Field management and critical care in mass disasters

Even in highly developed countries, definitive care hospitals may be compromised when the underlying disaster affects either the receiving facilities or the personnel who staff those facilities. Whether patients are brought to local facilities, distant facilities, or even to field critical care units, there will always be a certain element of obligatory prehospital care. Meticulous skeletal immobilization, splinting, and aggressive airway management are the basic tenets of prehospital injury management; however, management strategies should take into consideration both anatomic site and mechanism of injury. In serious head injury, provision of adequate lung inflation (preferably by endotracheal tube) to guarantee adequate oxygenation supersedes most other considerations, including attempts at therapeutic hyperventilation. Whatever considerations or therapeutic interventions are used, they must be under strict, knowledgeable, and experienced medical supervision.