Mobilizing on the back end of a disaster

A Queens College gymnasium served as an evacuation center after Hurricane Sandy.
A Queens College gymnasium served as an evacuation center after Hurricane Sandy.

Shannon Manzi, PharmD, chief pharmacist for the Massachusetts–1 Disaster Medical Assistance Team, directs the Clinical Pharmacogenomics Service at Boston Children’s Hospital and is team leader for Emergency and Combined Services in the hospital’s Department of Pharmacy. With MA-1 DMAT, she has deployed to Louisiana after Hurricane Katrina in 2005 and Hurricane Gustav in 2008 and to Haiti after the 2010 earthquake.

As I watch the Arizona-1 and Texas-3 Disaster Medical Assistance Teams (DMATs) respond to the tornado in Moore, Okla., I know they will serve with great skill and caring. But I wish the Massachusetts-1 DMAT was the team on call this month. Although we’re unlikely to be deployed for this disaster, our hearts are with the people of Moore and all our fellow responders.


Thirteen years ago, I was asked to join the MA-1 DMAT as the pediatric pharmacist. It’s been one of the most grueling and difficult commitments of my life, but I’ve never looked back. I love it.

I have slept for weeks on the ground, not being able to shower or eat anything other than MREs (meals-ready-to-eat)—all while working 18- to 20-hour days. However, I hold no illusions that what we do is heroic. I can go home in two to three weeks to an intact house and family. This is not the case for the people we serve.

When you serve on a medical disaster team, you often are responsible for creating a new, temporary health care infrastructure. Being first on the ground means that there is nothing established before you arrive. Everything from patient care areas to a clean water supply must be built and created from what is available and the small amount of equipment that travels with us.

Creating a disaster field hospital requires years of pre-planning and training. Logistics are paramount: personnel movement, shift rotations, resupply, trash removal, medical waste disposal, food for the patients, medication and oxygen, communications with other responders and many, many other duties.

Gym layout-Hurricane Sandy-cropThis was very evident during our deployment to Queens, N.Y., for superstorm Sandy last October. We had the complex task of integrating dozens of patients with behavioral health needs with a high-acuity nursing-home population in a college gymnasium (turned into a medical shelter). Simply identifying the patients took days, let alone ensuring that they were taking the correct medications and therapies for their conditions. Many were delusional or had signs of advanced dementia and could not provide reliable histories. Effectively and safely caring for all these patients required enormous cooperation between the local hospital supporting the shelter, the college, the force protection entity, the federal and state governments and non-governmental relief organizations such as the Red Cross.

During the Boston Marathon response in April, my disaster training was again put to the test here at home. Along with other members of MA-1 DMAT, I was staffing a medical tent along the route, but I was not at the finish line. When I received the page from the emergency department, I diverted immediately to Boston Children’s Hospital and organized my staff to ensure there was a pharmacist on every team, and that we had enough code carts and medications for every patient we received or might receive. My years of training in mass casualty event management were now being tested. I just never imagined it would be on my home turf.

In any disaster situation, we must be flexible and adapt to the needs of the community. At no time can we become a draw on already scarce resources. This often happens with “self-deployers,” generally good people who may or may not have a medical background and show up to help at the disaster area—with no food, no shelter, no extra fuel, no safety plan. They become liabilities.

We saw this particularly during Hurricane Katrina and after the devastating earthquake in Haiti. Well-meaning health care professionals have become ill and, in some cases, have been physically assaulted and hurt when self-deploying to an area with no plan or disaster training. As I watch the aftermath of the Oklahoma tornado disaster I worry again about the uninvited self-deployers.

Don’t go to a disaster area with no means of self-sustenance. If you desire to help, get trained. Join a reputable response organization that has a plan for food, shelter and security for the responders. In the meantime, send a donation to a trusted organization. In the end, it will do more good.

Ed note: Learn more on our sister blog, Thriving, about how to make a disaster plan of your own.