Emergency department disaster preparedness and response

P33 V3

Version	Date	Pages revised / Brief Explanation of Revision
V2	Oct-2020	Substantial review and merging of content from pre-existing ACEM Standards: P49 Policy on the Disposition of Patients in the ED on Notification of a Mass Casualty Incident P33 Policy on Disaster Health Services P66 Policy on ED Management of Medical & Nursing Volunteers During Disasters ST309 Standard for Medical Practitioners Responding to Sudden Onset Disasters – Qualifications  'Related Documents' updated with recent publications
V3	April-2025	Inclusion of content from P30 Emergency department hazardous materials plan (retired) – minor content updates. New content on CBRN.

 

This Policy should be read in conjunction with the following ACEM documents:

• P59 Policy on Heatwave and Heat Health
• G26 Reducing the Spread of Communicable Infectious Disease in the Emergency Department Guidelines
• P30 Policy on Emergency Department Hazardous Material Response Plan
• G764 Clinical Guidelines for the Management of COVID-19 in Australasian Emergency Departments
• Management of Respiratory Disease Outbreaks Guidelines

 

This document is a policy of the Australasian College for Emergency Medicine (ACEM; the College). This policy relates to the preparedness and response of emergency departments (EDs) to disasters of all types, including, but not limited to:

• natural disasters, such as bushfires, cyclones, pandemics, earthquakes, floods or tsunamis
• terrorist attacks
• plane, train or other major transport accidents
• chemical, biological, radiological, nuclear (CBRN) or explosive incidents.

These incidents are not mutually exclusive and may involve mass casualties or single presentations in the case of CBRN incidents.

This policy is applicable to all EDs in Australia and Aotearoa New Zealand. It provides general principles and adopts an all-hazards approach that is applicable to sudden onset events with impacts that may overwhelm the innate capacity and resources of the ED to cope.

This policy recognises that ED settings vary across Australia and Aotearoa New Zealand. As such, the scale of appropriate responses to similar events may necessarily differ between EDs. This may range from departmental surge to a hospital-wide response to a whole-of-system mobilisation. This policy should be applied within the context of local ED, hospital and state health emergency and disaster plans.

The clinical management of patients affected by disasters is outside the scope of this document.

 

All-hazards approach

An all-hazards approach to disaster health arrangements provides the foundation to manage any man made or natural disaster that may eventuate, including catastrophic and unforeseen and unimagined disasters.

Casualty

A casualty refers to a person involved in an incident who requires medical assistance.

CBRN materials

Chemical, biological, radioactive or nuclear materials.

Disaster

A disaster is any event or series of events causing a serious disruption of a community’s infrastructure – often associated with widespread human, material, economic, or environmental loss and impact, the extent of which exceeds the ability of the affected community to mitigate using existing resources. ¹

Disaster Health

Disaster health is the collaborative application of various health disciplines to the prevention, preparedness, response and recovery from the health problems arising from disasters.

Emergency

An emergency is a sudden and usually unforeseen event that calls for immediate measures to mitigate impact. ²

Emergency management

Emergency management is the organisation and management of resources and responsibilities for addressing all aspects of emergencies, in particular preparedness, response and initial recovery steps. ¹

Hazard

A hazard is a dangerous phenomenon, substance, human activity or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage. ³

Impact

The impact of a disaster or terrorist attack can be defined by the following formula: ³

Where vulnerability, preparedness and resilience refer to both individual and systemic attributes.

Mass Casualty Incident

A mass casualty incident is an event, typically occurring with little or no warning, that generates a demand for medical care that exceeds the capacity of the receiving health service or system to provide conventional standards of care to the affected population. ⁴ Examples include a plane crash or bus crash.

Patient

A patient refers to all people seeking medical treatment.

Sudden Onset Disaster

A sudden onset disaster is defined as occurring with little or no warning, meaning there is insufficient time for the complete evacuation of the at-risk population. ⁵ Examples include floods, cyclones, or earthquakes.

Surge capacity

Surge capacity is the measurable ability of a health system to manage a sudden influx of patients. There are four main components: space, supplies, staff and systems. Surge capacity includes both the adaptive use or augmentation of existing resources and the creation of additional capacity. ⁶

Terrorism

There is no universally accepted definition of terrorism. The Australian Government defines an act of terror as a “an act or threat to commit an act, that is done with the intent to coerce or influence the public or government by intimidation to advance a political, religious, or ideological cause”, and the act causes:

• death or serious harm or endangers lives
• serious damage to property
• a serious risk to health or safety of the public, or
• seriously interferes with, disrupts or destroys critical infrastructure such as telecommunications or electricity networks. ⁷

Perpetrator of terrorism are non-state actors and targets are innocent civilians or government institutions. Violent extremism is terrorism motivated by ideological beliefs.

Triage

Triage is the process of categorising and prioritising patients with the aim of providing the best care to as many patients as possible with the available resources.

 

Australia and Aotearoa New Zealand are prone to and experience a range of natural and man-made disasters. Such events impact the health system directly through an increase in the number of ill or injured patients and indirectly through disruption of community access to health services. ⁸ Terrorism can be perpetrated by international or domestic organisations and individuals. Lone actor attacks, inspired by extreme ideologies or beliefs, are considered most likely in the Australian or Aotearoa New Zealand context.

A comprehensive all-hazards approach to disaster health management requires coordinated and collaborative actions across all government levels, sectors, agencies and disciplines for the prevention, preparedness, response and recovery from the health impacts of a disaster. Without appropriate disaster planning, local health systems can become overwhelmed with the surge of casualties. ⁹

Planning is integral to effective response and recovery and to protect staff and the ED environment from harm, e.g., secondary contamination from chemical, biological, radioactive or nuclear materials (CBRN) agents. ¹⁰ An all-hazards approach is advocated to provide a foundation for managing any disaster, including those unforeseen or unimagined. ⁸ The planning and response to any sudden onset disaster must be flexible and scalable, involving all areas of the health system.

 

All hospital systems in Australia and Aotearoa New Zealand must have a disaster health plan for the management of external disasters. EDs represent the first stage (or frontline) of the hospital systems’ response to disasters of all types and scales, including mass casualty incidents, and natural and man-made disasters. EDs need to have specific policies and procedures in place to ensure established disaster systems, appropriately trained staff, adequate supplies and safe environments to respond to disasters. Disaster plans are necessary to protect staff, patients and other people in the ED while providing timely care for people affected by the disaster and continue essential medical services.

The planning and design of disaster health plans at any level must be based upon the best available evidence and experience gained from past major incidents and disasters. The expertise of emergency physicians must be sought the development of hospital and ED disaster health management plans.

 

5.1 Healthcare systems disaster planning

EDs, hospitals and healthcare systems should make plans to provide care for all casualties during a mass casualty incident or sudden onset disaster. Effective disaster management requires a high level of collaboration and coordination within and across all levels of government and with non-government stakeholders. EDs require specific disaster management plans. However, this planning must be done in conjunction with hospital emergency planning within federal, state or territory, and regional planning.

When developing any disaster management plan, it is important that a local hazard identification and assessment is conducted to identify risks specific to the local conditions. For example, some areas are more prone to weather events such as cyclones or flooding, or natural disasters such as fires. The remoteness of the facility also needs to be considered as well as the availability of local support services, including fire and rescue, other medical facilities and staff, police and social support services.

All hospitals should have a well-functioning incident command and control system, including a designated incident commander who oversees a hospital Incident Command Group (ICG) to run the hospital disaster response. The hospital must ensure that there is adequate training and simulated practice exercises, documentation is up-to-date, and that disaster health plans are accessible.

Emergency physicians must be involved in all aspects of disaster planning and management and should have representation on hospital ICGs. Emergency physician input into disaster planning is important to ensure that the planning process captures issues that may impact clinical outcomes. They are in an ideal position to facilitate disaster health responses and the smooth transition from the acute disaster health response to the on-going public health issues of disaster recovery operations.

5.2 ED disaster management plans

EDs must have disaster management plans, using an all-hazards approach that also cover identified setting-specific hazards. ED disaster management plans need to allow for emergency recognition and response when there may be little or no advanced warning that an incident has occurred. The majority of casualties after a disaster will leave the scene spontaneously and take themselves to the closest hospital rather than be transported by emergency medical retrieval. ¹¹ ED disaster planning should include measures to rapidly increase the treatment capacity of the ED and the hospital. During a disaster the clinical goals shift from individual patient satisfaction to doing “the most for the most”. ⁹ Emergency physicians should ensure that the ability of the ED to manage mass casualty incidents and other disaster situations are considered in any proposed changes to ED operating procedures or design.

5.2.1 Surge capacity and response

ED policies and procedures need to be developed for recognising and initiating surge response in the ED including expanding treatment spaces to manage a rapid influx of patients, manage surge staff and access necessary disaster supplies. Appropriate strategies for rapidly increasing treatment capacity at the onset of a mass casualty incident or disaster could include: ¹¹

• Discharging clinically well patients from the ED and inpatient units to promptly create treatment capacity within the hospital and ED.
• Transferring patients from the ED once initial assessment has been completed and resuscitation commenced to create treatment capacity within the ED.
• Diverting incoming stable patients to other health care facilities.
• Transferring casualties to other health care facilities if required.

Diagnostic imaging and blood supplies are often a “choke point” during disaster response and the ED disaster plan should specify how these resources will be prioritised and used.

5.2.2 Command and control

An ED disaster management plan must include clear outlines of the roles and responsibilities of the Incident Command Group (ICG) office bearers of the ICG, and this needs to be communicated to the ED staff. Communication pathways within the ED, with other hospital functions and departments, and with external agencies, need to be carefully planned and appropriately resourced.

To prevent the ED becoming overwhelmed after a disaster, the ED disaster management plan must include arrangements for additional security and crowd control and include a threshold and procedures for integrating local law enforcement and/or military personnel in hospital security operations.

Hospitals must ensure that their hospital staff contact list is updated regularly, especially the details for ICG officer bearers. The availability of officer bearers must be kept up-to-date and, if they are on leave, back up must be organised and clearly communicated. See Appendix 1 for suggested list of contacts.

A public affairs, media, and social media policy must be in place to ensure authorised timely and trustworthy information is provided. Spokespeople must be appointed and trained. A specific communication strategy for communicating with family members of people involved in the disaster also needs to be developed.

5.2.3 Continuity of essential services

ED disaster plans also need to plan for the continuation of essential medical services in the ED in parallel with the activation of an ED disaster management plan. The plan also needs to include procedures for de-escalation or transition to routine service delivery during recovery or maintenance phases of the disaster.

5.2.4 Inclusivity and diversity

ED disaster plans should align with relevant hospital, state and national plans and should be inclusive and reflect the diversity of Australian and Aotearoa New Zealand communities. The needs of higher risk populations, such as children, women, older persons, people with disabilities, Aboriginal and Torres Strait Islander people, Māori and Pacific Islanders, culturally and linguistically diverse groups, and socially disadvantaged groups must be considered and addressed. These groups are more vulnerable and disproportionately affected in a disaster. ⁸

5.3 Reviewing and testing ED disaster plans

ED disaster plans should be regularly tested, at least every 1-2 years. ⁸ Simulations and exercises build capacity and assist in the evaluation of plans and develop expertise. ⁹ Where possible, consideration should be given for multi-disciplinary and/or multi-agency exercises. EDs need to establish systems for regularly reviewing disaster plans and disaster preparedness, triggered by major changes in risk profile, regulatory changes, and following any real or simulated disaster responses as part of post-action review processes. This should include mechanisms for ensuring currency of staff training and credentialed staff databases and checking quality and sufficiency of disaster supplies. Decontamination guidelines are also a required part of an ED disaster response plan.

5.4 Staff preparedness and training

The response to any sudden onset disaster in the ED must ensure the safety of medical practitioners, patients and other responders. This is achieved by ensuring medical staff are appropriately trained, prepared and equipped. This applies to ED staff as well as potential surge staff including non-ED healthcare workers and volunteers. EDs must have policies and procedures to prepare and manage these different types of potential response staff to ensure their appropriateness and safety. These policies and procedures must be communicated and accessible to all ED staff members including auxiliary staff. There should be a clear designation of responsibility and appropriate training for ED team leaders, preferably ACEM Fellows. Action cards that can be quickly distributed and provide a succinct summary of roles and responsibilities may be useful.

All ED staff should have the opportunity to undertake education and training in disaster response ⁸ including Major Incident Medical Management System (MIMMS) courses, drills, simulations and exercises, ranging in fidelity and scale from departmental table-top to multi-agency field exercises. All ED staff and medical practitioners required to respond to a sudden onset disaster should be familiar with:

• respective state, territory or jurisdiction’s disaster and emergency management arrangements and procedures
• local hospital and ambulance services disaster plans and arrangements
• national arrangements for disaster response.

Medical practitioners responding to a sudden onset disaster in the ED should have the required skills to provide safe and appropriate assistance in these situations. Currency of relevant training and skills, and possession of relevant qualifications is required. The recommended standards are provided in Appendix 2.

5.4.1 Use of non-ED surge staff

In some instances, appropriate staff types and skillsets will not be immediately available to meet the ED demand for medical care. This is more likely to occur in catastrophic disasters, particularly in rural and regional environments. In these scenarios a decision may be made to use other, ideally local, healthcare professionals or volunteers in the ED. EDs should have pre-established procedures to activate, utilise and stand down such surge staff including pre-established role descriptions, allocations and emergency credentialing with local groups likely to be called upon, such as local General Practitioners (GPs) ¹², community service organisations and medical or nursing students. Ideally, such medical responders should:

• fulfil roles and duties that most closely approximate their usual role and skill set, and
• stand down and return to their usual work environment as soon as it is safe and appropriate for them to do so.

5.4.2 Unsolicited offers of assistance and volunteers

ACEM recognises EDs may receive unsolicited offers of assistance during a disaster. It is recognised that all physicians have a role to play in the response to disasters. ¹³ However, volunteers need to work as part of a system that uses their skill-mix in the most appropriate way, and ensures they are credentialed, indemnified and insured for the protection and welfare of patients, the organisation and themselves. ED disaster plans need to establish a system of rapidly providing healthcare workers, including voluntary medical personnel, with necessary credentials in a disaster situation.

An ED disaster plan should include provisions for:

• managing hospital medical, nursing and allied health staff who self-present to the ED in the immediate aftermath of a disaster to volunteer assistance. This will include a pre-designated point where all volunteers report, and a single person to allocate roles and duties and facilitate the rapid distribution of appropriate staff to areas of need. Security mechanisms should be in place to verify the credentials of volunteers, and to maintain a log of volunteer movements for the security of the individual and the organisation.
• ensuring that any non-ED medical and nursing volunteers are appropriately briefed on relevant ED operational procedures
• ensuring all medical and nursing volunteers presenting in the ED understand and operate within ED communications and command structures and, where possible, that volunteer medical and nursing staff work in association with an ED staff member (buddy system)
• ensuring that ED staff are distinctly and easily identifiable and that volunteers are separately identifiable
• re-assigning any volunteer presenting to the ED who is unable to perform the role allocated to them, or if that is not possible, then re-deploying them elsewhere or asking them to leave
• removing, by hospital security if necessary, any volunteer or surge staff who disrupt safe departmental function and refuse to leave on request.

5.4.3 Responders’ health and safety

EDs must ensure that there are relief and fatigue management systems to protect the welfare of all disaster response staff under their purview, including non-ED surge staff and volunteers. ED disaster plans must ensure staff are used appropriately both in terms of their skills and the ED and hospital’s ability to continue providing a service to the community once the initial impact of the disaster is over.

5.5 Equipment and supply management

EDs need to develop and maintain an inventory of all equipment, supplies and pharmaceuticals required for a disaster response. EDs should have a dedicated disaster store for specific equipment and supplies, including surge stock, required to respond to a disaster. This store must be easily and rapidly accessible to ED staff when required, secure, and protected against environmental damage. ¹⁴ A stock rotation process must be included to ensure this store is kept up to date with minimal wastage.

Procedures for ensuring adequate and appropriate disaster supplies are required. This includes:

• Identifying and procuring required disaster supplies/equipment in amounts appropriate to the ED’s setting and hazard profile.
• Ensuring appropriate storage, organisation and maintenance.
• Conducting regular checks for integrity and performance.
• Establishing arrangements for alternative avenues for sourcing items in case of disruptions with the normal supply chain or if additional supplies are required.

Disaster supplies should not only account for clinical needs, for example, trauma care or specific therapeutics/antidotes, but also administrative/clerical and communication needs, for example, mass casualty patient IDs, physical copies of critical documents, two-way radios etc. There should also be stores of food and water if there is a significant possibility of disruption of normal chains of supply such as from a large-scale natural disaster. A large-scale disaster may also affect the supply of power and communications within the hospital and ED. As part of the hospital and ED disaster management planning, provisions for backup power and processes for managing a breakdown in electronic communications needs to be provided. ¹⁵

5.5.1 Personal protection equipment (PPE)

Appropriate and sufficient levels of PPE must be available and provided to all ED staff responding to a disaster. Provision must be made for PPE needs for all types of disasters, including requirements specific to CBRN response or infectious disease outbreak. ¹⁶ Health services need to develop guidelines on the use of PPE in disaster situations, guided by relevant principles of Work Health and Safety.

Competency training in use of appropriate PPE (including fitting, donning, working in and doffing) should be provided on a regular and ongoing basis to staff who may be involved in a disaster.

5.6 Physical environment

ED design and any proposed changes to design should consider capacity to manage mass casualty incidents and disaster situations. ¹⁴ Consideration should also be given to the ability to implement necessary layout, flow and/or process modifications to mitigate specific event risks, such as contamination during a hazardous material incident with mass casualties. ¹⁷

ED disaster management plans should pre-emptively identify and articulate procedures for:

• expansible treatment areas within the ED.
• treatment space external to the ED. This may include adjacent clinical areas (or less ideally, temporary structures such as tents or marquees) that are utilised to temporarily enlarge ED capacity and/or separately established clinical services and spaces, such as surge clinics ¹⁶, or for diversion of appropriate patients from the ED. ¹¹

Entry and exit points to the ED space should be identified and procedures established for placement of security at entrances to control access.

Triage of mass casualties may take place within the ED waiting area or external from the ED but close to essential personnel, treatment areas and supplies. As part of the disaster planning process, an experienced, trained triage officer should be appointed to oversee all triage operations. Protocols for managing multiple casualties and appropriate triage process should be based on need and the best for the most rather than the best for each patient. ¹¹

 

Recovery is a vital part of disaster planning to ensure that the health system can support community recovery and provide ongoing health services. Prompt implementation of recovery efforts can help mitigate a disaster’s long-term impact on hospital operations. Some considerations when planning for post-disaster recovery include:

• Appointing an ED disaster recovery officer.
• Identifying essential criteria and processes for incident demobilisation.
• Reporting disaster response actions to hospital administration.
• Providing opportunities for staff to debrief 24-72 hours after the disaster to assist with coping and recovery. This should include ED staff, surge staff, volunteers and any other people involved in the response.
• Ensuring all medical and nursing disaster response staff, including non-ED surge staff and volunteers, have access to post-incident debriefing and counselling as required. ⁹

After the disaster the hospital and the ED need to conduct a thorough review of all actions taken, lessons learned and update the disaster management plan, including all policies, procedures and inventory lists as required. The hospital and/or ED staff may also be involved in wider post-disaster reviews to ensure that the experience of the ED is captured in any evaluations.

 

7.1 CBRN incidents

7.1.1 Hazardous materials contamination planning

Although responses to hazardous material may be included in generic disaster plans, additional planning specific to hazardous materials/CBRN response is required, and should consider scenarios of single presentation, limited casualty and mass casualty incidents.

EDs should consider specific sources of hazardous materials in the area they service, such as those used by industry and agriculture, in their planning and preparedness. This should include local supplies of any relevant antidotes or specific treatments for exposures to these hazardous materials. EDs should work with local industry bodies to ascertain pathways for accessing any antidotes and treatments they may stock for occupational exposures to hazardous materials. When possible, EDs should have sufficient antidote stocks.

When developing a disaster plan for CBRN incidents, ensure that the plan aligns with jurisdictional emergency plans, guidelines and legislation. ^{18 19} The plan should reference jurisdictional clinical guidelines and antidotes.

7.1.2 Equipment and supply management

Standard personal protection equipment (PPE) precautions may not be adequate for disasters involving CBRN hazards. ^{20 21} CBRN-specific PPE is required, that may include powered air-purifying respirators (PAPRs) and chemically protective clothing (with gloves, suits and boots). PPE selection should be based on anticipated ‘worst-case’ staff exposure scenario. ²² EDs should maintain a register of trained, available and willing response staff. ¹⁰

7.1.3 Physical environment

In addition to the physical environment considerations required for all-hazards disaster planning, additional processes may be required to respond to CBRN contamination events. EDs should develop procedures to protect the ED physical environment and equipment from contamination to ensure the safe continuation of care for patients not involved in the hazardous material incident. These procedures should include:

• Methods of isolating contaminated or potentially contaminated patients prior to full decontamination.
• Pre-designed and separated space(s) for triage and decontamination of contaminated patients prior to ED entry and away from ED entrance(s), to maintain free access for ambulances and other non-incident presentations.
• Decontamination facilities for single or multiple casualties incorporating considerations such as location, patient flow, patient privacy, gender segregation, water temperature regulation and management of waste-water run-off. ^{10 23}
• Procedures to manage the removal of contaminated clothing and personal effects/clothing, including placement in sealed plastic bags, identification and secure storage, as required.
• Clear designation of responsibility and appropriate training for the maintenance, assembly and operation of any decontamination facility. This responsibility may lie in part or fully with an external agency, such as the Fire Service, and should be clearly stated and mutually agreed. ⁸
• Appropriate access to relevant antidotes when needed.

7.2 Heatwave

For detailed information on preparing for heatwaves refer to ACEM policy P59 Heatwave preparedness for emergency department and emergency medicine systems. ²²

7.3 Infectious disease outbreak / pandemic

For detailed information on preparing for pandemics refer to ACEM guidelines Management of respiratory disease outbreaks. ²⁴

 

This Policy should be read in conjunction with the following ACEM documents:

• P59 Policy on Heatwave preparedness for emergency departments and emergency medicine systems. 2023.
• G26 Guidelines on Reducing the Spread of Communicable Infectious Disease in the Emergency Department. 2023.
• P56 Policy on Public Health. 2021.
• Guidelines on Management of Respiratory Disease Outbreaks. 2020.

 

9. Further reading

The following references may be useful in the development of an ED disaster management plan:

• Australasian College for Emergency Medicine and NSW Environmental Protection Authority. Impact of climate events on emergency departments. Melbourne: ACEM; June 2024
• Australian Institute for Disaster Resilience (AIDR). Australian Disaster Resilience Handbook Collection: Health and Disaster Management. 2nd ed. Melbourne: AIDR; 2019.
• National Critical Care and Trauma Response Centre. Clinical guideline: CBRN, toxicology and toxinology. 2023.
• World Health Organization (WHO). Hospital emergency response checklist. WHO: Geneva; 2011

1. United Nations International Strategy for Disaster Reduction. UNISDR terminology on disaster risk reduction. Geneva: WHO; 2009.
2. United Nations Department of Humanitarian Affairs. Internationally agreed glossary of basic terms related to disaster management. Glossary : [Accessed 15 Jan 2025]
3. Braitberg G. The nature of terror medicine. Emergency Medicine Australasia. Dec 2024;36(6):815-822
4. Timbie J, Ringel JS, Fox S, Pillemer F, Waxman DA, Moore M, Hansen CK, Knebel AR, Ricciardi R, Kellermann AL. Systematic review of strategies to manage and allocate scarce resources during mass casualty events. Annals of Emergency Medicine. 2013;61:677-689.
5. World Health Organization (WHO). Classification and minimum standards for foreign medical teams in sudden onset disasters. Classification and minimum standards for foreign medical teams in sudden onset of disasters [Accessed 15 Jan 2025]
6. American College of Emergency Physicians (ACEP). Policy statement: Health care system surge capacity recognition, preparedness, and response. Texas: ACEP; 2023.
7. Australian Government. Living Safe Together. https://www.livingsafetogether.gov.au/get-the-facts [Accessed 15 Jan 2025]
8. Australian Institute for Disaster Resilience (AIDR). Australian Disaster Resilience Handbook Collection: Health and Disaster Management. 2nd ed. Melbourne: AIDR; 2019.
9. World Health Organization. Hospital emergency response checklist. Hospital emergency response checklist [Accessed 15 Jan 2025]
10. Tan GA, Fitzgerald MCB. Chemical–biological–radiological (CBR) response: a template for hospital emergency departments. Medical Journal of Australia. 2002;177(4):196–9.
11. Bradt DA, Aitken P, FitzGerald G, Swift R, O’Reilly G, Bartley B. Emergency department surge capacity: recommendations of the Australasian Surge Strategy Working Group. Academic Emergency Medicine. 2009;16:1350-1358
12. Australian Medical Association (AMA). AMA position statement on involvement of GPs in disaster and emergency planning. AMA; 2016.
13. World Medical Association (WMA). WMA Declaration of Montevideo on Disaster Preparedness and Medical Response, adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011. WMA Declaration of Montevideo on Disaster Preparedness and Medical Response – WMA – The World Medical Association [Accessed 15 Jan 2025]
14. Australasian College for Emergency Medicine (ACEM). Emergency department design guidelines. Melbourne: ACEM; 2014.
15. Australian College for Emergency Medicine and NSW Environmental Protection Authority. Impact of climate events on emergency departments. Melbourne: ACEM; 2024.
16. Australasian College for Emergency Medicine (ACEM). Management of respiratory disease outbreaks. Melbourne: ACEM; 2020.
17. Paganini M, Conti A, Weinstein E, Corte FD and Ragazzoni L. Translating COVID-19 pandemic surge theory to practice in the emergency department: How to expand structure. Disaster Medical Public Health Preparation. 2020 Aug;14(4):541-550
18. Australian Government Department of Health. Domestic Health Response Plan for Chemical, Biological, Radiological or Nuclear Incidents of National Significance. 2018. Domestic Health Response Plan for Chemical, Biological, Radiological or Nuclear Incidents of National Significance [Accessed 15 Jan 2025]
19. Manatū Hauora Ministry of Health. National Health Emergency Plan: Hazardous Substances Incident Hospital Guidelines. 2005. National Health Emergency Plan: Hazardous Substances Incident Hospital Guidelines | Ministry of Health NZ [Accessed 15 Jan 2025]
20. National Critical Care and Trauma Response Centre. Clinical guideline: CBRN, toxicology and toxinology. 2023.
21. Occupational Safety and Health Administration (OSHA). Best practices for hospital-based first receivers of victims from mass casualty incidents involving the release of hazardous substances. Washington D.C. U.S. Department of Labor; 2005.
22. Australian College for Emergency Medicine. Heatwave preparedness or emergency departments and emergency medicine systems (P59). 2023. Melbourne: ACEM
23. Australian Health Protection Principal Committee & Australian Government Department of Health. Health CBRN Plan: Domestic health response plan for chemical, biological, radiological or nuclear incidents of national significance. Canberra, ACT: Australian Government Department of Health; 2018
24. Australian College for Emergency Medicine. Management of respiratory disease outbreaks. 2020. Melbourne: ACEM

 

Contact lists for external personnel and agencies should be maintained, regularly updated, and made available and known to all ED staff. This is especially important for personnel and agencies with which EDs do not regularly interact. These include, but are not limited to ^{6 17}:

• General: police, fire, HAZMAT, ambulance and retrieval services.
• Chemical: toxicologist, poisons information, HAZMAT scientist, environmental officer.
• Biological: infectious diseases specialists, public health unit.
• Radiological/Nuclear: medical physicists (nuclear medicine), radiation safety officers.
• Interpreters, religious leaders, local support services.
• Local GPs and other medical facilities, community service organisations, and medical and nursing students who may be called upon for volunteers in a disaster.

 

Essential (one of the following):

• An emergency physician qualified as a medical practitioner in the speciality of Emergency Medicine, holding the recognised qualification of Fellowship of ACEM, currently credentialed to work in an Australasian Emergency Department; or
• ACEM Trainees with at least 6 months experience in an ED, within the last 2 years; or
• Other registered medical practitioners who have completed either the ACEM Intermediate Emergency Medicine Training Program (IEMTP) or ACEM Advanced Emergency Medicine Training Program (AEMTP); or
• Other registered medical practitioner with currency (at least 6 months in the last two years) of practice within an ED, and appropriate continuing professional development in the field of Emergency Medicine practice; or
• Other registered medical practitioners who are credentialed to and who regularly provide acute clinical services in an ED such as: intensivists, anaesthetists, surgeons, currently employed junior medical staff and general practitioners, working within their usual scope of practice.

Desirable:

• Participation in disaster response training in the local hospital and district
• Familiarity with disaster plans for the ED and hospital in question

Limitations and Exceptional Circumstances

These recommendations apply to Australian and Aotearoa New Zealand medical practitioners responding to a sudden onset disaster in an ED setting in Australia or Aotearoa New Zealand. Recommendations for medical practitioners responding in a military or Australian or New Zealand Medical Assistance Team (AUSMAT or NZMAT) capacity are outside the scope of this policy.