Health South Rehabilitation - Disaster Medicine: A View from the Trenches
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From earthquakes to wars to floods and hurricanes, the history of disaster medicine is replete with success and failure when it comes to the results of the physicians and nurses and curative administrators who assist during and in the aftermath of a crisis. And it's a long history. "Really, when you look at where disaster medicine started, it goes back to the Civil War battlefields, and even pre-dating to Roman times," says Gary M. Klein, M.D., Mph, Mba, who practices acute care medicine in Atlanta.
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As a normal rule, it's never been a lack of willingness of the curative profession to help as a tragedy unfolds, but their efficiency has sometimes been lacking, notably during some high-profile catastrophes in the last few years.
As any trainee of history knows, for centuries physicians were mostly implicated with minimizing pain and suffering. Before the days of anesthesia, that often meant amputating a limb and hoping for the best, and because germs and permissible hygiene were slight understood, the doctor was often something of a walking disaster himself. But that began to convert during the Napoleonic Wars. "The thought of triage was coined by, I believe, a French soldiery doctor with Napoleon, and then you had Clara Barton, during the American Civil War, creating the American Red Cross. All of that's a part of disaster medicine, and then during each of the wars that the United States has been complicated in, disaster medicine has been ramped forward," says Captain James W. Terbush, Md, Mph, of the U.S. Navy curative Corps, and a Norad-Usnorthcom Command Surgeon at Peterson Air Force Base in Colorado.
Indeed. during the Napoleonic Wars, Dominique-Jean Larrey was a surgeon in the French emperor's army, not only conceived of taking care of the wounded on the battlefield, he also created the thought of ambulances, collecting the wounded in horse-drawn wagons and taking them to soldiery hospitals. Until that time, the wounded were ordinarily cared for near the end of the day, or whenever the battle paused or ended. By the time the Civil War began, Clara Barton learned that many wounded soldiers were dying not from lack of attention, but the need for curative supplies, and she began her own club to distribute medicine, bandages and other life-saving tools.
The actual term disaster medicine began cropping up in the newspapers with some regularity during the 1950s when curative associations had begun to truly adopt the idea of anticipating a disaster. Colonel and doctor Karl H. Houghton spoke to a custom of soldiery surgeons in 1955, telling them, "You won't have enough drugs or surgical materials to cope all the casualties and will have to rule rapidly and without hesitation who will receive this possibly life-saving material. This is not all the time simple. Do you save the banker or the truck driver? Do you go right down the line of casualties taking them as they come, or do you pick out those individuals who might be the most principal in terms of the resumption period to come?" Meanwhile colonel and physician, Joseph R. Schaeffer, Md, imagined a heavy nuclear attack. "We have 200,000 doctors to take care of 176,000,000 people in this country," he told a Texas hospital curative staff in 1959. "Therefore, the people must learn how to survive for themselves in case of an emergency." Schaeffer lamented that so few Americans had any permissible first aid schooling while Russia required its citizens to take 22 hours in first aid education--every year.
As Cincinnati-based internist John Andrews, Md, who spent 20 years as a Commissioned Corps doctor in the U.S. Communal health Service, artfully puts it: "It's not just that the disasters seem to be advent more frequently, they're more varied. In the old days, you had natural disasters like hurricanes, floods, tornadoes, and maybe occasionally a chemical spill. But now, somebody's verily trying to make a disaster."
While the disaster climate of the last some years has had a profound impact on many laypeople, it has uniquely affected many doctors, who, of course, are prone to having their own opinions on preventing suffering and dying. Dr. Klein, who was a pharmaceutical executive in New York City when the 9-11 attacks occurred, spent around 24 hours at Ground Zero, initially insisting upon dealing "with the worried well," people he describes as being "absolutely devastated, wandering around in a daze, acutely traumatized."
The terrorist attacks also had an acute consequent on Paul K. Carlton, M.D., the director of Homeland security at Texas A&M health Science center who believes disaster medicine should be a board-certified specialty like normal Surgery. As the surgeon normal of the Air Force, he had been practicing disaster training with curative students three months before a market jet hit the Pentagon. His group had, eerily enough, come up with a similar disaster scenario to practice, only they imagined an aircraft having an unsuccessful take off or landing, resulting in a crash into the Pentagon. In their exercises, they did quite poorly, admits Carlton, but because of the drills, on September 11, when Dr. Carlton rushed into the Pentagon as a first-responder, he and his team were understandably pleased by their performance. He led a salvage group into part of the building where the landing gear had impacted and they managed to pull three people to safety, "and we all got out alive." No small feat, since Dr. Carlton himself caught on fire. That he's alive at all is at least partially due to the fire-retardant vest he was wearing.
For Dr. Philip Merideth, M.D., J.D., a psychiatrist in Jackson, Mississippi, his evolution in thinking came after Hurricane Katrina. He spent two weekends in Mississippi and Louisiana, doing what he could, prescribing medicine and simply listening to people pour out their grief. "Everyone had a story of what happened in the hurricane, and they wanted to tell it," says Merideth, who offers one chilling example--talking to a slight boy who had been the only survivor of his household, and that had been because he swam out the second story window.
In the last some years, as disasters have seemed to be on the increase, careers have been created and defined, government plans were put into action, and first-responders such as police and firefighters began crafting ideas for effectively handling disasters. In 2003, infectious disease expert Robert Cox Md of Englewood, Colorado, had just started his company, Bioforecasts, intending to speak to curative and non-medical organizations about what society's time to come health and longevity might be like. However, he has since extensive his talk to comprise disaster medicine topics, like bioterrorism and how to inoculate your company against the avian (bird) flu.
"I had been thinking about those topics from the beginning," says Dr. Cox, "but after awhile, there was no way I couldn't not discuss them." That's how every person seems to feel.
Much of what needs to be taught is a mindset, says Dr. Carlton, who cites an example of a suicide bomber who attacked a cafeteria on an American soldiery base in Mosul, Iraq. "The kids there had a small team, where they did nine operations in the operating room and 10 in the hallway. That's the kind of Plan B doing that stands us in good stead when we need it. Our curative students need to perceive that we're not all the time going to have the technology they've come to be accustomed to. I think of Hurricane Katrina, where a woman was in labor, and all of the lights went out. The doctors performed a C-section--by flashlight. It's not an ideal circumstance, but they did a gorgeous job."
Physicians are addressing the topic on blogs and are forming groups like the Texas curative Rangers, which aims to acknowledge to natural disasters and weapons of mass destruction attacks inside Texas. In Washington state, Robert Cross, M.D. Is a 77-year-old retired physician, who for some years has been toiling to generate an club of retired doctors who will acknowledge to disasters in his home state. He, like many doctors, wanted to do something constructive in the wake of the terrorist attacks. Suddenly, he realized just how shortsighted the curative community had been in windup hospitals left and right due to the advent of patient care centers. "In any disaster, surge capacity is a base question in the hospitals," says Cross, knowing that while he may not be able to replace the hospital buildings, he can call upon a cadre of newly trained retired physicians and nurses on call to help the state when needed.
In the midst of all of this change, what once seemed incredible now seems inevitable: the creation of a curative board of certification in disaster medicine. It's an idea being championed by the American Board of doctor Specialties.
Nodding in approval is Dr. Andrews, board certified in internal, preventive and occupational medicine. "Most of us have many patients in a day, but we don't cope a disaster, say, once a week. They come every so often, and to be trained in disaster medicine, and updated, I think is a neat idea."
And necessary, says F. Matthew Milhelic, M.D., who is an assistant professor at the center for Homeland security Studies at the University of Tennessee's Graduate School of Medicine. "I think the way that this board has proposed this idea, development it an inclusive board, will do two things--raise the level of competency among physicians to deal with problems in a disaster, and it will also raise awareness over the curative community for the need of preparedness... And I think this board is looking at disaster medicine as much broader than just a brief curative response over a short period of time, and that all curative providers, all curative disciplines, specialties, subspecialties, and so on, will have a role in any major disaster."
"The majority of physicians are in original care, family practice, normal medicine, and, of course, there are pediatricians and ob-gyn," concurs Dr. Terbush, who was in the thick of things after Hurricane Rita and Hurricane Katrina. "It would be exceptionally helpful if original care physicians were experts in disaster medicine."
One request is roughly begging to be asked: Could the American curative community be doing too much? Are we creating layers of bureaucracy, ensuring that when a emergency comes, there will be hundreds or thousands of organizations mobilizing but not within the same framework as every person else? Dr. Cox agrees that it eventually could come to be a problem--that we would suffer from a "lack of coordination and transportation among the agencies, like the 9/11 experience. There could also be a dilution of resources being spread out rather than concentrated. This applies to both people as well as finances."
But Cox doesn't think the curative community or country should slow down just yet. "I think this is all part of the organizational evolution, and only time will tell what the spoton estimate is." He also points out that there are some efforts at coordinating disparate groups, citing his home state of Colorado's "Governor's expert Epidemic and emergency Response Committee," which includes representatives from the curative community, military, Communal health, agriculture and many others, so the next time a disaster strikes, no group will feel as if they're on their own.
But however this most modern history of disaster medicine is written, there seems to be one indisputable upside, agreeing to Dr. Fredrick Slone, visiting assistant professor at the University of South Florida College of Nursing, "The reality is that the more teams that are formed, the more people will be trained for a response, and in the long run, this is what we need." over the generations, from those who define their times by an incomplete New York City skyline or a mountain of bricks and blood in a tiny Texas town, few people are likely to argue with that.
By Geoff Williams, Dr. David McCann and Dr. Maurice A. Ramirez
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