Do you know what to do when disaster strikes?
At the time Hurricane Katrina made landfall, Lindy Boggs Hospital in New Orleans had 126 patients in addition to staff members, family members, pets, and families from the surrounding neighbourhood sheltering in place. Firefighters arrived from north Louisiana on August 31, 2005 to evacuate the hospital. The patients were previously triaged into three groups: A (ambulatory), B (wheelchair), and C (critical). It was intended that the most critical patients would be evacuated first; however, in accordance with triage in a mass-casualty event, the medical staff was told by the rescuers that critically ill patients would be evacuated last, when more help arrived, so that those deemed able to survive could be evacuated quickly. The pronouncement was emotionally difficult for both physicians and firefighters, but it was the physicians, not the rescuers, who were responsible for relaying this information to the patients and their family members.
Dr Anna Pou’s recent article (“Ethical and legal challenges in disaster medicine: are you ready?” in the South Medical Journal) describes the unimaginable experience she and her colleagues went through caring for patients at an isolated hospital during Hurricane Katrina in the United States in 2005.
The intense heat; lack of food, water, and electricity; lack of security for those who stayed at the hospital; and only sporadic communication with the outside world; made the situation truly harrowing.
The most heart wrenching aspect of this story is the triaging of patients, not according to who was the most critical, but according to who was most likely to survive.
This seems anathema to those of us who have not been involved in a disaster (or armed conflict) situation – where urgent medical care is required for a large number of sick and injured individuals with limited resources.
Dr Pou argues that the public, the medical community, and government agencies were unprepared for the disaster caused by Hurricane Katrina. In particular, although most doctors were not responsible for formulating disaster plans, they were the ones left to address the plans’ inadequacies, caring for patients with few resources.
Dr Pou wrote that: “The public was grossly uneducated regarding standards of care during catastrophes, which led to feelings of betrayal and abandonment, and these in turn led to public distrust and legal action.”
Fortunately, Australia has not experienced a domestic disaster on the scale of Hurricane Katrina, the Boxing Day tsunami, the earthquake that struck Haiti in 2010 or the tsunami and nuclear disaster that hit Japan in 2011.
But many of our colleagues have responded to Australian floods, bushfires, and storms, providing health care to the local communities during and after these events. A disaster can happen anytime, anywhere – it’s essential that we’re all prepared to respond at a moment’s notice.
As such, the AMA recently updated the Position Statement on Ethical Considerations for Medical Practitioners in Disaster Response in Australia 2008. Revised 2014.
The Position Statement outlines a doctor’s duty of care in disasters, including natural and man-made disasters, pandemics, and terrorist activities.
It highlights the personal and professional challenges faced by doctors, and stipulates the reciprocal obligation of employers, governments, and the public to protect and support doctors responding to a disaster.
The updated Statement provides a greater focus on triage during disaster response, explaining that during a disaster there may be limited resources immediately available in relation to a large number of sick and injured individuals in varying states of health.
In certain circumstances, the doctor may have to decide not to actively treat a gravely ill or injured individual who cannot be saved in the specific circumstances, in order to treat others who can be saved.
It’s imperative that the public are aware of, and support, disaster response protocols so they understand the process, rationale, and justification for clinical decision-making before a disaster actually occurs.
In order to ensure the medical profession is ready to respond to a disaster, we must continue to be involved in the development, implementation, and review of disaster response protocols, including standards regarding, amongst others, triage, resource allocation, treatment and quarantine, and consent, privacy, and confidentiality.
The Position Statement on Ethical Considerations for Medical Practitioners in Disaster Response in Australia 2008. Revised 2014 is available on the AMA’s website (at position-statement/ethical-considerations-medical-practitioners-public-health-emergencies-australia), along with two related statements, the Position Statement on Supporting GPs in the Immediate Aftermath of Natural Disaster 2012 and the Position Statement on Involvement of GPs in Disaster and Emergency Planning 2012.