Doctors Without Borders

Beyond the Call profiles efforts of individual providers, agencies and systems to enhance aspects of their EMS delivery and patient care. To suggest programs or efforts for consideration, e-mail nancy.perry@cygnusb2b.com.

     Emergencies can come in any size or shape, and the assets with which you answer them have to be fast and flexible, with a wide range of capabilities and expertise. In Western New York, a novel effort to deploy physicians in the field has grown into a scalable team of diverse volunteers who serve as an emergency-response asset for the entire region.

     The Specialized Medical Assistance Response Team (SMART) is sponsored by the Erie County Department of Health and Erie County Medical Center's Department of Emergency Medicine. It responds not only to disasters and large-scale incidents across Erie County and its region, but, as needed, to daily EMS events and community happenings.

     SMART grew out of a Medical Center program in the 1990s that sent EM residents and fellows into the field to assist at EMS scenes. In 2001, control of the program shifted to the health department, and the mission was expanded to include preparation and response for public health emergencies. The team now fields several dozen active volunteers (among a roster of more than 550) who are on call day to day. They are led by EM residents and EMS fellows from the State University of New York at Buffalo's program at the medical center, and can include not only doctors and nurses and EMS providers, but dentists, veterinarians and mental-health professionals and others. The team can respond with multiple trucks and trailers to treat casualties or dispense medications. The docs bring capabilities to the field that first responders can't, such as chest tubes and surgical airways and the ability to administer higher doses of narcotics. SMART members are also trained in terrorism response, ICS and hazmat.

     Since large-scale emergencies don't happen every day, SMART is also utilized for events such as entrapments, multicasualty crashes and airport calls. It also provides standby at things like festivals, fairs and football games, and conducts public outreach to spread health information. That's not a bad spectrum of work for an organization that, save for a few paid administrative staff, is composed wholly of volunteers.

     "We are a very pliable team," says SMART's medical director, Craig Cooley, MD, MPH, EMT-P, FACEP. "Erie County has over 100 EMS providers, from commercial services to municipal fire departments to rural small-town fire departments, and everybody does things a little differently. We cover the whole county and work with all those different agencies. We've responded with the SWAT team on criminal searches; we've gone into small towns when they've had chemical spills. We're sort of a jack of all trades. It's enabled us to break down some of those silos that have traditionally hindered disaster planning."

     The flexibility comes not only in the range of talents SMART brings to bear, but in how they're used. Team members are all trained in certain fundamentals so that they can assist in situations even where their specific skills aren't needed.

     "If there's no need for veterinary services, yet we have four or five veterinarians who show up for an exercise or deployment, there are other things they can do to keep things going," says Thomas Harvey, bioterrorism and emergency preparedness coordinator for Erie County EMS and SMART's logistics officer.

     Teaching dentists to set up vaccination tents when everyone's teeth are intact is an efficient use of resources, much in the same way as using your high-end physician-led response team for a relatively mundane school bus crash. Such all-hazards strategies are a must when everyone, every year, is seemingly asked to do more with less.

     "That's one of the reasons we've expanded into other areas," Cooley notes. "To make this more cost-effective and useful, instead of just sitting around, waiting for whatever."

     Whatever still happens, though. And that's where a resource like SMART truly pays off.

     In October 2006, a vicious winter storm socked the Buffalo area. Almost two feet of snow fell, and nearly 400,000 people lost power, some for up to 10 days. Many moved into shelters.

     "We activated the membership, and people were deployed to area shelters, where they provided support," Harvey recalls. "There were shelters for special medical needs, where they had people on oxygen and with other issues, and we went out with the supplies to handle whatever was on hand."

     This not only relieved some of the burden on local EMS, it availed the displaced of advanced medical services they might not otherwise have had at a time of crisis.

     For more on the Specialized Medical Assistance Response Team, see www.wnysmart.org.