The evolution of shortcomings in Incident Command System: Revisions have allowed critical management functions to atrophy.

The original Incident Command System (ICS) was created through the federally funded Firefighting Resources of Southern California Organized for Potential Emergencies (FIRESCOPE) program. Initially developed as one element of multiagency coordination for managing severe wildfires, the FIRESCOPE ICS guidance was adopted and evolved through increasingly routine wildl and firefighting. It then was modified for all hazards for the fire service.

Application of a plume model for decision makers' situation awareness during an outdoor airborne HAZMAT release.

In a large-scale outdoor, airborne, hazardous materials (HAZMAT) incident, such as ruptured chlorine rail cars during a train derailment, the local Incident Commanders and HAZMAT emergency responders must obtain accurate information quickly to assess the situation and act promptly and appropriately. HAZMAT responders must have a clear understanding of key information and how to integrate it into timely and effective decisions for action planning. This study examined the use of HAZMAT plume modeling as a decision support tool during incident action planning in this type of extreme HAZMAT incident.

Confined space medicine and the medical management of complex rescues: a case series.

Objective: A variety of hazards can precipitate the full or partial collapse of occupied structures. The rescue of entrapped survivors in these situations can be complex, require a multidisciplinary approach, and last for many hours.

Methods: The modern discipline of Urban Search and Rescue, which includes an active medical component, has evolved to address such situations.

Rapid disaster victim identification in mass fatality incidents: decision-support tool to facilitate human remains identification.

Objectives: A quantitative decision-support tool (DST), using a combination of selected human physical attributes as identification elements, was developed to facilitate body identification in mass fatality incidents, particularly in settings with limited availability of technological resources and forensic expertise.

Methods: To construct the DST, the external biological attributes of interest were first selected. A process was then developed to guide collection of the selected categories of attributes and record them into objective antemortem (AM) and postmortem (PM) records.

Survival interval in earthquake entrapments: research findings reinforced during the 2010 Haiti earthquake response.

Earthquakes can result in collapsed structures with the potential to entrap individuals. In some cases, people can survive entrapment for lengthy periods. The search for and rescue of entrapped people is resource intensive and competes with other postdisaster priorities.

-PLUS prehospital mass-casualty triage: a strategy for addressing unusual injury mechanisms.

Introduction: Simple Triage and Rapid Treatment (START) and more recently developed prehospital casualty triage algorithms are widely used, in part because they are easy to teach and learn, and can be performed rapidly. Every rapid triage protocol has inherent, significant limitations: (1) no mechanism of injury (MOI) considerations; (2) limited assessment points; and (3) no refinement in truly mass-casualty situations where transport of "minor" or "moderate" patients may be delayed.

Hypothesis: When rapid initial triage protocols are utilized, a significant triage deficiency ("under-triage") may occur when "minor" or "moderate" casualties actually are more severely injured than initially triaged.

Challenge of hospital emergency preparedness: analysis and recommendations.

In the United States, recent large-scale emergencies and disasters display some element of organized medical emergency response, and hospitals have played prominent roles in many of these incidents. These and other well-publicized incidents have captured the attention of government authorities, regulators, and the public. Health care has assumed a more prominent role as an integral component of any community emergency response.

Health care emergency management: establishing the science of managing mass casualty and mass effect incidents.

Particularly since 2001, the health care industry has witnessed many independent and often competing efforts to address mitigation and preparedness for emergencies. Clinicians, health care administrators, engineers, safety and security personnel, and others have each developed relatively independent efforts to improve emergency response. A broader conceptual approach through the development of a health care emergency management profession should be considered to integrate these various critical initiatives.

Refining surge capacity: conventional, contingency, and crisis capacity.

Health care facility surge capacity has received significant planning attention recently, but there is no commonly accepted framework for detailed, phased surge capacity categorization and implementation. This article proposes a taxonomy within surge capacity of conventional capacity (implemented in major mass casualty incidents and representing care as usually provided at the institution), contingency capacity (using adaptations to medical care spaces, staffing constraints, and supply shortages without significant impact on delivered medical care), and crisis capacity (implemented in catastrophic situations with a significant impact on standard of care). Suggested measurements used to gauge a quantifiable component of surge capacity and adaptive strategies for staff and supply challenges are proposed.

Assessing the integration of health center and community emergency preparedness and response planning.

Background: To assess the state of health center integration into community preparedness, we undertook a national study of linkages between health centers and the emergency preparedness and response planning initiatives in their communities. The key objectives of this project were to gain a better understanding of existing linkages in a nationally representative sample of health centers, and identify health center demographic and experience factors that were associated with strong linkages.

Methods: The objectives of the study were to gain a baseline understanding of existing health center linkages to community emergency preparedness and response systems and to identify factors that were associated with strong linkages.

Integrating hospitals into community emergency preparedness planning.

Background: Strong community linkages are essential to a health care organization's overall preparedness for emergencies.

Objective: To assess community emergency preparedness linkages among hospitals, public health officials, and first responders and to investigate the influence of community hazards, previous preparation for an event requiring national security oversight, and experience responding to actual disasters.

Design: With expert advice from an advisory panel, a mailed questionnaire was used to assess linkage issues related to training and drills, equipment, surveillance, laboratory testing, surge capacity, incident management, and communication.

Surviving collapsed structure entrapment after earthquakes: a "time-to-rescue" analysis.

Introduction: Massive earthquakes often cause structures to collapse, trapping victims under dense rubble for long periods of time. Commonly, this spurs resource intensive, dangerous, and frustrating attempts to find and extricate live victims. The search and rescue phase usually is maintained for many days beyond the last "save," potentially diverting critical attention and resources away from the pressing needs of non-trapped survivors and the devastated community.

Protective equipment for health care facility decontamination personnel: regulations, risks, and recommendations.

After recent terrorist attacks, new attention has been focused on health care facility decontamination practices. This article reviews core issues related to the selection of appropriate personal protective equipment for health care facility decontamination personnel, with an emphasis on respiratory protection. Existing federal regulations focus primarily on scene response and not on issues specific to health care facility decontamination practices.

Frail elderly as disaster victims: emergency management strategies.

Purpose: To identify the vulnerabilities of elderly to disasters, and to develop strategies to address these vulnerabilities.

Methods: A relevant literature search of journal articles, government training materials, news reports, and materials from senior organizations was conducted.

Results: The vulnerability of the elderly to disasters is related to their impaired physical mobility, diminished sensory awareness, chronic health conditions, and social and economic limitations that prevent adequate preparation for disasters, and hinder their adaptability during disasters.