraq,

362, 363regional governments, extreme heat events

(EHEs), 626regional support, surge capacity, 43registries, special needs populations,

122–123regulation factors, motor vehicle disasters,

269regulatory issues. See legislative authorities

and regulatory issuesrehydration salts, 366reimbursement issues, 159relational databases, 383–385relief aid, 67remains

condition of, 316identification, 312–313risks from handling, 314

Renal Disaster Relief Task Force (RDRTF),572

renal disease, end-stage, 573renters, 116reporting requirements, 155reputational risk management, 328–329rescue factors, motor vehicle disasters,

269–270research, disaster

cold war and, 4cross-sectional study design, 11data collection, 12Defense Civil Preparedness Agency, 4DRC, 4

early, 4, 7emergency medicine, 7Epidemiologic Reviews, 7epidemiology, 7estimation method consistency, 15–16ethics in, 13experimental study design, 9–10FEMA, 12GIS, 13longitudinal study design, 11methods, 8milestones in, 5–6mixed method study design, 12–13, 16MMWR, 7morbidity and mortality, 15NHRAC, 4NORC, 4objectives, 8observational study design, 10overview, 3–7physical vulnerability, 14political vulnerability, 14Prince, Samuel, 4psychological vulnerability, 14public health, 7quasiexperiment design, 10recommendations for future, 16–17settings, 8–9social vulnerability, 14study designs, 9–12U.S. Army Chemical Corps Medical

Laboratories, 4variables, 9vulnerability, 13–14

research, future. See future researchreservoir, 77resilience, 71resolution, 331resources

decontamination, 197–198EIDs, 83, 85estimation, medical, 241–243management, 96–97special needs populations, 128–129

respirator training, 191respirators, 189–190respiratory infections, 533responder

attire, 592–593local medical, 593–595resilience, 109–110risks, 591–592winter storms, 593–595

responseemerging infectious diseases, 85HazMat events, 519international, 56–57mass fatality management, 317system preparedness, explosive events,

414teams, 317

responsibility designation, 235restrictions of movement, 157resupply, 366Revised Trauma Score (RTS), 178–180






662 ■ IN D E X

RFID. See radiofrequency identificationribavirin, 469Richter scale, 564–565risk assessment

EHEs, 621floods, 539HazMat events, 516

risk factorsCHEs, 371dual-use risk, 93EHEs, 611–617EIDs, 93human remains, handling, 314mass fatality management, 314tornadoes, 555–556tsunamis, 580–581

risk management, 515–516, 536–537risk mitigation, 603risk perception, 334Robert T. Stafford Disaster Relief and

Emergency Assistance Act (StaffordAct), 161

rodent-borne diseases, 534RODS. See Real-time Outbreak and Disease

SurveillanceRSS location. See Receipt, Storing, and

Staging locationRTS. See Revised Trauma Score“Rule of Nines,” 425rumor management, 339Russian air disasters, 256–257

Sacco Triage Method, 177Safe and Well web site, American Red Cross,

378safe water loss, 530safety

air disasters, 257–258motor vehicle disasters, 271rail disasters, 265–266sea disasters, 260–261

Saffir-Simpson Hurricane Scale, 545Salamander Technology’s MedTrax system,

383SALT Triage. See Sort, Assess, Lifesaving

measures, Treat/Transport Triagesanitation loss, 530SARA Title III. See Superfund Amendments

and Reauthorization Actsarin (GB), 346, 448–450SARS-Cov. See severe acute respiratory

syndrome coronavirussatellite-based communications services,

353, 355SAVE. See Secondary Assessment of Victim

EndpointScandinavian Star, 259–260scars, 315SCBA. See self-contained breathing

apparatusscene management, Emergency Medical

Servicescommand and general staff, 279command, area, 279

command organization, 277–278decontamination, 281–282dispatch center, 276E-911, 276extended response and incident

organization, 278finance/administration section, 276, 279future research, 282–283hazards, special, 281–282initial response, 277–278logistics section, 276, 279medical management, 280–281multicasualty incidents, 277–278multijurisdictional coordination, 282,

911, 276operations section, 276, 277, 279overview, 275plans (planning) section, 276, 279PPE, 281PSAP, 276therapeutic interventions, 280–281transport, 279–280triage, 279–280victim tracking, 282

scene responseair disasters, 257–258motor vehicle disasters, 271–272rail disasters, 265–267sea disasters, 260–261

scene security, 404–405screening, mental and behavioral health,

107–108scrofula lesion of the neck, 368scurvy, 365sea disasters

Al Salam Boccaccio 98, 259assessment, 261bad weather navigation, 259Baltic Sea, 259command, 260communication, 261delayed rescue, 259design shortcomings, 259equipment, 260Estonia, 259fire on board, 259–260future research, 272Herald of Free Enterprise, 259human shortcomings, 259hypothermia, 261incidence data, 258injury events, current, 258–259injury events, historical, 258planning, 260preparation, 260Red Sea, 259safety, 260–261Scandinavian Star, 259–260scene response, 260–261ship wreck, 259training, 260transport, 261treatment, 261triage, 261

vessel speed, 259Zeebrugge, Belgium, 259

search and recovery, 317Secondary Assessment of Victim Endpoint

(SAVE) triage, 176, 178, 402, 570secondary prevention, 619–620secondary triage systems, 178–179security, 58, 294self-contained breathing apparatus (SCBA),

190, 436self-disclosure, 72self-effacement, 71–72septicemic plague, 464–466Sequential Organ Failure Assessment

(SOFA), 411service deliveries, 294severe acute respiratory syndrome

coronavirus (SARS-Cov), 76, 77, 79,84–86, 88, 207–208

Shadow Bowl, 356shared power and control, 72shelter

dose reduction factors, 482loss, 531special needs populations, 124

shielding benefits, 482ship wreck, 259shock waves, 564shootings, 256–257shoveling snow, 590shuttered hospitals, 41Simple Triage and Rapid Treatment

(START)burn patient management, 424earthquakes, 567, 570explosive events, 402, 410triage, 175–176

Sin Nombre virus, 77site emergency plan development, 236site plans, 235“skimming,” 382skin lesions, 462Slane Castle, 232–233slips and falls, 590smallpox

ACAM-2000 vaccine, 463–464antibiotics and vaccines, 213–214biological event, 461–464

SMI. See Strategic Stockpile ManagedInventory

smoldering country health profile,365–367

SNAKE. See Special Needs Assessment ofKatrina Evacuees

snowblower injury, 595SNS. See Strategic National Stockpilesoap and water, 196–197social contract, 68social support, 106–107, 540social vulnerability, 114–120sodium thiosulfate, 446SOFA. See Sequential Organ Failure

Assessmentsoman (GD), 448–450






IN D E X ■ 663

Sort, Assess, Lifesaving measures,Treat/Transport (SALT) Triage, 178,179

South America, 623–625southeast Asia, 623–625Spacebridge project, 347special medical needs populations, 560Special Needs Assessment of Katrina

Evacuees (SNAKE), 118special needs populations

age, 115–116bombing, Oklahoma City, 116children, 115–116community, knowledge of, 120congregate facilities, 118–119continuity of care, 124–125debris, 125–126disability, 117–118earthquake, Loma Prieta, California

1989, 117earthquake, Northridge, California 1994,

116the elderly, 115, 120emergency bag (“Go Kit”), 122emergency management life cycle,

120–127emergency response, 123–124evacuation, 118–119, 123FEMA, 114, 127FEMA Higher Education Project website,

121future needs in research, 127–128Hurricane Katrina, 115–117, 127Hurricane Mitch, 117Hurricane Rita, 119hurricanes, cyclones, and typhoons,

548–549immigrants and international visitors,

119–120income, 116intersected vulnerabilities, 120language and literacy, 118medical facilities, reestablishing, 126–127mitigation, 127NOD Emergency Preparedness Initiative,

118, 121nursing homes, 118–119overview, 113–114policies and practices, emerging, 127preparedness, 120Project Heartland, 116psychological impact, 126public education, 121–122race and ethnicity, 116–117recovery, 125recovery planning, 125registries, 122–123renters, 116resources, 128–129shelters, 124SNAKE, 118social vulnerability, 114–120tornado, Birmingham, Alabama,

116–117

training and education, 121tropical storm, Caddo County,

Oklahoma 2007, 119tsunami, Indian Ocean 2004, 117, 126vulnerable populations, sizes, 121WTC bombing 2001, 118, 125–126

specialized responses, explosive events, 405

SPHERE. See Humanitarian Charter andMinimum Standards in DisasterResponse

Sphere project, 352–353Spitak, Armenia earthquake, 346spokesperson role, 334–335spontaneous, negative-pressure ventilation,

409staff

HazMat events, 517–519healthcare facility disaster management,

291–292, 303mass gatherings, 236–237, 240–241surge capacity support, 42–43

Stafford Act. See Robert T. Stafford DisasterRelief and Emergency Assistance Act

stakeholdersconcerns and identification, 339–340ethics, 63needs, 341–342

Stalag 13, 433standardization, emergency management

systems, 141–142Staphylococcus aureus, 77START. See Simple Triage and Rapid

Treatmentstewardship, 71stigmatization, 334Stockholm, Sweden air disaster, 256stockpiles

antibiotics and vaccines, 214–215Canadian antiviral stockpile for

pandemic influenza, 214–215CSEPP, 450–451emergency management systems, 137Israel smallpox vaccine stockpile, 214medication stockpiles, 215SMI, 44SNS, 137, 215surge capacity, 44WHO, 215

store-and-forward applications, 347, 356strategic considerations, telemedicine and

telehealth, 358Strategic National Stockpile (SNS)

antibiotics and vaccines, 215emergency management systems, 137surge capacity, 44

Strategic Stockpile Managed Inventory(SMI), 44

stratification of care model, 40–41strenuous activity, 612streptomycin, 466strip and shower, 199study designs, disaster research, 9–12submarine earthquake, 579

Suicide Vehicle-borne Improvised ExplosiveDevices (SVBIED), 439–440

suicides, 535sulfur mustard. See mustardsuper cell, 553Superfund Amendments and Reauthorization

Act (SARA Title III), 516supplies, healthcare facility, 293, 301, 303support services, telemedicine and

telehealth, 352–353surge capacity

alternative care system development,40–41

APHT, 45burn surge, 46–47CAL-MAT, 43chempacks, 45community alternate care site partners,

41CRI, 45defining, 35–36defining requirements, 37–39DMAT, 44DMORT, 44earthquakes, 569EHEs, 614–615EMAC, 43explosive events, 412–413facilities of opportunity, 41FluSurge, 38FMS, 45healthcare facility, 40–41healthcare facility disaster management,

302–304Hospital Surge Model, 38IMSuRT, 44local level resources and tools, 41–43local surge planning and coordination,

39–41Mass Evacuation Transportation Model,

39medical planning assumptions, 38Medical Surge Capacity and Capability

Management System, 22MHT, 45MMRS, 39mobile medical and portable facilities,

41–42modular/phased immediate and

sustained capability, 40MRC, 43national planning, 43–45NDMS, 43, 44NMRT, 44outcomes-based planning, 36–37overview, 33–36pandemic influenza estimate model, 38planning assumptions, 37, 38preparedness, 36RDF, 45recommendations for future research,

47–48regional support, 43shuttered hospitals, 41






664 ■ IN D E X

surge capacity (cont.)SMI, 44SNS, 44spectrum of incidents, 34staff support, considerations for, 42staff support, local options, 42–43stratification of care model, 40–41U.S. crude death rates 1917–1919, 38U.S. Department of Defense resources,

45–47USPHS, 45VMAT, 44VMI, 44

surge program creation, 302–303surveillance

EIDs, 93–94floods, 539–540research, 99–100

surveillance system components, 166surveillance system examples, U.S., 167survey questions, 600survival kit, winter storms, 602sustainable development, 536sustainable flood risk management, 536–537

SVBIED. See Suicide Vehicle-borneImprovised Explosive Devices

Swine Flu vaccination program 1976, 213Swinfen Charitable Trust, 356syndromic surveillance

BioSense, 168CDC, 167, 168CPT5 codes, 166data analysis, 169data integration, 168–169EIDs, 170Electronic Surveillance System for the

Early Notification ofCommunity-based Epidemics, 168

Epi-X, 168future research, 170–171Global Outbreak and Alert Response

Network, 167healthcare diagnostic coding, 166ICD-10 codes, 166methicillin-resistant Staphylococcus

aureus, 170National Electronic Disease Surveillance

System, 167neural network, 168overview, 165–166procedural coding, 166Rapid Syndromic Validation Project, 167

RODS, 167–168surveillance system components, 166surveillance system examples, U.S., 167value of, 169–170WHO, 167

system design, patient identification andtracking, 378–382

system preparedness, winter storms, 603systemic arterial air embolism, 409systems reengineering, 347–348

tabun (GA), 448–450tactical combat casualty care (TCCC or

TC3), 403, 406tactical field care, 405tagging, 382. See also triage tagsTaipei, Taiwan air disaster, 255Tampere Convention, 353tattoos, 315TBI. See traumatic brain injuryTBSA Survival Grid. SeeAge/Total Body

Surface Area Survival GridTCCC or TC3. See tactical combat casualty

careteam leaders, 73Techa River, former Soviet Union, 478–479technology

EIDs, 79, 81, 92industry and, 79, 81National Energetic Materials Research

and Testing Center at the New MexicoInstitute of Mining and Technology,26

patient identification and tracking, 383PROACT, 355–356Salamander Technology’s MedTrax

system, 383science and, 92telecommunications technology support,

352telemedicine and telehealth, 346–347,

352, 355–356telecommunications technology support,

352telehealth. See telemedicine and telehealthtelemedicine and telehealth

amateur radio networks, 357anthrax, 357asynchronous telehealth, 347benefit, 350–351business processes, 354challenges, 347, 349clinical care networks, 354clinical effectiveness research, 358clinical video conferencing system, 346complex adaptive system, 358effectiveness, 350EHR, 351–352future research, 357–358HELP, 355home telehealth applications, 356home-telehealth device, 346Hurricane Katrina, 350, 353information systems, recommendations

for implementing, 352ISDN, 352land-based communications services,

355LANs, 352network development, 348–349networks of networks, 358North Carolina Domestic Training

Exercise, 356Operation Strong Angel, 356overview, 345

patient monitoring and management,350

policy considerations, 357–358population management, 351PROACT, 355–356public health emergency preparedness,

349public health emergency, response phase

elements, 350public telephone systems, 357real-time synchronous simulations, 356real-time videoconferencing, 355robustness, 358role in public health emergencies, 345sarin nerve agent, 346satellite-based communications services,

353, 355scenarios, 350–351Shadow Bowl, 356the Spacebridge project, 347the Sphere project, 352–353Spitak, Armenia earthquake, 346store-and-forward applications, 347,

356strategic considerations, 358support services, standardization,

352–353Swinfen Charitable Trust, 356systems reengineering, 347–348the Tampere Convention, 353technologies, 346–347telecommunications technology support,

352Telemedicine Information Exchange, 355WANs, 352, 353Web-based information, 357

Telemedicine Information Exchange, 355telescoping, 262temporary facilities

explosive events, 413winter storm shelters, 599–600winter storms, 599–600

Tenerife, Spain air disaster, 254–255tephra fall impacts, 638–639tephra volume, 634–635terrorism

air disasters, 256–257biological event, 456–458EIDs, 83, 87PPE, 185

tertiary prevention, 620tetanus, 368, 596therapeutic interventions, 280–281thermal effects, 480–481thoracic CT scanning, 409thoracic dynamics, 396threat list, 454–455Three Mile Island nuclear reactor, 478TICs. See toxic industrial chemicalsTM injury. Seetympanic membrane injuryTNT, 395Tokai-Mura Event (1999), 486top ten volcanic events in 20th century,

634






IN D E X ■ 665

tornadoesalternate care sites, 560blast injuries, 558death risk, 555–556EF Scale, 553–554epidemiology, 555fatalities 1940–2005, 558Fujita, Dr. T. Theodore, 553Fujita tornado damage scale, 553–555future research, 560hook (or hook echo), 553hospital impact, 559–560immediate medical considerations,

559–560incidence in U.S. 1950–2005, 556injury classification, 560injury patterns, 556–557injury risk, 555–556killer tornadoes, 555–557mesocyclone, 553overview, 553prehospital impact, 559special medical needs populations, 560special needs populations, Birmingham,

Alabama, 116–117standards of care, 560super cell, 553super outbreak April 3–4, 1974, 557terms, 553“Tornado Alley,” 555, 556triage, 559, 560

Toronto, Ontario, Canada air disaster, 256

town hall meeting management, 342–343toxic chemicals, 438–439toxic events. Seehazardous material eventstoxic industrial chemicals (TICs)

chemical events, 432toxic shock syndrome, 77toxins, 87TRAC2ES patient tracking system, 378training. See also education and training,

disasterair disasters, 257motor vehicle disasters, 271rail disasters, 265sea disasters, 260

transfer form, Institute of Surgical ResearchBurn Center, 427

transmission, 83–85transmission prevention, 91transmission rate (R0), definition, 77transport

air disasters, 258rail disasters, 267scene management, Emergency Medical

Services, 279–280sea disasters, 261

transport emergency cards (TREMCARDS),514

transportationHazMat events, 520–521mass gatherings, 245motor vehicle disasters, 271–272

transportation disasters. See also airdisasters; motor vehicle disasters; raildisasters; sea disasters

common challenges, 273future research, 272–273overview, 253

transportation guidelines, 426trauma triage, 520trauma units, 236traumatic brain injury (TBI), 400, 410travel restrictions, 206treatment

air disasters, 258ARS, 493–495chemical events, 444–450EHEs, 613facilities, mass gatherings, 247–248motor vehicle disasters, 271–272rail disasters, 267sea disasters, 261

TREMCARDS. See transport emergencycards

trench foot, 594triage

air disasters, 258Alfred P. Murrah Federal building

bombing, 176CareFlight Triage, 176CESIRA Protocol, 177chemical, 520common scales used for, 180context-specific triage, 181–182decision table for burn victims, 423–424disaster differentiation, 181ethics, 63, 65explosive events, 401–403, 408, 411future research, 182GCS, 178, 180goals, 181HazMat events, 519–520Homebush Triage Standard, 176ISS, 180JumpSTART, 179, 180LSIs, 178MASS, 177mass casualty triage history, 174mass gatherings, 241mental and behavioral health, 107–108military, 177–178motor vehicle disasters, 271NATO, 177–178overview, 174pediatric triage systems, 179–180PTT, 179–180radiological, 484–487rail disasters, 266–267RTS, 178–180Sacco Triage Method, 177SALT, 178, 179SAVE, 176, 178scene management, Emergency Medical

Services, 279–280sea disasters, 261secondary triage systems, 178–179

START, 175–176tornadoes, 559, 560Triage Sieve, 176–177Triage Sort, 178–179triage systems, 175–178winter storms, primary, 595winter storms, secondary, 598WTC bombing 2001, 176

Triage for Targeting, 401–402Triage for Transportation, 402–403Triage for Treatment, 402triage tags, 379, 381–382tropical cyclones. See hurricanes, cyclones,

and typhoonstropical storm, Caddo County, Oklahoma

2007, 119trust, 328tsunamis

community planning, 582–583debris, 579–580epidemiology, 581evacuation, 582–583future research, 583–584health assessments, 581high-energy waves, 579Indian Ocean 2004, 117, 126injury risks, 580–581on-shore effects, 578–580overview, 578prediction, 582PTWC, 582special needs populations, 117, 126submarine earthquake, 579terminology, 582warning systems, 581–582WC/ATWC, 582

tuberculosis, 368tularemia, 470–471Turning Point Model State Public Health Act,

203–20612-Hour Push Packages, 2152-pralidoxime chloride (2-PAM), 450tympanic membrane (TM) injury, 397–398,

410typhoons. See hurricanes, cyclones, and

typhoons

UN Disaster Relief Organization, 54UN SIN or UN Number. See United Nations

Substance Identification Numberunderpressure, 396undertriage, 402unintentional chemical events, examples,

440–443Union Carbide Bhopal, India 1984 disaster,

441–442, 512–513unique skeletal structures, 315United Kingdom SMART teams, 214United Nations Substance Identification

Number (UN SIN or UN Number),513

university programs, 29urban aid, 364urban heat islands, 618–619






666 ■ IN D E X

urban search and rescue (US&R)earthquakes, 567education and training, 27explosive events, 401, 405

U.S. Army Chemical Corps MedicalLaboratories, 4

U.S. biodefense research priorities, 473U.S. Biological Arsenal, 455U.S. Civilian Biological Warfare Medical

Countermeasures Research, 472–473U.S. Code: Title 42, 209–210U.S. crude death rates 1917–1919, 38U.S. Department of Health and Human

Services (HHS) select agents andtoxins, 456–457

U.S. Health Resources and ServicesAdministration’s (HRSA)requirements for current andaccurate bed availability, 385

U.S. Homeland Security PresidentialDirective 8, the NationalPreparedness Goal, 216

U.S. Military Biological Warfare MedicalCountermeasures Research,473–474

USPHS. See Public Health ServiceCommissioned Corps

US&R. See urban search and rescueutilitarianism, 63, 65

VA. SeeVeterans Affairsvaccines. See also antibiotics and vaccines

biological event, 463–464CHEs, 368EIDs, 92–93Vaccine Adverse Event Reporting System,

225Vaccinia Immune Globulin (VIG), 464Valery Borzov, 438–439Variola major and minor. See smallpoxvector, 77vector-borne diseases, 533vehicle factors, motor vehicle disasters,

269–270vehicle incapacitation, winter storms, 602vendor evaluation, patient identification and

tracking, 387–388Vendor Managed Inventory (VMI), 44ventilation. See heating, ventilation, and air

conditioningvesicants, 447–448vessel speed, 259Veterinary Medical Assistance Team

(VMAT), 44VHF. See viral hemorrhagic feverVibrio cholerae O139, 77vicarious rehearsal, 343victim assistance, 322–323victim tracking, 282VIG. See Vaccinia Immune Globulinvigilance, 71VIP care, 239–240viral hemorrhagic fever (VHF), 468–470,

469

virtue, 68–69Vitamin C deficiency, 365VMAT. See Veterinary Medical Assistance

TeamVMI. See Vendor Managed Inventoryvolcanic explosive index, 634–635volcanoes

ash, 638–639cities, 639–640cities, volcanic crises since 1980, 639cities, vulnerability of, 632–633dome collapse, 634effusive, 633–634emergency planning, 639–640explosion hazards, 636–637explosive, 633–634future directions, 640gases, 639historical record, 632human impacts, 633, 635–636injury agents, main, 633intensity, 634–635islands, 639–640lahars, 637–638lava flows, 637locations, 634magnitude, 634–635mass flow rate, 634–635mud flows, 637–638overview, 632pyroclastic flows, 635–636scale, 634–635surges, 635–636tephra fall impacts, 638–639tephra volume, 634–635top ten volcanic events in 20th century,

634types, 633–634volcanic explosive index, 634–635

volunteersantibiotics and vaccines, 221emergency management systems, 143,

145, 146ESAR-VHP, 146Federal Volunteer Protection Act of 1997,

152–153NDMS, 143

vulnerability, 13–14vulnerable special needs populations, 121

VX, 448–450

WANs. See wide area networkswar and famine, 80, 82warning systems, tsunamis, 581–582Washington, DC air disaster, 254water systems, 301water temperature, 197WC/ATWC. See West Coast and Alaska

Tsunami Warning CenterWeapons of Mass Destruction Act of 1996,

137–138weapons of mass destruction (WMD)

drill, 336

emergency management systems, 137sample hospital course, 25

weather, 591, 610Web-based information, 357WebPCR, 381West Coast and Alaska Tsunami Warning

Center (WC/ATWC), 582West Nile virus encephalitis, 77WHO. See World Health Organizationwhooping cough, 77wide area networks (WANs), 352, 353WiFi, 382–383WIISARD. See Wireless Internet

Information System for MedicalResponse in Disasters

Windscale nuclear power plant, 478winter storms

access to victims, 593ACS, 590“advisory,” 591amputations, 596antibiotics, 596black ice, 592bradycardia, 594chilblains, 593–594CO poisoning, 590, 597, 601–602cold injuries, 593–594, 596, 601common storm-related injuries, 590core temperatures, 594definitions, 587“DISASTER” training courses, 590–591disposition, 598DMATs, 600–601ED visits, 589–590emergency care, 595–596evacuation, 594–595external response, 600–601extremity fractures, 590falling objects, 590frostbite, 593–594, 596frostnip, 594future research, 603–604hazards, 589, 591healthcare systems, 598–600human access, care, and evacuation,

603–604human impact, 588–590hypothermia, 593–594, 596–597immersion foot, 594Internet resources, 601medication, storage temperatures, 593

MEMS, 599–600modified cluster sampling, 600morbidity, 589–590mortality, 588–589MVCs, 590, 592NWS, 591open wounds, 595overview, 586permanent facilities, 598–599pernio, 593–594PICE, 586, 588potential impact, 591






IN D E X ■ 667

public information, 601rapid needs assessments, 600, 604receivers, local medical, 595–598responder attire, 592–593responder risks, 591–592responders, local medical, 593–595risk mitigation, 603scope, 586shoveling snow, 590slips and falls, 590snowblower injury, 595survey questions, 600survival kit, 602system preparedness, 603temporary facilities, 599–600temporary shelters, 599–600tetanus, 596trench foot, 594triage, primary, 595triage, secondary, 598vehicle incapacitation, 602“warning,” 591weather information, 591

Wireless Internet Information System forMedical Response in Disasters(WIISARD), 387, 567

wireless transmission system for disasterpatient care (WISTA), 567

WISTA. See wireless transmission system fordisaster patient care

WMD. See weapons of mass destructionWood River Junction liquid criticality event,

502–504worker care, 321–322workforce preparedness, 94world assessment reports, 622World Bank, 54World Health Organization (WHO)

Global Outbreak Alert and ResponseNetwork, 215

international, 51, 54medication stockpiles, 215syndromic surveillance, 167

World Health Organization(WHO)/International Programme onChemical Safety (IPCS) Global

HazMat events, 523World Health Organization (WHO)/Pan

American Health Organization(PAHO) Hospital Safety Index, 54

world temperature anomalies January 2007,623

World Trade Center (WTC) bombing 1993,435–436

World Trade Center (WTC) bombing 2001,118, 125–126, 176

World War I, 432wound botulism, 467wound infections, 534WTC. See World Trade Center

XML. See Extensible Markup Language

Yersinia pestis. See plague

Zeebrugge, Belgium sea disaster, 259zoonoses, 77zoonotic diseases, 91






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