When I was posted in Emergency Department of Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) for two weeks, I have to learn all sort of things regarding primary care in an emergency setting. It was fun and I would say it to be the most active and productive two weeks of my life. Prior to the posting date, I thought I could have predicted all sort of things; what I perceived I would experience in Emergency posting. After all, the name "Emergency Medicine" is quite self-explanatory so I thought I knew what kind of thing to be expected, how busy my schedule would be and what spectrum of diseases that I'm expected to know in order to achieve, at the very least, a working diagnosis; Oh boy, I have never been so wrong. There is a lot of stuff that I need to learn.
A lot of condition and presentation that would make me stutter if someone were to ask me about it, not to mention some conditions which I have never known to be, well, exist. The most interesting part of that particular two weeks posting was the disaster exercise, a hands-on session which requires us, students, to be the one who manages patients in disaster situations. It was cool and I can say the situation is a little bit different in terms of patients prioritisation during phases of triaging and giving treatment in the field when compared to giving treatment in the hospital. Usually, when patients arrived at the hospital, we will give our attention and time to the most severe one to reduce mortality and post-disease complications. In the disaster area, however, is to treat the one who has the greatest chances of surviving; do good to the greatest number of victims.
Now, what is a disaster? According to the definition given by the Center For Research On The Epidemiology Of Disaster (CRED):
It is a situation or event which overwhelms local capacity, necessitating a request to national or international level for external assistance
There are some criteria which have been extended with the definition given above and basically, we can call an event a disaster if it satisfies at least 1 out of 4 of the criteria listed below:
- More than 10 people being killed
- At least 100 people were affected
- A call for an international event
- Declaration of a state of emergency
Whether you were using the definition given by CRED or any other recognised institution, you either classify an event as a disastrous phenomenon or just a simply an event which is bizarre but still can be handled by the local population. There is no standardised definition that can be used as a guide to classify an event as being disastrous or not. Let me tell you an example, let say there is a bus crash involving 20 passengers. They were sent to the nearest district hospital which can only house as much as 10 patients at a time and there are only 3 medical officers available for duty. Is this a disaster? It can be as 20 people who were needing urgent treatment can be too much for 3 medical officers to handle.
Now, what if all of those victims were sent to a tertiary centre which can house as much as 30 patients at a time with an appropriate number of available medical officers? Would it still be a disaster? You get the gist. That's why it is important to know that even with all of those criteria, the word "disaster" can be used in a certain situation in which the event extends to the normal capacity for people to cope; even if the event itself doesn't satisfy either of those 4. In June 2000, the American College of Emergency Physician (ACEP) stated that:
Medical disasters occur when the destructive effects of natural or man-made forces overwhelm the ability of a given area or community to meet with the demand for health care
It simply means that, in any type of disaster situation, the level of medical care being given were superficial, meaning, they would keep victims alive for a set of time but their condition would still deteriorate if they didn't receive definitive health care for the next few hours or so. Have you seen someone doing CPR during a disaster? Well, they would do it if there is enough manpower to cover all victims who were injured but for most of the time, if they encountered patients with no pulse, they would let them be (while tagging them with either black or white tag). There are so many more require medical attention; do good for the greatest number of victims hence doing CPR for 30 to 45 minutes is irrelevant, in the perspective of disaster medicine, when they could do so much good to other victims who could deteriorate while they were doing CPR on the pulseless victim.
The concept is the same as battlefield medicine. If you were an army doctor, your objective is to treat the most number of soldiers so that they could stand up and fight again before focusing on the severely injured soldier. Even with all of the medical skills that you acquired while being trained in a hospital, trying to work in the field is completely different. Not everything you learn behind the safe wall could be relevant when you were treating patients on the field and sometimes, you have to be creative especially when you were on a tight resource. According to a statistic, only 1/6 of all medical officers were trained to treat a patient in a disaster situation but out of that number, only 1/3 of them were confident that they can do it. That signifies the unpreparedness to face a disastrous situation especially when people are not familiar with a particular disaster. It makes us realised the gravity of the problem potentially faced by medical officers especially when they were working in an area that they are not familiar with.
Medical Student Roles In Disaster Management
One of the most interesting questions being asked by my lecturer is "what do you think your role (medical students) in disaster management?". As a medical student, I admit to being ill-prepared for disaster management but I'm sure there is something I can do to lighten the burden of medical officers who were on duty by performing basic procedures. Nevertheless, there are some situations in which medical student would be super clueless especially if everyone who was supposed to supervise us, were busy with their own active duty; natural disasters for example. Being a medical student, most of the medical procedures, especially when they are invasive, were observed and rarely performed to avoid complications. As a result, we are quite unfamiliar with a certain procedure which is usually required in the emergency setting.
However, as medical students are trained in basic clinical medicine, we can be one of the most valuable assets that can be utilised to lighten the burden of treating victims while doctors are shorthanded. In 1918, for example, when the United States of America stumbled upon a pandemic of influenza, medical students (especially those who are in clinical years) are recruited to work as intern or nurses while doctors were managing other victims. This is important especially if some of the victims were lightly injured and can be managed by a less trained hand allowing doctors to turn their attention to much more serious patients. When Copenhagen was attacked by the Polio epidemic in 1952, 1400 medical students were given tasks to ventilate patients who were experiencing respiratory failure giving opportunities for anaesthetists to work on a much more severe, probably atypical presentation.
We (medical students) are not obligated to help and treat people who were victimised by disasters of either cause but more to be driven by a sense of humanity to help. In Malaysia, there are several medical schools which offer disaster medicine as a part of their medical curriculum. It's important for us to be trained with at least basic first aid knowledge so that when a disaster or a certain undesirable situation strike, we will be able to help.
References: [1], [2], [3], [4]
All images were taken from Pixabay
Images: [1], [2], [3], [4], [5]
