TO QUOTE James Bryce: “Medicine is the only profession that labours incessantly to destroy the reason for its own existence.” Dr. Roslyn Bascombe-Adams, the deputy director of the Emergency Department and Hyperbaric Services at King Edward VII Memorial Hospital knows this better than anyone.This self-proclaimed workaholic admits that even after spending hours at the hospital dealing with her day to day overseeing of patient care and staff, she still finds the time to train EMT staff, is the chairperson of the Hospital’s Disaster Preparedness and Response Committee (DPRC), serves on the National Emergency Measures Organisation and is an active member of the Pan American Health Organisation, responsible for the training of some 200 staff every year.

It was this dedication to her profession that caught the eye of the Department of Health, that recently presented her with the Public Health Professional Award for going beyond the call of duty.

Presenting her with the award last week, Acting Minister of Health, Philip Perinchief said: “This remarkable individual did not have to contribute to any of the above mentioned initiatives. She chose to participate out of sheer commitment to the community and the principles of public health. Her job could easily limit her duties to day to day patient care, but she sees the value of collaborative working and truly lives up to it.”

Dr. Bascombe-Adams arrived in Bermuda from St. Vincent and the Grenadines in 1998 to work as a full-time night physician.

She was appointed deputy director of the Emergency Department and Hyperbaric Services in 2003 where today she assists with the administrative side of the two departments.

This includes scheduling physicians and staff and training EMT staff.<\p>She is also responsible for the continued medical education of nurses.

“I love interacting with patients,” she says, adding that her role as deputy director still allows her a fulltime clinical shift. “So I spend just as much time on the floor as any other physician.”

One of six children Dr. Bascombe-Adams recalls being the one to “patch up” her siblings as her mother could not stand the sight of blood.

“From a young age I was the one cleaning the bruised knees. I liked to do it ... my mum noticed that I liked to do it, so she just let me,” she recalls with a laugh.

She adds that she seriously entertained the idea of nursing, but after doing well in her A-levels set her heart on becoming a physician.

Dr. Bascombe-Adams studied at St. George’s University School of Medicine in Grenada, followed up with her sub-internship in England and completed some electives in the States, working in the New York area before coming to Bermuda.

“I’m an island girl by heart,” she says with a broad smile.

As for challenges over the years, Dr. Bascombe-Adams says being a female doctor is not always easy: “Especially in the Caribbean where we still struggle to hold our own. I recall being called doctoress a couple of times and even now in this environment, the male nurse will go in to see the patient and I will go in after and they will say, ‘Oh the doctor came and then the nurse’ so we are still being stereotyped.”

She adds:: “When I tell them I’m the doctor, it’s usually followed by profuse apologies.”

The one area of her career that she is particularly passionate about is her work with the Pan American Health Organisation as a mass casualty management instructor.

Every year she is sent to different areas to facilitate workshops on the medical aspects of disaster management.

Dr. Bascombe-Adams believes there is still so much to learn about dealing with mass casualities in a challenging setting like Bermuda, which only has one hospital.Using the recent massacre at Virginia Tech as an example, she says something like that happening in Bermuda would be “trying” as many of the victims would be known to the responders, who would be either relatives or close friends.

“We teach in mass casuality situations that you need to be as impersonal as possible because the object is to save as many as you can and cause as little lasting trauma, so that mortality is low,” she explains.

In Bermuda plans on dealing with mass casualities have been streamlined over the last five years: “We have adapted the Pan American Health Organisation model which involves setting up an advanced medical post on the field and moving supplies to the post to stabilise the victims there, and then transfer them in a less hurried way to the hospital.”

She points out that this is important in a community served by only one hospital because despite the major emergency, the hospital would also be dealing with day to day emergencies like heart attacks, asthma attacks and deliveries.

“We want to minimise the disruption that the disaster would have on the day to day function of the institution and that’s where the advanced medical post concept is crucial,” she says.

KEMH came one step closer to this realisation last year with the donation of a special EMT vehicle which will be used to move medical equipment to any scene.

However disaster scenarios in Bermuda do not include a Virginia-type massacre, but rather a plane crash, or fire on board a cruise ship.Dr. Bascombe-Adams says she always tells her trainees: “The longer it takes to have something in your area, the closer you get to when you have a disaster in your area, because it’s really just a matter of time.

“We have to strengthen our capacity on the island to deal with aircraft incidents simply because of volume. With 200 to 300 passengers on a flight, if we had a crash landing then we would have a major incident on our hands.”

She said the other possible scenario which would be “overwhelming” would be a fire on board a cruise ship, simply because KEMH does not have a burn unit, so all critically injured patients would need to be air lifted off island.

While Dr. Bascombe-Adams is optimistic that Bermuda can deal with such emergencies, she questions whether they can be dealt with effectively. “We depend a lot on the prevention systems and early recognition and intervention, which the cruise ships recognise and have in place.”

This includes having faith in airlines that they service their aircraft appropriately so incidents do not occur.

But she adds that being mid-Atlantic, it is not uncommon for both aircraft and seafaring vessels to be diverted to the island with medical emergencies.

“We have at least two medical diversions a week for passengers who become unwell, so we have aircraft and captains who are landing in an unfamiliar place, and if the weather is bad at a time when this sort of thing happens, the potential is there for something catastrophic to occur,” she warns, adding that a bus loaded to capacity at the height of the season leaving the road could also be catastrophic.

“We hope it never happens and that’s what disaster managers do; they prepare for things they hope will never happen, but God forbid it does happen, we need to be able to maximise what we have on the ground to save as many as we can, given what we have to work with.”