August 24, 2018
3 min read
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Should preparation for a nuclear or natural disaster be part of physician residency?

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Click here to read the Cover Story, “Preparing for chaos: Hem/onc response crucial to radiation exposure incident.”

POINT

Yes.

Residents in all specialties should have disaster medicine education, which includes training in nuclear disasters.

Jeffrey Luk, MD, MS, FACEP, FAEMS
Jeffrey Luk

Although physicians do not necessarily expect to encounter disasters, they can happen anywhere.

Look at the situation in Joplin, Missouri, where a tornado destroyed the hospital. It was completely unexpected.

It was not just the physicians who had done emergency medicine residencies, who had undergone this training, who dealt with this disaster. It was everyone, in all specialties, who were called into service. The same could be said about Hurricane Katrina in New Orleans.

This is why we need to incorporate disaster medicine training into all specialties.

I understand that, in a residency program, there is always a time issue. With that in mind, I do not think disaster medicine training necessarily needs to be really in depth for all specialties. It can be simple awareness-level instruction for individuals in specialties that may not routinely deal with disasters, and it could be operator level for those specialties that may care for disaster victims more often.

The awareness component can deal with triage, as well as some basic treatment and care issues that surround a disaster. There may be an ethical component, as well, for dealing with patients who have severe injuries. Those who want to gain additional training, of course, can do that.

For specialties like trauma surgery and emergency medicine that are likely to have a crucial role in caring for disaster victims, there can be more in-depth training.

The good news is, I do not think it would take a lot of time to train residents in all specialties on the basics of disaster medicine.

Jeffrey Luk, MD, MS, FACEP, FAEMS, is assistant professor of emergency medicine at Case Western Reserve School of Medicine, as well as director of prehospital and disaster medicine at University Hospitals Cleveland Medical Center. He can be reached at jeffrey.luk@uhhospitals.org. Disclosure: Luk reports no relevant financial disclosures.

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COUNTER

No.

It likely would be of limited use to train physicians for nuclear or other natural disasters during their residency, as the information they learn may not be applicable to the situation or facility where they eventually will work.

Sandra M. Ramirez, MHP, LMP, CHP, CLSO
Sandra M. Ramirez

Although there may be some similarities across the board in how patients are handled, there would be enough differences that training would be most beneficial at each individual facility.

The best approach to prepare for such events would be to train staff members — including emergency medicine doctors and nurses — most likely to be the first to respond to these types of events. For this training to be effective, it must be conducted often to ensure knowledge retention and comfortability. Physicians will need to be informed about radiation in general and be familiar with handling injured and contaminated patients.

It is important for physicians to work with the emergency management team at their facilities to develop a plan and to participate in periodic drills to maintain these skills. The University of Texas MD Anderson Cancer Center operates off of an all-hazards plan, in which we activate our incident command structure to varying degrees depending on the event. If a nuclear event were to occur in Houston or another city, we have specific plans in place that detail how our teams will respond.

Additionally, MD Anderson participates each year in a drill through the RITN. The drill — which typically simulates a radiation event somewhere else in the country — focuses on how our hospital would handle patients who are no longer contaminated but are potential stem cell transplant patients.

We are not a trauma hospital, but we have agreed with the RITN to accept a limited number of patents should such an event occur. We also have conducted tabletops with our Texas Medical Center partners related to this type of event.

In 2012, we conducted a more detailed drill with the support of federal and local officials. This drill — which simulated a scenario happening on our campus — allowed us to refine our plans and train those most likely to be first responders to such an event.

One of the largest barriers to instituting regular training and drills is funding. Radiological events are rare, and hospital time and resources may be scarce, so it can be difficult for hospitals to justify training for these events instead of more common scenarios. However, with recent events such as Fukushima, and the general public’s perception of radiation dangers, it is important to better educate the population. Federal and state agencies understand the monetary restrictions faced by hospitals, so funding for such programs often can be requested through local and federal government grants.

Another great resource is the Radiation Emergency Assistance Center/Training Site in Oak Ridge, TN. This program, supported by the Department of Energy’s National Nuclear Security Administration, is part of Oak Ridge Institute for Science and Education. This program provides continuing education credits for physicians to learn about medical management of radiological events through didactic and hands-on training.

Sandra M. Ramirez, MHP, LMP, CHP, CLSO, is radiation safety officer at The University of Texas MD Anderson Cancer Center. She can be reached at smramirez@mdanderson.org. Disclosure: Ramirez reports no relevant financial disclosures.