Derrick Tin

How did you become interested in disaster medicine? 

The first part of my medical career was fairly typical and streamlined, working in emergency departments in both remote and urban settings. I trained in the UK, did placements in France and the USA and after a few more years of work in and around London, I packed my bags and left for Australia in search of an adventure!

In 2012, I got recruited into a very unique job where I would deploy to extremely remote environments and ended up dealing with maritime disasters in the Indian Ocean. It wasn't something I was really prepared for but managed to survive and eventually took up a Senior Medical Officer role overlooking emergency medical services in the South Pacific. Setting up and designing field hospitals capable of dealing with the numerous mass casualty events we faced in a resource limited environment was, as you can imagine, extremely challenging. We routinely ran multi agency drills and simulations to keep improving our disaster preparedness and response and all that experience and education really triggered my interest in Disaster Medicine. As luck would have it, I was awarded a Commonwealth Scholarship to further my studies in this field and ended up completing a Masters in Disaster and Emergency Medicine. During that time, I was extremely fortunate to be introduced to the BIDMC/ Harvard Medical School fellowship here and somehow managed to interview well enough to secure a spot!

I am now in my second year as a senior fellow, getting ready to transition into a faculty role this summer. The program here is one of the biggest and oldest, with nearly 100 alumni around the world since it was established 15 years or so ago. We are still young compared to other established medical subspecialties but it’s been a really incredible journey for me here so far. 

I have great mentors here in Dr Ciottone and Ms Voskanyan, the co -directors of the fellowship and there is an incredible, supportive network all around. I’ve taken a specialist interest in Counter-Terrorism medicine which looks at the healthcare impacts of intentional man-made events. When you do a deep dive of this, actually, it’s very different in terms of psychosocial repercussions, in terms of clinical aspects of injuries between an accidental and intentional explosion. It’s something that we, in the civilian sector, are slow to recognize, and that’s problematic because the risks of someone intentionally doing something bad is extremely real today. And when something bad inevitably happens, you really want to be as prepared as you can be for that. 

How has your global experience influenced your career?

There is a big advantage to having a global perspective. If you’ve never left your homegrown system it’s harder to recognise that there are other ways of doing things to achieve the same goals. 

If you take Australia and the US as an example, the clinical pathways may be very similar and the medical language is universal, but the systems we operate under are completely different. A big part of disaster medicine is understanding system constraints and how we can improve inefficiencies and having a knowledge of how different systems solve similar problems is extremely advantageous.

Also, with a global perspective, you have more of an ability to work with international crews on deployments, you can better accept that things can be done differently. I learnt a lot from doctors and nurses used to working in resource poor countries, how they adapt to their environment, how they maximize whatever resources given to them, how they build resilience under such difficult circumstances. You can't be too rigid in your own framework when you’re learning to work with other people. All this, of course, comes with experience and there’s no better way to gain valuable experience than by working outside your comfort zone with people that you don't normally have an opportunity to work with.

What do you love about disaster medicine? 

I love high acuity care. I’m the kind of person who has the ability to stay calm and level-headed when things are difficult, so I think my personality is well suited for this type of environment. I remember being asked once — what do you want to achieve in your career? And I remember saying that I wanted to be a modern day millionaire. That’s not someone who makes a million dollars, but someone whose work influences a million people throughout their career. I realized that as a clinician on the ground seeing patients every day, it’s going to be very hard to get up to those sorts of numbers. But in a disaster setting, through research, or through education and changing policies at the top, one can influence how a field hospital is set up for example, how we manage resources, how care is given, and potentially influence a lot more people downstream.

Having said that, I also love being on the ground. The world of disaster medicine is where the most vulnerable deserve the best of standards, in the worst of times. To be able to play a small part in that is important to me. It’s a privilege, more than anything else.

What does a day in the life of a disaster medicine physician look like?

Disaster medicine is not your traditional medicine where you see patients day in and day out. When you’re not deployed, you’re busy with research, with education. Before COVID, I was in Zambia teaching field rangers some basics of tactical medicine, doing prolonged field care, and they actually ended up deploying to Mozambique when cyclone Idai hit a few months later. It was great to know that I could impart some of my knowledge to others that went on to help those in need. I  also learnt a lot about tracking animals and people in the field and how to make antelope steaks so you’re also always constantly learning something new as well!

Disaster medicine is still not considered a mainstream subspecialty, so it’s really important for us to push the agenda and educate those around us. Lots of organizations approach us to talk about our work so that definitely keeps us busy during non deployment days. It also gives us the opportunity to interact with experts in other fields, like climatologists or radiation scientists and terrorism and intelligence experts—there’s just so much great variety and diversity of people to speak to and learn from. 

Just last week, I was at Harvard Law School speaking to lawyers who specialize in international humanitarian law. They’ve also deployed into disaster zones, and it was just so interesting to hear their perspective and how differently they see things. Their work is so important and you quickly realize just how complex disasters are. Medicine is just a small cog that makes the hand move so I always try to take a step back and try and understand all the pieces that make up the bigger picture.

How is the field of disaster medicine changing?

The vast majority of people going into disaster medicine historically came from an emergency medicine or critical care background. There’s a natural attraction for this, but now we’re at a point where we’re starting to mature and there’s increasing recognition of Disaster Medicine as its own standalone specialized field. The clinical knowledge base is quite different and unique and the skills needed, things like crisis leadership training and emergency management, are also quite unique and not always taught in the other various critical care subspecialties. Historically that’s how subspecialties emerge… they branch out from something that already exists and eventually, matures to become its own independent entity.

What do you like to do in your free time?

Coming from Australia, surfing is our national pastime, so when I’m at home, I spend a lot of time in the water. We know how important physical health is to mental sharpness. Deployments can be physically very taxing so I try to stay fit and crossfit instead when the surf is flat or in the winter, when the water looks a bit murky and feels a bit sharky.

But what they say is really true — when you really love your work, it doesn’t feel like work. I love the educational aspects of medicine in general, so I spend a lot of time building lectures and looking at specific disaster related topics to learn more and contribute more during my downtime, as geeky as that sounds! 

We’ve also recently welcomed a little addition to our family, a beautiful little girl so i have been spending a lot more time at home helping our baby explore the world and watching her grow.

What advice would you give anyone interested in this field?

The World Association for Disaster and Emergency Medicine (WADEM) is a great place to start. They are a very well established international organization that really brings together the experts around the globe and opens up a lot of interesting discussions and conversations around the topic. WADEM’s next conference will be in Dublin next year and we’re all very much looking forward to catching up with everyone. I'm also more than happy to connect with anyone that wants to learn more about Disaster Medicine. I am fairly active on Linkedin where I post a lot of updates and interesting articles I come across but anyone can contact me via email as well!

Derrick Tin

Senior Fellow Disaster Medicine

BIDMC/ Harvard Medical School

Associate Professor Critical Care

University of Melbourne

Interviewed and compiled by Felicia Ho