Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX D n Disaster Preparedness and Response
teams to apply ATLS principles during natural and
human-made disasters. Successful application of these
principles during the chaos that typically comes in
the aftermath of such catastrophes requires both
familiarity with the disaster response and knowledge
of the medical conditions likely to be encountered.
Disasters involving weapons of mass destruction and
terrorist events are particular challenges for trauma
teams. Seventy percent of terrorist attacks involve the
use of explosive weapons with the potential to cause
multidimensional injuries. Explosions produce blast
injuries which are complex because of the multiple
mechanisms of injury that result (e.g., primary,
secondary, tertiary, and quaternary blast injuries).
The ATLS course focuses on initial management of
the traumatic injuries encountered in such complex
disasters by providing a framework of order to evaluate
multifaceted injury.
the aproach
The key concept in contemporary disaster management
is the “all hazards” approach to disaster preparedness.
This approach is based on a single plan for all disasters
that is flexible and includes branch points that lead
to specific actions depending on the type of disaster
encountered. Similar to the ABCs of trauma care,
disaster response includes basic public health and
medical concerns that are similar in all disasters
regardless of etiology. The ABCs of the medical
response to disasters include (1) search and rescue;
(2) triage; (3) definitive care; and (4) evacuation. Unique
to disasters is the degree to which certain capabilities
are needed in specific disasters and the degree to which
outside assistance (i.e., local, regional, national) is
needed. Rapid assessment will determine which of
these elements are needed in the acute phase of the
disaster. Trauma teams are uniquely qualified to
participate in all four aspects of the disaster medical
response given their expertise in triage, emergency
surgery, care of critically injured patients, and rapid
decision making.
Phases of Disaster
mANAgement
The public health approach to disaster management
consists of four distinct phases:
1. Preparedness (Planning–Training)
2. Mitigation–Hazard Vulnerability
3. Response–Emergency Phase
4. Recovery–Restoration
In most nations, local and regional disaster response
plans are developed in accordance with national response
plans. Multidisciplinary medical experts must be
involved in all four phases of management with respect
to the medical components of the operational plan.
Trauma team members must be prepared to
participate in all aspects of the medical response to
disasters, and they are uniquely qualified to do so.
ATLS principles are applicable both to prehospital
and hospital disaster care, and all providers should
be familiar with the ATLS course content. Ensuring
scene safety and determining the necessity for
decontamination of affected disaster victims are
among the first priorities of disaster response before
initiating medical care both at the disaster site and
in the hospital.
The Incident Command/ Incident
Management System
Medical providers cannot use traditional command
structures when participating in a disaster response. The
Incident Command System (ICS) is a key structure
to be used in all four phases of disaster management
to ensure coordination among all organizations
potentially responding to the disaster. ICS is a modular
and adaptable system for all incidents and facilities
and is the accepted standard for all disaster response.
The Hospital Incident Command System (HICS) is
an adaptation of the ICS for hospital use. It allows for
effective coordination in disaster preparedness and
response activities with prehospital, public health,
public safety, and other response organizations.
The trauma system is an important component of
the ICS. Various organizations and countries have
modified the structure of the ICS to meet their specific
organizational needs.
Functional requirements, not titles, determine the
ICS hierarchy. The ICS is organized into five major
management activities (Incident Command, Operations,
Planning, Logistics, and Finance/Administration). Key
activities of these categories are listed in n BOX D-2.
The structure of the ICS is the same regardless
of the disaster. The difference is in the particular
expertise of key personnel. An important part of
hospital disaster planning is to identify the incident
commander and other key positions before a disaster
occurs. The positions should be staffed 24 hours a
day, 7 days a week. Each person in the command
structure should supervise only 3–7 persons. This
approach is significantly different from conventional
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