Disaster Medicine - Time Line

Time Line

1812 – Napoleonic wars give rise to the military medical practice of triage in an effort to sort wounded soldiers in those to receive medical treatment and return to battle and those whose injuries are non-survivable. Dominique-Jean Larrey, a surgeon in the French emperor’s army, not only conceived of taking care of the wounded on the battlefield, he also created the concept of ambulances, collecting the wounded in horse-drawn wagons and taking them to military hospitals.

1863 – International Red Cross founded in Geneva, Switzerland.

1873 – Clara Barton starts organization of the American Red Cross, drawing on her experiences during the American Civil War.

1881 – First American Red Cross chapter founded in Dansville, NY.

1937 – President Franklin Roosevelt makes a public request by commercial radio for medical aid following a natural gas explosion in New London, Texas. This is the first presidential request for disaster medical assistance in United States history.

1955 – Col. Karl H. Houghton, M.D. addresses a convention of military surgeons and introduces the concept of “disaster medicine.”

1959 – Col. Joseph R. Schaeffer, M.D. reflecting the growing national concern over nuclear attacks on the United States civilian population initiates training for civilian physicians in the treatment of mass casualties for the effects of weapons of mass destruction creating the concept of medical surge capacity.

1961 – The American Medical Association, the American Hospital Association, the American College of Surgeons, the United States Public Health Service, the United States Office of Civil Defense and the Department of Health, Education and Welfare join Dr. Schaeffer in advancing civilian physician training for mass casualty and weapons of mass destruction treatment.

1962 – The North Atlantic Treaty Organization (NATO) publishes an official disaster medicine manual edited by Dr. Schaeffer.

1984 – The United States Public Health Service forms the first federal disaster medical response team in Washington, DC designated PHS-1

1986 – The United States Public Health System creates the National Disaster Medical System (NDMS) to provide disaster healthcare through National Medical Response Teams (NMRT), Disaster Medical Assistance Teams (DMAT), Disaster Veterinary Assistance Teams (VMAT) and Disaster Mortuary Operational Response Teams (DMORT). PH-1 becomes the first DMAT team.

1986 – A disaster medical response discussion group is created by NDMS team members and emergency medicine organizations in the United States. Healthcare professionals worldwide join the discussion group of the years to come.

1989 – The University of New Mexico creates the Center for Disaster Medicine, the first such medical center of excellence in the United States. Elsewhere in the world, similar centers are created at universities in London, Paris, Brussels and Bordeaux.

1992 – Hurricane Andrew, a category 5 hurricane strikes south Florida destroying the city of Homestead, Florida and initiation the largest disaster healthcare response to date.

1993 – On February 26, 1993 at 12:17 PM, a terrorist attack on the North Tower of the World Trade Center (the such attack on United States soil since World War II) increases interest in specialized education on the training disaster response for civilian physicians.

1998 – The American College of Contingency Planners (ACCP) is formed by the American Academy of Medical Administrators (AAMA) to provide certification and scholarly study in the area of medical contingency planning and healthcare disaster planning.

2001 – The September 11, 2001 attacks on the World Trade Center and the Pentagon is the largest loss of life resulting from an attack on American targets on United States soil since Pearl Harbor. As a result, the need for disaster medicine is galvanized.

2001 – On October 29, 2001, President George W. Bush issues Homeland Security Presidential Directive 1 (HSPD-1) establishing the organization and operation of the Homeland Security Council.

2002 – On March 11, 2002, President Bush issues HSPD-3 establishing the Homeland Security Advisory System.

2002 – On December 11, 2002, President Bush issues HSPD-4 outlining the National Strategy to Combat Weapons of Mass Destruction

2003 – The American Medical Association in conjunction with the Medical College of Georgia and the University of Texas debut the National Disaster Life Support (NDLS) training program providing the first national certification in disaster medicine skills and education. NDLS training would later be referred to as “the CPR of the 21st century.”

2003 – In February, 2003 the American Association of Physician Specialists (AAPS) appoints an expert panel to explore the question of whether Disaster Medicine qualifies as a medical specialty.

2003 – On February 28, 2003, President Bush issues HSPD-5 outlining the system for management of domestic incidents (man-made and natural disasters). HSPD-5 mandated the creation and adoption of the National Response Plan (NRP).

2003 – On September 30, 2003, the National Response Plan was published and adopted by all Federal agencies.

2003 – On December 17, 2003, President Bush issues HSPD-8 outlining the new framework for national preparedness and creating the National Incident Management System (NIMS).

2004 – In February, 2004 the AAPS reports to the American Board of Physician Specialties (ABPS) that the expert panel, supported by the available literature and recent HSPD’s has determined that there is a sufficient body of unique knowledge in Disaster Medicine to designate the field as a discrete specialty. ABPS empanels a board of certification to determine if board certification is appropriate in this new specialty.

2004 – On April 28, 2004, President Bush issues HSPD-10, also known as the plan for Biodefense for the 21st Century which calls for healthcare to implement surveillance and response capabilities to combat the threat of terrorism.

2004 – Hurricanes Charlie, Francis, Ivan and Jeanne batter the state of Florida resulting in the largest disaster medical response since Hurricane Andrew.

2005 – Hurricane Katrina batters the gulf coast of the United States destroying multiple coastal cities. For the first time in NDMS history, the entire NDMS system is deployed for a single disaster medical response. Among the many lessons learned in field operations following hurricane Katrina are the need for cellular autonomy under a central incident command structure and the creation of continuous integrated triage for the management of massive patient surge. The lessons learned in the hurricane Katrina response would be applied less than a month later following hurricane Rita and again following hurricane Wilma and the Indonesian tsunami.

2005 – In late October, 2005, the American Board of Disaster Medicine (ABODM) and the American Academy of Disaster Medicine (AADM) were formed for scholarly study, discussion and exchange in the field of disaster medicine as well as to oversee board certification in disaster medicine.

2006 – In June 2006, the Institute of Medicine published three reports on the state of emergency healthcare in the United States. Among the condemnations of emergency care is the lack of substantial improvement in disaster preparedness or “cross silo” coordination.

2006 – On September 17, 2006, the NIMS Integration Center publishes the NIMS Implementation Plan for Hospitals and Healthcare establishing a September 30, 2007 deadline for all hospitals and healthcare facilities to be “NIMS compliant.”

2007 – On January 31, 2007, President Bush issues HSPD-18 calling for the development and deployment of medical countermeasures against weapons of mass destruction.

2007 – On September 30, 2007, the NIMS Implementation Plan for Hospitals and Healthcare Facilities compliance deadline passes with fewer than 9% of all United States hospitals fully compliant and fewer than half of hospitals and healthcare facilities having made substantial progress towards compliance.

2007 – On October 18, 2007, President Bush issues HSPD-21 outlining an augmented plan for public health and disaster medical preparedness. HSPD-21 specifically calls for the creation of the discipline of “disaster healthcare” using the accepted definition of “disaster medicine.” HSPD-21 also calls on the Secretary of Health and Human Services (HHS) to use “economic incentives’’ including the Center for Medicare Services (CMS) to induce private medical organizations, hospitals and healthcare facilities to implement disaster healthcare programs and medical disaster preparedness programs.