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Tuesday, February 26, 2019

Guidelines on Disaster Service for DCs Provides Useful Information to Volunteers

The American Chiropractic Association’s Policy Quality Review Committee (PQRC) has been performing an extensive review of all ACA policies.  The public-facing policy center on the website is also in the process of being reorganized and will be available soon.  As part of the review, the "Disaster Scene - Primary Care Providers" policy was ratified by the House of Delegates in January and reassigned as the "Guidelines for Disaster Service by Doctors of Chiropractic" (see below). The guideline provides useful information, including basic skills needed, to those who have an interest in volunteer work with emergency preparedness or disaster response teams and proposes a sample plan for how ACA and state associations might work together during a local crisis response.

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Guidelines for Disaster Service by Doctors of Chiropractic

It is the position of the American Chiropractic Association (ACA) that Doctors of Chiropractic should be incorporated into emergency preparedness and disaster response teams on the federal, state and local level. Doctors of Chiropractic are uniquely qualified to serve in emergency situations in various capacities.

Musculoskeletal injuries are the most common injury in emergency workers.  Doctors of Chiropractic are experts in diagnosis and treatment of these types of injuries.  Moreover, their assessment and treatments can be performed in austere environments, on site or at staging areas providing rapid attention to the injury, accelerating healing and often decreasing or substituting the need for pharmaceutical intervention.  This may allow the worker to resume duties more rapidly without the potential physical or mental impairment of pharmaceutical treatment. 

Through their education as primary care physicians, Doctors of Chiropractic have demonstrated competence in first aid and resuscitation skills and are able to assess, diagnose and triage so they may serve as first responders in the immediate care of victims at a disaster site. 

Doctors of Chiropractic demonstrate administrative abilities in documentation, supervision and organization, allowing them to assess, direct and oversee operations, staging or sheltering.

The following are general guidelines and basic skills recommended for Doctors of Chiropractic seeking involvement with emergency preparedness or disaster response teams.  Regardless of the type of service or level of emergency, they reflect competencies on par with those expected of first responders by response teams.  Those seeking team involvement should consult the team commander for specific required skills relative to the team or location.  It is advisable that team interaction and skill acquisition be achieved before an event requiring engagement and response. 

Because of limited resources and security issues, individuals or teams should avoid responding to a disaster site unless approved or requested by authorities in command.  Self-deployment or independent response to an emergency situation, especially from out of the affected area, may pose an extreme risk for the responder, the victims and the community and may burden an already overwhelmed response structure and is discouraged. 

Responders should carry identification denoting their team or organizational affiliation.

Unless otherwise directed, responders should be prepared for complete self-sustenance for 72 hours including all personal needs, appropriate attire, protective equipment, food, water and basic equipment.  They should recognize that shelter, fuel, communication systems, sanitation and utilities may be locally unavailable.

Responders should be familiar with and follow incident command, including access to, positioning in and egress from the affected area. 

Recommended Skills:

  • Rapid assessment of medical and trauma patients
  • Basic vital signs, airway, breathing, circulation, consciousness
  • Documentation according to National Disaster Medical Service standards and protocol
  • Current protocol for stabilization and transportation of the injured
  • Current first aid techniques including, but not limited to, bleeding control, shock, rapid splinting, cold/heat/burn emergencies, poison, seizure, allergy
  • Current resuscitation techniques including, but not limited to, Cardio-Pulmonary Resuscitation (CPR), Foreign Body Airway Obstruction (FBAO) and Automatic External Defibrillation (AED) as per the American Red Cross or American Heart Association protocol for healthcare providers
  • Triage for mass casualties
  • Recognition of, response to and treatment of chemical, biological or radiological exposure
  • Special populations with specific interventions or needs
  • Scene assessment, personal protection, universal precautions, body substance isolation (personal health, safety and security)
  • Common patient emergency care equipment
  • Appropriate attire, personal go-kit
  • Local and national laws and licensure, malpractice and liability issues, behavior and chain of command, interprofessional interaction and confidentiality
  • Types of emergency situations, natural and man-made
  • Opportunities for service by Doctors of Chiropractic relative to team and situation
  • Appropriate chiropractic assessment, treatment and documentation in the field or mass care facility
  • Required personal health status for team members (vaccinations, physical abilities)
  • Sources of further information and training, community involvement and interprofessional opportunities

Furthermore, state chiropractic associations and ACA may initiate action, including, but not limited to:

  • Offering training opportunities relative to this protocol
  • Maintaining a list of doctors of chiropractic trained in this disaster protocol

And in the event of a disaster may act as liaison and communication link between local doctors and other entities according to the following or similar algorithm:

  • Disaster occurs.Local Doctors of Chiropractic respond with appropriate equipment, assist with primary victim care as needed, obtain permission to stage rehabilitation area(s) for disaster workers, assess the situation and contact the state association.
  • Local Doctors of Chiropractic report to the state association on location of rehabilitation areas, what supplies are needed, how much and when additional assistance is needed and how and when the state association can contact them.Local Doctors of Chiropractic also provide specific information useful to incoming doctors.They attempt to maintain a reasonable count of patients, basic documentation and future contacts.
  • The state association contacts its affiliated vendors for supplies and arranges transportation of supplies to the treating Doctors of Chiropractic.The state association communicates pertinent information with the state Doctors of Chiropractic and ACA.The state association assists in scheduling other Doctors of Chiropractic who wish to serve and provides them with directions and necessary information.The state association communicates with treating Doctors of Chiropractic at selected intervals for updates and provides these updates to state Doctors of Chiropractic and ACA.The state association monitors any needs that cannot be met in-state and requests assistance.It also reports any fundraising or donation opportunities (blood, clothing, food, etc.).
  • State doctors of chiropractic and other interested parties contact the state association for guidance in assisting the needs of the local area.They contribute services, equipment and money as needed.If unable to serve at the disaster site, in-state Doctors of Chiropractic may assist in communication, assist in scheduling, organize donations or aid Doctors of Chiropractic affected by the disaster.
  • ACA should contact the state association for guidance on needed assistance.ACA responds to calls or inquiries from non-state members.Ideally, for continuity, an individual person from ACA acts as liaison, answering questions and maintaining contact with the state association.

Reasoning:  the local Doctors of Chiropractic are overwhelmed by the disaster.  The state association can more easily broadcast mass information, receive calls and request supplies from vendors.  They can also coordinate scheduling and direction of other Doctors of Chiropractic to the most needed locations.  The ACA can provide support as needed.

During and after the disaster, the local Doctors of Chiropractic should interface with the state association and ACA to report on execution of action and outcome of the situation, make suggestions for response to future disasters and report any significant contacts made.

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1 comments on article "Guidelines on Disaster Service for DCs Provides Useful Information to Volunteers"

Nathan Cashion

3/14/2019 4:30 PM

As a licensed chiropractor, ACA member, trained wilderness EMT, and former member of neighborhood emergency response teams, I express concern with some of the statements in this guideline.

The chiropractic curriculum does not educate chiropractors as "primary care physicians." We are primary contact or portal of entry providers, but we are not qualified to be the provider who "who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis." (https://en.wikipedia.org/wiki/Primary_care_physician)

Based on my experiences in provider level BLS courses, I can say that we are not competent in first aid and resuscitation skills, as compared to trained first responders.

I agree that chiropractors have unique skills that can be used to provide care to first responders. We also can apply that skill set in unique ways in the field - with the addition of critical training for disaster scenarios.

I would be happy to provide additional information or resources to assist in refining this guideline on disaster service.

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