Who Will Provide Medical Care In A Disaster?

My wallet contains two unusual cards. One, which bears a picture of me at an earlier stage in my medical career, identifies me as a California Disaster Service Worker. The second, titled "Medical Volunteers for Disaster Response," identifies me as a physician specialising in internal medicine and hematology affiliated with the County of Santa Clara Public Health Department, Office of Disaster Medical Services.

It was in the context of the second card that I recently attended a three hour meeting of the Medical Volunteers. I learned that the system of federally recognized organized medical and public health professionals with which I am affiliated as a "sworn" volunteer is the 9th largest such emergency system in the nation, serves as daily population of about two million, covers more than 1300 square miles which includes 15 municipalities, and is headquartered in Silicon Valley. We are volunteering to respond to natural disasters and emergencies.

Santa Clara County's medical health system includes public and private elements, The County has 3 trauma centers, 11 emergency departments, 12 hospitals, a public health laboratory and disease outbreak teams. There are 12 fire service providers, 7 private ambulance service providers (with far more ambulances than the nearby City/County of San Francisco), and 14 public safety answering points. The medical health system is a major employer, with 1300 emergency medical technicians, 700 paramedics, 50 critical care transport nurses, 40 mobile intensive care nurses and more than 350 medical volunteers.

Medical health resources includes strategically placed chemical packs, elements of the strategic national stockpile, caches of personal protective equipment, stockpiled local pharmaceuticals, a biodetection system, environmental monitoring systems, hospital data systems, and field treatment site trailers. There is the capacity to electronically track patients, which experience in other catastrophes has proved to be essential.

Before an emergency, identification of the critical emergency players, facilities, equipment, resources, and system strengths and weaknesses, is essential. Santa Clara County has stepped up to the plate. In following blogs I will report my impressions of our readiness.

Is A "Surge" The Cure For A Massive Disaster?

A headline, by Dorsey Griffith, in March 2, 2008's Sacramento Bee , stated that "In a massive disaster, care will be scarce." The Bee's headline continued "State guidelines lay framework for deliberately letting some people die." The article noted that there is a broad State of California plan which abandons traditional means of providing care to its communities in a profound emergency.

The CDC Public Health Law News, Wednesday, March 5, 2008, devoted significant attention to the new California guidelines. Its release stated: "The California Department of Public Health (DPH) recently issued groundbreaking guidance for health care and emergency responders in the event of a disaster. The guidance document comprises 1,900 pages and focuses on the need to suspend or flex established laws and to ration health care during catastrophes. “I don’t know of any state that has taken it to this level of detail in outlining a surge plan for everyone who needs to respond to an emergency of this magnitude,” said Jeff Levi, executive director of Trust for America’s Health. The guidelines go against the ingrained instincts of professionals who are trained to save lives at almost any cost, according to Betsey Lyman, deputy director for public health emergency preparedness at DPH. “This is, ‘OK, we have limited resources. How do we best save the greatest number of lives?’” Lyman said. For instance, to minimize red tape, hospitals will not be required to report births, deaths, infectious disease outbreaks, medication errors, or suspected child or elder abuse. Also, unlicensed or retired health care providers with lapsed licenses will be recruited to provide emergency care during a health care surge. The guidance suggests that medical treatment go first to people who are more likely to survive with immediate intervention rather than to those who are most critically ill. “Everybody will have to think differently,” said Duane Dauner, president of the California Hospital Association."

Many physicians and other health care providers may not be aware of the revolutionary "surge" since, rather than the usual method of openly soliciting broad public opinion, the project appears to come out of a Sacramento office. If you would like to read the plan for yourself, see: http://bepreparedcalifornia.ca.gov/EPO/CDPHPrograms/PublicHealthPrograms/EmergencyPreparednessOffice/EPOProgramsServices/Surge/SurgeStandardsGuidelines/. Although you may find that some elements of the guidelines may be reasonable, you may not sleep well after reading it.