Barbara Morita is Alameda Health Consortium’s Emergency Preparedness Coordinator. She works with her colleagues at the clinics to prepare disaster plans that can be used in the case of an emergency. Barbara is also a Physician’s Assistant and a member of a federal disaster response team and has hands on experience dealing with extreme emergencies. I sat down with Barbara to discuss some of her experiences working as a first responder at some of our worst disasters in recent history.
Joi Wilson: How did you get started as a first respondent?
Barbara Morita: I’m not a traditional first responder but I am a member of a federal disaster medical assistance team (DMAT). I originally joined the team to understand more about earthquake response. One thing led to another and our first response was to the World Trade Center and then Hurricane Katrina. There is a temperament you need to do disaster response and come out the other end on your feet. We are kind of like M.A.S.H.; we take our medicine very seriously but, to keep our sanity, not much else. We stick together and look out for each other.
JW: Since this is a federal team are you actually paid for your time?
BM: We train as volunteers – all our meetings and finding time to pull our gear together is done as volunteers – but if we are activated to a federally declared disaster we become part of the Public Health Service Corps and are paid as intermittent federal employees in a way very similar to members of the National Guard when they are “called up”.
JW: What are some of the disasters you’ve been dispatched to?
BM: I was first deployed to the World Trade Center and was at Ground Zero for 2 weeks. For Hurricane Katrina I was at the Superdome for about 24 hours (which were the longest 24 hours of my life) and also at the New Orleans airport for handling the medical evacuations. For the State of California deployments (CalMAT), I’ve worked at some large California wild fires where we provide medical care for the firefighters and the inmates helping to control the blazes. We also provided medical care at shelters in the San Diego Wildfires of 2007. With the International Medical Corps I went to Indonesia after the tsunami for a month. And most recently I spent two weeks in Haiti after their massive earthquake.
JW: How do you help our clinics to prepare for an emergency?
BM: I work with the clinics on their plans for responding to disasters by providing training to staff and technical assistance. I work with them on testing their plans through drills to see if they’ll really work. There are generic templates available online for clinic disaster plans and sometimes it can be tempting to just adopt those plans as written. But it is important to remember that those templates are just a starting point; you need to develop a plan that is really workable and specific to your clinic. What you really want to have in a disaster is a one page check list that reminds you of the things not to forget to look at; not the 200 page binder. We have a running joke that in a real disaster the only thing those 200 page binders are good for is as a doorstop.
JW: Are there any lessons that you have learned from your experiences that are transferable to our clinics?
BM: The San Diego Consortia of Community Clinics (SDCCC) put together a report on what their clinics did during the San Diego wild fires of 2007. They ended up seeing a large number of patients who were not their registered patients but rather, people fleeing the fires and smoke who and ended up in their neighborhoods. The pace was so rapid some SDCCC clinics ended up providing free care to all comers. They weren’t able to register them in the usual way or match them to a reimbursement program. Some victims had lost their insurance information or had Kaiser.
The lesson for us - when we have a major earthquake the patients who our clinics will be seeing may not be their regular patients. I hope the clinics will operate under the mission that we are a resource to the community and are needed to take care of anyone who shows up to the door. In a true emergency it doesn’t make sense to focus on eligibility or redirect the Kaiser patients over to Kaiser when the roads are closed and they’re bleeding heavily. The clinics need to be prepared to see whoever shows up at our doors and know that, true, they may not be reimbursed for that visit. But, for those initial hours, providing universal care is the “right thing to do.” By stabilizing the less critical victims we could keep the emergency rooms open for the more severe injuries.
JW: If someone finds themselves in an emergency situation what should they do to survive the situation?
BM: The single most important thing you can do to improve your survival is to work with other people. In your neighborhood, even more important than buying a kit, is to have an arrangement with your neighbors to check on each other. If you do this in isolation and you buy the most expensive kit you can find, if you get pinned underneath a bookcase and no one comes to look for you, you will die. Over and over in Hurricane Katrina I heard people saying “I would have died if my neighbor hadn’t swum over and helped me get out.”
If you’re interested in learning what you should do to prep for an emergency, Barbara recommends her favorite publication for preparing for an earthquake, Putting Down Roots in Earthquake Country. She says, “Its very well written and illustrated. If you Google it choose the Northern California version (there’s Southern California also). It comes in multiple languages.”