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  • 2018 NEXT: Making the Case for the PT and PTA Role in Disaster and Emergency Responses

    A panel of 4 physical therapists (PTs) with firsthand experience in responding to Hurricane Harvey, the Orlando Pulse mass shooting, the Great White concert fire, and other emergencies agree: PTs and physical therapist assistants (PTAs) have an important role to play in responding to these situations. The problem, they say, is that not everyone fully understands that role—including many PTs and PTAs.

    The panelists shared their perspectives at the APTA NEXT Conference and Exposition in Orlando, Florida, during a session that allowed each to tell their own story and share lessons learned. Though the details and circumstances differed, what emerged was a consensus thatfacilities and programs responding to emergencies often aren't prepared to put PTs and PTAs to best use, leaving therapists little choice but to take the reins wherever they can.

    Jessica West, PT, DPT, was thrust into emergency response when Hurricane Harvey devastated the Houston area in 2017. Just 2 years out of PT school, "I was truly going off my education," she said.

    She felt prepared to help, but unfortunately many in charge of the emergency response weren't prepared for her offer. "It was frustrating—they were relocating people to a conference center designed to hold 5,000 that was now holding 10,000 people," West said. "At the same time they were turning away therapists [who wanted to help]."

    When West was finally able to join providers onsite, she found a host of situations that were suited to responses from a PT—wound care, functional needs, basic screenings, and more. In her particular situation, West found that an obvious role for a PT would be to help temporary shelters better understand how to set up beds and other components in ways that account for the varying mobility needs of those being sheltered. "They should've had someone like me, like you, telling them how to set up a facility," West said.

    Erin Jones, PT, DPT, encountered a different situation when her hospital found itself taking in victims of the Pulse nightclub shooting that took place in Orlando in 2016. Although she didn't have much training in emergency management, she had experience in critical care—and, thankfully, her hospital had just finished a "massive" multifacility drill that tested responses to a campus shooter scenario.

    As did other panelists, Jones stressed the importance of drills of all kinds. "Prepare to know your role," Jones advised, adding that the preparation should include more than just a solid understanding of duties. Providers also need to prepare emotionally, particularly for the sudden, unexpected emergencies such as mass shootings. "These events can be emotionally draining," Jones said.

    As a PT with experience working with the Red Cross in Arizona, Gail Zitterkopf, PT, DPT, felt fairly well-versed in the workings of emergency response efforts. What she wasn't prepared for, after she moved to Texas, was being told when she showed up to join response efforts for Harvey to "go open up the Houston Astrodome" as a temporary shelter.

    Like West, Zitterkopf sees PTs and PTAs as eminently valuable components of an emergency response team. One example: the PT's understanding of the relationship between fatigue, body mechanics, and the potential for injuries. Victims of disaster need to be evaluated for their risk of experiencing further injury due to the impact of fatigue on their mobility, and that could be a crucial role for the PT, she said.

    Zitterkopf also echoed West's opinion that her PT training "well-prepared" her for a role in emergency response efforts. The problem is that the response system itself can be hamstrung by its own logistical inefficiencies—lack of coordination among multiple agencies, technical shortcomings, and provider transportation plans that don't always connect the provider with the closest facility. Then, of course, there are the even-more-basic things: "Often, volunteer registration websites do not provide PT or PTA options among its list of providers," she said.

    Jamie Dyson, PT, DPT, president of the APTA Florida Chapter, added to the discussion by describing his involvement in responding to natural disasters and other emergencies. Over the course of these events—not only responses to Florida hurricanes but also to victims of the Great White concert fire at a Rhode Island nightclub in 2003—Dyson said he has learned that "we have a lot of education that we need to do, both inward and outward."

    The challenge, according the Dyson, isn't just making the case to those in charge of emergency response programs—it's also about informing those within the physical therapy profession that they have a role to play and then getting them to take action.

    "Let's say someone wants to contact PTs to help in response to a disaster. That's great! But who do you call? We are not organized," Dyson said. "If we want to sit at the big table with health care, we have to put our big boy pants on and show what we can do."

    Panelists agreed that a directive adopted by the APTA House of Delegates just a day before their presentation could make a difference. The charge directs the association to work with other organizations and stakeholders to better define the role of PTs and PTAs in disaster relief and recovery, and to promote this role throughout the profession. "There's so much to learn about, and I'm really excited about what APTA will be able to do," West said.

    However, he added, with more disasters in the near future a near certainty, PTs and PTAs shouldn't wait for instructions from the association. "I want to encourage everyone to get out there and try," she said.

    Comments

    • I am a yoga therapist and have done research related to disaster response. I would like to make contact with any of the PTs regarding future research in this area. Thank you.

      Posted by Marilyn Peppers-Citizen on 7/3/2018 4:12 PM

    • As a U.S. military PT, we have a unique environment to be a big part of disaster and emergency management within the military. As I get ready to retire from the Navy, I am very interested in the transition to civilian world in regards to this very topic. I am interested to know if there is already a Special Interest Group within any of your specific state APTA Chapters regarding this topic.

      Posted by Robert Wiederien on 7/5/2018 5:39 PM

    • I agree immensely that we are not utilized as we could be and use our expertise in various situations other than basic healthcare.

      Posted by Kimberly Crone on 7/6/2018 8:33 AM

    • I'm a physical therapist in Colorado. I happen to work in the trauma ICU at a level one hospital and enjoy this area but practioners in every area of PT should be versed in emergency response. School based therapists, hospital based (inpatient and outpatient), private practice and home health therapists may end up in a place where they could be of value. In mass casualty incidents such as hurricane response or shootings, yes. We also should consider small communities where services of all types are limited it isolated and a mass casualty may be a travel bus of 15 people. We need to move this forward!

      Posted by Megan Mitchell -> @OV`<L on 10/27/2018 2:18 PM

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