Organization is imperative to the success of disaster response. Because anesthesiology provides a key linkage between multiple specialties and also holds a central position in most medical care settings, providing the most efficient medical care to those in need should include the direction and coordination of an anesthesiologist. In ideal situations, there should exist a network of local and regional anesthesiology providers who are willing and able to provide their skill sets if called upon in the face of disaster. The creation of a core committee which includes these anesthesiologists as well as other subspecialties including, but not limited to, surgical subspecialties, critical care, nursing, emergency medicine, and internal medicine is essential. This committee will be the central unit in creating disaster management strategies to include pre-disaster awareness, disaster management planning, identifying resources and surplus availability, and creating mock-disaster trials. Given that the remainder of disaster strategy preparedness revolves around this central organization, there should also be elected/selected delegates of this group who hold ranking positions to ensure a tier-structure of command to facilitate instruction and direction in the event of impending catastrophe. The contact information of all ranking and registered providers should be available via various means in the case that activation of the group be needed and established lines of communication are jeopardized or destroyed entirely. Accordingly, all medical professional subspecialties should create similar registries with appointed ranking leaders and individual contact information should there be a breakdown in the ability for there to be a central organization coordinated disaster plan. Within each committee, rank should be appointed based on knowledge and experience within the particular specialty and subsequent positions should be appointed accordingly. It should be left to the discretion of committee leaders to determine the roles and responsibility given to each member. Creating individual committees, with their respective leaders, will ensure that once disaster is suspected or anticipated, all personnel, through a previously designed, or alternative, communication system will be informed and on high-alert that their individual skill sets may be called upon. The delegates of these groups should ensure that their registries are updated at least bi-annually and remain current to the best of their abilities. These appointed leaders would themselves join together to form a Disaster Management Board (DMB) which should similarly include senior ranking members/directors and administrators of all major hospital or health care facilities, local police and fire departments, and the local department of transportation. The DMB collectively formulates disaster plans and strategies built upon previous catastrophic experiences of all etiologies. Regularly scheduled meetings should be held in an attempt to review and update strategies and allocation of resources amongst many other facets of disaster management. These meetings may also be used to simulate potential disaster situations and test the abilities and limitations of the current policies and strategies. McIsaac et al. noted that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires all hospital to have biannual disaster exercises to help ensure proper coordination of operating room (OR) personnel and the department of anesthesiology [12].

It is also important to establish an organized group to be deemed “First Responders.” Ideally this group would comprised a select group of anesthesiology providers as well as surgical specialists of each region. The primary goal of these health care providers is to make initial assessments based on:

Once the initial assessments have been made and the disaster has been categorized, the DMB should activate predesigned protocols needed for the peri-disaster phase of management.

Communication amongst these committees is essential for initiation of proper disaster response. Particular attention should be given to the widespread distribution of a central set of contacts and contact numbers that others (professionals, administrators, media, etc.) may use for inter-group communication, reports, and updates. There should also be particular attention paid to the types of communications that may be lost given the type of disasters that are most likely to occur. In the event of widespread loss of electricity or cellular technologies, an alternative means for effective communication to facilitate and coordinate the disaster response is warranted. History has shown that the use of two-way radios provides a rather inexpensive means of communication in distances up to 12 miles. The Pan Am 103 flight bombing was an example of abilities of two-way radio communications as the pilots were able to make contact with the Shanwick Oceanic Area Control just seconds before the plane was subsequently destroyed by a terrorist bomb believed to be orchestrated by the regime under Libyan leader Muammar Gaddafi [13]. Ideally in disaster scenarios, the use of two-way radio communication would be able to provide key linkage between first responders and appropriate facilities or personnel in the event that other electricity-driven forms of media/communication were destroyed or rendered inoperable. The implementation of such alternative forms of communications would thus prove to be essential for execution of disaster strategies and providing up-to-date information regarding different aspects of disaster response(s).

Each DMB needs to identify potential resources and materials that can be mobilized in the event of a disaster which will require the input of hospitals and other medical facilities. Information that is usually needed includes, but is not be limited to, the numbers of hospital beds, including emergency room capacities, ICU and inpatient beds, functioning operating rooms (ORs), functioning mechanical ventilators, and emergency transportation vehicles (ambulances, fire trucks, other emergency vehicles).

It would be of great value to create a registry of approximate volumes of necessary resources particularly those that are more likely to be exhausted during a disaster situation. Of particular importance are the emergency medications that are specific to the treatment protocols of certain chemicals and nerve gases in the event of bio- or chemical disaster as well as those necessary to perform a wide array of anesthetics depending on the clinical scenario. The anesthesiologist must have the ability to treat patients both in and out of the hospital setting as it has been shown that the degree and types of injuries vary widely depending on the etiology of the disaster. The ability of the anesthesia provider to administer adequate clinical care for patients is heavily dependent on his/her ability to construct anesthetic regimens based on individual clinical conditions. The anesthetic regiment may consist of particular drugs which provide better hemodynamic control in the face of severe traumatic injuries. Of particular note, patients who have succumbed to collapsing infrastructures and whose survival is dependent on emergency surgeries involving amputation of a limb pose a difficult, yet manageable, anesthetic scenario for the anesthesia provider as securing of a patient’s airway may be impossible. In these dire circumstances, the anesthesia provider would be best served in utilizing medications whose side effect profile minimizes the possibility of respiratory depression (i.e. ketamine, non-steroidal anti-inflammatory drugs (NSAIDs)) but are capable of providing analgesia. See Fig. 23.5.