April 17, 2014 Leave a comment
When a tsunami hit Japan in 2011 and crippled the Fukushima Daiichi nuclear power plant, the American Ambassador called in a team of radiation, health, communications, and nuclear power plant experts to join him in Tokyo to provide Americans visiting or living in Japan with information they needed. The team used a real-time, medical decision model and now recommends that model to emergency managers as they make key decisions during an incident.
Used daily in emergency medicine, medical decision-making provides timely decisions and relies on on-site subject matter experts. Decisions are made based on the best information available at the time, and these decisions are modified the course as new information emerges.
Consider the process for treating cancer. When recommending a treatment plan, doctors look at the likelihood of the treatment’s effectiveness and risk of toxicity on the patient’s overall medical condition. They consider the properties of the tumor (not all of which will be immediately known), and current scientific data. They may consult with other experts as they identify a course of action to avoid tumor growth and dissemination. Then working closely with patients and their families, doctors develop a treatment plan, initiate it in a timely manner, monitor its effectiveness, and modify its course as appropriate.
This approach contrasts to the deliberative, multistep, and more time-consuming decision-making process that waits for a great degree of certainty when more of the outcome is known before making a decision. This deliberative approach can go on in the background and provide advice and guidance.
Like traditional approaches to disaster response, the medical decision model uses experts and committees for consultation and advice, but the medical decision model differs in that those experts are on-site, not “back at headquarters,” and decision makers are empowered to make time-critical decisions based on information, experience, and data from the on-site experts. Those decisions are made refined as new data becomes available.
Using the medical decision model, emergency response officials can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. The decisions they make are appropriately modified as the information changes. Ongoing assessment, consultation, and adaption to the changing conditions and additional information play prominently in this model.
In Japan, the decisions about the health-related consequences of the disaster encompassed more than just the potential risk from the radiation, which dominated the media and public conversation. The team also had to consider risks associated with evacuation and public relocation, the impact on physical and mental health from disruptions to normal life, economic losses, and the ongoing anxiety of living through a widespread physical and economic disaster.
Using the medical decision model requires decision makers to be open and transparent with the public about what is known and unknown and that recommended courses of action may change as they learn more data becomes available. The American ambassador embraced this concept and fostered public trust and credibility as a result.
In emergency response, the medical decision model would use the same lines of command and local control abdicated in the National Response Framework. Given the central role of health and medical issues in all disasters, the model should be considered in effective management of complex, large-scale, and large-consequence incidents.
Learn more about applying the medical decision model to emergency response (paper freely available for a limited time).