(p. 317) Anesthetic Considerations in Homeland Disasters 

This chapter will primarily focus on anesthetic considerations in homeland disasters likely to require the presence of the anesthesiologist in the out-of-hospital or prehospital environment. In order to understand the context within which anesthesiologists might be asked to function in the out-of-operating room setting during disaster response, we will provide a brief review of the disaster management functions of prehospital emergency medical services (EMS)/trauma systems. We will also describe the reorganization of hospital and intensive care services necessary to handle a surge of incoming critically injured or ill casualties. Our focus will be the role of the anesthesiologist, working in partnership with community or local EMS/trauma system and its network of hospitals, since the local EMS/ambulance system constitutes the basic functional unit of disaster medical response in the United States. We will end with a brief description of the major challenges we face in the delivery of intensive care services in mass and catastrophic casualty disasters.