Hospital responses to acute-onset disasters: a review.
BACKGROUND
Hospitals the world over have been involved in disasters, both internal and external. These two types of disasters are independent, but not mutually exclusive. Internal disasters are isolated to the hospital and occur more frequently than do external disasters. External disasters affect the community as well as the hospital. This paper first focuses on common problems encountered during acute-onset disasters, with regards to hospital operations and caring for victims. Specific injury patterns commonly seen during natural disasters are reviewed. Second, lessons learned from these common problems and their application to hospital disaster plans are reviewed.


METHODS
An extensive review of the available literature was conducted using the computerized databases Medline and Healthstar from 1977 through March 1999. Articles were selected if they contained information pertaining to a hospital response to a disaster situation or data on specific disaster injury patterns. Selected articles were read, abstracted, analyzed, and compiled.


RESULTS
Hospitals continually have difficulties and failures in several major areas of operation during a disaster. Common problem areas identified include communication and power failures, water shortage and contamination, physical damage, hazardous material exposure, unorganized evacuations, and resource allocation shortages.


CONCLUSIONS
Lessons learned from past disaster-related operational failures are compiled and reviewed. The importance and types of disaster planning are reviewed.
Milsten
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Department of Surgery, University of Maryland, Baltimore 21201, USA.
D004189:Disaster Planning / Q000458:organization & administration*; D004190:Disasters; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006297:Health Services Accessibility; D006739:Hospital Administration; D006761:Hospitals; D006801:Humans; D008297:Male; D020380:Needs Assessment; D012066:Relief Work / Q000458:organization & administration*; D018570:Risk Assessment; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology