Full spectrum neurorestoratology: enhancing neuroresponse to disasters

With more than 200,000 deaths in some years from earthquakes alone, disasters, both natural and manmade, are a major challenge for neurorestoratology. To minimize permanent neurological injury and death, it is essential for treatment to begin immediately, within minutes ideally, but certainly within 24 hours. Fortunately, the humanitarian and medical response to disasters removes the socioeconomic, legal, and political barriers that can hinder the treatment of neurological disorders under normal (nondisaster) situations. Here we review the resources and equipment already available as well as in development to enhance prompt treatment of neurological injuries arising from disasters. To be sustainable, the response to disasters must be integrated into the ongoing daily health care delivery systems worldwide, from medical education and specialty training (resident/registrar) to acute and subacute intensive care to long-term rehabilitation. The "trauma center" concept developed in the USA and elsewhere for nonmass casualty response is an example of a program developed within the existing health care training and delivery infrastructure. We therefore propose a model for worldwide disaster response that integrates disaster neurorestoratology into health care delivery systems worldwide, both governmental and nongovernmental, and national and international. An overall blueprint is presented for the full spectrum of disaster neurorestoratology, from prevention of nervous system injury, to comprehensive and immediate acute care, to long-term neurorehabilitation. Such a comprehensive response to disasters would overcome the geographic, socioeconomic, and political barriers that presently impair our ability to respond effectively to the nervous system devastation caused by disasters of all types.