Disaster medicine Study Guide

📖 Core Concepts Disaster Medicine – Provides health care to survivors & responders and leads preparedness, response, recovery across the disaster life‑cycle. Disaster Life Cycle – Four phases: Interphase → Disaster Event → Disaster Response → Disaster Recovery. Medical Surge & Surge Capacity – Surge: sudden influx of patients, families, media, etc. Surge capacity: system’s ability to absorb that surge without collapse. Medical & Psychosocial Triage – Sort patients by clinical severity (medical) or psychological injury severity (psychosocial) relative to available resources. Ethical Triage Approaches – Utilitarian (max‑benefit), Egalitarian (equal share or prioritized sub‑groups), Procedural (transparent rules/lottery). Regulatory Framework (U.S.) – NRP (mandatory federal response plan), NIMS (standardized incident management), NRTS (resource classification). --- 📌 Must Remember Four disaster phases: Interphase (planning/prep), Event (occurs), Response (acute services), Recovery (restore/better). Surge capacity ≠ surge; capacity is what you can handle, not the demand itself. Triage hierarchy: Medical triage – life‑threatening vs. minor injuries. Psychosocial triage – acute stress reactions vs. chronic trauma. Ethical metrics: DALY = years of healthy life lost. QALY = years of life adjusted for quality (0 = dead, 1 = perfect health). NIMS pillars – Command and Management, Preparedness, Resource Management, Communications & Information Management, Supporting Technology, Ongoing Assessment & Improvement. NRTS ensures the right type & level of resource (e.g., “Medical‑Team‑Type‑1” vs. “Type‑2”). --- 🔄 Key Processes Disaster Planning → Preparation → Event → Response → Recovery Planning: develop methods during interphase. Preparation: practice & implement the plan before an event. Medical Surge Management Activate surge plan → augment staff, space, supplies. Implement triage to prioritize care. Expand surge capacity (e.g., alternate care sites). Triage Workflow (Medical) Primary assessment (ABCs). Assign category (e.g., Immediate, Delayed, Minimal, Expectant). Re‑evaluate as resources shift. Ethical Decision‑Making Identify resource shortfall. Choose ethical framework (Utilitarian → DALY/QALY; Egalitarian → equal draw; Procedural → lottery). Apply consistent criteria & document. --- 🔍 Key Comparisons Utilitarian vs. Egalitarian Utilitarian: “Save the most lives/years” → prioritize low‑mortality, high‑survivability patients. Egalitarian: “Everyone gets an equal chance” → may use lottery or prioritize disadvantaged groups. Medical Surge vs. Surge Capacity Surge: the demand spike (patients, media, families). Surge Capacity: the system’s ability to meet that spike. Disaster Planning vs. Disaster Preparation Planning: design the response (policies, protocols). Preparation: practice the plan ( drills, trainings). Medical Triage vs. Psychosocial Triage Medical: focuses on physical injury severity. Psychosocial: focuses on mental‑health impact severity. --- ⚠️ Common Misunderstandings “Surge capacity is a fixed number.” – It is dynamic; can be expanded with staff cross‑training, alternate sites, and supply caches. “Utilitarian always means “first‑come, first‑served.” – It actually ranks by net benefit, not arrival order. “Disaster medicine is only for doctors.” – Specialists include behavioral health, legal, logistics, decontamination experts. “NRTS only classifies equipment.” – It classifies personnel, teams, facilities, and whole‑system capabilities. --- 🧠 Mental Models / Intuition “Fire triangle” for disasters – Threat + Vulnerability + Impact = Disaster. If any side weakens, the event may not become a disaster. “Capacity‑Demand Gap” – Visualize a bar graph: Demand (surge) vs. Capacity (baseline + surge capacity). The gap equals the triage pressure. “Ethical lever” – Imagine a lever with three fulcrums: Utility, Equality, Process. Shift the lever toward one fulcrum to select the corresponding triage philosophy. --- 🚩 Exceptions & Edge Cases Mass Casualty with Chemical Exposure – Standard medical triage may be superseded by decontamination priority; patients must be decontaminated before full assessment. Pediatric or Pregnant Patients – Some egalitarian variants give priority regardless of overall utility metrics. Resource Typing Mismatch – Deploying a “Type‑1” medical team to a “Type‑2” need can waste resources; always match NRTS level to the defined need. --- 📍 When to Use Which Use Utilitarian triage when objective outcome data (DALY/QALY) are available and the goal is maximizing lives/years saved. Use Egalitarian (lottery or priority groups) when societal equity is mandated by policy or law, or when outcome data are unreliable. Use Procedural triage in chaotic settings where speed and transparency outweigh nuanced outcome calculations. Activate NIMS Incident Command System for any multi‑agency response; otherwise, a simple hospital incident command may suffice. Apply NRTS when requesting external resources; match the type to the need (e.g., “Medical‑Team‑Type‑2” for moderate‑complexity care). --- 👀 Patterns to Recognize “Rapid influx + limited beds = triage activation” – Spot this pattern in MCQs to trigger the triage algorithm. “Legal liability language + resource allocation” – Indicates a disaster law question (focus on liability, property, financial recovery). “Behavioral health stressors + responder performance” – Points to disaster behavioral health competency. “Interphase activities listed (policy, drills, stockpiles)” – Signals planning or preparation phase. --- 🗂️ Exam Traps Distractor: “Triage is always based on who arrives first.” – Only true for egalitarian “first‑come” variant, not for utilitarian or procedural approaches. Distractor: “Surge capacity can be measured in number of patients only.” – It also includes staff, equipment, space, and systems. Distractor: “NIMS replaces all local emergency plans.” – NIMS integrates with local plans; it does not supplant them. Distractor: “Disaster law only covers liability.” – It also covers property abatement, condemnation, and financial recovery. Distractor: “Psychosocial triage uses the same categories as medical triage.” – It uses psychological severity criteria, not physical injury categories.