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Dome - Looking Back to See Ahead

June 2010

Looking Back to See Ahead

By: Mark Guidera
Date: June 7, 2010

A Hopkins medical disaster team brings back its successes and lessons from Haiti.

Thomas Kirsch, emergency medicine physician and Hopkins Go Team leader for the earthquake disaster mission to Port-au-Prince, Haiti, holds up an IV in one of the medical treatment tents.
Thomas Kirsch, emergency medicine physician and Hopkins Go Team leader for the earthquake disaster mission to Port-au-Prince, Haiti, holds up an IV in one of the medical treatment tents.

Working in tents set up outside an earthquake-damaged hospital in Port-au-Prince, a group of disaster-trained Hopkins doctors and nurses toiled in overdrive to treat an estimated 250 patients a day, a number that quickly soared to 500. They were driven by their desire to care for the victims and to carry out their mission. Not surprisingly, physical fatigue and mental burnout became top concerns.

“Staff health is the first priority when responding to a disaster,” says emergency medicine physician Thomas Kirsch, a member of the Go Team, the highly specialized medical staff organized and supported by the Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR). To address this issue, Kirsch put into place a system of mandatory time off and breaks to eat and hydrate.

This was just one of the many lessons that the Go Team brought home with them from a successful mission to Haiti—an experience that will likely expand the group’s reach from national to global disaster response. 

The unit of 185 doctors, nurses and other medical experts who are trained to respond to disasters was originally established to deploy medical assistance when calamities strike in the United States. But the Haiti crisis last January loomed so large—and so close—that senior team leaders believed they should move personnel into the country.

Despite a number of hurdles—supplies, reliable transportation and physical safety concerns among them—four separate missions were carried out to help Haiti’s earthquake victims. All told, 13 doctors and nurses were deployed under the banner of the Go Team. 

The first unit that went helped staff a damaged hospital in Port-au-Prince, while other missions were carried out onboard the Navy’s floating hospital, the USNS Comfort.

The complicated logistics of getting team members into Haiti proved to be yet another learning experience for emergency medicine physician and Go Team director Christina Catlett, along with other CEPAR senior executives.

James Scheulen, CEPAR’s executive director, says the Haiti missions showed that the team could perform well under difficult conditions in the field. For example, Kirsch and other leaders of the unit sent to Port-au-Prince quickly took over the daily operations of medical tents that were set up outside the damaged hospital and brought order to an inefficient triage and treatment system.

Another big plus of the missions, Scheulen says, was the valuable lessons about how the team’s structure, operations and mission might be adjusted to respond to future large-scale disasters.

For example, team members stationed in Port-au-Prince were met with a severe shortage of proper equipment and medicine and had to improvise often to treat patients the best that they could. Other team members struggled emotionally when they had to release patients with amputations or serious injuries, knowing they had no rehabilitation clinics or other health care support system to turn to once home.

“But I’m convinced that the way we faced these challenges,” Catlett says, “will really strengthen how the Go Team responds to future disasters.”

Some of the ideas CEPAR and Go Team leaders are discussing or pursuing:
• Potentially expanding the Go Team’s mission to serve as an international disaster response team, not just one set up to serve in the United States.
• Recruiting more members with specific medical expertise, such as pediatric nurses, neurologists and general surgeons.
• Solidifying relationships with the U.S. Navy or other military units, as well as with non-governmental organizations to ensure that future Go Team missions have reliable transportation, food and supplies in a disaster zone and thus can operate safely and
• Offering more in-depth training in what experts call austere medicine, or treating patients when proper diagnostics, medicines and medical specialists are in very short supply or nonexistent.