Treating the victims after disaster: physical and psychological effects

Disaster victims present in waves. The initial presenting group is traditionally suffering from mild physical injuries, and the second wave, usually following 6 h later, typically has more serious trauma. Medical problems typically are not adequately treated when a person has psychological reasons to worry about survival. The third wave of victims from untreated medical problems occurs 6 d after the initial disaster. Triage of the initial waves is important to prevent the system from becoming overwhelmed and to begin looking for those who will suffer long-term psychological sequelae. Early intervention in those at greatest risk for long-term issues is important and can be accomplished.