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CARE OF CASUALTIES UNDER CONDITIONS O F NATU RAL D ISASTER It is apparent that the problems of care of disaster victims differ from those of the care of individually injured persons in that they are concerned with unexpected expansion of first aid, rescue, communication, sorting, distribution, and medical care. No plan for emergency care in disaster is likely to succeed unless it provides for an orderly utilization of currently functioning facilities. For this reason, emphasis should be placed on employment of all elements of disaster services on a day-to-day basis so that they will be functioning smoothly when the load of casualties suddenly increases. Because disasters occur repeatedly in this country and because progress has been slow in solving problems of caring for mass civilian casualties, medical problems encountered in disaster should be under continued study and analysis by multi-disciplinary groups. The need for integration of public resources in coping Fitly material damage in disaster is apparent, but the community role in handling human casualties is less well prescribed. The Disaster Research Group of the Division of Anthropology of the National Academy of Sciences-National Research Council, in its extensive studies from 1951 to 1963 for the Office of Civil Defense, and the Ohio State University Disaster Research Center, estab- lished in 1963, have both concentrated on responses of local, state, and federal agencies to the stresses imposed by unexpected disaster with emphasis on behavioral and sociological problems. Efforts of the American College of Surgeons to encourage members to report on casualty care in disasters have added little. substantive information on which to improve results. The Committee on Dis- aster Medical Care of the American Medical Association has at- tempted to identify potentials for improved care, but no national action program has been implemented. An ad hoc Committee on Disaster Medical Care of tile National Academy of Sciences- National Research Council finds no evidence of effort by these groups, or by independent workers or federal organizations, to- ward pooling of resources to assemble substantial data or to analyze medical management in a sufficient number of disasters 28

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of different types. In no single large disaster do we have precise information on the causes of death, the numbers and types of injuries of survivors, or the rewards of efficiency and the penalties of inefficiency in rescue, first aid, transportation, and medical care. A pattern exists in the organization and functions of the Office of Emergency Planning of the Executive Once of the President for gaining this type of information and for implementing improvements in management and care that would result from its analysis. Trained disaster specialists based at eight federal centers throughout the nation move out at first warning to areas imperiled by disaster. Oat the basis of their assessments, the President can declare a major disaster; under the direction of the Office of Emergency Planning 24 agencies would then be automatically au- thorized to provide assistance. These are concerned mainly with supplies, equipment, and personnel to clear debris; provide food, medicine, and shelter; restore utilities; enforce law and order; and render financial assistance and welfare services. Many communities are unaware of the way to secure outside assistance in rescue, first aid, and medical help available through the American Na- tional Red Cross, the U. S. Public Health Service, civil defense agencies, and field units of the Armed Forces. Better utilization of these resources could be ensured if in each community or area a recognized committee or council on emergency medical services would assume the role of coordination of the efforts of these agencies. Physicians thoroughly familiar with the missions of the 24 federal agencies and versed in local medical problems in disaster should be included on the teams of trained disaster specialists of the eight federal centers. RECOMMENDATION Development of a center to document and analyze types and numbers of casualties in disasters, to identify by on-site medical observation prob- lems encountered in caring for disaster victims, and to serve as a national educational and advisory body to the public and the medical profession in the orderly expansion of day-to-day emergency services to meet the needs imposed by disaster or national emergency. 29