Disaster and Emergency Medicine: An Overview
/Disaster. It’s trending right now. In the last few years we have seen epidemic outbreaks of hemorrhagic fever, earthquake induced nuclear meltdowns, and large-scale civil war. It is no secret: both the scale and frequency of disasters are increasing. This appears to be due to a complex interplay of interconnected, global factors that show no signs of slowing. More people means harvesting more food, tapping more clean water, clearing more land, crowding more cities, and releasing more harmful products into the environment. The consequences to this include rising water levels, widening temperature extremes, increasing erosion, and a growing number of vulnerable people. With inevitably more disaster on the horizon, preparedness and experienced leadership are critical for the world’s future.
Accordingly, effective disaster management and response are becoming increasingly relevant on both local and global scales and require expertise and collaboration from a variety of disciplines. The foundations of an adequate disaster response emphasize providing sufficient water, sanitation, hygiene, nutrition and shelter, while minimizing disease and associated morbidity and mortality. Thus, disaster response routinely requires input from engineers, logisticians, policy makers, and healthcare workers amongst many others. The physician role represents one piece of a much larger whole. However, there is no doubt that this piece is vital.
Disaster relief crews after Japan’s 2011 earthquake and tsunami
Medical evaluation and treatment is needed as part of the response to essentially any disaster scenario. However, the type and extent of medical need varies depending on the specific situation and stage of disaster. In situations precipitated by massive destruction such as conflict and natural disaster, there is an early, near immediate need for trauma and orthopedic evaluation and treatment, which may continue longitudinally depending on circumstances. On a less acute basis, in scenarios where people are displaced en mass (often with suboptimal sanitation) there is a medical need for the monitoring and management of communicable diseases. These most commonly include diarrheal illness and measles but often also include meningitis, pneumonia and in many settings, malaria, all of which have the potential to quickly reach epidemic levels. In disaster scenarios where populations are displaced for longer amounts of time, there is a medical need for evaluation and treatment of more chronic illness, and includes care of especially vulnerable populations such as the elderly, young, pregnant, and those with pre-existing medical conditions. Finally, coordinating responses for all of the above and establishing infrastructure for healthcare in disaster environments is challenging, require physician input, and are often physician-led.
Due to the unpredictable nature of disaster, being fully prepared to launch an effective response is challenging, and there is no substitution for training and experience. There is not one set path in obtaining this and there are many starting points. Courses such as the National Disaster Life Support series offer a standardized, introductory, and generalized approach for health care providers to respond to mass casualty events. There are plenty of other on-line resources that provide valuable disaster management knowledge, but they do not offer hands-on experience. For this, becoming part of a local or federal Disaster Management Assistance Team (DMAT) is a reasonable starting place, as well as serving on the committees for disaster response of local hospitals. Similarly, on an international level joining a Medical Assistance Team (MAT) with an NGO such as the Red Cross can provide valuable experience. Whatever the experience, a ground up approach from training and drilling to managing smaller to larger disaster scenarios likely offers the most assured route to preparedness.
As emergency physicians we are particularly well equipped to respond to disaster. We are experts at triage and trained to evaluate and treat all-comers in all phases of acuity, and can manage multiple patients simultaneously. We are used to dealing with uncertainty and working in suboptimal conditions, with limited information, and in a time-sensitive fashion. Our profession requires adaptability, flexibility, and resilience, all of which are necessary in disaster response. For these reasons it is common to find members of our profession deeply involved in and holding crucial positions in disaster responses throughout the world. In a discipline of uncertainty, if disaster response as an emergency provider is something that interests you, at least two things appear to indeed be certain: disaster needs you and there is no shortage of disaster.
References
- Burkle Jr, Frederick M., Gerald Martone, and P. Gregg Greenough. "The Changing Face of Humanitarian Crises." Brown J World Affairs (2014).
- D. Guha-Sapir, R. Below, Ph. Hoyois - EM-DAT: International Disaster Database – www.emdat.be - Université Catholique de Louvain – Brussels - Belgium.
- Sphere Project. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. Practical Action Publishing, 2011.
Thanks to Dr. Mel Otten for providing pre-publication peer review on this blog post.
