Coordinating the U.S. medical response to disasters

May 15, 2012

As the chief medical officer of the National Disaster Medical System, Dr. H. Allen Dobbs instituted major reforms that have improved care for victims of man-made and natural disasters and afforded better protections for health providers who respond to such emergencies.

When Dobbs took over the national role of coordinating federal and non-federal medical resources into a unified response to meet patient needs during disasters, he realized that valuable information for disaster victims is often lost during evacuations.

In response, he oversaw creation of an electronic system that collects patient data from disaster victims and makes it available to the receiving medical institutions. With this system, disaster victims get a bar-coded identification tag to assist in tracking and an abbreviated electronic medical record containing essential elements of their care.

Records on diagnoses and conditions, stripped of personal identification, are also aggregated and analyzed in real time to make resource decisions and to assess emerging threats and supply needs.

“It gives us a situational awareness over what the patient care requirements are and saves lives in a unique way,” said Dobbs. “It’s important to think about unmet needs or emerging threats to health so you can quickly move the right resources, equipment and supplies to those locations to support life-saving efforts.”


(Sam Kittner/Kittner.com)

The system proved invaluable during the U.S. response to the 2010 earthquake in Haiti. Information was updated every five minutes, giving a current look at the ever-evolving situation and facts about communicable diseases, surgical procedures and patient care. It also was used during Hurricanes Gustav and Ike in 2008, and the 2010 Gulf of Mexico oil spill.

“He designed the system, beta tested it and worked with IT people literally from creation to final product,” said Kevin Yeskey, director of the Office of Preparedness and Emergency Operations. “You can provide good medicine in bad places. Not only does he believe that, he’s done that.”

Dobbs has instituted a number of other important changes.

Realizing the hazards faced by health care professionals, responders are now screened for compatibility with potential environmental hazards in a disaster zone, thereby limiting illness and injury of caregivers. For example, those with a pre-existing medical condition such as asthma might be more affected in an earthquake area with a lot of dust. They may still deploy, Dobbs said, but it’s important that they receive guidance on reducing the risk.

An online program he developed also streamlines the application process for more than 5,000 clinical providers who respond during emergencies and provides a searchable database for finding personnel with needed specialties.

“They now track the training and credentials and can instantly identify teams,” said Tom Sizemore, principal deputy director at the Office of Preparedness and Emergency Operations. “We are now able to put a team on the ground anywhere in the U.S. seeing patients within 24 hours.”

Dr. Clare Helminiak, deputy director for medical surge in the federal Office of Preparedness and Emergency Operations, said the American people expect their government will do everything it can to help citizens during a disaster.

“Allen Dobbs is the person who says, ‘We’re going to meet the expectations of the American people.’ That’s just how our government should work,” she said.

Dobbs instituted the reforms shortly after coming to the National Disaster Medical System in 2008, but he had a long public service career that began with providing medical care to poor and underserved patients on an Indian reservation.

He spent 17 years with the Indian Health Service, at the start caring for members of the Oglala Lakota tribe at Pine Ridge Reservation in South Dakota. In this capacity, he delivered comprehensive care in the emergency department, maintained a full clinic schedule that included delivering babies and assisting with surgeries and subsequently assumed responsibility as the clinical director of the hospital.

Dobbs later was a medical officer, clinical director and chief of emergency medicine at several health facilities in Arizona and New Mexico. During this period, he learned how important it was to gather data in order to get a handle on the enormous health disparity between Native Americans and the rest of the population, and how electronic tracking could help.

“I could see the benefits of health information making a difference in people’s lives and it’s been an ongoing focus of my career,” he said.

His primary goal, he said, has always been helping those most in need, whether it has been impoverished Native Americans or disaster victims.

“To go home at the end of the day knowing you’ve been working hard on a worthwhile mission—that’s important to me,” said Dobbs. “I’ve gained so much out of public service. I’ve really benefited from serving folks who may not have good access to health care.”

This article was jointly prepared by the Partnership for Public Service, a group seeking to enhance the performance of the federal government, and washingtonpost.com. Go to http://washingtonpost.com/wp-srv/politics/fedpage/players/ to read about other federal workers who are making a difference.

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