Prehospital and Disaster Medicine

Table of Contents
VOLUME 18, NUMBER 4
October – December 2003

Editor’s Corner
Times Have Changed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .276
Marvin L. Birnbaum, MD, PhD

Special Reports
PAHO-Guidelines for the Use of Foreign Field Hospitals in the Aftermath
of Sudden -Impact Disaster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..278
Department of Emergency and Humanitarian Action, the World Health Organization; Area on
Emergency Preparedness and Disaster Relief, the Pan-American Health Organization

Abstract
Natural and complex disasters can cause a dramatic increase in the demand for emergency medical care. Local health services can be overwhelmed, and damage to clinics and hospitals can render them useless. Many countries maintain mobile field hospitals for defense or humanitarian purposes. Dispatching these facilities to disaster-affected countries would seem an ideal response to emergency medical needs. Unfortunately, experience has shown that in the case of natural disasters, field hospitals often have not met the expectations of recipients and donor institutions. In July 2003, the World Health Organization and Pan American Health Organization sponsored a workshop in El Salvador to discuss the pros and cons of using foreign field hospitals in the aftermath of natural disasters. These guidelines are the result of that workshop. The workshop participants identified different phases when foreign field hospitals and specialized medical personnel are most useful. They can provide advanced trauma care and life support if at the disaster site within 48 hours of the impact of an event; they would provide follow-up care for trauma victims and resumption of routine medical care in the two weeks following the event; during rehabilitation and reconstruction phases (from two months to two or more years), a field hospital might serve as a temporary replacement for damaged health facilities. These guidelines propose conditions that field hospitals and their staff should meet for each of these phases. The guidelines also outline issues that authorities in donor countries and disaster-affected countries should
discuss before mobilizing a field hospital.

Planning for Resilience in Hospital Internal Disaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291
Ernest Sternberg

Israeli Defense Forces Medical Corps Humanitarian Mission for Kosovo's Refugees. . . . . . . . . . . . . . . . . .301
Howard Amital, MD, MHA; Michael L. Alkan, MD; Jakov Adler, MD; Iyzhak Kriess, MD; Yehezkel Levi, MD

Terrorism Section
The Threat of Mid-Spectrum Chemical Warfare Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .306
Pal Aas, PhD

Standardized Emergency Management System and Response to a Smallpox Emergency. . . . . . . . . . . . . . . .313
Robert J. Kim-Farley, MD, MPH; John T. Celentano, MD; Carol Gunter, RN;
Jessica W. Jones, MD, MPH; Rogelio A. Stone, MPA, MA; Raymond D. Aller, MD;
Laurene Mascola, MD, MPH; Sharon F. Grigsby, MBA; Jonathan E. Fielding, MD, MPH

Vaccine Administration by Paramedics: A Model for Bioterrorism and Disaster Response
Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .321
Bruce J. Walz, PhD, NREMT-P; Richard A. Bissell, PhD; Brian Maguire, Dr. P.H.;
James A. Judge II, BPA, CEM, EMT-P

Homeland Security and Public Health: Role of the Department of Veterans Affairs, the US
Department of Homeland Security, and Implications for the Public Health Community. . . . . . . . . . . . . . . . . . .327
Kristi L. Koenig, MD, FACEP

Original Research
Variables Influencing Medical Usage Rates, Injury Patterns, and Levels of Care for Mass
Gatherings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .334
Andrew M. Milsten, MD, MS, FACEP; Kevin G. Seaman, MD, FACEP; Peter Liu, MD;
Rick A. Bissell, PhD; Brain J. Maguire, MSA, PhD, EMT-P

Use and Analysis of Field Triage Criteria for Mass Gatherings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .347
Steven D. Salhanick, MD; William Sheahan, BS, AEMT-P; Jeffery J. Bazarian, MD, MPH

Measurement of Pain in the Prehospital Setting Using a Visual Analogue Scale. . . . . . . . . . . . . . . . . . . . . . . . .353
Bill A. Lord, Med; Brian Parsell, GDipHSM

Nurses in Disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .359
Satoko Mitani, RN, MSc; Kazutoshi Kuboyama, MD, PhD; Taro Shirakawa, MD, PhD

Randomized, Controlled Trial of Three Levels of Critical Incident Stress Intervention. . . . . . . . . . . . . . . . . . .367
Andrew Macnab, MD; Charles Sun, MD; John Lowe

Policies in Disaster Preparedness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .372
Rannveig Bremer