OVERVIEW

Responses to large-scale emergencies in recent years have reaffirmed what has long been said about disaster response: “all disasters are local.” Those jurisdictions whose plans rely primarily on outside assistance beginning with the initial stages of response are destined to fail. Stepwise, scalable incident organization is essential to meet initial goals and objectives of the response to the emergency. Large-scale multicasualty emergencies and disasters involving large numbers of injuries or illness are complex and will initially or eventually involve many agencies at various levels of jurisdiction that may have little or no experience working together. Local planning, preparedness, interdisciplinary training, and exercises can improve familiarity with multiagency strategic and tactical plans and improve understanding of missions, cooperation, and interoperability.

The emergency medical services (EMS) mission of triage, rapid clinical assessment, critical therapeutic interventions, medical communications, and capability and capacity-directed transport of victims in the management of a large-scale multicasualty emergency is part of a complex set of overlapping missions. Immediate hazard mitigation or containment for the protection of responders and protection of victims from further injury is the first priority. This may be possible quickly and the EMS mission may proceed rapidly. There may, however, be fire suppression, rescue, or hazardous materials concerns complicating the missions of EMS and each response organization. Another critical early step is communication of the evolving situation to the local healthcare infrastructure to assist them with preparing to receive patients.