View From the Ground

Between three functioning operating rooms, our team performed 15 to 20 daily operations for two weeks. The most common operations were amputations, extensive wound debridement and external fixation of open fractures. The injuries were almost all orthopedic. By the time patients were extricated from the rubble, almost anyone with a significant abdominal, thoracic or head injury had not survived, or didn't make it to a hospital.

A lesson we learned: In the aftermath of catastrophes, patients with access to transport will not wait for field hospitals and mobile clinics to set up within disaster zones, but will self-evacuate to peripheral treatment centers not directly impacted. These treatment centers represent an important reservoir of surge capacity. The rapid deployment of support teams to peripheral sites is a promising strategy.

SIDEBAR: LESSONS LEARNED

• While all deployments require significant preparation of administrative, leadership, assessment and field teams, each deployment hosts its own dynamic variables as well. Organizations and their personnel must be flexible and adaptable to overcome such challenges. Continuous evaluation, strategizing and communication among the field, home and leadership teams is necessary.
• Personnel cannot underestimate how their environment can affect them. There needs to be continuous monitoring of individuals, teams, stress and dynamics. Debriefings are an important part of the day.
• Early participation with other organizations can increase efficiency, but event evolution may cause organizational mission drift. If an organization desires to continue operations in a disaster area, it must be flexible enough to do so.
• Teams must allot more time than is usually necessary to accomplish tasks.
• Space out experienced members among teams for greater ease in adapting to situations and changes in environment and mission.
• Local leaders and volunteers know what is happening where, how, when and why. Utilize the community that directly benefits from its own involvement.
• An organization's niche fills a need in the greater system. Seek relationships that are symbiotic for greater effectiveness and efficiency.
• Be prepared with the right equipment and seek potential resupply channels before resources are depleted.

   David A. Violante, MPH, EMT-P, is a member of NYC Medics and has served on missions to Haiti and Pakistan. He is assistant director of EMS for the Arlington Fire District in Poughkeepsie, NY. Reach him at david.violante@gmail.com.

    Sean M. Kivlehan, MD, MPH, NREMT-P, is an emergency medicine resident at the University of California San Francisco and a former New York City paramedic for 10 years. Contact him at sean.kivlehan@gmail.com.

   Ruben Flores, EMT-P, is the cofounder and director of operations for NYC Medics. He previously worked as a paramedic in the New York City EMS 9-1-1 system, and with the Mexican Red Cross. Reach him at ruben@nycmedics.org.