To the Editor:
The title of this new, groundbreaking journal, Disaster Medicine and Public Health Preparedness, is profound indeed. In a single phrase, the title simultaneously challenges and promises the successful collaboration of medicine and public health. The outcome measure for successful collaboration here far exceeds “working well together.” It means collaboratively solving problems in disaster preparedness that can result in decreased morbidity and mortality from disasters.
Medical professionals learn in medical schools and teaching hospitals, emergency medical technicians and paramedics learn in a variety of educational settings, and public health professionals learn in schools of public health. They rarely, if ever, learn together; their schools are in different blocks of cities, often miles from each other. When we do not “grow up” and learn together, it is harder to prepare together. Six years after the tragic events of September 11, we know we work better together, but we need to be even better, even faster, and even more together.
This journal’s promise can be realized through the publication of scholarly, evidence-based articles. We aspire to evidence that is generated from randomized, double-blind, control trials, but we realize how hard this kind of research is to conduct during or after disasters. I was recently reminded that clinical and public health experience, even anecdotal, is indeed evidence that should be shared. I am hopeful that experience-based lessons will not be lost. The excuse that there “just isn’t enough evidence” can easily result in not doing anything at all in some areas of preparedness.
The fact that this journal is multidisciplinary in its approach speaks to the need to be better. I am hopeful, as are the journal’s leaders, that submissions come from emergency medical services, medicine, and public health. Having multiple authors from multiple disciplines on single submissions would be even better, exemplifying the power of synergy among them.
Making sure that the knowledge from the pages of this journal gets out to those who are responsible for preparing and responding is as critical as acquiring the knowledge. Disseminating the knowledge is the journal’s responsibility; readers must take it upon themselves to adopt the knowledge and put it into practice.
Does this concept of medicine, emergency medical services, and public health working together have any hope? It has been hard for all of us, but I have been fortunate to have watched it work through the Centers for Disease Control and Prevention’s collaboration with 9 organizations representing emergency medical services, emergency medicine, trauma surgery, and public health: the Terrorism Injuries: Information, Dissemination, and Exchange (TIIDE) project.
The TIIDE–Centers for Disease Control partnership has tackled the issue of preparedness for and response to terrorist bombings with partner organizations including the American Medical Association, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of Emergency Medical Services Physicians, National Association of Emergency Medical Technicians, National Native American Emergency Medical Services Association, and the State and Territorial Injury Prevention Directors Association. Accomplishments include a didactic and interactive curriculum, clinical fact sheets on injuries from bombings, and work on translation of military injury care lessons to the civilian environment. These partners have worked together far more successfully than most would imagine.
The American Medical Association’s leadership as a TIIDE partner was exemplified by its broad outreach. Presidents of 18 organizations, representing medicine, dentistry, nursing, emergency medical services, hospital systems, and public health have signed resolutions of commitment to improve health systems to better respond to terrorism and mass casualty incidents.
The success of this journal and the greater success of medicine and public health in improving our preparedness for disasters represent endeavors that are extraordinarily important to the nation, the public, and to individual citizens who may become patients in the wake of a disaster.
Richard C. Hunt, MD, FACEP
Director, Division of Injury Response, Centers for Disease Control and Prevention Injury Center, Atlanta
