Introduction

In the event of a disaster, physicians will be called upon to help provide care. Numerous human-made and natural disasters have highlighted the immense need for medical care of disaster victims. Physicians, however, often do not receive organized training related to disaster response or care of disaster victims. Although training recommendations exist for medical students and resident physicians in some specialties, there is currently no formalized or standardized training for physicians in the United States.[1][2][3][4]

Issues of Concern

Disaster training is required for many positions in law enforcement, government, and the emergency medical services (EMS); however, physician training in disaster medicine and response is currently not standardized or required for any physician training programs in the United States. A review of the current literature revealed several survey-based studies on the topic of disaster preparedness training for medical students and physicians.[5][6][7][8]

Medical Students

In 2003, the Associations of American Medical Colleges (AAMC) and the Centers for Disease Control and Prevention (CDC) released a joint report regarding disaster training recommendations for medical students. The report recommended disaster-related training in mass-casualty incidents and weapons of mass destruction (WMD) such as threats related to chemical, biological, radiological, nuclear, and explosives (CBRNE). Many medical schools, however, still provide little to no formal disaster education. According to a survey in 2010, only 20.7% of medical schools have a required disaster training program for medical students. A review of the literature shows wide variations in the time and type of training medical students receive. Two studies report the total number hours spent on disaster-related instruction ranging from approximately 2.2 hours to 9.3 hours with large variability between schools. The methods commonly used to teach medical students include lectures, table-top exercises, simulation, and full-scale exercises. Some schools offer optional seminars or elective rotations in disaster-related activities. Some schools have utilized simulation training and one school in Texas reports using a large-scale disaster training facility to help train medical students. A medical school in Philadelphia has taken a comprehensive approach, requiring an 8-hour course spread over 2 to 3 weeks consisting of lectures, simulation training, and ending with a disaster exercise during which the first-year medical students act as victims for the hospital’s full-scale disaster exercise.

Resident Physicians

Education of residents in disaster-related topics is also quite variable depending on the specialty and individual training program. While disaster preparedness training is required for emergency medicine and often provided in general surgery residencies, there is no standardized curriculum. Specialties such as family medicine and anesthesiology recommend disaster response training for residents, although it is not required. In emergency medicine residencies, the Accreditation Council for Graduate Medical Education (ACGME) requires residents to have experience in “emergency preparedness and disaster management” and “participation in multi-casualty incident drills.” There are no specific requirements regarding the methods or amount of time spent on these topics. One study evaluated the average number of hours of disaster training for several specialties per year. Emergency medicine residents appear to receive the most training (7.5 hours), followed by general surgery (3.1 hours), internal medicine (1.1 hours), and pediatrics (0.5 hours). Residents in each of these specialties desired significantly more training than they received. A survey of emergency medicine program directors published in 2017 evaluated training in disaster medicine for emergency medicine residents. Of program directors surveyed, 51.6% felt “too little” time was spent on disaster medicine concepts, while only 3.1% felt they currently spend “too much” time on disaster medicine. Reasons cited for not including more disaster topics include “limited time” and “limited resources.” Topics covered at nearly all responding programs included patient triage and decontamination. Lectures and hospital disaster exercises were the most common methods of disaster training for emergency medicine residents. Less commonly used methods were tabletop exercises, rotations, and formal courses such as Basic and Advanced Disaster Life Support. According to a study comparing emergency medicine to general surgery, emergency medicine residents receive significantly more training than general surgery residents in disaster response. Despite the increased training, emergency medicine residents felt only slightly more comfortable with the concepts of disaster response than general surgery residents. Military training, decontamination training, participation in exercises, and being involved in actual disaster response were all associated with higher levels of self-reported comfort in caring for patients in a disaster situation. The existing data suggest the need for increased training in disaster response and preparedness for all resident physicians who may have a role in a disaster or mass casualty incident.

Practicing Physicians

A study published in 2015 surveyed physicians across all specialties and found 61% felt prepared (an answer of “very prepared” or “somewhat prepared”) to handle a natural disaster or an outbreak of airborne infection or major foodborne infection. Only 34%, however, felt prepared to handle a CBRNE incident. Regarding disaster training for physicians, there are many opportunities available but no standardized training programs. A recent study attempted to review the disaster training available to emergency physicians and found a wide variation in opportunities available. Fellowship training in disaster medicine is an option for physicians with a strong interest in disaster medicine. Most other physicians require more of a working knowledge of the basic concepts of disaster preparedness and team-based disaster medical care. The authors of the previously mentioned study found hundreds of disaster preparedness courses available, but few specifically targeted to physicians or healthcare providers who provide care at a disaster incident. Many healthcare-related courses are available online, most for free or a small fee, and several include an online simulation component. Examples of free online courses include those available through the Federal Emergency Management Agency (FEMA). Authors of this study feel that an ideal course for physicians would include clinical and non-clinical disaster preparedness through lectures, scenarios, and virtual simulation. However, this type of comprehensive course for physicians does not currently exist.

Clinical Significance

Training is a vital part of disaster preparedness. Healthcare workers in Boston have credited their effective response to the Boston Marathon bombing to their training and preparedness exercises. Without training and preparation physicians working or volunteering in a disaster situation have the potential to hinder the disaster response or become a victim themselves.[1][9][10]

When disasters occur, physicians will be expected to provide care for disaster victims. More and more medical schools have started providing disaster training for students; however, relatively few schools require any significant training for medical students. Residents receive variable amounts of training based on the program and specialty. Emergency medicine residents appear to receive more training than other residency programs, but the number of hours is minimal, and methods of training vary by program. Practicing physicians have opportunities for training available through organizations such as FEMA or the National Disaster Life Support Foundation and hospitals are required to conduct disaster exercises; however, physicians must seek out these opportunities.

Physicians in all specialties should consider their potential roles in a disaster and attempt to prepare for these roles. Disasters are unpredictable. Preparation is vitally important. Disaster training and exercises can help physicians plan for and successfully respond to the next natural or human-made disaster.