Should New South Wales Hospital disaster teams be sent to major incident sites?

Background: The aim of the present review was to assess the suitability of hospital disaster medical teams' training, personal safety and medical equi pment for site casualty work at multiple casualty incidents (MCI), and to c ompare this with retrieval teams who routinely provide pre-hospital trauma care. The options for the provision of a site medical response based upon i nternational and Australian disaster planning guidelines are also reviewed. Methods: A questionnaire was mailed to all doctors dispatched to the 1997 T hredbo disaster as part of trauma service (TS) hospital medical teams, medi cal commanders or Helicopter Emergency Medical Service (HEMS) crew. Doctors with Sydney retrieval services (SRS) experience were compared with those w ithout SRS experience in regard to the reported level of relevant training and experience as defined by current Australian guidelines and the Educatio n and Training in Disaster Medicine Curriculum, Scientific Committee of the International Society of Disaster Medicine. Familiarity with medical equip ment was assessed. as was level of compliance with Australian guidelines fo r personal protective clothing and equipment. Results: Responses were obtained from all 25 doctors. Nine had SRS experien ce. None of the 16 doctors without SRS experience met the criteria of the E ducation and Training Curriculum, compared with four of nine doctors with S RS experience (44%). All six SRS doctors using SRS equipment had personally used or checked their equipment within 2 weeks prior to dispatch to Thredb o, compared with none of the 19 doctors using hospital equipment. Of the 11 areas of personal safety equipment and clothing assessed, all SRS doctors using SRS equipment complied with the guidelines in five areas (45%). There was no area assessed in which all the doctors using hospital equipment com plied. Conclusion: Hospital medical teams suffer from the same problems of inadequ ate training, experience and personal safety equipment that are identified in previous reports from disasters overseas. The continued focus on hospita l medical teams in counter-disaster planning as the primary sourer of on-si te medical services is inappropriate because, with the exception of retriev al doctors who routinely provide pre-hospital trauma care, appropriately tr ained and experienced doctors are unlikely to be available from within the hospital system.