After Disasters, PAs Step In To Provide Critical Medical Care

Can Join Nonprofits, DMAT or USPHS to Help

By Jennifer Walker

Several weeks after Hurricane Maria hit Puerto Rico last September, local communities still did not have electricity or running water, and they lacked access to fresh foods, says Agustina Boehringer, MS, PA-C. Boehringer, chief PA with AFC Urgent Care in Massachusetts, went to the island through Heart to Heart International, a humanitarian development and crisis relief organization, to provide medical care for 11 days. Her team traveled with the U.S. Army National Guard from Patillas, a municipality on the southeastern coast, to communities that didn’t have access to health care. They saw many patients who had gastroenteritis because of the lack of running water, or who had chronic issues like diabetes or hypertension.

But the biggest challenge that Boehringer’s team—including a nurse practitioner, two nurses, and a paramedic—faced was communications, which was often nonexistent. When it was critical that they get care for a lymphoma patient, “we couldn’t call for an ambulance or call to check in with the patient’s doctor,” says Boehringer, adding that her team was eventually able to evacuate the patient to a hospital.

“This is very much the nature of disaster medicine. Airports close and airports open, electricity comes and goes, and communications come and go…You have to roll with the punches.”

Maryann Ramos PA C emeritus and Dr Jesus Cruz, hospital dir of San Lucas hospital in Ponce, PR.

PAs Have Expertise and Willingness to Provide Disaster Care

Following natural and man-made disasters, PAs have the medical expertise and the willingness to provide care to affected populations, and their skills were particularly needed last year after hurricanes hit Houston, Florida, and Puerto Rico in succession. PAs can go to a disaster site with a nonprofit, as Boehringer did. Or they can apply to join one of the federal Disaster Medical Assistance Teams (DMATs), the State Medical Assistance Teams (SMATs) or the U.S. Public Health Service.

Practicing disaster medicine with a nonprofit can present some challenges. “PAs have to have a relationship with a physician to practice in every state, so that could be an issue,” says Ann Davis, Vice President of Constituent Organization Outreach & Advocacy at AAPA. A PA’s supervising physician at home may not be willing to be the supervising physician when he or she volunteers at a disaster site in another state, territory, or country. Boehringer was able to go to Puerto Rico because Heart to Heart’s medical director was willing to be her supervising physician.

Still, Davis adds, many states do have a provision that says PAs do not need a supervising physician if they voluntarily help during a disaster. This was the case for Maryann Ramos, MPH, PA-C emeritus, who went to Puerto Rico with a nonprofit last year. Although Ramos, who is the legislative and scholarship chair for PAs for Latino Health, had a fulfilling experience, her group, which included another PA and a nurse, ended up being responsible for finding much of their transportation and, ultimately, their assignment.

This is because inconsistent communications meant the group couldn’t find or reach their contact from the nonprofit after arriving at Isla Grande Airport in San Juan. (They later learned he was reassigned to help evacuate a hospital.) After waiting for three hours, they met a woman from a foundation who told them about a doctor in Ponce, the second largest city in Puerto Rico, who needed help at San Lucas Hospital, where he is medical director. The woman arranged for their transportation to Ponce. At the hospital, Ramos’ team sorted two truckloads of supplies, including water bottles, Clorox bottles, and medications, and visited three schools that were turned into shelters to distribute the water and Clorox to patients.

After two weeks, the nonprofit found transportation for Ramos’ group back to San Juan, but the group was responsible for securing their flight to Florida. They waited at the airport for five hours, until two pilots who had been dropping off water and generators, came by and asked if anyone needed a ride home. “We were never so happy to see someone,” Ramos says.

Base of operations in Caugus, Puerto Rico.

PAs may consider joining federal DMAT to help

PAs who want to have regular, coordinated involvement with disaster medicine might consider joining one of the federal DMATs. (Joining a state team, or a SMAT, is also an option.) DMATs are part of the National Disaster Medical System (NDMS), which also includes trauma and critical care teams and a national veterinary response team. On each team, there are about 36 people, including PAs, nurse practitioners, physicians, registered nurses, paramedics, pharmacists, and logistical, safety, and communications specialists. Each DMAT is on quarterly rotation, meaning that particular team will likely be deployed in the event of a disaster. Deployments can last up to 30 days, and PAs are paid when they are deployed. DMAT members also are protected under USERRA, meaning that employers have to let them go for deployment.

John Brandon, PA-C, who does contract per diem work for three medical facilities in Eugene, Oregon, and has been a member of his state’s DMAT since 2001, had two two-week deployments last year following the hurricanes. When Hurricane Irma hit Florida, Brandon was filling in as a PA on the Hawaii DMAT, which was deployed because they had the September rotation. After waiting in Atlanta for their assignment then driving to Orlando to wait out the storm, Brandon and the team flew to Key West. They set up their medical tents and operation across the street from the Lower Keys Medical Center to absorb some ER patients and reduce the ER patient volume.

Eight days after returning home, Brandon was deployed again as a fill-in PA for the Colorado DMAT to provide support in Puerto Rico. He first went to Miami to care for 20+ dialysis patients who had been evacuated from St. Thomas to Puerto Rico then to Florida. From there, he went to Caguas, a municipality located south of San Juan in Puerto Rico, where his team set up their medical tents and operation next to Hospital HIMA San Pablo Caguas and primarily cared for hospital in-patients.

Being involved with disaster medicine, Brandon says, “is an opportunity to provide direct aid to people in need, and that’s very rewarding. There’s also a personal challenge and exhilaration involved. It’s not a, b, c, like in the clinic every day with primary care.”

USPHS also an option for PAs

PAs may also consider joining the U.S. Public Health Service (USPHS). There, they will have day jobs as clinicians or public health experts working in one of 21 federal agencies. But, at the same time, “we are the government’s responders when we need to bolster health infrastructure in the case of some event that overwhelms it,” says Commander Tim McCreary, a family medicine and psychiatric PA with the Indian Health Service who was deployed to Puerto Rico last October. Generally, disaster assignments with the USPHS involve setting up Federal Medical Stations (FMS) where medical teams care for patients who needed to evacuate hospitals or nursing homes through the course of the crisis.

But McCreary’s deployment to Puerto Rico was unlike the others. As part of the USPHS team, McCreary was based in San Juan IRCT, a command center that “looked like the floor of the New York Stock Exchange,” he says, with its swarms of people from the armed services and government agencies that were also based there. McCreary traveled out to villages by road, if possible, or helicopter, if necessary, to find ill and injured patients in need. The USPHS team he served with then set up FMSs in Ponce and Bayamón, the second most populous city in Puerto Rico. McCreary was one of six PA members with the USPHS team who extended medical care to thousands of Puerto Ricans after the hurricane.

Join the Disaster Medicine Association of PAs

Before taking a disaster assignment, PAs might first consider becoming involved with the Disaster Medicine Association of PAs, one of AAPA’s special interest groups. The SIG was created to help PAs gain basic knowledge in disaster medicine. “There’s a big learning curve,” says Frank Caruso, PA-C, deputy commander of one of the North Carolina DMATs and chairperson of the SIG. “You cannot just want to get involved in providing services unless you belong to an organization, you’re properly trained, and you have the adequate knowledge to go to an area and serve without becoming part of the problem.”

Caruso recommends all PAs learn about disaster medicine by reading the latest news on the CDC and the NDMS websites monthly and by attending free trainings. “There’s basic knowledge that all PAs need to have. Then, in times of need, we can get involved.”

He also recommends that PAs become familiar with the “Stop the Bleed” program—an awareness campaign that encourages bystanders to become trained and equipped to help in a bleeding emergency—and get training in CPR, Advanced Cardiac Life Support, Pediatric Life Support, International Trauma Life Support and possibly Basic and Advanced Disaster Life Support Classes.

Jennifer Walker is a freelance writer in Baltimore, MD. Contact Jennifer at [email protected].