moved in previous wars (Miles, 2005). From the field surgery teams, patients are brought by helicopter to a larger combat support hospital in Iraq. Air medical evacuations are now lighter and more adaptable; patient support pallets can be moved from one aircraft to another, and medical teams carry much of their equipment in backpacks. If a soldier is critically wounded, a critical care air transport (CCAT) team joins the air medical evacuation to help transport the patient to a combat hospital in Iraq with additional equipment.

Lessons Learned

Experience gained from recent domestic and international incidents such as those described above demonstrates that many commonly held assumptions about disasters do not correspond to the research evidence (Auf der Heide, 2006). Typically, events unfolding in the aftermath of a disaster are likely to be much more chaotic than what is optimal from an emergency management standpoint. In disaster events, emergency response units from neighboring communities and states often self-dispatch, which can overwhelm the ability of local managers to process them; casualties at the scene of the disaster are likely to self-triage and self-transport; and nearby hospitals are likely to be overwhelmed with patients arriving at their doors (see Table 6-2). Although emergency responders play an essential role in caring for victims at the scene of a disaster, previous experience shows that the overall response is likely to be more disorganized than planners would hope.

IMPROVING EMS-RELATED DISASTER PREPAREDNESS IN THE UNITED STATES

The array of threats facing the United States is substantial. Existing dangers, such as natural calamities and the potential for disease outbreaks, are now compounded by the threat of terrorism. Many disaster scenarios involve the disruption or destruction of local emergency care assets and institutions and the need for immediate help from outside the affected area. Other scenarios involve broader threats that potentially could challenge emergency systems throughout the country.

Since September 11, considerable resources have been devoted to preparing for large-scale disasters. Homeland security spending, which is estimated to have been below $10 billion in the mid-1990s, rose to nearly $50 billion subsequent to September 11 and the establishment of DHS in 2002 (see Figure 6-1). These homeland security funds were directed to a number of different areas, including border security, aviation security, and bioterrorism. However, very little funding has been directed to strengthen-



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