Disaster Medicine for Emergency Medicine Residents

1. Disaster Medicine for Emergency Medicine Residents Jonathan L. Burstein, MD Member, ACEP Disaster Preparedness and Response Committee

7. Haiti 2010

8. Disaster Training Proposals • AAP • ACS • AAFP • AMA • NDLS program • A”B”PS • Disaster “Boards”

9. Outside World • Looking for medical experts • Hospital admin • EMS • Public safety • Government • “First impressions and all that”

10. Emergency Medicine and Disaster Medicine • Natural role • Patient triage and treatment • Hospital-based • EMS involvement • Natural expertise • We see everyone • We see everything • We look for things that aren’t there • Perhaps an unnatural interest

11. DM in the Core Curriculum • Already included • MCI • EMS • ID/pandemic/BT • Hospital preparedness/admin • Tox/chemical • Crush/compartment • Rad • Not necessarily conjoint • Not necessarily called out as DM

12. DM in the Core Curriculum • We ARE training residents as experts • They just may not realize it • And the materials may not be • Coordinated • Updated • Interesting

13. DM Uses for Residents • Reinforces their sense of mastery • Reminds them they have a role • Patient care • Hospital response • Outside world (govt., military, NGO) • Sparks interest in DM academics • Fellowship training and research • A junior faculty “niche” to develop

14. ACEP Disaster Committee “Objective #3” • Review and further define core curriculum in disaster medicine for emergency medicine residents and • Develop/identify training materials for use by residency programs. • Formalizing the core that exists

15. Who Were We? • ACEP and ACOEP • A program director • Two fellowship director • A core faculty member • An affiliate faculty member • A resident • Committee and ACEP/ACOEP BoD review

16. Principles for Curriculum • Based on review of existing material • Eric Noji’s proposal of 1990 • Textbooks • Courses • Fellowships • 12 hours of material • 1 grand rounds/major sesssion per year (4 hours) • 3 year residency training program

17. Resident Curriculum • Challenges in Response to Disasters 1 hour • Management of the Medical Response 1 hour • Key Operational Capabilities 3 hours • Special Needs Populations 1 hour • Critical Medical Knowledge 5 hours • Table Top Exercise 1 hour

18. Resident Curriculum I. Common Challenges in Response to Disasters • Common problems encountered during disasters • Failure of communication systems • Patient convergence • Importance of drills • Ethics and Legal Aspects • Changes in ability to meet the standard of care

19. Resident Curriculum II. Management of the Medical Response • Incident management systems (NIMS, ICS) • How physicians work with system for overall response • The role of public health • Mass dispensing of vaccines, medications • Medical facility planning

20. Resident Curriculum III. Key Operational Capabilities • Pre-hospital operations • Disaster triage • HAZMAT/PPE/decontamination • Surge capacity planning • Staff/stuff/structure • Medical system resilience (DMAT/USAR/SNS) • Forensic issues

21. Resident Curriculum IV. Special Needs Populations • Identify vulnerable populations • Elderly, pediatric, compromised, disabled, non-English-speaking • Unique medical issues related to these individuals • Medications/equipment/transfer agreements • Evacuation of congregate facilities (nursing homes, etc) • Social issues • Family reunification/pets/sheltering

22. Mass trauma Structural collapse Burns Chemical exposure Nerve agents Radiation Infectious disease Bioterrorism Pandemic influenza Blast injury Resident Curriculum V. Critical Medical Knowledge

23. Resident Curriculum VI. Table Top Exercise • Mass casualty triage exercise • Activation and implementation of incident management system • E.g. multiple casualties resulting from a terrorist bombing • E.g. nursing home evacuation to the hospital

24. Thank You Questions?