The goal of this study is to test an implementation and examine users’ perceptions about the usefulness of telemedicine in mass casualty and disaster settings and to provide recommendations for using telemedicine in these settings.

Ninety-two US Army Forward Surgical Team (FST) members participated in a high-fidelity mass casualty simulation at the Army Trauma Training Center (ATTC). Telemedicine was implemented into this simulation.

Only 10.9% of participants chose to use telemedicine. The most common users were surgeons and nurses. Participants believed it somewhat improved patient care, attainment of expert resources, decision-making, and adaptation, but not the timeliness of patient care. Participants reported several barriers to using telemedicine in the mass casualty setting, including (1) confusion around team roles, (2) time constraints, and (3) difficultly using in the mass casualty setting (eg, due to noise and other conditions).

There appear to be barriers to the use and usefulness of telemedicine in mass casualty and disaster contexts. Recommendations include designating a member to lead the use of telemedicine, providing telemedical resources whose benefits outweigh the perceived cost in lost time, and ensuring telemedicine systems are designed for the conditions inherent to mass casualty and disaster settings.

During natural disasters, hospital evacuation may be necessary to ensure patient safety and care. We aimed to examine perceptions of stakeholders involved in these decisions throughout the Mid-Atlantic region of the United States during Hurricane Sandy in October 2012.

Semistructured interviews were conducted from March 2014 to February 2015 to characterize stakeholders’ perceptions about authority and responsibility for acute care hospital evacuation/shelter-in-place decision-making in Delaware, Maryland, New Jersey, and New York during Hurricane Sandy. Interviews were recorded, transcribed, and thematically analyzed using a framework approach.

We interviewed 42 individuals from 32 organizations. Hospital executives from all states reported having authority and responsibility for evacuation/shelter-in-place decision-making. In New York and Maryland, government officials stated that they could order hospital evacuation, whereas officials in Delaware and New Jersey said the government lacked enforcement capacity and therefore could not mandate evacuation.

Among government officials, perceived authority for hospital evacuation/shelter-in-place decision-making was viewed as a prerequisite to ordering evacuation. When both hospital executives and government officials perceive themselves to possess decision-making authority, there is the potential for inaction. Future work should examine whether a single entity bearing ultimate responsibility or regional emergency response coalitions would improve decision-making. (Disaster Med Public Health Preparedness. 2016;10:320–324)