| 14 September 2005 Disaster Medicine I'm not Cassandra. I would never get you to believe that. The most obvious reason is that I am cursed with the XY chromosome, and thus share the dogged ability of all men to continue doing the same thing, over and over, expecting to get a different result. But I do share something with the woman of Greek Mythology. You remember Caassandra. The God Apollo wanted to work his way with her, and gave her the divine gift of prophesy. She accepted the present, but being a woman, she reserved the rights to her heart. The god punished her for the crime of failing to love him. He caused his present to become a curse. Everything that Cassandra saw coming down the road was true, but her words were twisted in the ears of her listeners so they sounded like lies. I heard some moron from FEMA on the radio this morning. But I repeat myself. The report described him as a Colonel, which meant to me that he was a National Guard officer, or maybe he got his commission from a mail-in coupon from a Skoal Tobacco tin, or the Kentucky Fried Chicken people. Someone had put him in charge of the field hospital at Louis Armstrong International Airport , which was manned by volunteer health professionals who signed up for the National Disaster Medical System. My head began to spin, because I knew what was going to come next. I flashed back to a Cassandra minute I had in February of 2003, the month before the Department of Homeland Security was established. I had just arrived at Health and Human Services to help out with the Public Health Emergency Preparedness mission. HHS is responsible for a lot of things you would find perfectly reasonable: The Surgeon General, the uniformed Corps of the Public Health Service, the National Institutes of Health and the Center for Disease Control and Prevention. There was much more, of course, some of which you might not have heard of. My favorite one was the National Disaster Medical System. The NDMS is a coalition of 150 assorted health organizations, staffed by Public health Service officers and volunteer physicians and nurses. They respond to all sorts of disasters, from night-club fires to hurricanes. There is a corresponding volunteer organization that cares for the dead, called the Disaster Mortuary Assistance Teams. My sense was that we preferred to help people with the former, rather than the latter. We were busy. HHS had medical teams deployed all over, dealing with outbreaks of fever and caring for burn victims. Imagine my shock when I was told that the NDMS was going to transfer to the new Department of Homeland Security. I felt the Cassandra stirring inside me. “But those guys don't know anything about medicine, or health, for that matter.” A wise old veteran of the Bureau was the operations officer in the unit. He sighed. “That is true,” he said. “But DHS is a black sucking hole that is sucking in everything in Washington that isn't nailed down. They are grabbing the Pharmaceutical Stockpile, too, even if they don't know what to do with it.” “But that ensures that people without experience are going to be directly responsible for providing medical care to large numbers of injured people. DHS and FEMA have never done that before. The infrastructure to support them doesn't exist. They are going to screw up the next disaster, big time.” “Yep,” said the Ops O. If he still smoked he would have ground out a Lucky in an overflowing ashtray on his paper-strewn desk. “But it doesn't matter. The bureaucrats are busy filling out the organization chart and that is what is important.” And so it was. The FEMAcrats down south after Katrina passed were demanding counter-signed forms from the NDMS doctors who responded to the disaster. The medical team was airlifted into the international airport, where the concourses had been transformed hospital wards. The bureaucrats were in Baton Rouge , the state capital, and the Doctors were in New Orleans , doing what they were supposed to do. But there were some issues. FEMA would not fly the donated medical equipment that the doctors tried to bring with them, since they lacked a properly counter-signed task order, and the drugs that were needed were running low. FEMA wanted the requisitions faxed to them in the capital. But the Doctors didn't have a fax machine. Or a working telephone, for that matter. The Colonel on the radio explained that the docs just didn't understand that procedures had to be followed. This was the Federal Government, after all, he said in pompous tones of reverence. He went on to dismiss some of the spectacular stories of incompetence. He explained that even if some physicians had been deployed to the Superdome refugee site without support equipment, and were left in the dark stinking vastness and attacked by thugs, he was in no position to tell if that was true. It is just what the doctors claimed. He hadn't been there himself. I turned off the radio in disgust. Now we have had our disaster, and then the disaster of FEMA's response. I wouldn't blame the Docs if they didn't volunteer again until the system is fixed. But that only means that next time will be even worse. I hate to sound like Cassandra, and wouldn't want my words to get all twisted around. Maybe we can just do things the same way and hope that it turns out different next time. Copyright 2005 Vic Socotra www.vicsocotra.com |