A PHYSICIAN’S ROLE IN PROVIDING CARE IN A
DISASTER
Welcome to a special segment, Focus on Disaster
Medicine. I am your host, Dr. John Armstrong, and our guest is Dr. Ralph
Shealy, Medical Director of South Carolina Charleston County EMS and Rescue
Squad and Co-Director of the Disaster Preparedness and Response Training
Network for the South Carolina Area Health Education Consortium. Dr. Shealy is
an emergency physician and internationally recognized voice in Disaster Medicine.
DR. JOHN ARMSTRONG:
Welcome Dr. Shealy:
DR. RALPH SHEALY:
John, it's good to be with you.
DR. JOHN ARMSTRONG:
Well Dr. Shealy, I have a list of lessons that have been
identified from an event in the past and I thought I would just read these because
I think there is a point in message. This came out of hurricane that occurred
here in America where the water pressure was lost, electrical power to an
entire region was lost, auxiliary generators were inaccessible during the
storm, operating rooms were contaminated. There were significant supply
shortages and roads were impassible to vehicles and pedestrians, and this does
sound all too familiar and for our out listeners out there, this is a report
from Hurricane Hugo, which hit South Carolina in 1989 as a category 4 storm.
It sounds yearly familiar coming out of Hurricane Andrew in 1992 in South
Florida and Hurricane Katrina in the Gulf Coast in 2005, Dr. Shealy, you have vast
experience around the globe in planning and response to disasters you were
involved and it was fought 9/11 in the Gulf Coast Katrina, you were involved in
Tsunami response in Sri Lanka as well as response to the recent China
earthquake in Sichuan province. What are some lessons that you have picked up
along the way that we need to actually learn and put in place?
DR. RALPH SHEALY:
Well! I think that the major lesson is we know these things
are coming; they are inevitable part of the life of a country. There is
planning that can be done. There is preparation and training that must be
done. There are issues of equipment and supply and investing in the materials out
of preparation, and we need to develop and practice the systems that we will rely
on to pull our society back above water surface being in one of these major
cataclysmic disaster and it is cursed. Disaster preparation and preparedness
for disasters is one of the cost of doing business for society. Its only an
option, we can pay now, we can pay later, and by organizing our social
machinery to allow us to have an effective impact in mitigating the severity of
these with this and responding to them when they occur is something that is
just not a choice.
DR. JOHN ARMSTRONG:
Was isn't that more of a federal government responsibility?
DR. RALPH SHEALY:
That's one of the most severe mistakes that we could
possibly make. One thing that has come out of the discipline of emergency
management is that the disasters are local event. Disaster inevitably isolates
a community or region and impairs communication and that it is really up to
local systems, local authorities, local resources, and local citizens to do
what needs to be done in the initial stages of the disaster event. It takes
time for outside resources to mobilize even when the outside resources are
prepared, willing, enthusiastic, and want to respond as rapidly as possible,
there is still a time down and we used to say in emergency management that a
community should be prepared to take care of itself for 72 hours in truly large
scale events where there is not a localized problem, but in regional or spread
out problem. If the response to a local community can be even more prolonged.
So, the expectation that somehow the cavalry is going to come and rescue in the
form of federal or even state response, its just an error.
DR. JOHN ARMSTRONG:
So I am hearing that one key lesson that all disasters are
local initially, and I am hearing another key lesson in that planning and
preparation are essential for response and that is going to involve some
training that on-the-job training really doesn’t work in a disaster?
DR. RALPH SHEALY:
Oh! Absolutely not! You know there is one message for
physicians who are in practice in communities and so always there is generally
the expectation that the professionals will take care of the emergency, the
disaster professionals, the people who do emergency medicine in Disaster
Response or the EMS, or law reinforcement people or the local government and the
federal government that somebody else is going to take care of the response,
and what local practicing physicians need to know is that when the number of
causalities reaches a level that exceeds what can be taken care of by normal
means, then reinforcements are going to be required and reinforcements are not
coming from Washington and nor they are coming from main stream and that
physicians need to understand that many aspects of the normal practice will
come to halt in a major disaster. People are not going to be doing routine
annual physicals and routine maintenance visits if the water is over their
elbows. That what will be needed is an influx of manpower into acute care and
that people whose practices have more of a scheduled quality will be shifting
out of routine or have the capability to shift out of their routine practice in
terms of the assistance of providing acute care in the community.
DR. JOHN ARMSTRONG:
If you are just joining us, you are listening to a
special segment, Focus on Diaster Medicine. I am your host, Dr. John Armstrong
and our guest is Dr. Ralph Shealy, medical director of South Carolina
Charleston County EMS and Rescue Squad and co-director of the Disaster
Preparedness And Response Training Network for the South Carolina Area Health
Education Consortium. We are discussing how physicians can get involved in
effective planning and response to disasters.
So Dr. Shealy, what is it those physicians should do so that
they are ready for the inevitable disaster?
DR. RALPH SHEALY:
We are speaking now of people who are not the disaster
professionals, the Rank And File practicing physicians in our communities.
They need to be aware that in a truly large emergency that they will be called
and will be needed to serve and there are certain things that have to be done
if they are to be effective in that role. In particular, first is advanced
planning of how you take care of your own family. Then you see your family
plan of how the members of your family going to be reunited if anything occur?
How you deal with communications of people who are separated? How will you be
sheltered? What provisions are made for loss of power and water? What will
you do if food distribution systems are not operational? When the electricity
go and the electronic economic system goes to pot, then you have rely on a cash
economy, how you manage those things and the resources available to help with
that planning. American Red Cross has been very clear about that and their
website contains a lot of useful information.
DR. JOHN ARMSTRONG:
I would also suggest www.ready.gov as another source for
finding individual and family planning tools and so that first step is to be
prepared for yourself and for your family and we should mention extended family
including pets, what comes after that?
DR. RALPH SHEALY:
Well I think that a physician has to think about its
practice and how the practice itself is prepared from a business continuity
basis to survive through a major disruptive event that involves issue such as
preservation of records, arrangements with employees because especially if the
event impacts your own community, then your employees will be victims and your
ability to resume operation after the event is subsided will depend on how will
your employees, coworkers, and others upon whom you depend are able to recover
from the storm. After those things are taken care of, there is the issue of
preplanning how you as a practicing community physician will become involved in
the community response. Lots of folks are moved after bad event come forward
and say, I want to help. They are called as spontaneous volunteer. The
trouble with spontaneous volunteers who come forward after disaster is that
disaster management does not know these people and not credentials, they had no
training, they are not equipped, they have not been prepared to serve in a
particular role. Each individual volunteer has to be managed as an individual
unit rather than as part of group. In major large-scale disasters, spontaneous
volunteers become more of a problem. They consume tremendous amounts of energy
and because of lack of preparation may not be able to contribute what they would
like. So that whole emphasis should be on a physician finding a niche in
disaster preparation or disaster response before the event occurs and in
credential with that organization or that agency or the entity which may be,
you know, your own hospital and being assigned past screen for task adequately
prepared and there is an issue of training for Disaster Medicine. I call it
practicing medicine in a tent. There are specific things that a physician must
realize to provide medical care in an environment which if a structure is
destroyed, resources are destroyed, there is no lab, there is no imaging, and
there is limited therapeutic intervention, and so on. So, doctors have got to
get ready. If they don't get ready then they are useful after the event is
strictly limited.
DR. JOHN ARMSTRONG:
So the key message then is, don't be part of a mass provider
incident. We appreciate good intentions, but the reality is that you have got
to think before the disaster occurs, the event occurs about what it is that you
would like to do in community response and get engaged beforehand whether
through your hospital emergency response plan, community emergency response
plan, medical societies, etc. What are some of those opportunities for
physicians to be part of this community response?
DR. RALPH SHEALY:
One opportunity that has been very valuable to me personally
is being involvement with the National Disaster Medical System. I am the
senior physician for South Carolina Disaster Medical Assistance Team, and our team
has been deployed to other places in the country in response to disasters with
some frequency that requires a fairly large commitment, but there are
alternatives to that kind of commitment that are also useful. There is now a
system called the Medical Reserve Corp in all of the states. These units of
Medical Reserve Corp are the result of a federal initiative which is managed by
the states and the health professionals are set up to receive training and to
be credentialed and organized so that they can be called upon in emergency to
provide reserve, resources to areas that have been impacted by disaster.
DR. JOHN ARMSTRONG:
Where can our listener's get more information about NDMS and
Medical Reserve Corp opportunities?
DR. RALPH SHEALY:
I would recommend going to the Internet, search for National
Disaster Medical System, which describes the opportunities in that system and
search for Medical Reserve Corp.
DR. JOHN ARMSTRONG:
I want to thank our guest, Dr. Ralph Shealy. We have been
talking about lessons for preparedness in disasters, and in particular how
physicians can engage before the disaster occurs.
I am Dr. John Armstrong. You have been listening to a
special segment. Make sure to visit our web site at www.reachmd.com featuring
on-demand pod cast of our entire library and thank you for listening.
You are listening to ReachMD XM160, The Channel For
Medical Professionals.
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