Overview Disaster Preparedness and Public Health

Whenever our nation has been challenged by natural or man-made disasters, the American people have responded with faith, courage, love for fellow man and strength. Although we cannot always know when and where a disaster will hit, we can ensure that we are ready to respond. Together, we can equip our families and communities to be resilient through preparedness in times of hardship and to respond to adversity in the same way America always has -- by picking ourselves up and continuing the task of keeping our country strong and safe. We can all be better prepared to minimize loss of life and property.

Preparedness is a shared "whole community" responsibility and approach to disaster response, from personal responsibility, family responsibility, to business responsibility and neighbor responsibility. This requires collaboration at all levels of government, and with America's private and nonprofit sectors. Individuals also play a vital role in securing our country. The trained and untrained people in a community can and should contribute to this effort. “First Do No Harm” by taking courses and becoming a prepared Trained Responder. In order for a physician to be able to be part of the solution and not contribute to the problem, they must ensure that their family and office staff is prepared and safe, before they can concentrate and focus on disaster casualties.

What is Disaster Preparedness?

Successful disaster preparedness results from strong collaboration, detailed and well-understood plans of action, and written agreements put in place before a disaster occurs. Coordination between those responsible for the safety and care of disaster victims and those responsible for the larger community is essential to providing the best quality of care to the greatest number of patients during a large-scale incident. In the preparedness phase, emergency managers develop plans of action carefully to manage and counter their risks, and take action to build the necessary capabilities to implement such plans. Common preparedness measures include:

Communication plans with understandable terminology and methods
Proper maintenance and training of emergency services, including mass human resources such as community emergency response teams, development and exercise of emergency warning methods, combined with establishment of emergency and development of evacuation plans
Stockpiling food, disaster supplies and equipment
Developing organizations of trained volunteers among civilian populations. Professional emergency workers are rapidly overwhelmed in mass emergencies, making trained, organized, responsible volunteers extremely valuable. Organizations like the Red Cross are ready sources of trained volunteers.

Another aspect of preparedness is casualty estimation; the study of how many deaths or injuries to expect for a given kind of event. This gives planners an idea of what resources need to be in place to respond to the event. Emergency managers in the planning phase should be flexible and all encompassing – carefully recognizing the risks and exposures of their respective regions and employing unconventional and atypical means of support. Depending on the region, municipal or private sector emergency services can rapidly be depleted and heavily taxed. Non-governmental organizations that offer desired resources, i.e., transportation of displaced home-owners to be conducted by local school district buses and evacuation of flood victims to be performed by mutual aide agreements between fire departments and rescue squads, should be identified early in planning stages, and practiced with regularity.

Osteopathic family physicians play an important role in the country’s disaster preparedness effort. The information presented here is aimed at providing information and resources that will assist them in becoming effective and knowledgeable members of the disaster preparedness team within their communities.

Disaster Response Training for osteopathic physicians

To ensure that osteopathic physicians (DOs) are prepared to treat victims of these disasters, members of the American Osteopathic Association’s (AOA) House of Delegates voted to support the addition of disaster response training to the overall College of Osteopathic Medicine’s (COM) curriculum in a resolution titled “HOD Resolution Disaster Response Course and Training.” ACOFP member William Bograkos, DO, a board-certified emergency medicine and family physician from Laurel, Maryland, who holds a master’s degree in national security and strategic studies, and is a member of the AOA Bureau of Scientific Affairs and Public Health, authored the resolution. The Resolution states:

We cannot deny that the dynamics of disaster influenced the life and career of Dr. (Major) A. T. Still. The disaster I am referring to was a "man-made" disaster and is remembered as our great Civil War. Historians write of the terror, irregular warfare, trauma, public health consequences, amputations, opium use/abuse, planning, response and reconstruction of the nation. Osteopathic physicians have deployed to many wars since that war between North and South.
The word "dis-aster" comes from Greek and Latin meaning that the stars are out of alignment. Disasters can be hopeless; depending upon what one sees, when looking into the heavens. Mass Casualty Incidents (MCIs) and disasters overwhelm resources and preparedness efforts (hence the terms). One can never be totally prepared for crisis and disaster; however one should seek resilience and preparedness.
The globalization of mankind brings opportunity for destruction as well as reconstruction. The first targets in war are bridges. As physicians we should seek to build bridges within our communities. "Let us build bridges, not walls" (Dr. Martin L. King). Training in disaster dynamics builds community bridges for the COMs, for the FEMA regions these graduates serve, for our nation (Homeland Security & Homeland Defense), and for the international community (IO, NGO, Department of Defense and WHO Global Health Cluster). The next generation of osteopathic physicians can serve and lead the international medical community. (WADEM)
Physicians, nurses and all health professionals are trained to see one patient at a time. After practicing 10-20-30, years we realize that we serve populations. Our "best practices" and "lessons learned" serve the public. Our EMS, hospital and public health systems connect through communication, collaboration and coordination of mature leaders. Trauma care is not limited to Advanced Trauma Life Support, but extends into the prevention and rehabilitation of survivors, families and their communities. This is the difference a DO makes in disaster dynamics.
All of our students deserve to be exposed to domestic preparedness, disaster relief and foreign humanitarian assistance. The exposure is intended to keep them safe, resilient and confident. It is intended to keep their patients safe and keep the Incident Command Management System safe from poorly-prepared responders. Basic disaster dynamics in medical school will inspire future leaders and prevent the emotional trauma that is so commonly seen in the well-meaning but poorly prepared responders. Our COMs are capable of hosting disaster preparedness CME/CEU. Our National Guard Bureau International Affairs State Partnership Program (NGB-IA SPP) has been involved in Military Support to Civil Authorities for decades.
There are many lessons to share in disaster dynamics at home and abroad. NGB-IA SPP also offers opportunities for the establishment of "sister-cities" and "sister-universities." These relationships provide safe nation building and strengthening of health systems through partnerships. The Primary Care mission of the AOA is essential in every phase of disaster dynamics. Our students should be exposed, not excluded, from the didactics of disaster dynamics. Emergency Medicine became a specialty in 1975. The AOA has an opportunity to provide mentorship for future leaders in Disaster & International Medicine.

Dr. Bograkos made the following comments after the HOD approved the resolution: “Since emergency situations, such as severe weather events or man-made disasters like terrorist attacks, can create a pool of multiple casualties, the response tactics for treating these patients is much different than standard emergency care. Trauma care is not limited to advanced trauma life support but extends into the prevention of serious injury and the treatment of survivors, families and their communities. By teaching basic disaster dynamics in osteopathic medical schools, we will be providing future DOs with the unique skills they will need to keep themselves and their patients safe when a disaster strikes.”

The Committee on Public Health and Wellness has as one of its primary initiatives and goals to provide Basic, Advanced and Trainer level Disaster Life Support (BDLS) Courses at spring and fall ACOFP meetings, to provide the needed expertise for osteopathic family physicians.

What is Public Health?

Naturally occurring disease outbreaks such as a multi-state outbreak of gastrointestinal illness due to contaminated food
Natural disasters such as floods, tornadoes, hurricanes or wildfires
Accidents such as chemical spills
Biological, chemical or nuclear terrorism

All of these threats have the potential to harm members of the public and affect the economic and social well-being of our communities and nation. Preparing for public health threats requires ongoing and coordinated efforts that involve all levels of government, the private sector, non-governmental organizations and individuals.