GOVERNMENT REPORTS: Inside Haiti’s makeshift hospitals Monday LEGS/ARMS REMOVED WITH RIP SAWS – NO ANESTHETIC

May 03, 2010

Chris Van Gorder, president and chief executive officer of Scripps Health, a nonprofit community-based health care delivery network in San Diego, visited Haiti three times to help provide medical care to the victims of the earthquake. Gorder spoke to Government Health IT about the technology tools that were useful to his medical team immediately following the catastrophe and the information that he wished they’d had. The interview is part of our story this month on the use of new mapping technologies that are changing the approach to catastrophic disaster response.

Here are excerpts of our interview:

Q: Describe your visits to Haiti.

A:  I went in on January 22 with our chief medical officer, Dr. Brent Eastman. We went to the Hospital St. Francis de Sales, which was one mile from the epicenter in downtown Port au Prince. The building was virtually destroyed. There was a four-storey pediatric unit that had 200 bodies encased in the building. That’s where we ended up working for two days. I was the scrub nurse for Dr. Eastman, who is a general, vascular and trauma surgeon. We went back again on January 27 for another week. This time we went back in with two trauma surgeons, two anesthesiologists, four nurses and two support people. We went back a third time in March.

Q:  What technology did you bring?

A:  The first time, we went in with satellite phones, our BlackBerries and our regular cell phones. The cell phones worked pretty well there, and we had e-mail and telephone communications. The satellite phones were less efficient than using the cell phones. We were able to get information and photos back to our people in San Diego. You need to understand that amputations were being done by rip saws. There was no general anesthesia. We had no oxygen. This was only a little better than Civil War-era medicine. When we went back to Haiti a second time, we brought our own anesthesia. We brought our own surgical instruments. We ended up bringing cautery. We brought in what we needed, but we had very little information technology. Our medical records consisted of writing on bandages. There was no technology available for us to use except for communications technology. I can’t imagine how isolated we would have been without our BlackBerries and iPhones.

Q:  Were you provided with any information from the Centers for Disease Control or other government agencies about the location of acute care patients in Haiti?

A:  We could see that material coming across the Internet, but we were not getting any information directly from CDC. The people in the command posts were getting all of that information, and they weren’t bothering us with it. We were in the thick of things in the operating room. So it wasn’t our job to worry about what was working or not working in Haiti. Our job was taking care of patients.

Q:  Was any mapping information useful in your work with patients?

A:  We did use Google Maps to get a sense of the damage in the area of the hospital, in Port au Prince and on the roads. We used it to access routes from the hospital to the airport, which is where patients were being transferred.

Q:  Did you use any crowd-sourcing tools such as Twitter to gather information about the conditions in Haiti?

A:  We did follow some blogs, so we had a general sense of what was going on from the people in Haiti. The information that we could get off of Twitter was more accurate than anything we heard from an official source, and it was far more timely.

Q:  Based on your experience, what type of medical or public safety information would be most useful to you as the head of a responder team preparing to go into a disaster zone?

A:  You need any intelligence from the military or the State Department if it’s an international disaster to make sure that they know where you are in case the situation starts to deteriorate. No medical response team can do anything useful if their own safety is at risk. It would help if there was technology available that said where doctors were needed and where they were not needed so we could have deployed medical resources more fairly. There’s no doubt in my mind that people died because we didn’t know where to deploy medical people coming in from the outside.

Q:  Did you come away from your experience with any new ideas or conclusions about how to best manage a crisis like this from your perspective as a volunteer?

A:  The level of care we provided was so basic. We were not using the technology to care for the patients. I believe it’s really critical for every person to have a BlackBerry so they can stay connected to the outside world and stay connected to each other. When you go in for the second or third response, then you can talk about telemedicine and the ability to connect with specialists back home. It would help to have the ability to connect with hospitals in the U.S. that can take patient referrals. That kind of technology is important in the second stage of the disaster.

Q: Any other thoughts on your experience in Haiti?

A: In Hurricane Katrina, 2,000 people died. We had 230,000 dead in this country. I’ve never seen anything like it, and I hope I never see anything like it again. The fact that we had any technology that worked was an extraordinary blessing, and that we were able to connect with the world, with the military and the Embassy.

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