Optimal Medical Care during the Super-acute Phase of a Disaster

Abstract

When large numbers of persons are injured and medical resources are limited in the super-acute phase of a disaster, medical care-givers must switch from their normal protocol of general examination and treatment to disaster medical care. When many people are injured, triage is the standard protocol. The most severe conditions to watch for when performing triage are cardiac tamponade, airway obstruction, flail chest, tension pneumothorax, open pneumothorax, massive hemothorax, abdominal hemorrhage, pelvic fracture, dysfunction of the central nervous system, and crush syndrome. The primary triage, which is classified by vital signs, is determined in disaster settings and at triage posts. Injured persons assigned the red tag in the primary triage are classified as the top-priority group in severity and urgency. The secondary triage is performed at a first-aid center to determine whether the patient requires immediate treatment and cure or transfer to the hospital. Patients complicated with hemorrhagic shock (especially non-responders) and central nervous system dysfunction must be conveyed to the hospital earlier. The definition and measures of a disaster vary by type, period, and place. As such, the measures to cope with a disaster in a hospital setting also vary. Our group developed an in-hospital disaster training course made up of four components: primary triage, secondary triage, training in the use of transceivers, and a disaster-imaging game. The course was designed to hold the interest and engage all hospital staff during simulated disasters. Quick action is required to immediately accept large numbers of injured patients when a disaster strikes. The preparations for an actual disaster must therefore be thorough and complete.