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When Disaster Strikes

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A flooded hospital ward

Xinhua/eyevine/Redux Pictures

Workers raced to save equipment in a hospital in Taiwan flooded by a typhoon in 2012.

During the years since 9/11 and Katrina, there has been no shortage of catastrophes to test the progress of disaster medicine. In October 2012, Superstorm Sandy submerged parts of New York City and washed out numerous hospitals, forcing them to evacuate patients and staff. The 15-hour mission to move patients led rescue workers and other staff at New York University Langone Medical Center to personally carry 20 newborns in intensive care and immobile patients on gurneys down darkened stairwells.

Six months later, the week of April 15, 2013, brought two horrific events, the bombings at the Boston Marathon and the explosion of a fertilizer plant in West, Texas. In Boston, every victim who made it to one of eight Boston hospitals—a total of more than 170 patients—survived. It helped that the explosions, near the finish line, happened in a place filled with emergency medical personnel who were there to aid runners, and that six hospital trauma centers were within two miles of the bombing site. But all of the hospitals had also been training for years to respond to a Boston catastrophe.

Past joint training drills had given hospitals a chance to evaluate their individual response plans as well as their ability to communicate with other facilities, coordinate care for a large number of victims and work with other emergency responders. Paul Biddinger, medical director for emergency preparedness at MGH, attributes much of the success to the fact that all of the city’s hospitals and health groups had gone through exercises to prepare for something like this. “We knew each other’s capabilities and we trusted our plans,” Biddinger says.

That same week, a fire and subsequent explosion at the West Fertilizer Co. plant in Texas killed 15 people and injured more than 200 while destroying dozens of buildings. The nearest hospital trauma centers were nearly 20 miles away, which put the spotlight on local doctors who had to jump in to help. George N. Smith, one of just three physicians in West, rushed to a nursing home to help evacuate its 130 residents who had to escape the fire’s noxious fumes. Twenty minutes later, when the plant exploded in a blast so powerful that it knocked down part of the nursing home, Smith was injured by falling debris. He used a medical helicopter’s satellite radio to call for additional help because the explosion had destroyed local cell towers. He asked emergency dispatchers to notify the county disaster manager, the governor, urban search and rescue, and every ambulance, fire truck and helicopter that could be made available. “If I hadn’t had disaster training, I wouldn’t have known what to do or who to contact,” he says.

In the aftermath of both events, Biddinger and Smith have shared their experiences with groups of health care providers around the country. Biddinger, in a push led by Marcozzi’s organization, NHPP, has been encouraging institutions to join coalitions that connect hospitals, EMS responders, nursing homes and others. Smith, meanwhile, is urging physicians to seek out disaster training. “This is something every single physician, especially in small towns, needs to know,” he says.

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1. Advanced Disaster Medical Response Manual for Providers, Second Edition, edited by Susan Miller Briggs, Ciné-Med, Inc., January 2014. Briggs, a trauma surgeon at Massachusetts General Hospital and global expert in disaster medicine, enlisted more than three dozen contributing authors to create a comprehensive handbook that reviews medical and public health response to disasters.

2. “Disaster Medical Sciences: Towards Defining a New Discipline,” by Kristi L. Koenig, Health Affairs Blog, Dec. 19, 2013. Koenig, a leading scholar in disaster medicine, provides a succinct review of the challenges under way as the field evolves as a science.

3. “Health Care Preparedness Funding: Are We Inviting Disaster?” by Dan Hanfling, Health Affairs Blog, Dec. 31, 2013. Emergency preparedness expert Hanfling addresses the potential domino effect of federal funding cuts for hospitals and other stakeholders in the emergency response system and the risks, such as potential lives lost and loss of public confidence, should a catastrophe take place.

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