Field hospitals are usually deployed to locations where, in response to adverse circumstances, normal health care is challenged. It is known that the prevalence of burn wounds in such situations is raised and it is highly likely that a field hospital will need to provide burn care. Many of the features of modern high-quality burn care are not deliverable in a field hospital and it is unlikely the best outcomes can be achieved. Burn care draws heavily on resources. Burns over about 30% total body surface area may cause significant physiological derangement requiring sophisticated critical care. If definitive surgical care of the wound is to be undertaken it is probably better to delay wound excision for about two weeks to allow superficial burns to heal spontaneously. Surgery should ideally be performed in repeated short sessions rather than a single large procedure.

Field hospitals can play a key role in the clinical treatment and public health management of infectious diseases during emergency situations, both in the setting of disasters primarily of an epidemic nature and of outbreaks that result secondarily in the midst of other crises. Planning and preparation are key components to successful operation in these settings and present unique issues compared to more routine field hospital scenarios absent a contagious threat. Special consideration needs to be given to site selection, the physical structure of a facility, infection prevention and control measures, personal protection, selection and training of staff, data collection and sharing, and clinical standard operating procedures. The mission of field hospitals can be expanded beyond clinical care to help stabilize epidemics through ensuring basic living conditions are available, including the provision of adequate food, clean water, sanitation, and shelter. The public health focused activities of a field hospital should include community-based prevention and health promotion activities, risk communication, and disease surveillance and control: all of which may provide invaluable contributions to broader public health response efforts during crisis.

Males and females are affected differently by natural disasters due to biologic, social, cultural, and reproductive health differences. Out of the female population, 25% are in the reproductive stage of their lives (age 15–45) and 20% of them are pregnant. While as many as 10% of natural disaster victims seeking medical assistance may need an obstetrician or gynecologist, these needs are not usually given high selection priority, whereupon rescue teams are likely to lack those essential specialists. The chapter gives clinical guidelines for managing labor in field hospital settings and dealing with ethical issues arising from treating pregnant women in disaster areas. Based on the literature and the authors’ experience, this chapter covers the effects of a disaster on women’s health in general and especially on pregnant women. The recommendation for the obstetric/gynecologic team composition, the medications and medical equipment needs, and how to arrange an Ob/Gyn department in a field hospital are given. The chapter gives clinical guidelines for managing labor in field hospital settings and dealing with ethical issues arising from treating pregnant women in disaster areas.

The chapter lists the recommendations on prevention and management of the consequences of sexual violence, reduction of HIV transmission, prevention of excess maternal and neonatal mortality and morbidity, and planning of comprehensive reproductive health services in the early days and weeks of an emergency.

The role of the ophthalmologist in the field hospital is important and irreplaceable; ocular injuries during a disaster can result in considerable disability and often require the care of an ophthalmologic surgeon. The ophthalmology field is a high technology area with the need for expensive equipment that are not available in the field hospital. The working scenario for the ophthalmologist in the delegation is very different than the one existing in a hospital in developed countries; therefore, first and foremost, a change in mental attitude is needed.

Understanding the characteristics of ocular injuries during various types of disasters in different geographical areas is important to be able to prepare for them properly, both mentally and practically.

Another dominant factor is time: the nature of ophthalmology patient’s varies significantly as time passes.

While in the first days after the disaster most ocular injuries are related to disaster, as time passes most of the referral patients are nondisaster related injuries such as chronic ocular problems of the local population.

This chapter covers the preparation needed for treating ocular injuries during disasters and the ophthalmology layout in the field hospital scenario.

The choice of the anesthetic technique in austere environments is dictated by the availability of medical personnel, electricity, oxygen, and supplies. TIVA appears to be a very promising, reliable alternative for the future of field anesthesia given its safety, simplicity, rapid setup, and small logistical footprint. Therefore, more anesthesia providers need to be trained and educated to be familiar and comfortable with administration of TIVA. Whenever regional nerve block anesthesia use is appropriate, it can be another excellent choice to provide better acute pain control and decrease postoperative complications in austere environments. There is no perfect analgesic, and hence multimodal approach for pain management is imperative. Early pain treatment has been proven to decrease chronicity, improve functionality, and reduce the risk of subsequent development psychological morbidities such as PTSD and depression. The chapter lists the recommendations on prevention and management of the consequences of sexual violence, reduction of HIV transmission, prevention of excess maternal and neonatal mortality and morbidity, and planning of comprehensive reproductive health services in the early days and weeks of an emergency.

Orthopedic treatment in a field hospital setting differs significantly from that in everyday practice in a high-income country. Field hospitals are deployed in a variety of scenarios, most commonly following earthquakes and armed conflicts, which cause a high incidence of musculoskeletal injuries. One should anticipate a large caseload of life and limb threatening injuries, delayed presentation with subsequent infections, limited operating theatre sterility, and a paucity of imaging, instrumentation, and fixation hardware.

These limitations dictate a damage control treatment approach, which includes “life over limb"": prioritizing life saving to limb saving procedures. Contamination and infection are treated by aggressive surgical debridement of contaminants and non-viable tissues. Fracture fixation is performed using the simplest and quickest methods; usually external fixation for open fractures casting for closed fractures, avoiding open reduction and internal fixation due to limited surgical sterility.

Indications for amputation include non-viable limbs due to irreparable vascular damage or severe crush injuries and infections uncontrollable by surgical and medical means.

Surgical decisions should take into account the cultural variability in the disaster milieu and informed consent should be obtained using interpreters, family and community members, and local medical personnel.

Effective administration of healthcare in an emergency setting, especially in field-hospital deployment where order must be established, needs assessed and limited resources allocated effectively, is considerably more complex than the regular patient–doctor interactions characteristic of routine times. Due to the complexity and uncertainty typical of such an environment, leadership is required not only by the field hospital staff but also by the affected public, which seeks leadership in those who are perceived to be the center of clinical service delivery.

This type of leadership demands organized command and control and practice of more than just basic leadership processes, and therefore requires, alongside the mission leader, a structured management and task-orientated chain of command.

For the hospital to operate effectively and independently, it is necessary to also define the organizational structure. The organizational structure discussed in this chapter is a model tested over the past three decades by the IDF Medical Corps hospital in numerous missions. This structure is generally similar to the basic structure of a small- to medium-scale hospital in routine times. At the same time, it allows more focused and simple managing processes required in non-routine scenarios such as emergencies or disasters.

Acute injuries contribute to significant morbidity in the immediate time following high magnitude earthquake. Illnesses resulting from poor shelter and lack of access to electricity, clean water, and sanitation will appear later.

The most common complaints are respiratory, gastrointestinal, genitourinary,malnutrition, and acute stress disorder.

Ambulatory service can be delivered as a department within the field hospital or by outreach. The triage is a crucial part of the clinic and the medical team should identify patients who could most benefit. Other parts of the ambulatory service should contain consultation area, treatment area, pharmacy and laboratory.

In the initial period the primary physicians will participate in triage of trauma patients, treating minor trauma and preparing patients for surgery. Therefore, they should be skilled in emergency medicine, ATLS and minor trauma.

Later on, the primary physician may lead the postoperative management and the last efforts will be treatment of acute problems emerging due to poor sanitation and crowding and also management of chronic medical problems. For this purpose, they should be familiar with common infections in the disaster area and antibiotic resistance. And finally, communication with local health-care services as well as public and religious facilities is mandatory.

According to the World Heath Organization's (WHO) EMT initiative, teams must meet an agreed set of standards, both clinically and logistically. EMTs must be self-sustainable and not create a burden on the already stretched resources of a host nation.

The technical demands of field hospitals require logistical personnel with specialist skills, which ensures a field hospital can continue to function when all around them has been destroyed. They must be multiskilled to fulfill multiple roles within the team.

A collection of tents does not constitute a field hospital: methodical planning around safety and security, patient flow, and overall functionality is a necessity. Field hospitals require large volumes of clean water that meets or exceeds the WHO standards of potable water; consequently, EMTs must understand the requirements of self sustainability, water quality, and quantities for the delivery of services they are offering. WASH requires an expertise and the capacity and capability to deliver high levels of WASH irrespective of the circumstances. Leading by example in health care to other health-care personnel and facilities is a essential criteria of an EMT: technical logistics is key to achieving this.

It is highly likely that a field hospital will need to provide wound care. The very presence of a field hospital indicates that a situation exists where normal healthcare is challenged. It is important that staff understand the situation as it directly impacts on the type of care that should be delivered. The wrong type of care will not just yield suboptimal results for the patients, but will adversely affect workload, impact on resources, and compromise the effectiveness of the facility. Achieving good outcomes in wound care is dependent on ensuring the patient’s general well-being is optimised. The core requirement for wound care is initial wound surgery, which fully evaluates the wound as well as performing debridement and essential immediate interventions. Wounds associated with conflict and disaster should not be primarily closed. Healing is achieved by delayed primary closure or later complex reconstruction.

It has been reported that 50% of the affected during natural or man-made disasters are children. They have unique vulnerabilities that require unique and specific management. It is therefore vital to understand the optimal management in pediatric emergencies, and to consider efforts regarding pediatric preparedness and response in humanitarian situations.

This chapter reviews the necessary means of pediatric care that must be included in medical relief delegations, and proposes a structure for a dedicated medical team, as well as necessary logistic and administrative considerations.

A triage algorithm is described, considering three key parameters: urgency, available resources, and the likelihood of saving a patient’s life. Ethical dilemmas posed by the above approach are discussed as well.

Lastly, the authors discuss the necessary collaboration between the pediatric team and the traumatology and obstetrics/gynecology departments, and describe the structure and function of a pediatric ward in a field hospital, based on experience from medical relief delegations deployed by the Israel Defense Forces (IDF) after natural disasters in Haiti and Nepal.

Field hospitals may be deployed within the borders of the jurisdiction of the care provider or, upon official request, within a different, often remote, jurisdiction such as during humanitarian missions. The field hospital is incomplete without capabilities in the areas of forensic medicine (FM) and victim identification (VI). The specifics of what constitutes appropriate indications and circumstances warranting deployment of FM and VI services in the field hospital setting, and the necessary functions and capabilities required, is the subject of this chapter.