David W. Callaway

Building community resilience to dynamic mass casualty incidents: A multiagency white paper in support of the first care provider.

N and manmade disasters are becoming more common and are creating increasingly complex response challenges. The current US emergency responsemodel relies heavily on the availability and expertise of highly trained public safety agencies. Too often, this leads the public to assume that professional emergency medical care will be immediately available. Unfortunately, there are frequent delays in first responders accessing victims, especially in complex high-threat events such as the attacks inNorway, theAurora shootings, theVirginiaTech shooting, the Westgate Mall attack, and most recently, the shootings at Umpqua College. Initiatives, such as theArlingtonRescue Task Force and 3-ECHO program, are creating ‘‘warm zone/indirect threat care’’ operational paradigms for first responders and are an important first step in shortening the time from injury to first medical intervention. However, despite aggressive and expedient deployment of professional medical providers, there remains a significant time gap from point of injury to lifesaving intervention that only first care providers (FCPs) can address. As noted in the original Tactical Emergency Casualty Care (TECC) guidelines and the Hartford Consensus III statement, empowered and trained community members can serve a critical role as FCPs during the initial moments after complex and dynamic disasters. The Hartford Consensus calls for ‘‘empowering the public to provide emergency care.’’ These FCPs often have immediate access to severely injured victims and can provide time-sensitive, lifesaving interventions. Appropriately trained and equipped, the FCP can be the first link in the trauma chain of survival. Public safety and first response agencies should acknowledge this operational reality and should lead the effort to integrate the FCP into the whole of community crisis response plans built on the tiered application of the civilian TECC medical guidelines. The purpose of this article was to render recommendations of a group of subject matter experts in civilian active shooter events regarding initial scene management and how to quickly and efficiently render care to the wounded using FCPs and the principles enumerated in TECC.

Disaster Diplomacy: Current Controversies and Future Prospects

1. Disaster Medicine Section, HarvardMedical School, Boston, MassachusettsUSA2. Division of Disaster Medicine, Beth IsraelDeaconess Medical Center, Boston,Massachusetts USA3. Department of Global Health andPopulation, Harvard School of PublicHealth, Boston, Massachusetts USA4. The Operational Medicine Institute,Harvard Medical Faculty Physicians,Boston, Massachusetts USA5. Kennedy School of Government, HarvardUniversity, Cambridge, MassachusettsUSACorrespondence:Eugene S.YimDivision of Disaster MedicineDepartment of Emergency MedicineBeth Israel Deaconess Medical CenterOne Deaconess RoadCC West, 2nd Floor, Emergency MedicineBoston, Massachusetts 02215 USAE-mail: eugene.yim@post.harvard.eduWeb publication:07 August 2009

Dignitary medicine: adapting prehospital, preventive, tactical and travel medicine to new populations

Dignitary Protection Medicine (DPM) is a new area of medical expertise that incorporates elements of virtually all medical and surgical specialties, drawing heavily from travel, tactical and expedition medicine. The fundamentals of DPM stem from the experiences of White House, State Department and other physicians who have traveled extensively with dignitaries. Furthermore, increased international travel of business executives and political dignitaries has mandated a need for proficiency in this realm. We sought to define the requisite knowledge base and skill sets that form the foundation of this new area of specialization.

Integrated response to the dynamic threat of school violence.

A terrorist attack on US schools no longer can be considered a Black Swan event. Mounting evidence suggests that extremist organizations actively are targeting US schools. Equally disturbing are data suggesting that schools, universities, and communities are unprepared for large-scale violence. The Operational Medicine Institute Conference on an Integrated Response to the Modern Urban Terrorist Threat revealed significant variations in the perceived threats and critical response gaps among emergency medical providers, law enforcement personnel, politicians, and security specialists. The participants recommended several steps to address these gaps in preparedness, training, responses, and recovery.

Time for a revolution: smart energy and microgrid use in disaster response.

Modern health care and disaster response are inextricably linked to high volume, reliable, quality power. Disasters place major strain on energy infrastructure in affected communities. Advances in renewable energy and microgrid technology offer the potential to improve mobile disaster medical response capabilities. However, very little is known about the energy requirements of and alternative power sources in disaster response. A gap analysis of the energy components of modern disaster response reveals multiple deficiencies. The MED-1 Green Project has been executed as a multiphase project designed to identify energy utilization inefficiencies, decrease demands on diesel generators, and employ modern energy management strategies to expand operational independence. This approach, in turn, allows for longer deployments in potentially more austere environments and minimizes the units environmental footprint. The ultimate goal is to serve as a proof of concept for other mobile medical units to create strategies for energy independence.

Integrating the disaster cycle model into traditional disaster diplomacy concepts

Disaster diplomacy is an evolving contemporary model that examines how disaster response strategies can facilitate cooperation between parties in conflict. The concept of disaster diplomacy has emerged during the past decade to address how disaster response can be leveraged to promote peace, facilitate communication, promote human rights, and strengthen intercommunity ties in the increasingly multipolar modern world. Historically, the concept has evolved through two camps, one that focuses on the interactions between national governments in conflict and another that emphasizes the grassroots movements that can promote change. The two divergent approaches can be reconciled and disaster diplomacy further matured by contextualizing the concept within the disaster cycle, a model well established within the disaster risk management community. In particular, access to available health care, especially for the most vulnerable populations, may need to be negotiated. As such, disaster response professionals, including emergency medicine specialists, can play an important role in the development and implementation of disaster diplomacy concepts.