It’s ironic. I started to write about disasters and radiology residency in the evening last month, only to wake up the next morning with Las Vegas headlines screaming about a disaster with mass casualties, gunshot wounds, and severe injuries to over 500 people from a crazed gunman. Unfortunately, these poor victims needed immediate care. And we, as radiologists were in the trenches. It is only a matter of time before we may encounter a horrible situation such as this.
Perhaps, you are on call at the time. Or maybe, you are the only radiologist in the hospital, covering this affected population. Again, we are not talking about a bus collision with a few victims. No. I’m talking about a real disaster such as this one. Hundreds or perhaps, thousands injured at a time. A dirty bomb. A World Trade Tower like incident. A mass casualty situation. What should you do first? Who would you contact to help? How would you cope? Where would you go? Let’s sort through some general rules and think through these issues together.
Make Sure You Are Safe To Perform Your Duties
It goes without saying. In order for you to perform your duties as a radiologist, first and foremost, you need to make sure that you are safe. Is there an active shooter in the building? Get out. Are you in a place of radioactive fallout? Move further from the epicenter. You cannot do your job unless you are alive and healthy to do so. So, be aware of your surroundings.
OK. So, you feel fairly safe at your post. But, you are not done with maintaining your safety. Be aware of the mass casualty situation. Is it a chemical exposure or radioactive contamination? Perhaps, an airborne illness. Follow the rules to avoid further exposure so that you can provide the most help to the maximum number of victims.
Does Your Department Have Electricity?
This might sound a bit silly. But, unique to radiologists, we rely almost entirely on the ability of the facility to generate electricity. No electricity and no x-rays, MRIs, CTs, and so forth. If there is no power, it is unlikely you are going to be able to help as much as a radiologist. (with the exception of battery powered ultrasounds) Rather, you may be only able to help as a treating clinical physician.
Take The Time To Call For Backup
Next… When hundreds or thousands of victims require acute medical care and you have electricity at your facility, one lone radiologist is unlikely to be able to provide imaging services for everyone. In a mass casualty situation such as this, make sure to call the covering attending radiologist. At least at this point, you can decide together if you will need more coverage to rapidly interpret and/or perform all these studies.
Triage, Triage, Triage
Different from standard operations, you no longer have the luxury of providing any study to just anyone. All the hospital’s imaging resources may be used. So, you are in a position to make sure that the appropriate victims receive the correct studies (the art of triage!).
In fact, the treating physicians are not the experts on imaging. You are. So, you need to monitor appropriateness criteria like a hawk. You want to save the most lives. Only the sickest and most needy patients should receive imaging first. And, of course, they need the correct study.
Read Where Help Is Needed
Perhaps, you are dealing with lots of inhalation injuries. Well then, concentrate on the chest x-rays. Or maybe, tons of gunshot wounds. Read the CT scans. It goes without saying that you should read what is most needed.
Assess What Happened And Create An Action Plan
So, you’ve run through all the initial steps of our disaster protocol recommendations. And, you’ve made it through the disaster scenario. What do you do next?. Well, it’s simple: Assess the disaster situation and create an action plan.
It becomes really important to create a radiology action plan so that if disaster strikes twice, you know the best ways to handle it. In fact, your hospital should have a radiology emergency protocol even prior to the disaster. (Not all hospitals do!) So, now is your opportunity to contribute to or create your own hospital’s disaster committee. Make the plan as efficient and as practical to implement as possible
Disaster Management Summary
No matter how you slice it, as a radiologist and a physician, a disaster scenario can be very difficult. So, you need to follow some of these general rules to make running a disaster protocol as efficient and as safe as possible, for you, the radiologist, and the patient. Be safe, call for back up, triage, and use appropriate resources. Finally, remember it is important to assess the situation and come up with an action plan (hopefully before the incident!). Next time, if it happens, you will be ready as you can be!