Physicians come to their profession with a high sense of personal honor and a high sense of personal duty. It is these two characteristics that spur physicians to contribute time, energy, talent and resources in times of local, regional or even national disaster.

Whether hurricane Andrew, hurricane Charlie, hurricane Katrina, hurricane Rita, hurricane Wilma, the terrorist attacks on the Murrah federal building, the World Trade Centers or the Pentagon, whether forest fires or large automobile accidents whenever the healthcare system appears to be overwhelmed physicians and other health care professionals find themselves spurred to action. Unfortunately they also find themselves spurred.

It seems senseless whether the time of tremendous need physicians would be turned away from such

places as Louisiana, Gulfport Mississippi, Port Charlotte, Florida, Oklahoma City, New York City and Washington D.C. Yet a small understanding of how disaster response systems work explains this phenomenon.

The first and most important thing that physicians and other health care providers must know is that if you are not part of a disaster plan, you are not part of a disaster response. Even though it may seem chaotic when disaster relief professionals are working side by side with volunteers and bystanders to save lives and livelihoods, what you are actually witnessing is a well choreographed dance. Long before the disaster struck plans were established on how best to respond in the event of a disaster.

It is in this planning phase that the use of volunteers whether lay persons or health care professionals is anticipated and integrated.

Therefore if you wish to be part of a response, if you wish your valuable skills to be used to help stave off disaster and prevent catastrophe the time to volunteer is now.

What Is The Disaster Life Cycle?

Disasters come in four phases:

* Interphase
* Adverse Event
* Response Phase
* Recovery Phase

With respect to most disasters we hope that interphase, that period between disasters, is the longest period of time. It is during interphase that plans are reviewed, practiced, refined and practiced again. It is during this period of time that it

is most optimal for health care professionals to join the ranks of volunteers to be called upon when the disaster strikes.

The Adverse Event is that brief moment in time when the disaster actually occurs. When the levy actually breaks, the hurricane passes directly overhead or the bomb blasts. This discrete moment is defined by the event itself. There is little that responders can do except survive to lend aid when the event has past. Adverse Events cannot be prevented, but can be mitigated. They will happen with little regard to what planning has or has not occurred. Occasionally man made events can be preventive but by and large the event phase is inevitable.

Immediately following the

event begins the response phase. It is this acute period that determines whether an event becomes a disaster. Disaster is defined as need exceeding resource. If during the interphase weaknesses in resource management, procedures or processes are identified such that needs never exceed resources, the event never becomes a disaster. Unfortunately, this occurs in precious few events.

It is in the response phase that defines whether a disaster goes on to be a catastrophe. While a disaster is when needs exceed resources, a catastrophe is when needs excess all ability to respond. When the response phase fails or the planning phase is found lacking catastrophe includes.

Medical Reserve Corps Your Chance to Serve

The Medical Reserve Corps (MRC) program was launched officially as a national, community-based movement in July 2002. It was formed in response to President Bush s call for all Americans to offer volunteer service in their communities. The objective of the MRC program is to strengthen communities by establishing a system for medical and public health volunteers to offer their expertise throughout the year and during times of community need. More than just a corps of available healthcare professionals, the MRC is a full partner of the White House s USA Freedom Corps and the Department of Homeland Security s Citizen Corps.

Volunteerism for America s healthcare providers has faced many obstacles in the days before the MRC. Issues of

liability insurance, malpractice, worker s compensation, injury insurance and many other serious concerns have plagued the medial volunteer effort in the United States for the past 2 decades. If insurance issues did not stand in the way of medical volunteers, licensure and accreditation issues stymied efforts to provide much needed disaster medicine services following disasters.

The adoption of Emergency Medical Assistance Compacts (EMAC) across all 50 states and all United States territories was designed to address the majority of these concerns, but recent legislation introduced in congress shows that the EMAC s are far from resolving the key insurance issues facing medical volunteers. Legislation is pending before both the U.S. House of Representative and the U.S. Senate to resolve the

interstate worker s compensation issue for healthcare providers who volunteer their services in time of disaster. In the near future, similar legislation will be proposed to resolve malpractice coverage issues for healthcare volunteers in disaster.

Membership in the Medical Reserve Corps resolves all these problems now and without the need for special legislation. Medical Reserve Corps volunteers are credentialed and their membership in the MRC provides Eminent Domain coverage for malpractice as well as volunteer injury coverage in the event of an on duty mishap.

Who Can Volunteer for the Medical Reserve Corps?
MRC volunteers may include medical and public health professionals including:
* Physicians
* Nurses
* Pharmacists
* Emergency medical technicians
* Dentists
* Veterinarians
*

Epidemiologists
* Infectious disease specialists.

In addition, volunteer interpreters, chaplains, amateur radio operators, logistics experts, legal advisors, and others may fill key support positions.
Most MRC response and recovery assignments are secured through local and state channels. However, opportunities for MRC volunteers to assist outside their local jurisdiction do arise. During the 2004 hurricane season, MRC volunteers were asked to support the American Red Cross (ARC) response activities in Florida. This was the first deployment of MRC volunteers outside of their local jurisdiction.

During the 2005 hurricane season, the MRC strengthened its partnership with the ARC. Prior to Hurricane Katrina’s landfall, the ARC disaster operations staff requested MRC support for their sheltering operations. Policies and processes were developed to

identify, assign, and activate MRC members willing, able, and authorized to respond. ARC provided transportation, logistical support, and supervision for the deployed MRC members who supported ARC health services and mental health and shelter operations.

MRC members also participated in response activities outside of their local/state jurisdiction through a mission to support HHS response and recovery efforts.

The first Federal activation of MRC volunteers occurred on September 15, 2005, when HHS needed staffing support for three special needs shelters in Louisiana. Subsequent mission assignments allowed MRC members to fill positions in Community Health Centers and health clinics on cruise ships housing evacuees in Mississippi and to perform health assessments in Texas.

For more information about the Medical Reserve Corps or

to become a member, please visit the MRC website at, or contact the Medical Reserve Corps at:

MRC Program Office
Office of the U.S. Surgeon General U.S. Department of Health and Human Services
5600 Fishers Lane, Room 18C-14
Rockville, MD 20857
Tel: (301) 443-4951
Fax: (301) 480-1163
E-mail: MRCcontact@hhs.gov

The National Disaster Medical System NDMS the Nation s Medical Ready Force

The National Disaster Medical System (NDMS) is a federally coordinated system that augments the Nation’s medical response capability. The overall purpose of the NDMS is to establish a single integrated National medical response capability for assisting state and local authorities in dealing with the medical impacts of major peacetime disasters and

to provide support to the military and the Department of Veterans Affairs medical systems in caring for casualties evacuated back to the U.S. from overseas armed conventional conflicts.

The National Response Plan utilizes the National Disaster Medical System (NDMS), as part of the Department of Health and Human Services, Office of Preparedness and Response, under Emergency Support Function #8 (ESF #8), Health and Medical Care, to support Federal agencies in the management and coordination of the federal medical response to major emergencies and federally declared disasters.

Much like Army Reservists, NDMS members are volunteers who become government employees when they are deployed and must commit to two weeks service if called.
NDMS teams are essentially designed to be a rapid-response element

that deploys to disaster sites with sufficient supplies and equipment to sustain themselves and care for patients for a period of 72 hours. In mass casualty incidents, their responsibilities include triaging patients, providing austere medical care, and preparing patients for evacuation.

In other types of situations, NDMS teams may provide primary health care and/or may serve to augment local health care staffs. Should disaster victims need to be evacuated to a different locale to receive more definitive medical care, NDMS teams may also be activated to support patient packaging, transport, reception and disposition.

The units are supported by a cadre of administrative, logistical, and communications personnel whose roles are vital to successful deployment. Medical members are required to maintain appropriate

certifications and licensure within their discipline. When members are activated as intermittent Federal employees, licensure and certification is recognized by all States.

In contrast to MRC members, as Federal employees, all NDMS team members are paid while serving.

NDMS medical personnel includes many disciplines from physicians to pharmacists, ARNP s and PA s. The NDMS teams are also replete with an experienced pool of healthcare talent with diverse medical backgrounds, ranging from RN s and LPN s to Nurses Assistants. Paramedics and EMT s, with years of training and daily emergency experience are also an integral part of the teams. Respiratory therapists bring yet another medical specialty to help round out the deep medical resources of an NDMS team.

Administrative,

Logistical and Communications experts round out an NDMS team and ensure that a fully self sufficient group of professionals is ready to deploy at a moment s notice when requested by federal disaster declaration.

Most NDMS teams are also state disaster medical response teams providing reservist style medical support for their local communities as a supplement to MRC assets in an area.

For more information about the National Disaster Medical System or to become a member, please visit the NDMS website at oep-ndms.dhhs.gov.

So How Do I Participate?

First, get educated. The sad truth is that few physicians have spent even eight hours learning how to keep themselves, their families and their patients alive in the event of a disaster.

Take a Basic Disaster Life Support Course or similar Healthcare First Receiver training. You are of no use to anyone if you fail to go home alive at the end of the day.

Next, get involved. Of the over 5000 hospitals in the United States, only a very small fraction have physicians on the hospital disaster planning committee. Of greater concern is that few if any of those physicians who do participate in hospital disaster planning have any formal training or certification in disaster medicine or disaster management.

Once you are educated and involved, become a resource. The 2006 Institute of Medicine reports on the state of emergency medicine in the United States soundly rebuked hospitals and healthcare in general

for poor and ineffective planning, preparedness, training and practice. Throughout the evolution of healthcare disaster preparedness, physicians have been conspicuously absent from the table. It is well past time that those who have the ultimate responsibility for patient care and well being take responsibility for their role in disaster planning and preparation.

Finally once you have become educated, involved and a resource, volunteer. If you are fortunate enough to have a career which allows you the freedom to deploy for weeks at a time to locations far from home, consider becoming a member of an NDMS team. If your career needs and practice responsibilities require that you stay closer to home, join an MRC team in your area. Either way

you will serve your community, your nation and your fellow man in a way not possible anywhere else in medicine.

Dr. Maurice A. Ramirez is the founder and president of the consulting firm High Alert, LLC.. He serves on expert panels for pandemic preparedness and healthcare surge planning with Congressional and Cabinet Members. Board certified in multiple specialties, Dr. Ramirez is Founding Chairperson of the American Board of Disaster Medicine and serves the nation as a Senior Physician-Federal Medical Officer in the National Disaster Medical System. Dr. Ramirez has a new book: You Can Survive Anything, Anywhere, Every Time. His website is http://www.High-Alert.com