Prime Time Replay:
Dr. Ernesto Pretto
on "disaster medicine"
MsgId: *breakthrough(11)
Date: Wed Dec 4 21:04:37 EST 1996
From: moderator At: 206.80.178.142
Welcome to Breakthrough Medicine. I'm Madeleine Lebwohl, and tonight I'll be speaking with Dr. Ernesto Pretto, associate director of the Safar Center for Resuscitation Research at the University of Pennsylvania. Good evening, Dr. Pretto. Let's start by talking a little about the nature of disaster medicine. Everyone watches ER on T.V. and is somewhat familiar with emergency room medicine; what distinguishes disaster medicine?
MsgId: *breakthrough(13)
Date: Wed Dec 4 21:08:56 EST 1996
From: eap At: 206.151.181.30
Disaster Medicine is a multidisciplinary field which deals with the practice of medicine as applied to the victims of disaster.
MsgId: *breakthrough(14)
Date: Wed Dec 4 21:10:15 EST 1996
From: moderator At: 206.80.178.142
So this is the care that victims of earthquakes, tidal waves, and wars receive?
MsgId: *breakthrough(15)
Date: Wed Dec 4 21:12:38 EST 1996
From: eap At: 206.151.181.30
Yes, that is correct. Ther are many challenges in a disaster environment which require special expertise on the part of the practitioner.
MsgId: *breakthrough(16)
Date: Wed Dec 4 21:13:33 EST 1996
From: moderator At: 206.80.178.142
Let's talk about the first crucial minutes after a disaster. What is essential for survival of victims?
MsgId: *breakthrough(17)
Date: Wed Dec 4 21:16:28 EST 1996
From: eap At: 206.151.181.30
In the first few minutes the most important is to be able to treat life-threatening conditions (usually physical trauma) such as hemorrhage, breathing compromise, crush injury, etc. This must be done promptly and occasionally under austere conditions and under adverse environmental conditions as well.
MsgId: *breakthrough(18)
Date: Wed Dec 4 21:17:37 EST 1996
From: moderator At: 206.80.178.142
Your group, the World Association for Disaster and Emergency Medicine, did extensive analysis of medical conditions in Sarajevo. Could you tell us a little about what you found?
MsgId: *breakthrough(19)
Date: Wed Dec 4 21:21:25 EST 1996
From: eap At: 206.151.181.30
Yes. In May of 1993 I was the first American physician to visit besieged Sarajevo. I found conditions to be extremely bad. First and foremost, there was no safety for health workers. Hospitals were targeted by the aggressors on the mountains. Lack of supplies such as intravenous fluids, oxygen, anesthetics, sterile supplies, etc.
MsgId: *breakthrough(20)
Date: Wed Dec 4 21:22:38 EST 1996
From: moderator At: 206.80.178.142
What recommendation came out of your visit to Sarajevo?
MsgId: *breakthrough(21)
Date: Wed Dec 4 21:28:08 EST 1996
From: eap At: 206.151.181.30
I observed the delivery of emergency medical services both in the prehospital setting and in hospitals. I found that most of the care provided to injured casualites was done by neighbors and relatives. Ambulances were destroyed early on. Therefore, the public was forced to transport and provide first aid. If more people would have been trained in life-saving first aid techniques, many more lives perhaps might have been saved. Also, at the start of the conflict doctors had little knowledge of how to deal with trauma patients.
MsgId: *breakthrough(22)
Date: Wed Dec 4 21:30:14 EST 1996
From: moderator At: 206.80.178.142
Are health care systems ever prepared for what you saw in Sarajevo?
MsgId: *breakthrough(24)
Date: Wed Dec 4 21:34:33 EST 1996
From: eap At: 206.151.181.30
I believe not. However, we need to be more aware of the potential for disaster. Not only human-caused disasters such as in Bosnia, but also sudden-impact disasters such as earthquakes which strike without warning. Steps which need to be taken include; 1) risk analysis (i.e. is my community at risk and if so, to what type of hazard); 2) are there community programs in place to mitigate damage to infrastructure and injuries to humans (i.e. EMS systems, anti-seismic construction, etc); 3) are hospitals and other vital structures well-versed in disaster operations, including doctors who work at these insitutions and 4) what can I (me, the public) do to improve what already exists?
MsgId: *breakthrough(25)
Date: Wed Dec 4 21:35:34 EST 1996
From: moderator At: 206.80.178.142
How do we in the U.S. stack up to those criteria?
MsgId: *breakthrough(26)
Date: Wed Dec 4 21:39:23 EST 1996
From: eap At: 206.151.181.30
Our experience in the U.S varies. First of all it is unlikely that we will experience the type of armed conflict which ocurred in Bosnia. More likely is a major earthquake in a vulnerable region. We have done a good deal of work preparing for and earthquake in California. However, other high risk areas in the U.S. such as the midwest (New Madrid fault), the Northwest (Seattle) and the Charleston, South Carolina areas, all of which are earthquake-prone are not prepared.
MsgId: *breakthrough(27)
Date: Wed Dec 4 21:41:09 EST 1996
From: moderator At: 206.80.178.142
Are there any plans under way to increase the preparedness of these areas?
MsgId: *breakthrough(28)
Date: Wed Dec 4 21:45:31 EST 1996
From: eap At: 206.151.181.30
There are plans underway in the Central US. However, due to budgetary constraints, plans are proceeding at a snail's pace. The National Earthqauke Reduction program has been established by the federal government (FEMA) to improve preparedness in these regions but very little is being done to enhance the level of awareness and training of the general public.
MsgId: *breakthrough(29)
Date: Wed Dec 4 21:46:51 EST 1996
From: moderator At: 206.80.178.142
Lack of funding seems to be a prevalent problem when there's no immediate threat. Just how immediate might the threat of earthquake be?
MsgId: *breakthrough(30)
Date: Wed Dec 4 21:49:38 EST 1996
From: eap At: 206.151.181.30
According to a 1990 article in Science: The risk of a moderate to large earthquake ocurring in the Central US in the next few years is greater than in California. An earthquake there would be much more devastating in the Central US than in California.
MsgId: *breakthrough(31)
Date: Wed Dec 4 21:50:39 EST 1996
From: moderator At: 206.80.178.142
What is the difference in survival if you are in an area with a prepared community, versus an unprepared one, for an earthquake?
MsgId: *breakthrough(32)
Date: Wed Dec 4 21:52:32 EST 1996
From: eap At: 206.151.181.30
That is a good question. That is one of the fundamental things we at the Safar Center, University of Pittsburgh and the World Association for Disaster and Emergency Medicine are trying to investigate. Not only the difference in survival but what works best and at what cost.
MsgId: *breakthrough(33)
Date: Wed Dec 4 21:53:29 EST 1996
From: moderator At: 206.80.178.142
Let's talk about that and some of the other research your center is investigating. You do research into physical survival techniques, in addition to creating policy for disaster survival. What medical research is your group working on?
MsgId: *breakthrough(35)
Date: Wed Dec 4 21:57:02 EST 1996
From: eap At: 206.151.181.30
Our research is interdisiplinary. We have physicians, engineers, social scientists, public health specialists working together. Our research team focuses on the life-saving efforts commonly observed in disasters. We also study the organizatinoal barriers to prompt emergency medical response. We have found that the public is the first and perhaps most important link in the chain of survival in disasters. This link is currently the weakest element.
MsgId: *breakthrough(36)
Date: Wed Dec 4 21:58:35 EST 1996
From: moderator At: 206.80.178.142
Do you see this improving in the near future?
MsgId: *breakthrough(37)
Date: Wed Dec 4 22:01:30 EST 1996
From: eap At: 206.151.181.30
Unfortunately, apathy reigns supreme. Especially in areas which have not suffered major disasters. It is very difficult to justify the types of programs we are advocating even in so-called disaster prone areas (I am referring to the U.S.), because the public (taxpayers) do not perceive the threat.
MsgId: *breakthrough(38)
Date: Wed Dec 4 22:02:53 EST 1996
From: moderator At: 206.80.178.142
You visited Turkey after an earthquake there. Was their level of preparation similar to ours? What did you see?
MsgId: *breakthrough(39)
Date: Wed Dec 4 22:08:28 EST 1996
From: eap At: 206.151.181.30
On March 12, 1992 the eastern sector of Turkey suffered a large-scale disaster. In earthquakes the most important element for preparedness is building design and quality of construction. Buildings in this region of Turkey were of the unreinforced masonry type (also common in many parts of the U.S.). These buildings suffered the greatest damage. Also, in Turkey there was no well-developed emergency medical services as in the US. Therefore, they are not as well-prepared as we are. The experience in Turkey, however, can serve as case-study for an earthquake in the Central U.S.in terms of building type.
MsgId: *breakthrough(40)
Date: Wed Dec 4 22:11:21 EST 1996
From: moderator At: 206.80.178.142
Dr. Pretto, how do you hope disaster medicine develops in the coming years? Do you anticipate increased government support, or increased population pressure on government for better preparedness? What would you hope for?
MsgId: *breakthrough(41)
Date: Wed Dec 4 22:16:10 EST 1996
From: eap At: 206.151.181.30
I hope to see improvements in the way we in this country plan for and respond to disasters. I hope to see improved research methods to help us learn from disasters. More funding for this type of research is needed.
MsgId: *breakthrough(42)
Date: Wed Dec 4 22:18:38 EST 1996
From: moderator At: 206.80.178.142
Dr. Pretto, thank you for speaking with me tonight on Breakthrough Medicine. Your area of research is crucial, and one we hope we can survive if necessary!
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