Disasters are everywhere. There are environmental events: toxic spills, radiation or emissions from industry or transportation accidents. There are biological events: naturally occurring or released infectious agents. There are also natural disasters: hurricanes, earthquakes, tornadoes, floods. Finally, there are man-made incidents: bombs, shootings, motor / air / train accidents, structural collapse or fire. Are chiropractic physicians prepared to respond to emergencies in their communities? You should be. Basic CPR, first aid, triage and appropriate transportation of patients are simple primary care skills all DCs should know.
How Should DCs Respond? What Not to Do
The most important thing you can do for your community when disaster strikes is to not freelance. With increasing risks to both victims and responders, most disaster sites are becoming inaccessible to anyone who is not a recognized member of a team. Simply showing up and setting up a table, no matter how well-intentioned, presents a huge liability and personal risk.
Serving at a disaster site does not fall under most Good Samaritan laws. Those are written to cover assistance in a "life-threatening" situation. If your malpractice does not cover you and you are not under the umbrella of a team's group policy, you are potentially a target for a lawsuit. Perhaps more significant, but less considered, is protection if you are injured during service at a disaster site. I know workers who have suffered heart attacks and fractures while working. Some brought home infections. Many of the 9/11 workers still haven't been compensated for their respiratory conditions. Even more frightening is the possibility of secondary devices planned to "take out" responders after a terroristic incident.
If you do not "belong" to a team, you are on your own. These are very real personal threats that can render you permanently disabled with no coverage for your care or future life.
How Can You Get Involved?
The choices are different depending on your educational background and the type of teams in your region. At the federal level, there are DMATs (Disaster Medical Assistance Teams). These are state-based teams that are federally deployed and managed under the U.S. Department of Health and Human Services (HHS). Unfortunately, at this time there is no category for "chiropractic physician," so any application has to be made under another license (nurse, EMT, respiratory therapist, paramedic) or as a non-health provider (communications, logistics).
Then there is the Red Cross. You need to go through organizational training and a background check. Service may be needed at shelters or headquarters. Like the DMAT, there is no chiropractic-specific category on these teams. Local Red Cross teams are extremely variable on what they allow team members to do. Typically, there is not a provision for Red Cross to deliver medical services of any kind, other than possibly very basic first aid. Victims are triaged and referred out.
Some teams have permitted DCs to treat emergency workers, but this is not a nationally approved service, so if you serve on a Red Cross team and provide chiropractic care, be sure to check what insurance coverage you would have.
At present, the only nationally available, easily accessible emergency teams are MRCs (Medical Reserve Corps). These are local, usually county-based teams that began as a federal mandate after 9/11. All health care providers are allowed to participate at full scope, and a doctor of chiropractic can even organize and start one if there is none immediately available to your community. Some of these provide coverage for responders. Further information can be acquired at www.medicalreservecorps.gov. You can also contact the office of emergency management for your county. They can possibly direct you to other local resources for involvement.
Make Sure You're Prepared
Refresh or learn the appropriate skills. Contact your malpractice carrier to see what liability coverage you have. Contact the team leader ahead of your first visit to get a feel for what types of services they provide, what degree of participation is expected, what types of situations they respond to, and whether they provide any worker's compensation-type coverage in case of injury during service.
The ACA has information on the chiropractic protocol for disaster response and recommended equipment. Remember, field work in austere conditions is very different than the usual chiropractic practice. You will see patients with minimal opportunity to perform more than cursory exams – and likely never see them again. You will also be expected to provide everything you will need for your own work and survival. Even as part of a team, you are expected to be completely self-sufficient.
Go to www.fema.gov and search under Independent Study Programs (ISP). Take the online training covering incident command and emergency team structure. (Courses 100, 200, 700 and 800 are recommended initially.) This will help you understand how teams work and to whom you will answer while serving. All these courses are free. Search through the list and take all courses that interest you. Make sure you print out the certificate of completion at the conclusion of each and keep it on file. Many teams now require this proof of training.
Finally, attend team exercises and meetings. Individually and as a team, you need to be able to respond in an organized fashion to an incident. Training helps in that preparation. Trying to react once an event occurs only increases the confusion of the crisis. Be a team player. That means helping other team members with their duties and looking out for them. No one serves alone, at least not for long.
Even if you never deploy to a disaster site as a responder, there are ways to be involved. You can assist others in packing emergency kits, especially for the elderly or infirm. Your local team may do community service by manning first-aid tents at large public events. You also can cover for another chiropractic physician who responds, or provide care to returning responders.
Disaster response is an excellent way to be involved with public health in your community. Providing that service in company with other health care providers forges bonds and fosters mutual understanding and respect. So join a team. Share the care.
I also invite you to join the chiropractic public health community. If you are already a member of the APHA Chiropractic Health Care section, you know how important the relationship is between public health and chiropractic. If you are not currently a member, consider joining and becoming active in this exciting organization. For further information on participating in the public health effort by joining APHA, go to www.apha.org/about/membership.
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