Disaster management. Lessons learned.

Our experiences have taught us that practice makes perfect and that it probably is unreasonable to expect everything to be orderly, sane, and appropriate during disaster management. The best we can hope for probably is controlled chaos. We do believe that we have generated an improved plan, that the plan is known, and that it is being revised continuously. We can no longer rely on our goodwill and good intentions to manage mass casualties in a disaster. There are too many factors that can reduce our ability to provide medical care in this situation. Hospital planning is essential. The hospital should be represented on the emergency preparedness committee so it is knowledgeable about the various plans throughout the city. Each plan must be practiced and critiqued to identify potential problems. Hospital staff must be kept current on the various plans to understand the communication, authority, responsibility, security, and medical control for each plan. We have instituted a video program outlining the various tasks for each hospital department for each disaster plan. This format allows the personnel in these departments to review their responsibilities continually in a concise manner and allows practice of disaster preparedness without implementing an entire disaster drill. Table 1 provides a quick review of the areas and questions we found to be problems when implementing our disaster plan.