Disaster Preparedness, Response, and Recovery
The cycle and the command structure
Disasters are described through a cycle: mitigation (reducing impact, such as seismic bracing or flood barriers), preparedness (plans, stockpiles, training, exercises), response (activation, surge, treatment, evacuation), and recovery (restoration and lessons learned). Questions frequently blur mitigation with preparedness; mitigation is a permanent structural or environmental change, preparedness is a readiness activity.
Response is managed through an incident command system. The incident commander sets objectives; sections handle operations, planning, logistics, and finance/administration. Span of control should stay between three and seven people per supervisor, with five as the target - when it exceeds that, you add a division or a branch rather than shouting louder. Hospitals use the same architecture as HICS, and the medical incident commander must be formally designated, not assumed to be the chief executive.
Surge capacity is tiered: conventional (normal space and staff), contingency (functionally equivalent adaptations), and crisis (standards of care altered, resources allocated by protocol). Disaster triage systems such as START and SALT sort by walking ability, breathing, perfusion and mentation, and add an expectant category that has no equivalent in daily emergency department triage. Decontamination follows hot, warm and cold zone logic with correct personal protective equipment at each boundary.
Trap to expect: candidates picture the emergency department as the whole response, forgetting pre-hospital triage, reception, lockdown, and family reunification. Another is skipping the after-action report; every exercise and every real activation ends with documented corrective actions.
Rule of thumb: name the tier before you improvise - if demand exceeds the plan, escalate deliberately to the next surge level and record the decision.