Keeping documentation up to date—including passports if you’ll be responding overseas—is important. And while Davis strongly advocates for advance registration and credential verification “so you don’t show up someplace with a handful of papers,” she also suggests that “there should be a place where you keep all of your core licensing documents, CPR certification, graduation records from school, those things, so that if you’re in a spot where you need to leave quickly, you can.”
National Issue
There is a touch of irony to the fact that the obstacles to international disaster response often relate to travel and access to remote sites, while within the US the obstacles have more to do with regulatory issues. “That’s the big hiccup, I think, of responding within the US,” says Bollinger, whose vast experience includes working on the MTI team that went to Indonesia in response to the tsunami in 2006. “We have all these laws in place: You must have medical direction, you must have signatures on this, this, and this. And that, I think, is going to become the albatross around our neck in domestic response, particularly for medical personnel.”
The difference? “National scope of practice,” Bollinger says. “The Ministry of Health in most of the countries we respond to, they’re the ones that call the shots.” Within the US, he adds, “We’re looking at significant health system change to make that a reality.”
It’s a reality (however unlikely) that not everyone would want anyway. After observing that most of the countries Bollinger refers to “are about the size of each of our states,” Towers notes that NPs “already have a national scope of practice. The states have set limits on that.” (This may or may not reinforce Bollinger’s point about bureaucracy.) Furthermore, Towers says, “I don’t think that we’re going to be able to create national practice acts. I don’t know that we even want to, for other reasons.”
When asked about national scope of practice, Davis responds, “My joke about that is, ‘I’m a young woman with good health habits, but I’m not going to live that long.’” She provides a brief history lesson for context, citing a 19th-century court case in which “we decided, at the Supreme Court level, that states would regulate health professionals as part of their duty to protect their citizens. People could make a very good case for this being something that the federal government should do, but that’s a big debate.”
On whatever level changes are made, the true test of how well the US has learned the lessons imparted by Hurricane Katrina will come only in the wake of another large-scale disaster—something no one wants to happen. Yet, with two international natural disasters (in Myanmar and China) occurring within a week, and tornadoes inflicting destruction on a smaller but still devastating scale in the US, it seems likely that the nation will eventually have extensive need of emergency responders again. In that case, it seems appropriate to fall back on the traditional Boy Scout maxim, Be prepared.
“If we can raise awareness of how to respond to disasters on the clinician level, I think it makes us a stronger country,” Bollinger says. “If we’re better prepared, we’re better able to respond, and I think a lot of these other issues will kind of go by the wayside. Hopefully.”