Disaster medicine
Encyclopedia
Disaster medicine is the area of physician medical specialization serving the dual areas of providing medical care to disaster survivors and providing medically related disaster preparation, disaster planning, disaster response
and disaster recovery
leadership throughout the disaster life cycle. Disaster medicine specialists provide insight, guidance and expertise on the principles and practice of medicine both in the disaster impact area and healthcare evacuation receiving facilities to emergency management
professionals, hospitals, healthcare facilities, communities and governments. The disaster medicine specialist is the liaison between and partner to the medical contingency planner, the emergency management professional, the incident command system
, government and policy makers.
Disaster medicine is unique among the medical specialties in that unlike all other areas of specialization, the disaster medicine specialist does not practice the full scope of the specialty everyday but only in emergencies. Indeed, the disaster medicine specialist hopes to never practice the full scope of skills required for board certification. However, like the specialists in public health
, environmental medicine
and occupational medicine; disaster medicine specialists engage in the development and modification of public and private policy, legislation, disaster planning and disaster recovery. Within the United State of America, the specialty of disaster medicine fulfils the requirements set for by Homeland Security Presidential Directives (HSPD), the National Response Plan
(NRP), the National Incident Management System
(NIMS), the National Resource Typing System (NRTS) and the NIMS Implementation Plan for Hospitals and Healthcare Facilities.
Disaster behavioral health - Disaster behavioral health deals with the capability of disaster responders to perform optimally, and for disaster survivors to maintain or rapidly restore function, when faced with the threat or actual impact of disasters and extreme events.
Disaster law – Disaster law deals with the legal ramifications of disaster planning, preparedness, response and recovery, including but not limited to financial recovery, public and private liability, property abatement and condemnation.
Disaster life cycle – The time line for disaster events beginning with the period between disasters (interphase), progressing through the disaster event and the disaster response and culminating in the disaster recovery. Interphase begins as the end of the last disaster recovery and ends at the onset of the next disaster event. The disaster event begins when the event occurs and ends when the immediate event subsides. The disaster response begins when the event occurs and ends when acute disaster response services are no longer needed. Disaster recovery also begins with the disaster response and continues until the affected area is returned to the pre-event condition.
Disaster planning - The act of devising a methodology for dealing with a disaster event, especially one with the potential to occur suddenly and cause great injury and/or loss of life, damage and hardship. Disaster planning occurs during the disaster interphase.
Disaster preparation - The act of practicing and implementing the plan for dealing with a disaster event before and event occurs, especially one with the potential to occur suddenly and cause great injury and/or loss of life, damage and hardship. Disaster preparation occurs during the disaster interphase.
Disaster recovery
- The restoration or return to the former or better state or condition proceeding a disaster event (i.e., status quo ante, the state of affairs that existed previously). Disaster recovery is the fourth phase of the disaster life cycle.
Disaster response
- The ability to answer the intense challenges posed by a disaster event. Disaster response is the third phase of the disaster life cycle.
Medical contingency planning - The act of devising a methodology for meeting the medical requirements of a population affected by a disaster event.
Medical surge – An influx of patients (physical casualties and psychological casualties), bystanders, visitors, family members, media and individuals searching for the missing who present to a hospital or healthcare facility for treatment, information and/or shelter as a result of a disaster.
Surge capacity - The ability to manage a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed the current capacity of the
health care system.
Medical triage
– The separation of patients based on severity of injury or illness in light of available resources.
Psychosocial triage
– The separation of patients based on the severity of psychological injury or impact in light of available resources.
The term “disaster medicine” would continue to appear sporadically in both the medical and popular press until the 1980s when the first concerted efforts to organize a medical response corps for disasters grew into the National Disaster Medical System
. Simultaneous with this was the formation of a disaster and emergency medicine
discussion and study group under the American Medical Association
(AMA) in the United States as well as groups in Great Britain, Israel and other countries. By the time hurricane Andrew struck Florida in 1992, the concept of disaster medicine was entrenched in public and governmental consciousness. Although training and fellowships in disaster medicine or related topics began graduating specialists in the Europe and the United States as early as the 1980s, it would not be until 2003 however that the medical community would embrace the need for the new specialty.
Throughout this period, incomplete and faltering medical responses to disaster events made it increasingly apparent in the United States of America that federal, state and local emergency management organizations were in need of a mechanism to identify qualified physicians in the face of a global upturn in the rate of disasters. Many physicians who volunteer at disasters have a bare minimum of knowledge in disaster medicine and often pose a hazard to themselves and the response effort because they have little or no field response training. It was against this backdrop that the American Academy of Disaster Medicine
(AADM) and the American Board of Disaster Medicine
(ABODM) were formed in the United States of America for the purpose of scholarly exchange and education in Disaster Medicine as well as the development of an examination demonstrating excellence towards board certification
in this new specialty.
give rise to the military medical practice of triage in an effort to sort wounded soldiers in those to receive medical treatment and return to battle and those whose injuries are non-survivable. Dominique-Jean Larrey, a surgeon in the French emperor’s army, not only conceived of taking care of the wounded on the battlefield, he also created the concept of ambulances, collecting the wounded in horse-drawn wagons and taking them to military hospitals.
1863 – International Red Cross founded in Geneva, Switzerland.
1873 Clara Barton
starts organization of the American Red Cross
, drawing on her experiences during the American Civil War
.
1881 - First American Red Cross chapter founded in Dansville, NY.
1937 - President Franklin Roosevelt makes a public request by commercial radio for medical aid following a natural gas explosion in New London, Texas
. This is the first presidential request for disaster medical assistance in United States history.
1955 – Col. Karl H. Houghton, M.D. addresses a convention of military surgeons and introduces the concept of “disaster medicine.”
1959 – Col. Joseph R. Schaeffer, M.D. reflecting the growing national concern over nuclear attacks on the United States civilian population initiates training for civilian physicians in the treatment of mass casualties for the effects of weapons of mass destruction creating the concept of medical surge capacity.
1961 – The American Medical Association
, the American Hospital Association
, the American College of Surgeons
, the United States Public Health Service
, the United States Office of Civil Defense and the Department of Health, Education and Welfare join Dr. Schaeffer in advancing civilian physician training for mass casualty and weapons of mass destruction treatment.
1962 - The North Atlantic Treaty Organization (NATO) publishes an official disaster medicine manual edited by Dr. Schaeffer.
1984 – The United States Public Health Service forms the first federal disaster medical response team in Washington, DC designated PHS-1
1986 – The United States Public Health System creates the National Disaster Medical System
(NDMS) to provide disaster healthcare through National Medical Response Teams (NMRT), Disaster Medical Assistance Team
s (DMAT), Disaster Veterinary Assistance Teams (VMAT) and Disaster Mortuary Operational Response Team
s (DMORT). PH-1 becomes the first DMAT team.
1986 – A disaster medical response discussion group is created by NDMS team members and emergency medicine organizations in the United States. Healthcare professionals worldwide join the discussion group of the years to come.
1989 – The University of New Mexico
creates the Center for Disaster Medicine, the first such medical center of excellence in the United States. Elsewhere in the world, similar centers are created at universities in London, Paris, Brussels and Bordeaux.
1992 – Hurricane Andrew, a category 5 hurricane strikes south Florida destroying the city of Homestead, Florida
and initiation the largest disaster healthcare response to date.
1993 - On February 26, 1993 at 12:17 PM, a terrorist attack on the North Tower of the World Trade Center
(the such attack on United States soil since World War II) increases interest in specialized education on the training disaster response for civilian physicians.
1998 – The American College of Contingency Planners (ACCP) is formed by the American Academy of Medical Administrators (AAMA) to provide certification and scholarly study in the area of medical contingency planning and healthcare disaster planning.
2001 – The September 11, 2001 attacks on the World Trade Center and the Pentagon is the largest loss of life resulting from an attack on American targets on United States soil since Pearl Harbor. As a result, the need for disaster medicine is galvanized.
2001 – On October 29, 2001, President George W. Bush
issues Homeland Security Presidential Directive 1 (HSPD-1) establishing the organization and operation of the Homeland Security Council
.
2002 – On March 11, 2002, President Bush issues HSPD-3 establishing the Homeland Security Advisory System
.
2002 – On December 11, 2002, President Bush issues HSPD-4 outlining the National Strategy to Combat Weapons of Mass Destruction
2003 – The American Medical Association in conjunction with the Medical College of Georgia
and the University of Texas debut the National Disaster Life Support (NDLS) training program providing the first national certification in disaster medicine skills and education. NDLS training would later be referred to as “the CPR of the 21st century.”
2003 – In February, 2003 the American Association of Physician Specialists
(AAPS) appoints an expert panel to explore the question of whether Disaster Medicine qualifies as a medical specialty.
2003 – On February 28, 2003, President Bush issues HSPD-5 outlining the system for management of domestic incidents (man-made and natural disasters). HSPD-5 mandated the creation and adoption of the National Response Plan
(NRP).
2003 - On September 30, 2003, the National Response Plan was published and adopted by all Federal agencies.
2003 – On December 17, 2003, President Bush issues HSPD-8 outlining the new framework for national preparedness and creating the National Incident Management System (NIMS).
2004 – In February, 2004 the AAPS reports to the American Board of Physician Specialties
(ABPS) that the expert panel, supported by the available literature and recent HSPD’s has determined that there is a sufficient body of unique knowledge in Disaster Medicine to designate the field as a discrete specialty. ABPS empanels a board of certification to determine if board certification
is appropriate in this new specialty.
2004 – On April 28, 2004, President Bush issues HSPD-10, also known as the plan for Biodefense for the 21st Century which calls for healthcare to implement surveillance and response capabilities to combat the threat of terrorism.
2004 – Hurricanes Charlie, Francis, Ivan and Jeanne batter the state of Florida resulting in the largest disaster medical response since Hurricane Andrew.
2005 – Hurricane Katrina
batters the gulf coast of the United States destroying multiple coastal cities. For the first time in NDMS history, the entire NDMS system is deployed for a single disaster medical response. Among the many lessons learned in field operations following hurricane Katrina are the need for cellular autonomy under a central incident command structure and the creation of continuous integrated triage
for the management of massive patient surge. The lessons learned in the hurricane Katrina response would be applied less than a month later following hurricane Rita and again following hurricane Wilma and the Indonesian tsunami.
2005 – In late October, 2005, the American Board of Disaster Medicine
(ABODM) and the American Academy of Disaster Medicine
(AADM) were formed for scholarly study, discussion and exchange in the field of disaster medicine as well as to oversee board certification in disaster medicine.
2006 – In June 2006, the Institute of Medicine published three reports on the state of emergency healthcare in the United States. Among the condemnations of emergency care is the lack of substantial improvement in disaster preparedness or “cross silo” coordination.
2006 – On September 17, 2006, the NIMS Integration Center publishes the NIMS Implementation Plan for Hospitals and Healthcare establishing a September 30, 2007 deadline for all hospitals and healthcare facilities to be “NIMS compliant.”
2007 – On January 31, 2007, President Bush issues HSPD-18 calling for the development and deployment of medical countermeasures against weapons of mass destruction.
2007 – On September 30, 2007, the NIMS Implementation Plan for Hospitals and Healthcare Facilities compliance deadline passes with fewer than 9% of all United States hospitals fully compliant and fewer than half of hospitals and healthcare facilities having made substantial progress towards compliance.
2007 – On October 18, 2007, President Bush issues HSPD-21 outlining an augmented plan for public health and disaster medical preparedness. HSPD-21 specifically calls for the creation of the discipline of “disaster healthcare” using the accepted definition of “disaster medicine.” HSPD-21 also calls on the Secretary of Health and Human Services (HHS) to use “economic incentives’’ including the Center for Medicare Services (CMS) to induce private medical organizations, hospitals and healthcare facilities to implement disaster healthcare programs and medical disaster preparedness programs.
Disaster response
Disaster response is a phase of the disaster management cycle. Its preceding cycles aim to reduce the need for a disaster response, or to avoid it altogether.The level of disaster response depends on a number of factors and particular situation awareness...
and disaster recovery
Disaster recovery
Disaster recovery is the process, policies and procedures related to preparing for recovery or continuation of technology infrastructure critical to an organization after a natural or human-induced disaster. Disaster recovery is a subset of business continuity...
leadership throughout the disaster life cycle. Disaster medicine specialists provide insight, guidance and expertise on the principles and practice of medicine both in the disaster impact area and healthcare evacuation receiving facilities to emergency management
Emergency management
Emergency management is the generic name of an interdisciplinary field dealing with the strategic organizational management processes used to protect critical assets of an organization from hazard risks that can cause events like disasters or catastrophes and to ensure the continuance of the...
professionals, hospitals, healthcare facilities, communities and governments. The disaster medicine specialist is the liaison between and partner to the medical contingency planner, the emergency management professional, the incident command system
Incident Command System
The Incident Command System is "a systematic tool used for the command, control, and coordination of emergency response" according to the United States Federal Highway Administration...
, government and policy makers.
Disaster medicine is unique among the medical specialties in that unlike all other areas of specialization, the disaster medicine specialist does not practice the full scope of the specialty everyday but only in emergencies. Indeed, the disaster medicine specialist hopes to never practice the full scope of skills required for board certification. However, like the specialists in public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
, environmental medicine
Environmental medicine
Environmental medicine is a multidisciplinary field involving medicine, environmental science, chemistry and others. It may be viewed as the medical branch of the broader field of environmental health. The scope of this field involves studying the interactions between environment and human health,...
and occupational medicine; disaster medicine specialists engage in the development and modification of public and private policy, legislation, disaster planning and disaster recovery. Within the United State of America, the specialty of disaster medicine fulfils the requirements set for by Homeland Security Presidential Directives (HSPD), the National Response Plan
National Response Plan
The National Response Plan was a United States national plan to respond to emergencies such as natural disasters or terrorist attacks. It came into effect in December 2004 , and was superseded by the National Response Framework on March 22, 2008....
(NRP), the National Incident Management System
National Incident Management System
The National Incident Management System is emergency management doctrine used nationwide to coordinate emergency preparedness and incident management and response among the public and private sectors.NIMS is a comprehensive, national approach to incident management that is applicable at all...
(NIMS), the National Resource Typing System (NRTS) and the NIMS Implementation Plan for Hospitals and Healthcare Facilities.
Definitions
Disaster healthcare – The provision of healthcare services by healthcare professionals to disaster survivors and disaster responders both in a disaster impact area and healthcare evacuation receiving facilities throughout the disaster life cycle.Disaster behavioral health - Disaster behavioral health deals with the capability of disaster responders to perform optimally, and for disaster survivors to maintain or rapidly restore function, when faced with the threat or actual impact of disasters and extreme events.
Disaster law – Disaster law deals with the legal ramifications of disaster planning, preparedness, response and recovery, including but not limited to financial recovery, public and private liability, property abatement and condemnation.
Disaster life cycle – The time line for disaster events beginning with the period between disasters (interphase), progressing through the disaster event and the disaster response and culminating in the disaster recovery. Interphase begins as the end of the last disaster recovery and ends at the onset of the next disaster event. The disaster event begins when the event occurs and ends when the immediate event subsides. The disaster response begins when the event occurs and ends when acute disaster response services are no longer needed. Disaster recovery also begins with the disaster response and continues until the affected area is returned to the pre-event condition.
Disaster planning - The act of devising a methodology for dealing with a disaster event, especially one with the potential to occur suddenly and cause great injury and/or loss of life, damage and hardship. Disaster planning occurs during the disaster interphase.
Disaster preparation - The act of practicing and implementing the plan for dealing with a disaster event before and event occurs, especially one with the potential to occur suddenly and cause great injury and/or loss of life, damage and hardship. Disaster preparation occurs during the disaster interphase.
Disaster recovery
Disaster recovery
Disaster recovery is the process, policies and procedures related to preparing for recovery or continuation of technology infrastructure critical to an organization after a natural or human-induced disaster. Disaster recovery is a subset of business continuity...
- The restoration or return to the former or better state or condition proceeding a disaster event (i.e., status quo ante, the state of affairs that existed previously). Disaster recovery is the fourth phase of the disaster life cycle.
Disaster response
Disaster response
Disaster response is a phase of the disaster management cycle. Its preceding cycles aim to reduce the need for a disaster response, or to avoid it altogether.The level of disaster response depends on a number of factors and particular situation awareness...
- The ability to answer the intense challenges posed by a disaster event. Disaster response is the third phase of the disaster life cycle.
Medical contingency planning - The act of devising a methodology for meeting the medical requirements of a population affected by a disaster event.
Medical surge – An influx of patients (physical casualties and psychological casualties), bystanders, visitors, family members, media and individuals searching for the missing who present to a hospital or healthcare facility for treatment, information and/or shelter as a result of a disaster.
Surge capacity - The ability to manage a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed the current capacity of the
health care system.
Medical triage
Triage
Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
– The separation of patients based on severity of injury or illness in light of available resources.
Psychosocial triage
Triage
Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
– The separation of patients based on the severity of psychological injury or impact in light of available resources.
History
The term “disaster medicine” first appeared in the medical lexicon in the post World War II era. Although coined by former and current military physicians who had served in World War II, the term grow out of a concern for the need to care for military casualties, or nuclear holocaust victims, but out of the need to provide care to the survivors of natural disasters and the not yet distant memory of the 1917-1918 Influenza Pandemic.The term “disaster medicine” would continue to appear sporadically in both the medical and popular press until the 1980s when the first concerted efforts to organize a medical response corps for disasters grew into the National Disaster Medical System
National Disaster Medical System
The National Disaster Medical System is a section of the United States Department of Health and Human Services responsible for managing Federal government's medical response to major emergencies and disasters....
. Simultaneous with this was the formation of a disaster and emergency medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
discussion and study group under the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
(AMA) in the United States as well as groups in Great Britain, Israel and other countries. By the time hurricane Andrew struck Florida in 1992, the concept of disaster medicine was entrenched in public and governmental consciousness. Although training and fellowships in disaster medicine or related topics began graduating specialists in the Europe and the United States as early as the 1980s, it would not be until 2003 however that the medical community would embrace the need for the new specialty.
Throughout this period, incomplete and faltering medical responses to disaster events made it increasingly apparent in the United States of America that federal, state and local emergency management organizations were in need of a mechanism to identify qualified physicians in the face of a global upturn in the rate of disasters. Many physicians who volunteer at disasters have a bare minimum of knowledge in disaster medicine and often pose a hazard to themselves and the response effort because they have little or no field response training. It was against this backdrop that the American Academy of Disaster Medicine
American Academy of Disaster Medicine
The American Academy of Disaster Medicine was founded in 2004 to promote the science and art of disaster healthcare. It is one of the newest medical organizations in the world...
(AADM) and the American Board of Disaster Medicine
American Board of Disaster Medicine
Disaster medicine as a specialty and mindset was not only a reaction from September 11, 2001, but to the numerous subsequent events that seemed to all too quickly follow: random anthrax attacks, the SARS outbreak, the New York City blackout in the summer of 2003, the December 26, 2004 Indian Ocean...
(ABODM) were formed in the United States of America for the purpose of scholarly exchange and education in Disaster Medicine as well as the development of an examination demonstrating excellence towards board certification
Board certification
Board certification is the process by which a physician , dentist , or podiatrist in the United States demonstrates through either written, practical, and/or simulator based testing, a mastery of the basic knowledge and skills that define an area of medical specialization...
in this new specialty.
Areas of competency
Internationally, disaster medicine specialists must demonstrate competency in areas of disaster healthcare and emergency management including but not limited to:- Disaster behavioral health
- Disaster law
- Disaster planning
- Disaster preparation
- Disaster recovery
- Disaster response
- Disaster safety
- Medical consequences of disaster
- Medical consequences of terrorism
- Medical contingency planning
- Medical decontamination
- Medical implications of disaster
- Medical implications of terrorism
- Medical planning and preparation for disaster
- Medical planning and preparation for terrorism
- Medical recovery from disaster
- Medical recovery from terrorism
- Medical response to disaster
- Medical response to terrorism
- Medical response to weapons of mass destruction
- Medical surge, surge capacity and triage
- Psychosocial implications of disaster
- Psychosocial implications of terrorism
- Psychosocial triage
Time line
1812 – Napoleonic warsNapoleonic Wars
The Napoleonic Wars were a series of wars declared against Napoleon's French Empire by opposing coalitions that ran from 1803 to 1815. As a continuation of the wars sparked by the French Revolution of 1789, they revolutionised European armies and played out on an unprecedented scale, mainly due to...
give rise to the military medical practice of triage in an effort to sort wounded soldiers in those to receive medical treatment and return to battle and those whose injuries are non-survivable. Dominique-Jean Larrey, a surgeon in the French emperor’s army, not only conceived of taking care of the wounded on the battlefield, he also created the concept of ambulances, collecting the wounded in horse-drawn wagons and taking them to military hospitals.
1863 – International Red Cross founded in Geneva, Switzerland.
1873 Clara Barton
Clara Barton
Clarissa Harlowe "Clara" Barton was a pioneer American teacher, patent clerk, nurse, and humanitarian. She is best remembered for organizing the American Red Cross.-Youth, education, and family nursing:...
starts organization of the American Red Cross
American Red Cross
The American Red Cross , also known as the American National Red Cross, is a volunteer-led, humanitarian organization that provides emergency assistance, disaster relief and education inside the United States. It is the designated U.S...
, drawing on her experiences during the American Civil War
American Civil War
The American Civil War was a civil war fought in the United States of America. In response to the election of Abraham Lincoln as President of the United States, 11 southern slave states declared their secession from the United States and formed the Confederate States of America ; the other 25...
.
1881 - First American Red Cross chapter founded in Dansville, NY.
1937 - President Franklin Roosevelt makes a public request by commercial radio for medical aid following a natural gas explosion in New London, Texas
New London, Texas
New London is a city in Rusk County, Texas, United States. The population was 987 at the 2000 census.On March 18, 1937, the London School Explosion killed in excess of three hundred people...
. This is the first presidential request for disaster medical assistance in United States history.
1955 – Col. Karl H. Houghton, M.D. addresses a convention of military surgeons and introduces the concept of “disaster medicine.”
1959 – Col. Joseph R. Schaeffer, M.D. reflecting the growing national concern over nuclear attacks on the United States civilian population initiates training for civilian physicians in the treatment of mass casualties for the effects of weapons of mass destruction creating the concept of medical surge capacity.
1961 – The American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
, the American Hospital Association
American Hospital Association
The American Hospital Association is an organization that promotes the quality provision of health care by hospitals and health care networks through such efforts as promoting effective public policy and providing information related to health care and health administration to health care...
, the American College of Surgeons
American College of Surgeons
The American College of Surgeons is an educational association of surgeons created in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.-Membership:...
, the United States Public Health Service
United States Public Health Service
The Public Health Service Act of 1944 structured the United States Public Health Service as the primary division of the Department of Health, Education and Welfare , which later became the United States Department of Health and Human Services. The PHS comprises all Agency Divisions of Health and...
, the United States Office of Civil Defense and the Department of Health, Education and Welfare join Dr. Schaeffer in advancing civilian physician training for mass casualty and weapons of mass destruction treatment.
1962 - The North Atlantic Treaty Organization (NATO) publishes an official disaster medicine manual edited by Dr. Schaeffer.
1984 – The United States Public Health Service forms the first federal disaster medical response team in Washington, DC designated PHS-1
1986 – The United States Public Health System creates the National Disaster Medical System
National Disaster Medical System
The National Disaster Medical System is a section of the United States Department of Health and Human Services responsible for managing Federal government's medical response to major emergencies and disasters....
(NDMS) to provide disaster healthcare through National Medical Response Teams (NMRT), Disaster Medical Assistance Team
Disaster Medical Assistance Team
A Disaster Medical Assistance Team is a group of professional and para-professional medical personnel organized to provide rapid-response medical care or casualty decontamination during a terrorist attack, natural disaster, or other incident in the United States...
s (DMAT), Disaster Veterinary Assistance Teams (VMAT) and Disaster Mortuary Operational Response Team
Disaster Mortuary Operational Response Team
A Disaster Mortuary Operational Response Team or DMORT is a team of experts in the fields of victim identification and mortuary services. DMORTs are activated in response to large scale disasters in the United States to assist in the identification of deceased individuals and storage of the bodies...
s (DMORT). PH-1 becomes the first DMAT team.
1986 – A disaster medical response discussion group is created by NDMS team members and emergency medicine organizations in the United States. Healthcare professionals worldwide join the discussion group of the years to come.
1989 – The University of New Mexico
University of New Mexico
The University of New Mexico at Albuquerque is a public research university located in Albuquerque, New Mexico, in the United States. It is the state's flagship research institution...
creates the Center for Disaster Medicine, the first such medical center of excellence in the United States. Elsewhere in the world, similar centers are created at universities in London, Paris, Brussels and Bordeaux.
1992 – Hurricane Andrew, a category 5 hurricane strikes south Florida destroying the city of Homestead, Florida
Homestead, Florida
Homestead is a city in Miami-Dade County, Florida, United States nestled between Biscayne National Park to the east and Everglades National Park to the west. Homestead is primarily a Miami suburb and a major agricultural area....
and initiation the largest disaster healthcare response to date.
1993 - On February 26, 1993 at 12:17 PM, a terrorist attack on the North Tower of the World Trade Center
World Trade Center
The original World Trade Center was a complex with seven buildings featuring landmark twin towers in Lower Manhattan, New York City, United States. The complex opened on April 4, 1973, and was destroyed in 2001 during the September 11 attacks. The site is currently being rebuilt with five new...
(the such attack on United States soil since World War II) increases interest in specialized education on the training disaster response for civilian physicians.
1998 – The American College of Contingency Planners (ACCP) is formed by the American Academy of Medical Administrators (AAMA) to provide certification and scholarly study in the area of medical contingency planning and healthcare disaster planning.
2001 – The September 11, 2001 attacks on the World Trade Center and the Pentagon is the largest loss of life resulting from an attack on American targets on United States soil since Pearl Harbor. As a result, the need for disaster medicine is galvanized.
2001 – On October 29, 2001, President George W. Bush
George W. Bush
George Walker Bush is an American politician who served as the 43rd President of the United States, from 2001 to 2009. Before that, he was the 46th Governor of Texas, having served from 1995 to 2000....
issues Homeland Security Presidential Directive 1 (HSPD-1) establishing the organization and operation of the Homeland Security Council
Homeland Security Council
The Homeland Security Council is an entity within the White House Office tasked with advising the President on matters relating to Homeland Security...
.
2002 – On March 11, 2002, President Bush issues HSPD-3 establishing the Homeland Security Advisory System
Homeland Security Advisory System
In the United States, the Homeland Security Advisory System was a color-coded terrorism threat advisory scale. The different levels trigger specific actions by federal agencies and state and local governments, and they affect the level of security at some airports and other public facilities. It...
.
2002 – On December 11, 2002, President Bush issues HSPD-4 outlining the National Strategy to Combat Weapons of Mass Destruction
2003 – The American Medical Association in conjunction with the Medical College of Georgia
Medical College of Georgia
Georgia Health Sciences University formerly known as, and now home of the, Medical College of Georgia , is a public academic health center, with its main campus located in the Medical District of Augusta, Georgia. It is the smallest of four research universities in the University System of Georgia...
and the University of Texas debut the National Disaster Life Support (NDLS) training program providing the first national certification in disaster medicine skills and education. NDLS training would later be referred to as “the CPR of the 21st century.”
2003 – In February, 2003 the American Association of Physician Specialists
American Association of Physician Specialists
The American Association of Physician Specialists, Inc. founded 1950, incorporated 1952 is a 501 not-for-profit organization whose executive offices are located in Tampa, Florida...
(AAPS) appoints an expert panel to explore the question of whether Disaster Medicine qualifies as a medical specialty.
2003 – On February 28, 2003, President Bush issues HSPD-5 outlining the system for management of domestic incidents (man-made and natural disasters). HSPD-5 mandated the creation and adoption of the National Response Plan
National Response Plan
The National Response Plan was a United States national plan to respond to emergencies such as natural disasters or terrorist attacks. It came into effect in December 2004 , and was superseded by the National Response Framework on March 22, 2008....
(NRP).
2003 - On September 30, 2003, the National Response Plan was published and adopted by all Federal agencies.
2003 – On December 17, 2003, President Bush issues HSPD-8 outlining the new framework for national preparedness and creating the National Incident Management System (NIMS).
2004 – In February, 2004 the AAPS reports to the American Board of Physician Specialties
American Board of Physician Specialties
The American Board of Physician Specialties , the official certifying body for the American Association of Physician Specialists is a non-profit umbrella organization for sixteen medical specialty boards that certifies and re-certifies physicians in fourteen medical specialties in the United...
(ABPS) that the expert panel, supported by the available literature and recent HSPD’s has determined that there is a sufficient body of unique knowledge in Disaster Medicine to designate the field as a discrete specialty. ABPS empanels a board of certification to determine if board certification
Board certification
Board certification is the process by which a physician , dentist , or podiatrist in the United States demonstrates through either written, practical, and/or simulator based testing, a mastery of the basic knowledge and skills that define an area of medical specialization...
is appropriate in this new specialty.
2004 – On April 28, 2004, President Bush issues HSPD-10, also known as the plan for Biodefense for the 21st Century which calls for healthcare to implement surveillance and response capabilities to combat the threat of terrorism.
2004 – Hurricanes Charlie, Francis, Ivan and Jeanne batter the state of Florida resulting in the largest disaster medical response since Hurricane Andrew.
2005 – Hurricane Katrina
Hurricane Katrina
Hurricane Katrina of the 2005 Atlantic hurricane season was a powerful Atlantic hurricane. It is the costliest natural disaster, as well as one of the five deadliest hurricanes, in the history of the United States. Among recorded Atlantic hurricanes, it was the sixth strongest overall...
batters the gulf coast of the United States destroying multiple coastal cities. For the first time in NDMS history, the entire NDMS system is deployed for a single disaster medical response. Among the many lessons learned in field operations following hurricane Katrina are the need for cellular autonomy under a central incident command structure and the creation of continuous integrated triage
Continuous integrated triage
Continuous integrated triage is an approach to triage in mass casualty situations. It is both efficient and sensitive to psychosocial and disaster behavioral health issues that effect the number of patients seeking care , the manner in which a hospital or healthcare facility deals with that surge...
for the management of massive patient surge. The lessons learned in the hurricane Katrina response would be applied less than a month later following hurricane Rita and again following hurricane Wilma and the Indonesian tsunami.
2005 – In late October, 2005, the American Board of Disaster Medicine
American Board of Disaster Medicine
Disaster medicine as a specialty and mindset was not only a reaction from September 11, 2001, but to the numerous subsequent events that seemed to all too quickly follow: random anthrax attacks, the SARS outbreak, the New York City blackout in the summer of 2003, the December 26, 2004 Indian Ocean...
(ABODM) and the American Academy of Disaster Medicine
American Academy of Disaster Medicine
The American Academy of Disaster Medicine was founded in 2004 to promote the science and art of disaster healthcare. It is one of the newest medical organizations in the world...
(AADM) were formed for scholarly study, discussion and exchange in the field of disaster medicine as well as to oversee board certification in disaster medicine.
2006 – In June 2006, the Institute of Medicine published three reports on the state of emergency healthcare in the United States. Among the condemnations of emergency care is the lack of substantial improvement in disaster preparedness or “cross silo” coordination.
2006 – On September 17, 2006, the NIMS Integration Center publishes the NIMS Implementation Plan for Hospitals and Healthcare establishing a September 30, 2007 deadline for all hospitals and healthcare facilities to be “NIMS compliant.”
2007 – On January 31, 2007, President Bush issues HSPD-18 calling for the development and deployment of medical countermeasures against weapons of mass destruction.
2007 – On September 30, 2007, the NIMS Implementation Plan for Hospitals and Healthcare Facilities compliance deadline passes with fewer than 9% of all United States hospitals fully compliant and fewer than half of hospitals and healthcare facilities having made substantial progress towards compliance.
2007 – On October 18, 2007, President Bush issues HSPD-21 outlining an augmented plan for public health and disaster medical preparedness. HSPD-21 specifically calls for the creation of the discipline of “disaster healthcare” using the accepted definition of “disaster medicine.” HSPD-21 also calls on the Secretary of Health and Human Services (HHS) to use “economic incentives’’ including the Center for Medicare Services (CMS) to induce private medical organizations, hospitals and healthcare facilities to implement disaster healthcare programs and medical disaster preparedness programs.