How do you track the medical care of thousands of people in disasters? My brother, Allen, as chief medical officer of the National Disaster Medical System, spent the last few years trying to answer that, among other challenges. The NDMS works primarily by mustering and deploying medical-response teams made up of medical volunteers pulled from particular regions — a hive-mind rapid response team. When a disaster looms or strikes, the NDMS fires up a mess of pagers to call particular teams together, and they quickly converge on the site, where the NDMS delivers oversight, pop-up triage units and hospitals, and supplies. It’s an organized scramble, and my bro’s job was to make it more organized and effective.
When Allen took the director’s job in January 2008, he’d already seen, as an on-the-ground responder to disasters like Katrina and other hurricanes during the 2000’s, how a lack of patient information can hamper care both during and after the disaster. In Katrina, for instance, the paper-record system was overwhelmed by the 165,000 patients for whom the NDMS tried to coordinate care; many patients went home with no record of their care, so that any following care was often blind to what had happened in the triage tents. Just as gravely, the NDMS coordinators got only slow, scattered, rather disorganized reports on what the biggest problems were, making it harder to send the right people, drugs, and facilities to the right places.
So when Allen became chief medical officer, he quickly oversaw the creation of a real-time electronic-record system. Along with collecting individual patient information that can travel with a patient after care, the system constantly aggregates and analyzes patient data during a disaster, updating the central database every 5 minutes, so the NDMS can adjust its response as the disaster unfolds.
As Allen explains in the interview above, this helped the NDMS quickly adjust its response to the Haiti earthquake. Four hours after the first NDMS teams arrived and started seeing patients, the records showed that children composed a bigger percentage of the patients than anticipated. So even as the NDMS was organizing and equipping its second wave of teams to leave for the island, those teams could go heavier on the people, equipment, and supplies most needed for kids and infants and the problems they were suffering; more Similac, diapers, and child-size splints, for instance. The same sort of real-time record-keeping could prove even more crucial in, say, an infectious-disease outbreak in which the infectious agent was at first hard to identify.
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I’m proud of my brother for doing this, and for his nearly 30 years of government service bringing medicine to people who particularly need it. Allen likes his surfing: Dude once won the over-25 surfing contest at Camp Pendleton, and that’s some surfing. Man can carve. He could have spent the last 20 years doing two or three ER shifts a week, easily matching and perhaps exceeding his government salary, while spending the rest of the time getting tanned and tubed. He could have run ER departments at private hospitals instead of Indian reservations and doubled, tripled, or quadrupled his salary.
But he did otherwise.
He doesn’t regret the missed cash; as he notes in this video, he’s managed to live comfortably on a government salary most private MDs would scoff at, even though he started medical school with little more than a Hobie surfboard, an aging Renault LeCar, and a modest stack of LPs. (This included a Santana record he stole from me, which I’ve yet to get back.)
A few years ago — quite a few — my brother sent me a photo of himself the day he graduated from Navy boot camp. It is, roughly, an earlier version of the photo at left, which was taken a few weeks ago. At the time, looking at the photograph from the insular cocoon of my dorm room, I was horrified that he had joined the Navy (I’m not now), but I liked the photograph. He was ridiculously handsome. I mean, ridiculously handsome. Compared to Allen, Richard Gere looked a dog.
On the back of the photo he had written, “To my brother, whom I will miss as long as we are apart.” I missed him, too — daily, badly.
I still do. But it struck me back then, looking at that photo and thinking about how brothers commonly treat each other as they grow up, that I had been particularly lucky that in the time after our parents split up, Allen, at 13, an age at which most older siblings shoo away their younger ones, had let his 10-year-old brother not just tag along but remain part of his life and circle, even though he spent his time (and thus did I) among kids his age and older. He had every excuse and rationale for leaving me behind to pursue unencumbered a bigger world of opportunity. No one would have questioned his decision. You couldn’t go through life pulling along those who by rights or bad luck or plain chance would trail you; in fact, to push ahead, even if it might leave others behind, was the way of things. It was what most people did.
Likewise, later, Allen could just as well have taken a different path through medicine. He had every excuse and rationale for shunning the public medical system to pursue unencumbered a bigger world of opportunity. No one would have questioned his decision. You couldn’t go through life pulling along those who by rights or bad luck or plain chance would trail you; in fact to push ahead, even if it might leave others behind, was the way of things. It was what most people did; it was what most doctors do.
But he did otherwise.
Allen’s been nominated for a so-called “Sammie,” or Service to America award, a sort of Emmy for public-service performance. I hope he gets it.