A disaster is a catastrophic event that often leads to great destruction and loss.1,2 Logue1 defines a disaster as an event that causes excessive morbidity and mortality. Extensive damage to property, roadways, electrical lines, and other crucial infrastructures limits a region’s ability to respond.1,2 Whether the origin of the disaster is natural or attributable to human causes, the outcomes can be devastating. These events often leave the local first responders, medical systems, and governmental operations overwhelmed. At that saturation point, a disaster is declared and a needs assessment is begun. Historically, the Federal Emergency Management Agency has been the branch of the federal government designed to coordinate efforts during a disaster. From 1990 to 1999, the agency spent more than $25.4 billion on declared disasters, compared with $3.9 billion for the preceding 10-year period. During the 1990s, 460 major disasters were declared, higher than any other decade on record.2
In 2001, in response to recent terrorist attacks and the risk of future assaults, the governmental structure was changed. This change has been regarded as one of the largest modifications in governmental structure in years. The Department of Homeland Security is now the central organization overseeing many different agencies that focus on the safety and security of the United States such as the Federal Emergency Management Agency, the Transportation Security Administration, the Coast Guard, and the National Disaster Medical System (NDMS). The focus of the Department of Homeland Security includes border and transportation security; chemical, biological, and radiological countermeasures; informational analysis and infrastructure protection; and emergency preparedness and response.3
Providing medical disaster relief is under the jurisdiction of the NDMS. The NDMS works in conjunction with local fire, police, and emergency medical services to provide comprehensive disaster relief through appropriation of effective resources. One component of the NDMS involves civilian, volunteer disaster response teams known as disaster medical assistance teams (DMATs). These teams are used in disasters that occur within the United States and its territories. Recently, this concept was expanded to include the international community. These teams, known as international medical/surgical response teams (IMSURTs), will be able to broaden the scope of disaster medical response by making resources available to more areas. More persons will be able to receive medical care at a desperate time, and this capability will ultimately decrease the morbidity and mortality of victims of disasters.
The goal of this article is to articulate the role of critical care nurses in a calamitous event. The experiences of the Boston disaster team (IMSURT MA-1) are used to highlight important aspects of disaster nursing. The significance for nursing in the area is 2-fold. First, statistics indicate that the number of natural disasters continues to grow.2 Further, because of current attacks and threats of terrorism in our society, critical care nurses are in a unique position to participate in all aspects of disaster response, including triage, stabilization, definitive care, and evacuation.