Disaster Response A Continual Learning Process, Says Dr. James Augustine

Dr. James Augustine is a national expert on disaster preparedness. He has written disaster plans for multiple regions and cities, has served on fire departments and EMS teams from Washington D.C., to Atlanta, to Dayton, and has assisted the state of Ohio in drafting its own disaster plan. He serves on the Board of Directors for ACEP and serves US Acute Care Solutions as chairman of its National Clinical Governance Board, but to this day he keeps a fire department scanner crackling in the background in case there is an emergency to which he can lend a hand.

Dr. James Augustine with the West Carrollton Fire Department
A young Dr. James Augustine with the West Carrollton Fire Department in 1986.

In a sense, it all started in the small Dayton suburb of West Carrollton, in 1986, when a young Dr. Augustine found himself smack in the middle of the largest evacuation in state history, and the largest evacuation from a chemical spill in U.S. history. “A lot of times people have an event that sort of springboards your career,” Dr. Augustine remembers. “And this event had national implications. People wanted to know what the lessons learned were.”

Dr. Augustine had graduated from residency training just a year earlier, and happened to be doing an EMS fellowship, when a 44-car freight train derailed as it traveled across a bridge in next door Miamisburg. Yellow phosphorous from one of the cars ignited, causing a plume of smoke to bellow upwards, covering the city in a yellow haze. What started as a 7,000 person evacuation eventually grew into a multi-day emergency to include 50,000 evacuations across multiple counties as the cloud engulfed neighboring communities.

Remembering the disaster, Dr. Augustine said he was left in charge of organizing the evacuation of West Carrollton, when most of the department left to go aid Miamisburg. “It’s really a fascinating thing to do, standing in the middle of the street, 5pm in the afternoon, people trying to go home, and we are blocking off the roads. This huge cloud was coming in. It was so thick at the front end you could actually reach out and touch it.”

“We made a good deal of it up as we progressed,” Dr. Augustine remembers of the disaster response. At the time, there were no procedures in place for how to respond to an event like that. Unlike with the hurricanes that have battered Texas, Florida, and Puerto Rico in the past two months, there was absolutely no advance warning for this. Much that is known today about community disaster response – the importance of coordination and communication amongst multiple responding agencies perhaps most of all – was improvised on the spot back then, Dr. Augustine says. “It requires you to very quickly and efficiently make good decision with limited resources.”

Miamisburg was the formative event in Dr. Augustine’s early career, but there would be more to come. In all of them, he remembers the importance of coordination and communication, and the response of multiple communities, departments, and responders who united to take care of people during their time of greatest need. Out of Miamisburg came national lessons on how to deal with chemical spills and sudden evacuations.

“Disaster management like this requires tremendous regional cooperation between agencies of all kind, including the entire health system. It is really important in these types of incidents that as much of the response be coordinated so that is consistent. Everyone needs to be using the same source of information and giving the same advice, otherwise there is mass confusion,” said Dr. Augustine. “My job is to make sure the entire health system is working collaboratively and consistently to give advice and provide medical care and get the community back on its feet afterwards.”

Dr. Augustine has built on his experience to develop effective disaster response plans for cities and regions across the country. But he says it is a continual learning process. Asked what he thought of the disaster response to Hurricanes Harvey, Irma, and Maria, he focused on the importance of continually learning from disasters and improving the response the next time around. Dr. Augustine happened to be in Austin just before Hurricane Harvey slammed in to Houston, where he visited a 911 emergency operations center in the middle of an exercise simulating widespread flooding: “I felt they were really well organized. They did the best job they could, and I’m sure the lessons learned will be very helpful. You have to build on it and allow us to do future responses even better and be prepared in more effective ways.”