The Stage of Alert refers to the time period leading up to a disaster or terrorism event, usually defined by warnings disseminated by the federal government about increased risk of a disaster or terrorism situation. The general consensus was the need for more accurate information from appropriate governmental agencies to the public about specific impending threats, to ensure better coping. The purpose of providing this information to the public is to avoid panic or inertia, and to encourage normal adaptive reactions. It is important for people in positions of leadership to realize that past experiences have shown that panic has not occurred if people were given accurate information about the anticipated threat and specific guidelines about what to do.

Natural and complex disasters can cause a dramatic increase in the demand for emergency medical care. Local health services can be overwhelmed, and damage to clinics and hospitals can render them useless. Many countries maintain mobile field hospitals for defense or humanitarian purposes. Dispatching these facilities to disaster-affected countries would seem an ideal response to emergency medical needs. Unfortunately, experience has shown that in the case of natural disasters, field hospitals often have not met the expectations of recipients and donor institutions.

In July 2003, the World Health Organization and Pan American Health Organization sponsored a workshop in El Salvador to discuss the pros and cons of using foreign fieldhospitals in the aftermath of natural disasters. These guidelines are the result of that workshop. The workshop participants identified different phases when foreign field hospitals and specialized medical personnel are most useful. They can provide advanced trauma care and life support if at the disaster site within 48 hours of the impact of an event; they would provide follow-up care for trauma victims and resumption of routine medical care in the two weeks following the event; during rehabilitation and reconstruction phases (from two months to two or more years), a field hospital might serve as a temporary replacement for damaged health facilities. These guidelines propose conditions that field hospitals and their staff should meet for each ofthese phases. The guidelines also outline issues that authorities in donor countriesand disaster-affected countries should discuss before mobilizing a field hospital.

This article seeks to clarify the terminology and methods of planning to avert hospital internal disaster. It differentiates “crisis” from “disaster” in the in-hospital setting. Preparedness, as contrasted with mitigation, is meant to reduce the likelihood that a crisis will turn into a disaster. Though there are some recurring features of crises, allowing for preparedness through the identification of a few high-likelihood contingencies, crises are subject to numerous, overwhelming uncertainties. These include hazard uncertainty, incident uncertainty, sequential uncertainty, informational uncertainty, consequential uncertainty, cascade uncertainty, organizational uncertainty, and background uncertainty. In view of the uncertainties, the primary aim of planners should not be to try to create plans for ever more contingencies, since contingencies are far too numerous and perhapsapproach infinity, but rather to create capabilities (through proper preparedness) for resilience during crisis. Resilience can be cultivated through improvements in information acquisition and dissemination, communication systems, resource management, mobility management, design for resilience, incident command, and staff versatility.