Remember the childhood game “Musical Chairs”? The music stops without warning and everyone scrambles frantically for seats, the loser left sadly standing without a chair. Much like that sudden stopping of the game’s music, disasters can happen suddenly and leave citizens frantically dependent on those doctors and nurses “left standing” in the hospitals to provide the best care possible under extreme adversity. Until help arrives in days or even weeks, who gets the remaining oxygen, batteries for monitors and IV pumps, the beds, the life-saving operation, the MRI, the attention of limited staff, the blood or intravenous fluids, the morphine or the antibiotic, or even the ventilator?
Will it be you? Maybe not.
This past Thursday evening, in keeping with the mission of whole-community involvement in preparing for disaster, The Disaster Medicine Project co-hosted with Swedish Edmonds an educational event focusing on why, when and possibly how the approach to patient care must change in the harsh aftermath of a catastrophic event such as the anticipated Cascadia megaquake that may hit our area. Some of the strategies depicted to the 60 or so physicians and senior leadership in attendance are pertinent even today as the flu season challenges medical centers up and down the I-5 corridor from Bellingham to Portland with over-flowing emergency departments and cancelled elective surgeries due to not enough beds or staffing.
Board-certified in both Emergency and Pediatric Medicine, guest speaker Dr. Vicki Sakata brought her years of high-intensity emergency department know-how, coupled with her domestic and international disaster front-line deployment experience, to discuss the tough decision-making that must drive patient care and limited-resource stewardship in the wrath of a major disaster.
Sakata reminded the doctors and staff that patients will seek care regardless of county borders, healthcare system or hospital labels such as “trauma” or “child-based” centers. Location and available routes of travel will dictate where people seek care. Pediatric, severe injury or burn victims, along with those needing their scheduled dialysis or chronic ongoing medical treatments, not to mention the daily allotment of appendicitis, heart attack and stroke patients, all will need care under extreme adversity and scarcity, power failures and in whatever weather conditions we are experiencing at the time. Add to those the in-patients already hospitalized prior to the crisis.
She emphasized the necessity of a regional approach to crisis health care with all centers and staffs operating within the same guidelines, using standardized, accepted operational “tool-kits” and decision trees. Sakata is a member of the planning team for King-Pierce County currently developing this process, incorporating the excellent work and thinking already done in other states like Minnesota, a leader in this area.
Sakata’s message and takeaways were well-received, evidenced by the many questions following her thorough presentation. She emphasized the process is ongoing and still requires much work and physician participation to create, educate and train to these infrequently employed crisis standards of patient care, should they be needed. Patient care in crisis conditions will require all hospital personnel, not only doctors and nurses, to understand the extreme burdens to be met. All will need to be familiar with the tools, tactics and strategies to provide the best care possible for the greatest number of casualties, given the severity of the crisis we are facing. This way of thinking is far different from what goes on every day in any hospital. In day-to-day patient care, no resource is spared if indicated; the maximum attention and resources are focused on each individual, not a population as in disaster.
The general public also needs to be included in this crisis-care education and process development. This will promote appropriate and realistic expectations to better coordinate and navigate the limited health care still available until outside reinforcements arrive. Focus groups from the public are being assembled to grapple with the many questions revolving around these complex resource-allocation and ethical challenges. Your participation is needed.
— By Robert Mitchell, MD, FACOG. For more information on the Disaster Medicine Project, see here.