PSYCHIATRIC ISSUES IN MEDICAL-
SURGICAL DISASTER CASUALTIES: A
James R. Rundell, M.D.
Psychiatrists can increase the efﬁcacy of their response to disaster victims in
the immediate aftermath of a disaster if they utilize a consultation-liaison ap-
proach to assessment and management of casualties. Medical-surgical disaster
responders use an algorithmic, stepwise approach to assess disaster or trauma
victims. This approach ensures that patients with life-threatening injuries who
are not expectant are treated ﬁrst. Then, secondary physical assessments ensure
proper triage of other victims so that disaster response resources are used most
wisely. A tertiary psychiatric assessment can assist with differential diagnosis of
post-disaster neuropsychiatric symptoms and signs to ensure valuable medical-
surgical resources are targeted to the correct patients. Psychiatric triage can
also identify those victims most in need of early preventive and therapeutic psy-
Consultation-Liaison psychiatrists and other psychiatrists in-
volved in disaster planning and response understand the impor-
tance of considering psychiatric symptoms among trauma victims
James R. Rundell, M.D., is Chief of Medical Staff, 86th Medical Group,
Ramstein Air Base, Germany.
Address correspondence to James R. Rundell, M.D., Professor of Psychiatry, F.
Edward Hebert School of Medicine, Uniformed Services University of the Health
Sciences, PSC-2, Box 7417, APO AE 09012; e-mail: james.rundell@ramstei-
PSYCHIATRIC QUARTERLY, Vol. 71, No. 3, Fall 2000
0033-2720/00/0900-0245$18.00/0 2000 Human Sciences Press, Inc.