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The recent massive disaster brought about by the December 26, 2004, tsunami in the Indian Ocean was one of the most lethal, costly, and destructive in modern history. Some experts predict, however, that an ever-increasing global population, with its attendant strains on natural, technological, and human resources, portend even greater and more frequent disasters to come.1 These realizations, coupled with technological innovations, microbial engineering, increasingly sophisticated terrorist capabilities, and the ever-present danger of war and sectarian strife, call to mind the myriad problems associated with effective disaster planning and disaster response.

Although disasters defy ready definition, and at least 35 different professions are involved in disaster assessment, study, and mitigation,2 a disaster might nonetheless be defined as a destructive event that results in the need for a wide range of emergency resources to assist and ensure the health and survival of the stricken population.3 Disasters can be natural or man-made, abrupt or insidious. Furthermore, disasters caused by man can include warfare and terrorism, as well as “technological” disasters (Table 79-1). “Natural” disasters, such as earthquakes, volcanic eruptions, hurricanes, floods, and the like, have been with us throughout history. The same can be said for warfare, and its accompanying destruction, disease outbreaks, and famine. Technological disasters have likewise been with us since the Industrial Revolution.4 Such disasters may involve explosions, fires, crashes, and chemical or radiological releases into the environment.5 More recently, the specter of man-made disasters related to terrorism and the deployment of weapons of mass destruction (WMDs) has focused considerable attention on public health and disaster preparedness.


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