Timboe, Harold L. MD
Reprint requests to Dr Harold L. Timboe, 11965 Beau Chalet Dr, Bentonville, AR 72712. Email: firstname.lastname@example.org
The author has no financial relationships to disclose and no conflicts of interest to report.
Accepted August 9, 2012.
Paraphrasing Sir Winston Churchill, to every person there comes in his or her lifetime that special moment when he or she is figuratively tapped on the shoulder and asked to do a special thing. What a tragedy if that moment finds him or her unprepared.
In the past century there have been tremendous advances in science and technology, particularly in the areas of medicine, transportation, telecommunication, information technology, and institutional organization and cooperation at the regional, national, and global levels. A rapid, well-organized, intelligent response with adequate numbers of well-trained personnel has become the new standard and the public’s expectation when disaster and other tragedies occur, whether they are caused by human acts or nature’s fury. In health and medicine specifically, knowledge and advances in trauma, infectious disease, and public health have given our profession and society in general the opportunity to save lives, mitigate suffering, and more rapidly bring order out of chaos at levels of effectiveness never before seen.
This special issue of the Southern Medical Journal is a timely and appropriate compilation of articles related to myriad issues and challenges related to improving society’s preparedness and resiliency in withstanding disasters. Each of us in our own specialty, subcomponent of our local health system, and building to the aggregate capabilities at the community, regional, state, and national levels contribute to a growing sense of confidence in our overall preparedness.
In many respects we pray we are never forced to demonstrate our preparedness, and the rhythm of life goes on without what seems to be an increased frequency of disaster and tragedy. Preparedness starts at the individual and family unit levels and builds across the community and outward. The key question in this effort is be prepared for what? What are the out-of-the-ordinary threats, events, and actions that may require our healthcare team, my family, and me to act in extraordinary ways? Many of the articles in this special issue address aspects of the healthcare system and subcomponents when disaster strikes, resulting in a surge in demand. These aspects include planning, assessment, simulation, training, triage, burns, critical care, emergency surgery, pediatrics, geriatrics, mental health—the list is virtually endless. Which of these may be unique to your responsibilities and specialty?
Since the terrorist attacks of September 11, 2001, our nation has undergone several iterations of improvement to our capabilities to prepare, prevent, and respond. We have made significant investments in research, planning, organizing, training, equipping, and exercising, as well as other aspects of preparedness at the community, regional, and national levels. It is not unlike being prepared for military contingencies. Projecting potential threats and the various scenarios resulting from them and key capabilities necessary for the planning and development to respond accurately are key components to keeping society functioning reasonably well during times of crisis. Scenarios attempt to provide a picture for individuals in authority as to the magnitude of the effects and the demand on essential functions. They can be modeled or simulated with varying degrees of accuracy, and from these estimates, personnel can develop reasonable capabilities, including situational awareness, training, facilities, communication, equipment, supplies, transportation, leadership, policy, timely analysis, and the ensuring of coordination across resources.
This system of threat-based scenarios and capabilities-based planning is found in several documents that are beneficial to medical professionals and health system leaders. The foundation document is the National Response Framework (http://www.fema.gov/national-response-framework) developed by the Federal Emergency Management Agency, which includes policy on Emergency Support Functions (the eighth being Public Health and Medical Services), the National Incident Management System (http://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf), and various training courses to better prepare before, during, and after a disaster. The Strategic National Risk Assessment (http://www.dhs.gov/xlibrary/assets/rma-strategic-national-risk-assessment-ppd8.pdf) enumerates the type of events used to develop the more detailed National Planning Scenarios from which communities can prepare their specific Threat and Hazard Identification Risk Assessment. Users can then focus resources and planning for capability targets in 31 designated Core Capabilities from the National Preparedness Goal (http://www.fema.gov/pdf/prepared/npg.pdf).
Although it may seem overwhelming, medical professionals should become familiar with the National Disaster Life Support Foundation’s (www.ndlsf.org) series of courses and the general standard operating procedures to better understand disaster response and responsibilities. It is also beneficial for medical professionals to familiarize themselves with their local health institutions’ emergency plans and participate in periodic exercises to test their adequacy and overall competency and ability to address catastrophic situations.
By each of us taking responsibility to personally prepare our healthcare teams, our families, and ourselves, we can gain the confidence that we will be a secure and resilient community/nation possessing the capabilities required to prevent, protect against, mitigate, respond to, and recover from the threats and hazards posing the greatest risk. We hope this duty never calls, but if it does, we will demonstrate our readiness—the moral ethics of our profession, duty to the public good, and commitment to serve others require our utmost diligence.