Role of primary care physicians in mass casualty incidents.

Sir,

India got worst affected because of emergencies in the last decade. Past experience in disaster response during Gujarat earthquake 2001(1) and Tsunami 2004(2) reflects that responding to increased demand of health personnel's and their effective deployment at incident site is an essential component in planning disaster response strategy. Depending on the nature of emergency, problems may arise in deploying forces from outside, especially in case of disruption of national transportation system or during floods etc. Following a mass-casualty event, the community and local government can be left “on their own” and may need to rely solely on local resources for at least one to two days and perhaps for as long as ten days.(3) Primary care physicians during these critical times may prove as an invaluable asset to perform triage and provide initial treatment to victims because of their breadth of knowledge and skills. This will even prevent emergency department overload of nearby hospitals resulting in better care of evacuees in critical state.

Further, studies indicate that most survivors of recent disasters (9/11 attack;(4) Istanabul bombings;(5) Hurricane Katrina(6) were either walking wounded with non-severe complaints (eye irritation and inhalational injuries) or were in need of prescription for essential medications especially to prevent exacerbations of chronic illnesses. Primary care physicians can act instrumental during these critical hours by extending care to majority of such patients who do not require hospitalization but need continuation of essential health care services. Besides, it has been reported that non-family physicians face discomfort in providing care for patients outside their speciality, adding to already prevailing chaos.(78)

Education and training of primary physicians in disaster medicine are in their relative infancy in India. Under, Integrated Disease Surveillance project (IDSP) decentralized surveillance and rapid response mechanisms for impending outbreaks are being established. In wake of recent avian flu and swine flu epidemic, medical officers and field health workers were successfully trained for early detection of warning signals of disease and initiation of effective response. Understanding the pivotal role of primary physicians and upgrading their knowledge and skills to effectively utilize community resources during disrupted time will enable public health administrators in India to accomplish dual responsibility of responding to specific health threats and will ensure that essential health services are maintained for the affected communities during emergencies.