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Medical Responses To Catastrophic Events In The U.S, Israel and Abroad. Presented to the. Scripps health And the U.S. Mexican border Health Commission. June 15, 2005. By Dr. Boaz Tadmor. Modes Of Responses. Passive- follow the events without self initiative

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Medical responses to catastrophic events in the u s israel and abroad

Medical Responses To Catastrophic Events In The U.S, Israel and Abroad

Presented to the

Scripps health

And the

U.S. Mexican border Health Commission

June 15, 2005

By Dr. Boaz Tadmor

Modes of responses
Modes Of Responses and Abroad

  • Passive- follow the events without self initiative

  • Active- take the initiative after the events and prevent deterioration

  • Proactive- prevention and mitigation prior to events.

Flow of stages of responses
Flow of stages of Responses and Abroad

  • Prevention- at all times.

  • Hyper-acute phase- Immediate Response : first 24 hours

  • Acute phase- primary response : 24-96 hours post event

  • Continuous phase- 96 hours- days, weeks, months

  • Recovery phase- Resuming normal life

Web of responses
Web Of Responses and Abroad

  • w.w.w.w

  • Who—When—With What—Why

Gant chart of responses

individual and Abroad



First responders












Gant Chart Of Responses

Need to know areas of responses
“ need to know” Areas of responses and Abroad

  • non specific knowledge, basic survival skills, - individual based

  • specific knowledge- individual, familial, community-web, risk communication

  • expert knowledge- community, local, state, federal- agency based

  • leadership skills and knowledge – at all levels.

Goals of responses in disaster
Goals of Responses in Disaster and Abroad

  • Prevent and Reduce as much as possible all types of damages.

    (human life, injuries-mental and physical, societal, economical, technological)


  • Synergistic interaction and collaboration through constant feedback mechanism

  • Look where are your relative advantages/ disadvantages and behave accordingly.

Goals of the medical system
Goals of the medical system and Abroad

  • Providing timely and needed care at all levels to all , at all times by all means.

Different additional concerns in disasters
Different, Additional concerns in Disasters and Abroad

  • limitation of specific knowledge

  • limitation of needed resources

  • limitation of physical space: surge capacity

  • role of primary physician, HMO’s , hospitals

  • define orders of priority of care- “Damage Control” mode

Different additional concerns in disasters1
Different, Additional concerns in Disasters and Abroad

  • Define level and type of care for each level of medical system

  • Delegate authority

  • Added responsibility

  • Decision making without “ evidence based medicine”

  • Different network of care and information

  • Reserve medical corps, NDMS, deployment, public health, web info

Role of the physician in times of disaster
Role of the physician in times of Disaster and Abroad

  • Hub of information- bilateral feed back mechanism

  • Reliable and knowledgeable

  • Has official authority and responsibility

  • Leader in the community

  • Specific different role in specific situation

  • New desired skills.

  • Part of a new team

  • Delegate authority

  • Learning and implementing capabilities.

Generic u s a mode of responding to disaster
Generic U.S.A mode of responding to Disaster and Abroad

  • Individual-community-local (county)-state-federal

  • No involvement of the army resources or national guard.

  • Minimal involvement of the private sector

  • No “ ONE SHOP STOP” for decisions

  • Long and convoluted lines of communication.

  • Different lines and modes of responsibility

  • “Babel -Tower” of integration and collaboration

Put some web sites www fema gov
put some web sites: and Abroad

  • Are you ready, National Response Plan

U s a medical model of responding
U.S.A. Medical model of Responding and Abroad

  • Individual-self care, HMO’s, primary physician, hospital

  • Community and Local- DOH, Hospitals, First Responders, Academia

  • State- DOD, Hospitals, HMO’s, specific units (DMAT, S&R, Epi), Academia

  • Federal- All of the above, DHHS( CDC, NIH, NDMS, National Stockpile), HLS, Different agencies in different ministries.

Continue 13
continue-13 and Abroad

  • Hierarchy of knowledge, expertise and resources

  • Different arms, different engagements, different language, different expertise, different leadership

Main scenarios threat assessments 1 of 2
Main Scenarios/Threat Assessments and Abroad (1 of 2)

  • Mega terror events

  • Toxicological events

  • Specific chemical events

  • Bioterrorism events

  • Mass vaccinations

  • Primary and secondary deployment

  • Antibiotic distribution

Main scenarios threat assessments 2 of 2
Main Scenarios/Threat Assessments and Abroad (2 of 2)

  • Public health disaster and preparedness issues

  • Principles of debriefing

  • Mental immunity issues

  • Rehabilitation issues

  • Quality control/evaluation issues

  • Special population issues

Integrated working milieu
Integrated Working Milieu and Abroad



Home Front
















  • MDA

  • Integrated Hospital

  • organs

  • Representative at the

  • Supreme Health Authority

  • Assistance to

  • Health Advisory

  • Committees






  • Surg. General HQ

  • Part of the Supreme

  • Health Authority

  • Authority for

  • deployed Medical

  • personnel

Primary care




Professional Advisory

Secondary deployment

international assistance

Integrated HQ at war time

Blood donation at war time

Instruction and guidance for medical forces

Members of the Supreme Health Authority

Medical forces as integrated hospital organs

National medical forces

MDA personnel

National Medical forces

Medical assistance


Aviational evacuation

Level A Medical Companies

Ministry of Health

Responsibility and preparedness medical department hfc
Responsibility and Preparedness-Medical Department-HFC and Abroad



Active Defense

Passive Defense+

Treatment and Evacuation

Preparedness and



Back to Routine

  • Individual

  • Community

  • Medical center

Ministerial offices

Surg. Gen. HQ

Medical Company-Level A

Medical Company-Level B

Medical Center

Primary care clinics

Physical Protection

Medical Protection

Illness surveillance

Public knowledge


International cooperation

MOH Committees

Assessment of Special

Population physical protection



Overseas cooperation

Continued surveillance

improvement according to

the experience gained

Evacuation/quarantine in the affected area

Secondary deployment of casualties

Blood Donation

Hospital assistance

life saving

integrated work with national HQ

Antibiotics and Vaccinations

Public information centers


Responsibility of the citizens
Responsibility of the Citizens and Abroad

  • Understanding the threat

  • Motivation to collaborate with authorities

  • Suspicion and possible alarm

  • Surveillance

  • Isolation

  • Protection

  • Treatment

  • Follow up

  • Reporting

Points of difference 1
Points of difference and Abroad (1)

  • Characterization of the threat

  • Type, kind, timeline, perspective

  • Size and diversity of agencies, organizations, academia, government

  • Individuals’ background

  • Military-civilian relationship

Points of difference 2
Points of difference and Abroad (2)

  • Command and control systems

  • Resources: workforce, logistics, money

  • Education

  • Training

  • Mental and child consideration

  • Risk communication and the media

  • Synergy of first responders

  • Academia

  • Leadership perspective

Generic mutual concerns
Generic mutual concerns and Abroad

  • Leadership and decision making

  • Synergy between first responders

  • Risk communication

  • Individual based responsibilities

  • Resiliency

  • Training and drilling

  • Academic involvement

Relative advantages israel
Relative Advantages: and Abroad Israel

  • Resiliency: individual, community

  • Hospital readiness and preparedness

  • Synergy of first responders

  • Military-civilian collaboration

  • Short lines of communication for command and control

  • Motivation to share experience and knowledge

Relative advantages united states
Relative Advantages: and Abroad United States

  • Diversity:

    • Academia

    • Local, state, and federal agencies and organizations

    • Excellent brainstorming

  • Media and technological capabilities

  • International collaboration

  • Scientific excellence

  • Resources

Collaboration and Abroad

  • Practical knowledge and experience

  • Scientific knowledge and innovation

  • Sharing and mutual involvement and understanding

  • Create the cutting edge of understanding preparedness, mitigation, practicability and recovery