Introduction
The attacks of September 11th 2001, followed shortly by the anthrax dissemination incident in Florida, the National Capital Region, and the New York metropolitan area (often referred to as Amerithrax), confirmed that the world faces a true threat of intentional mass casualty incidents caused by terrorism. Severe Acute Respiratory Syndrome (SARS), a re-examination of the 1918 Spanish Flu, and the currently evolving H1N1 influenza all emphasize the equally concerning threat from naturally occurring contagion. Recent experience from hurricanes and other extreme weather incidents (floods, tornados), and technological hazard incidents across the world, have added to the recognition that as a system, healthcare organizations must be prepared, resourced, and organized to respond to hazard impacts, regardless of their location. The diversity of potential hazard impacts may affect these systems in a multitude of ways that must be acknowledged and addressed by healthcare emergency managers.
According to the International Federation of Red Cross and Red Crescent Societies, internationally reported disasters in 2002 affected 608 million people worldwide and killed
24,532 well below the preceding decade’s annual average mortality of 62,000 (IFRC 2003). Many more were affected by myriad local disasters that escaped international notice.
Disaster has multiple and changing definitions. The essential common element of those definitions is that disasters are unusual public health events that overwhelm the coping capacity of the affected community. This concept precludes the universal adoption of a threshold number of casualties or victims. What would be a minor incident in a large country may constitute a major disaster in a small isolated island state. Not only are “quantitative definitions of disasters unworkably simplistic” as noted by Alexander (1997,