Disaster Medicine for Disaster Medicine for Emergency Medicine Emergency Medicine

ResidentsResidents

Jonathan L. Burstein, MDJonathan L. Burstein, MD

Member, ACEP Disaster Member, ACEP Disaster Preparedness and Response Preparedness and Response

CommitteeCommittee

Haiti 2010

Disaster Training ProposalsDisaster Training Proposals

►AAPAAP►ACSACS►AAFPAAFP►AMAAMA

NDLS programNDLS program

►A”B”PSA”B”PS Disaster “Boards”Disaster “Boards”

Outside WorldOutside World

►Looking for medical expertsLooking for medical experts Hospital adminHospital admin EMSEMS Public safetyPublic safety GovernmentGovernment

►““First impressions and all that”First impressions and all that”

Emergency Medicine and Emergency Medicine and Disaster MedicineDisaster Medicine

►Natural roleNatural role Patient triage and treatmentPatient triage and treatment Hospital-basedHospital-based EMS involvementEMS involvement

►Natural expertiseNatural expertise We see everyoneWe see everyone We see everythingWe see everything We look for things that aren’t thereWe look for things that aren’t there

►Perhaps an unnatural interestPerhaps an unnatural interest

DM in the Core CurriculumDM in the Core Curriculum

► Already includedAlready included MCIMCI EMSEMS ID/pandemic/BTID/pandemic/BT Hospital preparedness/adminHospital preparedness/admin Tox/chemicalTox/chemical Crush/compartmentCrush/compartment RadRad

►Not necessarily conjointNot necessarily conjoint►Not necessarily called out as DMNot necessarily called out as DM

DM in the Core CurriculumDM in the Core Curriculum

►We ARE training residents as expertsWe ARE training residents as experts►They just may not realize itThey just may not realize it►And the materials may not beAnd the materials may not be

CoordinatedCoordinated UpdatedUpdated InterestingInteresting

DM Uses for ResidentsDM Uses for Residents

►Reinforces their sense of masteryReinforces their sense of mastery►Reminds them they have a roleReminds them they have a role

Patient carePatient care Hospital responseHospital response Outside world (govt., military, NGO)Outside world (govt., military, NGO)

►Sparks interest in DM academicsSparks interest in DM academics Fellowship training and researchFellowship training and research A junior faculty “niche” to developA junior faculty “niche” to develop

ACEP Disaster Committee ACEP Disaster Committee “Objective #3”“Objective #3”

► Review and further define core Review and further define core curriculum in disaster medicine for curriculum in disaster medicine for emergency medicine residents and emergency medicine residents and

► Develop/identify training materials Develop/identify training materials for use by residency programs.for use by residency programs.

► Formalizing the core that existsFormalizing the core that exists

Who Were We?Who Were We?

►ACEP and ACOEPACEP and ACOEP A program directorA program director Two fellowship directorTwo fellowship director A core faculty memberA core faculty member An affiliate faculty memberAn affiliate faculty member A residentA resident

►Committee and ACEP/ACOEP BoD Committee and ACEP/ACOEP BoD reviewreview

Principles for CurriculumPrinciples for Curriculum

► Based on review of existing materialBased on review of existing material Eric Noji’s proposal of 1990Eric Noji’s proposal of 1990 TextbooksTextbooks CoursesCourses FellowshipsFellowships

► 12 hours of material12 hours of material 1 grand rounds/major sesssion per year (4 1 grand rounds/major sesssion per year (4

hours)hours) 3 year residency training program3 year residency training program

Resident CurriculumResident Curriculum

I.I. Challenges in Response to DisastersChallenges in Response to Disasters1 hour1 hour

II.II. Management of the Medical ResponseManagement of the Medical Response1 hour1 hour

III.III. Key Operational CapabilitiesKey Operational Capabilities3 hours3 hours

IV.IV. Special Needs PopulationsSpecial Needs Populations1 hour1 hour

V.V. Critical Medical KnowledgeCritical Medical Knowledge5 hours5 hours

VI.VI. Table Top ExerciseTable Top Exercise1 hour1 hour

Resident CurriculumResident Curriculum

I.I. Common Challenges in Response to Common Challenges in Response to DisastersDisasters Common problems encountered during Common problems encountered during

disastersdisasters►Failure of communication systemsFailure of communication systems►Patient convergencePatient convergence

Importance of drillsImportance of drills Ethics and Legal AspectsEthics and Legal Aspects

►Changes in ability to meet the standard Changes in ability to meet the standard of care of care

Resident CurriculumResident Curriculum

II. Management of the Medical ResponseII. Management of the Medical Response Incident management systems (NIMS, ICS)Incident management systems (NIMS, ICS)

►How physicians work with system for How physicians work with system for overall responseoverall response

The role of public healthThe role of public health►Mass dispensing of vaccines, Mass dispensing of vaccines,

medicationsmedications Medical facility planningMedical facility planning

Resident CurriculumResident Curriculum

III.III. Key Operational CapabilitiesKey Operational Capabilities► Pre-hospital operationsPre-hospital operations

Disaster triageDisaster triage HAZMAT/PPE/decontaminationHAZMAT/PPE/decontamination

► Surge capacity planningSurge capacity planning Staff/stuff/structureStaff/stuff/structure Medical system resilience Medical system resilience

(DMAT/USAR/SNS)(DMAT/USAR/SNS)

► Forensic issuesForensic issues

Resident CurriculumResident Curriculum

IV.IV. Special Needs PopulationsSpecial Needs Populations Identify vulnerable populationsIdentify vulnerable populations

►Elderly, pediatric, compromised, disabled, non-English-Elderly, pediatric, compromised, disabled, non-English-speakingspeaking

Unique medical issues related to these Unique medical issues related to these individualsindividuals►Medications/equipment/transfer agreementsMedications/equipment/transfer agreements

Evacuation of congregate facilities (nursing Evacuation of congregate facilities (nursing homes, etc)homes, etc)

Social issuesSocial issues►Family reunification/pets/shelteringFamily reunification/pets/sheltering

Resident CurriculumResident Curriculum

►Mass traumaMass trauma►Structural Structural

collapsecollapse►BurnsBurns►Chemical Chemical

exposureexposure Nerve agentsNerve agents

►RadiationRadiation► Infectious diseaseInfectious disease

BioterrorismBioterrorism Pandemic Pandemic

influenzainfluenza►Blast injuryBlast injury

V.V. Critical Medical Critical Medical KnowledgeKnowledge

Resident CurriculumResident Curriculum

VI.VI. Table Top ExerciseTable Top Exercise Mass casualty triage exerciseMass casualty triage exercise Activation and implementation of incident Activation and implementation of incident

management systemmanagement system E.g. multiple casualties resulting from a E.g. multiple casualties resulting from a

terrorist bombingterrorist bombing E.g. nursing home evacuation to the E.g. nursing home evacuation to the

hospitalhospital

Thank YouThank You

Questions?Questions?