Role of the pulmonary provider in a terrorist attack: resources and command and control issues

Hospital-based pulmonologists, intensivists, respiratory therapists, and others are trained in the triage of limited ICU assets and function well in the chaos this environment often entails. Additionally, many intensivists and other providers often participate in hospital disaster planning and drills. Their education, training, and utility outside this setting are often limited,however. Managing the turbulence surrounding a disaster outside an ICU requires special training and skills to optimize safety, security, and effectiveness of the response effort. Failure to orchestrate the many parties that arrive at the scene risks having various types of providers independently seeking to do good but failing to cooperate or share limited resources of people and equipment. The result may be endangerment of personnel and the in-completion of critical tasks. Health care providers who normally work in a health care facility must participate in disaster planning activities to prepare themselves and the irinstitutions better for disasters that may occur. Critical to that preparation is an understanding of the organizational framework of disaster management, both inside and outside the hospital. This preparation ensures safety if the individual leaves the hospital to support the disaster scene (an action that is not recommended, as discussed previously) and quality care. Understanding whom to ask for resources and the constraints surrounding multidisciplinary disaster response can only improve the care ultimately provided at the bedside.