Prehospital and Out-of-Hospital Disaster Response
Scene safety and command
Out-of-hospital response begins with scene safety and hazard assessment-responders must not become casualties. Establish scene command (first arriving unit assumes command until formally transferred) and integrate with fire, law enforcement, and public health. Know the difference between hot, warm, and cold zones and that only trained, PPE-equipped responders enter the hot zone.
Triage and transport
Prehospital mass-casualty operations emphasize triage at the casualty collection point, transportation group management, and patient distribution to avoid overloading one hospital. Know the role of medical communications/coordination in directing patients to facilities with capacity. A frequent trap: transporting to the nearest hospital regardless of capability (e.g., a trauma center vs. a community hospital).
Special considerations
Understand ambulance strike teams, mass-gathering medical operations, and aeromedical integration. In CBRN events, decontamination precedes transport (except immediate lifesaving). Recognize psychological first aid and the need to track unaccompanied minors and the worried well.
Rule of thumb
"Load and go" applies to individual trauma, but in mass casualty, distribute and coordinate-the transportation group leader, not individual crews, decides destinations.
Worked example: At a stadium collapse, the first-arriving medic establishes command, requests resources, and establishes a casualty collection point; a transportation group leader assigns patients to hospitals based on capability and current capacity, not proximity alone.