ABPS Disaster Medicine cheat sheet

All-hazards planning uses a common core of capabilities (communication, evacuation, surge, supply) that apply across hazard types.

Hazard Vulnerability Analysis (HVA) scores probability, human impact, property impact, preparedness, and response by multiplying likelihood by consequence.

The preparedness cycle: plan, organize/train, equip, exercise, evaluate/improve, then revise the plan.

Continuity of Operations (COOP) targets essential functions first; recovery time objective (RTO) defines maximum tolerable downtime per function.

Exercise types in ascending complexity: seminar, workshop, tabletop, drill, functional, full-scale.

A Corrective Action Program (CAP) converts exercise and real-event findings into tracked improvement items with owners and due dates.

Community Lifelines (FEMA): safety/security, food/water/shelter, health/medical, energy, communications, transportation, hazardous materials.

The Preparedness Grants cycle links capability gaps from the Threat and Hazard Identification and Risk Assessment (THIRA) to funding priorities.

ICS spans of control: a supervisor manages 3-7 subordinates, with 5 as the target.

Command Staff: Public Information Officer, Safety Officer, Liaison Officer; General Staff: Operations, Planning, Logistics, Finance/Administration.

Only Operations executes tactical actions; Planning produces the Incident Action Plan (IAP) on an operational period cycle.

Unified Command applies when multiple agencies with jurisdictional or functional authority share incident objectives.

Incident priorities in order: life safety, incident stabilization, property/environment.

Emergency Support Functions (ESFs) group federal capabilities; ESF-8 is Public Health and Medical.

The Hospital Incident Command System (HICS) mirrors ICS with an Incident Commander, Medical/Technical Specialists, and branch structure for patient care, logistics, and finance.

Transfer of command requires a briefing covering situation, objectives, organization, resources, and communications.

Risk = Threat x Vulnerability x Consequence; reducing any factor reduces overall risk.

Threat is the likelihood an adversary or hazard will attempt or occur; vulnerability is the susceptibility of an asset to harm.

The THIRA process: identify threats/hazards, give context, establish capability targets, then apply results to planning.

Qualitative tools (risk matrices) rank hazards by likelihood and severity; quantitative tools (probabilistic risk assessment) estimate annualized loss.

The HAZUS model estimates potential losses from earthquakes, floods, and hurricanes for planning.

Cascading effects are secondary failures triggered by a primary hazard (e.g., power loss causing hospital generator failure).

Risk communication uses the same mental models as the audience and avoids comparisons that minimize perceived threat.

A vulnerability assessment inventories critical assets, dependencies, and single points of failure.

Triage sorts patients by resource need and urgency; it is dynamic and repeated as resources and patient condition change.

START: assess Respirations, Perfusion (capillary refill/radial pulse), and Mental status (RPM); categories Immediate (red), Delayed (yellow), Minor (green), Expectant/Deceased (black/gray).

JumpSTART adapts START to children using respiratory rate thresholds and the AVPU mental status scale.

SALT triage: Sort, Assess, Lifesaving interventions, Treat/Transport; global sorting prioritizes walking wounded last for immediate treatment.

Surge capacity has four components: staff, stuff (supplies/equipment), space (beds), and systems (policies, processes).

Conventional, contingency, and crisis care represent a graded escalation of standards; crisis care activates when demand exceeds resources.

The casualty collection point (CCP) consolidates patients for secondary triage and transport assignment away from the hot zone.

Transportation priorities: Immediate patients go first to trauma centers; minor patients may be transported by non-ALS assets to reduce EMS burden.

Scene safety precedes patient care; the hot, warm, and cold zones define PPE and access requirements.

The Medical Branch within Operations oversees triage, treatment, and transport groups; each group has a leader and span of control.

Ambulance strike teams (typically 5 vehicles) and task forces (with command/support) standardize mutual-aid deployment.

The EMS branch coordinates with fire, law enforcement, and public health through the Incident Command System.

Patient tracking systems record triage category, location, and destination to reunite patients with families and support accountability.

Decontamination precedes treatment for contaminated patients; ambulatory patients self-decontaminate at the gross decon line.

Air medical transport is reserved for time-critical patients when ground transport exceeds the therapeutic window.

The Hospital Command Center (HCC) is the physical location for HICS operations; it must have redundant communications and power.

Surge capacity planning uses bed availability, staffing ratios, and supply burn rates to project sustainable patient load.

Evacuation decision levels: horizontal (within floor), vertical (between floors), and full building evacuation; shelter-in-place is preferred when movement is unsafe.

Decontamination capability includes a decon corridor outside the ED entrance, PPE stockpiles, and trained staff on every shift.

The Hospital Emergency Operations Plan (EOP) aligns with community ESF-8 and the Healthcare Coalition.

Essential utilities: emergency power (generators), potable water, medical gases, and HVAC; each has defined failure and restoration protocols.

Patient family reunification and tracking systems must be activated early to prevent loss of accountability.

Crisis Standards of Care (CSC) frameworks guide allocation when demand exceeds supply, using triage teams and published criteria.

Chemical agents: nerve (organophosphates; treat with atropine and pralidoxime), blister (mustard), blood (cyanide), choking (chlorine/phosgene), and riot control agents.

Biological agents of concern: anthrax (spores; post-exposure prophylaxis with ciprofloxacin or doxycycline), smallpox (contact/droplet isolation, vaccinia vaccine), and botulism (antitoxin).

Radiological events: contamination is external (remove clothing, wash with soap and water) or internal (decorporation agents such as Prussian blue for cesium, DTPA for plutonium).

Radiation exposure is measured in gray (absorbed dose) or sievert (equivalent dose); acute radiation syndrome appears above ~1 Gy.

Explosive injury phases: primary (blast wave), secondary (fragments), tertiary (displacement), quaternary (burns, inhalation, crush).

The hot zone requires level A/B PPE for unknown chemicals; the warm zone is for decontamination; the cold zone is the treatment area.

Bioterrorism detection relies on syndromic surveillance, laboratory confirmation, and epidemiological linkage rather than a single case.

Personal protective equipment levels: A (fully encapsulating, SCBA), B (chemical-resistant suit, SCBA), C (air-purifying respirator), D (standard work clothing).

Attack rate = (new cases / population at risk) x 100; it measures incidence during an outbreak.

Case fatality rate = deaths / confirmed cases; it estimates severity, not transmissibility.

Basic reproduction number (R0) is the expected secondary cases per index case in a fully susceptible population; R0 > 1 predicts epidemic growth.

Herd immunity threshold = 1 - 1/R0; vaccination coverage must exceed this to interrupt transmission.

Incubation period determines quarantine duration; isolation applies to symptomatic cases, quarantine to exposed contacts.

Syndromic surveillance monitors pre-diagnostic indicators (ED chief complaints, pharmacy sales) to detect outbreaks early.

Epidemic curve shape (point source, propagated, continuous) suggests exposure pattern and informs control measures.

Public health emergency powers include isolation/quarantine orders, mandatory reporting, and emergency use authorization of countermeasures.

Psychological first aid: safety, stabilization, connection, information, and linkage to services, delivered without pathologizing normal distress.

Most disaster survivors experience transient distress; a minority develop PTSD, depression, or substance use disorders requiring formal treatment.

Vulnerable populations include children, older adults, pregnant women, people with disabilities, non-English speakers, and those with chronic medical or mental health conditions.

Children's reactions vary by developmental stage; reunification with caregivers is the highest-priority intervention.

Risk communication principles: be first, be right, be credible, express empathy, promote action, show respect.

Stigma and fear can cause avoidance of care and discrimination against affected groups; messaging should counter this.

Behavioral surge refers to increased demand for mental health services after an event, often delayed by weeks to months.

Cultural competence and language access are required for equitable disaster response and recovery.

Recovery phases: short-term (weeks-months), intermediate (months-years), long-term (years); each has distinct funding and rebuilding priorities.

The After-Action Report (AAR) documents strengths, areas for improvement, and corrective actions; it follows the Improvement Planning cycle.

The Robert T. Stafford Act authorizes federal disaster assistance; a Presidential declaration triggers Public Assistance and Individual Assistance.

The National Response Framework (NRF) coordinates federal support to state, local, tribal, and territorial governments.

The Emergency Medical Treatment and Labor Act (EMTALA) requires screening and stabilization regardless of ability to pay, including during disasters.

The Health Insurance Portability and Accountability Act (HIPAA) permits limited disclosures for public health activities and to prevent serious imminent threat.

The Public Readiness and Emergency Preparedness (PREP) Act provides immunity for covered countermeasures during declared emergencies.

Ethical frameworks for scarce resources emphasize duty to care, fairness, transparency, consistency, and proportionality.

The Incident Command System applies to recovery operations through a Recovery Support Function structure.

Community recovery includes housing, economic restoration, infrastructure, and health/social services restoration.

AAR findings should be SMART: specific, measurable, achievable, relevant, time-bound.

The National Incident Management System (NIMS) provides the common doctrine for all responder coordination.

Legal authority for quarantine derives from state police powers, subject to constitutional due process limits.

Ethical allocation frameworks should be applied consistently and publicly disclosed to preserve trust.

Documentation of decisions and resource allocations is essential for reimbursement and legal defensibility.

Recovery funding streams include FEMA Public Assistance, Individual Assistance, and Hazard Mitigation Grant Program.

The Disaster Mitigation Act of 2000 requires state, local, and tribal mitigation plans for certain federal funding.

After-action reviews should include all participating agencies, not only the lead organization.

Corrective actions must be resourced, tracked, and validated in subsequent exercises.

Ethical duty to care includes obligations to protect responders as well as patients.

Transparency in scarce-resource decisions supports public trust and legal defensibility.

The AAR should be completed within a defined timeframe after the event or exercise, typically 60-90 days.

Improvement plans assign responsibility and deadlines to each corrective action.

Legal review should occur before implementing crisis standards of care.

Recovery planning should incorporate mitigation to reduce future risk.

Community engagement is essential for equitable recovery.

Documentation supports reimbursement and continuous improvement.

The Stafford Act's Public Assistance program reimburses eligible costs for emergency and permanent work.

Hazard mitigation reduces future disaster losses and is funded through HMGP.

Ethical frameworks emphasize fairness, duty to care, and transparency.

Legal authorities for isolation and quarantine rest with states.

After-action reviews identify strengths and areas for improvement.

Corrective actions should be tracked to completion.

Recovery includes housing, infrastructure, economic, and health/social restoration.

AARs document strengths, areas for improvement, and corrective actions.

The Stafford Act authorizes federal disaster assistance.

EMTALA requires screening and stabilization regardless of ability to pay.

HIPAA permits limited disclosures for public health activities.

Ethical allocation frameworks should be transparent and consistent.