Humans receive skilled care at veterinary school

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With the threat of Hurricane Rita looming, a group at Texas A&M University, along with human resources from state and federal organizations, turned the large animal teaching hospital at the College of Veterinary Medicine and Biomedical Sciences into a human surge hospital, or a medical care facility prepared for a sudden onrush of human patients.

By Friday, Sept. 23, the night before the hurricane made landfall, the surge hospital housed some 650 people, including 278 patients from Houston and Galveston, Texas, and their family members and health care providers. The facility was briefly the largest human hospital in central Texas, said Dr. H. Richard Adams, dean of the veterinary college.

The university received a request Tuesday, Sept. 20, from the Brazos County Health Department and Texas State Health Department to implement a human surge hospital concept that key staff members at the TAMU System Health Science Center and veterinary college happened to already have in the works for overall disaster preparedness. After receiving the request, the university's faculty, staff, and students—all volunteers—emptied the hospital of animals.

Dean Adams recalled the days leading up to Rita. "Up until Friday we were destined to be the target of the hurricane; the eye was supposed to come over us," he said. "We were worried about our own safety and our own animals. So our small animal (practice) went to emergency-only for a couple of days, and we either sent our large animals home if they were ready or we moved them into adjacent facilities."

After the roughly 40 animals that remained were moved to nearby facilities, the hospital was cleaned and disinfected in less than a day and converted into wards with human hospital beds and the medical instrumentation needed to provide human medical care. On Wednesday, Sept. 21, patients began to arrive.

"Some patients were indigent, physically immobile, or paraplegic," said Dr. Garry Adams, professor and associate dean of research in the department of pathobiology at TAMU. "A few were evacuated from their own home where they receive care, while the vast majority were from nursing homes or hospitals." The surge hospital featured a spectrum of medical care, including psychiatric, dementia, burn, and general care wards and two intensive care units. The patients included recovering, badly burned children from Galveston Shriners Hospital, geriatric patients from nursing homes, and physically handicapped children.

Retired Lt. Gen. Paul K. Carlton, MD, who initially supervised the incoming patients' medical care, said, "Many of the people showed up without their nursing staff, without their health care providers, so for a period of almost 36 hours the (veterinary) school was—in essence—the 90 percent solution for this human hospital." Over time, the national Centers for Disease Control and Prevention, Federal Emergency Management Agency, U.S. Public Health Service, U.S. Army, and local human hospital physicians and staff members were on deck to provide aid. Still, more than 200 veterinary college students, staff, and faculty—especially from the Large Animal Clinical Sciences Department—served as volunteer care providers throughout the one-week period.

Dr. Carlton, who earned his rank in the U. S. Air Force, serves as director of homeland security at the TAMU Health Science Center. Roughly four months prior to Rita's arrival, Dr. Carlton teamed with retired Marine Col. Chuck Vrooman, the assistant dean for finance and administration at the TAMU veterinary college, to develop a model for how the large and small animal hospitals could be converted into a human surge hospital in case a natural disaster or bioterrorism caused local and regional hospitals to overflow with patients. The model was still conceptual at the time Rita threatened TAMU but it was already approved by the veterinary college's executive committee and Dean Adams, and authorized for continued development.

Dr. Carlton's facilities counterpart was Dr. Bill Moyer, head of the large animal program, who supervised logistic support for the facilities side of the surge hospital.

Emergency management plays key role  

Incident command system training equipped key leaders at TAMU with the skills needed to plan and implement the human surge hospital, according to Drs. Garry Adams and Bill Moyer. The system is taught in many places, including the National Emergency Research and Rescue Training Center at TAMU. 

Dr. Dee Ellis, deputy director for Animal Health Programs at the Texas Animal Health Commission, serves as incident commander in Texas for animal issues during disasters. He said, "It's valuable that veterinarians understand incident command structure because that's the system that's used at the national, state, and local levels by other first responders, and veterinarians are becoming more and more acknowledged as a part of any first response for a natural disaster because animals play an important role."

According to Dr. Ellis, the incident command system was originally used by firefighters to manage their response to forest fires. It worked so well that the FEMA adopted it for all emergency management. Now, FEMA is part of the Department of Homeland Security, which has written the system into the national response plan, and it's integrated through all levels of private and government responses for any type of disaster.

Dr. Adams said that disaster preparedness and emergency response are an implied part of the Veterinary Workforce Expansion Act of 2005 (S 914) and a strong reason behind its introduction. This legislation would establish a grant program to expand capacity in veterinary schools and increase the number of veterinarians working in public health practice and biomedical research.

"Linked to the workforce expansion act is the concept of having 6,000 veterinarians across the country trained (in incident command system), two in each county," Dr. Adams said.

As past chair of the Strategic Planning Committee for the Association of American Veterinary Colleges, and AAVMC immediate past president, Dr. Bennie I. Osburn is deeply involved in furthering this legislation. Dr. Osburn is dean of the University of California-Davis School of Veterinary Medicine.

"The principal thing we're focusing on is funding to rebuild the veterinary infrastructure for veterinary public practice," Dean Osburn said. "The whole area of public health is of critical importance to us for a number of reasons." Those reasons include veterinarians knowing their role in bioterrorism and agroterrorism response, being prepared to deal with emerging and reemerging diseases—many of them zoonotic, and being familiar with food systems, including foodborne and waterborne diseases.

At the TAMU human surge hospital, veterinarians performed services ranging in nature from public health to nursing under supervision by physicians. By virtue of their training, veterinarians could provide treatment, but state licensing laws are a major deterrent, Dr. Osburn noted. In many parts of the world, he said, veterinarians have been the primary medical care providers in rural communities who have alleviated major suffering from diseases such as leishmaniasis and river blindness.

In the United States, many veterinarians serve as state or county public health officers, and Dean Osburn envisions a major need for more such "community health veterinarians" for rural or urban areas underserved by physicians. Veterinarians are already well trained in public health, and these veterinarians would have the added credentials of a master's in public health or equivalent degree.

According to Dean Osburn, some federal agencies have shown considerable interest in this idea and possibly in building language into the next farm bill. The AAVMC is working with Congress and various agencies on it. Another possibility is that a provision could be added to the Veterinary Workforce Expansion Act.

"This is a time when veterinary medicine can really step forward and demonstrate our service to society because of these major disease threats that are out there such as avian flu and prion diseases," Dean Osburn said. "In addition, we have to be prepared for various types of terrorist activities, so all of this fits together in a new concept of service to society."  

Improving surge hospital concept

The human surge hospital at TAMU could serve as a model for how the veterinary profession can step forward to serve society by providing human medical care during a major disaster. Dean Adams said, "Because this worked so well and the federal agencies here were so pleased with the quality of care that these patients received, this (concept) should be brought to the veterinary community in general as yet another public service, public practice element of veterinary medicine." 

Leaders at TAMU are already looking for ways to improve the concept. For starters, Dean Adams and Dr. Moyer said the surge hospital could enhance interaction between veterinarians and physicians. "In the very worse of circumstances, the model will incorporate one physician surgeon and one veterinary surgeon at each table so that we could expand the surgical capabilities," Dean Adams said. "People are finally starting to become much more aware of the depth and quality of medical skills held by veterinarians."

Dean Adams said some additional ideas included implementing standard operating and risk-management procedures for volunteers if they run into emotional or potential physical health problems, and permanently housing all equipment at the university that would be needed to set up an onsite hospital for 500 to 750 patients.

Veterinarians interested in incident command system training can log on to the Emergency Management Institute section of the FEMA Web site and click on "EMI Independent Study Courses," and then "Our Courses" in the lefthand bar. The agency offers small and large animal training modules in the incident command system. The USDA-APHIS's Veterinary Services also provides incident command system training for veterinarians. For more information, contact the USDA area veterinarian-in-charge of your state.