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Background: Neither professional consensus nor evidence exists to guide the choice of essential hospital disaster interventions. The objective of our study was to demonstrate a method for developing consensus on hospital disaster interventions that should be regarded as essential, quantitatively balancing needs and resources.Methods: A panel of pediatric acute care practitioners developed consensus using a modified Delphi process. Interventions were chosen such that workload per staff member would not exceed the previously validated maximum according to the Therapeutic Intervention Scoring System. Based on published models, it was assumed that the usual numbers of staff would care for a disaster surge of 4 times the usual number of intensive care and non–intensive care hospital patients.Results: Using a single set of assumptions on constrained resources and overwhelming needs, the panel ranked and agreed on essential interventions. A number of standard interventions would exceed crisis workload constraints, including detailed recording of vital signs and fluid balance, administration of vasoactive agents, invasive monitoring of pressures (central venous, intraarterial, intracranial), dialysis, and tube feedings.Conclusions: The quantitative methodology and consensus development process described in the present report may have utility in future planning. Groups with appropriate expertise must develop action plans according to authority within each jurisdiction, addressing likely disaster scenarios, according to the needs in each medical service region, using available regional resources, and accounting for the capabilities of each institution. (Disaster Med Public Health Preparedness. 2009;3:27–32)

1. The effects of cadmium on stimulus-response coupling in the skate ( Raja erinacea ) electric organ were examined. 2. Cadmium decreased the evoked electrical discharge and the evoked release of 3 H-ACh in a concentration-related fashion. 3. Cadmium (100 μM) also blocked voltage-dependent 45 Ca uptake. 4. Both d-tubocurarine and nifedipine blocked Ca uptake and evoked potential, but not 3 H-ACh release, thus most of the 45 Ca uptake measured was post-synaptic through L Ca channels. 5. Nickel, cadmium, and verapamil inhibited 3 H-ACh release and evoked potential, indicating a block of pre-synaptic T Ca channels.