Anesthesia and critical care during disasters and in austere environments requires improvisation.1-4  Partially trained personnel utilize some techniques, often adequately, yet occasionally dangerously. Triage is essential to prioritize care. Preoperative, recovery and postoperative care is often inadequate. In disasters, casualties exceed resources. Critical resources may be missing. Much of the anesthesia care takes place outside the O.R. Disaster may affect care providers. It is desirable to replenish providers and materials from outside. Surgery may focus on damage control, followed by definitive repair, often at other facilities. Infection control and sanitation are critical. Immunizations, such as for tetanus and pneumococcus, are usually indicated. Proper antibiotic administration is imperative.

Patients: Surgery is often urgent, in younger patients in poor general health. Stabilization of trauma victims is a major task. Surgical patients may suffer from various infectious diseases and...

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