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“Disaster medicine” is still underrated – The Post

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“Disaster medicine” is still underrated – The Post
Written by aquitodovale

Bellinzago Novarese is a small town twenty minutes from Novara, surrounded by wide flat expanses and rice fields, like the whole area. In one of these expanses, next to a sports center, at the end of May the Italian army set up a field hospital, with about a dozen air-conditioned and protected environments, including an analysis laboratory, a radiology laboratory, an operating room and a drug depot. These are the same hospitals that are installed in very different contexts from Bellinzago, such as Iraq (where Italy participates in a military mission) and until recently Afghanistan.

Alessandro Rota / CRIMEDIM

The hospital and the area served to set one of the largest health intervention simulations in Italy. It was organized by CRIMEDIM, a research center of the University of Eastern Piedmont which provides training in a field that is still little known: disaster medicine, which has been talked about for about forty years but which is not actually taught in universities or in hospitals, and which is only recently beginning to gain more attention and recognition.

The exercise was the practical part of a master’s degree in disaster medicine that the university organizes together with the Vrije Universitet of Brussels: it is a highly respected course, in which health professionals from all over the world participate every year (out of 32 enrolled this’ year there were only 4 Italians). During the simulation, which was very realistic, the students were confronted with a disaster scenario they knew nothing about, a road accident involving multiple vehicles, including a truck carrying refugees.

An explosion, a war, or a flood are perhaps the first things you think about when it comes to disasters. We tend to think that a disaster, whether natural or man-made, is something that brings devastation on a relatively large scale, the premise of which is intense and sudden violence, but that is not necessarily the case.

CRIMEDIM experts define a disaster as an extraordinary event that causes on the one hand a considerable and sudden increase in patients to be treated, and on the other hand a reduction or forced change of the resources with which to treat them. It is a definition that broadens the field and that can be applied to many more contexts: the coronavirus pandemic is a perfect example in this sense, and in fact it has brought many people closer to ethical concepts (“choosing” who to treat) that those involved in disaster medicine has known and taught for a long time.

“There is a generalized gap in training in disaster medicine”, says Luca Ragazzoni, scientific coordinator of CRIMEDIM. Ragazzoni is an anesthetist but no longer a clinician and has been involved in training and project development for years, after having had various experiences, for example in Haiti, when there was an earthquake, or in Sierra Leone to help organize the response to the epidemic. of Ebola. “In Italy we are the only ones as an academic center that tries to fill this gap, in Europe there are few of them and we are among the seven worldwide designated as a collaborative center of the World Health Organization”.

“We deal with natural disasters but also with man-made ones, such as the collapse of a bridge, a plane crash or terrorism” continues Ragazzoni. “Our task is to increase the skills of health systems and their ability to adapt, training both the health personnel who are already experienced, as well as postgraduates and university students”.

The center also intervenes in a more targeted manner: Ragazzoni gives an example linked to the war in Ukraine, following which the National Plan for the management of radiological and nuclear emergencies was activated in Italy. “The Piedmont Region called us and asked us to write the plan locally, and now we will implement it by purchasing equipment such as decontamination tents and Geiger-Müller counters, but also by training staff for this specific risk”.

The point is that healthcare personnel are used to working in “peacetime”, that is, ordinary time, dedicating themselves to one patient at a time. Nobody teaches them to adapt the skills they have to an extraordinary situation, in which the load of patients increases all together. “But that’s not all,” adds Ragazzoni. “It is also the environment that surrounds them that can change, working in a tent is a very different thing than doing it in a hospital. And the hospitals themselves change during a disaster, one part can collapse, there can be brownouts. Not to mention the need to establish a chain of command and control of a military type, to which doctors and nurses are not used to ».

Another example is the so-called “maxi emergency triage”, which had to be applied in the most critical phases of the pandemic in Northern Italy. Managing patient acceptance during a disaster is not a standard procedure taught in universities, it involves a series of ethical choices that vary according to the resources and time available. Choices which, moreover, are humanly heavy to make, and that is why it is advisable to share them, to talk about them in a group “also to have a technical opinion that you may not have thought of,” says Ragazzoni.

A moment of the exercise inside the field hospital (Alessandro Rota / Crimedim)

Or, more trivially, before the pandemic many healthcare workers had no idea how to handle personal protective equipment, which is complex to wear and requires a number of ancillary procedures to avoid contamination and infection.

Since the skills that healthcare personnel must have during a disaster can vary widely, preparation also involves a risk assessment, to choose what to prepare for and which specific skills to develop. Ragazzoni gives the example of the Novarese, which is not an earthquake zone and therefore it makes no sense for hospitals to equip themselves to respond to that disaster; however, it is an area with a high concentration of chemical industries and at risk of flooding, therefore the hospitals in the area must focus on these eventualities.

Marta Caviglia, medical anesthetist and researcher at CRIMEDIM, says that there is a very specific aspect that during a disaster an inexperienced person does not imagine having to face: learning how to use radios to communicate. They are critical in many disaster contexts, when there is no field or line clogging, but hospital staff have no reason to use them in times of peace. However, learning how to do it in a short time is not trivial so, among many other things, the students of the master are also taught this.

Another mostly new element for the students – even for the many with a lot of experience behind them – is the chain of command and control that Ragazzoni also mentioned. “People in stressful situations react differently, someone can happen to go haywire and freeze” says Caviglia. «Only in a direct confrontation with a disaster do you realize how you react, you have to learn to understand people and understand yourself in order to know what role to assume within the chain. This is also what the exercises are for, it’s a way to prepare psychologically ».

The people enrolled in the master make up a very heterogeneous group, they tend to be adults and experts and share the desire to improve their training on the issue. Each is interested in disaster medicine for different reasons, but those with whom the Post they agree that this is a very important subject but it is not taught anywhere and at any level.

Nikolaos Markou-Pappas, student of the CRIMEDIM master (Alessandro Rota / Crimedim)

For example, there is Nikolaos Markou-Pappas, an aspiring Greek war surgeon, who graduated in Italy but has not yet chosen the specialist. “If you want to be a war surgeon, you are forced to take general surgery, but it’s a different path, it’s not what I’d like to do,” he says. Markou-Pappas is one of the few relatively young members, he is 30 years old. “I like the path I’m taking here because it also talks about ideas, projects to change the way things are done, but it’s a long process”.

Or there is Cristina Castellano, an Apulian resuscitator who currently works in the hospital, but has had experience abroad with Doctors Without Borders and Emergency. “In my role I feel like a soldier, a cog,” says Castellano, who instead would like to take on a managerial role in missions in places of disasters. «From my position I have no idea how decisions are made, how resources are decided. Nobody teaches you these things ».

#Disaster #medicine #underrated #Post

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