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N Engl J Med. Civil?Military Collaboration in the Initial Medical Response to the Earthquake in Haiti
Civil-Military Collaboration in the Initial Medical Response to the Earthquake in Haiti (N Engl J Med., perspective, extract, edited)
Published at www.nejm.org February 24, 2010 (10.1056/NEJMp1001555)
Civil?Military Collaboration in the Initial Medical Response to the Earthquake in Haiti
Paul S. Auerbach, M.D., Robert L. Norris, M.D., Anil S. Menon, M.D., Ian P. Brown, M.D., Solomon Kuah, M.D., Jennifer Schwieger, M.D., Jeffrey Kinyon, D.O., Trina N. Helderman, M.D., and Lynn Lawry, M.D
Two days after Haiti's devastating earthquake, a medical relief team made up in part of four emergency physicians and four emergency nurses from Stanford University Hospital and three emergency physicians from Columbia University Medical Center traveled under the auspices of the International Medical Corps, a nonprofit organization based in Los Angeles, to provide emergency medical support. After an all-night bus ride from the Dominican Republic, the team arrived at the H?pital de l'Universit? d'?tat d'Haiti in Port-au-Prince on the morning of January 17. The scene we faced was apocalyptic. Approximately 800 victims were within the hospital compound, most of them outdoors. A damaged building was filled with the patients deemed in greatest need of emergency surgery. Hundreds of patients awaited evaluation and treatment. An internal medicine ward was packed with patients with crush and other severe soft-tissue injuries, amputations, open and infected fractures, compartment syndromes, hemorrhagic shock, and other conditions threatening to life and limb. In a central wooded area outside, the ground was barely visible for the suffering people, many of whom had distorted limbs, maggot-infested wounds, deforming facial injuries, skull fractures, and spinal cord injuries. A single operating room with a few tables was staffed by overworked surgeons who amputated limbs and d?brided infected tissue. The morgue was overflowing, and approximately 40 bodies were stacked near the medical ward.
For the next 2 days, we practiced continuous battlefield medicine. Working side by side with a few other physicians and nurses, we did our best to evaluate every patient. Two of our physicians and two nurses initially staffed the preoperative area, one physician and a nurse cared for 60 to 80 critically ill patients in the ward, two physicians and a nurse triaged and treated the patients outside, and the remaining physicians and nurse assisted in areas of greatest immediate need. We carried backpacks filled with syringes of injectable narcotics and antibiotics to reduce pain when splinting shattered bones and to treat infections. We improvised by adding povidone?iodine to saline-filled intravenous bags to irrigate wounds before dressing them. We rapidly exhausted our supplies of splints and casting material. Since there was no cold chain (temperature-controlled supply chain), we could not store either tetanus toxoid or tetanus immune globulin. The stoic patients endured our treatments and thanked us.
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<cite cite="http://content.nejm.org/cgi/content/full/NEJMp1001555?query=TOC">NEJM -- Civil-Military Collaboration in the Initial Medical Response to the Earthquake in Haiti</cite>
Civil?Military Collaboration in the Initial Medical Response to the Earthquake in Haiti
Paul S. Auerbach, M.D., Robert L. Norris, M.D., Anil S. Menon, M.D., Ian P. Brown, M.D., Solomon Kuah, M.D., Jennifer Schwieger, M.D., Jeffrey Kinyon, D.O., Trina N. Helderman, M.D., and Lynn Lawry, M.D
Two days after Haiti's devastating earthquake, a medical relief team made up in part of four emergency physicians and four emergency nurses from Stanford University Hospital and three emergency physicians from Columbia University Medical Center traveled under the auspices of the International Medical Corps, a nonprofit organization based in Los Angeles, to provide emergency medical support. After an all-night bus ride from the Dominican Republic, the team arrived at the H?pital de l'Universit? d'?tat d'Haiti in Port-au-Prince on the morning of January 17. The scene we faced was apocalyptic. Approximately 800 victims were within the hospital compound, most of them outdoors. A damaged building was filled with the patients deemed in greatest need of emergency surgery. Hundreds of patients awaited evaluation and treatment. An internal medicine ward was packed with patients with crush and other severe soft-tissue injuries, amputations, open and infected fractures, compartment syndromes, hemorrhagic shock, and other conditions threatening to life and limb. In a central wooded area outside, the ground was barely visible for the suffering people, many of whom had distorted limbs, maggot-infested wounds, deforming facial injuries, skull fractures, and spinal cord injuries. A single operating room with a few tables was staffed by overworked surgeons who amputated limbs and d?brided infected tissue. The morgue was overflowing, and approximately 40 bodies were stacked near the medical ward.
For the next 2 days, we practiced continuous battlefield medicine. Working side by side with a few other physicians and nurses, we did our best to evaluate every patient. Two of our physicians and two nurses initially staffed the preoperative area, one physician and a nurse cared for 60 to 80 critically ill patients in the ward, two physicians and a nurse triaged and treated the patients outside, and the remaining physicians and nurse assisted in areas of greatest immediate need. We carried backpacks filled with syringes of injectable narcotics and antibiotics to reduce pain when splinting shattered bones and to treat infections. We improvised by adding povidone?iodine to saline-filled intravenous bags to irrigate wounds before dressing them. We rapidly exhausted our supplies of splints and casting material. Since there was no cold chain (temperature-controlled supply chain), we could not store either tetanus toxoid or tetanus immune globulin. The stoic patients endured our treatments and thanked us.
(...)
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