The hallmark of a successful response to a nuclear detonation will be the resilience of the community, region, and nation. An incident of this magnitude will rapidly become a national incident; however, the initial critical steps to reduce lives lost, save the lives that can be saved with the resources available, and understand and apply resources available to a complex and dynamic situation will be the responsibility of the local and regional responders and planners. Expectations of the public health and health care systems will be met to the extent possible by coordination, cooperation, and an effort to produce as consistent a response as possible for the victims. Responders will face extraordinarily stressful situations, and their own physical and psychological health is of great importance to optimizing the response. This article illustrates through vignettes and supporting text how the incident may unfold for the various components of the health and medical systems and provides additional context for the discipline-related actions outlined in the state and local planners’ playbook.

(Disaster Med Public Health Preparedness. 2011;5:S73-S88)

While information for the medical aspects of disaster surge is increasingly available, there is little guidance for health care facilities on how to manage the psychological aspects of large-scale disasters that might involve a surge of psychological casualties. In addition, no models are available to guide the development of training curricula to address these needs. This article describes 2 conceptual frameworks to guide hospitals and clinics in managing such consequences. One framework was developed to understand the antecedents of psychological effects or “psychological triggers” (restricted movement, limited resources, limited information, trauma exposure, and perceived personal or family risk) that cause the emotional, behavioral, and cognitive reactions following large-scale disasters. Another framework, adapted from the Donabedian quality of care model, was developed to guide appropriate disaster response by health care facilities in addressing the consequences of reactions to psychological triggers. This framework specifies structural components (internal organizational structure and chain of command, resources and infrastructure, and knowledge and skills) that should be in place before an event to minimize consequences. The framework also specifies process components (coordination with external organizations, risk assessment and monitoring, psychological support, and communication and information sharing) to support evidence-informed interventions.

(Disaster Med Public Health Preparedness. 2011;5:73-80)

Effective emergency response among hospitals and other health care providers stems from multiple factors depending on the nature of the emergency. While local emergencies can test hospital acute care facilities, prolonged national emergencies, such as the 2009 H1N1 outbreak, raise significant challenges. These events involve sustained surges of patients over longer periods and spanning entire regions. They require significant and sustained coordination of personnel, services, and supplies among hospitals and other providers to ensure adequate patient care across regions. Some hospitals, however, may lack structural principles to help coordinate care and guide critical allocation decisions. This article discusses a model Memorandum of Understanding (MOU) that sets forth essential principles on how to allocate scarce resources among providers across regions. The model seeks to align regional hospitals through advance agreements on procedures of mutual aid that reflect modern principles of emergency preparedness and changing legal norms in declared emergencies.

(Disaster Med Public Health Preparedness. 2011;5:54-61)

Objectives: To assess necessary treatment and degree of urgency for patients admitted to emergency rooms, and potential health consequences of transfer to nearest alternative hospital.

Methods: During 1 month, we included all 1,300 emergently admitted patients in all seven general hospitals in a Norwegian county with a population of 236,921 inhabitants. The number of patients in need of surgical and/or intensive medical treatment, the urgency of the necessary treatment, and the risk to each patient of adverse permanent health consequences of further transport to nearest alternative hospital were assessed by a multidisciplinary expert panel.

Results: Ninety-four patients (7.2% of 1300 patients) were considered in need of either surgical (n = 22) or intensive medical treatment (n = 70) or both (n = 2) within 8 hours of arrival in hospital. Medical treatment had the greatest urgency, while surgery most often could be postponed. In cases where the patients were initially to be given only stabilizing treatment and then transported (assisted by qualified personnel) to another hospital, the panel estimated the risk of losing health benefit to be high for 14 patients. In six of these cases the risk was linked to delay of thrombolytic treatment.

Conclusions: Fewer than 10% of the patients who are admitted as emergency cases to general hospitals in Norway need surgical or intensive medical treatment within 8 hours of their arrival. The medical consequences of transport of patients to the nearest alternative hospital are generally small and can often be further reduced by simple means.

The paper deals with a stochastic organization model described by a generalized Poisson input process and given probabilities of entering individuals obtaining certain attributes in this organization. The distribution of attributes at any given instant is derived. Examples illustrate the application of obtained results.