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The New England Journal of Medicine Showcases Miller School Insights on Providing Rapid Medical Relief in Haiti

2/24/2010

In an article published today in The New England Journal of Medicine, six Miller School faculty members involved in the University's initial response to Haiti's catastrophic earthquake shared valuable insights on organizing immediate emergency care for future disasters.

The article, "Rapid Medical Relief - Project Medishare and the Haitian Earthquake," was published in the prestigious weekly journal's online Perspective section.

The authors are Enrique Ginzburg, M.D., professor of surgery and co-director of neuroscience intensive care; William W. O'Neill, M.D., executive dean for clinical affairs; Dean Pascal J. Goldschmidt, M.D., senior vice president for medical affairs and CEO of UHealth; Eduardo de Marchena, M.D., associate dean for international medicine; Daniel Pust, M.D., surgical critical care fellow; and Barth Green, M.D., professor and chair of neurological surgery whose 15 years of humanitarian work in Haiti with Project Medishare facilitated the rapid response.

"The report is important because we think it serves as a model for future medical relief crises, such as earthquakes," O'Neill said. "This won't be the last earthquake in the Western Hemisphere and medical organizations have to be prepared to provide emergency medical relief."

Accompanied by four pictures, the article chronicles how, just 20 hours after the late afternoon earthquake, a five-person team led by Green arrived in the devastated capital of Port-au-Prince on a donated jet and immediately began treating 225 severely injured Haitians in two United Nations storage tents with limited supplies and no lab tests.

"The injuries included open and closed long-bone fractures, suspected pelvic and spinal fractures, complex open wounds, and crush injuries, as well as severe dehydration," the article said. "The only medical supplies were those brought by the initial corporate jet. On day 1, the overwhelming need was for intravenous hydration, narcotic analgesics, and casting supplies for splinting of fractures."

By day 4, with the initial team fortified by reinforcements and new supplies, a provisional operating room was created and doctors performed 12 operations, including nine amputations and three open debridements and fasciotomies. When four patients with crushed limbs died from sepsis and more supplies arrived from Miami, doctors initiated a more aggressive surgical approach on unsalvageable limbs and switched to broad-spectrum intravenous antibiotics.

"With this strategy, the condition of many patients with impending sepsis stabilized and improved, and we lost no further patients from sepsis," the article said.

Neither did tetanus claim any patient who was brought to the University's makeshift emergency clinic for initial care, probably due to the policy of immediately treating patients with toxoid on admission, the article said.

By the end of the first week, with a rapidly assembled command center in Miami coordinating the arrival of additional medical relief workers and supplies, more than 100 volunteers had treated 425 severely injured, immobile patients. By then, the authors said, it was clear the U.N. compound was an inadequate field hospital, and plans were well under way to assemble the four-tent compound that is now the University of Miami hospital in Haiti.

"Our experience," the article concludes, "indicates that small, correctly staffed and equipped teams arriving in small jets and with knowledge of the region can provide effective first-response medical care to remote locations within hours after an earthquake. A command center that can organize and supply needed volunteers and needed supplies as conditions change at the disaster site is key."

The article may be viewed in its entirety in The New England Journal of Medicine.