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Worldwide disaster medical response: An historical perspective

Dara, Saqib I. MD; Ashton, Rendell W. MD; Farmer, J Christopher MD, FCCM; Carlton, Paul K. Jr MD, FACS

doi: 10.1097/01.CCM.0000151062.00501.60
Scientific Reviews

Objective: Disaster medicine and disaster medical response is a complex and evolving field that has existed for millennia. The objective of this article is to provide a brief review of significant milestones in the history of disaster medicine with emphasis on applicability to present and future structures for disaster medical response.

Results: Disaster medical response is an historically necessary function in any society. These range from response to natural disasters, to the ravages of warfare, and most recently, to medical response after terrorist acts. Our current disaster response systems are largely predicated on military models derived over the last 200 yrs. Their hallmark is a structured and graded response system based on numbers of casualties. In general, all of these assume that there is an identifiable “ground zero” and then proceed with echelons of casualty retrieval and care that proceeds rearward to a hospital(s). In a civil response setting, most civilian models of disaster medical response similarly follow this military model. This historical approach may not be applicable to some threats such as bioterrorism. A “new” model of disaster medical response for this type of threat is still evolving. Using history to guide our future education and planning efforts is discussed.

Conclusion: We can learn much from an historical perspective that is still applicable to many current disaster medical threats. However, a new response model may be needed to address the threats of bioterrorism.

From the Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN (SID, RWA, JCF); the Program in Translational Immunovirology and Biodefense, Mayo Clinic, Rochester, MN (JCF); and the Office of Homeland Security, Texas A&M University Health Science Center, College Station, TX (PKC).

Address requests for reprints to: J. Christopher Farmer, MD, Professor of Medicine, Mayo Clinic, 200 First Street SW, OL2-115, Rochester, MN 55905.

© 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins