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Winter 2010 issue (pdf)

Masters of disaster readiness

Alumni respond at federal, state & local level

Dean, Dolly, Gustave, Ike. Charles R. Bauer, MD ’58, rattles off the names of hurricanes like he’s reminiscing about old pets. But hurricanes aren’t merely a pet project for Dr. Bauer. Preparing health care providers in southeastern Texas for the arrival of natural disasters is a serious and significant part of his professional life.

Local Masterworks

In his daily job as Professor of Surgery & Emergency Medicine and Director of the Center for Public Health Preparedness & Biomedical Research at the University of Texas Health Science Center in San Antonio, Dr. Bauer prepares for a variety of disaster situations, most recently dealing with the H1N1 flu pandemic that claimed its first U.S. death in his state in April 2009.

“At this minute in San Antonio we’re between waves,” Dr. Bauer said of the virus that hospitalized 100,000 and killed 4,000 people in the first six months of its arrival in the United States. “We’re monitoring and working with the local health departments in the process of how to distribute the vaccine and teaching people how to protect themselves from the virus.”

As a Texas Medical Ranger and Commander for the 2009 Operation Lone Star Joint Task Force, Charles R. Bauer, MD ’58, traveled by helicopter to all of the health care sites set up in the Rio Grande Valley, which covers more than 10,500 square miles.
As a Texas Medical Ranger and Commander for the 2009 Operation Lone Star Joint Task Force, Charles R. Bauer, MD ’58, traveled by helicopter to all of the health care sites set up in the Rio Grande Valley, which covers more than 10,500 square miles.

Like most other parts of the country, Dr. Bauer is concerned about the threat of terrorist attacks, random acts of violence and the possibility of mass exposure to hazardous materials. But from a South Texas point of view, Dr. Bauer’s main concern is natural disasters. “We don’t know where or when they’re coming,” he said, “but we know they’re coming.”

Dr. Bauer was the first trauma physician leader for the Southwest Texas Regional Advisory Council (STRAC), an organization that responds to hurricanes affecting Texas as well as neighboring states such as Louisiana and Mississippi. During hurricane Katrina, he coordinated the medical triage of hospital-to-hospital patients arriving at Kelly Air Force Base in Bexar County, Texas. Eight aircraft brought in 320 patients who were transferred to San Antonio area hospitals. In addition, more than 900 general population evacuees requiring shelter were treated in area clinics or emergency departments.

Charles R. Bauer, MD ’58
Charles R. Bauer, MD ’58

In his spare time, Dr. Bauer trains with the Texas State Guard Medical Brigade, also known as the Texas Medical Rangers, a volunteer organization that responds to public health emergencies and disasters at the request of the governor. Each year, the Texas Medical Rangers join forces with the Department of State Health Services on a medical mission to the Rio Grande Valley, a four-county area along the Texas-Mexico border with a population of over 1 million. There they set up temporary medical facilities throughout the area for two weeks to care for thousands of indigents.

The operation teams civilians with military volunteers and trains them for a highly mobile medical response to disasters. Dr. Bauer was commander of the military side of the mission in 2009. They provided dental care, immunizations, school physicals, vision and hearing screening, as well as diabetes and hypertension screening for 12,341 patients.

In 2008, the Rio Grande Valley operation was more than a drill for hurricane readiness. Hurricane Dolly hit that part of the state just before the health care crew arrived. Dr. Bauer assisted with the care of several National Guardsmen requiring medical care and helped coordinate care for local residents. Two months later, Dr. Bauer and the other volunteers were able to apply what they learned from the Rio Grande Valley on the eastern side of the state in response to the powerful hurricane Ike.

Charles R. Bauer, MD ’58Clare Helminiak, MD ’82, MPH ’98

Federal Headmasters

As Dr. Bauer prepares for the unknown in South Texas, Clare Helminiak, MD ’82, MPH ’98, works to predict what local disasters will need backup from the federal government. Dr. Helminiak is the Deputy Director for Medical Surge in the U.S. Office of Preparedness and Emergency Operations (OPEO), a component of the Department of Health and Human Services (HHS). She prepares and provides federal medical resources to communities where medical infrastructures are maxed out due to a disaster.

Reacting on extremely short notice, OPEO activates additional health care workers to state, local, tribal and territorial communities through the National Disaster Medical System – a group of 7,000 civilian doctors, nurses and pharmacists who are recruited and trained to respond to medical emergencies nationwide. Dr. Helminiak also oversees the Hospital Preparedness Program, which provides about $400 million annually to 62 state and territorial grantees to enhance their hospital capabilities.

All disasters are local before they become a national problem, Dr. Helminiak said. Therefore, accessing state and local capabilities, developing a good working relationship with them and understanding where and when some backstopping may be needed is an important responsibility of HHS.

“Because that’s how things really get done,” she said. “It’s at the state, local and regional level, and then as needed the federal government can step in with resources that meet the needs that arise.”
Forging the communication gaps among all levels of government to remove what she refers to as the “stovepipes in preparedness and response” is one of the proactive aspects of Dr. Helminiak’s job.
“The director of public health doesn’t talk to the fire chief who doesn’t talk to the police chief who never talks to the ambulance company who never talks to the primary care doctor who never talks to the hospital CEO,” she said.

Dr. Helminiak provides grant money from the Hospital Preparedness Program to encourage development of health care coalitions that organize the various types of people in a health care community. Members of the coalition perform drills together and get to know each other as well as what their roles and capabilities are to break down the “stovepipes” that bind health care providers.
Additionally, Dr. Helminiak coordinated the HHS H1N1 Flu Task Force, which completed its work in December and has since transitioned to the HHS H1N1 After Action Review, also under her leadership. She is also Chief Medical Officer for the U.S. Public Health Service, providing leadership and coordination of medical professional affairs for the Office of the Surgeon General.

Vivian C. Rush, MD, MPH ’96
Vivian C. Rush, MD, MPH ’96

Masterminds

“It doesn’t have to be ad hoc when a disaster happens,” said Vivian C. Rush, MD, MPH ’96, president of JVR Health Readiness, Inc., a health care consulting and services firm in Salado, Texas, that focuses on managing disasters. The company combines Dr. Rush’s occupational and environmental medicine expertise with professionals in medical logistics, environmental engineering, disaster recovery, emergency response and health care law.

Most hospitals put their effort into day-to-day operations, so there is very little left for disaster preparations, Dr. Rush said.

The Joint Commission recently released new disaster preparedness standards for hospitals as part of their accreditation process. Dr. Rush thinks most hospitals aren’t ready. “I think a lot of hospitals are sort of scratching their heads about how they’re going to meet the standards,” she said.

The biggest step in preparing for the Joint Commission is knowing your deficits, she said. To help hospitals prepare, JVR utilizes a handheld, interactive questionnaire that serves as a pre-inspection to identify the facility’s weaknesses.

“Vulnerabilities are different in different parts of the country,” she said. “The highest priority in disaster preparation will differ for a community that’s near a nuclear facility compared to one that’s in a desert community or another that’s near a factory or another that has terrorist potential.”

Stocking enough medical supplies for a disaster and keeping them fresh can also be a challenge. To cut expenses for storage space, many organizations, hospitals included, are using just-in-time inventory software to order their supplies within days of when they anticipate they will be needed. That’s not the best situation when a disaster occurs, Dr. Rush said. When the need isn’t anticipated, the supplies are unavailable at the most essential time.

JVR proposes an alternative inventory system where governments and hospitals team up to purchase disaster levels of supplies, and the hospital pulls from the disaster stock to fulfill its daily needs. By using the older supplies first, and restocking what was used, the supplies would be ready when a disaster hits.

Coordination between hospitals in a jurisdiction and between jurisdictions is another area Dr. Rush believes can be improved. She proposes the echelon hospital system that the military uses. Echelon 1 hospitals provide first aid/buddy care. Echelon 2 hospitals are designated for acute/emergency care. Hospitals designated Echelon 3 provide definitive care. Some communities may have already used this strategy in a disaster response, but Dr. Rush points out that it all should be planned in advance.

Dr. Rush is also evaluating the protection of first-responders and health care workers during a disaster to make sure conditions are conducive to their attendance at work, not fear for the safety of their family or their own health.

 

History lesson

About Charles R. Bauer, MD ’58
During his 24 years in the Air Force, Dr. Bauer was a flight surgeon at Tinker AFB, Okla.; cared for Vietnam War casualties at Tachikawa Air Base, Japan; and was Commander of the 659th Air Transportable Hospital. He was also stationed at Luke AFB, Glendale, Ariz.; and was the Commander of the Medical Center at Keesler AFB, Biloxi, Miss. He retired from the Air Force as a Colonel in 1982 after which he joined the faculty of the University of Texas Health Science Center, San Antonio (UTHSCSA) , as a general and trauma surgeon and Assistant Dean for Ambulatory and Emergency Services. Dr. Bauer completed a four-year residency in general surgery and an additional year in plastic and reconstructive surgery and thoracic and cardiovascular surgery at University of Florida, Gainesville (1962-67). He is board certified in general surgery, emergency medicine and medical management.

As Chair for the Bexar County Medical Society Emergency Preparedness Committee, Dr. Bauer was instrumental in developing area HazMat Response teams. He was also a member of the Texas Department of Health committee that established the Texas Poison Center Network. The six-center network includes the South Texas Poison Center established at UTHSCSA by Dr. Bauer and serves the poison control needs of more than 5 million people living in 47 counties of South Texas.

On Dec. 9, 2009, Dr. Bauer was honored with the Governor’s One Star Award for his many years of volunteer service in disaster response for the state of Texas.

About Clare Helminiak, MD ’82, MPH ’98
Dr. Helminiak worked in the Indian Health Service (an agency of the U.S. Department of Health and Human Services) for 23 years (from 1983-2006) as a clinician and health care administrator in New Mexico, Alaska, Montana and Arizona. Beginning in 2002, she added international responsibilities by working on Afghanistan health care reconstruction both domestically and on-site abroad. In 2006, Dr. Helminiak transferred to the HHS Office of the Assistant Secretary of Preparedness and Response (ASPR) in Washington, D.C. From 2007-09, she was detailed to the Office of the Vice President as the Medical Advisor for Homeland Security Affairs, returning to ASPR in 2009.

She completed a flexible internship at Michigan State University and is board certified in public health and general preventive medicine.

About Vivian C. Rush, MD, MPH ’96
In addition to her reservist years while in medical school, Dr. Rush was on active duty in primary care with the Air Force for four years, serving in South Korea and Germany. As a civil servant, she was an emergency room physician at Landstuhl Army Regional Medical Center in Germany before returning to the United States to work for the Agency for Toxic Substances and Disease Registry, an agency associated with the Centers for Disease Control and Prevention in Atlanta. Afterward, she worked as an occupational physician for the U.S. Army Center for Health Promotion and Preventative Medicine in Edgewood, MD. Dr. Rush received her medical degree from the New York University School of Medicine, performed an internship at the University of Louisville and is board certified in occupational and environmental medicine.

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