Disaster Preparedness: Emergency Physicians Respond to the Call

By Dr. Nicholas Kman @DrNickKman, OSU EM Associate Professor and Medical Student Clerkship Director // Editor Dr. Michael Barrie @MikeBarrieMD, OSU EM Assistant Professor

I was sitting in the study lounge at the Ohio State University College of Medicine in between lectures on September 11, 2001.  Knee-deep in my second year of medical school, I could clearly remember dreading going back into the lecture hall to hear another stimulating hour on Aspergillosis.  Then, Wolf Blitzer or Anderson Russell or some other CNN anchor, broke in with terrible news.

Two planes had crashed into the twin towers of the World Trade Center.  Later that day, we learned of the news that another plane had struck The Pentagon while yet another crashed on its way to Washington.  I remember my disbelief and strong desire to help.

The Emergency Departments of the United States of America stand on the front lines in the event of a disaster.  Emergency Physicians were integral to the disaster response following the tragedies of September 11th, an emergency physician helped diagnose the first case of Anthrax in October of that year, and emergency specialists were quick to care during the Boston Marathon Bombings.  After most mass-casualty events, emergency departments are crowded with everyone from the critically wounded to the worried-well.  The opportunities to be a hero abound.  It’s just a matter of finding out how to lend a helping hand.

In the fall of 2001, I wanted desperately to help the fallen in New York City, but I barely knew which end of the stethoscope goes in your ears.  I’ve worked since then to learn what I can about disaster response.  Emergency Medicine and Surgery are arguably the best specialties for someone interested in disaster response and recovery.  Both specialties are trained in trauma, shock, crush injuries, infectious disease, and burns which are all commonly seen after a disaster.  That said, any medical professional can help and it is common to see doctors, nurses, paramedics, veterinarians, and coroners working together at the scene of a disaster.

As an emergency physician, we receive specialized training in everything from environmental emergencies to weapons of mass destruction.  We know how to treat a patient exposed to either Anthrax or Sarin Gas.  We learn the basics about Hazmat Decontamination, Toxicology, Critical Care, and Ballistics.  If an emergency physician wants to expand upon this training, the opportunities are also limitless.

Dr. Nick Kman and Dr. David Notley complete a course on Advanced Disaster Life Support at the National Center for Medical Readiness in Dayton, OH 2014. They are practicing decontamination for Hazmat.

Several years ago, I experienced a training course that expanded my knowledge of emergency medicine tremendously.  I was sent to Ocala, Florida, for a once yearly FEMA Medical Team Training.  As a Medical Manager for Ohio Task Force 1, I was afforded the opportunity to learn disaster response from the experts that responded to the Oklahoma City Bombing, the terrorist attacks of 9/11, and Hurricane Katrina.  The course was conducted by the U.S. Department of Homeland Security as a part of the National Urban Search and Rescue (US&R) Response System.  Ohio Task Force 1 is Ohio’s US&R team.

During my week of specialized training and in the years since then, we learn the nuances in treating bioterrorism agents such as Anthrax, Small Pox, or Plague.  We learn the presenting signs and symptoms of exposures to VX, Sarin, and Mustard Gas.  We are taught how to treat a victim with a crush injury while the victim is still pinned in the rubble.  These experiences truly expanded my scope as an emergency physician.  After all, where else can you practice airways skills while suspended in a tunnel!   I have included some photos from my FEMA Training.

FEMA Training
Dr. Nick Kman and Dr. Daniel Bachmann (also an OSU Emergency Physician) at a FEMA Training Session at Camp Atterbury Muscatatuck Training Center in Indiana in 2011 (http://www.atterburymuscatatuck.in.ng.mil/)
Night Drill
Nick Kman at Medical Cache drawing up medications while preparing for a victim extraction during a night time drill.
FEMA medical team
My team at FEMA Medical Team Training as pictured above. Top row Billy Murray, LJ Hupp, George Gasper, Joel “Brooklyn” Pierce, and Sarah Stark; Bottom row Chad Augustin, Nick Kman MD, Ted Angus MD, Scott Richmond.
Extraction traning
Performing a victim extraction in a tunnel during FEMA Medical Team Training
Nick Kman MD by the rubble pile prior to a disaster drill at the 2009 FEMA Medical Team Training.

If you want the training to respond to a disaster…the opportunity to be a hero…consider a career in emergency medicine.  If emergency medicine doesn’t interest you, consider joining your local DMAT, US&R, or FEMA teams.  Opportunities exist for medics, nurses, physicians, firefighters, policemen, and veterinarians (we were trained to resuscitate the canine members of our team while in Florida!).  I pray to never see another terrorist attack on U.S. soil, but like most emergency physicians, I hope for the best but prepare for the worst.