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With the emphasis from disaster experts on the importance of developing a core response team that meets regularly prior to the disaster, the question arises of how to foster collegiality, respect and trust. Dr. McSwain described the need for medical representation in these core response teams:
"Most of the committees that I have been peripherally associated with don’t have any medical planning. It is all mechanical planning; it is the fire department and the disaster FEMA-type people and very little if any planning for the management of patients. As an example, a disaster drill was held here two months ago. The disaster planners for the drill wanted to terminate it at the scene – didn’t want to transport any patients to any hospitals, didn’t want any triage done. And I think some of the medical folks prevailed on them and said we needed to do that. But they sent only one patient to Charity trauma center, and that patient didn’t have any significant injuries. So it was basically a medical waste of time because they didn’t do anything that would stress or test the medical system."
"If injured people are involved, then the medical system has got to be involved in the management of it. Simply to say that we have taken a patient out of a disaster situation – an automobile wreck or a fire or something like that- and stop when the patient is taken out is obviously a lack of understanding on the part of planners because they don’t understand that an injured patient has got to get cared for. And not only get cared for in transport or in the emergency department, but they must be cared for in the operating room, in the ICU and they may stay 3, 4, or 5 weeks in the hospital. That kind of thing has got to be taken into consideration."
"You’ve got to have somebody that’s knowledgeable in disasters. It’s an old thought – old saying – that in a disaster you don’t give somebody a job to do that they don’t do every day. But that’s unfortunately what we do. We assign jobs and responsibility to people who don’t do that on a daily basis, don’t know how to manage it; don’t give them any training to manage it - or we give them the wrong training. The wrong training is on the last disaster and currently in disasters, we plan for biochemical disasters. I’ll ask you the question I asked you a little while ago, but in a slightly different fashion. How many biochemical disasters – that would include bacteria, any kind of contamination – or any kind of gasses - nerve gasses or anything else how many of those have happened as compared to mechanical disasters, suicide, suicide bombers, the roof of the Superdome falling in, bomb blowing up a building and the building falling on a bunch of people? How many of those happen as compared to biochemical disaster?. . . The politicians have spent a whole bunch of money to train people for biochemical disasters because that is the catch phrase. . . They have spent no money in training for mechanical disasters which is going to be by far the most common thing that’s going to happen."
"I think that the next disaster [response] we have should be run by the military. They know more about disaster management than anyone in the world, certainly a lot more than the public health people do because when they manage disasters all the time, they are trained, they are experienced in it. So the military should be taking care of it."