View From the Ground
Lessons learned by an American assistance group on the ground following an international disaster
Just as it is important to be prepared for expected injuries and illnesses, teams cannot overburden themselves with supplies unlikely to be used. In Haiti, the most common injuries were soft tissue trauma, crush injuries and bone fractures. Wounds were often dirty and infected, requiring extensive debriding prior to bandaging. Local anesthetics, debriding equipment, betadine, bandaging supplies and antibiotics were needed most. Suspected fractures were diagnosed by traditional physical exams and splinted or casted as necessary using fiberglass, since it required much less water than plaster.
Whereas referrals to definitive care would be the normal standard, this was not possible during the acute response phase. Functioning stationary and surgical field hospitals had high triage standards: Closed femur and pelvic fractures were not considered for surgery. Such patients were treated by casting and had to wait days for admission. Common medical conditions included pain management, dehydration, upper respiratory infections and flulike symptoms. Many people were treated with Tylenol, oral rehydration fluids and oral antibiotics, respectively.
Supplies not extensively needed included sutures, IV supplies and airway equipment. Most soft tissue injuries were a few days old and at too high of an infection risk to close. Aside from the orthopedic and trauma cases encountered, most severely ill or injured patients had either been treated or deceased within the first few days of the disaster. Responsible donating is important for any organization, as it reduces waste of unusable donations. While thousands of dollars of useful in-kind donations were received, some, such as bovine skin grafts, were impractical and had to be refused.
Other challenges inherent to disaster situations are exposure to the elements, crowds and animals/insects/disease. Luckily, there was no rain during the mission; however, shade was in short supply, and temperatures often reached over 100°F. Natural barriers, tarps and careful placement of clinic areas helped mitigate such issues. Stray animals rarely presented a problem, but they do create risks for rabies, infestations and potential attacks. Insects provided a unique problem outside the anticipated malaria and dengue concerns: Keeping flies out of wounds while cleaning and bandaging was a constant challenge.
The lack of dependable follow-up was a perpetual issue and partially solved by educating patients and providing supplies for cleaning and redressing, information about signs and symptoms suggestive of infection, and instructions to seek further care as needed.
CARE FROM WITHIN
The nature of NYC Medics' small and mobile teams necessitates operating from within the communities needing help. Accordingly, team members face similar risks as everyone else. Daily mission planning must account for such situations. Vaccinations and malaria prophylaxis depend on the general mission area, but potable water purification and dried food are necessities. Some local foods and bottled beverages are safe, but access is never guaranteed. Additionally, if international staff rely on local foods, this eventually leads to price inflation, which can accentuate scarcity.
Success is the result of many people at many levels working together with the end in mind. How can we take care of a community in need that has not been reached? It takes not only organization, planning, communication and funding, but experience, adaptability, improvisation, flexibility and commitment.
For more on NYC Medics, visit www.nycmedics.org.
SIDEBAR: RAPID SURGICAL RESPONSE TEAM
The Rapid Surgical Response Team NYC Medics sent to Haiti, composed of trauma surgeons and anesthesiologists, responded to Hôpital Albert Schweitzer (HAS), a tertiary care center outside Port-au-Prince. Members of the team had an established relationship with the hospital and correctly assumed it would require additional staffing. Arriving five days after the earthquake, the team found HAS had not been damaged and was well supplied with food, water and medical-surgical supplies, but the 80-bed facility was overwhelmed with more than 600 patients who had self-evacuated from the Port-au-Prince area, many requiring surgical intervention. Local staff was exhausted, and existing surgical capacity was being underutilized due to lack of staff.
