During a new session at the Society of Thoracic Surgeons Annual Meeting in Tampa, Fla., in January, 200 participants experienced a simulated mass casualty disaster, with interaction via an audience-response system. “After the introductory remarks, the first speaker showed a video clip of a disaster scene in another country, and while the lights in the room were still dim, we had volunteers stage a disaster that included a fake bomb. We made arrangements in advance with the local fire and police departments to be sure we weren't going to cause any problems,” says Jeffrey P. Gold, MD, who led the session.

The attendees participated in triage by responding via the audience-response system to what they could see happening on large screens that broadcast from cameras on stage. “They diagnosed one patient as having a problem germane to a cardiothoracic surgeon. Then, the scene changed to a hospital emergency department where that same patient was also diagnosed with anthrax. We walked the audience through how they would make that diagnosis. In a disaster, you can't just focus on one type of injury,” says Gold.

The session, entitled, “National Disaster Life Support: The Role for Cardiothoracic Surgeons,” also included presenters from the Department of Homeland Security, the American Medical Association's Center for Disaster Preparedness and Emergency Response, and the University of Texas Southwestern Medical Center in Dallas.

The Effect of 9/11

Like many New York City physicians, Gold, a cardiothoracic surgeon, treated trauma victims on 9/11 and for several days thereafter. The experience had a profound effect on his views of CME and the need to train physicians in disaster management.

“It dawned on me that I could be more knowledgeable in terms of the relationship between thoracic surgery and national disaster preparedness. As a physician you have to understand the triage systems, the possibility of biological contamination, and how it affects you and the rest of the healthcare team and the primary responders,” says Gold, who is currently professor of cardiac and thoracic surgery at Albert Einstein College of Medicine in New York City. In May, he'll join the faculty of the Medical College of Ohio, Toledo, as dean and professor of surgery and public health.

Last summer, Gold attended a retreat sponsored by the AMA and the Centers for Disease Control that focused on the need for a broader-based effort to train primary responders and physicians in mass casualty life support. The retreat prompted him to become certified by the National Disaster Life Support Foundation in basic disaster life support and advanced disaster life support.

While Gold's response to 9/11 was to face the issues head-on, some healthcare practitioners have the opposite reaction. In fact, issues related to stress and safety can lead to denial of the need to prepare for disasters, according to Elizabeth Krajic Kachur, PhD, director, Medical Education Development, New York City, and co-presenter of the session “Disaster Preparedness Training: How to Overcome the Challenges,” at the Alliance for CME Annual Conference, held in January in San Francisco.

“Disaster management is different from other types of training because the healthcare providers themselves are under threat. So, understandably, many would rather not think about that,” says Krajic Kachur. “Yet the reality is that every provider faces the possibility of being pressed into service during a disaster.” To gauge participants' attitudes regarding personal safety and traumatic stress — important aspects of disaster management training — STS used the audience response system.

Both Gold and Krajic Kachur advise medical societies to use the resources already available from well-established organizations when developing disaster management courses (see sidebar). “Also, don't make the first session too long; use it to raise awareness,” says Gold. STS gave attendees a mail-in certificate for a free CD-ROM on disaster preparedness from the AMA. “Many participants want more in-depth sessions in the future and would like to obtain certification themselves, which STS may offer as a joint activity with the NDLSF.”

Disaster Management Resources

These organizations offer training and provide resources for developing disaster management CME programs:

• American Medical Association, www.ama-assn.org
• National Disaster Life Support Foundation, www.ndlsf.org
• Department of Homeland Security, www.dhs.gov
• Alliance for CME, www.acme-assn.org
• New York University School of Medicine, chip.med.nyu.edu