Focus on Disaster Medicine and Preparedness

Host: Maurice Pickard, MD Guest: Beth Macy Beth Macy’s Dopesick is a heartbreaking trajectory that illustrates how America’s twenty-plus year struggle with opioid addiction has persisted for this long and has become so firmly entrenched in practically every corner of our country—from desolate cities to once idyllic farm towns. Tune in as Beth Macy joins Dr. Maurice Pickard to illuminate the persistent and often conflicting gaps in the treatment and criminal-justice landscapes while shining a hopeful light on the heroes battling the worst drug epidemic in American history.

Host: Andrew Wilner, MD, Author of "The Locum Life: A Physician's Guide to Locum Tenens" There is still a great deal to learn about the long term effects of blast injuries on military personnel. Emerging evidence suggests that exposure to a blast can produce both overt and subtle neurological consequences in the brain, but much remains unknown. Host Dr. Andrew Wilner is joined by Dr. Jack Tsao, Director of Traumatic Brain Injury Programs for the US Navy Bureau of Medicine and Surgery, and Professor of Neurology at the University of Tennessee Health Science Center. He is a Captain in the United States Navy, and an expert in detection and prevention of traumatic brain injury in active duty military personnel.

Host: Brian P. McDonough, MD, FAAFP In the aftermath of mass violence, from September 11th to the Paris attack to the Orlando shooting, fear and confusion often dominate the public consciousness. Unfortunately, most clinicians are not trained in tactical medicine to respond in times of crisis such as these. But a small subset of survuval medicine experts are working to change this pattern. Dr. Brian McDonough speaks with Dr. Joseph Alton, Fellow of the American College of Surgeons and the American College of OB/GYN, and author of The Survival Medicine Handbook: A Guide for When Help is Not on the Way. The two discuss key survival and disaster response considerations for clinicians caught in violently dangerous situations.

Host: Brian P. McDonough, MD, FAAFP Dr. Brian McDonough welcomes Denise Daniels, Peabody Award-wining broadcast journalist, author, and child development expert who specializes in the social and emotional development of children. Ms. Daniels talks about the challenges in helping children cope with the consistent exposure to tragic news around the world stemming from terrorism, wars, and natural disasters.

Host: Matt Birnholz, MD Dr. Matt Birnholz sits down with Dr. Andrew Bern, an emergency physician and independent health care consultant in South Florida. They discuss the process of forming specialty sections in ACEP, and focus on Dr. Bern's role in the evolving Disaster Medicine subspecialty through his continuing work in Ecuador. Dr. Bern, a former member of ACEP's Board of Directors, is a founding member of the Disaster, Geriatric, Tactical, Telemedicine and Disaster medicine sections at ACEP.

Host: Matt Birnholz, MD Dr. Matt Birnholz sits down with Dr. Carl Schultz, Research Director at the Center for Disaster Medical Sciences at University of California, Irvine. Dr. Schultz is a Professor of Emergency Medicine at the UC Irvine and recipient of the Disaster Medical Science Award at ACEP. He talks about the challenges of securing funding for disaster relief in the field and the integration of citizen volunteers in a disaster incident.

Host: Matt Birnholz, MD Dr. Matt Birnholz welcomes Dr. Clifton Callaway, Professor and Executive Vice Chairman of the Department of Emergency Medicine at the University of Pittsburg School of Medicine. Dr. Callaway received ACEP's Outstanding Contribution to Research Award for his more than two decades of research dedicated to improving brain resuscitation after cardiac arrest. He joins Dr. Birnholz to discuss a research-guided evolution in resuscitation protocols based on improved physiological understandings of secondary brain injuries, comas, and recoveries.

Host: Brian P. McDonough, MD, FAAFP Dr. Brian McDonough welcomes Dr Ken Yeager, Associate Professor of Psychiatry at Ohio State University School of Medicine. Dr. Yeager examines how physicians can help their patients handle the stress of a "24-hour news world" with depictions and images of disasters coming into their homes every day.

Host: Brian P. McDonough, MD, FAAFP Joining Dr. Brian McDonough to discuss clinical approaches to endemic fears and anxieties spread by acts of mass violence and terrorism, both abroad and within the U.S, is Dr. Arthur Caplan, Professor and founding Director of the Division of Medical Ethics in NYU Langone Medical Center’s Department of Population Health.

Guest: George Korch, PhD Host: Bruce Japsen The federal government has acknowledged the United States needs to overhaul its effort to develop better measures to counter pandemic flus and bioterrorist threats. So with nearly $2 billion committed, Dr. George Korch, secretary of preparedness and response at the US Department of Health and Human Services, tells host Bruce Japsen about how this new initiative should improve the system of developing and manufacturing drugs and vaccines to prepare for public health crises.

Guest: Karen DeSalvo, MD Host: Bruce Japsen Five years after Hurricane Katrina, the horrific memories of disaster and devastation remain, but the healthcare system has created a legacy of resilience for the city's safety net and a potential national model beyond the primary care medical home. Dr. Karen DeSalvo, professor of medicine at the Tulane School of Medicine and a leader in the health system's post-Katrina recovery, tells host Bruce Japsen about the new community-based effort that has since been created to improve medical care delivery in New Orleans.

Guest: Edward Mello, Jr Host: Mimi Secor, DNP, FNP-BC, FAANP It takes the entire community working together to effectively respond to a disaster. Trained first responders and medical professionals are key to saving lives. Nurse practitioners and physician assistants play a vital role, but it's crucial that community agencies know your specialties and how you can to be best utilized before a disaster strikes. Nurse practitioner Lt. Colonel Ed Mello joins host Mimi Secor to discuss how advanced practice clinicians can be involved in disaster training and what goes into becoming part of a disaster team.

Guest: Angela Gardner, MD Host: Bruce Japsen As healthcare reforms take place, changes are also in the offing in the emergency department amid demands that EDs be able to turn attention from treatment of routine conditions to disasters and other true emergencies. Dr. Angela Gardner, president of the American College of Emergency Physicians, tells host Bruce Japsen about tomorrow's needs for the emergency department, which will have a greater role as health reform is implemented and patients seek primary care.

Guest: Maureen Lichtveld, MD, MPH Host: Maurice Pickard, MD Long after the clean-up process from the Deepwater Horizon oil spill is complete along the Gulf of Mexico, we'll still be examining the health effects of this catastrophe. While there is a wealth of information on the health effects of specific contaminants, the effects are less known regarding mixtures of contaminants. What are some of the immediate and potential long-term health risks (both mental and physical) of this disaster? Dr. Maureen Lichtveld, professor and chair of the department of environmental health sciences at the Tulane University, School of Public Health and Tropical Medicine in New Orleans, Louisiana, discusses the role of physicians in this type of public health disaster. How are we identifying the populations most at risk of experiencing health effects from the oil spill, and what are some of the most effective risk communication strategies for these populations? What types of surveillance methods are being used? What can we learn from this disaster to be more prepared for the next? Dr. Maurice Pickard hosts.

Guest: Thomas Kirsch, MD, MPH Host: Maurice Pickard, MD Triage isn't the only issue facing healthcare professionals during the acute phase of responding to a disaster: there are also the challenges of limited resources and staffing, as well as the mental and physical preparedness of the medical response team. Dr. Thomas Kirsch, co-director of the Center for Refugee and Disaster Response in the Johns Hopkins Bloomberg School of Public Health, assistant professor and the director of operations for the department of emergency medicine at the Johns Hopkins School of Medicine and deputy director of the Johns Hopkins Office of Critical Event Preparedness and Response, describes his on-the-ground experiences during the first few months after the Haiti earthquake and reflects on the acute phase of the response there. What are some of the lessons learned from Haiti that we can apply to future crises, and what parts of the response were effective? Our guest also discusses the need for ethical training for disaster response teams. Dr. Maurice Pickard hosts.

Guest: Sanjay Gupta, MD Host: Matt Birnholz, MD The role of a physician-journalist reporting from the immediate aftermath of a disaster area is not easily defined, and poses both logistic challenges and ethical questions in caring for patients. Is media coverage of physician involvement in disasters altruistic or self-serving? Our guest Dr. Sanjay Gupta, a practicing neurosurgeon and chief medical correspondent for the Health, Medical & Wellness unit at CNN, was one of the first physician journalists to report from the earthquake in Haiti, and joins us to discuss balancing reporting as a journalist during a disaster and caring for patients. Is journalistic objectivity compromised when broadcast media feature live coverage of physicians treating patients? Hosted by Dr. Matthew Birnholz.

Guest: Matt Baker, PhD, PA-C Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA When disaster strikes, the first instinct of a medical professional is to jump in and help; however, that's not necessarily the best tactic. Dr. Matt Baker, dean of the school of science and health at the University of Philadelphia, joins host Lisa Dandrea Lenell to discuss volunteer options for PAs in the event of a local or national disaster. The two also discuss state licensing issues and educational opportunities for PAs who may want to become first responders.

Guest: Richard Besser, MD Host: Jennifer Shu, MD The Centers for Disease Control and Prevention (CDC) plays a significant role in preparing for and responding to public health emergencies. How has the CDC's emergency response process changed for the better in recent years, particularly as we apply lessons from our response to Hurricane Katrina, and what improvements can still be made? How can we maintain continuity of care among multiple providers during these discombobulating times? Dr. Richard Besser, pediatrician and director of the CDC's Coordinating Office for Terrorism Preparedness and Emergency Response, explores the critical role of doctors on the local level to prepare for emergencies and take action once they occur. Dr. Besser also encourages us to think about personal response and communication plans, as well as stockpiling supply strategies. Dr. Jennifer Shu hosts.

Guest: Richard Besser, MD Host: Jennifer Shu, MD One major goal of the Centers for Disease Control and Prevention (CDC) is to help prepare the public for emerging health threats. What is the status of public health emergency preparedness at the federal, state and local levels? What progress has been made in preparing our country for natural, biological, chemical and other hazards? And in the context of progress, where is there room for improvement? Dr. Richard Besser, pediatrician and director of the CDC's Coordinating Office for Terrorism Preparedness and Emergency Response, addresses these questions and more with host Dr. Jennifer Shu.

Guest: Narayan Nair, MD Host: Maurice Pickard, MD Guest: Robert J. Tosatto, RPh, MPH, MBA Have you thought about joining the Civilian Volunteer Medical Reserve Corps? Captain Robert Tosatto and Dr. Narayan Nair, directors of the Civilian Volunteer Medical Reserve Corps discuss how all medical professional can join local units to improve health literacy. The MRC works to increase disease prevention, eliminate health disparities and improve public health preparedness. They are trained to respond to emergencies and support the health infrastructure of local communities. Join host Dr. Maurice Pickard to learn more.

Guest: Narayan Nair, MD Host: Maurice Pickard, MD Guest: Robert J. Tosatto, RPh, MPH, MBA Organized in 2002, this nationwide network of local, volunteer medical and public health professionals contribute their expertise throughout the year as well as in times of community need. Corps Directors - Captain Robert Tosatto and Dr. Narayan Nair, describe how the program is working.

Guest: Mark Smith, MD Host: Larry Kaskel, MD Dr. Mark Smith, professor and chair of emergency medicine at Georgetown University School of Medicine, and chief of emergency medicine at Washington Hospital Center in Washington, DC, explains to host Dr. Larry Kaskel the positive impact of disaster preparedness guidelines on the day-to-day function of an emergency department. Dr. Smith outlines how the physical facility design and communication system of ER One, the federally-funded project to construct the national prototype for next-generation emergency care, where Dr. Smith is the director, will protect patients from hospital-acquired infections, reduce hospital errors and create an overall safer work environment for care providers.

Guest: Mark Smith, MD Host: Larry Kaskel, MD Intended to be built at the Washington Hospital Center in our nation's capital, ER One is projected to serve as the national prototype for emergency department design, to maximize our risk management capabilities in all scenarios, including large-scale terrorist threats and natural disasters. Host Dr. Larry Kaskel welcomes Dr. Mark Smith, director of ER One and professor and chair of emergency medicine at Georgetown University School of Medicine, to describe key design recommendations for an all-risk ready emergency care facility, which features single-patient care rooms that are negatively pressurized to prevent the spread of infection, with self-decontaminating surfaces, and modular equipment solutions.

Guest: Ralph Shealy, MD Host: John Armstrong, MD No matter where we live and work, we know that disasters will happen in our community. We don’t necessarily know when and in what form, but in the view of Dr. Ralph Shealy, co-director of the Disaster Preparedness and Response Training Network for the South Carolina Area Health Education Consortium, and an internationally recognized expert in disaster medicine, the eventual certainty of these tragedies makes disaster medicine ‘one of the costs of doing business for society.’ In this conversation with host Dr. John Armstrong, Dr. Shealy implores us to remember that when disaster strikes, there is no guarantee that help is coming from Washington and other government resources. With this in mind, how do we keep ourselves prepared and ready to respond when an emergent calamity strikes in our community?

Guest: Ralph Shealy, MD Host: John Armstrong, MD We may one day find ourselves in a disaster scenario that far outstrips our normal capabilities of emergency response. In this circumstance, we may well find ourselves without imaging capabilities or lab results, while also lacking the possibility of consultation or referral. So how can we, as healthcare providers, persevere to create the best possible outcome? Dr. Ralph Shealy, co-director of the Disaster Preparedness and Response Training Network for the South Carolina Area Health Education Consortium, and an internationally recognized expert in disaster medicine, encourages us to get back to the basics of ‘doctoring.' Dr. John Armstrong hosts.

Guest: Ralph Shealy, MD Host: John Armstrong, MD There are many avenues for participation by healthcare professionals in disaster preparedness and larger-scale emergency response, but in a sense, many of us are unsure exactly where our areas of expertise would allow us to make a contribution in preparation for, and in response to, a disaster. Should we just accept that disaster will happen, and begin our preparations from there? If not, how and why should we facilitate broader preparations? Dr. Ralph Shealy, co-director of the Disaster Preparedness and Response Training Network for the South Carolina Area Health Education Consortium, and an internationally recognized expert in disaster medicine, presents a series of interesting considerations about our individual roles in disaster scenarios during this conversation with host Dr. John Armstrong.

Guest: James J. James, MD, DrPH, MHA Host: Bill Rutenberg, MD Where can a physician get disaster life support training, and what does it entail? Joining host Dr. Bill Rutenberg for a lively discussion of this novel concept is Dr. James James. A retired brigadier general, Dr. James is the director of the American Medical Association Center for Public Health Preparedness and Disaster Response. He is also the editor in chief of the journal Disaster Medicine and Public Health Preparedness. You'll learn about a unique series of courses currently available to train physicians and medical personnel how to function as effective healthcare providers and team leaders during times of disaster.

Guest: James J. James, MD, DrPH, MHA Host: Bill Rutenberg, MD The spread of communicable diseases is prevalent following disasters. Joining host Dr. Bill Rutenberg for a conversation of new recommendations for vaccine preparedness to protect disaster survivors is Dr. James James. Dr. James is the director of the American Medical Association Center for Public Health Preparedness and Disaster Response and editor-in-chief of the journal Disaster Medicine and Public Health Preparedness.

Guest: Dave Gruber Host: Susan Dolan, RN, JD How are states addressing preparatory needs for a pandemic influenza outbreak? How does a state's preparedness dovetail with other state and federal efforts? Dave Gruber, senior assistant commissioner for the division of health infrastructure preparedness and emergency response for the state of New Jersey, evaluates key preparedness indicators to measure progress in your state. More specifically, Mr. Gruber looks at state-level movement toward anti-viral stockpiling, in collaboration with national preparedness organizations. Susan Dolan hosts.

Guest: Dave Gruber Host: Susan Dolan, RN, JD It's been almost a century since the outbreak of Spanish flu in 1918, arguably our most significant struggle with pandemic influenza. Dave Gruber, senior assistant commissioner for the division of health infrastructure preparedness and emergency response for the state of New Jersey, briefly chronicles the breadth of our 20th century pandemic encounters, and examines how these events apply to our evolving understanding of the public health consequences. Very simply, what defines a case of pandemic influenza? Mr. Gruber also updates us on the details of a potential vaccine for prospective Avian flu scenarios. Susan Dolan hosts.

Guest: Philip Smith, MD Host: Mark Nolan Hill, MD Guest: Lona Mody, MBBS A major disaster scenario in the United States would likely overwhelm acute care hospitals. Nursing homes present one alternative location for providing care. In the case of a pandemic influenza outbreak, are these care facilities prepared to handle an overflow of patients? From an ethical standpoint, are they obliged to extend their services to the population at large? Dr. Philip Smith, professor and chief of infectious diseases at the University of Nebraska School of Medicine, and Dr. Lona Mody, assistant professor of internal medicine in the division of geriatric medicine at the University of Michigan Medical School, also examine the need for nursing homes to maintain open lines of local and regional communication with other facilities and public health officials. Dr. Mark Nolan Hill hosts.

Guest: Philip Smith, MD Host: Mark Nolan Hill, MD Guest: Lona Mody, MBBS Providing healthcare in an influenza pandemic would likely bring an all-hands-on-deck approach. The staff at nursing homes and other care facilities would be enlisted to supply treatment to their own residents, likely in addition to outside patients requiring immediate assistance. How can nursing home institutions train their care providers for the specific demands of a pandemic flu scenario? What would be the special needs of nursing home residents during this time? For a closer look at these questions and more, host Dr. Mark Nolan Hill welcomes Dr. Philip Smith, professor and chief of infectious diseases at the University of Nebraska School of Medicine, and Dr. Lona Mody, assistant professor of internal medicine in the division of geriatric medicine at the University of Michigan Medical School.

Guest: Mauricio Lynn, MD Host: Shira Johnson, MD Blast injuries present a special set of medical issues. Dr. Mauricio Lynn, director of the Trauma Resuscitation Unit at Ryder Trauma Center at Jackson Memorial Hospital in Miami, discusses the science and medicine behind current strategies for blast injury treatment. From this perspective, Dr. Lynn shares nearly 20 years of military experience in the Israeli Defense Forces Medical Corps with host Dr. Shira Johnson.

Guest: Mauricio Lynn, MD Host: Shira Johnson, MD The threat of explosive device attacks is an everyday reality in Isreal. Dr. Mauricio Lynn, associate professor of surgery at the University of Miami Miller School of Medicine and director of the Trauma Resuscitation Unit at the Ryder Trauma Center at Jackson Memorial Hospital in Miami, served in the Israeli Defenses Forces for 18 years. He talks with host Dr. Shira Johnson about our preparedness for an explosive device attack on US soil. What have we learned from the experiences of Israelis and others?

Guest: Edward Pombier Host: Shira Johnson, MD Dr. Shira Johnson explores with Ed Pombier, director of the University of Miami Radiation Control Center at Jackson Memorial Hospital, the reality and the impact of a possible radiologic attack. Several years after September 11th, what do you really know about the aftermath of a dirty bomb?

Guest: Richard Weisman, PharmD Host: Shira Johnson, MD On March 20, 1995, a group of terrorists launched a chemical attack on the Tokyo Metro, one of the world's busiest commuter transport systems, at the peak of the morning rush hour. The chemical weapon was sarin nerve gas. What do we know about this weapon, its devastating impacts on the body, and how to treat its victims? Dr. Richard Weisman, research associate professor of pediatrics at the University of Miami Miller School of Medicine and coordinator of their Weapons of Mass Destruction Response Program, reviews the critical facts about nerve gas and our current clinical understandings.

Guest: Richard Weisman, PharmD Host: Shira Johnson, MD How would the survivors present after a nerve gas attack and what do you need to know to treat them? Dr. Richard Weisman, research associate professor of pediatrics at the University of Miami Miller School of Medicine and coordinator or the Weapons of Mass Destruction Response Program at the University of Miami Jackson Memorial Medical Center discusses the clinical picture of exposure to nerve gas. Dr. Shira Johnson is the host in this infomative session to teach you about the short and long term clinical effects and practical implications.

Guest: Maureen F. Orr, MS Host: Larry Kaskel, MD Should health professionals be concerned about secondary contamination? How often does it occur and what are the signs that should prompt you to take extra precautions? Maureen Orr, an epidemiologist at the Centers for Disease Control's Agency for Toxic Substances and Disease Registry, talks with host Dr. Larry Kaskel about her published report, "Secondary Contamination of Medical Personnel, Equipment, and Facilities Resulting From Hazardous Materials Events, 2003-2006."

Guest: Derek Robinson, MD Host: Maurice Pickard, MD Emergency room visits nationwide are on the rise, even as the total number of emergency rooms is falling. Add this to the fact that, according to the Center for Disease Control and Prevention's recent publication, National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary, only 15.9 million out of 119 million visits to the emergency room in 2006 were urgent or emergent, and we see just how taxed our emergency rooms are. Dr. Derek Robinson, of the American College of Emergency Physicians, explores solutions to this expensive and inefficient way to provide care. Dr. Maurie Pickard hosts.

Guest: James W. Jones, PsyD, PhD, ThD Host: Leslie P. Lundt, MD Religious terrorism has become commonplace in our lifetime. What causes a person to kill innocent strangers in the name of religion? Our guest Dr. James Jones is uniquely qualified to address this question. Dr. Jones, a professor of religion and adjunct professor of clinical psychology at Rutgers University is an authority on comparative religion and a clinical psychologist. Host Dr. Leslie Lundt welcomes Dr. Jones to discuss how we can help patients struggling with these issues.

Guest: Mitchell Levy, MD Host: Shira Johnson, MD What is the impact of re-education on outcomes in sepsis in an ICU? Host, Dr. Shira Johnson is joined by Dr. Mitchell Levy, professor of medicine at Brown Medical School and Medical Director of the Medical Intensive Care Unit at Rhode Island Hospital, who discusses the "Surviving Sepsis Campaign." Re-education of physicians and nurses in this global study had a remarkable impact on reducing mortality and morbidity. Dr. Levy explains why outcomes were so dramatically affected.

Guest: W. Frank Peacock, MD Host: Shira Johnson, MD Dr. W. Frank Peacock, vice chair in the Department of Emergency Medicine at the Cleveland Clinic Foundation, joins host Dr. Shira Johnson to discuss risk stratification after acute CHF. What does the first BNP really tell you? And what did the ADHERE trial discover about troponin and CHF?