AMA understands need for disaster preparedness

A message to all physicians from AMA President John C. Nelson, MD, MPH.

By John C. Nelson, MD, MPHis an obstetrician-gynecologist from Salt Lake City, Utah, and was AMA president during 2004-05. Posted Sept. 20, 2004.

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Last month, I pointed out some of the many reasons I am proud to be an AMA member. That pride extends to the prompt, effective response AMA has shown through the years to a broad range of public health emergencies.

Right now, that tradition is being expanded by AMA's leadership in dealing with disasters -- man-made or natural. I vividly remember how the need for preparedness was brought home to me.

The day after the terrorist attacks on the World Trade Center, two trains collided not far from my hometown of Salt Lake City.

An Amtrak passenger train collided with a freight train near Wendover, Utah, 120 miles due west of Salt Lake City.

Emergency vehicles and personnel drove pell-mell to the scene in fear of great loss of life. Twenty-five people were hurt; three of them were airlifted to Salt Lake City hospitals with minor injuries.

Meanwhile, the city of Salt Lake was stripped of the great bulk of its emergency response assets.

The random, uncoordinated, confused, haphazard response demonstrated beyond a shadow of a doubt the need for better preparation.

The Wendover episode reminded me of a similar uncoordinated response to one of Salt Lake City's few-and-far-between tornadoes. In the aftermath of the storm, I looked out my window at LDS Hospital in Salt Lake City to see literally dozens of medical personnel milling around outside.

Everyone was there to help; no one was in charge. Not a soul had an idea what to do next.

All they knew was that they meant well and meant to do well. The problem is, "What do I do?"

The problem is a public health challenge of enormous proportions. Whether it's bioterrorism, hurricanes, radiological/biological attacks, tornadoes, nuclear mishap, massive flooding or any other traumatic, explosive event, we all need to be prepared to act effectively.

That's why the U.S. Dept. of Homeland Security awarded the AMA a $1 million grant last month. The grant will help AMA develop and distribute a life support training program, Core Disaster Life Support.

In talking with James J. James, MD, DrPH, MHA, who heads the AMA's Center for Disaster Preparedness and Emergency Response, I learned the importance of placing the new field of disaster medicine in a public health context. He said, "The public health approach should improve physician effectiveness, leadership and service to patients in an integrated system."

Matt Mayer, chief of staff of the department's Office of State and Local Government Coordination and Preparedness, noted that the DHS grant would fund an Internet-based course to better prepare professionals.

Whether it's a train wreck or a tornado, a man-made or a natural disaster, a nuclear or radiological weapon attack or a biological event, physicians need to play their role in a coordinated, effective way.

The AMA National Disaster Life Support program is a three-pronged training program to both educate and standardize emergency response training nationwide and strengthen our nation's public health system in the process.

The three-course integrated program curriculum gives physicians, health care workers and first responders the comprehensive training they need to ensure a uniform and efficient response to emergencies involving mass casualties from unforeseeable events.

It is a big step toward uniform, standardized procedures to get the right skills in the right places at the right time -- no matter what the disaster is.

Already, about 3,000 physicians, health care workers and first responders have taken one or another of the three modules in the package.

The DHS grant will underwrite a Web-based Core Disaster Life Support course available around the clock.

CDLS provides an introduction to preparing for all hazards, including an overview of natural and man-made disasters, and introduces participants to basic concepts and terms reinforced in the other two courses.

The second course, Basic Disaster Life Support, adds critical information on the health care professional's role in the public health system and includes information on incident management systems, community mental health and special needs of vulnerable populations.

The third component, Advanced Disaster Life Support, is designed for individuals who already have completed the basic course. It's an intensive course that covers mass casualty decontamination, use of personal protective equipment, essential skills, and mass casualty incident information systems and technology applications. ADLS simulates all-hazards scenarios, interactive sessions and drills with both high-fidelity mannequins and volunteer patients -- giving a true-to-life experience in practical treatment and response.

A key component of the training is a clinical component that does not duplicate existing knowledge, but augments that knowledge with public health system components -- most notably surveillance, reporting and incident management.

Many disasters -- whether natural or man-made -- can involve infectious disease, trauma, chemical burns and a host of clinical situations.

The AMA program accounts for these. It is a cooperative venture involving the Medical College of Georgia, the University of Georgia, the University of Texas Southwestern Medical Center at Dallas and the University of Texas at Houston School of Public Health.

Some of the best minds in the AMA and academia, working closely with the Centers for Disease Control and Prevention, have produced a first-class training module.

Physician preparation is the key in disaster life support preparedness. Effective integration of emergency medical services, hospital, nursing, police, fire and public health officials is the goal. The AMA is taking the lead in providing the training needed to make that happen.

I urge you to contact Dr. James directly if you have questions about the new program. You can reach him either at 312-464-5719 or by ([email protected]" target="_blank">link). His Center for Disaster Preparedness and Emergency Response is leading the way.

This is just one more reason why I am proud to be a member of the American Medical Association.

John C. Nelson, MD, MPH is an obstetrician-gynecologist from Salt Lake City, Utah, and was AMA president during 2004-05.

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