GERM
00:00:09.200 – 00:00:11.360
Bonjour, je m’appel Germ.

WORM
00:00:11.680 – 00:00:12.640
I’m Worm.

GERM
00:00:13.200 – 00:00:34.080
Welcome to episode 91 of the Germ and Worm Travel Health Podcast: Fifteen years on a U.S. Federal Disaster Response Team–An interview with Dr. Chris Sanford. It’s a big planet. See it in good health.

I’m Dr. Paul Pottinger. Yep. You can also call me Germ. I’m a physician specializing in infectious diseases at the University of Washington in Seattle.

WORM
00:00:34.720 – 00:00:41.920
I’m Dr. Christopher Sanford, also a physician at the University of Washington. I’m in the departments of Family Medicine and Global Health.

GERM
00:00:42.960 – 00:03:01.370
Well, welcome to our podcast. To our loyal listeners: As you know, every week, Chris, we have the pleasure of answering questions about travel health and travel wellness from our listeners across the country and around the world. And, and today we’re going to switch it up a little bit because I have one series of questions from me to you, Dr. Chris Sanford.

We’re going to talk about your time on federal disaster response because a lot of our listeners have asked about that role and something that you’ve done as part of your career. We’re going to jump right into that. This will be a really fun conversation. I am looking forward to it.

Before we start, I want to begin, as always, with our medical disclaimer. This podcast is designed to inform, inspire, and entertain. However, you should not use this podcast as clinical care before you travel. Please see a qualified healthcare specialist for recommendations specific to you and to your itinerary.

Now, with that in mind, I’m going to start this fun session with a quick introduction to our listeners because some of our loyal Germ and Worm Nation folks may not know all the details of what you’ve done in the past. We’re going to learn about this today. So here’s what I wanted to say. Dr. Chris Sanford is my co host. You might know him as Worm.

He’s a family medicine specialist who really has a role as a physician, a healer, and a public health doctor. Chris has training beyond his MD he also has training as a physician in tropical medicine and a Master’s of Public health.

He joined a US federal disaster response team called IMCERT back in 2004, and that’s what we’ll talk about.

He’s undergone many deployments on behalf of IMCERT, including the New Orleans airport disaster in 2005 immediately following Hurricane Katrina, Port au Prince, Haiti, after the massive 2010 earthquake. And he’s done a lot of stuff over his career beyond what he’s done with insert. He writes and edits books for both medical and lay audiences.

And he has run a travel clinic here at the University of Washington and helped to establish a course for physicians on tropical medicine in East Africa. He’s also worked in clinics at hospitals in Latin America and Africa.

But he’s told me that some of the most interesting work he’s done is serving on a disaster response team. So that’s what I want to talk to you about today. Chris, tell us in a nutshell, how did you end up on this disaster response team, please.

WORM
00:03:02.890 – 00:04:16.650
Yeah, I joined the University of Washington in 2000, so kind of mid career.

And a few Years later in 2004, I was just reading a campus publication and I saw a little notice that a new disaster response team was being started up and at Harborview Hospital, which is the big county and trauma hospital in Seattle. I thought it would be super interesting to join. It looked like they went to respond to disasters in both the US and abroad.

However, when I called the team, they said they didn’t want me because I’m a family practice doc. And initially all they wanted were surgeons and anesthesiologists and emergency room docs. So that was too bad.

So that was the end of that for a day or two. But then I thought, this sounds super interesting. How can I weasel my way on onto this team?

And then I thought, hey, I’m a travel medicine doc, I run a travel clinic and they’re going to go international. Maybe I can be their travel medicine advisor.

So I went to a meeting or two and I think I took donuts and they invited me to be on the team and that was that. Interestingly, they now of course take physicians of every specialty.

And one of the lessons I learned, which I’ll talk about in a little bit, is that actually primary care is one of the most important parts of disaster response.

GERM
00:04:17.619 – 00:04:48.659
Well, there’s no question about it. And a good lesson that donuts solve all the world’s great political problems, I think that’s amazing.

It’s interesting to me because I think that’s exactly right. Your skill set as a family physician, it means that you touch the lives of people in all different phases of the lifespan.

And it would seem to me that in a complex humanitarian emergency, that’s key. So I want to hear more about that. And tell me what were you doing actually leading up to that particular process?

What was the first disaster that you responded to as part of this group?

WORM
00:04:49.680 – 00:06:47.670
Well, actually the first disaster was many years prior, before I joined the team. And this was the one disaster that I didn’t travel to but the disaster traveled to me, as it were.

So I finished residency way back when, in 1988, Northern California, in San Jose, which is the Stanford program. And a year later, I was living in the Santa Cruz Mountains in a cabin on stilts.

And on a day, 1989, the day of the World Series game, there was a big earthquake, a huge earthquake. So I’m sitting in my cabin and suddenly it started shaking like crazy.

And all the windows blew out and all the bookshelves fell over and part of the chimney collapsed and all the furniture danced to the other side of the room. And then it stopped. And that actually was the last time in my life that I forgot I was a doctor.

So for about 30 minutes I was with my then girlfriend. We just kind of babbled. And of course the phones were out and the electricity was out and my concrete patio was all busted up.

But after about half an hour, there were aftershocks and trees were swaying. After half an hour I thought, wait, I’m a doctor, I should go into town and somebody see if somebody needs help. So we drove into town.

By the time we got there, it was dark and all the chimneys had collapsed. And it was kind of very eerie and calamitous.

But I was working then at an urgent care center and went in, it was only lit by flashlight and basically for three days sewed people up who had been hit by bricks and glass. And it was super interesting. I actually ended up writing an article about it for a medical newspaper. There were helicopters overhead all the time.

After the initial wave that was primarily medical, on about day three, we started seeing all the psychiatric stuff because everybody was sleep deprived and stressed. So we saw more anxiety attacks and things like that. So it was really interesting.

Again, this was 1989, but after that I didn’t really join a team until 15, 16 years later.

GERM
00:06:48.470 – 00:07:04.390
That’s super fascinating. And so fast forwarding until that time that you’re joining this group that you linked to through UW and Harborview. Was the attraction, the pay? Was it the glamor? Was it the academic recognition? What did you think you were going to get out of this?

WORM
00:07:05.530 – 00:07:44.160
Super good question. It was none of those things. There is pay, but it’s minimal. It’s less than regular doctor pay. When you deploy glamour.

I don’t know if I’d call it glamour academic credit. No. It took me away from work and research and writing and all that kind of stuff. I guess I thought it would be interesting.

I guess I thought I would hear good stories. And it sounded very different and also I like going to foreign countries. So I guess it was just the allure of using my skill set in a.

In a timely way. I guess that was it. That was. But no, it wasn’t. Wasn’t the pay or the glamour. It’s kind of a low pay, low glamour situation.

GERM
00:07:45.280 – 00:07:50.960
And so tell us about that, please. Your first deployment with the team in Seattle, where did you go and what did you do?

WORM
00:07:51.440 – 00:08:35.610
Yeah, that was super interesting. So I had only been to two meetings actually, and done a course or two online.

And in late August of 2005, I got a phone call and they said, hey, this is the disaster team. Can you drive a truck?

And I’m like, yeah, I can drive a truck, but I’m a doctor, you know, because there was the big Katrina coming towards New Orleans. And they said, yeah, can you drive a truck? I said, yeah.

So what it was was our cash, all our supplies were designed to be put on a jet, but there was no jet available. So they wanted me to drive a truck to. With all our supplies between Seattle and New Orleans, and those cities are not particularly close.

So I said, sure. But it turned out when they asked more questions, my license had just expired. So they hung up on me and said, you’re staying in Seattle.

GERM
00:08:38.170 – 00:08:41.890
Not a truck driver’s license. You mean your regular civilian driver’s license?

WORM
00:08:41.890 – 00:08:44.330
Yeah, yeah. They didn’t require anything commercial.

GERM
00:08:44.410 – 00:08:45.130
Hilarious.

WORM
00:08:45.690 – 00:15:46.960
And so luckily for me, though, a couple hours later, I got another phone call from an Oregon disaster team within the same network, and they needed a dock and they were going to fly me. I didn’t need to drive, so I said, sure.

So within a few hours, I flew to Houston and then we drove in convoy to New Orleans, the site of Hurricane Katrina. So when I got to the airport, and this again is late August 2005, we were all sleep deprived.

And Paul, you’ve seen me present on this with photos, I saw the most amazing thing I’ve seen in my life. We get to the airport and there’s maybe 500 people on the floor, most of them from nursing homes and retirement places and hospitals.

Almost all of the hospitals in New Orleans had flooded. 23 out of 26 hospitals were flooded or were otherwise incapacitated by flooding.

Plus all the nursing homes and all those people were transported to the airport and put on the floor, but there were no medical people or anyone else taking care of them. So there was a tiny medical team there, but they’d been up 24 hours and they were no longer functioning well due to to sleep deprivation.

So there’s maybe 500 people on the floor, not even getting water or food, let alone medical care. There’s maybe 2,000 people wandering outside the airport. And then there’s my Little team, about 35 people, of whom only four of us were physicians.

And it was kind of overwhelming. We do very well taking care of one person at a time. But, you know, a lot of the people on the floor were actively dying.

And we just went room to room. We went boarding area to gate area to shopping mall. And we just found more people in hospital gowns on the floor.

Some were conscious and asking for water, and some were unconscious and some were dead. And we were sleep deprived at this point, at the start of my longest medical shift in my career. So after some very salty language, we just jumped in.

The nurses set up a very important station, the triage station, and basically they decided which of four tents people went to. And we used classic military triaging.

So if people were only a little hurt, maybe a broken arm, but they’re pretty good, then they went to the green tent. And these were actual physical tents we set up under skylight so that when we had daylight we would have some light because there was no electricity.

Yellow tent. And each of these tents held about 20 people. Yellow tent was moderately ill people. So maybe a heart attack, but not actively dying.

Red tent, actively dying. So somebody with a heart attack with vital signs that are crashing, or somebody in diabetic ketoacidosis who’s in a coma and unstable.

And then also the last place we set up, and this is only one of two times we had to do this, we had to set up a black tent, also called hospice, also called the expectant area.

And what we did, and again, this is classic military triaging, is we decided that if somebody had a poor prognosis, despite medical care, we were going to do nothing for them. No care at all, just food and water if they were awake. And.

And we thought that was the best use of the resources we had at the time, although it was difficult to set up, difficult to tell relatives and patients, that’s what we were doing. And so we just jumped in. My first shift was over 36 hours long there. We didn’t have enough people, we didn’t have enough medical staff.

And very frustratingly, the organization was horrible. We didn’t follow ICS Incident Command system, which I’ll talk about a little bit later, which is sort of the state of the art command system.

And our higher ups didn’t believe that we needed more care. So we were saying, hey, We’re a tiny team. We’re overwhelmed. We can’t take care of all these people.

But, you know, two or three levels above us in the hierarchy of disaster response, they basically said, no, we think you’re wrong. You’re doing fine. Hang in there. What we had was a lot of media. So there was ABC and CBS and CNN and Fox and so on.

So we knew we were on the news, but they wouldn’t send us doctors and nurses and medical supplies.

Luckily, the military was there, and they had a great attitude, a lot of manpower, their army, the Navy, the Coast Guard, and they shared drugs and their communications. So thank goodness they were there. They really helped markedly.

Our main decision with anybody was we stabilize them and do they go to a shelter or to a hospital? And the first big lesson that I learned there, sort of driving there, what I thought I was going to see was. Was hurricane trauma.

So I thought I was gonna see broken limbs and near drowning, things like that. And that, indeed, was a little bit of what we saw, but it was less than 5% of what we saw.

And most people who we saw there were acutely ill from having all their medical care taken away abruptly.

So it was people with diabetes who hadn’t had insulin for a week, people with chronic renal failure who hadn’t had dialysis, people with high blood pressure who had all their medications taken away. And now they were having strokes and heart attacks from not having their medications.

We saw people with epilepsy and asthma and schizophrenics, everyone getting worse without their medications. Interestingly and frustratingly, apparently the people in New Orleans were doing surgery until the last minute.

And so we saw people who had had surgery just a few days prior, but with no medications, no medical records. So that was a challenge to work with. It was good that it was at the airport.

Some of the buildings were banged up, but that was the designated trauma center. And that was good because we had, you know, jets, helicopters, buses coming there 24, 7, but we had a phenomenal volume of jets coming in.

And in the peak hour, we actually had 160 helicopters land in one hour. So we had difficulty getting people off the tarmac.

Unfortunately, there were a significant number of deaths there, and I think there were more than there would have been had we had enough doctors and nurses there. So that was difficult to see. I think in the peak, we transported almost 3,000 people by air.

And that, actually, I read somewhere was the biggest medical evacuation ever, even including wartime. And we ended up sending about 25,000 people to shelters who didn’t need help. So it was fascinating, it was surreal.

And actually one photo that I know you’ve seen, Paul, when I present on this, I’ll give you an example. One rule in disaster response is that at least one surreal thing has to happen on every deployment.

And at one point I’m working, it’s the middle of the night and already it’s surreal because I’m working on urine soaked carpet and I’m in front of a, I don’t know, a Hudson News or something and I look up and there’s empty carpet.

And I look up a minute later and there’s all these boxes in front of me with a glassine envelopes, like hundreds, thousands of boxes with glassine envelopes. And what they were was Krispy Kreme donuts. And they just appeared magically there.

So I couldn’t get penicillin, I couldn’t get vaccines, I couldn’t get medical supplies, I couldn’t get oxygen. But somehow the Krispy Kreme truck got through. So that’s just an example of how the logistics there were just really messed up.

GERM
00:15:47.200 – 00:15:49.520
New Orleans has its priorities clearly.

WORM
00:15:49.680 – 00:16:31.430
Yeah, and they–I mean, I ate them. But you know, when you’ve got a lot of people with diabetes, it’s not the ideal food stuff.

But you know, after you become refractory to caffeine, you can get a few more hours with wakefulness, with sugar. So anyway, by September 4th, we started getting some more medical staff in and the number of patients coming in decreased.

And I left after two weeks and boy, I had trouble sleeping for a month. I would wake up in the middle of the night, just kind of like, what do I need to do? Where do I need to be?

And then I chilled out and I decided I actually liked being on the team. I won’t use the word fun, but I saw fascinating stuff, heard fascinating stories, and after all of that, decided to be on the team long term.

GERM
00:16:31.830 – 00:17:07.410
It’s just amazing to me that that was your first official deployment because it sounds just for our listeners to understand, for physicians, to many thousands of patients. This ratio is completely different from what we would do in our everyday life. I mean, it’s literally a true disaster.

And I’m just fascinated that when you came through that, in spite of what sounds crisp like ptsd, that you resolved to go back. And it’s a remarkable story. So tell us more about that, please. How are these response teams organized? What does it look like moving beyond Katrina?

WORM
00:17:07.810 – 00:18:40.840
Yeah, it’s a federal thing. It’s under the Department of Health and Human services. And there’s two types of disaster teams in the US the.

There’s DMATs, disaster medical assistance Teams, and there’s about, I don’t know, 60 or 70 in the country. Most states have one, and they’re set up to be outpatient clinics.

And then there’s the type of team that I was on for most of my time called the IMSuRT, International Medical Surgical Response Team, when I was on it now called TCCT, Trauma and Critical Care Team. There’s only three in the country. One is in Seattle. And these are set up not to be clinics but to be field hospitals.

So we have surgeons and generators and can do surgery, but also we do everything else from delivering babies to, you know, sewing up lacerations. And these were set up in the late 1990s. They were a response to the embassy bombings in East Africa, in Kenya and Tanzania.

And when you’re a member of the team and you get a call, suppose there’s a hurricane or a forest fire, you’re called. You can say yes or no to this. So I’m a civilian, but when I joined the team, I am a temporary government employee.

But I found that the sweet spot was saying yes, not more than once a year, because when I leave, you know, you leave at midnight in the middle of a working week. You’re dumping all of your work onto your co workers. And if you do this very often, they will shoot you.

And so I found they were quite willing to help me once a year, but I didn’t want to abuse that because immediately they have to take my call and see my patients and so on. On. So it’s a nice deal of where I can say, and I did say sometimes, no, I can’t leave on that one. But about once a year was the sweet spot.

GERM
00:18:41.960 – 00:19:00.280
I love that call out to the professional repercussions and ripples that go through your own practice. Curious about your family as well. No doubt. I mean, you’re married, you have kids.

I’m wondering how this impacted them as well, if they were supportive of this or what their opinion was about that as well.

WORM
00:19:00.880 – 00:20:06.020
Yeah, they were super supportive.

When I left For Katrina in 2005, my kids were only 4 and 6, but I have photos of them with me in my uniform when I went to the Obama inauguration deployment. Around that same time, Ted Kennedy became ill. I think he had a stroke. And one of my boys speculated that maybe I was the doctor who took care of Ted Kennedy, but. But it wasn’t me. I. I didn’t meet Senator Kennedy at that time.

They’re worried because what they see on the news is sometimes more violent than what I see. So what I see is people taking care of each other. You know, it’s busy, but usually not violent.

But if there’s a riot anywhere, that tends to be what’s on the news. And so I think that can distort what’s going on. So there was some worry.

My wife Sally certainly was worried about me during these things, but they were super supportive. And both my co workers and my family said they felt they were helping the disaster a little bit by taking care of my tasks while I was gone.

And so that was actually a pretty optimal attitude.

GERM
00:20:06.340 – 00:20:16.980
I think that’s true. I don’t think they were shining it on. So mad props to them as well. Let’s talk about this after the Katrina experience.

Chris, what was your next deployment in this role?

WORM
00:20:17.940 – 00:27:16.820
Well, I had a bunch and I’ll summarize most of them. The one I want to talk about in some detail was the 2010 Port au Prince post earthquake deployment. That was the most intense and interesting.

But some of the others. We went to New Orleans again 2006 during Mardi Gras to be sort of, er, overflow. And we set up in a parking lot there.

And it was nice to go back because we were busy, but we were not overwhelmed.

And after the psychic trauma of the, that first deployment, it was just nice to go and put in a 12 hour day and then get some sleep and have it be normal. We went to a hurricane called Ernesto in 2006, but by the time we got to the hotel in Atlanta, the hurricane was going away.

So all we did was eat donuts for three days and go up and down in elevators in the hotel. But remember I said something surreal has to happen at every deployment.

The hotel was also the site of DragonCon, which is this huge convention of people who dress up in fantasy costumes. So for the three days we bumped shoulders with Klingons and, you know, and such. So that was kind of, kind of interesting.

In 2007 we went to Southern California, to the San Diego area. There were huge wildfires there then.

And we ended up going door to door on a Native American reservation just east of Oceanside, inland from Oceanside. And that was interesting. A lot of houses burned, burned down. Everybody with anything pulmonary, like asthma, they got worse.

So that was, that was interesting and satisfying. Then we went to one that was different. In 2009, we went to Obama’s first inauguration in Washington D.C. and what we were there for.

Was in case there was a mass casualty event, because, you know, you’ve got whatever, a million people on the, on the green there.

And so we had some very interesting grim training in not just bombs going off and how to treat people, but biological attacks, chemical attacks, even nuclear attacks, radiologic attacks. Luckily, nothing did happen. There was no mass casualty event. So we just hung out for a few days in our tents.

Then 2010, there was the huge earthquake in January in Port au Prince, Haiti. And that was fascinating. Went there, let’s see, we got people out the door. Three days after the earthquake, there were some delays.

I ended up going with the second contingent that got there about two weeks after the earthquake hit. And we set up tents in a bad part of town. It was a huge earthquake and it was shallow. When it was right by Port au Prince, it was 7.0.

But because a lot, a lot of the buildings were poorly constructed, the number of fatalities was huge. As many as a quarter million people died, 300,000 people were injured and a million people.

So about an eighth of the population of the country were homeless. So driving between the airport and our clinic site, we just saw every other building was pancaked.

We set up tents and we were busy all day, every day. It was a much better deployment, I’m glad to say, after the relative chaos of New Orleans, that the system got better.

And I won’t get into the politics of who was leading it at the time of Katrina and why it got better, but we were busy, but we were not overwhelmed. We had a platoon of soldiers from the 82nd Airborne as security. We had a perimeter, and this was the only deployment at which we saw a lot of trauma.

All of the other deployments, I would say trauma was less than 5%. And we had more primary care type things here. In the earthquake, trauma was as much as 34% of everything.

We saw primarily orthopedic injuries, primarily from falling bricks and such in the earthquake, but also we delivered babies, and there was mental health and chronic care and things like that. One of the things that I like a lot about being on the team is talking with the other members, because I’m a family practice document.

But there are surgeons and OB GYNs and psychiatrists and pediatricians and social workers, and they all have their skill set.

So in Haiti, during a lull, I hung out on the landing zone one day and a nurse showed me how to bring in a helicopter where the helicopter needs to come in with respect to the wind and how you check for telephone Wires and that kind of stuff. Another day, I talked with a surgeon, and he taught me what’s called the message, the Mangled Extremity Severity Score.

And basically it’s this numerical scale that helps you decide if you can save a limb or it needs to be amputated. And there were a lot of amputations in Port au Prince due to collapsing buildings.

So you look at things like age and pulse and blood pressure, and this gives you a score which helps you to decide.

And again, as in all the previous disasters, I just heard story after story, like one guy who came in 14, 15 days after the earthquake who said he had been in a building for 15 days, basically, you know, crushed under a building. And I didn’t believe him at first because he could talk a little. He was dehydrated and he had a broken hip, but he could talk.

And I thought, no way was he really in a building for 15 days. But then what I learned was that he was a water vendor, and he was by a three or four story building.

It collapsed, but he had a little crawl space and he could reach some of his water. So he drank water, maybe one bottle every two days. And after his water ran out, he got pulled out when they started lifting up pieces of concrete.

So I heard story after story of amazing things like that, and I saw a lot of things I’d never seen before there. I had never seen tetanus, lockjaw, and we saw both generalized and neonatal tetanus there. I saw typhoid fever.

And then we saw a ton of infectious things. Dengue fever, molten malaria, pneumonia, heart things like heart attacks and strokes.

And one thing I learned, too, is that when you set up a clinic somewhere, you can’t turn people away just because they were hurt by something that’s not the disaster. So we started, you know, people came in for about their diabetes and high blood pressure and asthma and things like that. And we delivered babies.

And we also saw trauma that was not related to the earthquake. You know, car crashes, knife wounds, gun wounds, wounds, things like that. So a huge variety of different types of things.

One member, there’s a surreal thing that has to happen. And Paul, you’ve seen photos of this one day. Busy day. I’d been in Port au Prince, like, 10 days.

Nurse taps me on the shoulder and says, Dr. Stanford, there’s 10 Slovakian exterminators at the gate. Should I let them in? And I go out and there’s like a bunch of guys in uniforms with tanks on their back. They look kind of Like Ghostbusters.

And they were a international exterminator team and their thing was going around to disasters and killing mosquitoes and other insects. And at first I thought it was funny, but then once I thought about it, I thought, what a good idea. So I said, yeah, come on in. And they sprayed.

And we all had markedly fewer bug bites for a few days. So again, docks are just part of the, part of the picture here.

GERM
00:27:17.220 – 00:27:47.010
It’s really remarkable to me that, that, that diversity of what you were seeing and the volume, it must have simply been overwhelming. Now you’re describing it in such a calm, cool and collected manner. But I’m curious, can you cast your mind back to that time?

Were there things that you could do in your everyday experience to help stay grounded, sane, to calm you down, to deal with this, what sounds to me like an indescribable tragedy?

WORM
00:27:48.050 – 00:30:49.300
Yeah. What we couldn’t do because of communications issues was talk to family. And that is too bad because that would have helped a lot.

It helped that in Port au Prince, our shifts were only 12 hours so you could get away for a few hours, although not really because we couldn’t leave our compound and it was super noisy and, you know, the generators filled up the compound with diesel smoke and there were always helicopters and people yelling and so on. So sleep deprivation was a problem. In answer to your question, one thing that I did, sometimes we had babies there, we had newborn babies.

And sometimes I would go over to the nursery and I’d pick up a newborn and I’d just sit down and I’d rock the newborn for 20 minutes in my off time.

And that was good for the kid to have some human contact, but it was good for me too, just to take some big breaths, let my pulse slow down, look at the newborn. Life goes on. I’m doing what I can. And then after I had chilled out a bit, give the newborn back to, you know, back to the nurse.

Other things I did that helped is I’m a journaler and I do some writing, I do some journalism. So I wrote. And writing made sense of it a little bit. So those were a couple things I did.

But basically I came out of there not as shaken up as I was after Orleans, but pretty shaken up.

And I tell you, and I don’t think I’ve told you this anecdote before, Paul, Immediately after the Port au Prince thing, and again, a lot of people died, a lot of young people lost limbs. It was a pretty bad scene. And Haiti is a low income place that was in crisis. Even before the earthquake, and they were hurting worse afterwards.

So I worked hard. I was there two weeks. I left. I flew immediately to Big sky for a medical conference where I was lecturing on wilderness medicine.

And I went into this outdoor hot tub with my wife. And I just felt terrible because this is like the peak of luxury. I’m there with my wife in a hot tub at this high expensive resort, and I just thought, you know, all these images of what I had just seen for two weeks were in my head. I thought, what did I do? I was one of the rich people who ran away.

And so I just felt guilty and horrible initially and could not enjoy any of the luxury luxury of this place I was at. And that feeling lasted again for a month or so before things got back to normal. Back to your question. Journaling helps. Holding a baby helps.

Talking to other people and complaining helps. Talking to people on the team. And the thing that helps. Now, this is related to your question.

I kind of get now why Veterans of Wars like to get together with other people who were there. It’s really comforting for me now to get together with somebody who was at New Orleans with me and basically say, was it really that bad?

Yeah, it was really that bad. That sucked. That was screwed up. That was nutty. Just that conversation is comforting because it was so surreal that it almost seems it didn’t happen.

A And if I tell somebody about it who wasn’t there, there’s no way they could get it. So talking to somebody else who was pummeled in the same way I was and having them say no, that was nutty, that shook me up. That’s really comforting.

GERM
00:30:49.940 – 00:31:09.700
It’s a fascinating idea and so many lessons that all of us can take from this. Thank you for sharing that.

My recollection also is that not only have you worked in that capacity, I think you’ve also volunteered to work for Centers for Disease Control in Atlanta on a separate mission. Am I right about that? What was that about?

WORM
00:31:10.260 – 00:34:15.620
Yeah, that was super interesting also. And that was different. That was not for a disaster here. But. But there was a big.

You may recall a huge Ebola epidemic in West Africa between 2014 and 2016. And the CDC, which is based in Atlanta, Georgia, they basically needed more health professionals to man the phone lines.

They were getting a ton of phone calls from doctors and nurses and even State Department people overseas saying, hey, how do I test for this? How do I isolate this guy? Should I be worried? And I.

And so they contacted the disaster team, and for two weeks, I was the Midnight shift in the disaster center.

So I sat for eight hours every night, starting at midnight, in their huge room, this control room, which is like something out of a spy movie with all these screens up on the wall, this huge cavern of data all over the electric walls. And I got calls from doctors and public health officials, and I got a little training there basically, on what’s the protocol? Who do you.

You test, who do you not test? How do you interpret the test results? Who do you isolate? And learned several things during that.

For one thing, my respect for the cdc, which was high before this, went up even higher after being in on some of the committee meetings where the CDC doctors and health PhDs were trying to issue guidelines based on limited data. So a question would come up, like, what shall we say? How long after a man. A man has potentially been exposed to Ebola?

How long before he can have unprotected sex? Well, there’s not data on that, so. But they got to say something on their website.

So I saw these smart doctors just agonize over the data and come up with what they thought was best. You know, a very good, reasonable summary of advice. But anyway, I saw work with a lot of very bright people there.

Some other things I learned is that disasters are kook magnets. And I knew this before because, like at Katrina, we had fake doctors show up, and we had fake, even helicopter pilots show up.

During the Ebola epidemic in New York, for example, somebody would want to go to the front of the line in the emergency room. So they would tell the nurse, hey, I just got back from Sierra Leone and I have a fever. Maybe I should be seen first.

Well, that starts off, yeah, they did go to the front of the line. But that sets off, as you can imagine, imagine, a huge public health alert. They would call us. They would involve all sorts of protocol.

Then I would check with the fda, or not the fda, the faa, who had flight manifests. We would find out that this person had never left the country. Maybe they had schizophrenia.

And also we learned that Americans are very bad at geography. So the main countries that were involved in West Africa in that epidemic were Guinea, Liberia, Sierra Leone.

So I would get a call from somebody saying, hey, I just went to Papua New guinea, or, hey, I just went to Guyana. Do I need to be worried? We. We’d say, no, that’s a different country. It’s guinea in West Africa, where the. Where the epidemic is happening.

So, anyway, super interesting. Enjoy being on the phones for a couple weeks.

That was just another piece where I got to See, a little bit of the US healthcare system I never would have seen had I not been on this team.

GERM
00:34:16.500 – 00:35:07.190
And furthermore, something that you wouldn’t have seen if you hadn’t chosen this original path of medicine. Many of our listeners are doctors, but many are not.

And if you’re medicine curious or you’re just wondering why do we do this crazy career that we have, it is about the daily experience in the domestic life that we have as doctors. But as Chris points out, this goes beyond that too.

Whether you’re in a volunteer situation, traveling for work or for pleasure, the point is being a doctor, I think, Chris, I hope you agree it just opens these doors and it, you know, when we volunteer in this way, and I have not volunteered in the exact way that you have, but I hope you’ll agree that it’s more fulfilling that you got back more from that experience than you could ever hope to give. At least that’s a theme that I’ve heard from doctors time and again.

WORM
00:35:08.470 – 00:35:36.100
Definitely.

I mean, as we were saying, it’s not the money, it’s not the glamour, but the one, one on one interactions with people you would not get were you not on this team. And there’s just, there’s more than I can remember, hundreds with every deployment I’ve been on. Just to name one.

When I was at Katrina, I was talking to a man who was having a heart attack, but he actually was doing okay.

And he said rather laconically, yeah, I knew when I killed the water moccasin in my living room with the nine iron that it was time to leave the house.

GERM
00:35:36.500 – 00:35:37.700
Holy smokes.

WORM
00:35:38.430 – 00:35:51.390
And you know, I just heard things like that all day, every day for two weeks. And you would not have that view, that slice of life had you not done this. So yeah, for me, I’m really glad I became a doc.

I’m glad I joined this team.

GERM
00:35:52.350 – 00:36:04.230
Well, let me ask you to boil it down even further. Any lessons, learnings, musings and wisdoms that you want to share, having, reflecting back on your years of service in this capacity?

WORM
00:36:05.340 – 00:40:26.480
Yeah, a few things.

One is, I didn’t really know about command systems before I joined this team, but there’s this type of command system called ICS Incident Command System. And basically it’s how a chain of command works and it was invented by California firefighters in the 1970s.

I won’t go into it in detail, but in any kind of disaster, using ICS Incident Command System makes everything work much better. Another thing is don’t play plan on obtaining anything at the site. Of the disaster. So this applies both to your home.

You know, I’m not a prepper, but I do have three days of food and water in my basement. But also for a disaster, you got to take everything with you.

Another lesson, and this would be something for our listeners, and you can join a team, whether you’re a doctor or a medical person or not, because on our team, we needed people who were 19 and just knew what box was where and move stuff around. So you don’t have to be medical person to be on a disaster team. But the time to be involved is now.

Don’t wait till there’s a disaster, because when there’s a disaster, everyone’s running around like crazy. And credentialing takes a long time.

So if you have an interest in this, given that they need to credential you, make sure you’re really who you say you are. Become involved now. Go through the paperwork so that when something happens, you’ll be ready to go.

And the thing that’s related to that is the don’t do something by yourself. The only reason I was effective anywhere was because I was part of a team and I had security and logistics and so on with me.

So don’t just show up where there’s been a disaster. You’re more likely to be a liability than a help. But join a team, and there’s a lot of teams that respond to disasters.

Another thing I would say is that communications should be redundant. Everything’s going to fail. Cell phones are going to fail. Electricity is going to fail. Internet’s going to go down.

So have something like ham radio so you can get in touch with people.

Another lesson is that in a city like Seattle, when we have our eventual earthquake, all the bridges are probably going to go down, or at least many of them. So you want to have a landing zone near your medical facility, something that hospitals can access.

Another lesson that I mentioned before is that most of the care you’re going to have to give probably is not going to be trauma, but it’s going to be care of the chronically ill. So, you know, think diabetes, oxygen, hypertension, things like that. That may be the bulk of what you need to see.

As I say, out of all my deployments, the only one with significant amount of trauma was the earthquake. Docs are only part of it.

When I first joined the team, I thought maybe I was the big cheese or one of the big cheeses, but in fact, you need security. And now there’s morticians on the team who deal with human Remains.

And there’s veterinaries who deal with dogs because people were bringing their parrots and their cats to the airport, which is a big deal. So you really need this big network of people. Few more lessons. One, the rules change. You got to be flexible.

So for example, at Katrina, you know, Paul and I know that as doctors, when we discharge people from one medical facility to another, you write this long note, you know, two pages, four pages with all the diagnoses and what you did at the airport. I was writing one to two sentences on a piece of paper that we would bobby pin to someone’s gown.

You know, chest pain, 65 year old man gave half an ampoule of morphine. End of note. Just because we had such a long line. And also we did things like set up the hospice that I’d ordinarily never do.

Also we put unstable people onto jets and helicopters, which ordinarily I would never do, but we thought that was their best chance. A couple more things, last two. One, if the military is there, involved them.

After working with the National Guard and other military, I thought they were professional, they had a great attitude. They have better organization communications than the medical people. So work with them, liaison with them if that’s an option.

And the last point I want to make is that this has really warmed my heart over the years, years is that people rise to the occasion, both the providers and the people affected by the disasters. So what I see is people waiting in line for 24 hours and then at the front of the line saying no, take care of this guy first.

He’s more hurt than I am. People on my team worked long hours without complaining. People realize it’s a disaster and the great majority of people really rise to the occasion.

And so that really has me, me optimistic about people, which is a wonderful thing to, to discover.

GERM
00:40:35.920 – 00:41:32.420
Well, Chris, I just, I don’t know how else to say it. I just want to thank you for sharing this with us. And I’m sure I speak on behalf of all our listeners when I say just thanks for your service.

Thanks for what you’ve done and you know, to shed a light on this entire, entire industry, this discipline, this field. My hope is that some of our listeners will be response curious and maybe they’ll be interested in figuring out how they may be able to respond.

Your wisdom is much appreciated and it’s gold for us.

To our listeners, if you have enjoyed this conversation with Dr. Chris Sanford, please share it, share it with friends, family and on social media, Throw us a bone, give us a favorable review on whatever platform you’re listening, and follow us on the socials. Our website is germandworm.com and if you have questions for us, you can also just send us an email: germandworm@gmail.com we’d love to hear from you.

Until next time, I’m Germ.

WORM
00:41:32.420 – 00:41:36.980
I’m Worm. It’s a big planet. See it in good health.

GERM
00:41:36.980 – 00:41:58.240
We’ll see you next time.

This podcast is designed to inform, inspire, and entertain. However, this podcast does not establish a doctor patient relationship and therefore it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure. The opinions in this podcast are Dr. Sanford’s and Dr. Pottinger’s alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.