American journal of disaster medicine
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Mass disaster medicine is characterized by the need to manage limited resources that are far inadequate to meet the population's demands. Under these hectic conditions, lack of specific medical equipment is expected and requires improvisation using available items. ⋯ Creative solutions were found to several problems in a variety of medical fields: blood transfusion, debridement and coverage of complex wounds, self-production of orthopedic hardware, surgical exposure, and managing maxillofacial injuries. We hope that the methods described will help to inspire medical teams working in disaster regions.
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While many hospitals have developed preliminary emergency department and in-patient surge plans, the ability to surge is often limited by critical resources. The resource which is often the most limited is usually the human resource and within this category the limiting factor is almost universally nursing. As a result, nursing shortages can result in an inability of a hospital or emergency department to create surge capacity to deal with large numbers of ill or injured patients. Utilizing paramedics in acute-care hospitals or at alternate care sites could serve as expansion staff to supplement existing nursing staff allowing fewer nurses to care for a larger numbers of patients during a disaster, act of terrorism, or public health emergency. While the procedures performed for nursing do vary from hospital to hospital, there are national certifications for both emergency nursing (CEN) and critical care nursing (CCRN) that can be used to establish a standard for comparison. ⋯ With appropriate training and orientation, paramedics may be used in an in-patient setting to augment emergency and critical care nursing staff during a disaster, act of terrorism, or public health emergency.