Dr. Disaster

When the world is falling to pieces, emergency doctor Paul Pepe makes order from chaos

Wigginton and Pepe did a study on child drowning victims, showing that 70 percent of those who received immediate CPR or mouth-to-mouth resuscitation came out "neuro-intact." All of the children who had to wait for treatment suffered some kind of neurological damage. It was practical research illustrating the importance of civilians knowing how to do CPR.

On a recent day, Pepe starts work at 5 or 6 a.m., doing an early shoot with Channel 11 on Halloween safety. He meets with head nurses at shift change, then bounces through Parkland's ER touching base with nurses, residents and paramedics ("Anything I can do to help you?"). The ER is still crowded from the previous night's patients. Paramedics are transporting a woman in labor on a gurney. To Pepe, it looks like an average crowd. It's busy but not chaotic. People tell Pepe "hi" with big smiles. (His number one requirement when hiring: "good citizenship.")

Mid-morning, he confers with the Secret Service in preparation for Vice President Dick Cheney's visit and then heads downtown for a meeting of the Dallas City Council's transportation committee, where he pulls out his laptop to answer e-mail and finishes a PowerPoint presentation while awaiting his spot on the agenda.

Mark Graham
Dr. Ray Swienton shares a story with faculty member Dr. Dale Simmons at UT Southwestern.
Mark Graham
Dr. Ray Swienton shares a story with faculty member Dr. Dale Simmons at UT Southwestern.

Then it's up and out on the streets, checking out paramedic response to a car accident in Oak Cliff. One of the victims has hit his head on the windshield but doesn't want to go to the hospital. Pepe persuades the guy to get it checked out.

Back in the ER, a shaken nurse tells Pepe about a patient she just released to police custody. He'd allegedly shot and killed someone, then was brought to the ER where his own wounds were treated. They'd saved a killer's life.

Business as usual.

But as "Katrita" vividly demonstrated, emergency medicine is evolving in ways not anticipated 30 years ago. A sub-specialty called disaster medicine has emerged in response to September 11 and other threats: sarin gas on a Tokyo train, bombs on a London subway, an avian flu pandemic and "weapons of mass effect" such as toxic chemical releases and suitcase nukes. Another sub-specialty: tactical physicians, doctors who accompany SWAT teams and FBI agents on operations. In a homeland security project conceived by Pepe called GEMSS (government emergency medical security services), Southwestern has a surgeon serving as a "SWAT doc."

As Rita barreled up the Gulf of Mexico, Pepe and members of his team went back to Baton Rouge and New Orleans to "resolve disputes" that would affect emergency medical efforts. Pepe later made a formal presentation to the White House Medical Unit. "Me being a glass-is-half-full guy, we could classify this as the most amazing rescue in U.S. history," Pepe says of Katrina.

Most of the lessons reinforced by Katrina are being taught in the disaster life support courses:

··· Medical technology has many limitations when the power fails or equipment doesn't work.

··· A means of foolproof communications is needed when cell networks are jammed.

··· Well-meaning but superfluous volunteers and donations must be managed.

··· Doctors need security in chaotic situations where patients or their loved ones may be armed.

··· In the midst of a big disaster, there are a lot of little disasters, like an outbreak of dysentery at Reunion Arena that required rigid enforcement of hand-washing.

"There will always be new obstacles," Pepe says. "Instead of being upset, you just do the best you can. What I hope is that people understand there are risks and benefits to everything we do. I hope the public gets to learn that we all are vulnerable and need to help each other."

But the biggest lesson, Pepe says, is that it can happen here. For all the hype about homeland security and combating terror, resources haven't been directed to the hospitals. Pepe wants to make sure Dallas is ready.

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