الفهرس 
Introduction
Scope of Disaster and its StagesOnly 14 pages are availabe for public view
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Abstract
In order to be familiar with mass casualty and its effects on the health care system, some terminologies should be known:
”Risk” is the probability of the occurrence of a disaster or its consequences.
”Disaster” is the result of the adverse interaction between a man-made or natural hazard and the environment, resulting in widespread human or structural damage that exceeds human capacity to respond in a timely and adequate manner.
Disaster planning and preparedness” is integral to the development and implementation of disaster prevention and preparedness.
”Disaster medicine” refers to the emergency health and medical response to surviving victims of disaster. However, there is also a distinction between civilian and military disaster medical response.
Classification and magnitude of a disaster mainly depends on:
1. Extent of geographic area involved.
2. Number of people affected by it.
3. Capacity of the central government to deal with it.
Trauma scores, scales and triage should be applied to evaluate and assess all traumatic patients at the scene of trauma and during transport to a hospital to quickly determine which victims need immediate transport to the closest and most appropriate medical center for emergency surgery and which can wait.
The primary survey is designed to evaluate airway, breathing, circulation, disability and exposure and to recognize and treat immediately life-threatening conditions within the first few minutes of the patient’s arrival to the hospital. The secondary survey is described as a head-to-toe examination and is intended to diagnose all injuries before formulating a definitive management strategy. A tertiary survey should also occur and is typically conducted in the surgical intensive care unit, after the initial resuscitation and operative interventions and prior to discharge within 24 hours of injuries (i.e.“delayed evaluation”) and serves as an additional screen to decrease the risk of missed injuries.
Acute blood loss is a very common problem following traumatic injury. So, rapid recognition and restoration of homeostasis is the corner stone of the initial care of any badly injured patients
All trauma patients are assumed to have a “full stomach” and so aspiration prophylaxis must be undertaken with premedication as anti-emetic drugs prior to anesthetic induction and applying cricoid pressure together with presence of ready suction device.
The standard of care for initiation of anesthesia and securing the airway following trauma is rapid sequence intubation RSI (after optimal preoxygenation) unless the patient has a known cervical spine injury or difficult airway, in which case an awake intubation should be considered which can only be safely conducted when patients are stable, cooperative Although many Neuromuscular Blockade (NMB) drugs exist, only succinylcholine and rocuronium are recommended for RSI in the trauma patients. In many traumatic cases, the combination of ketamine with a rapid onset neuro-muscular blockade (NMB) drug (succinylcholine or rocuronium) will provide the best induction conditions for the trauma patients.
Volatile anesthetics and intravenous anesthetic drugs (for induction or maintenance) are selected based on a patient’s neurological and hemodynamic condition and often required titration with careful attention to patient response with frequently reduced doses for trauma patients who are often hypovolemic.
Preoperative, intraoperative and postoperative complications for the trauma victim such as hypothermia, coagulopathy, hazards of massive blood transfusion and acidosis should be suspected and avoided. So, all warming
techniques and prophylactic measures against any complication should be applied for traumatic patients to improve their survival.
Regional anesthesia and its role in the trauma patients are complex due to its risk/benefit ratio and so can be applied
according to hemodynamic state of the patient and the spectrum of injuries and alone or with general anesthesia to provide profound pain relief which has been shown to reduce morbidity.