Kansas City, Mo. — Thirty years after the disaster, Joseph F. Waeckerle, MD, still prays that he made the right calls.

The 1981 collapse of the interior skywalk system in the Hyatt Regency in Kansas City killed 114 people and injured 216 under the crushing weight of concrete and steel. Dr. Waeckerle directed the rescue effort and decided with just a few moments’ review who could be rescued and who could be offered only a morphine drip and advised to make peace with God.

Dr. Waeckerle and others at the scene had to determine how to save the most lives and limbs with little assurance that their judgments would be well-regarded in the aftermath.

A medical disaster is when the need for care outstrips the available resources — medicines, equipment, personnel. Such a chasm between demand and supply stretches far beyond a hectic day in the emergency department and requires a shift in ethical thinking because not every patient can get the care he or she would be entitled to under normal circumstances.

Which patients get the highest priority? What obligation do physicians have to respond to patient need in disasters? What should physicians do to prepare?

My latest. Read the whole shebang.