title: Mass casualty disasters: who should run the show?
abstract: BACKGROUND
  A clear command structure ensures quality patient care despite overwhelmed resources during a mass casualty incident (MCI). The American College of Surgeons has stated that surgeons should strive to occupy these leadership roles.
  
  
  OBJECTIVE
  We sought to identify whether surgeons, as compared to emergency physicians, are sufficiently prepared to assume command in the event of a mass disaster.
  
  
  METHODS
  We surveyed hospital-affiliated surgeons and emergency physicians to assess their knowledge of MCI response principles and to gauge opinions regarding who should be in charge during a disaster.
  
  
  RESULTS
  One hundred and forty-nine (58%) surveys were completed, 78 by surgeons and 71 by emergency physicians. Both groups demonstrated a critical lack of knowledge regarding fundamental principles and key logistical components of preparedness and MCI response. Surgeons as a group were even less prepared than emergency physicians. Of those surgeons who had reviewed their hospital's disaster plan, half (50%) still did not know where to report for an MCI activation. Nonetheless, both groups believed they had sufficient training and both asserted they ought to occupy command positions during a disaster scenario.
  
  
  CONCLUSIONS
  Errors in disaster triage have been known to increase mortality as well as the monetary cost of disaster response. Funding exists to improve hospital preparedness, but surgeons are lagging behind emergency physicians in taking advantage of these opportunities. Overall, it is imperative that physicians improve their understanding of the MCI response protocols they will be tasked to implement should disaster strike.
authors.affiliation: Division of Trauma/Critical Care, University of California, Davis Medical Center, Sacramento, California.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Russo
authors.affiliation: Division of Trauma/Critical Care, University of California, Davis Medical Center, Sacramento, California.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Galante
authors.affiliation: Division of Trauma/Critical Care, University of California, Davis Medical Center, Sacramento, California.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Jacoby
authors.affiliation: Division of Trauma/Critical Care, University of California, Davis Medical Center, Sacramento, California.
authors.forename: David V
authors.initials: DV
authors.lastname: Shatz
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004189:Disaster Planning / Q000458:organization & administration; D004632:Emergency Medical Services / Q000458:organization & administration*; D004635:Emergency Medicine / Q000193:education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007857:Leadership; D054527:Mass Casualty Incidents; D008875:Middle Aged; D010819:Physician's Role; D013043:Specialties, Surgical / Q000193:education; D011795:Surveys and Questionnaires
keywords: disaster; disaster management; incident command; mass casualty incident; triage