The Importance of Maintaining Simplicity in Planning and Preparation for Major Accidents and Disasters

Disaster medicine is still a young discipline. Half a century ago very few people, the military organization as a natural exception, did not recognize any need of planning and preparation for a sudden exposure to a high number of traumatized or critically ill patients. The general and accepted philosophy was that good skills in 'normal' management of trauma and critical care was sufficient for the medical profession. The capacity of the major hospitals was also until the end of the 20th Century usually sufficient to receive an additional high number of casualties. As an example, textbooks in disaster medicine stated that 50 percent of the beds in a major hospital could be rapidly available by sending home patients who could manage without in-patient care. While this might have been true at the time, this is certainly not the case now. Today, especially in high-tech countries, hospital facilities are, or at least should be, optimally utilized 24 hours a day, the 'reserve capacity' being minimal or non-existing. This editorial describes the current state of hospital system disaster planning and makes recommendations for a renewed planning process.