As we have suggested, the cost of effective disaster planning is enormous. It is not realistic to expect budget-constrained facilities to absorb these additional costs, and yet relief from governments will not fill the gap. It therefore seems reasonable to seek economies of scale, such as dual-use modalities. For example, to increase ICU surge capacity, consider our ability to provide critical care outside of a designated geographical location. A significant volume of critical care is provided (nondeliberately) every day outside the geographical constraints of an ICU, hence the growing development of medical emergency teams in hospitals around the world . With little additional training, these teams could provide a highly effective adjunctive capability during disaster medical response when critical care units are full but additional ICU services are required.
As a second example, ensuring patient safety in the hospital is also emerging as a significant resource-consuming, but essential, activity . This is especially true as we move beyond compliance activities into multidisciplinary, tiered accident and error prevention. From this perspective, a medical catastrophe may encompass a single patient who receives improper medication through to mass casualty circumstances. While these events are fundamentally different in scope, magnitude, and cause, they share at their core a need for accurate and complete planning and education to prevent or mitigate their consequences. Is there sufficient overlap to merge some of the planning, education, and practice of hospital patient safety and disaster medical response?
In summary, where we have been will not get us to where we need to go for disaster critical care response. First, we must work around apathy, confusion of purpose, and a lack of monetary resources to widen the spotlight of disaster medical response from the prehospital arena to include the hospital. We must enhance our abilities and capacity across the whole spectrum of disaster medical response.
These efforts are the responsibility of society as a whole. All involved organizations including hospitals, emergency medical services, fire services, police, the public health system, local municipalities and government authorities, and other health care institutions will need to integrate into a well-developed disaster educational system and response team . In the present article we have attempted to outline conceptual elements that may facilitate some of this integration. For this to happen, someone with comprehensive understanding and the necessary expertise is required nationally, regionally, and locally to provide the leadership imperative that drives integration of these disparate entities and resources. The first step is ownership, and as critical care professionals we are obliged to step forward and provide the leadership for these processes.