From earthquakes to wars to floods and hurricanes, the history of disaster medicine ends in success and failure when it comes to the results of doctors and nurses and medical administrators who help during and after the crisis. And it is a long story. “Indeed, when you look at how disaster medicine began, it goes back to the fields of civil war and even precedes Roman times,” says Gary M. Klein, MD, MPH, MBA, who practices pharmacy medicine in Atlanta,
As a rule, there has never been a lack of readiness of the medical profession to help in the proliferation of tragedy, but their effectiveness has sometimes been lacking, especially during some high-profile accidents over the past few years.
As any student of history knows, for centers, physicians were mainly involved in minimizing pain and suffering. Before the days of anesthesia, this often meant amputation of the limb and hope for the best, but because microbes and proper hygiene were poorly understood, the doctor was often something of a walking catastrophe. But it began to change during the Napoleonic wars. “The concept of sorting was invented, I think, by a French military doctor with Napoleon, and then you had Clara Barton during the American Civil War, creating the American Red Cross. Each of the wars that the United States participated in, disaster medicine has been pushed forward, ”says captain James W. Terbush, MD, MPH, US Navy Medical Corps and team surgeon NORAD-USNORTHCOM at Peterson air base in Colorado.
Indeed. During the Napoleonic wars, Dominique-Jean Larry was a surgeon in the French army of the emperor, who not only wanted to take care of the wounded on the battlefield, but also created the concept of ambulances, collecting the wounded in horse-drawn wagons and deliver them to military hospitals. Until that time, the wounded were usually interested at the end of the day or when the battle stopped or ended. By the time the Civil War began, Clara Barton had learned that many wounded soldiers were dying not because of lack of attention, but because of the need for supplies of medicines, and she started her own organization for the distribution of medicines, bandages and other life-saving equipment.
The actual term “cure for natural disasters” began to appear in newspapers with some regularity in the 1950s, when medical associations really began to accept the idea of anticipating a catastrophe. Colonel and physicist Karl H. Houghton talked to the consulate of military surgeons in 1955, saying: “You will not have enough drugs or surgical materials to cope with all the atrocities, and they will have to quickly and without hesitation decide who will get it, perhaps life It is not always easy. Are you saving a banker or truck driver? Go straight along the line of casualties taking them when they come, or do you choose the people who can be the most valuable in terms of the future rehabilitation period? “Meanwhile, the colonel and physician Joseph R. Scheffer, MD, were a massive nuclear attack. “We have 200,000 doctors who will take care of 176 million people in this country,” he told medical staff at a hospital in Texas in 1959. "Therefore, people must learn to survive for themselves in the event of an emergency." Schaeffer lamented that so few Americans had any proper first aid instruction, while Russia demanded that its citizens get 22 hours in first aid - every year.
As a Cincinnati therapist, John Andrews, MD, who spent 20 years as a Corps doctor for the US Public Health Service, skillfully states: "It’s not just that opponents seem to come more often, they You had natural disasters such as hurricanes, floods, tornadoes, and sometimes chemical spills. But now someone is really trying to make a catastrophe. ”
While the natural disaster crisis of the past few years has had a profound effect on many lay people, this inevitably affected many physicians, who, of course, would rather have their own opinion on preventing suffering and death. Dr. Klein, who was the drug manager in New York when the 9-11 attacks occurred, spent about 24 hours at Ground Zero, initially insisting on dealing with “well-worried” people, which he describes as “completely devastated, wandering around in a daze, sharply injured. "
The terrorist attacks also had a keen impact on Paul C. Carleton, MD, director of the National Security Service at the Texas A & M Science and Medical Center, who believes medicine for medicine should be certified in specialties like general surgery. As a surgeon general for the Air Force, he trained with medical students three months before a commercial plane hit the Pentagon. His group, unfortunately, came up with a similar disaster scenario to practice, only they imagined a plane that had an unsuccessful takeoff or landing, which led to the Pentagon crash. In their exercises, they did rather slowly, Carlton admits, but because of the training sessions, September 11, when Dr. Carlton rushed to the Pentagon as the first responder, he and his team were, for obvious reasons, pleased with their performance. He led the rescue team to the part of the building where the chassis affected, and they managed to pull the three people to a safe place, "and we all came out alive." There is nothing to move, since Dr. Carlton himself caught fire. That he is generally alive, at least in part because of the fire resistant vest that he was wearing.
Dr. Philip Merideth, MD, MD, psychiatrist in Jackson, Mississippi, his evolution in thinking occurred after Hurricane Katrina. He spent two weeks in Mississippi and Louisiana, doing his best, prescribing medicine and just listening to people who pour out their grief. “Everyone had a story about what happened in the hurricane, and they wanted to tell it,” says Meridith, who offers one exemplary example — talking to a little boy who was the only survivor of his family, for the fact that he emerged the second window of history.
In the past few years, when opponents were on the rise, careers were created and defined, government plans were put in place, and first respondents, such as the police and firefighters, began to develop ideas for dealing effectively with disasters. In 2003, infectious disease specialist Robert Cox Maine from Englewood, Colorado, just started his Bioforecasts company, intending to talk with medical and non-medical organizations about what future society could have a future and longevity. However, he has since expanded his conversations to include topics such as medicine medicine, bioterrorism, and how to get vaccinated against bird flu.
“I thought about these topics from the very beginning,” says Dr. Cox, “but after a while I could not discuss them.” This is what everyone sees.
Much of what needs to be taught is thinking, says Dr. Carlton, who cites the example of a suicide bomber who attacked a cafeteria at a US military base in Mosul, Iraq. “The children there had a small team, where they performed nine operations in the operating room and 10 in the corridor. They didn't always have the technology they were used to. I think of Hurricane Katrina, where the woman was in labor, and all the lights went out. The doctors made the C-section a flashlight, not an ideal circumstance, but they did an excellent job. ”
Doctors look at the topic on blogs and form such groups as the Texas Medical Rangers, which is focused on responding to natural disasters and attacks of weapons of mass destruction in Texas. In Washington State, Robert Cross, MD, is a 77-year-old retired physicist who for several years worked to create an organization of retired doctors who will respond to natural disasters in his home state. He, like many doctors, wanted to do something constructive after the terrorist attacks. Suddenly, he realized how short-sighted was the medical community in closed hospitals left and right because of the emergence of outpatient care centers. “In any disaster, a surge is a common problem in hospitals,” says Cross, knowing that although he cannot replace hospital buildings, he can turn to a staffing group of newly trained retired doctors and nurses by telephone to help her condition of necessity.
In the midst of all this change that once seemed incredible, it now seems inevitable: the creation of a medical board for certification in medicine for disasters. This is an idea advocated by the American Council of Physician Specialties.
A nod of approval is Dr. Andrews, a board certified in internal, preventive and occupational medicine. “Most of us have many patients a day, but we don’t cope with a catastrophe, say, once a week. They come every so often, and in order to study medicine in case of illness and be updated, I think this is a neat idea. "
And it is necessary, says F. Matthew Milelik, MD, who is an associate professor at the Center for National Security Studies at the University of Tennessee Graduate School of Medicine. "I think this council suggested this idea, making it an inclusive council, will do two things: increase the level of competence of doctors to solve problems related to the disaster, as well as increase the awareness of the medical community about the need for readiness ... and I think that this advice looks at medicine in case of illness as a leader, and not at a short medical response within a short period of time, and that all medical personnel, all medical disciplines, specialties, subseries, etc., will play a role in any a serious disaster. ”
“Most doctors are in primary health care, family practice, general medicine and, of course, there are pediatricians and ob-gyn,” agrees Dr. Terbusch, who was in the thick of events after Hurricane Rita and Hurricane Katrina. “It would be very helpful if primary care physicians were specialists in disaster medicine.”
One question is almost begging: can the American medical community do too much? Are we creating layers of bureaucracy, ensuring that when a crisis comes, hundreds or thousands of organizations are mobilized, but not within the same framework as everyone else? Dr. Cox agreed that this could be a problem - that we would suffer from "lack of coordination and communication between agencies, as well as the experience of September 11," both for people and for finances.
But Coke does not think that the medical community or country should slow down. "I think this is all part of organizational evolution, and only time will tell what the correct number is." He also points out that there are some attempts to coordinate disparate groups, citing his state of Colorado "Committee for the Prevention and Elimination of Emergencies of the Governor of the State of Colorado", which includes representatives of the medical community, military, public health, agriculture and many other therefore, the next time a natural disaster occurs, no group will feel as if they are on their own.
But, nevertheless, this latest story of disaster medicine seems to have one undeniable potential, according to Dr. Fredrick Elephant, a visiting assistant professor at the College of Nursing at the University of South Florida: “In fact, the more groups that have been formed, the more people will be trained to respond, and ultimately this is what we need. ” For generations, from those who determine their time on the incomplete horizon of New York or in the mountains of bricks and blood to the tiny city of Texas, few people are likely to argue with that.
Jeff Williams, Dr. David McCann and Dr. Maurice A. Ramirez
