Koenig and Schultz's Disaster Medicine 2Nd Edition Frontmatter More Information

Home , Disaster medicine

Cambridge University Press 978-1-107-04075-5 — Koenig and Schultz's Disaster Medicine 2nd Edition Frontmatter More Information

Koenig and Schultz’s Disaster Medicine

Second Edition

As societies become more complex and interconnected, the global risk for catastrophic disasters is increas- ing. Demand for expertise to mitigate the human suffering and damage these events cause is also high. A new field of disaster medicine is emerging, offering innovative approaches intended to optimize disaster management. However, much of the information needed to create the foundation for this growing specialty is not objectively described or is scattered among multiple different sources. This definitive work brings together a coherent and comprehensive collection of scientific observations and evidence-based recommendations with expert contributors from around the globe. This book identifies essential subject matter, clarifies nomenclature, and outlines necessary areas of proficiency for healthcare professionals handling mass casualty crises. It also describes in-depth strategies for the rapid diagnosis and treatment of victims suffering from blast injuries or exposure to chemical, biological, and radiological agents.

Dr. Kristi L. Koenig, Professor of Emergency Medicine and Public Health, Director of Public Health Preparedness, and Director of the Center for Disaster Medical Sciences at the University of California, Irvine, is an internationally recognized expert in the ﬁelds of homeland security, disaster and emergency medicine, emergency management, and emergency medical services. During the U.S. terrorist attacks of 9/11, she served as National Director of the Emergency Management Ofﬁce for the Federal Department of Veterans Affairs. Professor Koenig is a Fulbright Scholar and fellow of the International Federation for Emergency Medicine. She holds multiple appointments including Visiting Professor at universities in Australia, Italy, and Belgium. With a strong health policy and academic background, including more than 100 peer-reviewed publications and nearly 500 invited lectures in about 35 countries, she is widely sought for presentations at regional, national, and international forums.

Dr. Carl H. Schultz is a Professor of Emergency Medicine and the Director of Research at the Center for Disaster Medical Sciences, University of California, Irvine, School of Medicine. He is an internationally recognized expert and researcher in the ﬁelds of disaster and emergency medicine. He has written more than 100 peer-reviewed publications, and his investigations have resulted in two ﬁrst-author publications in the New England Journal of Medicine. He chaired the Disaster Preparedness and Response Committee of the American College of Emergency Physicians and received the College’s Disaster Medical Sciences Award. He has served as a consultant for the U.S. Department of Defense, the Joint Commission, and the State of Israel. Dr. Schultz holds faculty appointments at universities in Belgium and Italy.

In loving memory of my mother, whose unwavering love, guidance, and support allowed me enormous life opportunities, including the ability to create this book And with appreciation and admiration for my students, residents, EMS and Disaster Medical Sciences Fellows, International Fellows, and the European Master of Disaster Medicine family who will continue to move the science of disaster medicine forward into the future to mitigate loss of life and human suffering from disasters Kristi L. Koenig, MD, FACEP, FIFEM

To all the organizations worldwide that support the emerging specialty of disaster medicine To Noriaki Aoki, MD, PhD, whose premature death robbed our specialty of a truly gifted and visionary talent, and me of a great friend To my father, Irwin M. Schultz, MD, and in memory of my mother, Ruth L. Schultz, BSN, whose love and encouragement have sustained me throughout my career Carl H. Schultz, MD, FACEP

Koenig and Schultz’s Disaster Medicine Comprehensive Principles and Practice

Second Edition

edited by Kristi L. Koenig University of California, Irvine, Center for Disaster Medical Sciences Carl H. Schultz University of California, Irvine, Center for Disaster Medical Sciences

University Printing House, Cambridge CB2 8BS, United Kingdom One Liberty Plaza, 20th Floor, New York, NY 10006, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia 4843/24, 2nd Floor, Ansari Road, Daryaganj, Delhi - 110002, India 79 Anson Road, #06-04/06, Singapore 079906

Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning, and research at the highest international levels of excellence.

www.cambridge.org Information on this title: www.cambridge.org/9781107040755 C Kristi L. Koenig, Carl H. Schultz 2016 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2016

A catalog record for this publication is available from the British Library. Library of Congress Cataloging in Publication Data Names: Koenig, Kristi L., editor. | Schultz, Carl H. (Carl Herman), editor. Title: Koenig and Schultz’s disaster medicine : comprehensive principles and practice / edited by Kristi L. Koenig, Carl H. Schultz. Other titles: Disaster medicine : comprehensive principles and practice Description: Second edition. | Cambridge ; New York : Cambridge University Press, 2015. | Includes bibliographical references and index. Identiﬁers: LCCN 2015041206 | ISBN 9781107040755 Subjects: | MESH: Disaster Medicine. | Disaster Planning. | Disasters. Classiﬁcation: LCC RA645.9 | NLM WA 295 | DDC 616 – dc23 LC record available at http://lccn.loc.gov/2015041206 Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party Internet Web sites referred to in this publication and does not guarantee that any content on such Web sites is, or will remain, accurate or appropriate.

Contents

Contributors page vii 10. Populations with Functional or Access Needs 137 Foreword xv Brenda D. Phillips and Laura M. Stough Perspective xvii PART II. OPERATIONAL ISSUES Carl H. Schultz Preface xix 11. Public Health and Emergency Management Systems 165 PART I. CONCEPTUAL FRAMEWORK AND STRATEGIC Connie J. Boatright-Royster and Peter W. Brewster OVERVIEW 12. Legislative Authorities and Regulatory Issues 183 1. Disaster Research and Epidemiology 3 Ernest B. Abbott and Jeffrey H. Luk Megumi Kano, Michele M. Wood, Judith M. Siegel, 13. Syndromic Surveillance 199 and Linda B. Bourque Gary A. Roselle 2. Disaster Health Education and Training: Linking 14. Triage 208 Individual and Organizational Learning and Christopher A. Kahn, E. Brooke Lerner, and Performance 23 David C. Cone Peter W. Brewster 15. Personal Protective Equipment 219 3. SurgeCapacityandScarceResourceAllocation 38 Howard W. Levitin Donna F. Barbisch 16. Decontamination 232 4. Climate Change 52 Howard W. Levitin and Christopher A. Kahn Richard A. Matthew and Jamie L. Agius 17. Quarantine 241 5. International Perspectives on Disaster Management 59 JamesG.Hodge,Jr.andLawrenceO.Gostin Jean Luc Poncelet 18. Mass Dispensing of Medical Countermeasures 250 6. Community Resilience 71 Susan E. Gorman Rose L. Pfefferbaum, Richard Reed, and Betty Pfefferbaum 19. Management of Mass Gatherings 265 Michael S. Molloy 7. Ethical Issues in Disaster Medicine 81 George J. Annas 20. Transportation Disasters 294 Ulf Bjornstig¨ and Rebecca Forsberg 8. Emerging Infectious Diseases: Concepts in Preparing for and Responding to the Next Microbial 21. Emergency Medical Services Scene Management 321 Threat 93 Kenneth T. Miller Shantini D. Gamage, Stephen M. Kralovic, and 22. Healthcare Facility Disaster Management 330 Gary A. Roselle John D. Hoyle, Sr. 9. Disaster Behavioral Health 124 23. Mass Fatality Management 361 James C. West, Merritt D. Schreiber, David Benedek, Paul S. Sledzik and Sharon W. Bryson and Dori B. Reissman

vi ■ CONTENTS

24. Rehabilitation of Disaster Casualties 376 34. Hazardous Material, Toxic, and Industrial James E. Gosney, Jr. and Colleen O’Connell Events 579 Hoon Chin Lim and Hock Heng Tan 25. Crisis and Emergency Risk Communication 390 Barbara J. Reynolds and Gilead Shenhar SECTION IIIB: ENVIRONMENTAL EVENTS 26. Telemedicine and Telehealth: Role in Disaster and 35. Floods 603 Public Health Emergencies 415 Mark E. Keim Adam W. Darkins 36. Cyclones, Hurricanes, and Typhoons 624 27. Complex Public Health Emergencies 433 Kelly R. Klein and Frank Fuh-Yuan Shih Frederick M. Burkle, Jr. 37. Tornadoes 635 28. Patient Identiﬁcation and Tracking 450 Arthur G. Wallace, Jr. Andreas Ziegler 38. Earthquakes 642 PART III. CLINICAL MANAGEMENT Carl H. Schultz and Shira A. Schlesinger 39. Tsunamis 661 SECTION IIIA: CBRNE AND HAZMAT Samuel J. Stratton 29. Explosive Events 467 40. Winter Storms and Hazards 670 GlennD.BurnsandJohnM.Wightman John M. Wightman and William H. Dice 30. Burn Disaster Management: Planning and Resource 41. Extreme Heat Events 692 Needs 490 Carl Adrianopoli and Irving Jacoby Tina L. Palmieri, Ariel Tessone, and Joseph Haik 42. Landslides 716 31. Clinical Aspects of Large-Scale Chemical Events 499 Iain T. R. Kennedy, David N. Petley, and Jonathan Newmark Virginia Murray 32. Biological Events 522 43. Volcanoes 724 Zygmunt F. Dembek and Theodore J. Cieslak Peter J. Baxter 33. Radiation Accidents and the Medical Management of Acute Radiation Injury 544 Index 737 Richard J. Hatchett, David M. Weinstock, and Ronald E. Goans

Contributors

Ernest B. Abbott, JD, MPP practices emergency management and physicians working together to promote human rights and law at Baker Donelson in Washington, DC, after 12 years at health. He is the author or editor of 20 books on health law FEMA Law Associates, PLLC and four years’ service as General and bioethics, including Worst Case Bioethics: Death, Disaster, Counsel of FEMA (from 1997 to 2001). He is a graduate of Har- and Public Health. vard Law School and a frequent author, editor, and speaker on emergency management law. He is coeditor of ALegalGuideto Donna Barbisch, RN, MPH, DHA, a retired U.S. Army Major Homeland Security and Emergency Management and adjunct pro- General, is President of Wicked Solutions and Senior Policy fessor of Disaster Law at the George Washington University Law AdvisorfortheCenterforDisasterMedicalSciencesatUC School. Irvine. She is a visionary who drives senior leader decision- making to improve threat reduction and outcomes associated Carl Adrianopoli,PhD,MSistheRegionalAdministratorfor with catastrophic disasters. She is widely published and fre- the Ofﬁce of Preparedness and Emergency Operations in the quently an invited speaker at national and international meet- U.S. Department of Health and Human Services, Federal Region ings on building resilience and the process and policy underlying V. He represented the Department of Homeland Security in the preparedness. multi–federal agency development of the Excessive Heat Events Guidebook (2006) and most recently was one of the co-authors Peter J. Baxter, MD recently retired as consultant physician in on a Presidential Climate Change Work Group. He has presented occupational and environmental medicine at the University of and published numerous papers on extreme heat events and Cambridge and Addenbrooke’s University Hospital, Cambridge. integrated response to disasters including the uses of Chemical, He has researched the human impacts of volcanic eruptions and Biologic, Radiologic, Nuclear and Explosive Weapons of Mass advised governments and the World Health Organization since Destruction. He deployed in response to the 1995 Chicago Heat his involvement with the eruption of Mount St. Helens in 1980, Wave, the World Trade Center disaster in 2001, Hurricane Katrina when he was a medical epidemiologist at the U.S. Centers for in 2005, the Florida Hurricanes in 2004–2005, the BP Oil Spill Disease Control and Prevention in Atlanta. He has also advised in 2010 and the Unaccompanied, Migrant Children’s Mission in the U.K. government on the public health effects of air quality Nogales, Arizona in 2014. standards, major industrial incidents, climate change, and other disasters. He is honorary visiting research fellow in the Institute Jamie Agius, BA, MA is an environmental engineering teacher at of Public Health at the University of Cambridge. asecondarycharterschoolinPaciﬁcPalisades,CA.SheholdsaBA in Urban Studies with a focus on Environmental Sustainability COLDavidM.Benedek, MD is Professor/Deputy Chair, Depart- and an MA in Teaching from the University of California, Irvine. ment of Psychiatry, Uniformed Services University School of While attending UC Irvine, she conducted research with the Medicine and Associate Director/Senior Scientist at the Univer- Center for Unconventional Security Affairs in the areas of climate sity’s Center for the Study of Traumatic Stress. He has authored change mitigation and adaptation projects in peacebuilding, as over 100 publications and has presented extensively on military, well as on climate change and emergency medicine. disaster, and forensic psychiatry at regional, national, and international conferences. Dr. Benedek is a Distinguished Fellow of George J. Annas, JD, MPH is the Warren Distinguished Professor the American Psychiatric Association (APA) and past president at Boston University, and Chair of the Department of Health of the APA’s military district branch. He was principal consultant Law, Bioethics & Human Rights at Boston University School to the APA’s Practice Guideline working group in their develop- of Public Health. He is the cofounder of Global Lawyers and ment of the Practice Guideline for the Treatment of Acute Stress Physicians, a transnational professional association of lawyers Disorder and Posttraumatic Stress Disorder (PTSD), lead author

vii

viii ■ CONTRIBUTORS

of the APA’s subsequent PTSD Guideline Watch and co-editor of Frederick M. Burkle, Jr., MD, MPH, DTM, FAAP, FACEP has the APA’s Clinical Manual for Management of PTSD. extensive global experience, research and publications relating to complex emergencies. He has worked for nongovernmental Ulf Bjornstig¨ ,MD,PhDisSeniorProfessorofSurgeryatUmea˚ agencies, the World Health Organization, the Red Cross, the U.S. University in Sweden. He is the Deputy Director of the Center government, and the military. He is a Senior International Public for Disaster Medicine at Umea˚ University, as well as Director Policy Scholar at the Woodrow Wilson International Center for of Traffic Safety Center North. He has published 135 original Scholars, a Senior Fellow and Scientist at the Harvard Humani- scientific articles and approximately 75 book chapters, traffic tarian Initiative, Harvard School of Public Health, a Senior Asso- safety plans, and other articles. Dr. Bjornstig¨ was Traffic Safety ciate in the Departments of International Health and Emergency Director in the Swedish National Road Administration from Medicine at Johns Hopkins, and an elected member of the Insti- 1998 to 2000. He holds several board positions in national and tute of Medicine, National Academy of Sciences. international scientific organizations. Glenn Burns, MD, FACEP is an emergency physician and Connie J. Boatright-Royster, MSN, RN, COL, USA (Ret.) is a Associate Professor of Emergency Medicine and Military Senior Crisis and Continuity Advisor with the MESH Coalition, Medicine. Over his career, he has engaged with key international a partner of the Indiana University Schools of Medicine and partners in developing military medical education curricula and Nursing. She also serves as faculty for the Federal Emergency training programs for point-of-injury care, medical disaster lead- Management Agency (FEMA) national Center for Domestic Pre- ership, medical response to weapons of mass destruction and paredness. An expert in emergency management in healthcare, child/family reintegration in disaster response. He has published COL Boatright-Royster served for over 20 years as a national on medical leadership education, blast injury, tactical combat leader in the Department of Veterans Affairs Emergency Man- casualty care, mass casualty response and point-of-injury care. agement System, where she contributed significantly to national disaster medicine standards and guidelines. Theodore J. Cieslak, MD, FAAP, FIDSA received his MD degree at the Ohio State University prior to completing a Pediatric Resi- Linda B. Bourque, PhD is Professor in the Department of Com- dency at Baylor and Infectious Disease fellowship at Walter Reed. munity Health Sciences in the Fielding School of Public Health Retired from the U.S. Army after a 30-year career, notable assign- at the University of California at Los Angeles, where she teaches ments included: Chairman of Pediatrics in San Antonio, Defense research methodology with focus on the design, data processing Department Liaison to CDC, and Chief of Operational Medicine and analysis of data collected with questionnaires in population- at USAMRIID. He also served as Biodefense Consultant to the based surveys. Her professional interests include impacts of nat- Army Surgeon General and as Head of delegation to NATO’s ural, technological and human-initiated disasters on communi- Biomedical Advisory Council. He recently joined the faculty at ties and household preparedness for disasters, with an emphasis the University of Nebraska’s School of Public Health. on preparedness for earthquakes in California, and ophthalmic clinical trials. Her publications are featured in several jour- David C. Cone, MD is Professor of Emergency Medicine and nals, including in Environment and Behavior, Risk Analysis,and EMS Section Chief at the Yale University School of Medicine in Earthquake Spectra. New Haven, Connecticut. A graduate of the European Master in Disaster Medicine, he has worked in emergency medical services PeterW.Brewster, BS is the Program Manager, Strategic Plan- for 30 years and as a firefighter for 15. Dr. Cone has served as ning/Quality for the Office of Emergency Management, Veter- Medical Team Manager for two urban search-and-rescue task ans Health Administration (VHA). He participates on several forces. He is a past president of the National Association of EMS National Fire Protection Association technical committees and Physicians and editor-in-chief of the journal Academic Emergency supports the Emergency Management Accreditation Program Medicine. as an assessor and member of the Program Review Commit- tee. In 2011–2012, Mr. Brewster was detailed to the Depart- Adam W.Darkins,MBChB,MPHM,MD,FRCSisVicePresident ment of Health and Human Services, Assistant Secretary for for Medical Affairs and Enterprise Technology Development for Preparedness and Response as the Acting Director, National Medtronic Plc. He formerly led the National Telehealth Program Disaster Medical System. His experience prior to joining VHA at the U.S. Department of Veterans Affairs. With a clinical back- includes work as an Emergency Management Coordinator for ground in Neurosurgery and in health services development in the Consolidated City of Indianapolis/Marion County, and with the U.S. and UK; his background as a clinician, healthcare exec- the National Park Service at Grand Teton National Park and utive, and director of enterprise technology programs gives him the U.S. Forest Service in Medicine Bow National Forest in unique insights into developing virtual care services to increase Wyoming. access to healthcare. Dr. Darkins is internationally recognized as an expert in developing the clinical, technology and business pro- Sharon W. Bryson, MC is the Director of the Office of Trans- cesses necessary to create and sustain new models of healthcare portation Disaster Assistance at the National Transportation delivery. Safety Board. Prior to serving on the Board, she worked as the Director of the Family Support Center at Dover Air Force Zygmunt F. Dembek, COL (USAR, Ret), PhD, MS, MPH, LHD Base. She served as adjunct faculty in psychology and sociology (Hon) is an internationally recognized bioterrorism prepared- at Wilmington College, Wesley College, and the University of ness and public health expert. He has authored over 80 publi- Delaware. She is certified by the National Board for Certified cations, many directly relevant to civilian and military defense Counselors and is a Licensed Professional Counselor of Mental against bioterrorism and biological weapons; served as Senior Health. Editor for the Textbook of Military Medicine: Medical Aspects

CONTRIBUTORS ■ ix

of Biological Warfare 2007; and as the lead editor for USAM- Philippines. He is also coauthor of the chapter “Natural Disas- RIID’s Medical Management of Biological Casualties Handbook ters, Health-related Aspects” in The International Encyclopedia of (Blue Book) 7th Edition, 2011. the Social & Behavioral Sciences, 2nd edition.

William H. Dice, MD is Assistant Professor in the Department of Lawrence O. Gostin, JD is University Professor (Georgetown Emergency Medicine at the State University of New York, Buffalo. University’s highest academic rank), O’Neill Chair in Global He has more than 35 years of experience with disasters, human- Health Law, and Director of the O’Neill Institute for National itarian assistance, preparedness training, and response. He has and Global Health Law. Professor Gostin holds international served as Director for Emergency Planning in the Office of the professorial appointments at Oxford University, University of Assistant Secretary of Defense for Health Affairs, and as Depart- Witwatersrand, and Melbourne University. He is Director of the ment of Defense Liaison to Emergency Support Function 8 for WHO Collaborating Center on Public Health Law & Human Hurricane Andrew. He is an alpine patroller for the National Ski Rights, and serves on expert WHO advisory committees on Patrol and is an emergency preparedness consultant for county mental health, international health regulations, and pandemic and state departments of health. influenza preparedness. Professor Gostin holds several editorial appointments, notably for the Journal of the American Medical Rebecca Forsberg, RN, PhD holds a BA in peace and conflict Association. management. She works as a researcher and project manager at the Center for Disaster Medicine at UmeaUniversity,Ume˚ a,˚ Richard J. Hatchett,MDisChiefMedicalOfficerandDeputy Sweden. Dr. Forsberg has worked many years with research and Director of the U.S. Biomedical Advanced Research and Devel- development with a focus on passenger safety within the rail- opment Authority (BARDA), where he oversees programs to bound transport system. The work is supported by the Swedish develop medical countermeasures against chemical, biological, National Board for Health and Welfare. radiological and nuclear threats, pandemic influenza, and emerging infectious diseases. Previously, he was Director for Medical Shantini D. Gamage, PhD, MPH is a Health Science Epidemi- Preparedness Policy on the White House National Security Staff ologist with the Department of Veterans Affairs (VA), National and Associate Director for Radiation Medical Countermeasures Infectious Diseases Service, where she focuses on translating sci- and Emergency Preparedness at the National Institutes of Health. ence and epidemiologic data into infectious diseases policy in the He completed a fellowship in medical oncology at Duke Univer- healthcare setting. She has contributed to numerous national sity Medical Center. VA and interagency biopreparedness initiatives, including the National Biosurveillance Integration System and the National Josef Haik, MD, MPH is Professor of Plastic and Reconstruc- Biosurveillance Science and Technology Roadmap. She holds an tive Surgery, Director of the Division of Plastic and Recon- adjunct affiliation with the University of Cincinnati College of structive Surgery and Director of the National Burn Center Medicine where she lectures on infectious diseases and public at the Sheba Medical Center, affiliated with the University of health policy. Tel Aviv, Israel. He is a leader in burn management in Israel, a member of the Israeli Council of Trauma, chairman of the RonaldE.Goans, MD, PhD, MPH is an Associate Professor at the Israel Burn Prevention Committee, and serves as a civilian Tulane School of Public Health and Tropical Medicine and Senior and military advanced trauma life support instructor. Profes- Scientist at the Radiation Emergency Assistance Center/Training sorHaikisanactivereserveforcescaptainintheIsraeliDefense Site. He is also the senior medical adviser at MJW Corporation, a Forces. He is an established author in the burn management major health physics consulting firm. His current research activ- literature and serves as a reviewer for the Journal of Burns. ities include development of early radiation triage techniques Dr. Haik is an awardee of the Talpiyot Medical Leadership and the mathematical modeling of local and systemic radiation Program. damage. James G. Hodge, Jr., JD is Associate Dean and Professor of Pub- Susan E. Gorman,BS,PharmD,MS,DABAT,FAACTistheAsso- lic Health Law and Ethics at the Sandra Day O’Connor Col- ciate Director for Science, Division of Strategic National Stock- lege of Law, Arizona State University (ASU). Through schol- pile, U.S. CDC. Her primary roles include oversight of the stock- arship, teaching, and varied applied and funded projects, Pro- pile formulary and provision of technical and scientific advice on fessor Hodge explores multiple areas of public health, law, and pharmacological and toxicological issues regarding the stockpile. ethics. He is Director of ASU’s Public Health Law and Policy She participates in numerous intergovernmental counterterror- Program and the Western Region Office of the Network for Pub- ism working groups involving radiological, chemical, and bio- lic Health Law. He has published extensively on law, medicine, logical agents. She is a nationally and internationally recognized public health, and bioethics topics, notably including emergency speaker on stockpiling for terrorist events and other large-scale legal and ethical preparedness. public health emergencies. John D. Hoyle, Sr., MHA, CHE, LFACHE has been active in James E. Gosney, MD, MPH, MS serves as the chair of the Com- disaster medical preparedness and response for 35 years. He was mittee on Rehabilitation Disaster Relief (CRDR) of the Interna- a hospital executive for 31 years, including 22 years as CEO of tional Society of Physical and Rehabilitation Medicine (ISPRM) a three-hospital system. He served as National Disaster Medical which advocates for the emerging disaster medicine specializa- System Hospital Coordinator in greater Cincinnati for 19 years tion of disaster rehabilitation. He is a peer-reviewed author, jour- and led a Disaster Medical Assistance Team for 15 years. He has nal reviewer, and speaker on this topic and has performed related responded to numerous hurricanes, airline crashes, the World research following large-scale disasters in China, Haiti, and the Trade Center disaster, and medical preparedness operations for

x ■ CONTRIBUTORS

the Olympics in Atlanta and Salt Lake City. He also has served as and Hurricane Katrina. She is an invited lecturer both nation- commissioned officer in the U.S. Public Health Service. ally and internationally and has published on disaster topics in textbooks and peer-reviewed journals. Irving Jacoby, MD, FACP,FACEP,FAAEM is Emeritus Professor of Emergency Medicine at the UCSD School of Medicine. He is Kristi L. Koenig, MD, FACEP, FIFEM, Professor of Emergency an attending physician in the ED, and served as Hospital Director Medicine and Public Health and Director of Public Health Pre- for Emergency Preparedness and Response. As Commander of paredness at the University of California, Irvine, is an interna- the San Diego Disaster Medical Assistance Team (DMAT CA-4), tionally recognized expert in the fields of homeland security, he has responded to more than 18 federally-declared disasters disaster and emergency medicine, emergency management, and in the U.S. and its territories. He is Disaster Section Editor for emergency medical services. During the U.S. terrorist attacks of the Journal of Emergency Medicine, co-developer of a healthcare 9/11, she served as National Director of the Emergency Man- facilities evacuation course, and has authored numerous articles agement Office for the Federal Department of Veterans Affairs. and book chapters in disaster medicine. Professor Koenig is a Fulbright Scholar and fellow of the Inter- national Federation for Emergency Medicine. She holds multi- Christopher A. Kahn, MD, MPH is Associate Professor of Emer- ple appointments including visiting professor at universities in gency Medicine and Division Chief for Emergency Medical Ser- Australia, Italy and Belgium. With a strong health policy and vices and Disaster Medicine at the University of California, San academic background, including more than 100 peer-reviewed Diego (UCSD). He serves as Medical Co-Director for Emer- publications and nearly 500 invited lectures in about 35 coun- gency Preparedness and Response and Base Hospital Medi- tries, she is widely sought for presentations at regional, national, cal Director for the UCSD Health System. He is the “NHTSA and international forums. Notes” section editor for Annals of Emergency Medicine,hav- ing formerly trained as the National Highway Traffic Safety StephenM.Kralovic, MD, MPH is Medical Epidemiologist with Administration Medical Fellow during his EMS/Disaster Medi- the National Infectious Diseases Service for the Department of cal Sciences fellowship at UC Irvine. Dr. Kahn is a member of Veterans Affairs. He is an Associate Professor of Medicine in the DMAT CA-4. Division of Infectious Diseases at the University of Cincinnati College of Medicine. He holds a secondary faculty appointment Megumi Kano, DrPH is Technical Officer for the World Health in the Division of Epidemiology and Biostatistics within the Organization, Center for Health Development in Kobe, Japan. Department of Environmental Health. His major expertise is in Her areas of focus are urban health, health inequity and health infectious diseases epidemiology within large patient popula- metrics. Her previous work includes research in disaster public tions, particularly within healthcare settings. health as Senior Researcher at the Southern California Injury Pre- vention Research Center, University of California, Los Angeles, E.BrookeLerner, PhD is Professor at the Medical College of Wis- Fielding School of Public Health. consin in Milwaukee. She has authored more than 90 emergency medical services and disaster-related peer-reviewed publications. Mark E. Keim, MD, MBA is the founder of DisasterDoc, She is principal investigator on federally funded research projects LLC, a consulting firm specializing in disaster risk reduction examining trauma triage and led the U.S. CDC–sponsored work- as applied to health. He is recently retired from CDC. His group that developed the Model Uniform Core Criteria, the awards include: the U.S. Department of Health and Human Ser- national guideline for mass casualty triage. She also serves on vices Secretary’s Award for Distinguished Service (twice) and the Board of Directors of the National Disaster Life Support the Special Service Award. In 2015, he was nominated for the Foundation. prestigious United Nations Sasakawa Award for Disaster Risk Reduction. Howard W. Levitin, MD, FACEP is a practicing emergency physician at Franciscan St. Francis Health and Clinical Assis- IanT.R.Kennedy, BSc (ClinMed), MB ChB, FFPH is Con- tant Professor of Medicine at the Indiana University School of sultant in Public Health Medicine (Communicable Disease and Medicine. He has served as subject matter expert in the areas Environmental Health) in the Public Health Protection Unit, of victim decontamination, chemical and biological weapons, NHS Greater Glasgow and Clyde since August 2015. His prin- medical surge capacity planning, and emergency management ciple interests are communicable disease epidemiology, “natu- for hospitals, national think tanks, and government agencies. ral” disasters and global health. During his training he worked He has several publications on decontamination and emergency with a variety of organizations including Public Health England’s preparedness and speaks nationally and internationally on these (PHE) Extreme Events and Health Protection team, PHE Cen- topics. tre for Infectious Disease Surveillance and Control, and WHO Patient Safety team. Hoon Chin Steven Lim, MBBS, MRCS, FCDMS is Chief and Senior Consultant at the Accident and Emergency Department, Kelly R. Klein, MD, FACEP is Associate Professor of Emergency Changi General Hospital, Singapore. Dr. Lim is an Adjunct Assis- Medicine at UT Southwestern Medical Center in Dallas, Texas, tant Professor at the Yong Loo Lin School of Medicine, National and a supervising medical officer with the MI-1 Disaster Medical University of Singapore, and is also an advanced hazmat life sup- Assistance Team (DMAT). She received her fellowship training port course instructor. He is the vice president of the Society for in weapons of mass destruction, disaster medicine, and emer- Emergency Medicine in Singapore and Program Director of the gency medical services at Wayne State University/Detroit Receiv- Diploma in Emergency Medicine Course. He is an International ing Hospital in Detroit, Michigan. She has deployed for multiple Fellow at the Center for Disaster Medical Sciences, University of DMAT missions, including the 2009 Presidential Inauguration California, Irvine.

CONTRIBUTORS ■ xi

Jeffrey H. Luk, MD, MS is Medical Director for Emergency U.S. Department of Homeland Security, Washington, DC. From Medical Services, Critical Care Transport, and UH MedEvac at 2002 to 2012 he served as Chemical Casualty Care Consultant to University Hospitals Case Medical Center, the primary teaching the U.S. Army Surgeon General. affiliate for Case Western Reserve University School of Medicine, in Cleveland, Ohio. He is Assistant Professor of Emergency Colleen M. O’Connell, MD FRCPC is Assistant Professor, Dal- Medicine and is board-certified in emergency medicine and EMS. housie University Faculty of Medicine, specializing in brain and He is co-chair of the Emergency Management Subcommittee at spinal cord injury and upper limb amputation rehabilitation. UHCMC. He is an Associate Medical Physician for the Cleveland She is past president of the Canadian Association of Physical Browns and medical director for First Energy Stadium. Medicine and Rehabilitation, and member of the International Spinal Cord Society Disaster Committee. Through research and Richard A. Matthew, PhD is a Professor of Planning, Policy delivery of rehabilitative care and training in low resource and and Design and Political Science; Director of the Blum Cen- disaster environments, she has collaborated with Handicap Inter- ter for Global Engagement (http://blumcenter.uci.edu); Direc- national, Team Canada Healing Hands, and the International tor of the Center for Unconventional Security Affairs (www Committee of the Red Cross Special Fund for the Disabled. .cusa.uci.edu); and Co-Principal Investigator of the FloodRISE Project (http://floodrise.uci.edu), all at the University of Cal- Tina L. Palmieri, MD, FACS, FCCM, is Professor and Director ifornia at Irvine. He is also a member of the United Nations of the Firefighters Burn Institute Burn Center at the University ExpertGrouponEnvironment,ConflictandPeacebuilding,and of California at Davis, Assistant Chief of Burns at Shriners Hos- has served on several UN peacebuilding missions, including two pital for Children, Northern California, and past-president of he led in Sierra Leone. He has over 170 publications, including the American Burn Association. She directs the U.C. Davis Burn 11 books. Data Coordinating Center and has been active in the development and conduct of international burn multicenter outcome Kenneth T. Miller, MD, PhD serves as the Medical Director of trials for more than 10 years. She is board certified in surgery the Orange County Fire Authority, Assistant Medical Director and critical care and treats burned adults and children. of the Orange County Healthcare Agency/Emergency Medical Services, and Director of Operational Medicine for the Center David Petley, PhD is Pro-Vice-Chancellor (Research and Enter- for Disaster Medicine Sciences at the University of California at prise) at the University of East Anglia in eastern England. A Irvine. He is the Medical Team Manager of Federal Emergency geologist by background, he has worked extensively on the mech- Management Agency (FEMA) Urban Search and Rescue Task anisms of landslides and the human costs that they inflict on soci- Force 5 and Medical Officer of the FEMA Urban Search and ety. His field areas have focused on high mountain areas, often in Rescue Incident Support Team. poor countries, including Nepal, Bhutan, China, Pakistan, Tai- wan and New Zealand. He has worked extensively on landslides Michael S. Molloy, MB, BAO, BCh, EMDM, MCEM, MFSEM, triggered by intense rainfall (for example from monsoons and MFSEM (U.K.) Grad Dip Medicine (NUI), Dip Sports Med typhoons) and by earthquakes. (RCSI) is an emergency medicine specialist registrar in Ireland with expertise in disaster medicine and mass gathering medi- Betty Pfefferbaum, MD, JD is George Lynn Cross Research Pro- cal care. He completed a fellowship in disaster medicine at Beth fessor in the Department of Psychiatry at the University of Okla- Israel and Harvard and was awarded a master degree in disaster homa College of Medicine in Oklahoma City, Oklahoma. She medicine in Europe with research focusing on alert systems for is the Co-Director of the Terrorism and Disaster Center of the major incidents. He served as past President of the Irish Medical National Child Traumatic Stress Network. Her expertise is in Organization and has been part of the Mass Gathering Medical child trauma and disaster mental health. She is a general and Care team for 10 years, acting as Chief Medical Officer in recent child psychiatrist and holds a law degree. years. Rose L. Pfefferbaum, PhD, MPH is a project director with the VirginiaMurray, FFPH, FRCP,FFOM, FRCPath is Public Health Terrorism and Disaster Center (TDC) of the National Child Consultant in Global Disaster Risk Reduction for Public Health Traumatic Stress Network. She is responsible for TDC com- England since April 2014. This appointment is builds on her munity resilience activities. A recently retired Professor of Eco- work as vice-chair of the UN International Strategy for Disaster nomics and Director of Terrorism and Disaster Preparedness at Reduction (ISDR) Scientific and Technical Advisory Group for Phoenix Community College in Phoenix, Arizona, she has had the Post-2015 Framework for Disaster Risk Reduction. Prior to extensive experience in community-based programs including this she was appointed as Head of Extreme Events and Health work with community disaster response groups. Her PhD is in Protection, Public Health England where she led the develop- economics. ment of evidence-based information and advice on flooding, heat, cold, volcanic ash, and other extreme weather and natural Brenda Phillips, PhD is Associate Dean and Professor of Sociol- hazards events. ogy at Ohio University in Chillicothe. She is an author of multiple books, including Disaster Recovery, Introduction to Emergency Jonathan Newmark,MD,FAAN,COL(ret.),MedicalCorps, Management, Qualitative Disaster Research and Mennonite Dis- USArmyisAdjunctProfessorofNeurologyattheUniformed aster Service: Building a Therapeutic Community after the Gulf Services University of the Health Sciences, Bethesda, Maryland, Coast Storms. She has co-edited Social Vulnerability to Disas- attending neurologist at the University of Cincinnati Medical ters and Women and Disasters. Dr. Phillips earned the Blanchard Center, Cincinnati, Ohio, and Special Government Employee in Award for excellence in emergency management education and the Chemical Preparedness Program, Office of Health Affairs, the Myers Award for work on the effects of disasters on women.

xii ■ CONTRIBUTORS

Jean Luc Poncelet, MD, a national of Belgium, physician, Master University of California at Irvine. Dr. Schlesinger lectures on EMS in Public Health and Specialist in Tropical Medicine, is the Pan topics for both prehospital and hospital providers. Her current American Health Organization (PAHO)/ World Health Orga- research focuses on Community Paramedicine. Other research nization (WHO) representative in Haiti. Until April 2013, he interests include hospital preparedness in disaster response, qual- directed the Emergency Response and Disaster Risk Reduction ity improvement in EMS, and public health integration in emer- Program in the PAHO/WHO regional office for Latin America gency medicine. Dr. Schlesinger is a member of the American and the Caribbean. He has actively participated in almost all College of Emergency Physicians EMS Committee and the Cal- major emergencies that have affected the Western Hemisphere ifornia EMS for Children Technical Advisory Committee, and since 1986 by either leading health field response, or in PAHO’s serves as the EMS Section Editor for the Western Journal of regional capacity to coordinate international health assistance in Emergency Medicine. support to member states. He has many technical publications in emergency and disaster medicine. Merritt D. Schreiber, PhD is Associate Professor of Emergency Medicine at University of California Irvine School of Medicine Richard Reed, MSW is Senior Vice President, Disaster Cycle Ser- in the Center for Disaster Medical Sciences. He is involved in vices, American Red Cross. He leads the development and exe- the development of best practice models bridging public health cution of programs which help Americans prepare for, respond and mental health for mass casualty events. He developed the to, and recover from disasters. His 20 years of federal govern- PsySTART Rapid Mental Health Triage and Incident Manage- ment service includes positions in the Department of Veterans ment System for victims and responders; a psychological first Affairs, Federal Emergency Management Agency, and the Gen- aid program called Listen, Protect and Connect; and a responder eral Services Administration. He served at the White House as resilience system known as Anticipate-Plan-Deter. He received Special Assistant to the President (2006–2012), Deputy Assistant a special commendation from the U.S. surgeon general for his to the President (2012–2013), and Deputy Ebola Coordinator response to Hurricane Katrina and a Joint Service Meritorious (2014–2015). Service Medal from U.S. Northern Command/Department of Defense. He was a responder to the Sandy Hook School Tragedy Dori B. Reissman, MD, MPH (Captain, U.S. Public Health and the Boston Marathon Bombing. Service) leads the World Trade Center Health Program at the National Institute for Occupational Safety and Health, within CarlH.Schultz, MD, FACEP is Professor of Emergency Medicine the U.S. CDC. She has deployed to many disasters, serving in and Director of Research at the Center for Disaster Medical Sci- both emergency operations and field positions. Dr. Reissman is ences, University of California Irvine School of Medicine. He an expert in disaster mental and behavioral health. She integrates is an internationally recognized expert and researcher in the resilience into command and programmatic structures dealing fields of disaster and emergency medicine. He has over 100 peer- with worker health and safety and consults with a variety of reviewed publications and his investigations have resulted in two organizations. first-author publications in the New England Journal of Medicine. He chaired the Disaster Preparedness and Response Committee Barbara J. Reynolds, PhD has been a Crisis Communication of the American College of Emergency Physicians and has served Specialist at the U.S. CDC since 1991. She currently serves as an as a consultant for the U.S. Department of Defense, The Joint Adjunct Assistant Professor at Tulane University. Dr. Reynolds’s Commission, and the State of Israel. Dr. Schultz holds faculty communication expertise has been used in the planning or appointments at universities in Belgium and Italy. response to pandemic influenza, vaccine safety, emerging infectious disease outbreaks, and bioterrorism. Internationally, she Gilead Shenhar, MBA is Senior Consultant on Homeland Secu- has acted as a crisis communication consultant on health issues rity and an expert in risk communication. He is an instruc- for France, Hong Kong, Australia, Canada, former Soviet Union tor and the academic coordinator at Tel Aviv University’s Mas- nations, the North Atlantic Treaty Organization, and the World ter Program for Emergency and Disaster Management. He is Health Organization. also an investigator at the Israel Center for Trauma Research. During large-scale emergencies, he is a national spokesper- Gary A. Roselle, MD, FACP is Director of the National Infec- son for the public. He is also a UN expert in UNDAC. He tious Diseases Service, Department of Veterans Affairs (VA) was previously Head of Doctrine and Development for the Central Office in Washington, DC. The scope of this national Israeli Defense Forces, Home Front Command and assisted with program includes infectious diseases, infection prevention and planning and executing risk communication for the civilian control, national bioterrorism surveillance, and VA’s Emerging population. Pathogens Initiative. Recent emphasis has been placed on control of multidrug resistant organisms and implementation of Frank Fuh-Yuan Shih, MD, PhD is Assistant Professor of Emer- antimicrobial stewardship. Dr. Roselle is a member of the Forum gency Medicine at National Taiwan University in Taipei. He is on Microbial Threats of the National Academy of Sciences, Insti- also the Chief Operating Officer for the Taipei Region Emer- tutes of Medicine. He is also a physician on staff at the Cincinnati gency Operations Center in the Taiwan Department of Health. VAMedicalCenterandProfessorofMedicine,Departmentof He received disaster medical preparedness fellowship training at Internal Medicine, Division of Infectious Diseases, University of George Washington University. He was involved in the emergency Cincinnati College of Medicine. response to the 1999 Taiwan Earthquake, the severe acute respi- ratory syndrome epidemic in 2003, and many other incidents. He Shira A. Schlesinger, MD, MPH is a practicing emergency physi- was one of the founders of the Disaster Medical Assistance Team, cian in Los Angeles and Orange Counties, California. She com- Urban Search and Rescue, and hazmat and biohazard response pleted her Fellowship in EMS and Disaster Medical Sciences at the systems in Taiwan.

CONTRIBUTORS ■ xiii

Judith M. Siegel,PhD,MSHygisProfessorofPublicHealth Group, National Disaster Medical System, and former team com- in the Department of Community Health Sciences, University mander for the Oklahoma-1 Disaster Medical Assistance Team. of California at Los Angeles, Fielding School of Public Health. He has been involved with disaster medical responses for 22 years She investigates the impact of disaster exposure on psychological and has extensive experience treating tornado victims. distress. She has expertise in individual and community charac- teristics that may increase vulnerability to disaster-related dis- David Weinstock, MD is Associate Professor of Medicine at tress, as well as the factors that may mediate this relationship. the Dana-Farber Cancer Institute and Harvard Medical School, Associate Member of the Broad Institute and Affiliated Scientist Paul S. Sledzik, MS is director of the Transportation Disaster of the Harvard Stem Cell Institute. He currently serves as the Assistance Division of the U.S. National Transportation Safety Medical Advisor for the Radiation Injury Treatment Network and Board. Trained as a forensic anthropologist, he specializes in a member of the National Preparedness and Response Science forensic issues related to mass fatality events. He has responded Board in the Office of the Assistant Secretary for Preparedness to numerous disasters of all types. He is a Fellow of the American and Response, Department of Health and Human Services. He is Academy of Forensic Sciences and has consulted for the Joint a frequent author and lecturer on hematologic radiation toxicity Prisoner of War/Missing in Action Accounting Command and management. the National Center for Missing and Exploited Children. James C. West, MD is Assistant Professor of Psychiatry at the Laura M. Stough, PhD is Associate Professor of Educational Uniformed Services University of the Health Sciences and Sci- Psychology, Fellow at the Hazard Reduction and Recovery Cen- entist at the Center for the Study of Traumatic Stress. He is a ter, and Faculty at the Center for Disability and Development graduate of University of Michigan Medical School. As a military at Texas A&M University. She coedited the book Disaster and psychiatrist he deployed to both Iraq and Afghanistan in sup- Disability: Exchanges and Explorations and has authored over 40 port of Marine Expeditionary Forces and led behavioral health publications that explore inequities in emergency management, services at Walter Reed National Military Medical Center. He social, and educational services provided to individuals with dis- coauthored Psychological Responses to Disaster in Tasman’s Psy- abilities. She serves on the Office of Emergency Management chiatry,4th edition. Disability Task Force for the State of Texas. John M. Wightman, EMT-T/P, MA, MD, FACEP, FACFE is Samuel J. Stratton, MD, MPH, FACEP is Professor at the Univer- Director of the Human Research Protections Program and Bio- sity of California at Los Angeles, School of Public Health and a surety at the 711th HumanPerformanceWing,AirForceResearch Deputy Health Officer for the Orange County California Health Laboratory, Wright-Patterson Air Force Base, Ohio. He is also Care Agency. He is also the Medical Director for the Orange Professor and Assistant Director for Academics, Division of Tac- County, California Health Care Agency Health Disaster Manage- tical Emergency Medicine, Department of Emergency Medicine, ment/Emergency Medical Services Division. Dr. Stratton serves Boonshoft School of Medicine, Wright State University, Day- as the Editor-in Chief for the journal, Prehospital and Disaster ton, Ohio. He published the definitive review on blast injuries Medicine andisaseniorreviewerfortheAnnals of Emergency and has been a highly sought consultant, author, and speaker Medicine. on integration of mechanistic and clinical knowledge into disaster, emergency, military, and tactical planning and response for Hock Heng Tan, MBBS, FAMS, FRCSEd (A&E), DABT is explosive incidents. an emergency physician and clinical toxicologist with Changi General Hospital Emergency Department, Singapore. He was Michele Wood, MPH, PhD is Associate Professor in the Califor- involved with the Ministry of Health Disaster Site Medical Com- nia State University, Fullerton Department of Health Science. She mand until 2011. He directs the Clinical Toxicology Consultation teaches graduate and undergraduate courses in research meth- Service, Joint Environmental Occupational Toxicology Clinic ods, statistics, and program design and evaluation. She holds a and is Secretary for the Toxicology Society of Singapore. He is the master degree in Community Psychology and a doctoral degree chief editor of the local Hazmat Basic Provider Manual and lec- in Public Health from the Department of Community Health tures at hazmat medical life support courses locally and overseas. Sciences in the School of Public Health at the University of CaliforniaatLosAngeles.Herresearchfocusisonriskcom- ArielTessone,MDisaphysicianintheDepartmentofPlasticand munication for disasters, including preparedness and alerts and Reconstructive Surgery. He is a member of the Israeli Burn Center warnings. team and the microsurgical reconstruction team located at the Sheba Medical Center and affiliated with the University of Tel Andreas Ziegler, MD, MSc EMDM, MBA serves within Vienna Aviv, Israel. Dr. Tessoneis also a specialist in breast reconstruction Emergency Medical Services as Teaching Physician of the EMS and oncoplastic surgery, and is an awardee of the Talpiyot Medical Academy and CBRN Advisor. He is responsible for NBC-Defence Leadership Program. and involved in education and training. He is a member of numerous working groups and committees regarding radiation Arthur G. Wallace,Jr.,DO,MPH,FACEPisanemergency protection and CBRN management. He was also author of the physician at Magnum Health St. Johns Healthcare System and Austrian Federal Medical Emergency Plan for Diagnosis and Treat- MedNow urgent care in Tulsa, Oklahoma. He serves as Clini- ment after Radiation Accidents. He graduated from Vienna Medi- cal Instructor at Oklahoma State University-College of Health calSchoolandacquireddegreesfromtheUniversitiesofLeicester, Sciences. He is a former member of the Senior Medical Working Novara and Krems.

Foreword

Marvin L. Birnbaum, MD, PhD Emeritus Professor of Medicine and Physiology, University of Wisconsin Past-President, World Association for Disaster and Emergency Medicine (WADEM) Editor-in-Chief Emeritus of Prehospital and Disaster Medicine Co-Editor, Health Disaster Management: Guidelines for Evaluation and Research

Medical care and public health textbooks are published to docu- of the information provided is limited to achievement indices ment what we know about a particular subject and what to expect (how many of something was accomplished). Such information when an event occurs, and to define current evidence-based best does not provide evidence as to what worked and what did not. practices. Textbooks are based on the latest evidence as distilled Unstructured information is difficult to compare. Without an by the authors and synthesized with their experience and knowl- ability to conduct randomized, controlled trials, comparisons edge. This is particularly relevant given the current state of the with other studies have remained elusive, are replete with opin- science in the relatively new discipline of disaster medicine. The ions, and often do not contribute to the establishment of both textbook, Disaster Medicine: Comprehensive Principles and Prac- external and internal validity (cause-effect). Therefore, currently, tices, Second Edition, edited by Koenig and Schultz, successfully there is little evidence available to define best practices to be used identifies this body of knowledge and presents it in an objective in a given setting. and accurate manner. These factors complicate the development of a textbook on Assembling textbooks addressing evolving disciplines can disaster medicine. The assembly of accurate and valid informa- be difficult. While there are an abundance of epidemiologi- tion is a very difficult task. Building on the worldwide success cal descriptions of the health aspects of disasters in the peer- of the first edition (including translations into Arabic and Man- reviewed disaster literature, for the most part, such reports have darin Chinese), Koenig and Schultz have assembled a cadre of no standardized format. Without structure, it is difficult, at best, seventy-six noted authorities who have been at the forefront of to compare findings with those of studies conducted in other disaster medicine and public health responses and risk-reduction similar or dissimilar settings. Failure to identify similarities and for decades. For this second edition, additional chapters have differences between descriptions makes it difficult to establish been added: Climate Change; Community Resilience; Rehabili- what to expect epidemiologically or evidence as to the impacts of tation of Disaster Casualties; and Landslides. The text expands interventions; these difficulties threaten the external validity of its international authors and global perspectives to include con- the findings. External validity for such evidence is based on the tent discussions from academic, military, civilian, and intergov- same or similar findings obtained in other studies and is essential ernmental perspectives. This integrated approach coupled with for the design of interventions aimed at reducing the risks for scientific rigor delivers both a conceptual framework for strate- future disasters. gic decision making as well as practical information for use in Additional challenges faced in the development of disaster disaster management. medicine textbooks involve capturing all the available evidence. The task for the assembled global team of national and inter- This can be inspiring particularly when studying disaster-related national experts was to sift and winnow through the available interventions. These investigations are conducted to identify the information and synthesize their findings with their own knowl- changes in levels of function that resulted from the implementa- edge and experience. Each chapter provides a systematic review tion of an intervention. The findings are used to determine best of the existing peer-reviewed and grey literature related to the practices for management of the needs during an emergency or assigned topic, much as is done by the systematic reviews con- disaster or for reduction of the disaster risks in a given setting. ducted by Evidence Aid and the Cochrane Collaboration. This To date, interventional studies of the health aspects of disasters very difficult and lengthy process synthesizes the best informa- (relief, recovery, and risk-reduction) rarely have been published tion currently available. The resultant second edition of Koenig in the peer-reviewed literature. The information that does exist and Schultz’s Disaster Medicine: Comprehensive Principles and has been published primarily in the grey literature, and is not only Practices captures the essence of disaster medicine as we know unstructured, but lacks information of what changes resulted it today. As a definitive reference, it reflects the state of the from the intervention (such as outcomes and impacts). Much science, codifies current practices in all aspects of the field of

xvi ■ FOREWORD

disaster medicine, and lays the foundation for the development the time of publication and should not be construed as ofﬁcial of a research agenda for the study of the health aspects of future College policy. ACEP recognizes the complexity of emergency disasters. medicine and makes no representation that this work serves as an authoritative resource for the prevention, diagnosis, treatment, or intervention for any medical condition, nor should it DISCLAIMER FOR ACEP be the basis for the deﬁnition of or standard of care that should be practiced by all healthcare providers at any particular time The American College of Emergency Physicians (ACEP) makes or place. To the fullest extent permitted by law, and without every effort to ensure that contributors to its educational prod- limitation, ACEP expressly disclaims all liability for errors or ucts are knowledgeable subject matter experts. Readers are nev- omissions contained within this work, and for damages of any ertheless advised that the statements and opinions expressed in kind or nature, arising out of use, reference to, reliance on, or this work are provided as the contributors’ recommendations at performance of such information.

Perspective

Carl H. Schultz

The specialty of disaster medicine has witnessed significant Unfortunately, this has been true until fairly recently. The term progress in the last 20 years. New organizations and publica- “lessons learned” has become part of the disaster medicine lex- tions have arisen as governments and societies have become icon and disaster responders still refer to acquired knowledge more determined to address the impact of disasters. However, using this phrase. a brief review of just one of history’s previous catastrophes illus- In truth, knowledge is not a lesson, learned or otherwise. trates how much significant work remains ahead. Although the It is an established fact that is identified and recorded for all event in question occurred in the United States, its root cause to acquire. It represents scientific advancement and information and consequences apply to all countries. that should be incorporated into a growing body of knowledge. This event is a disaster that many anticipated but were unable One does not find physicists or biologists referring to newly to prevent. Multiple clues and warnings existed but were ignored. identified discoveries as “lessons learned.” The perpetuation of Had even one entity or person of influence attended to these the term “lessons learned” has its origins in the creation and alarms and responded, the tragedy would have been averted. In development of our specialty. When disaster medicine was in its the end, over 2,200 people died preventable deaths. In any real infancy, no formal educational curriculum or scientific journal sense, this event represents the quintessential challenges faced by dedicated to the field existed. As individuals accepted appoint- the disaster community. ments to disaster-related positions, they discovered a dearth of Most reading this text will probably assume the event was the legitimate training opportunities. Given these limitations, they attack on the World Trade Center in New York on September 11, had no choice but to acquire knowledge by personal experience. 2001. However, this disaster occurred 125 years ago in the city of Hence the term “lessons learned” crept into the disaster medicine Johnstown, in the state of Pennsylvania. An earthen dam, poorly taxonomy. managed and maintained by disinterested parties, collapsed in The problem with lessons, however, is that they are personal a rainstorm, flooding the town downriver. The text entitled The and cannot be generalized or systematically disseminated. A good Johnstown Flood by David McCullough chronicles the missteps example is the small child who learns not to touch a hot stove by and arrogance leading up to the disaster. This work should be experiencing a burn. The child has learned the lesson, but as an mandatory reading for anyone who commits to the study of and adult, will find it difficult to pass on that knowledge to his or her response to disasters. own child. Each child must learn the lesson as a personal unique The errors committed by those responsible in the John- event. stown tragedy have been repeated multiple times in the ensuing In a field where knowledge is acquired by personal experi- years during different disasters throughout the world, resulting ence, an individual may gain wisdom and understanding but will in similar outcomes. A reluctance persists to invest significant have difficulty distributing such information to others. When resources that bolster community resilience. Governments con- the knowledgeable person leaves the job, retires, or dies, the tinue to assign low priority to rigorous disaster preparedness and knowledge goes with that individual and others must begin mitigation. In the United States, the National Disaster Medical all over again. As such, the system perpetuates itself with the System, which is responsible for coordinating the acute medical new employee needing to “learn the lesson” anew. The bot- response after a disaster from the national level, remains largely tom line is that no progress is made and the field of disaster a volunteer organization without permanent funding from the medicine remains a cottage industry, devoid of new develop- federal government. The commitment is lacking to provide this ments and science. At best, the term “lessons learned” pro- entity with appropriate resources so it can properly protect the vides tacit support for this suboptimal method of knowledge public’s safety. acquisition. At worst, it is disrespectful of those who pursue Such observations support the contention that we contin- disaster medicine as a career and the field as a whole. The uously learn the same lessons without making real progress. phrase incorrectly implies the specialty lacks a systematic body of

xvii

xviii ■ PERSPECTIVE

literature that can be used to advance the field and better prepare ment. The specialty is finally beginning the evolution to a for catastrophes. science. Fortunately, this is beginning to change. There is an early Publishing the second edition of Koenig and Schultz’s Dis- but clear movement away from learning the field of disaster aster Medicine: Comprehensive Principles and Practice marks a medicine through personal experience and an evolving empha- milestone of sorts. It attests to the establishment of an authorita- sis on developing knowledge through formalized education and tive text with international input and support. While insufficient training. Although every disaster has unique and unanticipated by itself, this definitive reference is a necessary achievement in a features, underlying patterns exist. Employing a formal edu- long process that will ultimately result in creation of a scientific cation and training approach can impart this growing body specialty and cadre of true experts. This will significantly improve of information in the classroom by systematizing knowledge the care of populations impacted by disasters. Besides the empha- gained through objective investigation and observation. Many sis on science, the text also focuses on the functional impact of universities in the United States and Europe now offer master’s disasters and strategies for effective management regardless of degrees in disaster-related studies and several sponsor doctor- etiology. Less emphasis is placed on such issues as who is “in ate degree programs. Some medical schools offer fellowships charge” of the response or whether the event is “natural or man- in disaster medicine, emphasizing both clinical and research made.” Such classifications do little to improve understanding skills. Professional organizations are creating clinical compe- or outcome. If successful, our journey toward science will render tencies for those who would respond to disasters. There is an the term “lessons learned” obsolete. Someday, one will only find international movement to professionalize response teams and the term listed in Wikipedia under the disaster medicine heading train them to essential skill levels prior to permitting deploy- as, “an archaic term of historical interest only.”

Preface

Welcome to the second edition of Koenig and Schultz’s Disaster Chinese ongoing, disaster medical sciences is moving forward. Medicine: Comprehensive Principles and Practices.Wearepleased We include a new “Perspective” in the front matter to provide a to offer the next evolution of the book with timely updates by solidframeworkasyoudigestthisnewknowledge. world-renowned contributors. This definitive reference on dis- Please enjoy this new edition. Use the knowledge for teach- aster medical sciences also contains new chapters that reflect the ing and practical applications to improve all-hazard emergency progression of the science of disaster medicine. management and provide the best possible outcomes for popu- With more than 1,000 copies of the first edition sold, translations affected by disasters. lation into Arabic completed, and translation into Mandarin

xix