Surgery of violence. II. Disaster procedures.

Abstract

One of the effects of bomb blast is that patients often arrive simultaneously in large numbers. This kind of multiple accident has been given many names, but recently the word disaster has become the generally accepted one. Bombing itself is a symptom of an illness in the community, and is unlikely to be an isolated incident. Over a 3 yr period the Royal Victoria Hospital, Belfast, had to receive multiple casualties from bombs on 48 occasions. (There were also 15 occasions when street rioting gave rise to a disaster situation). The repeated use of the hospital's disaster plan gave unusual opportunities to assess the value of its provisions. A difficulty arises from the multidisciplinary nature of disaster planning. Within the hospital it is a co-operative venture co-ordinating medical, nursing, and administrative services. Outside hospital, as well as medical services, it involves police, ambulance, and fire services, and possible welfare services and some voluntary bodies. Multidisciplinary agreement is always more difficult to achieve than agreement between people inside any one discipline. The conclusion drawn from this concrete situation is that planning for disaster still presents many difficulties. The question arises of who is ultimately responsible to see that proper plans exist in an adequate state of readiness, covering the whole country and all the services needed. It is a question which is so far unanswered.