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Your fellow volunteers // Few supplies // A sense of mission // And a clear idea of what to do…

When Disaster Strikes

By Linda Keslar // Spring 2014
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Doctors looking a wounded boy over in a tent

Jes Aznar/The New York Times/Redux Pictures

When you work in disaster medicine, no two disasters are alike, which means that every day is an exercise in improvisation. Consider what Miriam Aschkenasy, a physician and deputy director of global disaster response at Massachusetts General Hospital, encountered when she arrived in the Philippines last November. Typhoon Haiyan had killed and injured thousands of people and displaced millions more, and the first challenge she and her team of six faced was making their way over severed roads, downed power lines and remnants of buildings. Then, for three weeks, they headed out from their base camp each morning, sometimes by boat, toting backpacks full of medicine and supplies. One day they would work out of a tent, the next in an ad hoc clinic set up in a wrecked school. Long lines snaked outside, and once they saw nearly 200 patients in an hour and a half. Much of their work was standard primary care, treating comparatively minor wounds suffered during the storm and its aftermath, or providing medication for chronic conditions. “We also offered a lot of reassurance, which is what people largely need after such a trauma,” says Aschkenasy, an emergency physician who has graduate training in global health.

But with other catastrophes, the drill may be entirely different. After the earthquake in Haiti in 2010 that killed more than 220,000 people, physicians and other volunteers had to try to function in an environment of extreme poverty, a crippled infrastructure, and overwhelming numbers of other rescue and medical teams. In the United States, hurricanes Katrina and Sandy, both devastating, posed distinct challenges, and the emergency response to Sandy in fall 2012 was helped by lessons learned from Katrina seven years earlier. Similarly, preparedness plans and training programs put in place after the terrorist attacks of September 11, 2001, helped save many lives after the 2013 Boston Marathon bombings.

That’s the thing about disaster medicine—there’s no clear consensus about what it is or what training can best equip physicians to practice it. Delivering this care has traditionally been considered an extension of emergency medicine and trauma surgery, and even now it typically involves teams of emergency personnel taking time off from their usual jobs. Still, disaster medicine has begun to emerge as its own field. To become certified in the specialty—a controversial designation that some physicians consider unnecessary—doctors must know how to deal with problems that go beyond what they would normally see in an emergency room—including injuries caused by explosions, earthquakes or biochemical attacks—and also have a knowledge of public health, emergency management and epidemiology, among other fields.

In the Philippines, for example, Aschkenasy and her team had to coordinate with other disaster responders, including the Philippine government. And because infectious diseases such as diarrhea and measles often surge in the wake of a natural disaster, every evening the team reported surveillance data on the illnesses they saw to the Philippine Department of Health and the World Health Organization.

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hed-dossier

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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