Catastrophic disasters and the design of disaster medical care systems.

The National Disaster Medical System (NDMS) is aimed at medical care needs resulting from catastrophic earthquakes, which may cause thousands of deaths and injuries. Other geophysical events may cause great mortality, but leave few injured survivors. Weather incidents, technological disasters, and common mass casualty incidents cause much less mortality and morbidity. Catastrophic disasters overwhelm the local medical care system. Supplemental care is provided by disaster relief forces; this care should be adapted to prevalent types of injuries. Most care should be provided at the disaster scene through supplemental medical facilities, while some can be provided by evacuating patients to distant hospitals. Medical response teams capable of stabilizing, sorting, and holding victims should staff supplemental medical facilities. The NDMS program includes hospital facilities, evacuation assets, and medical response teams. The structure and capabilities of these elements are determined by the medical care needs of the catastrophic disaster situation.

Disaster medical assistance teams.

Five medical care functions are essential in disaster medical care--field rescue and first aid, casualty clearing, medical staging, field surgical intervention, and definitive care. Each of these functions requires substantial augmentation in response to disaster. Three functions, clearing, staging, and field surgical care, are complex functions requiring organized and skilled disaster medical units. We describe two kinds of disaster medical units designed to meet these needs. One unit is designed for casualty clearing and medical staging, the other for field surgical services. We describe how they can be created and used as part of a National Disaster Medical System.

Designing a National Disaster Medical System.

The National Disaster Medical System (NDMS) is a partnership of private and public sectors to provide care to the victims of great disasters. The system is being developed as a voluntary cooperative effort of four major Federal agencies, State and local governments, and the American professional and hospital communities. A medical response component will include 150 disaster medical assistance units capable of clearing or staging operations in a disaster. Each unit will comprise three 29-person teams containing physicians, nurses, medical technicians, and support personnel and will include a 16-person unit command and support element. An evacuation component will be founded on the military aeromedical evacuation system, augmented by civilian aircraft and other transportation resources. A hospital component will enroll 100,000 pre-committed beds in hospitals throughout the nation. The system is designed to care for up to 100,000 casualties arising from a massive peacetime disaster or an overseas conventional military conflict. The National Disaster Medical System will be implemented over a period of 3 to 5 years. The authors recommend that all parts of the American health care community join in support of the system.

Animal bites: patterns of treatment.

Between 1972 and 1979, more than 350,000 animal bite incidents were reported to the Los Angeles County Department of Health Services. Each incident was investigated by county health authorities. To determine the type of treatment given to animal bite victims, a mailed questionnaire was sent to 1,201 persons selected from the 1972 report files. Eighty-nine percent of respondents received treatment for animal bite. The most frequent treatment (64.5%) was tetanus immunization alone or with cleaning and bandaging of the wound. Three of the 710 respondents (0.4%) received post-exposure antirabies treatment. The authors discuss recommendations for treatment of animal bites.

Air pollution and respiratory mortality in Los Angeles.

An epidemiologic study in Los Angeles showed a regular statistical association between respiratory mortality and the spatial distributions of ozone and particulate matter. There was an irregular association of respiratory mortality with maximum temperature. These findings are consistent with those of other studies relating respiratory morbidity to oxidant and particulate air pollution, and suggest that these pollutants may be health hazards.

Treatment failure in filariasis mass treatment programmes.

The data from the first 3 years of the Samoan pilot filariasis control programme were reanalysed using incidence instead of prevalence statistics. With these statistics, failures of diethylcarbamazine treatment can be roughly divided into three groups: primary treatment failures, manifested by persistent microfilaraemia; secondary treatment failures, manifested by microfilaraemia recurring within the prepatent period after apparently successful treatment; and new infections. When cases of persistent and recurrent microfilaraemia are excluded by appropriate statistical manipulations, the incidence of new infections is seen to be many times higher in persons who originally showed microfilaraemia. This suggests that susceptibility or exposure, or both, are not homogeneously distributed in the population, and indicates that proposed mathematical models of filarial epidemiology must be further refined. It also indicates that filariasis control programmes should devote more attention to studies and control methods aimed at this high-risk subgroup of the population.