Physical Therapist suits up in disaster gear for training

What to do in a Disaster

Step 1 – Don’t Panic.

Step 2 – Meet Dr. Megan Mitchell PT, DPT

Dr. Megan Mitchell is a full time physical therapist at Denver Health Medical Center specializing in emergency care and surgical trauma intensive care with recent program development in the emergency department. Dr. Mitchell has specialty training in chemical, biological, radiological, nuclear and explosive event recognition, triage and medical care.  She holds CBRNE and hospital emergency response team train-the-trainer certifications through FEMA.  She is active with the Denver Health Emergency Management Team for policy review, emergency management drills, and regulatory compliance. She serves as a geographic area associate for Team Rubicon as the WY-CO Wellness lead and a level 1 sawyer volunteering in domestic disaster response. 

Additionally, she is an instructor in emergency response for the athlete with Cogent Steps LLC and associated faculty with the University of Colorado PT program with additional duties to assist with program emergency management policies and procedures. 

Outside of her roles as a PT and educator, she is back in school working on an MPH in global disaster management, homeland security and humanitarian aid.  In her spare time (!), Dr. Mitchell and her husband like to foster dogs.

Describe how you became involved in Emergency Department Physical Therapist Practice.

I had an incredible experience working with a patient in the emergency department where the patient was in her 20s with a new onset foot drop that the ED had determined did not require emergent intervention. I was consulted to assist with the management of the foot drop. After my evaluation, I determined that it was more than a foot drop in presentation but the patient also had whole leg weakness, clonus and ataxia. After my evaluation she was sent for brain imaging where she was ultimately diagnosed with MS. That experience was very validating for my education and really made me believe that PT had a role in the ED. 

Once I made that declaration to myself I decided to take an emergency response course hosted through the sports section of the APTA. That same weekend I was taking the EMR course was the same weekend hurricane Harvey made landfall in Texas. It was that weekend that sent me on my journey to get PT involved in the ED and domestic disaster response.

Describe your practice setting and ED PT model.

I work in a level one trauma center covering adult and pediatric emergency rooms. At this point in time the department functions on an on-call basis where there may be no consults in a day or 10+ consults before noon. I prefer to function in the trauma section of the ED but will consistently cover in the medical section and the quick clinical decision unit the most. Less commonly I will cover the urgent care, low acuity blue zone, pediatric department, adult psychiatric unit and the labor and delivery ED.  

Why do you think this is a valuable practice area?

I believe that physical therapists have a unique lens for patient examination and evaluation that adds value to the traditional care model. The physicians in the emergency department are there to save lives but emergency departments are often filled with those in need of care but not life saving intervention. We are able to see the patient beyond the immediate care interventions and make assumptions about follow up care needs, safety concerns, discharge needs, service coordination. We do so much more than we are recognized for doing that it is important to practice up to our education and potential.

What was the biggest adjustment for you in practicing in the ED?

I find that the biggest adjustment is fighting the perception of what our scope of practice and the role of PT is from other professions. I have never agreed with the mindset of inpatient versus outpatient skills. I don’t agree with the drawing of lines across the body with PT treating the legs and walking while OTs will treat the arm.  Finding the internal calm to not get angry or frustrated with the system for not having an understanding of what a PT is capable of doing. 

Do you have an area of specialty?

Within my function in the emergency department, I really prefer to function in hospital disaster response and emergency management. Since I know what I can do best it is best for me to write the physical therapy role into our response plans. I also really like differential diagnosis and going into an evaluation with only a generic complaint allows me to use my training to make the determination for diagnosis.

What barriers did you have to overcome personally and within your facility to practice successfully in this environment?

This is a constant battle. It cannot be about inpatient and outpatient skills. It cannot be about “they can walk, send them to an outpatient.” 

In the context of disaster response and training, the most statement is “I don’t know what that would look like” or “we don’t need someone to walk people in a disaster zone” which is completely fine because I don’t “walk” people either.

What is your philosophy about what makes an ideal ED PT?

You trained to be a generalist and this is the chance to practice at the top of the profession. The ED PT and the disaster PT provider needs to be fast, flexible, willing to continually learn and practice up.

What was your biggest win in the ED?

My biggest win thus far is training with FEMA in Alabama and being able to rewrite the role of PT in my hospitals’ mass casualty response and CBRNE response.

Curious About Dr. Mitchell’s Disaster Work? Listen/Watch for More

To Learn More About PTs in Disaster Training Dr. Mitchell Recommends These Resources

TEEX.ORG
ICS Resource Center (fema.gov)
Home – CO.TRAIN – an affiliate of the TRAIN Learning Network powered by the Public Health Foundation
FEMA’s Premier All-Hazards Training Center – Center for Domestic Preparedness (dhs.gov)
NDPC – National Domestic Preparedness Consortium – The National Domestic Preparedness Consortium (NDPC) is a professional alliance sponsored through the Department of Homeland Security/FEMA National Preparedness Directorate.

Dr. Griffith & Dr. Mitchell at APTA CSM 2022