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Can There Be a Consensus on Critical Care in Disasters?

Dennis Amundson, CAPT, MC, USN
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San Diego, CA

Correspondence to: Dennis Amundson, CAPT, MC, USN, c/o Clinical Investigation Department, Naval Medical Center San Diego, 34800 Bob Wilson Dr Suite 5, San Diego, CA 92134-1005; e-mail: Dennis.Amundson@med.navy.mil



Chest. 2008;133(5):1065-1066. doi:10.1378/chest.08-0581
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A common adage in the social sciences, “Those who cannot learn from history are doomed to repeat it,”1 resonates loudly in the discipline of disaster medicine, where we seem to learn and relearn disasters one event at a time. Institutional memory in disaster mitigation seems to be particularly short lived, likely due to the ongoing demands of providing current medical care with little time for reflection.

Traditionally, the occurrence of a major national or regional event is followed by a modicum of general interest. Proactive communities that invest in redundant disaster mitigation strategies and attempt to build effective coalitions have proven to fare better in disaster readiness. As a case in point, the October 2007 firestorms in Southern California resulted in one of the largest US civilian evacuation events in recent history. In San Diego alone, > 500,000 people were evacuated, with thousands finding shelter in fairgrounds, stadiums, schools, and churches. At least 14 nursing homes and 85 long-term care facilities evacuated > 3,000 residents; two acute care hospitals and one psychiatric facility were forced to reincorporate into the county's health-care system. Deemed a highly successful mitigation event, this disaster relief came 4 years after a less-than-laudatory response to a similar catastrophe, demonstrating that experience and planning can and does improve disaster management. Thankfully, the danger of the San Diego wildfires passed with few major injuries or deaths.

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