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Cambridge University Press978-1-107-49825-9 — Essentials of Disaster AnesthesiaEdited by Joseph McIsaac , Edited in association with Kelly McQueen , Corry Kucik IndexMore Information

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Index

9–11 New York terroristattacks

emotional reactions,children 124

preparedness 122psychiatrists 116

ABC emergency approach 55ABCDE, children 72ABCs, children 71C-ABCDE algorithm 20chemical warfare 131during decontamination 130

abdominal woundsconservative management 24muscle-relaxingdrugs 10 fig

prophylaxis 23 tablethoracic-abdominal, oxygen12–13

volatile anesthetic caution 9wound closures 28

abduction insurance 182absolute lymphocyte counts

(ALC), serial,hematopoietic syndrome134–135

absorbed radiationmeasure 133

access, vascular 55–58children 10–11, 79–80, 92table

see also intra-osseousinsertion

accommodation, securitychecklist 179

accountability, medicalcare 189

acetaminophen (paracetamol)essential pain medications149 table

pain management, combatenvironments 146

post-dural punctureheadache 210

WHO Model List 144–146acetaminophen (paracetamol),

childrendosing 74 table

drug recommendations 87,92 table

peri-operative dosing 88table

Tylenol with codeine 92 tableacetazolamideacute mountain sickness 108pharmacology 113

acetic acid (diluted vinegar),infections 29

ACOG, cesarian section 210acupuncture, pain

management 148acute mountain sickness

(AMS) 108–109acute pain treatment 148, 149

tableacute phase of disastermental health assessments118–119

mental health interventions119–121

Operation Tomodachi198–199

psychiatric diagnoses 119psychological first aid 120

acute psychiatric symptoms,triage 119

acute radiation syndrome seeradiation sickness

acute stress disorder (ASD),medication 121

acute stress reaction, painmanagement 148

acyclovir, radiation sicknesswith HSV 137

adaptation, patient safety vscomfort 2–4, 7

adaptation, tacticalanesthesia 7–8

addiction prevention,opioids 146

Additional Protocols seeGeneva Convention

adductor canal nerve block 224table

adenosine, children, peri-operative dosing 88 table

adolescents

catheter size 79central venous lines 79central venous lines, size anddepth 79

emotional reactions 125informed consent 126

adrenalin, local anesthetictechniques 11

adsorbents, chemical 130advanced life support for acute

toxic injury (TOXALS)protocol 131

advanced pediatric life support(APLS) formula 75

advanced trauma lifesupport (ATLS)course 128

C-ABCDE algorithm 20chemical exposures 131

Afghanistan, militaryoperations

fuel shortages 12ICRC hospital, Kabul 4 fig, 4,5, 7 fig, 10 fig

nerve blocks, non-sterilesetting 147

African countriesinternational humanitarianlaw 188

legal position, drugs 16–17agents see children, drug

recommendations; drugs;specific drugs

aggressive treatmentschronic pain prevention 143debridement, radiationinjuries 139

rapid rewarming, highaltitudes 111

volitional hydration, highaltitudes 112

agitation symptom 119aid organization field

locations 185aid workers see medical

emblem display; security,responder/aid worker

air handling systems,contaminations 203, 204

332

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air ventilation see room airventilation

Airtraq fiberoptic scope,disposable 82

airway management, masscasualty events 48–53

apneic patients 52biologic events orweapons 48

chlorine gas weapons 48device selection algorithm 52diagnosis-managementparadigms 51

disaster drill 49equipment and supplies 50,92 table

explosions 57nerve agent exposure 48personal protectiveequipment 49–50

personnel, novice providers51–52

personnel, roles 50preparation phase 49–52prevention/mitigationphase 49

recovery phase 53response phase 52stress, provider 50–51supraglottic airway device49, 50–51, 52

training requirements 51triage off-site 50see also airways, difficult;children, airwaymanagement

airways, difficultASA algorithm 82children 82guidelines 48obstetric anesthesia 207table, 207–208

albuterol, children,peri-operative dosing 88table

ALC (absolute lymphocytecounts), serial,hematopoietic syndrome134–135

alcohol, high altitudes 112alcohol use disorder 116alginates, strontium-90

binding 136allergies, beta-lactam

antibiotics 23 tablealpha particle radiation 132

alpha-2 antagonists, painmanagement 146

aluminium sheeting, betaparticle protection 132

aluminium-based antacids,strontium-90 binding 136

alveolar gas equation, high-altitude anesthesia106, 112

amateur radio seecommunications, amateurradio

Ambu® bag 83American Medical Association(AMA), mental health 122

American PsychiatricAssociation (APA) 122

American Red Cross 125American Society of

Anesthesiologists (ASA)Committee on Trauma andEmergencyPreparedness 140

difficult airway algorithm 82intra-partum platelet countguidelines 210–211

monitoring standards,basic 77

pulse oximetry 77amikacin, radiation

sickness 137aminocaproic acid, children,

blood conservation 84aminoglycoside, radiation

sickness 137amitriptylineessential pain medications149 table

WHO Model List 144–146ammonia exposure 130ammonium chloride, oral,

radiation injuries 136amoxicillinessential pain medications149 table

radiation sickness, infectionprophylaxis 137

war wounds 23 tableampicillin, war wounds 23

tableamputations, decisions 29,

30amputations, pain,

acupuncture 148amputations, traumatic,

prophylaxis 23 table

AMS (acute mountainsickness) 108–109

analgesiaanesthetic pharmacy 218anesthetic triangle 5 fig, 5epidural 11, 146–147, 209essential pain medications149 table

LMICs, availability 145neuraxial, obstetric 208opioid availability 145oral 146, 149 tablepost-operative, ketamine 22self-administeredopioids 146

as standard 24 figWHO Model List144–146, 218

analgesia, children 74 table,87–88, 92 table

neuromuscular blockingagents 87

non-opioid 87opioid 87

analysis paralysis 50anatomical landmarks vs

ultrasound guidance10

anesthesia challenges 1–13 box,32

basic framework 5 fig, 5competing challenges 8cultural interpretations 1expertise availability 22fallback anesthesia 86general anesthesia 8–10logistics 11–13machine failure 86main challenges 4–6, 8obsolete methods 9pre-hospital 10 figtactical adaptation 7–8and trauma anesthesia 2see also draw-overvaporizers; localanesthetics; oxygenlogistics; regionalanesthetics; resourceconservation, anesthetics;TIVA; volatile anestheticgases

anesthesia machine/operatingtable ratio 2–4, 7

anesthesia machines, draw-over see draw-overvaporizers

Index 333




anesthesia systems checklist,children 92 table

anesthesia technicians, roleflexibility 212

anesthesiological triangle,classic 5 fig

anesthesiologist assistants, roleflexibility 212

anesthetic deliveryfull stomach assumption 137muscle relaxants 216obstetric anesthesia 208

anesthetic equipment, tacticaladaptation 7

anesthetic pharmacy seechildren, drugrecommendations; drugs;pharmacy, anesthetic;specific drugs

anesthetist role, challenges32, 212

anesthetist role, culturalvariations 1

anesthetist to patient ratio 141ankle block 224 table, 233anthrax toxin 132antibioticsessential pain medications149 table

local resistance, endemicdiseases 216

radiation injuries 138 tablewar wounds protocol 23table

WHO Model List 144–146anticholinergic drugs

reminder, children 10antidepressants, pain

management 148, 149table

antiepileptics, painmanagement 146, 149table

antifibrinolytic drugs, children,blood conservation 84

antifungal medications, WHOModel List 144–146

anti-infectives, WHO ModelList 144–146

anti-inflammatory agents,children 87

antimicrobials, anestheticpharmacy 216–218

antimicrobials, disasterresponse surgery217 table

antineuropathics, painmanagement 146

antipsychotic medications 121antitetanic serum 21antitetanus measures 23 tableantiviral medications, WHO

Model List 144–146anus wounds, prophylaxis 23

tableanxiety, children, disaster-

induced 124anxiety, children, pre-operative

77, 85anxiety, chronic pain 148anxiety symptom 119anxiolytic medicationsacute stress disorder 121benzodiazepines 146essential pain medications149 table

pain/stress cycle 148APAP see acetaminophenapneic patients, airway

management 52aprophen treatment,

nerve agent poisoning131–132

ArcGIS mapping product 15argon exposure 130armed conflict see combat

environmentsArmed Forces Radiobiology

Research Institute 136Armenian earthquake 1988

56–57arterial and central venous

lines 62arterial blood gas analysis

(ABG) 98Article 55 and 56, Geneva

Convention 185ASA see American Society of

AnesthesiologistsASD (acute stress disorder),

medications 121Asian countries, legal position,

drugs 16–17asphyxiants 130aspirinessential pain medications149 table


WHO Model List 144–146Assigned Protection Factors

(APF) 130

ATLS (advanced trauma lifesupport) course 128

C-ABCDE algorithm 20chemical exposures 131

atmosphere, basic science 106atmospheric pressure, and

altitude changes 106atropinehyperthermia risk 35intravenous lines 10–11ketamine premedication 35nerve agent poisoning131–132

rescue drugs list, children 88table

atropine, childrendrug recommendations 85peri-operative dosing 88table

attack situation, immediateactions 181

Aum Shinrikyo cult, sarinattacks 48, 52

auricular acupuncture, painmanagement 148

austere anesthesia courses 15austerity, surgical 18, 32Australian pediatric weight

estimate formula 75autologous blood donations 21autologous blood donations,

children 84awareness, situational 51, 62axillary block, MEC 90

concentration 221 tableaxillary brachial plexus block

224 tableMEV 90 volume 222 tableneedle choice 233

axillary nerve block, isolated,needle choice 233

azaprophen treatment, nerveagent poisoning 131–132

babies see infants; neonates;toddlers and smallchildren

bacteria, drinking watertreatment 176–177

bacterial growth, drugemulsions 8, 214, 216

bacterial infections, essentialpain medications 149table

bactericide anesthetics 8bacteriostatic anesthetics 8

334 Index




bag-mask ventilation 50ballistic (bullets), internal,

mass shootings 2barium sulfate, strontium-90

binding 136barometric pressure see

atmospheric pressure, andaltitude changes

beds/stretchers 62benactyzine treatment, nerve

agent poisoning 131–132benzodiazepams, and ketamine

mixes 35benzodiazepine, drawbackscontraindications 121intravenous lines 10–11

benzodiazepinesnerve agent poisoning131–132

pain management 146trauma patients, calming146

benzodiazepines, children, pre-operative anxiety 77

benzylisoquinolinesatracurium, musclerelaxants 216cisatracurium, musclerelaxants 216

beta particle radiation 132beta-hemolytic streptococcal

sepsis, invasive,epidemiology 18–19

beta-lactam antibiotics,allergies 23 table

Bhopal gas tragedy, India 19842, 48, 60

bicarbonate buffer 56Bing 15biologic events, natural, airway

management 48biologic weaponsairway management 48fluid management 56metabolic poisons 132

biomedical engineers, criticalcare delivery 62

bioweapon, Class A, fluidmanagement 56

BiPAP, HAPE 109biperiden treatment, nerve

agent poisoning 131–132bladder, isolated wounds,

prophylaxis 23 tablebleeding patients,

explosions 57

block placement, vital signs221–222

blocking agents, radiationinjuries 136

blood, availability 22,63

blood bank supply 215blood center management 84blood coagulation testing,

PoC 98blood donorscultural considerations21

laboratory testing 215managing influx 84

blood fractionation, culturaldifferences 21

blood glucose levelsDMAT standards 96pre-operative testing 97

blood loss, hypotension 8blood loss, mass shooting

scenarios 2blood products, availability

63, 215blood transfusions,

guidelines 63blood transfusions,

traditional practice21, 215

blood vessels, major, woundexcision 26

blood-pressure drop, cardiacarrest prevention 8

blood-pressure increase,ketamine anesthesia 8

blunt-tip needles, regionalanesthetics 223

blunt trauma 3 boxboiling method, drinking water

treatment 176–177boiling point, anesthetic

agents 115bolusing, labor anesthetic,

cautions 211bolusing, labor epidural

209, 211bolusing, labor spinals,

continuous 210bombardment effects 19–20bombs, homemade, aftermath

security 182–183bone, wound excision,

initial 26Boston Marathon bombing

2013 60

bottled oxygen, transporting16–17, 216

botulinum 132bowel obstruction, intubation 5bradyarrhythmia prevention,

ephedrine 11brain abscess, surgery

prophylaxis 23 tablebrain injury, explosions 57breathing problems see airway

management, masscasualty events

Bristol method, children,ketamine 38

Bristol method, propofol 33Broselow pediatric emergency

tape 74, 75building collapse see

earthquakesbuildings, non-violent risks

175–176bullets, wound excision,

initial 26bupivacainechildren, drugrecommendations 91

disadvantages 218epidural, labor 209essential pain medications149 table

hyperbaric, obstetricanesthesia 209

intermittent bolusing,epidurals 211

isobaric 209local anesthetictechniques 11

MEC 90 concentration 221table

MEV 90 volume 222 tableobstetric anesthesia 209–210regional blocks,concentrations 11

spinal blocks 11WHO Model List 144–146yield 42

bupivacaine, children, standardmedications 92 table

bupivacaine and lidocainemix, MEV 90 volume 222table

burn contractures, electivereconstruction 30

burns surgerychildren, disaster risks 69table

Index 335




burns surgery (cont.)fluid management 57PTSD prevention 35see also chemical exposures;fire accidents

burns trauma 3 boxbutalbital, post-dural puncture

headache 210

C-ABCDE algorithm 20caffeine, post-dural puncture

headache (PDPH) 210calcium chloride, children,

rescue drugs list88 table

calcium diethylenetriamine-pentaacetic acid, radiationinjuries 136

calcium gluconatechemical exposures 131children, peri-operativedosing 88 table

radiation injuries136

rescue drugs list, children 88table

cannula requirements, drugdilution bottles 12 fig

cannulas, vascular access56

carbamazepinechronic neuropathicpain 146

essential pain medications149 table

WHO Model List 144–146carbon dioxide (CO2), expired,

children 78carbon dioxide (CO2)

exposure 130carbon monoxide (CO) 131cardiac function, ether

stimulating effect 9cardiac life support,

advanced, trainingrequirements 51

cardiopulmonary monitors,supply chain 62

cardiovascular systemsyndrome, radiationsickness 133, 135, 142

car-hijacking situation, escapechecklist 180

casualty load assessment,Operation Tomodachi195–196, 199–200

see also resourceconservation; surgecapacity; triage

cautions, drugboiling point, anestheticagents 115

crystalloid solution,severely injuredpatients 21

diazepam, fat emulsion 8dinitrous oxide (laughinggas) 9

heat variations 11ketamine, congestive heartfailure 8

ketamine-induced salivation10, 34, 35

mannitol 56morphine solutions 218neuromuscular blockingagents, children 82

opioid predictability,neonates 87

prilocaine, obstetricanesthesia 209

propofol, fat emulsion 8propofol, nerve agentpoisoning 132

vasodilating drugs 8cautions, drug emulsions 8,

214, 216cautions, equipment/

proceduralbolusing, obstetricanesthesia, intrathecalcatheter with epiduraldoses 210

draw-over vaporizers 44–45elderly people, generalanesthesia 9

peripheral nervestimulator 223

sharp-tipped needles,regional anesthetics 233

volatile anesthetic,abdominal wounds 9

volatile anesthetics 216cautions, respondersairway management trainingshortfall 50

critical care delivery quality61

see also training, deploymentcefazolinanesthetic pharmacy 217table

children, standardmedications 92 table

cefepime, radiationsickness 137

ceftriaxone, anestheticpharmacy 217 table

ceftriaxone, children, standardmedication 92 table

ceftriaxone, radiationsickness 137

Centers for DiseaseControl (CDC)

contaminated surgery 216country information 15immunization protocols 137ventilators, national stock 49

central blocks, localanesthetic 11

central nervous system, diseasefrom pain 144

central nervous systemsyndrome 133, 135,142

central sensitization 149 tablecentral venous lines 10central venous lines,

children 79cephalosporin, radiation

sickness 137cephalosporin, rash reaction,

children 88cerebral hypoxia 108certified powered air-purifying

respirators (PAPR) 130cervical plexus block,

superficial 224 tableneedle choice 233

cesarian sections, elective 211cesarian sections, emergencyketamine anesthesia 35local anesthesia 210

cesium-137 binding, radiationinjuries 136

charcoal, activated, chromiumbinding 136

Checklist, Draft ConnecticutAcute Care HospitalPediatric DisasterPreparedness 326–329

chelating agents, heavy metalsexposure 131

chelating agents, radiationinjuries 136

chemical exposuresBhopal gas tragedy, India1984 2, 48, 60

336 Index




combined trauma-exposuremanagement 130–131

treatments 142chemical weapon

exposures 128emergency airwaymanagement 48

CHEMM resource (ChemicalHazards EmergencyMedical Management)128, 132, 142

CHEMTREC resource 128children 3 box, 66–74, 75–91families/carers, working with124–126

Pediatric AssessmentTriangle (PAT) 71–73

preparedness phase 66–68,75–91, 125, 326–329

response phase 68–74SALT triage steps 71–73vulnerability 66see also families/carers,working with

children, advanced life support,pediatric (PALS) 91

children, airway management80–83

airway adjuncts 80breathing systems 82–83difficult airwayequipment 82

endotracheal tubes(ETTs) 80

equipment list 92 tablelaryngeal mask airway 82laryngoscopes 81, 82masks 80, 85ventilatory modes 83

children, anesthesia resources92 table

children, anxiety, disaster-induced 124

children, anxiety, pre-operative77, 85

children, caudal epidural 90children, communication

during response 68children, demographics 3

fig, 14children, disaster preparation

66–68children, disaster surge

formulary 330–331children, distraction

techniques 85

children, drugrecommendations 85–90

analgesics 74 table, 87–88, 92table

antibiotics 88anti-inflammatory agents,non-steroidal 87

anxiety, pre-operative 77blood conservation 84CPAP, inhaled agents 86difficult airways 82emergence delirium 38, 85emergency drugs list 92 tableessential drugs, normalsaline (NS) 215

fallback anesthesia 86induction, rapid 85induction agents 85–87inhaled induction agents85–86

intravenous inductionagents 85

ketamine. see children,ketamine

maintenance, anesthesia86–87

non-opioid analgesics 87opioid analgesics 87penicillin-based agents, rashreaction to 88

peri-operative medications,common 88 table

propofol, induction agent86–87, 88 table

rapid induction 85rescue drugs list 87, 88 tablesodium bicarbonate 87

children, fasting guidelines 76children, femoral nerve

block 90children, fluid management 74,

83–84blood conservation 84blood sources 84blood transfusion 84blood warming systems 84crystalloid solution 74crystalloid solutioncaution 21

intravenous fluid choice 83massive transfusion 84

children, hospital checklists326–329

decontamination protocols328 table

evacuation strategies 329

HICS 326 table, 326infection control 328 tableoperational continuitystrategies 327 table

sheltering in place 329staff safety protocols 328table

surge capacity planning 327table

children, human traffickingrisks 126

children, hyperthermia,malignant 86–87

children, hypothermia duringsurgery 78

children, instruments/equipment list 330

children, intravenous solutionslist 330

children, irrigation solutionslist 330

children, ketamineanticholinergic drugsreminder 10

apoptosis of immatureneurones 39

difficult airways 82emergence delirium 35, 38as fallback anesthesia 86hypersalivation caution 10intravenous induction 85peri-operative dosing 88table

sedative role 38–39TIVA 38–39

children, life support,advanced 91

children, local anesthetics 91children, mass

communications 68children, monitoring 77–79breath sounds 78checklist 92 tablecirculation 77electrocardiogram 78Foley catheter 78heart sounds 78oxygenation 77precordial stethoscope 78temperature 78urine output 78ventilation 78

children, pediatric advancedlife support (PALS) 91

children, pre-operativeevaluation 75–76

Index 337




children, pre-operativepreparation 75–76

children, recovery 91children, regional

anesthetics 90children, “rule of nines” 70

table, 73 figchildren, sleep routines 125children, special needs 125children, supplies list 331children, TIVA, ketamine

38–39children, transport priorities 73

tablechildren, triage steps 68–73children, vascular access 79–80catheter size 79catheterization tools 79central venous lines 79difficulties, intravenous lines10–11

equipment list 92 tableintra-osseous line 79peripheral access 79

children, weight estimation 74chloramphenicolessential pain medications149 table

war wounds 23 tablechlorine exposure 130chlorine gas weapons,

emergency airwaymanagement 48

chlorine method, drinkingwater treatment 176–177

chromium binding, radiationinjuries 136

chronic painacupuncture 148aggressive treatments 143early intervention 148essential pain medications149 table

neuropathic,antiepileptics 146

prevention 143psychopathology oftrauma 148

chronically critically ill patients63–64

CIA World Fact Book 15ciprofloxacinessential pain medications149 table

gastrointestinal radiationexposure 137

radiation sickness,prophylaxis 137

citalopram, psychiatrictherapy 121

citrate buffer 56citrated blood collection

sets 215civilian life, mass casualtiessee also hospital plans; masscasualty events

civilians, Geneva Conventioneffectiveness 188

Class A bioweapon, fluidmanagement 56

classified treatments,neurotoxins 132

clindamycin, anestheticpharmacy 217 table

clindamycin, children,standard medications 92table

clonazepam, psychiatrictherapy 121

clonidine, surgical mortality,1-year 146

clostridial enterocolitis,radiation sickness,prophylaxis 137

clotting abnormalities, PoC(point-of-care) testingdevices 98

cloxacillin, essential painmedications 149 table

coagulation testing, PoCtesting 98

Cocoanut Grove nightclub firein Boston 1942 116

codeinechildren, dosing 74 tableessential pain medications149 table

WHO Model List 144–146cognitive behavior therapy

(CBT) 120cold injuries, high-altitude

physiology 110–112collapse, buildings see

earthquakescolon wounds, prophylaxis 23

tablecombat environmentshypothermia (too cold) 110injury profile 18ketamine, subanestheticdoses 146

vs natural disasters 18

needle choice, regionalanesthetics 223–233

pain management143–144, 146

self-administered painmanagement 146

unconventional warfare 188USGRA 222–223see also Geneva Convention;ICRC; internationalhumanitarian law (IHL)

Commission on NarcoticDrugs, UN 39

communications 164–174children, disaster setting 68,92 table

documentation, regionalanesthetics 220, 233–234

drug names 214external hospitalcommunications 166–168

mass communications 68redundant systems andpathways 168–169, 171

skin color, markingissues 234

tools list, children 92 tablecommunications, amateur

radio 164–165expeditionary medicaloperations 171

hospital disaster plan 171locating operators (hams)169–171

long distance 166medium distance 166radio operator job actionsheets 172 fig

radio wavebands 166volunteer emergencyoperators 164, 171

within building 166compartment syndrome 147compensated events 19compound fractures,

prophylaxis 23 tablecomputed tomography

(CT) 161concentrations, drugdilution bottles 12 figMEC 221MEC 90 221 tableWHO guidelines 11

conflict environments 214 seeinternationalhumanitarian law

338 Index




conflict protection seeinternationalhumanitarian law

congestive heart failure,ketamine caution 8

constraints, main surgical 22consumables, levels, disaster

scenarios 7–8continuous peripheral nerve

catheters 196contraindicationsneuromuscular blockingagents 87

proximal brachial plexusblocks 223

see also cautions, drugcontraindications, childrencaudal epidural 90penicillin-based agents, rashreaction 88

contrimoxazole, essential painmedications 149 table

cosmic radiation exposure 132counselingpain/stress cycle 148pregnant women, radiationsickness 136

provider 53country/destination

informationdrugs, legal position 16–17first aid capacity 19logistics 11–13useful websites 15see also culturalconsiderations

COX-2 inhibitors, selective (anNSAID), combatenvironments 146

CPAP (continuous positiveend-expiratory pressure)83, 86

cranio-cerebral wounds,penetrating

prophylaxis 23 tablewound closures 28

creatinine levels, pre-operativetesting 97

criminal activity, aftermathsecurity 178–179

critical care delivery, masscasualty events 60–65

administrative director,supply chain 62

biomedical engineers 62cautions, responders 61

chronically critically illpatients 63–64

clinical staff shortages 62critical care team leader(CCTL) 61

data collection factors 64disaster logistics 11–13,61–62

disaster medicalresponders 61

disengagementpreparation 61

equipment supply chain 62essential emergencyequipment list 62

ethics 63–64longer-term adaptation 64post-disaster hand-off 64pre-planning 60–61provider alignment 61quality improvementfactors 64

rationing 63–64responder training 61responder/local staffrelationship 61

security staff supply 62supply chain 62supply chain, pharmacy213, 220

support service staffsupply 62

systems planning 62–63triage care decisions 63–64triage principles 63–64see also hospital plans

critical care team leader(CCTL) 61

critical incident stressdebriefing(CISD) 120

crush syndrome 2, 3 boxcryoprecipitate, powder form

drugs 11crystalloid solution, fluid

managementcaution 21children 74thermal injuries 57

cultural considerationsanesthetist role 1disaster concept 1logistics 11–13nerve blocks, peripheral146–147

priorities 3 box

skin color, markingissues 234

triage 63–64VAS (visual analogscore) 143

working hours 2–4currency/money, aftermath

security 179cyclizine, essential pain

medications 149 tablecyclizine, WHO Model List

144–146cyclooxygenase-2 (COX-2)

selective inhibitor (anNSAID), combatenvironments 146

cytokine therapy, radiationinjuries 137

Dalton’s Law 106damage control resuscitation

21, 57damage control surgery 24–25dantrolenechildren, malignanthyperthermia 87

children, peri-operativedosing 88 table

transporting 16–17data collection 64Da Costa’s syndrome 116dead, definition 73 tabledebridement, radiation

injuries 139debridement, serial 28decontaminationchemical exposures 130flammable metals 130gastrointestinal radiationexposure 137

vs lifesavinginterventions 130

personal protectiveequipment 141

planning 50protocols 328 tableradiation injuries 132reactive decontaminationskin lotion (RDSL) 130

and resuscitation 141toxic injuries 128–130

defense techniques 181deferoxamine, radiation

injuries 136dehydrationchildren 74

Index 339




dehydration (cont.)cold injuries, high-altitudephysiology 112

earthquake scenario 2high-altitude physiology 112hypovolemic shock 21

delirium, emergenceketamine anesthesia 35,38

ketamine with propofol 36midazolam 85

demographics 60children, disaster setting 3fig, 14

disaster scenarios 14high-altitude physiology 107LMICs 60

dependence prevention,opioids 146

deployment preparation 14–17disaster scenario types 14DMAT gear checklist244–258

equipment, medicalspeciality specific 17

equipment, personal 14, 17equipment organizational 17family care, while you areaway 16

insurance 16, 182medication transport 16–17personal qualities/health 14personnel, roles 14reconnaissance andintelligence 15

revision 15security situation,specific 183

training requirements 15deployment trainingsee also training, deployment

depressionacupuncture 148children, disaster-induced124

chronic pain 148major 116

desflurane, children 85desflurane vaporizerboiling point hazard 115vaporizers, high-altitudeeffects 114

developmental issues, children39, 69 table

dexamethasoneacute mountain sickness 108


children, standardmedications 92 table


HACE 110pharmacy, disasterresponse 218

WHO Model List 144–146dexmedetomidine, children,

difficult airways 82dextrose, and normal saline

(NS) 215dextrose, children, standard

medications 92 tabledextrose, fluid management 74diabetes, type 2 prevalence 97diagnostic technologies, supply

challenges 20, 63diarrheal disease prevention,

checklist 176diarrheal illness, children,

disaster risks 69 tablediazepamchildren, ketamine co-administration 38


nerve agent poisoning131–132

prior to ketamine 8, 35as standard 24 figWHO Model List 144–146

diazepam caution 8digital block 224 table, 233diluting agents, radiation

injuries 136dilution bottles, concentrated

drugs 12 figdimercaprol, chemical

exposures 131dinitrous oxide (laughing gas),

cautions 9diphenhydramine, children,


diphenhydramine, psychiatrictherapy 121

disability insurance 16disabled patients, critical care

delivery 63–64disaster anesthesia, in

literature 2see also anesthesia challenges

disaster definitions 1, 116

disaster management goal 50disaster management, training

requirements 51disaster medical assistance

teams (DMATs)Great East Japan Earthquake2011 197

pre-operative laboratorytesting standards 96–98

disaster medicine 1disaster threats, effects 148disaster variables, anesthetic

pharmacy 213dissociation symptom 119dissociative anesthetic state 34distraction techniques,

children 85diuretics, HACE 110dizziness, essential pain

medications 149 tableDMATs (disaster medical

assistance teams)gear checklist 244–258Great East Japan Earthquake2011 197

pre-operative laboratorytesting standards 96–98

DMSA (dimercaptosuccinicacid), heavy metalsexposure 131

DNA damageionizing radiation 157mustard (bis-(2-chloroethyl)sulfide) 131

neutron particleradiation 132

radiation injuries 133radiology 157

documentation challenges seeunder patientdocumentation

dopamine, children, peri-operative dosing 88 table

dosimeters, personal, radiationinjuries 132

doxycycline, essential painmedications 149 table

Draeger Fabius Tiro “M” 43,45 fig

draw-over vaporizersadvantages anddisadvantages 44–45

anesthetic pharmacy,disaster response 216

basic mechanism 9, 87definition 87

340 Index




Gegel–Mercadomodifications 46

safety concerns 44–45training suggestions 47

dressings, honey/sugar 29dressings, vacuum-assisted 27drinking water treatment

176–177drug cautions see cautions,

drugdrug concentrationsdilution bottles 12 figMEC (minimum effectiveconcentration) 221

MEC 90 anestheticconcentrations 221 table

WHO guidelines 11drug lists, essentialanalgesia, children 74 table,92 table

analgesics 149 tableantibiotics, war woundsprotocol 23 table

children, anesthetics 92 tablechildren, rescue drugs 87, 88table

cytokine therapy, radiationinjuries 139 table

local anesthetic MECs 221table

local anesthetic MEVs 222table

normal saline 215pain medications 149 tableradiation injuries 138 tablesupply chain 62WHO Model List ofEssential Drugs 11

see also children, drugrecommendations

drug names,communications 214

drug properties, anesthetictriangle 5 fig

drug properties, bacterialgrowth 8, 214, 216

drug shortages see resourceconservation, anesthetics

drug storagerecommendations 214

drugs, fat emulsion caution 8drugs, legal positions 16–17drugs, powder form 11Dunant, Henry 184dural puncture, obstetric

anesthesia 209

duration variable, anestheticpharmacy 213

earthquakes 2effects 19–20electrolyte testing 97Haiti, high-pressureanesthesia machines 9

hygiene 19injury profiles 195–196Japan 2011, lessonslearned 204

non-violent risks 175–176pre-hospital anesthesia 10 figpsychiatrists, Haitiearthquake 2010 116

regional blocks 195standards, Haiti earthquake2010 189

see also OperationTomodachi

Ebola viral disease (EVD) 140Ebola epidemic, WestAfrica 11

Ebola guidelines 140fluid management 56

EC50, intermittent bolusing,epidurals 211

ECGs 63eclampsia, ketamine

anesthesia 35economic calamities, effects on

children 125ED50, obstetric anesthesia 209edema, soft tissue, wound

excision 28edema, soft tissue, wound

issues 29 figEDTA (calcium disodium eth-

ylenediaminetetraaceticacid), heavy metals expo-sure 131

elbow block 224 table, 233elderly patientsdisaster scenarios 3 boxgeneral anesthesia cautions9

supraclavicular block, MEV90 222 table

electricity supplyanesthetic pharmacy,disaster response 214

epidural pumps 211non-violent risks 175–176supply chain 63

electrolytes

laboratory testing, pre-operative 97

PoC testing 96electromagnetic radiation

waves 132elevator issues 204embassy permissions, narcotics

and sedatives 16–17emblem display see medical

emblem displayEM-DAT 116emergence deliriumketamine 35, 38ketamine with propofol 36midazolam 85

emergency communicationssee communications

emergency managementcommittee, psychiatrists117–118

emergency responders seepersonnel, roles;responders

Emergency System forAdvance Registration ofVolunteer HealthProfessionals (ESAR-VHP) 327 table

emotional bonds, families 125emotional distress, pain/stress

cycle 148emotional risks, children 69

table, 124endemic diseases, preparedness

15, 216endotracheal tubes (ETTs),

childrenairway management 80difficult airways 82

enflurane, children, drugrecommendations 86

engineer roles 175–176Enterobacteriaceae,


entry wound excision 26 figenvironmental issues 19–20biological disasters 141children, disaster risks 69table

disaster scenarios 20 figephedrinechildren, peri-operativedosing 88 table

local anesthetic dose 11epidemics 140–141

Index 341




epidural analgesialocal anesthetics 11obstetric labor 209polytrauma patient, painmanagement 146–147

epidural blood patches,obstetric anesthesia 210

epinephrinechildren, dosing 88 tablechildren, drugrecommendations 91

epidural, labor 209local anesthetic addition 147mental health effects,LAST 147

ePoC device 96equipment, listschildren, disaster setting 92table

deployment preparation 17DMAT gear checklist244–258

protective 175equipment, notesairway device selectionalgorithm 52

blunt-tip needles 223cannulas, vascular access 56children, anesthesia delivery92 table

citrated blood collectionsets 215

continuous catheters,peripheral nerve 196

difficult airways, children 82drug storagerecommendations 214

needle choice,regional anesthetics223–233

pain assessment tools 143peripheral nervestimulator 223

pre-operative testing 96–97syringes, continuous use 8syringes, pre-drawn 214Thorpe tubes, highaltitudes 114

vaccine storagerecommendations 218

vaporizer performance, highaltitudes 113–114

equipment failuresdinitrous oxide (laughinggas) 9

fallback anesthesia 86

equipment limitations,regional anesthetics 220,222–223, 224 table

equipment maintenance,importance of 63

equipment shortagesblunt-tip needledecisions 233

disaster scenarios 7–8drug choices 11mass casualty events 141,209

ultrasound guidance vsanatomical landmarks 10

erector spinae block 224table, 233

erythromycin, essential painmedications 149 table

erythropoietin, children, bloodconservation 84

ESRI, disaster-responsesupport 15

essential anesthesiaequipment and supplies(ICRC) 24 fig

essential drugs see drug lists,essential

eszopiclone, psychiatrictherapy 121

ether/scautions 9modern 43Morton 1846 44open drop ether 1983 45training requirements 9, 43

ethical dilemmascritical care delivery 63–64radiation sickness 135

etomidate, childreninduction agent 85standard medications 92table

etomidate, nerve agent (NA)poisoning 132

ETTs (endotracheal tubes),children 80

difficult airways 82evacuation insurance 16evacuation timescales 19evaluation, response

adequacy 53explosionsBoston Marathon bombing2013 60

closed room (high-pressure)trauma 3 box

improvised explosive devices57, 182–183

mass casualty events 57exposure see hypothermiaextreme altitude, definition 106extremity injuries 43extremity nerve blocks 224

tableeye injuries, penetrating,

prophylaxis 23 tableeye injuries, radiation

exposure, treatment 136eye movement desensitization

and reprocessing(EMDR) 120

eye surgery, nystagmuscaution 22

face, wound closures 28facemasks, patient see masks,

patient ventilationfailed intubation, guidelines

2015 48failure, anesthesia machine

9, 86failure, gas supply 86Falklands war, draw-over

vaporizers 45families/carers, working with

77, 124–126children, special needs 125communication issues 68economic calamity 125post-operative care 25, 29pre-operative anxiety,children 77

rehabilitation care 25relatives, blood donations 84special needs children 125

family care (responderfamily) 16

fascia iliaca (FI) block 224table, 233

fascial-plane blocks, needlechoice 233

fasciotomy, wound excision 26fat emulsion, drugs in 8,

214, 216fatigue, acupuncture 148FDA (US Food and Drug

Administration)acute stress disordermedication 121

draw-over vaporizers, safetyrequirements 45

plasma, freeze-dried 215

342 Index




Federal CommunicationsCommission (FCC) 164

femoral block 224 tableblunt-tip needles 233MEC 90 concentration 221table

fentanyl 210and ketamine mixes 33pharmacy, disasterresponse 218

fentanyl, childrendosing 74 tableperi-operative dosing 88table

standard medications 92table

fentanyl caution, nerve agent(NA) poisoning 132

fentanyl derivatives, synthetic,metabolic poisons 132

fetal demise risk, possibleconditions 207 table

fever, wound issues 29 figfiberoptic scope, disposable 82fibromyalgia, acupuncture 148field hospital organizationanesthesia 2, 11–13hygiene 19–20operating tables peranesthesia 2–4

see also under ICRC hospitalfield machines, inhaled

anesthetics 43see also draw-overvaporizers; inhaledanesthetics

filgrastim (G-CSF), radiationinjuries 139 table

filters, water 176–177fire accidents 2children, risks 69 tablepsychiatric grief 116see also burns surgery;thermal injuries

firefighters, chemicalexposures 131

flammable metals,decontamination 130

fluconazole, radiationsickness 137

fluid management 55–58chemical exposures 131children 74crush injuries 56–57epidemics 57–58explosions 57


preparedness, emergency57–58

rehydration, oral,lifesaving 57

thermal injuries 57vascular access 56

fluid resuscitation goal 56fluids, mass casualty events

55–58fluoroscopy and interventional

radiology 159–160fluoxetinepsychiatric therapy 121WHO Model List144–146, 214

foreign bodies, woundexcision, initial 26

formula, modified Brooke 57formula, modified

Parkland 57fractional atmospheric

oxygen 106fracture fixation 28fractures, wound excision 26freeze-dried plasma, FDA (US)

position 215freezer shortages, drug

choices 11fridge shortages, drug

choices 11frostbite, definition 111fuel shortagesAfghanistan, 1990 12Operation Tomodachi 204oxygen logistics 12

Fukushima nuclear plantdisaster 202


full stomach assumption 5,132, 137

functional residual capacity(FRC), neonates andinfants 81

fungal infections, radiationsickness, prophylaxis 137

furosemide, childrenhyperthermia, malignant87


future issues, ketamine 39future research, pain

assessment 143, 148

GA (tabun) nerve agentpoisoning 131–132

gabapentin, nerve injury 146gabapentin, neuropathic

pain 146games, for children 126gamma rays 132Gamow bag, high altitudes

109, 110gas gangrene, epidemiology

18–19gas gangrene, wound issues

29 figgas supply failure, fallback

anesthesia 86gas tragedy, Bhopal, India 1984

2, 48, 60gastric emptying decisions 5,

132, 137gastrointestinal radiation

exposure, gutdecontamination 137

gastrointestinal syndrome,radiation sickness 133,135, 136, 142

GB (sarin) nerve agentpoisoning

effects 131–132emergency airwaymanagement 48

weapons 49G-CSF (Filgrastim), radiation

injuries 139 tableGD (soman) nerve agent

poisoning 131–132general anesthesia 8–10Geneva Convention (GC)

184–189Additional Protocol I 184,185–186

Additional Protocol II184, 187

Additional Protocol III 186arming medical personnel186, 187

Articles 55 and 56 185current/future challenges187–189

Customary InternationalLaw (CIL) 185

international conflictprotection 185–186

non-international conflictprotection 187

protocols 184–185genitals, wound closures 28

Index 343




gentamycin/gentamicinchildren, standardmedications 92 table



war wounds 23 tableglycopyrrolatechildren, drugrecommendations 88, 92table


hyperthermia risk 35ketamine premedication 35standard medications 92table

glycopyrrolate, sialorrhea,children, drugrecommendations 85

GM-CSF (sargramostim),radiation injuries 139table

gold standard, anestheticpharmacy 213

gold standard, painassessment 143

golden hour 55golden mixture 8GON (greater occipital nerve)

block 224 tableGoogle Maps 15Google searches 15governments, LMICs (low- and

middle-incomecountries), strategicrelations 60–61

Gram-negative infectionanesthetic pharmacy 217table


Gram-positive infectionanesthetic pharmacy 217table


Grays (Gy) 133Great East Japan Earthquake

2011 see OperationTomodachi

greater occipital nerve (GON)block 224 table

grief, acute 116Grotius, Hugo 184

guerrilla warfaredevelopments 184

guidelinesadvanced trauma lifesupport course 20, 128,131, 210–211

airway management 48blood transfusionguidelines 63

C-ABCDE algorithm,ATLS 20

chemical exposures,ATLS 131

children, fastingguidelines 76

difficult airways 48Ebola guidelines 140essential drugs, WHO 11failed intubation 48intra-partum platelet count,ASA 210–211

intubation, failed 48invasive surgery 25ketamine procurement,WHO 11

lidocaine procurement,WHO 11

nurse-driven care, shortagesituations 62

pain, MCEs 143waste disposal, WHO 63water supply 63WHO guidelines,concentrations, drug 11

see also protocols; standardsgut decontamination

procedure,gastrointestinal radiationexposure 137

gut flora, radiation effects 137

H5N1 epidemic, airwaymanagement 48

HACE (high-altitude cerebraledema) 109–110

Haemophilus influenzae B,radiation injuries 137

Haiti earthquake 2010 9, 116,189, 195

halothaneboiling point hazard 115children 86essential pain medications149 table

general anesthesia 8WHO Model List 144–146

hams see communications,amateur radio

hand cranks, mobile devicecharging 126

hand injury, chemicalexposures 131

HAPE (high-altitudepulmonary edema) 109

harm to others, psychiatrictriage status 119

Hartman’s solution, fluidmanagement 74

hazard analysis-riskassessments 48

hazardous anesthesia, high-altitude 112

hazardous equipment, draw-over vaporizers 47

hazardous materials(HAZMAT) suits 49

head and neck blocks 224 tablehead injury, ketamine

anesthesia 35head injury, prophylaxis 23

tablehealth disaster 1healthcare communications see

communicationshealthcare providers, radiation

injuries 132healthcare providers, sleep 7–8healthcare providers, stress

50–51heat variations, drug

cautions 11heavy metals exposure 131hematopoietic syndrome 133,

134–135, 137, 142Hemocue, PoC device 96hemodynamically unstable

patients, anestheticchoice 8

hemodynamics, midazolameffect 38

hemoglobin, testing 96, 97hemothorax, prophylaxis 23

tablehepatitis, drinking water

treatment 176–177HF (high-frequency) radio

wavebands 166HI-6 treatment, nerve agent

poisoning 131–132HICS (hospital incident

command system) chart326 table, 326

344 Index




high altitude, definition 106high-altitude physiology

106–115acute adaptation to highaltitude 107

acute mountain sickness108–109

basic science 106cold injuries 110–112dehydration 112demographics 107descent vs treatment110, 112

effects summary 106, 107Gamow bag 109, 110HACE 109–110HAPE 109hyperventilation 107hypothermia 110–112longer-term adaptation 107pathophysiology, patient 108pathophysiology,providers 108

rewarming 111rewarming, rapid 111standard lapse rate, ambienttemperature 110

treatment, cold injuries 111high-altitude physiology,

anesthetic management112–115

caveats 115flow meters 114oxygen logistics 112pharmacology 113regional anesthesia 113risk and difficulty levels 112vaporizer performance113–114

high-pressure draw-overmachines see draw-overvaporizers

high-pressure injections, nerveinjury 147

high-pressure oxygendinitrous oxide (laughinggas) 9

oxygen sufficiency 12–13high-pressure trauma

(explosions in closedrooms) 3 box

Holliday and Segar, fluid ratecalculation, children 83

homicidality, psychiatric triagestatus 119

honey dressings 29

hospital communications seecommunications

hospital incident commandsystem (HICS) chart 326table, 326

Hospital Pediatric DisasterPreparedness Checklist,Draft Connecticut AcuteCare 326–329

hospital plans 13analysis paralysis 50ICRC hospital, Kabul 7 figKabul 1992 4 figlogistics 11–13strategic thinking 2–4tactical approach 7–8see also airway management,mass casualty events;critical care delivery, masscasualty events;preparedness

hostage crisis, MoscowDubrovka Theater2002 51

hostage insurance 182hostage situation, responder

checklist 181–182Hotline, fluid warmer 84household bleach, drinking

water treatment 176–177HSV (herpes simplex virus)

infection, radiationsickness, infectionprophylaxis 137

Hudson mask 37human physiology, high-

altitude effect 106, 107human trafficking risks,

hotline 126humanitarian aid workers see

security, responder/aidworker

humanitarian principles 188Humanitarian Space Working

Group 189Hurricane Andrew, 1992,

media image effects 124Hurricane Harvey, 2017pre-operative testing210–211

responder self-care 208supply chain 208

Hurricane Katrina, 2005obstetric decisions 208psychiatrists 116

Hurricane Maria, 2017 213

hydralazine, HAPE, pulmonarypressure reduction 109

hydration see fluidmanagement

hydration, fluids and access,mass casualty events55–58

hydration, mass casualty events55–58

hydrocortisone, WHO ModelList 144–146

hydrogen cyanide (HCN),metabolic poisons 131

hydrogen fluorideexposure 131

hydrogen sulfide (H2S),metabolic poisons 131

hydromorphone, childrenperi-operative dosing 88table


hydroxyzine, psychiatrictherapy 121

hygiene challengeschallenges 147epidurals 11radiation injuries 136syringes 8, 214

hyperalgesia, opioid-induced,prevention 146

hyperbaric bupivacaine,obstetric anesthesia209

hyperbaric bupivacainehydrochloride, obstetricanesthesia, notavailable 209

hyperbaric oxygen therapy,carbon dioxideexposure 131

hypercarbia, in highaltitudes 113

hypermetabolic stress,nutritional support 137

hypersalivation caution,ketamine 10, 34, 35

hypertensive disorders,pregnant women,Hurricane Katrina 208

hyperthermia (too hot) 3 boxhyperthermia, malignant,

children 86–87hyperthermia risk, atropine 35hyperthermia risk,

glycopyrrolate 35

Index 345




hyperventilation, coldinjuries 112

hyperventilation, high-altitudephysiology 107

hypobaric illnesses seehigh-altitude physiology

hypocalcemia monitoring 131hypotension, due to blood

loss 2hypotensive resuscitation,

competing anesthesiachallenges 8

hypothermia (too cold) 3 box,111

bleeding patients 20children, during surgery 78high-altitude physiology110–112

rubble victims 20hypovolemic shock,

dehydration 21hypovolemic shock, thermal

injury 57hypoxemia, cold injuries 112hypoxemia, high-altitude

physiology 113hypoxic pulmonary reflex,

ketamine anesthesia 8

IBS (irritable bowel syndrome),acupuncture 148

ibuprofenessential pain medications149 table

WHO Model List 144–146ibuprofen, childrendosing 74 tableperi-operative dosing 88table


ICBN (intercostobrachialnerve) block 224 table

ICRC (InternationalCommittee of the RedCross)

American 125antibiotic protocol, warwounds 23 table

founders 184humanitarian principles 188provider alignment 61

ICRC hospital, Kabul 4 fig, 4, 5,7 fig, 10 fig

ICRC hospital, Khao I Dang 6fig, 10 fig

ICU (intensive care unit)availability 24–25

ideal anesthetic pharmacy,disaster response 213

IDSA (Infectious DiseaseSociety of America),immunizationprotocols 137

IEDs see improvised explosivedevices

IFRC (International Federationof Red Cross and RedCrescent) 186, 188

I-gel LMA device 50ileus 146illness risks in disasters,

pediatric 69 tableimipenem, radiation

sickness 137immobilization event, Moscow

Dubrovka Theater2002 51

immune compromise,radiation injuries 137

immunization protocols 137impartiality 188improvised explosive devices

(IEDs)aftermath security 182–183terrorist events 57

Indian Ocean tsunami,psychiatrists 116

induction, intra-muscular10–11

induction agents, children85–87

industrial disasters, emergencyairway management 48

infantscatheter size 79central venous line, size anddepth 79

dextrose 74endotracheal tube sizing 80fluid management 83–84functional residualcapacity 81

hypothermia duringsurgery 78

laryngeal mask airways 82laryngoscopes 81, 82mask ventilation 80neuromuscular blockingagent sensitivity 87

pressure controlventilation 83

supplies list 331warming systems 84

infected wounds, operatingcycle 28

infections, bacterial,medications 149 table

infections, risk conditions 207table

infections, superficial, aceticacid 29

infections, with radiationinjuries 136

Infectious Disease Society ofAmerica (IDSA),immunizationprotocols 137

infectious diseases, fluidmanagement 56

infectious diseases, prevention176–177

infective process odors 28inferior alveolar nerve block

224 tableinfiltration, local anesthetics 11inflammation, medications 149

tableinformed consent,

adolescents andteenagers 126

infraclavicular block224 table

MEV 90 volume 222 tableinfrastructure, destruction

effects 3 box, 11–13,19–20

inhaled anesthetics 42–44children 85–86essential pain medications149 table

ether/s 9, 43, 44field machines 43see also draw-over vaporizers

inhaled poisons 131in-hospital transport

challenges, OperationTomodachi 204

injections, high-pressure, nerveinjury 147

injury profile, earthquakes195–196

injury risks, children 69 tableinsomnia symptom 119International Committee of the

Red Cross see ICRCinternational conflict

protection 185–186

346 Index




International CriminalCourt 185

International Federation ofRed Cross and RedCrescent (IFRC) 186, 188

international humanitarian law(IHL) 184–189

challenges 184, 187–189Customary InternationalLaw 185

Geneva Convention 184–185international conflictprotection 185–186

international treaties184–185

NGO initiatives 188non-international conflictprotection 187

protection, humanitarian-based medical services185–187

standards 189interscalene nerve block 224

tableMEV 90 volume 222 tableneedle choice 223–233

intra-cranial pressure,ketamine anesthesia 35

intra-muscular induction 10–11intra-osseous insertioncannulas 56children 79fluid resuscitation 56, 58intravenous lines 10PPE difficulties 130

intravenous access, masscasualty events 55–58

children 10–11, 79–80, 92table

see also intra-osseousinsertion

intravenous anesthesia seeTIVA

intravenous fluids, coldinjuries 111

intravenous fluids, supplychain 62

intravenous lines 10–11intubation, failed, guidelines

2015 48intubation, rapid sequence 5, 12invasive surgery, guidelines 25iodine, drinking water

treatment 176–177ionizing radiation, DNA

damage 157

Iraq, nerve blocks, non-sterilesetting 147

iron supplementation,children, bloodconservation 84

isobaric bupivacainehydrochloride 209

isocyanate exposure 130isocyanate gas leak 1984 2, 48isofluraneboiling point hazard 115children, drugrecommendations 86


general anesthesia 8WHO Model List 144–146

isolation procedures, biologicaldisasters 140, 141 table

isolation rooms, biologicaldisasters 140

isotonic saline 55–56iStat, PoC device 96

Japan 2011, Great East JapanEarthquake 128

Fukushima nucleardisaster 202

tsunami 19, 60, 191–193,196, 202


Japanese Red Cross 2011,volunteer responders 197

joints, wound closures 28judgment, high-altitude effects

on 108jugular vein access, intravenous

lines 10

K+ cautions 56Kabul, ICRC hospitaloperating tables peranesthesia 4, 4 fig

pulmonary shunting 7 figstomach emptying 5TIVA 10 fig

Kellenberger, Jacob 185ketamine 22, 24 fig, 33advantages 33, 35, 42, 45, 215blood-pressure effect 8co-administered withpropofol 36

disadvantages 8, 9, 34, 35fallback anesthesia 86general anesthesia status 8

head injury 35high-altitude physiology 113hypersalivation caution 10,34, 35

monitored anesthetic care(MAC) 195

muscle-relaxing drugs for 9,10 fig, 22

narcotic issues 16–17, 39nerve agent poisoning131–132

obstetric anesthesia 208and pentazocine 8post-operative analgesia 22procurement concentrationguidelines 11

respiratory effects 8as standard 24 fig, 149 tablesubanesthetic doses, combatenvironments 146

with thiopental 8with volatile anesthetics 9WHO Model List 144–146see also children, ketamine

ketamine, children seechildren, ketamine

ketamine, TIVA (totalintravenous anesthesia) 9,10 fig, 33–38

advantages 33, 35boluses, intermittent 37–38cardiovascular effects 34central nervous systemeffects 35

children 38–39disadvantages 9, 34dissociative anestheticstate 34

emergence phenomena35, 38

future issues 39hemorrhagic shock 33hypovolemic shock 38infusion 36–37intra-cranial pressure 35mix potential 33muscle tone effects 35–36pharmacodynamics 34pharmacokinetics 34practicalities 36–38pre-medications 35with propofol 36PTSD prevention 35pulmonary hypertensionpatients 35

respiratory depression 9

Index 347




ketamine, TIVA (cont.)respiratory effects 34–35special scenarios 38–39

ketorolac, childrendrug recommendations 87,92 table


kidnapping, preventionchecklist 179–181

kidney wounds, prophylaxis 23table

laboratory monitoring,radiation sickness 136

laboratory testing, pre-operative 96–98

arterial blood gasanalysis 98

blood glucose levels 97coagulation testing, PoC 98DMAT standards 96equipment selectionconsiderations 96–97

hemoglobin 97Hurricane Harvey 210–211obstetric anesthesia 210–211PoC testing 96urea, creatinine andelectrolytes 97

labor, women in see obstetricanesthesia

language barriersLAST issues 147pain management 143,146–147

visual analog score 143laparoscopic surgery 25lapse rate, standard, cold

injuries 110laryngoscopes, children 81, 82LAST (local anesthetic

systemic toxicity) 147,223, 233

law enforcementbreakdowns 178

laws, local, scheduled drugs 218laxatives, gastrointestinal

radiation exposure 136lead (Pb) exposure, therapy 131legal liability, personal 16levobupivacaine and lidocaine

mix, MEV 90 volume 222table

levofloxacin, radiationsickness 137

lewisite (2-chlorovinyldichloroarsine), chemicalexposures 131

LFCN (lateral femoralcutaneous nerve) block224 table

lidocaine 209epidural, labor 209essential pain medications149 table

local anesthetictechniques 11

MEC 90 concentration 221table

MEV 90 volume 222 tablepost-dural punctureheadache 210

procurementconcentration 11

tachyphylaxis 209WHO Model List 144–146

lidocaine, childrendrug recommendations 91,92 table


lidocaine and levobupivacainemix, MEV 90 volume 222table

lidocaine and ropivacaine,obstetric anesthesia 210

Lifebox project, pulseoximeters 77

lifesaving interventionsvs decontamination 130intra-osseous cannulas 56oral rehydration 57SALT triage steps 71–73SGAs 50see also resuscitationnotes

lifts, electricity issues 204limb damage, prevalence

18–19liver wounds, prophylaxis 23

tableLMAs (laryngeal mask

airways) 82LMICs (low- and middle-

income countries)analgesic availability 145critical care rationing 63–64demographics 60muscle-relaxing drugavailability 6

post-disaster hand-off 64

pre-disaster planning in60–61

strategic relationships 61surgery standards 18triage 63–64

local anesthetic systemictoxicity (LAST) 147,223, 233

local anesthetics 11, 42anesthetic pharmacy,disaster response 218

central blocks 11epidural 11essential pain medications149 table

infiltration 11MEC 221 table, 221MEV 221, 222 tablemulti-modal painmanagement 146

obstetric anesthesia 210pain management choice 147pharmacy, disasterresponse 218

regional blocks 11sedation recommendations221–222

spinal blocks 11wound infiltration,local 147

see also nerve blocks,peripheral; regionalanesthetics; specific localanesthetics; specific nerveblocks

location variables,anesthetic pharmacy213, 216

logistics, disaster 11–13critical care delivery 11–13,61–62

infrastructure constraints3 box, 11–13, 19–20

see also oxygen logisticsLonely Planet 15looting 178lorazepam, psychiatric

therapy 121low- and middle-income

countries see LMICslower extremity nerve blocks

224 tablelungs, radiation exposure

treatment 136lymphopenia, radiation-

induced 139

348 Index




machine failure, fallbackanesthesia 86

Macintosh laryngoscope blade,children 81

magnesium citrate,gastrointestinal radiationexposure 136

magnesium sulfate treatment,nerve agent poisoning131–132

magnetic resonance imaging(MRI) 162

maintenance anesthesia,children 86–87

maintenance drugs, anestheticpharmacy 215–216

malaria testing, DMATstandards 96

malignant hyperthermia,children 86–87

malpractice insurance 16mannitol, childrenmalignant hyperthermia 87peri-operative dosing 88 table

mannitol, fluidmanagement 56Mapleson circuits 82–83masks, patient ventilationbag-mask 50children 80, 85Hudson mask 37laryngeal mask airways 82

Maslow’s hierarchyof needs 15

mass casualties, civilian life 2mass casualties, definition 19mass casualty events

(MCEs) 55crush injuries 56–57epidemics 57–58explosions 57fluid management 56fluid resuscitation 55–56operating room procedures,checklist 302–303

pain guidelines andprotocols 143

preparedness, emergency57–58

thermal injuries 57see also airway management,mass casualty events

mass communications,children 68

mass trauma, disaster and 2massive transfusion protocols

(MTPs), when irrelevant 21

master plans, hospital seehospital plans

material safety data sheets(MSDS) 131

maxillo-facial wounds 23 tableMCEs see mass casualty eventsMCN (musculocutaneous

nerve) block 224 tableMEC (minimum effective

concentration)local anesthetics 221table, 221

USGRA 222media images, psychological

effects 124, 148medical care standards 189medical checklists, post-

disaster hand-off 64medical emblem displayinternational conflictprotection 186

internationally accepted 186misuse levels 186non-international conflictprotection 187

war crimes against 185medical personnelinternational conflictprotection 185


war crimes against 185see also personnel, roles;security, responder/aidworker

medical services, protection,Geneva Convention (GC)185–187

medical transportchemical burns patients 131children, priorities 73 tableinternational conflictprotection 186


patient movement,Operation Tomodachi200, 204

war crimes against 186medical units, international

conflict protection 186medical units, non-

international conflictprotection 187

medication transportbottled oxygen 16–17, 216

dantrolene 16–17deployment preparation16–17

succinylcholine 16–17medications 144–146 see under

drugsmedications, personal 16Médicins Sans Frontières

(MSF, Doctors WithoutBorders) 14

provider alignment 61melatonin, children,

sleep routines 124–126mental health effects 30,

116–122acute phase assessment118–119

acute phase interventions119–121

acute stress disorder 121disaster definitions 116education, post-trauma121–122

hostage situation,responders 182

initial psychiatricsymptoms 119

local anesthetic systemictoxicity (LAST)issues 147

pain 144, 148, 149 tablepain/stress cycle 148personnel, roles 116pharmacological options121, 149 table

pre-disaster phase 117–118psychological first aid 120psychological impact 119PTSD descriptions 116radiation injuries,longer-term effects 140

threats, disaster/terrorism 148

trauma effects 116, 118urgent triage situations 119see also children; PTSD

mental health professionals 116mental health, responders

53, 117meperidineessential pain medications149 table

WHO Model List 144–146mepivacainecaution, obstetricanesthesia 209

Index 349




mepivacaine (cont.)MEC 90 concentration 221table

MEV 90 volume 222 tablemetallic fragments, wound

excision 26metallic ions, removal from

circulation 136methadone, WHO Model List

of Essential Drugs144–146

methane exposure 130methyl isocyanate tragedy,

India 1984 2metronidazoleanesthetic pharmacy,disaster response 217 table

brain abscess 23 tablechildren, standardmedications 92 table



MEV (minimum effectivevolume)

local anesthetics 221, 222table

USGRA 222midazolamcardiovascular effects 34hemodynamic effects 38and ketamine 33, 38pain medications, essential149 table

premedication doses 33, 37respiratory depression 35WHO Model List 144–146

midazolam, childrenemergence delirium 38, 85peri-operative dosing 88table

pre-operative anxiety 77respiratory depression 35standard medications 92table

Middle Eastern countries, legalposition, drugs 16–17

middle-income countries seeLMICs

military responders, provideralignments 61

Miller laryngoscope blade,children 81

minor injuries, transportpriorities 73 table

mirtazapine, psychiatrictherapy 121

mobile devices, charging 126mobilizing agents, radiation

injuries 136Model List of Essential Drugs,

WHO 144–146modified Brooke formula 57modified Parkland formula 57money/currency, aftermath

security 179monitoring patientsASA basic standards 77block placement, vital signs221–222

challenges 147limitations 8, 220, 221–222local anesthetic 147radiation sickness 136see also children, monitoring

Monster Guard app 125mood dysregulation

(irritability) symptom 119morphineessential pain medications149 table

and ketamine mixes 33pharmacy, disasterresponse 218

WHO Model List 144–146morphine, childrendosing 74 tableperi-operative dosing 88table


morphine cautionsHAPE 109morphine solutions 218nerve agent poisoning 132

Morton 1846, ether/s 44Moscow Dubrovka

Theater 2002, hostagecrisis 51

MTPs (massive transfusionprotocols), whenirrelevant 21

muggings, aid workerresponders 178

multi-dose vials, resourceconservation 209

multiple-casualty incident 19muscle debridement, wound

excision 25muscle-relaxing drugsfor ketamine 9, 10 fig

LMIC availability 6muscle relaxants 216recurarization threat,managing 5

as standard 24 figvolatile anesthetics 9

muscle tone effects, ketamine35–36

musculocutaneous nerve(MCN) block 224 table

musculoskeletal disorders 148mustard (bis-(2-chloroethyl)

sulfide) exposure 131Myers solution 56myoepithelial flaps 30

naloxone, children, peri-operative dosing 88 table

naloxone, opioidintoxication 132

narcotic issuesketamine 39legal positions 16–17

narcotization, neonates,avoiding 87

National Comorbidity Survey,US 118

National Human TraffickingResource Center 126

natural biologic events,emergency airwaymanagement 48

natural disasters vs armedconflict 18

nausea, essential painmedications 149 table

naval tragedies 2neck, wound closure

recommendations 28necrotic tissue, operating

cycle 28Neisseria meningitidis vaccine,

radiation injuries 137neomycin, oral,


neonatesaccess, peripheral 79catheter size 79central venous line, size anddepth 79

central venous lines 79child-specific supplies,list 331

dextrose, fluidmanagement 74

350 Index




endotracheal tube sizing 80fluid management,dextrose 74

functional residualcapacity 81

hypothermia duringsurgery 78

laryngeal mask airways 82laryngoscopes 81, 82mask ventilation 80mepivacaine, caution,obstetric anesthesia 209

neuromuscular blockingagents, sensitivity 87

obstetric anesthesia 208opioid predictability 87pressure controlventilation 83

warming systems 84neostigmine, childrenblocking reversal 88peri-operative dosing 88table


nerve agent (NA) poisoningadvanced potency 132weapons 49, 131–132

nerve blocksmajor nerves, blunt-tipneedles 233

MEC 221 table, 221modern developments 220non-sterile setting 147sharp-tipped needles 233

nerve blocks, peripheral146–147

pharmacy, disasterresponse 218

polytrauma patient,pain management146–147

see also local anesthetics;regional anesthetics

nerve injury, high-pressureinjections 147

nerve injury, primary,multi-modal painmanagement 146

nerve lesions, tendon transferfor, electivereconstruction 30

nerves, hand, wound closurerecommendations 28

nerves, severed, woundexcision 26

nervous system see centralnervous system

nervous system syndrome,radiation sickness133, 135

neuraxial blocks, essential painmedications 149 table

neuraxial obstetric anesthesia/analgesia 208

neuraxial opioids, obstetricanesthesia 209

neuraxial placement, avoiding,obstetric anesthesia 211

neuropathic painessential pain medications149 table

multi-modal painmanagement 146

neuropathic pain, chronic,antiepileptics 146

neurotoxins see nerve agent(NA) poisoning

neurotoxins, advancedpotency 132

neurotrauma, normal saline(NS) 215

neutrality, humanitarianprinciples 188

neutron particle radiation 132Newtown shooting

disaster 117next-line therapy

recommendationsobstetric anesthesia 209Society for ObstetricAnesthesia andPerinatology 209

NGOs (non-governmentalorganizations)

LMICs, strategic relations60–61

non-violent risk assessments175–176

provider alignment 61nifedipine, HAPE 109nitric oxide (NO), HAPE,

pulmonary pressurereduction 109

nitrogen exposure 130nitrogen oxides exposure 130nitrous oxidechildren, drugrecommendations 85


high-altitude physiology 43

high-altitude physiology,anestheticmanagement 112

WHO Model List 144–146NMDA (N-methyl-

D-aspartate) receptorantagonists 146


non-sterile setting, nerveblocks 147

non-steroidal anti-inflammatory drugs 146

normal saline (NS), propertiesand uses 215

normocarbia, in highaltitudes 113

Norway shootout, 2011 1Norwegian Armed Forces,

dinitrous oxide (laughinggas) 9

Novichok exposure, UK2018 132

NSAIDs (non-steroidal anti-inflammatory drugs)

COX-2 146ibuprofen 144–146, 149 tableibuprofen, children 74 table,88 table

nuclear blast, following 132rehydration 57

nuclear disaster, Fukushima2011 202


nurse anesthetists 212nurse-driven care 62, 220nurse-to-patient ratio 62nutrition, radiation

injuries 137nutritional support,

hypermetabolic stress 137

obidoxime treatment, nerveagent poisoning 131–132

obstetric anesthesia 207–212alternative therapies 211bolusing 209cautions, bolusing 210cesarian sections,elective 211

continuous spinals 209disaster scenario perspective207–208

dural puncture 209epidural, labor 209

Index 351




obstetric anesthesia (cont.)epidural blood patches 210epidurals 208high-risk pregnancycases 208

Hurricane Harvey 208Hurricane Katrina 208intermittent bolusing,epidurals 211

next-line therapyrecommendations 209

obstetric hemorrhageprevention 211–212

peripheral nerve blocks 211personnel, roles 212post-dural punctureheadache 210

pre-operative testing210–211

pudendal nerve blocks 211rapid induction/anestheticdelivery 208

TAP (transversus abdominisplane) block 210

obstetrics knowledge,deployment training 15

odors, infective process 28odors, volatile agents, child

distraction 85Office of US Foreign Disaster

Assistance (OFDA) 116Ohmeda Universal Portable

Anesthesia Complete(UPAC) draw-overdevice 45

olanzapine, psychiatrictherapy 121

ondansetron, childrenperi-operative dosing 88table


one man deep anesthesiateams 7–8

operating cycle, infectedwounds 28

operating room arrangements2–4, 4 fig

operating room essentials,patient management 7

operating room procedures,checklist 302–303

operating tables per anesthesia2–4, 7

operating temperature, traumapatients 20

Operation Smile 14Operation Tomodachi 191–205air-handling systems,contamination 203, 204

casualty load assessment195–196, 199–200

communication challenges193–195

disaster scale 191–193,202

electricity supply 202, 204evacuation scale 193,198–199, 200, 202

food supply, patient/staff201, 204

fuel shortages 204Fukushima nucleardisaster 202

hospital facilities 198hospitals availableimmediate action,earthquakes 198–199

in-hospital transportchallenges 204

initial response 193injury profile 195–196intra-operative management199–200

ketamine generalanesthetic 195

lessons learned 204–205operating room during anearthquake 199

oxygen supply 200–201,204

patient movement andtransport 200

personnel, roles 196–197preparedness, nucleardisasters 203

regional anesthetics 195water supply disruption200

opioid intoxication, severe132

opioid therapyanalgesic availability,low–middle-incomecountries 145

avoiding 222–223children, pre-operativeanxiety medication77

clonidine adjunct 146complication prevention146

disadvantages 220disaster responsepharmacy 218

high-altitude physiology,anestheticmanagement 113

importance 145ketamine adjunct 34multi-modal painmanagement 146

nerve agent poisoning 132new formulations 146respiratory depression113, 132

self-administered, painmanagement, combatenvironments 146

oral analgesicsessential pain medications149 table

self-administeredopioids 146

oral rehydration 57see also fluid management

oral saline solution, shocktreatment 56

organ failures 2organization variable,

anesthetic pharmacy 213organophosphate toxidromes

131–132osmotic laxatives,


overstaffing, responders,volunteer 327 table

oxime treatment, nerve agentpoisoning 131–132

oxygenessential pain medications149 table

hyperbaric, carbon dioxideexposure 131

lack of supplemental 9supplemental, HAPE 109vasodilating drugreduction 8

warmed, cold injuries 111WHO Model List 144–146

oxygen logistics 12–13airway management, masscasualty events 50

concentrators 16–17pulse oximeter 13, 77supply chain 62transporting bottled16–17, 216

352 Index




oxygen saturation levelschildren, assessing 72healthy patients 8minimum 12–13nerve blocks 147, 221–222pulse oximeter 72, 147

PACU (post-anesthesia careunit) 220

pain, as a disease process/pathology 143, 144

pain assessment 143, 148pain management 143–150acupuncture 148acute pain 148,149 table

challenges 143–144chronic neuropathicpain 146

chronic pain 146, 148combat environments 146early intervention 148essential pain medications144–146, 149 table

ketamine, combatenvironments 146

multi-modal approach 146neuropathic,antiepileptics 146

non-drug interventions146–148

polytrauma patient 146–147psychopathology oftrauma 148

self-administered, combatenvironments 146

treatment algorithm 145 figvolatile anesthetics 9

pain scores 143pain/stress cycle 148pancuronium-bromide (non-

depolarizing agent)LMICs (low- and middle-income countries) 6

oxygen saturation levels,minimum 12–13

pandemics 140–141paracetamol see

acetaminophenparasternal block/transthoracic

muscle plane block 224table

paravertebral block 224 tableparental roles see families/

carers, working withParis terrorist attack 2015 49

Parkland’s formula, burns,children 69 table

partial pressure for alveolaroxygen 106

particular radiation 132patient care instructions, post-

disaster hand-off 64patient comfort vs safety 2–4, 6

fig, 7–8patient documentation,

children 92 tablepatient documentation, nerve

block challenges 147, 220,233–234

patient flow, hospitals 2–4, 7,302–303

patient information, regionalanesthetics 220

patient management, flow-charts, in-hospital 7

patient monitoring seemonitoring patients

patient movement andtransport, OperationTomodachi 200

patient pain, self-reporting 143patient security, IEDs planted

on 183patient skin color, marking

issues 234patient-to-nurse ratio 5, 62PDPH (post-dural puncture

headache)obstetric anesthesia 210spinal anesthesia, high-altitude 113

peacetime effects, medicalemblems 186

PECS II block 224 table, 233Pediatric Assessment Triangle

(PAT) 71–73Pediatric Preparedness

Resource Kit, AAP 68pediatric risks in disasters 69

tablePEEP (positive end-expiratory

pressure)HAPE 109inhalation injuries 130

pegfilgrastim (PEG G-CSF),radiation injuries 139table

penetrating cranio-cerebralwounds, prophylaxis 23table

penetrating trauma 3 box

penetrating trauma, cranio-cerebral, prophylaxis 23table

penicillin, essential painmedications 149 table

penicillin, radiation sickness,prophylaxis 137

penicillin-G, war wounds 23table

penicillin-V, war wounds 23table

pentazocine, and ketamine 8pentazocine, with volatile

anesthetics 9perineal nerve blocks 211peri-operative medications,

children 88 tableperi-operative test see

laboratory testing, pre-operative

periosteum, wound excision 26peripheral nerve blocksessential pain medications149 table

obstetric anesthesia 211perineal nerve blocks 211polytrauma patient, painmanagement 146–147

ultrasound-guided 146–147see also regional anesthetics;specific local anesthetics;specific nerve blocks

peripheral nerve stimulator,cautions 223

permissions across countries16–17

personal medications,permissions acrosscountries 16

personal protective equipment(PPE) 62

biological disasters 140–141cannula placement 56, 57–58checklist 175chemical exposures 131and decontamination 141mass casualty events 130Precautionary Principle 140principles 141 tableprotective equipment,list 175

radiation injuries 132toxic injuries 128–130training requirements 49–50vascular access 57–58warm tents 57–58

Index 353




personnel, levels see staffshortages, clinical

personnel, rolesbiomedical engineers 62blood center management 84child-specific 92 tablecritical care team leader 61disaster psychiatry 117disaster scenario types 14familiarization process117–118

hospital plans,leaderships 326

mental health professionals116, 117–118

mental healthresponders 117

non-medical roles 175–176obstetric anesthesia 212pharmacists 16–17psychiatrists 116responder qualities 117security staff, supply chain 62

pesticide exposures 131–132pesticide plant accident,

Bhopal 1984 2, 48, 60pharmacists 16–17pharmacokinetics, low

temperature 110pharmacy, anesthetic 213–218analgesics and localanesthetics 218

antimicrobials 216–218challenges 213–214draw-over vaporizers 216drug storagerecommendations 214

electricity supply 214ideal anestheticpharmacy 213

induction and maintenancedrugs 215–216

intravenous fluids 215muscle relaxants 216normal saline 215pain medications, essential144, 149 table

plenum anestheticmachine 216

supply chain disruption 213surgery antimicrobials 217table

vaccines 218variables in disasterresponse 213

volatile anesthetics 216

WHO Model List 144–146see also under drugs;specific drugs, children,drugs

pharmacy, disaster responseideal pharmacy 213local anesthetic 218opioid pharmacy 218regional anesthetics 218

phenobarbital, WHO ModelList 144–146

phentolamine sublingualnifedipine, HAPE,pulmonary pressurereduction 109

phenylephrine, children, peri-operative dosing 88 table

phenytoinchronic neuropathicpain 146

essential pain me

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