Some disasters produce circumstances that require the emergency removal of some or all of the citizens from a geographic area. Emergency or mass evacuation can be divided into immediate evacuation, in which the citizens are given no warning of their need to evacuate, and potential evacuation, in which citizens are given time (usually a day or two) to evacuate. The mass evacuation aspect of disaster planning frequently is neglected, but must be planned in detail. An essential ingredient of a plan is the designation of a person who has the authority to order an evacuation and that that person or an authorized alternate, is available instantly 24 hours a day. The plans should identify likely scenarios which could require emergency evacuation for a given community requiring, means of communicating with the citizens, evacuation routes, evacuation mechanisms, and shelter arrangements. All plans need to take into account human behavior during such a stressful situation.

The concept of Urban Heavy Rescue is gaining increasing recognition within the emergency response community. Urban Heavy Rescue has come to denote the unique demands for special equipment and personnel as the result of structural collapse. Recent earthquakes in California, the Philippines, and Soviet Armenia as well as the building collapses in Brownsville, Texas, and New York City provided excellent demonstrations of the concept of specialized structural collapse teams. These events even have prompted the Federal Emergency Management Agency (FEMA) to establish a National Urban Search and Rescue System of special task forces trained in victim location and extrication from collapsed structures. This system will comprise an immediate federal response mechanism for assisting first responders in such activities. The National Search and Rescue System was based on post-event evaluations that pointed out a need not only for more applicable equipment and trained personnel, but also for the timely placement of the these resources.

The resuscitator bag has been considered the standard for prehospital, ventilatory managment. Recently, the Berg Resuscitation Apparatus (BRA) was developed as an alternative. Two devices were compared for their ability to deliver adequate tidal volumes and efficacy during simulated, single-rescuer CPR In the first phase, emergency care providers ventilated a test lung using a resuscitator bag, BRA, and demand valve. No significant differences between methods were found. During the second phase of the study, subjects performed single-rescuer CPR on a resuscitation mannikin for two minutes, using the bag-valve-mask and the BRA with a mask. The BRA delivered a volume of 0.81±0.26 liters compared to 0.35±0.19 liters using the resuscitator bag. The BRA allows ventilation to be performed as does the traditional equipment. When used in single rescuer CPR, it appears to provide a substantial increase in the tidal volumes delivered.

The Metag triage label system was assessed during a major incident exercise at an international airport. The exercise simulated a crash of a plane carrying 40 passengers within the airport boundaries. A secondary incident also was staged involving an explosion resulting in a fire with three victims injured. The exercise involved the airport, fire, police, ambulance, and medical services of three counties—Leicestershire, Derbyshire, and Nottinghamshire. Use of the labels enabled evaluation of the triage process, early medical intervention for victims, and completion of the cards.