CMH Disaster Preparedness 1) Decon/HazMat – Requires patient decontamination 
prior  to treatment (nuclear, chemical, biological exposure)

2) non-Decon – No patient decontamination (earthquake, 
train crash, conventional bomb)
Surge Volume and Standards of Care
Home. References. Physician Call-In. Disaster Command. Standards of Care. Disaster Staging. START Triage.

SURGE LEVEL I (>10 seriously ill/injured patients)

Emergency Department Director summoned to hospital to coordinate.

All ED Physicians, Hospitalists, and on-call physicians summoned.

All General and Orthopedic Surgeons, and Anesthesiologists summoned.

All elective surgery canceled.

SURGE LEVEL II (>50 seriously ill/injured patients): All the above plus

Call-in to all members of medical staff and retired physicians.

Restrict lab, X-ray, other services to smaller number of critical tests.

Medical Care Branch Director considers cancellation of cardiac caths and
other resource-intensive procedures.

Minimal charting requirements until situation stabilized.

Physicians from other facilities recruited and emergently credentialed.

SURGE LEVEL III (>100 seriously ill/injured patients): All the above plus

Military Triage Standards: Patients with resource intensive problems
offered comfort-only care.  

Medical Care Branch Director cancels all resource-intensive procedures.

Restrict or stop all further ICU admissions.

SURGE LEVEL IV (>500 seriously ill/injured patients): All the above plus

All inpatient care severely restricted.

Physicians employed primarily for outpatient services alone.

SURGE LEVEL V (>1000 seriously ill/injured patients): All the above plus

Physicians employed exclusively for triage, rapid stabilization, and comfort.

As the number of critically ill and injured rises in a disaster, standards of care
must change in order to provide services for the greatest number of patients.