Now that we've marked the five-year anniversary of September 11, I've decided to survey the state of disaster preparedness among medical professionals in our country. Many questions must be considered in order to assess our ability to manage emergencies. What types of disasters must we be ready for? What are the roles of the various players in this system? Are we any better organized and prepared than we were before 9/11? And finally, what mechanisms, if any, are in place to prevent burnout in the service providers involved with this highly draining field? The Leawood, KS-based American Academy of Family Physicians has developed a curriculum that addresses many of these questions.

Types of disasters

There are three major recognized categories of widespread disasters: natural disasters, accidents and intentional acts of violence. The most common natural disasters are earthquakes, floods, hurricanes, fires, tornados, volcanic eruptions, heat waves and cold.

The most serious accidents are nuclear accidents, chemical or biological contamination, agricultural or industrial accidents involving insecticides or pesticides, and transportation accidents involving large vehicles such as planes, trains and buses.

Intentional acts of violence can be physical, such as bombing or shooting, or they can involve the use of "terrorism agents" such as biological or chemical agents that cause bacterial or viral infections. Among the bacterial agents that are of value to terrorists are anthrax, cholera, plague, tularemia and Q fever. Viral agents of concern include smallpox, Venezuelan equine encephalitis and viral hemorrhagic fevers. Biological toxins include botulinum and staphylococcal enterotoxin B.

Chemical agents attack specific body functions or organ systems. They include nerve agents such as sarin, various insecticides and pesticides, blister agents such as mustard and lewisite, choking agents such as phosgene and chlorine, blood-altering compounds such as hydrogen cyanide and cyanogen chloride, and riot-control gases that cause vomiting and eye-tearing.

Preparing for an emergency

Given the enormous diversity of agents with which we can be attacked, it is very important to have specific protocols in place long before an attack occurs. The American Academy of Family Physicians has suggested many protocols for family physicians and other providers. Before looking at these protocols, though, it is important to consider the attitudes providers need to function adequately during a large-scale emergency.

First and foremost, practitioners must be aware of the need to prepare in advance for catastrophic events. Secondly, the understanding that teamwork is essential cannot be emphasized enough. There must be seamless coordination of healthcare workers; police and fire personnel; the media; the providers of essential services like electricity, mass transit and water; local officials; and, in some cases, the military, in order to benefit the public during times of need.

There are three P's that this team must keep in mind to best serve the public during a disaster: planning, preparation and participation.

Planning involves devising a series of protocols for all the entities listed above based on the type of disaster that strikes – essentially, "Who does what in case of X?"

Preparation includes setting up channels of communication among these entities; procuring equipment and medications; securing the proper financing to ensure delivery of services, food, water and medications; and educating the public about different protocols.

Participation is the actual delivery of goods and services. To participate effectively, providers must be reminded of certain simple but extremely important concepts. First, excellent communication skills are important during times of crisis. Providers and victims are understandably under severe stress and therefore are not concentrating optimally during disaster scenarios, so clear, plain, calm speech is an invaluable tool. Second, providers must be resourceful when the usual supplies, personnel, communication and transportation are not available. And, finally, providers and the public must be taught the importance of the concept of leadership and following instruction.

Next month, I will discuss specific protocols and skills required by providers, as well as the pharmaceutical industry's role in disaster scenarios.