Although emergency medicine is rarely considered a part of the dermatologist’s scope, both natural and man-made disasters can cause a range of skin conditions including secondary infections from flooding, irritation from blistering agents in chemical warfare, and the effects of cutaneous radiation syndrome. As natural disasters continue to increase in intensity and frequency, the call for clinicians to prepare for the rise in need for emergency clinical care is now more urgent than ever. Prior research has found that up to 88% of dermatologists felt unprepared to respond to biologic disasters in 2003. A recent study conducted by an interdisciplinary team of dermatology and emergency medicine researchers at George Washington University aimed to examine whether the field of dermatology has advanced its disaster preparedness since then.
Published in the Journal of Drugs in Dermatology, their findings implicate that the majority of dermatologists still feels unprepared to respond to biological disasters as a result of a pervasive lack of disaster preparedness training.
“Recognizing and diagnosing the conditions that can arise following a disaster requires diagnostic acumen, knowledge on reporting, and short- and long-term management strategies,” Dr. Adam Friedman, interim chair of the Department of Dermatology at George Washington University and senior author on the study told EurekAlert. Current deficits in this knowledge may have detrimental effects on patient outcomes in the case of natural or synthetic disaster.
Current State of Physician Preparedness
Researchers assessed dermatologists’ preparedness for the treatment of natural, chemical, and nuclear disaster-related conditions, along with their perceptions regarding the appropriateness of such training in dermatology. The team conducted an IRB-approved survey and performed statistical analysis using chi-square tests to evaluate results gathered from 242 participants. Comprised primarily of females (61%), the cohort included practitioners of all ages although the largest responding group was between 25 and 34 years old (45%). The majority of participants were dermatologists beyond residency (68%), while 41% worked in academic practices, 30.4% were employed at group practices, 26.3% were private practice owners, and 2.5% reported other practice settings.
Need for Disaster Preparedness Training
Only 28.9% of the participants surveyed reported having received disaster preparedness training. Of the trained respondents, over 78% said they would be comfortable caring for patients affected by natural events, intentional chemical exposures (52.7%) and natural biological events (50.9%). However, fewer physicians reported being comfortable responding to unintentional chemical exposures (47.3%), intentional biological attacks (34.6%), and nuclear or radiological injuries (16.4%). In addition, even trained respondents said they did not feel adequately prepared to care for patients affected by disasters – especially biological, nuclear, or radiological events.
Of the trained respondents, 41% received training during medical school, 37.5% during residency, and 42.9% after residency while 16.1% additionally reported receiving training through the military. The most common training mediums were lectures/conferences (59.4%), self-directed learning (34.4%), and field-based training (26.6%). Meanwhile, the likelihood of training did not vary by practice type, age, or residency status.
Researchers found that a vast majority of dermatologists thought disaster preparedness should be included in dermatology training (75%), while only 25.3% reported that it should not because they either felt it was not important or that they had other educational priorities. Overall, survey respondents commented that they believed that dermatologists should be well prepared for bioterrorism-related cutaneous diseases – anthrax or small-pox related disease – as well as infections from natural disasters in the current environment.
“While few respondents to the survey were trained in disaster preparedness, it is encouraging that 75% reported that it should be included in dermatology training,” Dr. Friedman told EurekAlert, “It is a necessary tool to advance the field.”
The latest findings emphasize the need for formal disaster preparedness training in the dermatologic community, both for the benefit of patients and physicians. While disaster medicine and emergency management fall within the category of emergency medicine, strategic education and training for professionals of other specialties may prove extremely valuable and requires further investigation.
