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Global Medic is sending a 5 person rapid response team. They'll send a mobile field hospital and water purification units.
Haiti Earthquake EMS response
- Thread starter ExpatMedic0
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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.
lightsandsirens5
Forum Deputy Chief
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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.
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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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.
The wheels are turning. Folks are going. As is ALWAYS said, it will take several days for true relief to arrive.
firetender
Community Leader Emeritus
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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.
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.
mycrofft
Still crazy but elsewhere
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Central California USAR went yesterday
Dogs and all.
Dogs and all.
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
Paramedic
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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.
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.
reaper
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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.
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.
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.
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.
18G
Paramedic
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When people hear the term "emergency personnel, they automatically think of Fire/Rescue and EMS.
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.
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.
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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Only those involved in EMS believe that is all there is to the term.
Do you know everyone on the many anonymous EMS forums personally to know their sense of humor?
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".
You must have been living in what cave to not have heard about this.
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
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Just watched that on CNN.com. They did a pretty good job reporting on that.
18G
Paramedic
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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.
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.
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.
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.
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.
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?
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.
I think this is situation specific.
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.
I think we will have to agree to disagree on this point.
Amen
JPINFV
Gadfly
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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,
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).
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.
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?
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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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.
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.
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?
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.