Disaster medicine
The disaster medicine specialist is the liaison between and partner to the medical contingency planner, the emergency management professional, the incident command system, government and policy makers.
By the time Hurricane Andrew struck Florida in 1992, the concept of disaster medicine was entrenched in public and governmental consciousness.
Although training and fellowships in disaster medicine or related topics began graduating specialists in Europe and the United States as early as the 1980s, it was not until 2003 that the medical community embraced the need for the new specialty.
One of the most common dilemmas occurs when the aggregate medical need exceeds the ability to provide a normal standard of care for all patients.
One paper estimated that in the United States, the need for ventilators would be double the number available in the setting of an influenza pandemic similar to the scale of 1918.
Useful ethical approaches to guide the development of such triaging protocols are often based on the principles of the theories of utilitarianism, egalitarianism and proceduralism.
"[9] Procedural Approach[9] The inherent difficulties in triage may lead practitioners to attempt to minimize active selection or prioritization of patients in face of scarcity of resources, and instead rely upon guidelines which do not take into account medical need or possibility of positive outcomes.
This approach prioritizes simplification of the triage and transparency, although there are significant ethical drawbacks, especially when procedures favor those who are part of socioeconomically advantaged groups (such as those with health insurance).
This can take place in the form of a fair lottery for instance; or establishing transparent criteria for entry into hospitals - based on non discriminatory conditions.
[9] These are by no means the only systems upon which decisions are made, but provide a basic framework to evaluate the ethical reasoning behind what are often difficult choices during disaster response and management.
1937 – President Franklin Roosevelt makes a public request by commercial radio for medical aid following a natural gas explosion in New London, Texas.
"[13] 1959 – Col. Joseph R. Schaeffer, M.D., reflecting the growing national concern over nuclear attacks on the United States civilian population, initiates training for civilian physicians in the treatment of mass casualties for the effects of weapons of mass destruction creating the concept of medical surge capacity.
[15] 1962 – The North Atlantic Treaty Organization (NATO) publishes an official disaster medicine manual edited by Schaeffer.
[16] 1984 – The United States Public Health Service forms the first federal disaster medical response team in Washington, D.C., designated PHS-1.
1986 – A disaster medical response discussion group is created by NDMS team members and emergency medicine organizations in the United States.
2003 – In February 2003, the American Association of Physician Specialists (AAPS) appoints an expert panel to explore the question of whether disaster medicine qualifies as a medical specialty.
2003 – On February 28, 2003, President Bush issues HSPD-5 outlining the system for management of domestic incidents (man-made and natural disasters).
2004 – On April 28, 2004, President Bush issues HSPD-10, also known as the plan for Biodefense for the 21st Century which calls for healthcare to implement surveillance and response capabilities to combat the threat of terrorism.
Among the many lessons learned in field operations following Hurricane Katrina are the need for cellular autonomy under a central incident command structure and the creation of continuous integrated triage for the management of massive patient surge.
2007 – On January 31, 2007, President Bush issues HSPD-18, calling for the development and deployment of medical countermeasures against weapons of mass destruction.
2007 – On October 18, 2007, President Bush issues HSPD-21, outlining an augmented plan for public health and disaster medical preparedness.
HSPD-21 also calls on the Secretary of Health and Human Services (HHS) to use "economic incentives" including the Center for Medicare Services (CMS) to induce private medical organizations, hospitals and healthcare facilities to implement disaster healthcare programs and medical disaster preparedness programs.
As with all core competencies documents, the specific knowledge and skills required for certification are subject to constant refinement and evolution.
This statement cannot be more true than for a specialty like disaster medicine where the nature of the threats faced, the responses undertaken, and the lessons learned become more complex with each event.
