Working in healthcare means regularly dealing with urgent and emergent situations. Decompensating patients or unexpected surgical problems means that healthcare providers are often good at staying calm in the face of an emergency. Many healthcare providers will one day find themselves dealing with the medical consequences of a disaster or act of terrorism. While they are no strangers to emergency situations, providers may lack the preparedness to deal with the more widespread problems associated with disaster and terrorism.
Related: Medical Consequences of Acts of Terrorism and Disaster: A National Perspective
Local, state-wide, and national responses
Response to disasters and terrorism is dependent on the number of patients affected and the severity of the problems associated with the crisis. Local fire departments, hospitals, and EMS teams typically deal with local problems. If the city or town is unable to manage the patient volumes, they can call the state for assistance. A statewide emergency would require the help of State fire and EMS departments, the state health department, National Guard units, and the State Department of Homeland Security.
National emergencies such as hurricanes, large-scale terrorist attacks, and earthquakes may require State and government agencies to work together.
Regional divisions for national crisis intervention
In the case of a national crisis, the nation is divided into regions that work together and share resources. These regions include ten groups:
- Region I: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
- Region II: New Jersey, New York, Puerto Rico, and the Virgin Islands
- Region III: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia
- Region IV: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee
- Region V: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
- Region VI: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
- Region VII: Iowa, Kansas, Missouri, and Nebraska
- Region VIII: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming
- Region IX: Arizona, California, Hawaii, Nevada, American Samoa, Guam, Commonwealth of the Northern Mariana Islands, Republic of the Marshall Islands, and the Federated States of Micronesia
- Region X: Alaska, Idaho, Oregon, and Washington
Crisis standards of care
The most urgent problem facing healthcare providers dealing with disasters is the volume and degree of patient injuries. Because of this, healthcare providers may need to implement crisis standards of care.
Providers often view crisis standards of care as a last resort. Difficult decisions must be made about utilizing resources to benefit the most people. These are only implemented when the needs of the community exceed the system’s ability to care for them. Even when crisis standards of care are implemented, care providers have an obligation to do what is for as many people as they can. The AMA provides guidance on how and when crisis standards of care should be used.
Some of these guidelines include:
- Apply triage protocols fairly and consistently for all patients without regard to socioeconomic status
- Triage teams should consist of providers who have healthcare experience and expertise in emergency medicine
- Care providers should routinely reassess ongoing life-sustaining procedures for all patients
- Provide palliative care for patients when they are no longer receiving life-sustaining treatments
Triage protocols for healthcare providers
In addition, the AMA Journal of Ethics also recommends that providers use the following protocols to triage patients:
- Priority 1: Patients whose lives are in immediate danger and who require immediate treatment. (Red tag)
- Priority 2: Patients whose lives are not in immediate danger and who will require urgent, not immediate, medical care. (Yellow tag)
- Priority 3: Patients with minor injuries who will eventually require treatment. (Green tag)
- No Priority: Patients who are either dead or who have such extensive injuries that providers cannot save them with their limited resources. (Black tag)
Post-emergency medical consequences of disasters
Once there is no more immediate danger, and providers have addressed injuries threatening the life and limb of patients, the care team can move on to less urgent, but still important problems. Beyond traumatic injuries, communities affected by disasters often face problems like:
- Dehydration
- Hunger or starvation
- Exposure to the elements
- Infection
- Inability to access their regular medications
Supply chain problems
Disasters in certain areas of the Nation can impact resources available to people inside and outside of that area. For example, Hurricane Helene disrupted production of intravenous fluids in North Carolina, which has caused a shortage of IV fluids across the United States.
Healthcare providers must be good stewards of resources, especially when there are shortages of life-saving supplies and medications. Nurses and physicians should do their best to find alternative solutions for patients who are in need of limited supplies.
Psychological consequences
Making tough choices about triaging patients, allocating care, and conserving supplies can have severe psychological consequences for healthcare providers. Sadly, AAMC reports that over 80% of physicians deal with at least one distressing patient situation each year. Many of these physicians develop symptoms of depression and PTSD.
Providers who have to step up during a large crisis are at an even higher risk of developing long-term psychological and emotional difficulties.
It is important for healthcare providers to take time for self-care after any kind of distressing patient event. Nurses, physicians, and other members of the healthcare team should lean on each other, use mental health resources, and take breaks when they need them.
