Disaster Medicine
Domain focus
The Disaster Medicine domain tests incident command, surge capacity, triage, and resource allocation. The exam expects you to think in systems, not just individual patients.
Core rules
- Declare an incident early and establish incident command; unified command with fire, EMS, and police.
- Use triage (START or similar) and allocate scarce resources to salvageable patients.
- Surge: expand staffed beds, supplies, and staff; consider cancellation of electives.
- Blast injury: primary blast lung, tympanic membrane rupture; secondary fragmentation; tertiary blunt trauma; quaternary burns/inhalation.
- Chemical exposure: protect responders, decontaminate before hospital entry, use PPE.
- Documentation and communication are part of command.
Worked example
After an earthquake, 40 patients arrive in 30 minutes. Declare internal disaster, open incident command, call in staff, and use START. The reasoning is that individual perfection is impossible; the goal is to do the most good for the most patients while keeping the hospital functioning.
Traps
Waiting for perfect information before declaring a disaster, treating walk-ins first, and failing to decontaminate chemical casualties are common. Do not let one critical patient consume all resources.