Disaster planning occurs during the disaster interphase. 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. 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. 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. 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 [ citation needed ] , but out of the need to provide care to the survivors of natural disasters and the not-yet-distant memory of the Influenza Pandemic. 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 , 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 s, it was not until that the medical community embraced the need for the new specialty [ citation needed ]. Throughout this period, incomplete and faltering medical responses to disaster events made it increasingly apparent [ citation needed ] 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 [ citation needed ].
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. The Disaster Medicine practitioner must be well-versed in the ethical dilemmas that commonly arise in disaster settings. One of the most common dilemmas occurs when the aggregate medical need exceeds the ability to provide a normal standard of care for all patients. In the event of a future pandemic, the number of patients that require additional respiratory support will outnumber the number of available ventilators .
Although a hypothetical example, similar natural disasters have occurred in the past. Historically, the influenza pandemic of and the more recent SARS epidemic in led to resource scarcity and necessitated triage. One paper estimated that in the United States, the need for ventilators would be double the number available in the setting of an influenza pandemic similar to the scale of .
In other countries with fewer resources, shortages are postulated to be even more severe. How, then, is a clinician to decide whom to offer this treatment? Emergency services often use their own triaging systems to be able to work through some of these challenging situations; however, these guidelines often assume no resource scarcity, and therefore, different triaging systems must be developed for resource-limited, disaster response settings. Useful ethical approaches to guide the development of such triaging protocols are often based on the principles of the theories of utilitarianism , egalitarianism and proceduralism .
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The Utilitarian theory works on the premise that the responder shall 'maximise collective welfare'; or in other words, 'do the greatest good for the greatest numbers of people  '. The utilitarian will necessarily need a measure by which to assess the outcome of the intervention. This could be thought of through various ways, for instance: the number of lives saved, or the number of years of life saved through the intervention.
Thus, the utilitarian would prioritize saving the youngest of the patients over the elderly or those who are more likely to die despite an intervention, in order to 'maximise the collective years of life saved'. Commonly used metrics to quantify utility of health interventions include DALYs Disability Adjusted Life Years and QALYs Quality Adjusted Life Years which take into account the potential number of years of life lost due to disability and the quality of the life that has been saved, respectively, in order to quantify the utility of the intervention.
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Principles of egalitarianism suggest the distribution of scarce resources amongst all those in need irrespective of likely outcome . The egalitarian will place some emphasis on equality, and the way that this is achieved might differ. The guiding factor is need rather than the ultimate benefit or utility of the intervention.
Approaches based on egalitarian principles are complex guides in disaster settings. Procedural Approach . The inherent difficulties in triage may lead practitioners to attempt to minimize active selection or prioritization of patients in face of scarcity of resources, and instead rely upon guidelines which do not take into account medical need or possibility of positive outcomes.
This approach prioritizes simplification of the triage and transparency, although there are significant ethical drawbacks, especially when procedures favor those who are part of socioeconomically advantaged groups such as those with health insurance. Procedural systems of triage emphasize certain patterns of decision making based on preferred procedures. This can take place in the form of a fair lottery for instance; or establishing transparent criteria for entry into hospitals - based on non discriminatory conditions.
This is not outcome driven; it is a process driven activity aimed at providing consistent frameworks upon which to base decisions . These are by no means the only systems upon which decisions are made, but provide a basic framework to evaluate the ethical reasoning behind what are often difficult choices during disaster response and management.
Internationally [ citation needed ] , disaster medicine specialists must demonstrate competency in areas of disaster healthcare and emergency management including but not limited to:. This is the first presidential request for disaster medical assistance in United States history. Karl H. Houghton , M. Joseph R. Schaeffer , M. Healthcare professionals worldwide join the discussion group of the years to come. Elsewhere in the world, similar centers are created at universities in London, Paris, Brussels and Bordeaux.
As a result, the need for disaster medicine is galvanized [ citation needed ]. ABPS empanels a board of certification to determine if board certification is appropriate in this new specialty. 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. Among the condemnations of emergency care is the lack of substantial improvement in disaster preparedness, or "cross-silo" coordination. HSPD specifically calls for the creation of the discipline of "disaster healthcare" using the accepted definition of "disaster medicine.
Physicians who hold board certification in disaster medicine have demonstrated by written and simulator-based examination that through training and field experience, they have mastered the spectrum of knowledge and skills which defines the specialty of disaster medicine. As with all medical specialties, this body of knowledge and skills is contained in the core competencies document created and maintained by the American Board of Disaster Medicine and the American Academy of Disaster Medicine.
As with all core competencies documents, the specific knowledge and skills required for certification are subject to constant refinement and evolution. This statement cannot be more true than for a specialty like disaster medicine where the nature of the threats faced, the responses undertaken, and the lessons learned become more complex with each event.
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About Richard Gordon. Richard Gordon.
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As Richard Gordon, Ostlere has written several novels, screenplays for film and television and accounts of popular history, mostly dealing with the practice of medicine. He is most famous for a long series of comic novels on a medical theme starting with D Richard Gordon is the pen name used by Gordon Ostlere born Gordon Stanley Ostlere on September 15, , an English surgeon and anaesthetist. He is most famous for a long series of comic novels on a medical theme starting with Doctor in the House , and the subsequent film, television and stage adaptations.
Gordon worked as anaesthetist at St.
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Bartholomew's Hospital where he was a medical student and later as a ship's surgeon and as assistant editor of the British Medical Journal. He has published several technical books under his own name including Anaesthetics for Medical Students ; later published as Ostlere and Bryce-Smith's Anaesthetics for Medical Students in , Anaesthetics and the Patient and Trichlorethylene Anaesthesia In , he left medical practice and took up writing full time.
He has an uncredited role as an anesthesiologist in the movie Doctor in the House. The early Doctor novels, set in the fictitious St Swithin's, a teaching hospital in London, were initially witty and apparently autobiographical; later books included more sexual innuendo and farce. The novels were very successful in Britain in Penguin paperback during the s and s. Richard Gordon also contributed to Punch magazine and has published books on medicine, gardening, fishing and cricket.
The film adaptation of Doctor in the House was released in , two years after the book, while Doctor at Sea came out the following year with Brigitte Bardot. Dirk Bogarde starred as Dr. Simon Sparrow in both. The later spin-off TV series were often written by other well-known British comic performers. Books by Richard Gordon.