Disaster Medicine for
Emergency Medicine
Residents
Jonathan L. Burstein, MD
Member, ACEP Disaster Preparedness
and Response Committee
Haiti 2010
Disaster Training Proposals
► AAP
► ACS
► AAFP
► AMA
 NDLS program
► A”B”PS
 Disaster “Boards”
Outside World
► Looking




for medical experts
Hospital admin
EMS
Public safety
Government
► “First
impressions and all that”
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
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
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
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
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
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
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
Resident Curriculum
I.
II.
III.
IV.
V.
VI.
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
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
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
Resident Curriculum
III. Key Operational Capabilities
►
Pre-hospital operations


Surge capacity planning
►


►
Disaster triage
HAZMAT/PPE/decontamination
Staff/stuff/structure
Medical system resilience (DMAT/USAR/SNS)
Forensic issues
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
Resident Curriculum
V.
► Mass
Critical Medical Knowledge
trauma
► Structural collapse
► Burns
► Chemical exposure
 Nerve agents
► Radiation
► Infectious
disease
 Bioterrorism
 Pandemic
influenza
► Blast injury
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
Thank You
Questions?