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Emergency Response: Physician Training and Obligations



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Am Fam Physician. 2007 Feb 1;75(3):401-405.

Case Scenario

Since September 11, 2001, it seems that we have been bombarded with warnings from government and other officials about threats such as a “bird flu” pandemic or a bioterrorism attack. The general public assumes that health care professionals will be the first to respond to these situations, and I, as a family physician, may be expected to serve on the front line.

I was impressed by how many of my colleagues responded in the wake of Hurricane Katrina. This response clearly demonstrates that family physicians are more than capable of responding to mass casualty events and other emergencies. However, I am concerned that many physicians do not receive specific emergency response training. Even if I actively pursue such training, how useful would I really be in an emergency? When does my role as a physician take second place to my own safety and that of my family?

Commentary

Mass casualty events can happen anywhere and range from epidemics and bioterrorism to natural and other catastrophes (e.g., severe weather, earthquakes, train derailments, industrial fires or explosions). Almost all such disasters can be safely responded to if responders are appropriately prepared.

There is no question that physician training in emergency response is available and effective, and that physicians, if properly prepared, are extremely valuable in mitigating mortality and morbidity during an emergency. Table 1 includes resources for emergency preparedness and training.

A physician cannot effectively care for others without being reasonably confident about personal safety. There are, however, effective ways to stay safe while responding to virtually any mass casualty event, and an important focus of all emergency response training is personal (and family) safety.

Basic family preparations include creating an emergency kit containing a several-day supply of food and water, weather-appropriate clothing, blankets, and first aid supplies to be used at home or in the car. Families also should have an emergency plan that includes a well-defined meeting place for family members and clear communication strategies. It is important to review and practice this plan regularly.

TABLE 1

Resources for Emergency Preparedness and Training

American Academy of Family Physicians

Web site: http://www.aafp.org/online/en/home/clinical/disasterprep.html

American Family Physician

Web site: http://www.aafp.org/afp/20060901/783.html

American Medical Association National Disaster Life Support program

Web site: http://www.ama-assn.org/ama/pub/category/12606.html

American Red Cross

Web site: http://www.redcross.org/services/prepare/0,1082,0_239_,00.html

Centers for Disease Control and Prevention

Web site: http://www.bt.cdc.gov

Medical Reserve Corps

Web site: http://www.medicalreservecorps.gov/HomePage

U.S. Department of Homeland Security

Web site: http://www.ready.gov

TABLE 1   Resources for Emergency Preparedness and Training

View Table

TABLE 1

Resources for Emergency Preparedness and Training

American Academy of Family Physicians

Web site: http://www.aafp.org/online/en/home/clinical/disasterprep.html

American Family Physician

Web site: http://www.aafp.org/afp/20060901/783.html

American Medical Association National Disaster Life Support program

Web site: http://www.ama-assn.org/ama/pub/category/12606.html

American Red Cross

Web site: http://www.redcross.org/services/prepare/0,1082,0_239_,00.html

Centers for Disease Control and Prevention

Web site: http://www.bt.cdc.gov

Medical Reserve Corps

Web site: http://www.medicalreservecorps.gov/HomePage

U.S. Department of Homeland Security

Web site: http://www.ready.gov

Professional training for emergency response is widely available. The National Disaster Life Support training program, developed by the American Medical Association (AMA) and others, is available to all physicians. The program consists of three sections: (1) Core Disaster Life Support (an introduction to all-hazard preparedness); (2) Basic Disaster Life Support (a review of all-hazard topics with an emphasis on the health care professional's role); and (3) Advanced Disaster Life Support (for program graduates who desire additional training). Many state governments, local public health agencies, and local medical societies also have training resources.1

Physicians who have a special interest in emergency response should consider joining the Medical Reserve Corps. In addition to training opportunities, the Medical Reserve Corps organizes multidisciplinary teams of health care professionals to prepare for and respond to emergencies. Medical Reserve Corps units are usually affiliated with a local community, public health agency, or hospital system; volunteers are dispatched to local disasters and, if desired, to larger-scale national disasters.

Physicians have an ethical obligation to help when they are needed,24 and the general public assumes that health care professionals will respond and assist in emergency situations. The AMA's Declaration of Professional Responsibility reflects this ethical obligation,3 and a report from the AMA's Council on Ethical and Judicial Affairs is even more explicit: “…[I]ndividual physicians have an obligation to provide urgent medical care during disasters. This ethical obligation holds even in the face of greater than usual risks to their own safety, health or life… Moreover, individual physicians should take appropriate advance measures to ensure their ability to provide medical services at the time of disasters, including the acquisition and maintenance of relevant knowledge.”4 There is a practical reason for these ethical requirements: physician response to public health emergencies is crucial for minimizing morbidity and mortality and for preventing the spread of injury and illness.2 Simply put, a physician's failure to respond in an emergency may put many others at risk.

However, a recent survey showed that many physicians feel underprepared to respond to an emergency.5 Only one in five primary care physicians feels “well prepared to play a role in responding to a bioterror attack,” and less than one half feel that their local health care systems are well prepared to respond to natural epidemics.5 Physicians should remedy this by finding a training program in their area and possibly a colleague to sign up with them. Well-prepared physicians will not only fulfill their ethical obligations, they will be much more effective contributors to the crucial medical and public health response during a mass casualty event or other emergency.

Address correspondence to Geoffrey R. Swain, M.D., M.P.H., at gswain@milwaukee.gov. Reprints are not available from the authors.

Author disclosure: Nothing to disclose.

REFERENCES

1. Medical Society of the State of New York. Accessed January 12, 2007, at: http://www.mssny.org/mssnyip.cfm?c=f&nm=Emergency_Preparedness.

2. Wynia MK, Gostin LO. Ethical challenges in preparing for bioterrorism: barriers within the health care system. Am J Public Health. 2004;94:1096–102.

3. American Medical Association. Declaration of responsibility. Accessed September 23, 2006, at: http://www.ama-assn.org/ama/pub/category/7491.html.

4. American Medical Association Council on Ethical and Judicial Affairs. Physician obligation in disaster preparedness and response (E-9.067). Accessed September 23, 2006, at: http://www.ama-assn.org/apps/pf_new/pf_online?f_n=resultLink&doc=policyfiles/HnE/E-9.067.HTM&s_t=Disaster&catg=AMA/HnE&&nth=1&&st_p=0&nth=3&%22.

5. Alexander GC, Larkin GL, Wynia MK. Physicians' preparedness for bioterrorism and other public health priorities. Acad Emerg Med. 2006;13:1238–41.

Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous.

Please send scenarios to Caroline Wellbery, MD, at afpjournal@aafp.org. Materials are edited to retain confidentiality.



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