Do you know about - Disaster Medicine: A View from the Trenches
Rehabilitation Centers! Again, for I know. Ready to share new things that are useful. You and your friends.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 healing administrators who sustain while 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 general rule, it's never been a lack of willingness of the healing profession to help as a tragedy unfolds, but their efficiency has sometimes been lacking, notably while some high-profile catastrophes in the last few years.
As any learner 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 allowable hygiene were tiny understood, the doctor was often something of a walking disaster himself. But that began to change while the Napoleonic Wars. "The belief of triage was coined by, I believe, a French soldiery doctor with Napoleon, and then you had Clara Barton, while the American Civil War, creating the American Red Cross. All of that's a part of disaster medicine, and then while 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 healing Corps, and a Norad-Usnorthcom Command Surgeon at Peterson Air Force Base in Colorado.
Indeed. while 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 belief of ambulances, collecting the wounded in horse-drawn wagons and taking them to soldiery 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 were dying not from lack of attention, but the need for healing 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 while the 1950s when healing associations had begun to truly adopt the idea of anticipating a disaster. Colonel and doctor Karl H. Houghton spoke to a practice of soldiery surgeons in 1955, telling them, "You won't have enough drugs or surgical materials to deal with all the casualties and will have to settle 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 indispensable in terms of the rehabilitation period to come?" Meanwhile colonel and physician, Joseph R. Schaeffer, Md, imagined a massive nuclear attack. "We have 200,000 doctors to take care of 176,000,000 people in this country," he told a Texas hospital healing 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 allowable first aid study 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. Collective 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 of course trying to make a disaster."
While the disaster atmosphere of the last any 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 administrative in New York City when the 9-11 attacks occurred, spent nearby 24 hours at Ground Zero, initially insisting upon dealing "with the worried well," people he describes as being "absolutely devastated, wandering nearby in a daze, acutely traumatized."
The terrorist attacks also had an acute supervene on Paul K. Carlton, M.D., the director of Homeland protection 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 healing 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 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 reasoning came after Hurricane Katrina. He spent two weekends in Mississippi and Louisiana, doing what he could, prescribing medicine and naturally 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 tiny 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 any 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 healing and non-medical organizations about what society's time to come health and longevity might be like. However, he has since expanded his talk to contain disaster medicine topics, like bioterrorism and how to inoculate your enterprise against the avian (bird) flu.
"I had been reasoning 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 everybody 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 restaurant 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 carrying out that stands us in good stead when we need it. Our healing students need to comprehend that we're not all the time going to have the technology they've become 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 healing Rangers, which aims to write back 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 any years has been toiling to create an club of retired doctors who will write back 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 healing society had been in windup hospitals left and right due to the advent of sick person care centers. "In any disaster, surge capacity is a tasteless 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 foreseen, now seems inevitable: the creation of a healing 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 deal with 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 protection 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 over the healing society for the need of preparedness... And I think this board is seeing at disaster medicine as much broader than just a brief healing response over a short period of time, and that all healing providers, all healing disciplines, specialties, subspecialties, and so on, will have a role in any major disaster."
"The majority of physicians are in traditional care, house 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 traditional care physicians were experts in disaster medicine."
One interrogate is approximately begging to be asked: Could the American healing society 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 everybody else? Dr. Cox agrees that it ultimately could become a problem--that we would suffer from a "lack of coordination and communication 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 healing society or country should slow down just yet. "I think this is all part of the organizational evolution, and only time will tell what the literal, whole 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 crisis Response Committee," which includes representatives from the healing community, military, Collective 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 new 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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