Mission to Haiti

At this year’s Annual Business Meeting & Reception, attendees heard from registered nurses Karen Slutsky and Dominic Parone from Cooper University Hospital, who traveled to Haiti with a government team to aid victims of the earthquake last winter. Following the events of 9/11, Nurse Slutsky joined the New Jersey Disaster Medical Assistance Team (DMAT), which functions as part of Federal National Disaster Response Teams. She has responded to many disaster situations since joining NJ-DMAT. The Haiti mission was Nurse Parone’s first deployment since he joined DMAT shortly after Hurricane Katrina. Nurse Slutsky provided general information about responding to disasters, and Nurse Parone spoke about the clinical care they provided during the Haiti mission.

Nurses Slutsky and Parone joined us for dinner after their presentation

Nurse Slutsky indicated that one must be part of a team to successuly participate in humanitarian missions. Besides DMAT, the Red Cross, Medical Reserve Corps, religious groups, hospital groups, and federal organizations are all organizations through which one can volunteer to help. She joined DMAT for several reasons:

• Security was provided, so there was less chaos
• Members received specialized instruction that enabled them to succeed in their mission
• Supplies were often provided
• Transportation was often provided
• DMAT, now under the aegis of the Public Health Service and formerly under FEMA, is government-supported. Accordingly, as soon as team members were activated, they became federal employees.

In order to join such an organization you must provide proof of your clinical credentials. You must also have a passport and undergo fingerprinting and a background check. You must show your commitment to the cause. Lastly, you must provide your own survival gear and be able to carry it.

Activated
Often the first mention of a disaster comes through the news media; when members hear of a disaster they must start packing and alert everyone involved in their lives that they will be activated shortly. They must check their emails for specific instructions as more information becomes available. Then they wait: the government of a country that has experienced a disaster must formally ask for assistance from other countries and specify what assistance is needed (search and rescue, food and water, medical supplies, medical personnel, security support, etc.); only then can forces be deployed. In the case of Haiti, the disaster occurred at 3 p.m., team members were activated by 6 p.m. and were on a plane to Haiti by midnight. On the plane they received their immunizations for malaria, tetanus, and typhoid.

Once they arrived, they were delivered by dump truck to the U.S. embassy, where they slept on the grass that evening. A line of U.S. citizens extended around the block: people watiting to get processed to catch a cargo plane home. Some people waited in that line up to five days, during which the team provided food, water, and medical care to U.S. citizens; only basic medical care was provided to any non-citizens at the embassy. Meanwhile, the Coast Guard examined the coast to determine whether the team’s skills were a good fit for the needs of survivors there. As there was not a good fit, the team was instead sent to a university hospital under military escort; they were not allowed to go anywhere without military security. There they experienced an aftershock registering 6.0 on the Richter scale, and people went outside for safety. Although they treated many people for burns, fractures, crush injuries, and infections, surprisingly little or no sedation was used for procedures; the people had an incredibly high tolerance for pain.

The team was also deployed with another DMAT team from California to a country club sixteen miles from the epicenter of the earthquake. They often had to fashion tents from sheets. Three tents were used for triage. Medical teams treated, stabilized, and moved patients back for supplementary services. Treatment notes were taped directly onto the patients to communicate transfer information to other facilities. During her time there, Nurse Slutsky delivered two babies.

Some team members served on strike teams, going further afield to deliver care in the street and refer victims to specific facilities. They were able to receive satellite images indicating clusters of people needing assistance. Due to the language barrier, they usually needed a translator to help them.

Challenges
The team faced many challenges on their mission. It was difficult to move to locations due to the lack of street signs and addresses. They were plagued by insects. Not enough people spoke English–most spoke Creole or a little French, and finding translators was difficult, but each patient team included a doctor, nurse, and translator, even if the translator had to be borrowed from another team. Updrafts from arriving helicopters blew dirt around and lifted tents up, so they often had to stop what they were doing to hold the tents down. It was also difficult getting people to tents, especially amputees and people with fractures, but people supported one another, volunteering to be litter bearers and in some cases carrying the wounded on their backs.

When their mission was over, they left their equipment there. A non-governmental organization took over, including a group formed by actor Sean Penn. The rainy season approached after Nurses Slutsky and Parone returned home. Nurse Parone indicated that coming home was a big adjustment. Team members were debriefed and were given medical exams. Astonished by the amount of pain the victims had to endure when first injured and then when receiving treatment without adequate pain medication, he wonders about the pain experienced by his patients back home.

Additional information about the team from Cooper Hospital is available at <http://abclocal.go.com/wpvi/story?section=news/health&id=7251183&rss=rss-wpvi-article-7251183>.

-RR