From forest fires to terrorism: A champion for structure within chaos

Rear Admiral Scott Deitchman, M.D., M.P.H., actually is able to see the forest for the trees and has diligently championed more coordinated emergency response at CDC since his work with forest fighters in 1988.

"I was a second year EIS [Epidemic Intelligence Service] Officer working in occupational health at CDC/NIOSH. We were investigating smoke inhalation risks to firefighters at the Yellowstone forest fires. To work in the fire environment, we had to attend Wildland Firefighter Training and there I was introduced to the incident command system. I saw the organization it brought to the response," he said.

Deitchman went on to investigate occupational illnesses and deaths in diverse workplaces. On the morning of September 11, 2001, this medical officer returned from a morning run in Wyoming to see images of the burning Twin Towers on televisions in the hotel lobby.

Didn't want to be out of touch

"I was attending a National Emergency Management Association conference. We had a number of FEMA staff out there," he said. While the FEMA staff caught a military plane back to D.C., others at the conference were scrambling for available cars to drive back. "I was on telephone and laptop with CDC and was helping from there. I didn't want to be out of touch for a three-day drive back to Atlanta, so I stayed."

The occupational health veteran helped craft recommendations for workers, including the use of personal protective equipment and respirators. "It was important to take the worker's perspective and understand the conditions in which they were responding," he noted. During the anthrax response that started soon after, he led the working group that addressed both occupational and environmental health issues including worker protection, environmental sampling, and building clearance.

Ultimately, Deitchman led CDC's first program to ensure the safety of first responders and other workers responding to acts of terrorism and other diseases. His path was set as he went on to lead the environmental and health work for terrorism and emergency response, preparing for chemical and radiological disasters. He also collaborated with infection control specialists at CDC to develop worker safety measures against TB, SARS, monkeypox, smallpox, and plague.

No formal protocols

When the anthrax response started at CDC, Deitchman knew we had no effective emergency management system in place. "People did exceptionally well with what they had, but we soon saw information overload and no formal protocols for responding to the demands," he said.

"At the time of the 9/11 attack CDC had a small operations center at Chamblee focused primarily on environmental health response. CDC had to build a makeshift operations center in the old Building 1 in Auditorium A, with specialty teams working at side-by-side tables in the classrooms beneath Auditorium B. It was so noisy you had to step out to make a cell phone call," he recalled. Anthrax also exposed weaknesses in CDC's efforts to communicate with its public health partners and the public. CDC was criticized for its failure to communicate vital information to health-care workers and the public.

"We had to accept the chaotic nature of disasters and the need to have effective protocols in place to coordinate and communicate with others," he explained. "We finally modernized and found a permanent place for an emergency operations center. Based on the incident command system, it provides an infrastructure to support specialized teams that can disseminate timely and reliable information."

A penchant for calmly managing

Deitchman discovered, as did his leadership, he had a penchant for calmly and effectively managing large public health responses. He has been designated as the incident manager for CDC during a number of high-profile events, including the Asian tsunami disaster, Hurricane Katrina and the more recent oil spill and Japan disasters.

Since 9/11 and anthrax much has changed at CDC in emergency response. "Compared to 10 years ago, the way we think is as different as night and day. I can see that our scientists here get it. We understand the 80-percent solution. We may not have statistical certainty when we make a decision and, yet, we have to recommend something and be willing to modify it later if the information warrants it. It's better than doing nothing at all," he said.

Deitchman perceives himself as a "generalist," with experience that spans environmental and biological health threats—useful for someone managing complex and overlapping health concerns in an emergency. What Deitchman may actually be is a unique public health pro who can see the forest and the trees.