Disaster training for emergency physicians in the United States: a systems approach.

Disaster strikes more frequently and with greater impact than ever before, and the demand for improved community disaster preparedness rises. The American College of Emergency Physicians (ACEP), in collaboration with the Federal Emergency Management Agency (FEMA), has responded by developing a 16-hour course that prepares emergency physicians and other emergency providers to serve as knowledgeable members of their community's disaster team. The course was developed using a standard instructional design system to cover the basic components of disaster planning and emergency medical operations, including: disaster elements, general planning and organization, victim flow, communication, evacuation modalities, field and hospital management, documentation, public relations, and application to the local community. The 35 national faculty members present the course on a geographic basis across the United States. Further considerations for emergency medicine in the disaster domain include questions of education, research and the formation of a network to coordinate with other medical, health, and nonhealth care sectors nationally and internationally.

Stress reactions among participants in mass casualty simulations.

Specific stress reactions have been observed in health care providers involved in disaster relief and mass casualty care. To determine whether similar stress reactions occurred in mass casualty simulations, we observed the participants in five large military mass casualty simulations. Using a framework of specific questions, descriptive data were obtained using direct observation and discussion with participants by faculty present to evaluate the exercise. Observations revealed that stress reactions occurred consistently during these mass casualty simulations, and these reactions resembled those seen in health care workers involved in actual mass casualty care. Application of this information to disaster medicine training for emergency physicians is discussed.