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Original Research
Conflicts of interest: Dr. Coule serves as an uncompensated member of the Board of Directors of the National Disaster Life Support Foundation. None of the other authors have any conflicts of interest to declare.
Introduction
Mass-casualty incidents (MCIs) are events which overwhelm the resources for emergency response by the quantity and severity of casualties.1This broad definition applies to both large-scale natural disasters with many thousands of victims and small-scale incidents which overwhelm local emergency resources despite only a handful of victims. Many otherwise treatable injuries result in fatalities due to inadequate preparedness and rationing of medical resources. Survivors of MCIs often carry long-term physical, mental, and emotional disabilities.2,3Although the number of first responders is variable in each locale, education in disaster preparation, triage, and treatment is vital to maximize the utility of all available personnel and minimize the loss of life.
Mass-casualty incidents are both infrequent and difficult to predict, making advance preparation a challenging endeavor. According to the World Health Organization (WHO; Geneva, Switzerland) and Centre for Research on the Epidemiology of Disasters (CRED; Brussels, Belgium), the number of recorded natural disasters and victims have increased since 1975.4Thailand in particular has suffered both natural and man-made MCIs. On December 26, 2004, a 9.1 magnitude earthquake struck off the coast of Indonesia, triggering a tsunami which caused considerable casualties in several countries in Southeast Asia. In Thailand alone, this event resulted in 5,388 confirmed fatalities, 3,120 missing, and 8,457 injuries.5In 2011, widespread flooding in 65 of Thailand's 77 provinces resulted in at least 884 confirmed deaths and 1.4 trillion baht (US $45 Billion) in economic damage.6Furthermore, militant Islamic secessionists in southern Thailand have terrorized citizens through bombings, arson, and other forms of violence since early 2004. Total casualties from this violence as of January 2012 were 5,243 lives and 8,941 injuries.7These MCIs prompted several Thai medical centers to develop disaster education programs to improve disaster and MCI preparedness.
The National Disaster Life Support (NDLS) training program was developed in 2003 to address the lack of a standardized training program for disaster management in the United States.8The program includes several courses which stress a comprehensive approach to help...