# Haiti Earthquake EMS response



## ExpatMedic0 (Jan 12, 2010)

Does anyone know if anyone (I.E. AMR DRT) is sending any employees for disaster response? I would be interested in possibly going if there was an opportunity. I know a major hospital has collapsed and it sounds like we will be sending resources.


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## MMiz (Jan 12, 2010)

I don't ever remember American Medical Response sending personnel for foreign incidents.


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## reaper (Jan 13, 2010)

Miami-Dade Task force is most likely halfway there by now. They normally respond to all international disasters like that.


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## Jeffrey_169 (Jan 13, 2010)

I made some calls this morning to see what people interested could do when I found out about it. I haven't heard anything yet, still waiting. 

From reports I have seen on T.V. and on Youtube.com it is horrible and almost unreal.


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## 46Young (Jan 13, 2010)

Fairfax County FRD USAR leaves Dulles Airport at 1200 hrs today for Haiti. Our OMD is a member of USAR, and always deploys. It's nice to have a physician on hand for medical direction, field amps and such. We have a good number of medics on the team as well.


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## Jeffrey_169 (Jan 13, 2010)

I will keep him in my prayers.


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## enjoynz (Jan 13, 2010)

Just a thought - Maybe try the Union Nations or the Government Dept in your State.
They  probably can put you in contact with the correct people?
It looks like the US are going to send a co-ordinated rescue team to Haiti. 
Other countries are doing likewise.
Good Luck and stay safe, if you do get to go!


Cheers Enjoynz


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## lightsandsirens5 (Jan 13, 2010)

I'd check and see if a FD in your area is sending a USAR. I would think that Portland is big enough to have one and they may go. Who knows. Let us know how it goes.


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## catskills (Jan 14, 2010)

Check out the Medical Reserve Corps.

http://www.medicalreservecorps.gov/UnitZipSearch.asp


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## JPINFV (Jan 14, 2010)

I'm going to make an argument that EMS is essentially worthless right now on Haiti. USAR? Yes. EMS? No. Given the damage, any hospitals that are left function are going to be overdrawn completely anyways. What is more important at this point is sanitation and potable water.


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## Jon (Jan 14, 2010)

Matt, Now that AMR has the FEMA DRT contract, it is possible.

I actually should get the rest of my app in to AMR's DRT for giggles.


But I've got to agree with JPINFV and question the purpose of the mission. Although it is also entirely possible that EMS providers will be used in a fixed clinical role, as some of my comrades from Katrina were.


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## Veneficus (Jan 14, 2010)

JPINFV said:


> I'm going to make an argument that EMS is essentially worthless right now on Haiti. USAR? Yes. EMS? No. Given the damage, any hospitals that are left function are going to be overdrawn completely anyways. What is more important at this point is sanitation and potable water.



Outstanding point


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## reaper (Jan 14, 2010)

I disagree. I think that an EMS response is needed there, Now. They have lost almost all hospitals and there is no medical response at all.

EMS in It's normal stage is not going to work. But, EMS workers providing any medical needs they can, is what is going to be needed. Basically work it like a large triage response. Provide what service you can, for the most people.


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## Veneficus (Jan 14, 2010)

*This is completely out of the league of most US EMS providers*

I think in the ideal EMS world it may be so. But the current idea of “start” triage and rapid transport simply will not work. In what is known as “refugee” conditions the highest causes of death and disability is trauma followed by public health complications. (dysentery, mal nutrition, etc) Most US EMS providers are not educated nor trained for such conditions. (obviously there are those who are) The mindset is totally different. You cannot focus on one patient, you must be constantly aware of your ever dwindling resources. People with what would seem minor injuries during a normal day will likely succumb to infection. There will be walking, talking people who will ultimately receive no help for the benefit of the most. 

During all of this it takes education and training that is simply not part of US EMS at large. Look at uniformed health services, there are nursing spots but not paramedic spots. As you pointed out, there are no hospitals to run to. Transfer to definitive care? The level of definitive is normally reduced.  Drop off 200 patients in a parking lot with a handful of doctors and nurses? Hardly helpful. Are these same providers going to independently take care of patients for days or weeks on site?

How about logistical support? Where would these providers stay? Who would be responsible for feeding them? How about hygeine?

FEMA? I Wouldn’t hold my breath waiting for them to help with anything except a post incident investigation of what went wrong. Right now one guy who can hammer boards together to make a hut or purify drinking water or set up a soup kitchen is worth 1000 EMS providers there. 

The reason we have a small amount of specific teams is so these people can be trained, equipped and supported while deployed. What about vaccinations? How is it a good idea to turn loose a bunch of wackers from the US in a tropical environment during a disaster? Not everyone is a wacker, but how do you screen for them if you just have open enrollment to go now? How do you ensure their home area isn’t negatively affected when you send them overseas? How do you account for and evacuate them when they figure out their family isn't independantly wealthy enogh to do without their income back home? Planning on paying them for their service? Who is responsible for their health and welfare? What if they are hurt or killed? What if they contract a communicable disease? Under who’s medical direction do they work? Most are certainly not educated enough to be let loose on the world without oversight. Who provides the oversight? 

What practical aspect of care are they going to provide? Inoculations? The Military and Uniformed service is more than capable with tremendous experience in the matter. Bleeding control? So what is the next step in bleeding control if you get the bleeding to stop? What are they going to do then? Sit them in line to see a doctor or get evacuated? Why do you need an EMT for that? What about the emotional aspects? Several here have recently stated they would do everything they could to give a kid a chance. In disaster medicine, old, previously ill, and very young are at the bottom of the resources list. Even if they survive the initial event, someday all this international help is going to dry up. They will not be able to survive on their own afterword. 

I could write a book on this matter, but the long and short is that while there are Medics and probably a handful of EMTs that could have a positive impact, that number is small, has not already been prescreened, largely without training, experience, or the raw knowledge to improve the situation, not capable of acting without oversight, and brings far too few contributions while being another mouth to feed, water, and a body to account for. Who is providing the PTSD counciling after they get home? Plan on just giving them disability with "thanks and best of luck?"


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## Jeffrey_169 (Jan 14, 2010)

I could not agree more with Reaper. This is what sets us apart from nurses; the ability to work in ALL weahter, in ALL conditions, and the ability to improvise and do what we can with what we have. You do not need walls to have a hospital; you need trained professionals willing to do whatever it takes to get the job done, and who are willing to improvise in the field to provide the best patient care possible. These people are accustomed to having little to nothing; I doubt they are going to less then extremely grateful for us doing the best we can with what is available. 

In the words of one of the refuges, "PLease help us...help us anyway you can".


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## reaper (Jan 14, 2010)

Veneficus said:


> I think in the ideal EMS world it may be so. But the current idea of “start” triage and rapid transport simply will not work. In what is known as “refugee” conditions the highest causes of death and disability is trauma followed by public health complications. (dysentery, mal nutrition, etc) Most US EMS providers are not educated nor trained for such conditions. (obviously there are those who are) The mindset is totally different. You cannot focus on one patient, you must be constantly aware of your ever dwindling resources. People with what would seem minor injuries during a normal day will likely succumb to infection. There will be walking, talking people who will ultimately receive no help for the benefit of the most.
> 
> During all of this it takes education and training that is simply not part of US EMS at large. Look at uniformed health services, there are nursing spots but not paramedic spots. As you pointed out, there are no hospitals to run to. Transfer to definitive care? The level of definitive is normally reduced.  Drop off 200 patients in a parking lot with a handful of doctors and nurses? Hardly helpful. Are these same providers going to independently take care of patients for days or weeks on site?
> 
> ...




I do not remember anyone saying that there should be an open enrollment for any EMT or Medic that wanted to go. We are talking organized teams. USAR only goes so far in these situations. The medical response that is there to help the masses is what does the most good.

I have seen this first hand. I have worked many natural disasters in many countries. The medical response provided to these people is what is the difference. You are not there to "save the world". You are there to provide the basic medical needs, that they no longer have available.

This has been done countless times in some of the worst areas of the world. An organized response is priceless to these people at this time. Yes, you have to have providers that can work independently and with few resources. You are not there to provide transport to a hospital or Dr. You are there to provide any medical care that can be done. Even if this means just providing comfort for the end of life.

A blanket statement that EMS is not needed, is ridiculous. Unless you have experienced this first hand, then you have no way of knowing what helps in these situations!


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## Veneficus (Jan 14, 2010)

EMS is not needed. 

What is needed is medical providers. As I eluded to, the already organized response is already being deployed. 

I do not know your background, but based on your posts here and good personal references, I do not doubt that you could be an asset. Maybe you know a handful of people who can. But I bet my last dollar it wouldn't be in the EMS role. Particularly as it is executed in the US.

I would imagine in your experience it was with the military or already organized expedition. But the heartfelt response of EMS providers is what leads to things like "staging point maveric" as demonstrated in the WTC attack and the risk and worry of "self dispatching." 

In the last 2 days I have had several people contact me, some who haven't been EMS providers in years, ask me how they could get involved and telling me how they might be able to contribute. 

But passionate as people may be, their involvement will mean little. Those who really want to be involved will start after this disaster for the next one. But i seriously doubt that even 25% of the people who are so passionate about helping today will be follow up after this leaves the news. Just as when the next disaster hits everyone and their brother will want to help at that moment. 

I apologize if you think my comments were an attack on you, it was not what I meant, but I did want to point out how complex the issue is and how little the average EMS provider would help.

After all, how much time in EMS education is spent on trauma or public health? A class? A week?

There is always the Advanced Disaster Life Support course. All there is to know in 14.5 hours. Outstanding. (that is after the Basic disaster life support course)


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## Jeffrey_169 (Jan 14, 2010)

I see the merits of Veneficus's argument, but I also see the merits of reaper's as well. My experience here in incidents of this size is limited, but I do think in the absence of a better solution something beats nothing. 

As for the opinions on FEMA, well they took a hard ht after Katrina, and truth be told the blame here is misplaced. There were hundreds, a thousand by some estimates, of school buses left in the wake of this, and they were destroyed. The mayor of LA said something to the effect of not wanting to demote the poor people of New Orleans by making them ride a bus to some distant and unknown destination. I guess he thought living in filth in the Super Dome was somehow more humane. Besides, the Gov. needed to call FEMA in advance and request their help, which she did not. The federal gov't cannot and will not intervene in the sovereign matters of a state, unless national security is at risk, unless they are asked by said state. I am no fan of FEMA, or any federal agency (they botch everything they set their hand to), but place blame where blame is due. Many people do not know the whole story, and the media didn't make it any better. 

IN any event, there are those here who know far more then I about the matters of mass causality and disaster services, so perhaps I too was out of turn. I don't know, I just think something is better then nothing, and too much is better then not enough; right?


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## MrBrown (Jan 14, 2010)

I agree with Veneficus; civillian ambo's have no real use in this sort of situation they may be able to perform some basic field triage and initiate one or two things like IV therapy or bleeding control but thats about it.

What these dudes need is high level infrastructure; surgeons, hospitals, intensive care consultants, stuff like that and I don't see a bunch of ambo's being able to provide that.

As for FEMA, where is that black dude with his shotgun from New Orleans off TV who was trying to shoot down Air Force One?


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## EMSLaw (Jan 14, 2010)

Yes, the usual EMS algorhythm that ends with transport to the ED is not going to work in this situation.  But even Doctors Without Borders was saying that all they can do in this situation is first aid care.  At least in these initial stages, I suspect that anyone who can make a basic patient assessment and apply a splint and bandage would be able to contribute.

That doesn't mean that everyone should run off, by the way.   I'm just saying - while EMTs and Paramedics usually focus on transfer to definitive care, their skills, with some little adaptation, would be applicable to this sort of disaster situation.

I agree, though, that people who want to volunteer for something like this should, instead of rushing off to Haiti, start looking now at what they can do to be ready for the next disaster, that way they actually will be valuable, instead of just in the way.


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## phabib (Jan 14, 2010)

Global Medic is sending a 5 person rapid response team. They'll send a mobile field hospital and water purification units.


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## Veneficus (Jan 14, 2010)

EMSLaw said:


> Yes, the usual EMS algorhythm that ends with transport to the ED is not going to work in this situation.  But even Doctors Without Borders was saying that all they can do in this situation is first aid care.  At least in these initial stages, I suspect that anyone who can make a basic patient assessment and apply a splint and bandage would be able to contribute.
> 
> That doesn't mean that everyone should run off, by the way.   I'm just saying - while EMTs and Paramedics usually focus on transfer to definitive care, their skills, with some little adaptation, would be applicable to this sort of disaster situation.
> 
> I agree, though, that people who want to volunteer for something like this should, instead of rushing off to Haiti, start looking now at what they can do to be ready for the next disaster, that way they actually will be valuable, instead of just in the way.




The first aid care is an extremely short period. By the tme you can deploy (the US govt. target is 48 hours) that type of care is not as critical or even useful. As of about 15 minutes ago what are being saught is: "Surgeons, ER doctors, nurses and full surgical teams."

The need is just a higher level than what EMS can do. It is one of the reasons outside of regional mutual aid contracts you never see somebody come on TV and say "If you are medically trained please report to you local fire station or hospital."  The resources those providers use is greater than the benefit they bring. It means individuals suffer, it sucks, but the bandage used to secure a splint is the same bandage that is better served packing a surgical repair. The same food and water is better served feeding the natives than it is to feed an EMS person who makes a very small difference. Boy scouts splint fractures, you don't need an EMT or a Medic. There is not going to be any wandering around the countryside distributing IV pain meds and fluids. Those are more resources that will be pooled and focused on the needs best served and done in other circumstances. 

I don't think anyone would dispute and EMS provider could bring a smile to somebody's face or reduce the pain of a handful. But again, you cannot simply send out for pizza or go to wal mart for bottled water, the resources a proider uses to bring that smile can cost somebody else or a greater number their lives. 

Where will the outpouring of support be 2 months from now, when what the populous needs is somebody to come over and rebuild a school? How many are going to set aside all their normal responsibilities in the spirit of altruism and go help hammer nails or give MMR injections? (my guess is the same ones doing it now) How about taking a week off of work to dig graves?

Like I said, in the ideal EMS world, providers would have the education and training to help. We do not live in that world.

Please keep in mind there is a difference between doing something to make one's self feel better during a catastrophe and actually helping.


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## lightsandsirens5 (Jan 14, 2010)

OK. TBoth sides are making great points here, but I think you are actually arguing along pretty parallel paths.

Who says that an EMS person cannot hammer nails or build a hut. Lots of us are perfectly capable of dong that and I would argue that in this situation we would be better than the average volunteer worker. We know how to work under stress, bad conditions, etc. Plus, my personal experience has shows me how simple and easy it is to switch from urban or civilized style EMS to field medical care.

No the people of Hati do not need amb crews or triage people. They need multi-purpose workers who have a heart to help people, who can work under authority, understand command structure, work with stress, etc. Well, who says that could not be a team of EMTs? Plus there you have the added benefit of some kind of medical knowledge if someone is injured or a victim is found. No, you cannot cut them open and fix their problem, but at least you know more than the average Red Cross food distribution person or church sponsored hut building crew. Yes, the kind of medical care neede there is not what we are used to, but like I said, what we know is easy to adapt and we are alot closer to that ideal "all around" responder.


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## GeekMedic (Jan 14, 2010)

Lightsandsirens5 sums it up quit nicely.  Our ability to improvise on the fly, multi-task and stay calm under pressure makes us useful when all hell breaks loose like that.

Like many, I wish I was going to help.

Good luck and stay safe to those who are.


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## Jon (Jan 14, 2010)

I've got at least one friend deploying on the USNS Comfort.

The wheels are turning. Folks are going. As is ALWAYS said, it will take several days for true relief to arrive.


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## firetender (Jan 14, 2010)

All you well-intentioned folk wanting to rush down to Haiti would do well to consider it would be a hugely gross extension/magnification of the biggest boondoggle for medics: you think you're there to save lives, but you end up as a horizontal taxi; except there, you wouldn't even have a rig to drive and your biggest service may be handling body bags; if there are any!

Sure, you can go there to help but be aware EVERY ASPECT OF YOUR LIFE WILL CHANGE, EVERY THOUGHT YOU'VE HAD ABOUT WHO YOU THINK YOU ARE AND WHAT LIFE IS ABOUT WILL CHANGE.

This is not meant to discourage, it's only outlining the stakes.


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## mycrofft (Jan 14, 2010)

*Central California USAR went yesterday*

Dogs and all.


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## VentMedic (Jan 14, 2010)

reaper said:


> A blanket statement that EMS is not needed, is ridiculous. Unless you have experienced this first hand, then you have no way of knowing what helps in these situations!


 
I have also been in many disaster situations and only those from EMS who have extensive additional training as it pertains to more advanced patient care than first aid, advanced training for SAR and those with a knowledge of public health are needed. For basic first aid services, the locals can be recruited to provide and thus conserving resources for essential personnel and the patients. Too many outside helpers can be as detrimental to recovery efforts as too few. Too many people with too few skills can also create chaos and exhaust resources rapidly.


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## 18G (Jan 14, 2010)

I think it is also ridiculous to say that EMS and emergency responders are not needed in a disaster such as Haiti. With over 50,000 deceased and hundreds of thousands injured, sick, and displaced, how would having EMS personnel not be of any great help? 

You say EMS is not needed, yet the Haiti ambassador specifically stated that they are in great need of emergency personnel. From what I been reading its a logistical nightmare there right now. What do you think the ratio of physicians to the sick and injured right now? A Paramedic would be useless? They couldn't assess and triage? Provide stabilizing care to those still trapped? Help with extrications? Give tetanus shots? Provide analgesia? Give fluids to the many that Im sure are very dehydrated? The list is endless.  

So now Paramedics and RN's can only provide "basic first aid"? That's interesting. Emergency personnel are trained and adapted to deal with disasters and have the mental ability to remain focused on the mission. The "locals" as you say have been through enough don't you think. They need help.


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## reaper (Jan 14, 2010)

As I stated before. I am not for cowboy responses. Organized teams of medical providers can do the best work.

That said. In the first 96 hours of a disaster response your Dr's,Rn's and surgeons are no better then your basic first aid.

In Mexico City there was a lot of Trauma Surgeons and Dr's that could not function for the first week. Trauma Surgeons are useless with out an OR to preform in. Most Dr's cannot preform on the streets without a hospital. There are teams of Dr's that train for just this and are excellent in the field. But, they are very few. The Rn's are a lot better, as they can preform well in these situations. Again, not enough of them to do the job.

What was utilized the most was the medical teams of Rn's and Medics. They were able to provide care with minimal resources.

As I stated earlier, disaster response is not about saving everyone. Those that need surgical interventions normally do not survive. The medical crews in the field are there to provide basic care and relief.

Yes, as part of an organized team, you need to have additional training in public health and disease transmission. Beyond that, most Medics are very capable of providing the medical treatments needed in these situations.

I encourage those that want to help in disaster response, to get the additional training needed join and organized team. For any future need.


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## VentMedic (Jan 14, 2010)

18G said:


> I think it is also ridiculous to say that EMS and emergency responders are not needed in a disaster such as Haiti. With over 50,000 deceased and hundreds of thousands injured, sick, and displaced, how would having EMS personnel not be of any great help?
> 
> You say EMS is not needed, yet the Haiti ambassador specifically stated that they are in great need of *emergency personnel.* From what I been reading its a logistical nightmare there right now. What do you think the ratio of physicians to the sick and injured right now? A Paramedic would be useless? They couldn't assess and triage? Provide stabilizing care to those still trapped? Help with extrications? Give tetanus shots? Provide analgesia? Give fluids to the many that Im sure are very dehydrated? The list is endless.
> 
> So now Paramedics and RN's can only provide "basic first aid"? That's interesting. Emergency personnel are trained and adapted to deal with disasters and have the mental ability to remain focused on the mission. *The "locals" as you say have been through enough don't you think.* They need help.


 
Emergency personnel is a broad term and does not necessarily mean EMTs.  

Have you even considered providing the food, water and housing of those going to assist?  Did you consider the water and food they are consuming could be used for the patients and residents of Haiti?   How many U.S. EMS workers fall to pieces if their AC isn't working well in their ambulance? How long do they work outside especially when the FD is also there to assist with extrication?   How many complain if they can't get 16 hours of sleep in a nice bed during their shift?   Yeah, the average U.S. EMS providers are well prepared to "rough it". 

How many also have all their vaccinations up to date? Passports and other proper paperwork?  Those who do participate in planning for large scale disasters are very well prepared.    Send over EMS providers who have had absolutely NO disaster training on this scale and where the only MCI they may have done is an MVC with 2 patients,  you just get many unprepared people who look as helpless as the victims of the disaster.  

If there is not some control over the providers responding it truly does become a logistical nightmare.

As you can see by the many threads on the EMS forums, many U.S. Paramedics disagree on how to triage in certain situations.  Thus, they are not prepared for something this large scale and right now is not the time to sort out all the U.S. EMS protocols and levels.  Hell, we can't even decide who in EMS can give out flu shots in the U.S.  If they have special training for a situation such as this, then yes their services might be very needed.     Very few in EMS have ever been part of a large scale disaster and few have received the training necessary to deploy to an area such as this.   There are many more health care providers who are better prepared including those in EMS from other countries who should be given priority to joining the medical teams.  

During the hurricanes, including a little category 5 named Andrew, we found that putting people to work kept tempers from flaring while they were living in tent cities worrying about what would happen next. They were more than happy to help their neighbors and community. 

Send the best trained emergency personnel and leave the egos out of this.  If you want to be part of an international emergency response team, find out what type of training and education will be required.  Enough with this egotistical whining especially if you have never worked a large scale disaster and especially without the comforts of your ambulance.  Again some put their own ego ahead of doing what is best for the patient and get into the never ending peeing match to which you believe you are better than any nurse and definitely as good as the doctors if not better.


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## VentMedic (Jan 14, 2010)

reaper said:


> In Mexico City there was a lot of Trauma Surgeons and Dr's that could not function for the first week. Trauma Surgeons are useless with out an OR to preform in. Most Dr's cannot preform on the streets without a hospital. There are teams of Dr's that train for just this and are excellent in the field. But, they are very few. The Rn's are a lot better, as they can preform well in these situations. Again, not enough of them to do the job.


 
Our team, which included the doctors/surgeons only stayed for 8 days and then rotated with another group.  Unfortunately there are still a few things required to do surgery safely or the patient dies of complications later which then makes all the efforts futile.  Few doctors want to do something knowing it will have deadly consequences later.


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## 18G (Jan 14, 2010)

> Emergency personnel is a broad term and does not necessarily mean EMTs.



When people hear the term "emergency personnel, they automatically think of Fire/Rescue and EMS. 



> How many U.S. EMS workers fall to pieces if their AC isn't working well in their ambulance? How long do they work outside especially when the FD is also there to assist with extrication? How many complain if they can't get 16 hours of sleep in a nice bed during their shift? Yeah, the average U.S. EMS providers are well prepared to "rough it".



This is an unfair generalization and stereotype. Yes, we do complain sometimes which I think is more out of humor than anything else. When it comes down to it and we need to perform in a priority situation, there are no complaints. 



> As you can see by the many threads on the EMS forums, many U.S. Paramedics disagree on how to triage in certain situations. Thus, they are not prepared for something this large scale and right now is not the time to sort out all the U.S. EMS protocols and levels. Hell, we can't even decide who in EMS can give out flu shots in the U.S.



So who than is better at triaging? Who do you recommend? A Paramedic knows how to prioritize care. Triaging by its nature is not perfect and some patients will get re-triaged with a different priority. That does not mean necessarily they were triaged wrong initially. Its an ongoing process.   

I don't know where your from, but in my region Paramedics are allowed to give flu shots. I have never heard any problem with this. 



> Send the best trained emergency personnel and leave the egos out of this. If you want to be part of an international emergency response team, find out what type of training and education will be required.



Nobody is saying a blanket response should occur. Although it sounds right now they need as much help as they can get. I agree responders should have some specialized training in disasters prior to responding. Hopefully, the responders would be working under some kinda structured command system and would receive their assignments and get daily briefings to enable them to do what needs to be done safely. Unless a person has functioned in a massive situation such as Haiti, I dont see how anyone could ever be fully prepared. 

You made a blanket statement that EMS is not needed there. I strongly disagree. EMS (Paramedics and RNs) would be a very valuable resource in Haiti right now.


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## VentMedic (Jan 14, 2010)

18G said:


> When people hear the term "emergency personnel, they automatically think of Fire/Rescue and EMS.


 
Only those involved in EMS believe that is all there is to the term. 




18G said:


> This is an unfair generalization and stereotype. Yes, we do complain sometimes which I think is more out of humor than anything else. When it comes down to it and we need to perform in a priority situation, there are no complaints.


 
Do you know everyone on the many anonymous EMS forums personally to know their sense of humor? 




18G said:


> So who than is better at triaging? Who do you recommend? A Paramedic knows how to prioritize care. Triaging by its nature is not perfect and some patients will get re-triaged with a different priority. That does not mean necessarily they were triaged wrong initially. Its an ongoing process.


 
Again, you have absolutely NO training for an event this size and you are trying to compare it to some MCI drill in the U.S. with a school bus MVC. This is not going to be a "what color tag" quiz for the correct answer or "it is against my religion not to work a dead baby with every bit of supplies I have left". 




18G said:


> I don't know where your from, but in my region Paramedics are allowed to give flu shots. I have never heard any problem with this.


 
You must have been living in what cave to not have heard about this. 




18G said:


> Nobody is saying a blanket response should occur. Although it sounds right now they need as much help as they can get. I agree responders should have some specialized training in disasters prior to responding. Hopefully, the responders would be working under some kinda structured command system and would receive their assignments and get daily briefings to enable them to do what needs to be done safely. Unless a person has functioned in a massive situation such as Haiti, I dont see how anyone could ever be fully prepared.


 


18G said:


> You made a blanket statement that EMS is not needed there. I strongly disagree. EMS (Paramedics and RNs) would be a very valuable resource in Haiti right now.


 
I never said anything about RNs since they are utilized on our teams. But, like everyone else that are utilized on these missions, they have specialized training. This is not a time for a totally "on the job" training event. 

Your comments sound like someone who just go their EMT card and can't wait to try out that O2 tank they just bought on Ebay. However, just like any MVC or injured person you come into contact, you DO NOT just rush in without preparation. Remember that scene safety section in your EMT book? This is scene safety on a very large scale. An area that has just ungone a disaster has many more disasters just waiting to happen. Only fools without special training or who believe their EMT patch covers it all want to rush head first into a situation like this. Why do you think it took several days to get teams mobilized to provide assistance? That includes the teams that train for these disasters and ARE ready. This should not be done with an emotional knee jerk response as the rescuers themselves may need rescuing or will be ill prepared to be of any assistance to anyone in that country.

Leave your emotions and ego out of this when you look at the broad spectrum of things. Too many get injured or killed when they think only by their ego and refuse to believe anybody could be more trained than an EMT(P) or that they don't need more training as their one little text book covered it all. Disaster Management, Disaster Preparedness as well as Rescue and Recovery are specialties. Few EMT(P)s are involved in recovery or the consequences of what mass death brings.


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## lightsandsirens5 (Jan 14, 2010)

mycrofft said:


> Dogs and all.


 
Just watched that on CNN.com. They did a pretty good job reporting on that.


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## 18G (Jan 14, 2010)

VentMedic
Why do you always make assumptions about people? You know nothing about the detailed backgrounds of the people who post on here yet, you always act as though you know everything about them. Its extremely nauseating. Do you talk to people like this on the job? I can't imagine you would have many friends if you do. You sound like someone who would be really miserable with themselves. 

My comments sound like a new EMT, huh? That excites me! I'm glad that the new EMT's are progressing and able to come out into the field with logical and experienced level thinking.

Your not the one who needs to be preaching to anyone about ego. You have enough ego problems of your own. Why is it so hard for you to accept that your ideas and opinions may not always be the best? If your wrong your wrong, who cares! Learn from it and become a better provider. Nobody is always right and nobody is always wrong. 



> I never said anything about RNs since they are utilized on our teams. But, like everyone else that are utilized on these missions, they have specialized training.



So Paramedics on a disaster response team would be lacking the same specialized training as the RN's? Most RNs I know work in a hospital and have NO disaster training. I am more likely to run into a Paramedic with this training than an RN. 

I don't even know why you are involved in EMS (or are you a has been & just a card carrying Paramedic). You are so anti-EMS its not funny.


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## Veneficus (Jan 14, 2010)

reaper said:


> As I stated before. I am not for cowboy responses. Organized teams of medical providers can do the best work.
> 
> That said. In the first 96 hours of a disaster response your Dr's,Rn's and surgeons are no better then your basic first aid.



I don't know if I would drag the number out to 96 hours. But I agree that in the early stages, that only basic first aid can be provided. But why would you waste resources and time bringing people who would likely be less benefcial later? A doctor providing first aid, becomes a doctor after first aid is finished. A medic or EMT becomes a set of hands. 




reaper said:


> In Mexico City there was a lot of Trauma Surgeons and Dr's that could not function for the first week. Trauma Surgeons are useless with out an OR to preform in.



I do not think this is an accurate statement, though not entirely untrue. Advanced procedures cannot be done without an OR, however, a capable trauma surgeon can surgically stop bleeding and open somebody's chest on a kitchen table. As well, the metods of bleeding control available to surgeons are considerable. I have personally seen surgeons sew up gunshots holes in hearts in the ED, create temporary vasculature using standard V tubing, and use foley catheters as intravascular baloons to occlude carotid artery bleeding. As well any doctor, but particularly surgeons should be capable of handling compartment syndromes. Surgery is not reliant on the OR, the best results long term results come from the OR. 

Have you ever seen a medic use their knowledge of facial compartments to cut open one and  stuff gause into it to compress bleeding in another? 





reaper said:


> Most Dr's cannot preform on the streets without a hospital. There are teams of Dr's that train for just this and are excellent in the field. But, they are very few. The Rn's are a lot better, as they can preform well in these situations. Again, not enough of them to do the job.



It is easier to train a doctor to work in the field than it is to train a medic or a nurse to do the work of a doctor.



reaper said:


> What was utilized the most was the medical teams of Rn's and Medics. They were able to provide care with minimal resources..



I think this is situation specific. 



reaper said:


> As I stated earlier, disaster response is not about saving everyone. Those that need surgical interventions normally do not survive. The medical crews in the field are there to provide basic care and relief...



I agree patients needing complicated surgery do not survive the initial period of response. BUt like I stated, if those patients do survie the early phases, return of function will not be returned by a medic. 




reaper said:


> Yes, as part of an organized team, you need to have additional training in public health and disease transmission. Beyond that, most Medics are very capable of providing the medical treatments needed in these situations..



I think we will have to agree to disagree on this point.



reaper said:


> I encourage those that want to help in disaster response, to get the additional training needed join and organized team. For any future need.



Amen


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## JPINFV (Jan 14, 2010)

18G said:


> I think it is also ridiculous to say that EMS and emergency responders are not needed in a disaster such as Haiti. With over 50,000 deceased and hundreds of thousands injured, sick, and displaced, how would having EMS personnel not be of any great help?
> 
> You say EMS is not needed, yet the Haiti ambassador specifically stated that they are in great need of emergency personnel. From what I been reading its a logistical nightmare there right now. What do you think the ratio of physicians to the sick and injured right now? A Paramedic would be useless? They couldn't assess and triage? Provide stabilizing care to those still trapped? Help with extrications? Give tetanus shots? Provide analgesia? Give fluids to the many that Im sure are very dehydrated? The list is endless.
> 
> So now Paramedics and RN's can only provide "basic first aid"? That's interesting. Emergency personnel are trained and adapted to deal with disasters and have the mental ability to remain focused on the mission. The "locals" as you say have been through enough don't you think. They need help.



Assess and triage to what? Help with extrications (isn't that why the military and USAR teams are going in?)? Provide what fluids? Given the amount of destruction, I'm not betting that there's a large amount of medical supplies available nor potable water. Analgesia? Who's going to supply it and how long are you willing to monitor the patient? 

Mind you, anyone who goes over there is still going to need food, water, sleeping space. The director for the Center for Global & Community Health at my school forwarded an email to the entire school today from international collaboration mailserve for the AACOM that read, in part, 





> ...Here are notes from a session on relief efforts hosted by the White House:
> 
> As per USAID at this point, food first, conditions grave, and support people should not put themselves at risk.  Here is the official plan info I recieved.
> 
> ...



It went on to talk mostly about the US Government's immediate concerns, such as overflights, rescue operations, and air traffic control (I know that the news mentioned that USAF has established a field ATC center at the main airport this morning to help coordinate).


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## VentMedic (Jan 14, 2010)

> My comments sound like a new EMT, huh? That excites me! I'm glad that the new EMT's are progressing and able to come out into the field with logical and experienced level thinking.


 
That wasn't a compliment since you exhibited no logical or experienced level of thinking in your posts. In fact, I apologize to the EMTs for comparing you to them as most are not whackers. 



18G said:


> So Paramedics on a disaster response team would be lacking the same specialized training as the RN's? *Most RNs* I know work in a hospital and have NO disaster training. I am more likely to run into a Paramedic with this training than an RN.


 
For goodness sakes! Do you not even read my posts where I made several statements that EMS providers with *ADDITIONAL TRAINING* are welcome and some of our FDs who have trained for this are going. What part of *ADDITIONAL TRAINING* do you not understand? 

Most RNs don't go and most Paramedics don't go to a disaster in another country. Most Paramedics also don't get extensive disaster training either especially the type that is required to deal with something on this scale. Those that do go get the *ADDITIONAL TRAINING* before the event happens. Again, what part of *ADDITIONAL TRAINING* do you not understand?



18G said:


> I don't even know why you are involved in EMS (or are you a has been & just a card carrying Paramedic). You are so anti-EMS its not funny.


 
I could ask you the same thing since you fail to see what ADDITIONAL TRAINING means. Just because you have an EMT or Paramedic card does NOT make you automatically qualified to rush into a situation such as the one in Haiti. Yes, I am against the Paramedics who think they are just like a doctor only better with their 6 months of training for the patch. And, with NO *ADDITIONAL TRAINING* for a disaster of this magnitude. 

So again, what part of *ADDITIONAL TRAINING* do you not understand?


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## Veneficus (Jan 14, 2010)

18G said:


> So who than is better at triaging? Who do you recommend? A Paramedic knows how to prioritize care. Triaging by its nature is not perfect and some patients will get re-triaged with a different priority. That does not mean necessarily they were triaged wrong initially. Its an ongoing process.



Physicians hwere I go to school are extensively taught to triage. Additionally from the hospital side, every patient who comes through the door is retriaged paying no attention to the label EMS gave them. EMS triage revolves around transport priority. Additionally the considerable education of hospital providers (aka more than a few clock hours) gives them a much better insight on likely prognosis as well as pathology that EMS education doesn't even mention.



18G said:


> I don't know where your from, but in my region Paramedics are allowed to give flu shots. I have never heard any problem with this. .



I understand what Vent was trying to say, I think the example is poor.(though she is right, in some states medics are not permitted to give vaccinations) How many paramedics know microbiology epidemiology? Do you have the training to select ab therapy? How about parasitology? Can you trace the vectors of the different species of tape worms? Can you look into a standard microscope found in any high school and identify a protazoa? When you travel to less developed nations or in events when basic sanitation breaks down, this becomes a real issue. It takes no more effort for a physician to render treatment as it does to delegate it. 




18G said:


> Nobody is saying a blanket response should occur. Although it sounds right now they need as much help as they can get. I agree responders should have some specialized training in disasters prior to responding. Hopefully, the responders would be working under some kinda structured command system and would receive their assignments and get daily briefings to enable them to do what needs to be done safely. Unless a person has functioned in a massive situation such as Haiti, I dont see how anyone could ever be fully prepared.




Have you studied the accounts of self dispatch and the amount of providers that showed up from all over the world during the WTC attack? How about the ones that drove lights and sirens several hours from out of state? Have you not seen the pictures of medcs standing in line waiting for reciprocity after Katrina? Did you know only ~20% of the US populous has a passport? How many happen to have all the innoculations or even the minimum that would make traveling to an undeveloped country safe? Read one of my earlier posts, I've had former providers ask me how they could get involved this week. (Why is it you think they would call me and ask?) You start spouting ideas on how EMS is needed and can help and people just may start taking it upon themselves to go. You can get there by boat. How many people with nothing more than an EMT-B cert do you think might seriously be planning a trip right now?  

The first step in preparedness is education. The second is number of patient contacts in a non disaster situation. A disaster creates a sudden refugee type of climate. There are several places where you can go and get experience in a non disaster situation.

Experience counts, you ever notice how the same disaster response teams are dispatched first despite no shortage of DMAT teams? Have you noticed that many countries have one or two teams that always respond to disasters? If you want to respond you have to get into one of these teams. Even then, they may respond with one or two inexperienced people. Not a bunch of people with one or two having experience. 

This idea that something, anything in medicine is better than nothing, is uniquely American. In a disaster "something" may only makes things worse. Also as vent accurately pointed out. the "skills" involved are easily taught. How long do you think it would take for me to teach somebody to give an IM injection without telling them anything else other than what to do?  




18G said:


> You made a blanket statement that EMS is not needed there. I strongly disagree. EMS (Paramedics and RNs) would be a very valuable resource in Haiti right now.



Please if you would, explain to me exactly what a non USAR or medic having considerable advanced training would accomplish?

Clearly somewhere in all of my experience and education I missed some critical point that has denied me such hubris.


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## VentMedic (Jan 14, 2010)

Veneficus said:


> I understand what Vent was trying to say, I think the example is poor.(though she is right, in some states medics are not permitted to give vaccinations) How many paramedics know microbiology epidemiology? Do you have the training to select ab therapy? How about parasitology? Can you trace the vectors of the different species of tape worms? Can you look into a standard microscope found in any high school and identify a protazoa? When you travel to less developed nations or in events when basic sanitation breaks down, this becomes a real issue. It takes no more effort for a physician to render treatment as it does to delegate it.


 

We've had a few threads in the past on the topic.  Unfortunately, public health is too boring to lead to much discussion and some are still trying to decipher the topic of disinfecting their ambulance and stethoscope.

http://www.emtlife.com/showthread.php?t=9484&highlight=vaccinations

http://www.emtlife.com/showthread.php?t=14772&highlight=vaccinations

Unfortunately it is more about the "skill" rather than an understanding of the vaccine, its implications or consequences.

State disaster action plans.
http://www2a.cdc.gov/phlp/H1N1flu.asp

Several states were also still slow in establishing disaster plans after Katrina.  

Massachusetts
http://www.mass.gov/legis/bills/senate/186/st02/st02028.htm


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## 18G (Jan 14, 2010)

First off, I am generally speaking about the positive effect EMS could have in Haiti when organization is achieved. I have never said that as of this minute all EMS providers load up into a plane and head for Haiti. So I'm not sure where that perception came from. 



> Physicians hwere I go to school are extensively taught to triage. Additionally from the hospital side, every patient who comes through the door is retriaged paying no attention to the label EMS gave them.



I have no argument that physicians are better suited to triage however, there are not enough physicians to go out into the field and perform this task. They need to be at the field hospitals ready to receive patients. 



> How many paramedics know microbiology epidemiology? Do you have the training to select ab therapy? How about parasitology? Can you trace the vectors of the different species of tape worms? Can you look into a standard microscope found in any high school and identify a protazoa? When you travel to less developed nations or in events when basic sanitation breaks down, this becomes a real issue. It takes no more effort for a physician to render treatment as it does to delegate it.



To me this is completely irrelevant. You don't need to be a microbiologist to give a vaccination. Do we need to be cardiologists to give cardizem? An endocrinologist to treat diabetic issues?


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## Veneficus (Jan 14, 2010)

VentMedic said:


> We've had a few threads in the past on the topic.  Unfortunately, public health is too boring to lead to much discussion and some are still trying to decipher the topic of disinfecting their ambulance and stethoscope.
> 
> http://www.emtlife.com/showthread.php?t=9484&highlight=vaccinations
> 
> ...



To repeat an important concept since it seems I have not been clear and not directed at Vent:

In a refugee environment, Trauma followed by public health concerns, are the leading causes of mortality. 

A disaster is a refugee environment. Right down to the environment being made inhospitable.

In adition to all of the formal education, it takes 7 years of post graduate education to become a trauma surgeon. 6 to be a cardio thoracic surgeon, and 5 to become a cardiologist. Look at the difference between the amount of time spent on cardiology vs. trauma in EMS education.

There is not even a full 4 hours devoted to public health in paramedic education. 

If these are the 2 significant medical problems in a disaster, how much help could the *average* paramedic possibly be? 

What would an EMT-B do at all? 

I am pro EMS. I even teach. but a spade is a spade, there is simply not enough of the education needed in the average US provider to make a significant difference in a situation like Haiti without considerably more education. 

I have not encountered one person I know that works in USAR or disaster planning/response anywhere that thinks the average US EMS worker would be worth the resources they would use. This is an Island. Foreign response teams have to bring their own equipment, food, and water plus enough to help. The deep water port is damaged, not functioning! That is the best way to bring mass amounts of resources. The airport is overwhelmed now. You can't simply call somebody up the street in Texas or California and have them drive stuff down.  They need the best of the best down there, not just anyone with some applicable skills.


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## Veneficus (Jan 14, 2010)

18G said:


> To me this is completely irrelevant. You don't need to be a microbiologist to give a vaccination. Do we need to be cardiologists to give cardizem? An endocrinologist to treat diabetic issues?



You need to be able to figure out why the patient is malnurished. You have to know if the antibiotic you have will have any effect at all. 

If you are planning to stop vomiting and Diarrhea you need to know what is causing it. 

Anyone can stick a needle in somebody you don't need an EMS provider. Which means your resources are better used by teaching the locals how to do these mundane skills.

You don't have to be a cardiologist or endocrinologist to treat these things because you have things like direct and functioning medical oversight, you are taking these patients to the hospital where somebody who does know will help. (I know sometimes they refuse) You have near limitless resources, do you worry about running out of the cardizem or d50? Do you know what drugs you can use to get similar outcome by a different mechanism? 

The public health issues I cited have a direct impact on the outcome of a disaster. 

I am most interested in learning what exactly you can do to help. I am not interested in excuses for what you cannot.


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## VentMedic (Jan 14, 2010)

18G said:


> I have no argument that physicians are better suited to triage however, there are not enough physicians to go out into the field and perform this task. They need to be at the field hospitals ready to receive patients.


 
That is a U.S. way of thinking and few here have actually seen a mass mobilization of professionals in times of a disaster. It is very impressive. 

Doctors Without Borders have an impressive number of doctors. Cuba already has almost 350 doctors in Haiti and are sending more. If you remember Cuba also offered 200 doctors to the U.S. during Katrina but was snubbed by Bush. Spain and France have sent their doctors. Major university hospitals from around the world are also sending their teams. Doctors at Jackson Memorial Hospital in Miami are considering using a satellite phone system to better assist doctors treating the injured on the Caribbean island. JMH is also where some of the injured are being airlifted to.


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## Jeffrey_169 (Jan 14, 2010)

Can anyone tell me why the Sea Bees and Marine Combat Em=ngineers haven't been sent in yet? I have heard nothing about it. Truth is these people are experts at building things overnight. Why not send them in and let them build hospitals? They really are the engineering miracles behind these types of events, and yet I have heard nothing about them.


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## VentMedic (Jan 14, 2010)

Jeffrey_169 said:


> Can anyone tell me why the Sea Bees and Marine Combat Em=ngineers haven't been sent in yet? I have heard nothing about it. Truth is these people are experts at building things overnight. Why not send them in and let them build hospitals? They really are the engineering miracles behind these types of events, and yet I have heard nothing about them.


 
Obama just outlined the Military response:

http://www.fox10tv.com/dpps/military/USS-Bataan-ordered-to-Haiti_3187915


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## lightsandsirens5 (Jan 15, 2010)

Jeffrey_169 said:


> Can anyone tell me why the Sea Bees and Marine Combat Em=ngineers haven't been sent in yet? I have heard nothing about it. Truth is these people are experts at building things overnight. Why not send them in and let them build hospitals? They really are the engineering miracles behind these types of events, and yet I have heard nothing about them.


 
USNS Comfort and an aircraft carrier are being sent right now, the Coast Gaurd already has a cutter I beleive and several helo crews working there and the Air Force and Coast Gaurd are airlifting supplies and teams in now. I beleive that several Marine bases were mobilizing as well.

EDIT: Oh ha ha! Yea, look at the link Vent posted.


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## Cory (Jan 15, 2010)

I've always wondered what emergency responders to disasters do about risk of diseases in unsanitary places like Haiti, I guess this is the place to ask. So are you given vaccinations or masks or what?


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## Jeffrey_169 (Jan 15, 2010)

ventmedic said:


> obama just outlined the military response:
> 
> http://www.fox10tv.com/dpps/military/uss-bataan-ordered-to-haiti_3187915



oorah!!!


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## Veneficus (Jan 15, 2010)

VentMedic said:


> Obama just outlined the Military response:
> 
> http://www.fox10tv.com/dpps/military/USS-Bataan-ordered-to-Haiti_3187915



That is a truly inspiring response.


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## VentMedic (Jan 15, 2010)

Cory said:


> I've always wondered what emergency responders to disasters do about risk of diseases in unsanitary places like Haiti, I guess this is the place to ask. So are you given vaccinations or masks or what?


 
To be on a team it is your responsibilty to keep basic vaccinations up to date.  That includes:  Hep A&B, Varicella, MMR, Polio, Tetanus-diphtheria and influenza as well as having a current TB test.   

You should also have your own supply of insect repellant, ear and eye protection, leather gloves as well as gloves to work on patients, protective masks and/or a filtered  respirator, appropriate footwear and clothing.   The type of team you are deployed with will determine where you will be working and the type of equipment and protection you will need.

9/11 gave the U.S. many valuable lessons with some being learned the hard way.  Katrina also was a learning experience for what should have be done and who not to do before, during and after the storm.   Of course it also helps to have the right Governor and President during a time of disaster.

For more reading on the topic, the CDC - NIOSH have a good website.
http://www.cdc.gov/niosh/topics/emres/default.html


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## Double-E (Jan 15, 2010)

sooooo....for all this discussion and debate about who has the most knowledge about what the proper response will be...we've yielded no list of agencies where we can volunteer our services? 

as an emt i dont think there's much i can do to help but i *can* speak french...that's enough to make me want to at least offer to help and let more qualified people decided whether or not i'll be able to help.

anyone have any idea where to inquire?


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## Double-E (Jan 15, 2010)

from the american red cross site:

*We are not accepting volunteers to travel to Haiti.* If you would like to volunteer for the American Red Cross, please contact your local chapter.

well...my local chapter says nothing...one down...more to go...


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## VentMedic (Jan 15, 2010)

Double-E said:


> sooooo....for all this discussion and debate about who has the most knowledge about what the proper response will be...we've yielded no list of agencies where we can volunteer our services?


 
Yeah thanks for insulting those of us who have worked many disasters as both paid and volunteer. 

There's a reason why lists aren't posted. This is not something one can or should volunteer for on the spur of the moment. If you have not already been part of an agency that regularly trains for a disaster, it is unlikely that you would be appropriate for this type of situation regardless of what language you speak. You will also often have to make a commitment of 2 weeks which should be approved by your employer when you join since you will be leaving your employer on a very short notice. You may also be expected to pick up some of the cost yourself for your own supplies. For some volunteer organizations, you pick up all of the cost which can be several thousand dollars from your own pocket. Be very careful and research thoroughly before you jump into any situations. 

However, if you are serious about volunteering and actually want to put forth the effort to train for a disaster, apply to your state's' DMAT chapter. This is also the safest way to volunteer since you will be afforded the benefits of being a Federal Employee.

http://www.hhs.gov/aspr/opeo/ndms/teams/dmat.html

Of course you could become employed at a FD or EMS agency that has an elaborate disaster team and work you way onto it.

In summary, with all the disasters we have had in this country and others, if you really wanted to be part of a team that responds, you would have already started doing your research and preparation. As with anything, even disaster preparedness for your own family, don't wait until a disaster happens.


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## VentMedic (Jan 15, 2010)

For those of you who might want to volunteer to be part of a future disaster response, here is what HHS/DMAT is doing now.

http://www.hhs.gov/news/press/2010pres/01/20100114b.html

*HHS Deploying U.S. Medical Personnel to Haiti*



> The U.S. Department of Health and Human Services (HHS) has activated the National Disaster Medical System and the U.S. Public Health Service Commissioned Corps. More than *250 personnel are* in the process of deploying to Haiti and over *12,000 personnel could* possibly assist in the coming days.


 


> The medical teams include doctors, nurses, paramedics, emergency medical technicians, emergency medical and surgical physicians, and other medical personnel from Georgia, California, New Jersey, Massachusetts, and Florida. An International Medical Surgical Response Team will provide care for severely injured patients and five Disaster Medical Assistance Teams will provide basic medical care. These personnel will be accompanied by 22,000 pounds of medical equipment and supplies.


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## techinthemic (Jan 16, 2010)

Hi guys I have been reading this thread with some interest. I am an EMT in the uk, soon to taking my para degree. Is there anyway I can join the international effort? Things here seem to be very segmented and heavily government controlled with only a select rescue team based within the fire service being deployed. (Ambulance staff here work for their local National Health Service ambulance trust, not the county Fire and rescue service.) I would be eager to join an organisation who are prepared and familiar with taking international ambulance staff and placing them in a position where we can be of most use. I understand and expect tests and references will need to be taken and checked before any further training can begin, but this disaster has prompted me not to let my own countries' reservedness stop me from doing more. I hope you can suggest an appropriate organisation - I'm sure you must have one, thanks.


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## Jeffrey_169 (Jan 16, 2010)

techinthemic said:


> Hi guys I have been reading this thread with some interest. I am an EMT in the uk, soon to taking my para degree. Is there anyway I can join the international effort? Things here seem to be very segmented and heavily government controlled with only a select rescue team based within the fire service being deployed. (Ambulance staff here work for their local National Health Service ambulance trust, not the county Fire and rescue service.) I would be eager to join an organization who are prepared and familiar with taking international ambulance staff and placing them in a position where we can be of most use. I understand and expect tests and references will need to be taken and checked before any further training can begin, but this disaster has prompted me not to let my own countries' reservedness stop me from doing more. I hope you can suggest an appropriate organization - I'm sure you must have one, thanks.



You might try the International Red Cross. If they cannot help you, they should be able to recommend one. I doubt they will need you immediately, but they might be able to refer you to someone who can help. There is a great deal of special training involved, and so while your intentions are valiant, it would be doubtful they could use you right away. With the proper training, they will surely be able to use you in the future. 

I am no expert on this issue, however I believe this is a good place to start.


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## Aidey (Jan 17, 2010)

Not to change the subject, but has anyone been watching the new coverage with Dr. Gupta on CNN?

He keeps going on about how horrible the situation is, and how they have been reduced to using cardboard for splints until the doctors can look at people and they are hanging IV bags from trees. 

Now, call me crazy, but am I the only one who thinks he is making it sound worse than it is? I'm not saying it isn't bad, but he's making it sound like cardboard splints and IVs from trees are signs of the apocalypse. 

I've personally done both (wildland fire...lots of trees, no IV poles). We've also used those folding cardboard mass casualty backboards during MCI drills and we use the cardboard splints on my ambulance now. It sounds like they are MacGyvering what they need out of what they have and doing pretty well. Or at least doing better than the news is making it sound like. 

I know they probably aren't using the pre-fab cardboard splints, but those seem like they would be a more than acceptable method of splinting during a MCI. Am I wrong in thinking this?


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## Veneficus (Jan 17, 2010)

a TV personality make something sound more than it is, I thought that's what they were paid for?


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## Jeffrey_169 (Jan 17, 2010)

No, I think you have a point. In the Marines we have a saying, "Adapt and overcome". He probably is trying to dramatize the situation in order to gain public support, but as you said in an MCI improvision is to be expected; especially in a poor nation such as Haiti, and when the Hospital has been destroyed. 

I don't know, as I am not there, but it seems he is trying to persuade public donations. I can understand why, althought I do see your point.


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## VentMedic (Jan 17, 2010)

Jeffrey_169 said:


> No, I think you have a point. In the Marines we have a saying, "Adapt and overcome". He probably is trying to dramatize the situation in order to gain public support, but as you said in an MCI improvision is to be expected; especially in a poor nation such as Haiti, and *when the Hospital has been destroyed*.
> 
> I don't know, as I am not there, but it seems he is trying to persuade public donations. I can understand why, althought I do see your point.


 
There's more than one hospital in that country and a couple were built within the last 50 years to better code standards.  

Gupta may not be aware of what happens even in the U.S. when we evacuate thousands of people from hospitals and LTC facilities when a hurricane is approaching.  If we don't have something that is all nice and store bought pre-packaged, we make do with what we have that will work just as well rather than delaying transport.


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## karaya (Jan 17, 2010)

I think the word is - improvise.


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## Jeffrey_169 (Jan 17, 2010)

VentMedic said:


> There's more than one hospital in that country and a couple were built within the last 50 years to better code standards.
> 
> Gupta may not be aware of what happens even in the U.S. when we evacuate thousands of people from hospitals and LTC facilities when a hurricane is approaching.  If we don't have something that is all nice and store bought pre-packaged, we make do with what we have that will work just as well rather than delaying transport.



I was unaware there was more then one hospital. I was under the impression this was the only one capable of providing the advanced care necessary. Perhaps I should do more research next time. Thank you.


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## lightsandsirens5 (Jan 17, 2010)

*EMTs could help with this.....*








From an MSNBC slide show:





> A man lies in a bed outside a nursing home in Port-au-Prince. More than 100 seniors were living outside the damaged home, with no food or care other than an occasional bath from two orderlies who remained to help.


 
This is where EMT's could help. Over 100 people who cannot take care of themselves. Two trying to take care of all of them. Two people. Each has to take care of over 50 patients. Who says an EMT would not be more valuble than the average Red Cross volunteer?


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## Veneficus (Jan 17, 2010)

lightsandsirens5 said:


> From an MSNBC slide show:
> 
> This is where EMT's could help. Over 100 people who cannot take care of themselves. Two trying to take care of all of them. Two people. Each has to take care of over 50 patients. Who says an EMT would not be more valuble than the average Red Cross volunteer?



When you have 1 local red cross volunteer and 1 EMT you have 2 mouths to feed not 1.

Logistics is what solves crisis like this. There is a major issue with logistics.

Are you suggesting that in the EMT (or even medic) curriculum they were even taught the basic needs of humans, what aid is needed and how to deliver aid in a disaster? (I have taught for years, never once saw it in the curriculum)

Perhaps the EMTs could figure out where to get the medicine, clean sheets, food and water from that even the resources available to the US military is struggling to distribute?

I urge you to go to the international redcross website and look at the qualifications they demand of international aid workers and the needs.

These are current vacancies:

http://www.icrc.org/Web/Eng/siteeng0.nsf/htmlall/section_vacancies

Not to be confused with those jobs always in demand:

http://www.icrc.org/Web/Eng/siteeng0.nsf/htmlall/section_skills_always_in_demand

(I was particularly surprised they want surgeons with 5-7 years of experience to be considered) How do you measure up to that? I certainly don't come close.

The 120 hour EMT looks a little meager compared to these. Again consider as far as skills go, it is still better to logistically to teach a local 1 or 2 skills then it is let loose a bunch of basic providers that only add to the needs of the situation.

As for the elderly and chronically infirm, these people are expected to die. Look up the current disaster recommendations in the US. Even young children are on the bottom of the list for resources! (that is a realistic part of the tragedy)

It is a far different game then what is played in the US under normal conditions. There probably only 2 people taking care of the people in your picture because the rest left to search out food and water. They are laying in the steet because there is no way to take them somewhere else. They can't get medicine to the people to administer. 

http://news.yahoo.com/s/ap/20100117/ap_on_re_la_am_ca/cb_haiti_waiting_to_die

_"One man has already died, and administrator Jean Emmanuel said more would follow soon unless *water and food arrive immediately*.

"I appeal to anybody to bring us anything, or others won't live until tonight," he said, motioning toward five men and women who were having trouble breathing, a sign that the end was near."_

What are you planning to do? Use a BVM on them till help arrives? (before you say "yes." Consider you are doing nothing for the illness and metabolic needs causing the trouble breathing) 

I'm not trying to be mean to EMTs, tremendous resources are already on site. The Most experienced and educated people from around the globe are trying to overcome the difficulties. People who have done this before, people who practice it before "the big one" hits. 

Arguing that you can change a diaper (when there are no diapers) or that you can inject medicine (that cannot be delivered to the sick) or that you will provide "first aid" unfortunately demonstrates you do not even understand what "helps." You can post all the heart wrenching photos you like, you cannot help. You are out of your league.


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## VentMedic (Jan 17, 2010)

> Who says an EMT would not be more valuble than the average Red Cross volunteer?


One also has to remember that the Red Cross Volunteer has probably taken every available first aid and advanced first aid class to be eligible for such a mission. That can add up to many more hours than a 120 hour EMT course. They will then get many more hours for disaster specific rescue first aid and relief work which will differ from EMT training in that it will not consist of a well stocked ambulance to work out of. 

Thus, I would take a Red Cross Volunteer over the average U.S. EMT with no disaster appropriate training. 



> This is where EMT's could help. Over 100 people who cannot take care of themselves. Two trying to take care of all of them. Two people. Each has to take care of over 50 patients.


 
This actually is not much worse than some nursing homes in the U.S. that have 2 RNs per 100 patients, all total care, and maybe a couple of CNAs. But, these RNs and CNAs are trained and educated to oversee that many patients. Some EMTs fail to see what total patient care involves by the numerous comments on the EMS forums. Thus, if you can not forsee problems due to lack of training, 50 patients would be very overwhelming for the average U.S. EMT.


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## FLEMTP (Jan 17, 2010)

Maybe we should just send VentMedic to haiti.. just her... and only her.. since she is the GOD of everything EMS (in her own mind) and knows everything about anything ( demonstrated by her arrogance and condescending attitude she takes in every post in this forum)

just a thought!


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## FLEMTP (Jan 17, 2010)

I'll prolly get a warning for the above post.. but I know my words echo the thoughts and feelings of many people here in the forum.


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## VentMedic (Jan 17, 2010)

FLEMTP said:


> Maybe we should just send VentMedic to haiti.. just her... and only her.. since she is the GOD of everything EMS (in her own mind) and knows everything about anything ( demonstrated by her arrogance and condescending attitude she takes in every post in this forum)
> 
> just a thought!


 
Have you ever been part of a disaster? I would not want to babysit you when I could be doing something useful for the area I am assigned. I have been on enough missions to know those that make comments like yours have absolutely no idea what to say because this is something they know nothing about. Even if you say you have been active in a hurricane, you probably only did the same EMS duties and wouldn't dream of doing anything other than your regular job description. Florida does have an elaborate Disaster plan to prevent EMS providers from just running around clueless with the possibility of becoming patients themselves. I would hope Lee County has been updating their to stay current. However, if you have no plan, then again I would be very disappointed with Lee County EMS.

Now as far as going to Haiti, I have my duties here to assist with those being brought to the U.S.



FLEMTP said:


> I'll prolly get a warning for the above post.. but I know my words echo the thoughts and feelings of many people here in the forum.


 
What advice do you want me to give here? Run off to Haiti and possibily get yourself injured or killed? Some have an unrealistic view of what happens in a disaster and I would put you in that category as well. I will not tell anyone to do something such as volunteer for a mission of this magnitude without proper training. I have given the names of organizations to which they can join if they are sincerely interested but an EMT card is NOT enough. Do you understand that? Do you know anything about responsibily and that include personal responsibility of seeking out information with the sources that have been linked to know "something" or anything before you run off to a foreign country in a time of disaster?

Now what part of that do you consider inappropriate?

If you do not believe in safety and appropriate training, then you are more of a fool than even I thought you to be.


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## FLEMTP (Jan 17, 2010)

VentMedic said:


> Have you ever been part of a disaster? I would not want to babysit you when I could be doing something useful for the area I am assigned. I have been on enough missions to know those that make comments like yours have absolutely no idea what to say because this is something they know nothing about. Even if you say you have been active in a hurricane, you probably only did the same EMS duties and wouldn't dream of doing anything other than your regular job description. Florida does have an elaborate Disaster plan to prevent EMS providers from just running around clueless with the possibility of becoming patients themselves. I would hope Lee County has been updating their to stay current. However, if you have no plan, then again I would be very disappointed with Lee County EMS.
> 
> Now as far as going to Haiti, I have my duties here to assist with those being brought to the U.S.




haha.. yet another PERFECT example of exactly what I was talking about in my above post.... more arrogance and condescending attitude.

For once, Im going to thank you VentMedic... you proved my point quite well.

Oh, and I wont be bothering to address your almost offensive post...in fact im really beginning to doubt you as a valid contributor to this forum. You claim to have all this experience, but yet your words and attitude seem to contradict that claim.


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## VentMedic (Jan 17, 2010)

FLEMTP said:


> haha.. yet another PERFECT example of exactly what I was talking about in my above post.... more arrogance and condescending attitude.
> 
> For once, Im going to thank you VentMedic... you proved my point quite well.
> 
> Oh, and I wont be bothering to address your almost offensive post...in fact im really beginning to doubt you as a valid contributor to this forum. You claim to have all this experience, but yet your words and attitude seem to contradict that claim.


 
Then give examples. 

What part of safety and appropriate training do you dispute?

I do not find wanting someone to be safe and have appropriate training to be offensive. Why do you see it that way?
It is actually a serious subject and if you go to Haiti, you shouldn't just be another mouth to feed or another patient.


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## DV_EMT (Jan 17, 2010)

i just signed up with my wifes church to go out to one fo the orpanages in haiti to provide aid with some doctors and nurses. If they grab me and my wife, we'll probably be headed out in a few weeks.


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## lightsandsirens5 (Jan 18, 2010)

FLEMTP said:


> Maybe we should just send VentMedic to haiti.. just her... and only her.. since she is the GOD of everything EMS (in her own mind) and knows everything about anything ( demonstrated by her arrogance and condescending attitude she takes in every post in this forum)
> 
> just a thought!


 
Dude don't say that. Don't say any of what you have said in your last few posts. Take it back now.

I may not agree with everything she says right off the bat, but I have learned more from her than just about anyone else on this forum. I think that these "many people" you speak of are in reality, only a few people. I for one have seen the stupidness of my beginning stand in this argument about Haiti and once again have learned something from the wiser posters on this forum.


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## Marty Mcfly (Jan 18, 2010)

Asked my supervisor if we were. He said being as it is not in the U.S. the D.R.T. will most likely not be sent.


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## mycrofft (Jan 18, 2010)

*Too bad Cuba can't be a big player in this.*

We could ship huge quantities of supplies there then ship them to Haiti. Not "aircraft carrier" or "C-130", whole _ship_fuls. Or ship them to Cuba then they would be in flying distance for helos to bring loads to the underserved areas, and maybe tactical air controllers (who bring their own securitywith them). 

Also _mui beaucoups_ earthmoving equipment for burials, clearing debris, reestablishing proper drainage, digging new wells and laying sewers.


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## Chimpie (Jan 18, 2010)

The admins are watching.  Keep it polite.


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## VentMedic (Jan 18, 2010)

mycrofft said:


> We could ship huge quantities of supplies there then ship them to Haiti. Not "aircraft carrier" or "C-130", whole _ship_fuls. Or ship them to Cuba then they would be in flying distance for helos to bring loads to the underserved areas, and maybe tactical air controllers (who bring their own securitywith them).
> 
> Also _mui beaucoups_ earthmoving equipment for burials, clearing debris, reestablishing proper drainage, digging new wells and laying sewers.


 
Cuba has already been helping Haiti as much as possible with medical care by having over 300 doctors there before the earthquake. They now have over 400 doctors helping out. Other countries may use Cuba as a port of storage for the supplies. It is only the U.S. that has a problem with Cuba and no other country.  Unfortunately, in the U.S., you may not hear of what Cuba does unless you watch or read news on international stations.


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## Jeffrey_169 (Jan 18, 2010)

VentMedic said:


> Cuba has already been helping Haiti as much as possible with medical care by having over 300 doctors there before the earthquake. They now have over 400 doctors helping out. Other countries may use Cuba as a port of storage for the supplies. It is only the U.S. that has a problem with Cuba and no other country.  Unfortunately, in the U.S., you may not hear of what Cuba does unless you watch or read news on international stations.



Cuba is not the same nation since Castro bit the dust. It has made efforts to improve relations with its neighbors, and in particular the US.


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## VentMedic (Jan 18, 2010)

Jeffrey_169 said:


> Cuba is not the same nation since Castro bit the dust. It has made efforts to improve relations with its neighbors, and in particular the US.


 
Cuba was still a nation willing to help with or without Castro. During Katrina, 200 doctors were offered to the U.S. within 24 hours. This little country has also gone to assist with relief in the islands for other major hurricanes and the U.S. problem has not stopped them from offering medical care to those who need it. Cuba has not had issues with other governments such as what exists with the U.S. and many other countries use Cuba still as a big tourist destination as well as sending monetary support by way of investments.


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## Jeffrey_169 (Jan 18, 2010)

VentMedic said:


> Cuba was still a nation willing to help with or without Castro. During Katrina, 200 doctors were offered to the U.S. within 24 hours. This little country has also gone to assist with relief in the islands for other major hurricanes and the U.S. problem has not stopped them from offering medical care to those who need it. Cuba has not had issues with other governments such as what exists with the U.S. and many other countries use Cuba still as a big tourist destination as well as sending monetary support by way of investments.



True, however due to his health was he in control of his country, or were other members of his cabinet? At the time of Katrina his health was in a defacto state of deterioration and he had all but abdicated his authority to trusted relatives. 

lets not forget this is the man who wanted nuclear weapons to annihilate us during the cold war, now you imply he was a humanitarian? in my opinion this a contradiction in terms.


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## VentMedic (Jan 18, 2010)

Jeffrey_169 said:


> True, however due to his health was he in control of his country, or were other members of his cabinet? At the time of Katrina his health was in a defacto state of deterioration and he had all but abdicated his authority to trusted relatives.
> 
> lets not forget this is the man who wanted nuclear weapons to annihilate us during the cold war, now you imply he was a humanitarian? in my opinion this a contradiction in terms.


 
Castro had not fully left his post at that time.  There have also been many, many other disasters that Cuba has participated in as well as some of their own.  Do no criticize a country that you may not know much about except for propaganda issued by some who want the border to remain closed for their own agenda.

Do you understand the role played by Russia in the Cuban Missle crisis?

Why the double standard?  What about our relations with China, Russia, Germany, Korea and Japan?  Remember a little incident called "Pearl Harbor"? 

Get over your hatred for Cuba.  The U.S. has also been judged by the actions of its Presidents as well and Bush was not a shining star on this planet. Should all Americans be judged by his actions?  Should the humanitarian efforts which are allowed by Cuba be disregarded because you hold a grudge for something that happened 50 years ago?


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## reaper (Jan 18, 2010)

Is America a humanitarian country? We wanted Nuclear weapons to annihilate Russia during the cold war, does that make us heartless?

Of course not. Castro did treat his own people bad and that is why he was a Dictator. Treating his enemies bad, does not make his country bad. Cuba has always been known for the aid it provides to other small countries, even when Castro was in power.

The Cuban people are very giving. Unless you have been around them, you would not realize this from what you read in the news.


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## Jeffrey_169 (Jan 19, 2010)

reaper said:


> Is America a humanitarian country? We wanted Nuclear weapons to annihilate Russia during the cold war, does that make us heartless?
> 
> Of course not. Castro did treat his own people bad and that is why he was a Dictator. Treating his enemies bad, does not make his country bad. Cuba has always been known for the aid it provides to other small countries, even when Castro was in power.
> 
> The Cuban people are very giving. Unless you have been around them, you would not realize this from what you read in the news.



The fact is I have met a few Cubans, and as you said, they are people like any other. Truth be told, I have never met one I didn't like. I went to the Island with a kid from Cuba, and he was a good man; honest and sincere. However, Castro was a different issue. 

How many people died becasue he sent them of in rafts across the Atlantic ocean? He may have put on a good show for the world, but he was an evil man. He may have done some good but even Hitler did good; in my opinion it doesn't make either one of them good people. 

I am disputing he may have done good deeds, but when put into perspective, at least in my opinion, political motives are not morally justified.


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## Chimpie (Jan 19, 2010)

*Get the thread back on topic or it will be closed.*


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## Aidey (Jan 19, 2010)

reaper said:


> Is America a humanitarian country? We wanted Nuclear weapons to annihilate Russia during the cold war, does that make us heartless?
> 
> Of course not. Castro did treat his own people bad and that is why he was a Dictator. Treating his enemies bad, does not make his country bad. Cuba has always been known for the aid it provides to other small countries, even when Castro was in power.
> 
> The Cuban people are very giving. Unless you have been around them, you would not realize this from what you read in the news.



Kind of like Venezuela...we don't always get a long, but they have been charitable. 

/off topic

So back on topic, has anyone seen and numbers on how many rescuers are there or a list of the resources? We were discussing it today at work, and I was curious if someone was keeping track somewhere (besides some UN guy in an office).


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## VentMedic (Jan 19, 2010)

Jeffrey_169 said:


> The fact is I have met a few Cubans, and as you said, they are people like any other. Truth be told, I have never met one I didn't like. I went to the Island with a kid from Cuba, and he was a good man; honest and sincere. However, Castro was a different issue.
> 
> How many people died becasue he sent them of in rafts across the Atlantic ocean? He may have put on a good show for the world, but he was an evil man. He may have done some good but even Hitler did good; in my opinion it doesn't make either one of them good people.
> 
> I am disputing he may have done good deeds, but when put into perspective, at least in my opinion, political motives are not morally justified.


 
Again you have little knowledge about what has happened in Cuba or the relations with the U.S. 

Anyway, the rest of this should be taken to the "Violence in Haiti" thread.

Haiti has been under political turmoil for decades. The U.S. had its own opinions of Haiti's government and of its people as well. The treatment of Haitians coming to this country is very different than others because they have not been granted politicial asylum. That was also a hindrance initially in the early airlift efforts. Priority was also given to U.S. citizens and others from countries that asked for assistance to get their people evacuated.  But then this is not different than when the U.S evacuates its citizens from other disaster areas be it war or natural.


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