Volunteer Focus
Thomas Williams, MD, Medical Director of The Pathology Center, on Disaster Preparedness and Response

Thomas Williams, MD, has held a lifelong interest in disaster preparedness and response, which has extended from his teenage years as Cadet Commander of the Lincoln, NE Squadron of the Civil Air Patrol—the official auxillary of the United States Air force—to his current work as Medical Director of The Pathology Center in Omaha, Nebraska, where he plays a vital role in disaster and terrorism preparedness, serving on the committees of the Omaha Metropolitan Medical Response System, Nebraska Bioterrorism Advisory Committee, and Bioterrorism Task Forces of the Nebraska Medical Association and College of American Pathologists.  A member of the Clinical and Laboratory Standards Institute Area Committee on Clinical Chemistry and Toxicology, Dr. Williams became a part of the Working Group on Emergency Response, which formed for the authorship of the 2003 CLSI/NCCLS Report, Planning for Challenges to Clinical Laboratory Operations During a Disaster (X4-R).  

Tell me about change in a laboratory in the event of a disaster.
One thing that needs to be remembered is that laboratories don’t exist in a vacuum. They exist in an environment that includes the facility in which they reside, which is frequently a hospital—and that hospital resides within a community. And, so, in a disaster situation, there will be things that will be imposed upon both the community and the hospital, and the things they are expected to do, are very different. One of the things that I realized in the work I’ve been privileged to do in Omaha, and what we’ve tried to put in X4-R, is that it’s useful for the laboratory to have some knowledge of what would happen in the case of a disaster—in the hospital especially, but also in the community at large.

Why is that awareness of community dynamics on the part of a laboratorian important, when the hospital and the lab are going to be the center of life-saving efforts?
In a disaster situation, there will be many, many changes throughout the community—in community relationships; in what institutions are asked to do; in what laboratories may be asked to do, and other encumbrances imposed by what first responders are asked to do.

What kind of changes?
How they interact, how they communicate, what law enforcement does, what security needs will be imposed upon the facility or will complicate transportation around the community, and so on. I think it’s important to realize that there’s just kind of a global change in space when a disaster happens, and your world changes quite a bit.

How particularly for the laboratory?
For one thing, there are challenges in communications. In most disasters, there are predictable disruptions—if not complete loss—of cell phone, telephone, and fax services. Secondly, possible interruptions in electrical power. I encourage laboratories to understand what having a true electrical power failure really means to them, because so often the emergency power tests that are done do not really test the system. In a true power failure, one can be caught unawares about what they might have to be dealing with. So it’s important to understand these things in advance.

How can the pathologist’s role change?
Well, there will definitely be things that people in laboratories will be asked to do—some of them on the fly, and some of them in advance—so they can respond to some of these challenges.

Can you give me an example?
I happen to know a pathologist in Omaha who was in Oklahoma City when the Murrah Federal Building was bombed, and he wound up in the emergency room taking care of patients, because they needed him to do that—he’d done that in his internship or training, and that’s what he did—so I think that people will do what they need to do. But there are some things you can be trained to do in advance, will help you respond more effectively.

You’ve emphasized the importance of communications. In X4-R, communication itself is discussed as the single most prevalent challenge in large-scale disaster operations. As compared to what, and for what reason?
I think if you look at most disaster assessments—including some I can pull out of my file about New Orleans—you see that, in a number of incidents, the major issues were communications failures—at many levels. There was one quote-up of a New Orleans hospital that (said), "We cannot communicate with our sister hospital across the street."  When you think about it, the laboratory’s product is fundamentally communication. Aside from the fact we deliver some services—blood products and so on—what we’re tasked to do is to take in biological materials and convert those to data, and then refer those interpretational data or quantitative data out to the submitters. And we do that with communication. So, in many ways, it’s potentially worse for us than even for others in delivering our product, depending on who the recipients are and how effective they’re likely to be.

And what happens structurally as communications break down—like a situation in New Orleans where these hospitals were completely running out of resources, and the hospital is just existing to keep people from dying.  At a point, doesn’t the structure dissolve and the laboratory staff, for example, begin to spill over into other duties in the hospital?
Yes, I think, certainly. Some of those duties may be spelled out in the Hospital Emergency Incident Command System (HEICS)—an incident command model that’s been pretty widely disseminated nationwide, and has provided a pretty reproducible command structure for an incident. Hospitals are now being encouraged to adopt an incident command system similar to those that have been used, for example, by fire departments, for years. And there now is a National Incident Management System, or NIMS, that they’re all being trained on—these systems are all supposed to integrate, and what that fundamentally means is there’s a predictable and integratable control structure for everybody who is responding to the incident. And in the HEICS system, there are roles that laboratorians and pathologists would fulfill within various structures within that organization.

How difficult is it to gather the human and monetary resources to train for that, though? Particularly in places unlike New Orleans, where you don’t live with that same kind of sense of imminent threat?
Well, one thing to be emphasized is that vast preparedness for a community or a lab really doesn’t necessarily take a lot of money. It does take some time. There are some suggestions in X4-R about how to prepare for various things—a lot of it is just probably getting out and meeting the people and getting interested and learning about it and assessing your own weaknesses for various disasters in your institution and attempting to institute plans to mitigate them. People always turn out and volunteer when there’s an incident, and that’s a terrific thing to do, but if you didn’t spend the six weeks you needed to be trained to do that effectively now, then you’re not of any good to anybody. So one of the things, I think, to take home from a disaster, is that a volunteer database is very important in surge capacity for any community.

Through that training, what becomes required of those people logistically?
There are job sheets that are given to people who have basic positions, and job sheets that are given to people who have designated positions, and generally there’s an identifier for that position—colored vests, for example.  Basically you get handed a clipboard and get told these are the first five things you do—you go talk to this person, you do this thing next, you do this thing next, you go talk to this person… So there’s not a terrific amount of training required, because one is given a relational system to work in with a variety of designated cooperating personnel and commanders, and one relates to them in a predictable fashion to do these selected things—you know, logistics, or operations, or other things.

What can laboratorians proactively do?
People in a laboratory can be trained in CERT (Community Emergency Response Team), so they can be effective in their communities; there are some things they can do in the medical reserve corps; they can become Red Cross volunteers, learn how to run shelters, and shelter people in situations like this. Some of our folks have been trained on our hospital's decontamination team in the past.  Two of our pathologists received smallpox vaccinations so they can help with community mass vaccinations if that is ever required. 

In the disasters we’ve had over the past four years—in New York, DC, the Gulf Coast—that people from around the country, including, of course, the Midwest, have gone and are continuing to go to those places to volunteer at the site of the disasters. But, have you seen an upsurge of people who have said, "Okay, I want to prepare in case there’s a disaster right here"?
I think we’re seeing that—I know the Medical Reserve Corps in Omaha picked up a lot of additional volunteers and people to be trained. We’ve picked up a couple of additional people here in our own laboratory who would like to be trained as communicators, following a talk I gave (on that topic) recently. I think people are beginning to think more that way, and I think that’s a good thing. But in my experience, what often happens is that there’s a lot of interest for awhile, and then it trails off again. I think this should be a time to get people’s attention, and get them thinking that, yes, it can happen here.

For medical and public health professionals interested in becoming a part of the emergency preparedness infrastructure in their community:  Medical Reserve Corps (MRC).  

For more information on disaster preparedness in your workplace: National Safety Council (NSC).

Anyone interested in taking part in local disaster preparedness and management efforts are encouraged to seek information from their area Police Community Relations program, or the local chapter of such national organizations as the American Red Cross, the Salvation Army, or the United Way.

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