DISASTER MEDICINE: A View from the Trenches
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 medical 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.
As a general rule, it s never been a lack of willingness of the medical profession to help as a tragedy unfolds, but their efficiency has sometimes been lacking, notably during
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As any student of history knows, for centuries physicians were mostly concerned 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 proper hygiene were little understood, the doctor was often something of a walking disaster himself. But that began to change during the Napoleonic Wars. The concept of triage was coined by, I believe, a French military physician 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
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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 concept of ambulances, collecting the wounded in horse-drawn wagons and taking them to military hospitals. Until that time, the wounded were generally 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
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The actual term disaster medicine began cropping up in the newspapers with some regularity during the 1950s when medical associations had begun to truly adopt the idea of anticipating a disaster. Colonel and physician Karl H. Houghton spoke to a convention of military surgeons in 1955, telling them, You won t have sufficient drugs or surgical materials to handle all the casualties and will have to decide rapidly and without hesitation who will receive this perhaps life-saving material. This is not always simple. Do you save the banker or the truck driver?
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While the disaster climate of the last several 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
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The terrorist attacks also had an acute effect 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 General Surgery. As the surgeon general of the Air Force, he had been practicing disaster training with medical students three months before a commercial 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
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For Dr. Philip Merideth, M.D., J.D., a psychiatrist in Jackson, Mississippi, his evolution
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In the last several 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.
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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 everyone 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
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Physicians are addressing the topic on blogs and are forming
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In the midst of all of this change, what once seemed improbable now seems inevitable: the creation of a medical board of certification in disaster medicine. It s an idea being championed by the American Board of Physician 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 handle 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.
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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, making 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 across the medical community for the need of preparedness and I think this board is looking at disaster medicine as much broader than just a brief medical response over a short period of time, and that all medical providers, all medical disciplines, specialties, subspecialties, and so on, will
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The majority of physicians are in primary care, family practice, general 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 primary care physicians were experts in disaster medicine.
One question is almost begging to be asked: Could the American medical community be doing too much? Are we creating layers of bureaucracy, ensuring that when a crisis comes, there will be hundreds or thousands of organizations mobilizing but not within the same framework as everyone else? Dr. Cox agrees that it eventually could become a problem that
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But Cox doesn t think the medical 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 correct number 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 medical community, military, public health, agriculture
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But however this most recent history of disaster medicine is written, there seems to be one indisputable upside, according 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. Across 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
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By Geoff Williams, Dr. David McCann and Dr. Maurice A. Ramirez
Geoff Williams is a nationally syndicated columnist and author. Dr. David McCann and Dr. Maurice A. Ramirez are co-founders of Disaster Life Support of North America, Inc., a national provider of Disaster Preparation, Planning, Response and Recovery education. Through their consulting firm High Alert, LLC., they serve on expert panels for pandemic preparedness and healthcare surge planning with Congressional and Cabinet Members. Board certified in multiple medical specialties, Dr. Ramirez was Founding Chairperson of the American Board of Disaster Medicine and Dr. McCann is the current Cahirperson of the American Board of Disaster Medicine. They are both Senior Physicians-Federal Medical Officers for the Department of Homeland
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