Shock Trauma has a GO-TEAM (
http://www.umm.edu/shocktrauma/go_team.html) that responds when requested to MCIs that might/do require field surgery.... Remember...at an MCI there should be no ALS outside the treatment area.
Amen. R Adams Cowley is smiling down on us from his heavenly "death lab."
Seriously, though, physician (and RN, PA) response to disasters should be coordinated via a centralized incident command. No one, not even injured patients, benefits from a throng of doctors that self-dispatch to the scene of an incident. If there's anything we learned from the post 9-11 FDNY response, it is the value of integrated communications between emergency responders. DMAT, USAR, and other teams function best when they are integrated into an ordered, tiered mass disaster response. Advanced life support resources are already strapped, and any meaningful physician-type response to a disaster needs to take into account the availability of resources. It wouldn't make much sense, for example, to send every trauma surgeon to the scene of some building collapse while salvagable patients are arriving at the hospital... with no one to operate on them! Incident command systems aren't perfect, but they are designed to take situations like these into account.
I was fortunate enough to work with an emergency physician who witnessed first hand some of the patient care disasters occuring after the Murrah Federal Building was bombed (Oklahoma City.) Even though he "self dispatched" (along with a paramedic student, no less), he credits the regional fire and EMS agencies with much of the success. Ironically, the arrival of healthcare providers at the scene only contributed to prevailing catastrophe. An unfortunate testament to the hazards implicit in a mass, disorganized healthcare provider response occured when a well-meaning LPN was struck on the head by a piece of falling debris. She became an additional casualty and eventually died from a closed head injury. This is an extreme example, to be sure, but it nevertheless echoes the need for communication and an apporpiate delegation of responsibility. Ideally, RNs/MDs/DOs/PAs, and other non field personnel who wish to provide assistance at the scene of an MCI should do so through existing incident command channels. Field medical directors, GO-TEAMS, DMAT teams, and other units are examples of EMS sanctioned MCI response.
-P
