1. Anesthesiologists basic understanding of physiology and pharmacology, and their airway skills, fluid resuscitation expertise, and ability to manage ventilators and to provide anesthesia in the field environment, in the emergency department, in the operating room (OR), and in intensive care units (ICUs) will be invaluable.
2. During a mass casualty incident, an anesthesiologist may well be asked to provide anesthetic services in an area other than the OR or ICU.
3. Triage
   1. If assigned to triage patients, the anesthesiologist will be expected to classify patients into four groups—those requiring immediate care, delayed care, first aid, and expectant (not expected to survive inadequate resources to adequately resuscitate without jeopardizing the lives of patients more likely to survive).
   2. In the future, biotechnology may play a role, but at present, hospitals must rely on physicians' experience
   3. As emotionally difficult as the process might be of identifying or managing patients not expected to survive is the assessment of patients who may have been injured or been affected during a disaster but do not appear to require treatment but who might require delayed care (Table 53-2: Evaluation of Patients Who Do Not Require Immediate Treatment But May Require Delayed Care).
4. Decontamination
   1. Decontamination is normally performed first and then patients are evaluated and triaged. (Clothes are removed, and individuals are washed with copious amounts of water, and if they have been exposed to a chemical agent a dilute solution of sodium hypochlorite, 0.5% [household bleach] can be used.)
   2. If the patient presents with life-threatening injury (acute respiratory failure requiring emergency tracheal intubation), the patient is treated first and decontaminated afterward.
      1. The intubation must be performed with the anesthesiologist wearing a hazard materials (HAZMAT) or a biohazard suit with multiple-layered gloves and a gas mask.
      2. Consider securing the airway with a laryngeal mask airway, when indicated, rather than with a tracheal tube.
5. Emergency Department
   1. Depending on the types of casualties but especially for casualties from a violent explosion, anesthesiologists might be assigned to manage patient's airways and secure central venous access.
   2. Anesthesiologists should position themselves at the head of the bed and assume responsibility for the airway and venous access.
   3. If chemical weapons are also used, not only may tracheal intubation be required, but ventilator management may also be necessary.

Emergency Preparedness for and Disaster Management of Casualties from Natural Disasters and Chemical, Biologic, Radiologic, Nuclear, and High-Yield Explosive (Cbrne) Events

1. Preparation: Personal Preparedness
2. Role of Anesthesiologist in Management of Mass Casualties
3. Chemical
4. Biologic
5. Nuclear Radiation