Updated April 8, 2016
By Charles Krin
Earthquake. Tsunami. Hurricanes. Tornados. Building collapses.
All of these events cause devastation that range from localized (the Twin Towers on 9/11) to regional (Hurricanes Katrina/Rita on the U.S. Gulf Coast 2005) to nation destroying (such as the recent earthquake in Haiti). Our first impulse as human beings is often to rush in to provide aid and comfort. For a variety of reasons, this is not the best response for providers outside the afflicted area.
Here are four things you need to understand to begin with:
1. Never freelance
If you are not within two hours by limited ground transportation AND do not have a previous relationship with an appropriate organization inside the disaster area, you will not be of any use in the first 12 to 24 hours of any given major incident. You will end up being part of the problem.
Please DO NOT head into the disaster area on your own and then try to find a way to help. This leads to congestion and disorganization in some areas and inability to get care to other areas. Much time and effort have had to be diverted from projects that are more important during disaster response to clear out well-meaning but uncoordinated, unsupplied and unneeded volunteers.
2. Positions are for volunteers
Many, if not most, of these positions will be volunteer, and you may be responsible for your own costs of transportation, if not your own food. If your personal finances can’t handle those costs in addition to the loss of your normal income, then stay home and offer financial support to one of the various organizations providing relief.
3. Dangerous and unstable conditions
You are going into an area of devastation, where conditions are primitive at best, and feral at the worst. You are potentially putting your body in a life-threatening situation for the benefit of others. You are at risk for personal injury, disability, disease and even death. Your personal insurance will try to invoke any “act of war” clauses in your policies if you are injured or die.
You may also find yourself in a position where the local officials want you to pull out and leave patients behind without care. Consider how you will respond emotionally to that problem.
4. Remote and difficult communications
You have become accustomed to instant communications, including cellphones, email, electronic medical records, television, radio and many others. Most of these means of communicating with your local colleagues and to back home may be interrupted or lost.
Still interested in disaster response?
Start by joining one of the established Humanitarian Aid groups so that you can integrate into the system well ahead of time. A shortlist of these groups can be found in the sidebar in this article. In addition to taking advantage of training offered by the group, you should also go on one or more of the “routine” humanitarian missions undertaken by the group, where you will assist with ongoing assistance programs in underserved areas of the world, which is good training for disaster relief operations.
Other, more dedicated, alternatives include joining one of the Disaster Medical Assistance Teams (DMAT), Urban Search and Rescue Teams (US&R), or military reserve or medical reserve corps, which are now common here in the United States. Most other developed countries have professional equivalents – the Belgian and Icelandic Urban Search and Rescue teams were some of the first on the ground in Haiti.
Note that most DMATs and the US&R teams usually fill their slots at 200 percent or more of their standard, to ensure that all critical positions will be filled during a call up. As these are mostly government sponsored/supported units, members may be eligible for pay and insurance benefits during deployments.
Hospitals, ambulance and other medical support companies often have agreements in place to provide support during local, regional or national situations. The State of Texas has been particularly aggressive about setting up such mutual support agreements ahead of time.
If you’re a volunteer EMS provider, other companies, in particular utilities, construction outfits, chemical, trucking, information technology and large retail companies may be involved in similar mutual aid or community support agreements. If so, make sure that your boss knows you are willing to go whenever those agreements are activated, and also ensure that you understand under what conditions you will be deployed (paid vs. volunteer, what support the company will offer, etc.).
All of these groups offer various forms of training to help you adapt to the more austere working conditions, which may include (but is not limited to) class time, reading material, preceptorships for students and online resources. They will also provide the opportunity to go on training exercises or medical missions, where you will be exposed to various levels of austere field conditions and learn to work in them.
If you do join a U.S. military reserve unit, you will be able to attend one or more of the courses offered by the Defense Medical Readiness Training Institute , located at Fort Sam Houston in San Antonio, Texas. While many of these courses are U.S. Department of Defense specific and only offered at Ft. Sam, there are other courses, which are exportable, and may be available to DMAT and organized medical reserve personnel.
You should also consider obtaining additional training from groups such as the Wilderness Medical Society, which provides training for all levels of skill, from wilderness first aid on up to expeditionary physician training. Training such as this is very important, as most modern medical training does not emphasize the level of improvisation needed to treat patients for extended periods without organized medical supplies.
Surprisingly, any advanced medical and trauma skills that you have will not get as much of a workout as you might expect, especially after the first four days of response, due to the fact the folks needing that kind of help will often not survive past that time. Skills which will be in more demand include pediatrics (especially the use of oral rehydration techniques), obstetrics, splinting (and by extension, plaster casting), open wound care, field sanitation and water purification. Anyone who is interested can learn how to help with these high touch/low tech procedures through training provided by the organizations that you will be volunteering with.
For the medical types interested in volunteering, think of everything you do clinically, and how much of it depends on electricity, maintenance and repair, and the presence of specialized technicians. None of this will be available, and you can’t count on when it will become so. You need to be flexible enough to be able to practice good hands-on medicine with care and compassion, without the “high speed, low drag” equipment and techniques many of us take for granted in our daily work.
Other sources include the online and classroom training available to U.S. citizens and residents for many subjects through the U.S. Centers for Disease Control , and the U.S. Department of Homeland Security, covering infectious diseases, hazardous materials and the National Incident Management System (NIMS). NIMS is the extension of the Incident Command System developed several decades ago to coordinate wildland firefighting, and which has proved to be an invaluable and flexible command tool. Basic training for these matters is available for folks who have no medical, military, police or firefighting backgrounds, by following the appropriate links.
Because of the need for other skills in support of the relief operations, just about anyone can be of assistance. These skills include:
- Speaking more than one language
- Being able to use radio voice or data communications
- Basic skills in carpentry, masonry, plumbing, electrical, and small engine maintenance
- The field expedient rope and timber engineering that the Scouting movement used to call “Pioneering.”
It also helps if you can teach what you know any of the skills you know.
The final training is learning to camp “rough:" hiking in at least a mile with all your gear on your back, living without running water or flush toilets, using mantle type lanterns for lighting after dark, and cooking over a portable stove for a full week. You might not have to do this when you deploy, but being physically fit enough to do this, and being comfortable with the idea that everything you personally need for a week can be carried on your back will go a long way to making you successful in an austere situation. This will also allow you to understand how you need to dress to cope with extremes of sun, heat, cold or wet conditions that you may encounter.
In the final part of the article I will highlight how to prepare for a deployment.
About the author:
Charles Krin is a retired Family and Emergency Medicine physician with more than 30 years of experience in the field. Initially trained as an EMT-A in 1976, he spent three years as an air ambulance medic in the US Army, and then attended medical school, graduating in 1987. Residency trained in Family Medicine through one of the programs associated with the Louisiana StateUniversity Medical Center, he spent almost a decade in full time clinical medicine while teaching and working in local emergency rooms on the side.
Moving to full time Emergency Department work in 1999, he continued his interest in teaching EMS personnel at all levels. He was called up in support of Desert Storm in 1991, where he provided medical care while assigned at Ft Hood, Texas. He later participated in the local response to Hurricanes Opal, Katrina and Rita while practicing in Louisiana. Recently retired, he is now taking care of his wife, nine dogs and six cats in the Ozarks. You can contact Charles at krin135@aol.com.
The author wishes to acknowledge the contributions from the many correspondents from the Trauma-List in the development of this article.