When Disaster Strikes
Francisco Guerrero/Redux Pictures
Each new disaster, and the unique challenges it poses, underscores the need for additional study that could help shape future efforts, says David Marcozzi, an emergency physician who directs National Healthcare Preparedness Programs (NHPP) at the U.S. Department of Health and Human Services. Yet research quality remains a major challenge. “The science of disaster medicine is in its infancy,” says Kristi L. Koenig, director of the Center for Disaster Medical Sciences at the University of California-Irvine.
Koenig notes difficulties in reaching consensus about terminology and metrics, developing standardized training criteria and dealing with the reality that disasters are by definition unpredictable and infrequent. Still, says James J. James, executive director of the Society for Disaster Medicine and Public Health, which publishes a journal devoted to the field, “I think people are realizing how much we need disaster medicine and that a lot more should be done.”
Disaster medicine has roots in diverse settings, including the Napoleonic wars of the early 19th century. An essential concept, triage—from the French trier, meaning “to sort”—emerged there as a tool to make sure that soldiers who most urgently needed care, regardless of rank, were attended to first. “It is, psychologically, the most difficult mission of disaster medical response,” says Susan Briggs, a trauma surgeon at MGH and an expert in the field. “The objective is to do the greatest good for the greatest number of patients, instead of treating every individual with a maximum level of care, which is what we’ve always been trained to do.”
The Cold War, with its threat of nuclear conflict, was another milestone. Joseph R. Schaeffer, a Texas physician, was an advocate for physician and civilian training to prepare for an atomic attack, and in the early 1960s, he wrote the first official disaster medicine manual of the North Atlantic Treaty Organization. Then, during the 1980s, the National Disaster Medical System was established. The system included dozens of federally coordinated disaster medical assistance teams of trained volunteer physicians, nurses, paramedics and other providers.
In the wake of 9/11, legislation in 2002 provided federal funds for the Hospital Preparedness Program (HPP), originally designed to bolster hospital readiness to respond to bioterrorism. Four years later, the focus shifted to “all hazards preparedness” that would also encompass pandemics and natural disasters. That change came in the wake of Hurricane Katrina, which decimated the Gulf Coast, killed nearly 2,000 people and exposed large gaps in readiness when hospitals and nursing homes lost power, communications, and water and sewer services. Unable to resupply drugs, blood, linens and food, the facilities were blamed for the deaths of more than 200 patients. Disaster medical assistance teams (DMATs) deployed to the region weren’t prepared for the numbers of patients they encountered and were hampered by poor coordination with local providers and a lack of training and equipment. “Katrina taught us what a natural disaster could do, and we weren’t well prepared,” says Toby Clairmont, director of emergency services for the Healthcare Association of Hawaii, who led a post-Katrina DMAT. “We were literally stacking up dead people, which is not something a normal health care worker will see.”