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Massachusetts Medical Society's Physician Focus

June 2013

Disaster Medicine


  • The bombings at the Boston Marathon again showed that disasters, whether man-made or natural, can happen at any time, with little or no warning, and that the key to responding successfully is preparation.

  • The medical response to the bombings followed from well-developed plans using a “whole community” approach to disaster planning and response.

  • While actions by runners and spectators in Boston helped to save lives, experts have mixed feelings about bystander participation and urge caution.

  • Successful response to disasters also includes lessons learned from prior emergencies, battlefield experience in wars, and sharing information and experiences on an international basis.

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The 2013 Boston Marathon now joins September 11, Hurricane Katrina, the Madrid and London bombings, Superstorm Sandy, and other natural and man-made disasters on a growing list that demonstrates just how critical emergency preparedness is.

The medical community’s reactions to the Marathon bombings, generally hailed as a model example of emergency response, provide the basis for a discussion of preparedness and the specialty of disaster medicine in the June edition of Physician Focus with two emergency physicians who are experts in disaster medicine.

Paul Biddinger, M.D., Chief of the Division of Emergency Preparedness and Medical Director of Emergency Department Operations at Massachusetts General Hospital in Boston, and Mary-Elise Manuell, M.D., Director of the Division of Disaster Medicine and Emergency Management at UMass Memorial Medical Center in Worcester, join host James Kenealy, M.D. in describing the key elements to emergency preparedness and how disaster medicine is practiced.

“Disaster medicine is emergency management applied to the medical setting,” Dr. Biddinger explains.“It includes planning for disasters, mitigation or limiting the effects of the event; responding when called, and recovering from the event.”

“Disasters are when your needs are greater than your resources,” adds Dr. Manuell, “and there are a number of different training avenues we use to prepare, such hands-on exercises and drills. A key part is reaching out to establish inter-agency coordination, to plan together as a community.”

Planning and coordination are paramount, say the physicians, as disaster medicine has moved to a “whole community approach” with all relevant agencies – hospitals, police, fire, emergency medical systems, public health, and public safety - participating in the effort. Exercises, drills, and planning sessions are directed at different types of disasters – weather events like hurricanes, mass casualty events like bombings or shootings, hazardous material exposures, or hospital evacuations.

Yet no one perfect plan exists, and the practice of disaster medicine, usually occurring in an environment of disruption or chaos, demands constant examination and review to make it ever more responsive.

“Practice early, practice often, and learning from previous experiences and others are keys to disaster medicine,” notes Dr. Biddinger, who is also Chair of the Committee on Preparedness for the Massachusetts Medical Society. “We’re trying to figure out what works and what doesn’t with every event that happens. And we’ll change our system once we get the evidence it’s the right thing to do.”

While the actions of bystanders helped to save lives in Boston, both physicians have mixed feelings about citizens responding. “We always practice and preach scene safety,” says Dr. Manuell, who also serves as Director of the Center of Excellence for Emergency Preparedness Education and Training at UMass Medical School in Worcester.

“Human nature propels people to help,” she adds, “but there are a number of potentially dangerous scenarios where people have to realize they are putting themselves in harm’s way if they do respond. But a lot of people will take that risk if they’re able to help.” Dr. Biddinger calls the bystander willingness to help a “laudable instinct,” but urges thoughtfulness and caution, because such actions could lead to more casualties.

Because the when and where and type and intensity of disasters usually defy prediction, the physicians urge everyone to create their own emergency plan and learn techniques, like basic first aid, that can save lives.

“Everyone has something they can do,” says Dr. Biddinger. “The first thing to do is to be prepared at home. The more prepared people are, the less likely they will need help.” Dr. Manuell agrees: “Preparedness really starts at the personal level, and if each person in their community gets better prepared, that will help the community as a whole.”

Watch the above video for much more conversation, including the physicians’ perspectives on the unique aspects of Boston that contributed to a successful response to the Marathon bombings, how medical personnel and civilians can participate on response teams, how battlefield experience in wars and cooperation with other countries has led to improved planning for and response to disasters, and what smaller communities should consider in preparing for emergencies.

MMS/Richard Gulla

U.S. Centers for Disease Control and Prevention Emergency Preparedness and Response

U.S. Federal Emergency Management Agency

Massachusetts Department of Public Health Emergency Preparedness Bureau

Disaster Information Management Resource Center

MA Responds

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"Disaster Medicine" PSA

From left, James Kenealy, M.D.; Mary-Elise Manuell, M.D.; Paul Biddinger, M.D.
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