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When Disaster Strikes

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Since 9/11, by conservative estimate more than 200,000 people, about a third of them physicians, have taken courses addressing what to do in the wake of everything from fires and floods to nuclear attacks. The American Medical Association, the National Disaster Life Support Foundation, the Federal Emergency Management Agency and the American College of Surgeons, among others, have sponsored training, while many hospitals offer in-house courses for their own workers.

But many of these courses haven’t had any uniform curriculum or focus, and a study on their effectiveness published in the 2008 Annals of Emergency Medicine found that many programs lack clarity and consistency. Medical schools, meanwhile, have also been slow to embrace disaster medicine. A pilot survey by researchers at Johns Hopkins University School of Medicine published in 2012 found that only a small percentage of schools include disaster medicine in their core curricula.

Several medical schools, however, now offer postgraduate fellowships in disaster medicine. “Academic institutions are starting to look at disaster medicine in a much more serious way,” says Gregory Ciottone, an emergency physician at Beth Israel Deaconess Medical Center in Boston who directs a disaster medicine/emergency management fellowship program there. Still, those who complete such fellowships will find few choices if they want to make the specialty their life’s work. “You can have a career as a professional emergency manager, but doing solely disaster medicine is rare,” he says.

Meanwhile, the American Board of Physician Specialties and the American Academy of Disaster Medicine have created a certification program for disaster medicine that 70 physicians have completed since 2006. The credentialing process includes a written exam and real-time disaster simulations. But the American Academy of Emergency Medicine opposed the certification of the disaster medicine specialty, and others say having physicians become board certified in disaster medicine isn’t the right step forward. “A lot of us feel that disaster medicine should be an integral part of everyone’s training, whether in nursing, medical or dental school,” says Briggs at MGH.

Although UC-Irvine’s Koenig does believe disaster medicine should be a separate specialty, she sees many hurdles slowing its development. One is a lack of standardized methods and terminology. There are no national guidelines for mass casualty triage, for example, and that can result in confusion and miscommunication among the many groups that may respond to an emergency. “Even something as basic as the terms ‘disaster’ and ‘casualty’ don’t have standard definitions, which makes it very difficult to have a science in which you can compare apples to apples,” Koenig 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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