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Disasters and Emergency Medicine

September 2nd, 2005 Nicholas Genes the good old days...

Our weekly restrospective on medicine, devices, and systems is called “the good old days,” though it’s not easy to look at this week’s topic — disaster medicine — with much fondness.
Readers may want to familiarize themselves with the discipline, starting with an excellent wiki introduction to battlefield and disaster triage. Implementation of the tagging system calls for some grim decision-making — which runs counter to every health professional’s instict to help the sickest first. But it’s the greatest good for the greatest number.
Such scenarios may be avoided with expert planning. eMedicine.com has an organized but vague overview of disaster planning, along with a table showing the worst US disasters in history. The authors claim only six occasions in which the death toll topped 1000. However, they overlooked 9/11 and are probably out of date regardless, after Katrina.
Those wishing to dig deeper into the subject ought to check out the January 2005 Supplement edition of Critical Care Medicine, which is entirely devoted to disaster research. The issue kicks off with an international historical perspective (library subscription req’d), written by authors Dara, Ashton, Farmer, and Carlton:

The birth of the Red Cross organization in 1863 marks the beginning of the modern era of organized response in disaster medicine. In 1859, during a battle between Austria and the Franco-Sardinian alliance in Solferino, Italy, a young Swiss man named Henry Dunant witnessed the fate of unattended wounded soldiers. Moved by the consequences of this manmade calamity, he called for the creation of national relief societies to render assistance in case of emergencies. These societies evolved into what are now the national and international Red Cross organizations. His work also paved the way for a code for treating victims of war and disaster that eventually became the Geneva Conventions.
In England, Sir William Monatgu, Sir John Furley, Sir Edmund Lechmere, and Col. Francis Duncan established the St. John Ambulance Association in 1877 with the aim of emergency relief in peace and war. Soon it took the lead in providing “first aid” instruction across England and Continental Europe and is given credit for the origin of this term.
Another progressive development in disaster medicine was the designation of trained response personnel as first responders in emergencies. This concept has become known as the Emergency Management System (EMS). The earliest EMS was reportedly the rescue society formed by Jaromir V. Mundy, Count J. N. Wilczek, and E. Lamezan-Salins after the disastrous fire at the Vienna Ring Theater in 1881. Named the “Vienna Voluntary Rescue Society,” it served as a model for similar societies worldwide. During the first and second world wars, advances were made in military EMS, but development in the civilian setting did not occur until well into the 1950s when J. D. Farrington and Sam Banks, two civilian physicians, established a first aid training program for the Chicago Fire Department. This became the prototype for the first basic emergency medical technician training program in the United States.
In 1966, the National Academy of Sciences released a paper titled “Accidental Death and Disability: The Neglected Disease of Modern Society,” which ushered in the modern era of EMS in the United States. The federal government responded by creating an organized EMS and trauma system, and later that year, created the U.S. Department of Transportation. Among its functions, the U.S. Department of Transportation was charged with improving EMS in the United States and developing a basic emergency medical technician training curriculum.

Just as the 1966 NAS paper prompted the development of EMS, Hurricane Katrina may spur the development of a system to quickly and thoroughly evacuate a major city. It’s an idea whose time, sadly, has come.
Have a safe weekend, everyone.

Nicholas Genes

Nicholas Genes, MD, PhD, has been with Medgadget since almost the beginning. He's now Assistant Professor of Emergency Medicine at Mount Sinai, where in addition to patient care and teaching responsibilities, he studies EHR usability and physician uses of social media. Dr. Genes serves on the editorial boards of Emergency Physicians Monthly and Emergency Medicine Practice. More about Nick: http://nickgenes.com

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