Management of Disasters and their AftermathBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6994.1615 (Published 17 June 1995) Cite this as: BMJ 1995;310:1615
- Patrick K Plunkett
Ed W Angus Wallace, John M Rowles, Christopher L Colton BMJ Publishing Group, pounds sterling36, pp 314 ISBN 0 7279 0841 3
Having previously been fascinated by air disasters and read, at length, various reports on them, I automatically assumed that Management of Disasters would be the usual self congratulatory internal report. I was wrong. I read this book from cover to cover, in two evenings, and found it fascinating.
The details of how the Air Accident Investigation branch operates, and the analysis of both survivors' and victims' placement in an aircraft, kept me enthralled. They also helped me understand the practical difficulties in arranging for the investigations to occur—for instance, setting up a site for a major disaster mortuary with a very large floor space at ground level, which should have adequate lighting, heating, ventilation, water supply, and drainage. This mortuary must have easy access for transportation and collection of the bodies but, at the same time, be totally secure and allow some privacy. Then there are such details as the necessity for refrigerated containers to store bodies and for storage facilities for clothing and property while awaiting identification, pathological investigation, embalming, and putting into coffins.
I well understand, from my own clinical practice, the enormous pressure for bereaved relatives to be able to carry on with the interment or cremation of their loved ones at the earliest possible moment, rather than waiting for long drawn out investigative procedures to take place. I was not previously aware of such analytical capabilities as crash simulation and the highly complex mathematics entailed in trying to understand what has happened and how to prevent problems in the future.
Hindsight can be used very effectively for forward planning. After the Stockport air disaster in 1963 underseat bars were modified because of the number of victims who sustained bilateral lower limb fractures, just above the ankle, preventing emergency evacuation. What has come from the Nottingham, Leicester, Derby, and Belfast crash study group is the new brace position, as currently recommended by the Civil Aviation Authority. The recommendation is to adopt a crouched position like a ball, apply both hands to the top of the head without interlocking the fingers, to pull the head down and bring the elbows down towards the knees; legs should be positioned firmly on the floor with feet together slightly behind knees. Needless to say, seat belts should be positioned across the anterior superior iliac spine.
Herb doctor taking the pulse of a pregnant woman in 17th century Korea, from History of the Disorders of the Cardiac Rhythm (Futura, $75, ISBN 0 87993 606 1). This short monograph by Professor Berndt Luderitz of Bonn University illustrates a fascinating corner of cardiology.
Immediately before receiving this excellent book, I had been involved in updating the major emergency plan for my own hospital. Though much of it mirrors the advice from the study, I feel that I will have to go back yet again and make some modification to my own plan in light of the information contained in the book—in particular, the concept of an overall summary of the plan being given to all employees, each department having a detailed plan with a step by step guide for the workers. The book is not a master plan for dealing with a major emergency, but it achieves what it sets out to do, which is to help readers learn things that will place them in a much better position should they be unfortunate enough to experience a disaster in the future.—PATRICK K PLUNKETT, consultant in accident and emergency medicine, St James's Hospital, Dublin
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