LAC-USC Trauma Surgery Team/Keck School of Medicine
Port-au-Prince and outside Croix-des-Bouquets
January 17-22, 2010
Kären Embrey, CRNA, MS, is an instructor of Clinical Anesthesiology and assistant director of Clinical Services at the University of Southern California (USC), Program of Nurse Anesthesia, Keck School of Medicine. Kären is also a doctoral student at the Rossier School of Education, at USC. She volunteered with the Los Angeles County (LAC) + USC Trauma Surgery Team out of the USC Keck School of Medicine.The LAC + USC team was in Haiti from January 17-22, 2010. They worked for three days in the Israeli Defense Force (IDF) Field Hospital outside of Port-au-Prince, and then at the Double Harvest Clinic, in the countryside, near Croix-des-Bouquets, for another three days.
Originally published on Page 3 of the California Association of Nurse Anesthetists'
Spring 2010 CANA E-Newsletter
(AANA Member number and personal PIN required to view E-Newsletter)
Kären Embrey, CRNA, MS, outside the operating room in the IDF Field Hospital, January 17, 2010.
This brief writing cannot possibly do justice to the intensity of our experience or the human suffering our team witnessed in Haiti nor can it give testimony to the indomitable spirit of the people, especially the children we encountered. Our team could not have been so effective on our brief mission during this time of great need without the dedicated members of the Israeli field hospital who welcomed us like family and worked tirelessly, side-by-side with us. We also owe a debt of gratitude to the Double Harvest Farm for housing us and feeding us during our last three days in Haiti and for allowing us to provide surgical services on the night shift, so as to facilitate around-the-clock care for the patients in that location. For additional information, slides and podcast interviews please visit the USC, Keck School of Medicine blog at: http://www.usc.edu/schools/medicine/haiti_blog/
Following the January 12, magnitude 7.2 earthquake, centered 15 miles out of Port-au-Prince, Haiti, the USC Keck School of Medicine’s Dean Puliofito and Dr. Demetriades of Trauma Services, organized a team of trauma surgeons and other personnel to respond to the zone, in an effort to help in the acute hours following the mass devastation. At the time, the exact number of injured was estimated in the hundreds of thousands and the death toll was thought to be between 100,000 and 150,000 with a million people left homeless. The volunteer team members mobilized in hours and included two trauma surgeons, Dr. Ramon Cestero (team leader) and Dr. Andrew Tang; orthopedic surgeon Dr. David Dromsky; Chairman of Emergency Medicine Dr. Edward Newton; intensivist Dr. Howard Belsberg; trauma service physician assistant (PA) Mira Lenzeni; emergency room (ER) registered nurse (RN) Kara Hammons; CRNA Kären Embrey; as well as intensive care unit (ICU) RN Claudel Thamas, who is a native Haitian and who had agreed to act as the team’s translator.
Through a series of fortunate events, we were hosted by the Israeli field hospital which was set up in a soccer field, five miles out of Port-au-Prince. The field hospital was extremely well organized and ran with amazing efficiency. Each morning we rounded on all of the patients including the new arrivals in the neonatal intensive care unit (NICU) (yes life does go on even amid untold destruction), the pediatric tent, and the ICU, as well as all of the patients on whom we would perform surgeries that day. Amid constant incoming wounded and around-the-clock dedication, the field hospital even managed to institute quality improvement measures.
Kären Embrey, CRNA, MS, placing spinal anesthesia for external fixation of the femur.
By day three, preoperative antibiotics and surgical time-outs were becoming routine – we saw nothing as well organized anywhere else in the other three field hospitals we visited in Haiti. The triage area remained inundated around the clock, and many patients had to be turned away, as the admitting criteria included only the most salvageable patients. This made for very difficult decisions and many ethical discussions each day. There were so many stories of unimaginable suffering, but we all kept busy with the tasks at hand, lest a quiet time allowed us to absorb what we were seeing. Some things do not translate well to the written word and so I would beg your indulgence in the brevity of this writing.
Lessons to be learned include those of packing appropriately for the region of a disaster and preparing well for the types of injuries one might encounter in the given disaster. The patients in Haiti had very different needs compared to those of Hurricane Katrina or the IndonesianTsunami. In this case, the need for regional anesthesia equipment and pulse oximetry was largely due to the number of extremity injuries and the need for so many amputations. Team members had to protect themselves from malaria and acquired immune deficiency syndrome (AIDS), and it was only by luck that that we had enough food and water, though we did stock up on military Meals, Ready-to-Eat (MREs) before leaving the U.S. We were very fortunate to have security, donated transport, and a healthy dose of blind luck. We also learned that to be effective in a zone of mass destruction where there exists no infrastructure, it is best to be paired with a military facility where security, order, and accountability replace the chaos and power struggles we witnessed in other facilities where volunteers had come armed only with good intentions and the distribution of resources was almost nonexistent.
More info and interviews with the LAC/USC Trauma Surgery Team out of the USC Keck School of Medicine are archived as podcasts on the USC site
where Kären's interview is number two.