Susan M. Briggs

International medical response to a natural disaster: lessons learned from the Bam earthquake experience

An earthquake measuring 6.5 on the Richter scale devastated Bam, Iran on the morning of 26 December 2003. Due to the great health demands and collapse of health facilities, international aid could have been a great resource in the area. Despite sufficient amounts and types of resources provided by international teams, the efficacy of international assistance was not supported in Bam, as has been experienced in similar events in other countries. Based on the observations in the region and collecting and analyzing documents about the disaster, this manuscript provides an overview of the medical needs during the disaster and describes the international medical response. The lessons learned include: (1) necessity of developing a national search and rescue strategy; (2) designing an alarm system; (3) establishing an international incident command system; (4) increasing the efficacy of the arrival and implementation of a foreign field hospital; and (5) developing a flowchart for deploying international assistance.

Acute idiopathic gastric dilatation with gastric necrosis in individuals with Prader-Willi syndrome

Individuals with Prader-Willi syndrome (PWS) have excessive appetite with the ability to consume large quantities of food. Absence of vomiting and a high pain threshold are considered manifestations of the disorder. We present 6 patients with PWS with acute dramatic gastric distention. In 3 young adult women with vomiting and apparent gastroenteritis, clinical course progressed rapidly to massive gastric dilatation with subsequent gastric necrosis. One individual died of overwhelming sepsis and disseminated intravascular coagulation. In 2 children, gastric dilatation resolved spontaneously. Gastrectomy specimens--in 2 cases subtotal and distal, in the other with accompanying partial duodenectomy and pancreatectomy--showed similar changes. All cases demonstrated signs of ischaemic gastroenteritis. All specimens showed diffuse mucosal infarction with multifocal transmural necrosis. Vascular dilatation and small bifrin thrombi were apparent within the infarcted areas. These 6 women with PWS had acute idiopathic gastric dilatation. It is possible that a predisposition to acute gastric dilatation may be related to abnormal gastric homeostasis on a genetic basis. Understanding the mechanisms responsible for this event could increase the understanding of gastrointestinal and appetite regulation in individuals with PWS.

Disaster management teams

Purpose of reviewAll disasters, regardless of cause, have similar medical and public health consequences. A consistent approach to disasters, based on an understanding of their common features and the response expertise they require, is becoming the accepted practice throughout the world. This strategy is called the mass casualty incident response. The complexity of todays disasters, particularly the threat of terrorism and weapons of mass destruction, has increased the need for multidisciplinary medical specialists as critical assets in disaster response. A review of the current literature emphasizes the expanding role of disaster management teams as an integral part of the mass casualty incident response. Recent findingsThe incident command system has become the accepted standard for all disaster response. Functional requirements, not titles, determine the organizational hierarchy of the Incident Command System structure. All disaster management teams must adhere to this structure to integrate successfully into the rescue effort. Increasingly, medical specialists are determining how best to incorporate their medical expertise into disaster management teams that meet the functional requirements of the incident command system. SummaryDisaster management teams are critical to the mass casualty incident response given the complexity of todays disaster threats. Current disaster planning and response emphasizes the need for an all-hazards approach. Flexibility and mobility are the key assets required of all disaster management teams. Medical providers must respond to both these challenges if they are to be successful disaster team members.

Building a global surgery initiative through evaluation, collaboration, and training: the Massachusetts General Hospital experience.

OBJECTIVE The Massachusetts General Hospital (MGH) Department of Surgery established the Global Surgery Initiative (GSI) in 2013 to transform volunteer and mission-based global surgery efforts into an educational experience in surgical systems strengthening. The objective of this newly conceived mission is not only to perform advanced surgery but also to train surgeons beyond MGH through international partnerships across disciplines. At its inception, a clear pathway to achieve this was not established, and we sought to identify steps that were critical to realizing our mission statement. SETTING Massachusetts General Hospital, Boston, MA, USA and Mbarara Regional Referral Hospital, Mbarara, Uganda PARTICIPANTS Members of the MGH and MRRH Departments of Surgery including faculty, fellows, and residents RESULTS The MGH GSI steering committee identified 4 steps for sustaining a robust global surgery program: (1) administer a survey to the MGH departmental faculty, fellows, and residents to gauge levels of experience and interest, (2) catalog all ongoing global surgical efforts and projects involving MGH surgical faculty, fellows, and residents to identify areas of overlap and opportunities for collaboration, (3) establish a longitudinal partnership with an academic surgical department in a limited-resource setting (Mbarara University of Science and Technology (MUST) at Mbarara Regional Referral Hospital (MRRH)), and (4) design a formal curriculum in global surgery to provide interested surgical residents with structured opportunities for research, education, and clinical work. CONCLUSIONS By organizing the collective experiences of colleagues, synchronizing efforts of new and former efforts, and leveraging the funding resources available at the local institution, the MGH GSI hopes to provide academic benefit to our foreign partners as well as our trainees through longitudinal collaboration. Providing additional financial and organizational support might encourage more surgeons to become involved in global surgery efforts. Creating a partnership with a hospital in a limited-resource setting and establishing a formal global surgery curriculum for our residents allows for education and longitudinal collaboration. We believe this is a replicable model for building other academic global surgery endeavors that aim to strengthen health and surgical systems beyond their own institutions.

Burn Specialty Teams

Natural disasters have always been a threat. human-caused disasters, especially terrorist acts, are increasing in frequency. Burn centers and providers have an important contribution to make in caring for those injured in these incidents. The most effective way to make a contribution is to act in cooperation with the Federal Disaster Response, which is organized by the Department of Homeland Security and the Federal Emergency Management Agency. It appears that this can be most effectively accomplished through participation in the Burn Specialty Team Program, which has been developed to rapidly augment emergency medical teams with burn expertise.

Regional Interoperability: Making Systems Connect in Complex Disasters

Effective use of the Incident Command System (ICS) is the key to regional interoperability. Many different organizations with different command structures and missions respond to a disaster. The ICS allows different kinds of agencies (fire, police, and medical) to work together effectively in response to a disaster. Functional requirements, not titles, determine the organizational hierarchy of the ICS structure. The ICS is a modular/adaptable system for all disasters regardless of etiology and for all organizations regardless of size.

Lessons learned from a landslide catastrophe in Rio de Janeiro, Brazil.

INTRODUCTION On January, 2011, a devastating tropical storm hit the mountain area of Rio de Janeiro State in Brazil, resulting in flooding and mudslides and leaving 30,000 individuals displaced. OBJECTIVE This article explores key lessons learned from this major mass casualty event, highlighting prehospital and hospital organization for receiving multiple victims in a short period of time, which may be applicable in similar future events worldwide. METHODS A retrospective review of local hospital medical/fire department records and data from the Health and Security Department of the State were analyzed. Medical examiner archives were analyzed to determine the causes of death. RESULTS The most common injuries were to the extremities, the majority requiring only wound cleaning, debridement, and suture. Orthopedic surgeries were the most common operative procedures. In the first 3 days, 191 victims underwent triage at the hospital with 50 requiring admission to the hospital. Two hundred fifty patients were triaged at the hospital by the end of the fifth day. The mortis cause for the majority of deaths was asphyxia, either by drowning or mud burial. CONCLUSION Natural disasters are able to generate a large number of victims and overwhelm the main channels of relief available. Main lessons learned are as follows: 1) prevention and training are key points, 2) key measures by the authorities should be taken as early as possible, and 3) the centralization of the deceased in one location demonstrated greater effectiveness identifying victims and releasing the bodies back to families.

New Horizons for OR Nurses—Lessons Learned from the World Trade Center Attack

The terrorist attacks of Sept 11, 2001, we a horrifying wake-up call for the United States and the rest of the world. The attacks led to the deployment of the disaster medical assistance team (DMAT) from Massachusetts General Hospital in Boston. In this article, members of the team outline what they did during the days after Sept 11 and the lessons they brought back to better prepare their DMAT for the next disaster.

Response to Challenges and Lessons Learned From Hurricanes Katrina and Rita: A National Perspective

Geographic circumstances: We participated intimately in disaster response after Hurricane Katrinas landfall and other disasters since then. About the lead author (Dr Weiner): I am a pediatric emergency medicine physician at Childrens Hospital Boston (CHB)/Harvard Medical School (HMS) and the CHB representative and a charter member of the HMS Section on Disaster Medicine. I have been a National Disaster Medical System member on the Disaster Medical Assistance Team, the International Medical Surgical Response Team, and the Pediatric Specialty Team since 1995. I am a member of the American Academy of Pediatrics Extended Disaster Preparedness Advisory Council Network. I have served as a domestic and international consultant in disaster planning and am developing technology-based resources for disaster training and response. Hurricane Katrina was a disaster unlike others for which the US National Disaster Medical System (NDMS) had been deployed. Never before had the NDMS attempted to provide sustained disaster relief over a geographic area as expansive as the multistate region devastated first by Hurricane Katrina and then by Hurricane Rita. There were challenges we anticipated and those that we did not. Lessons learned from Hurricanes Katrina and Rita, and subsequent disasters, have led and continue to lead to strategic conceptual, organizational, and operational modifications to improve care to disaster victims.1 Increased emphasis on the care of children in disasters is an important component of these initiatives, given that for most disasters more than one-third of victims are children.2 As demonstrated by the hurricanes in the Gulf Coast region, and again by the earthquake in Haiti in January 2010, the NDMS remains a critical asset for disaster relief and one of the few US disaster-relief organizations/agencies with the capacity to provide care for critically injured or ill disaster victims including children. Lessons learned from and actions taken since Hurricanes Katrina … Address correspondence to Debra L. Weiner, MD, PhD, Emergency Medicine, Childrens Hospital Boston, 300 Longwood Ave, Boston, MA 02115. E-mail: debra.weiner{at}childrens.harvard.edu

A Surgical Response to the Haiti Earthquake 2010

This chapter focuses on the surgical response to major earthquake events based on the lessons learned from the response of the US International Medical Surgical Response (IMSuRT) teams to the Haiti Earthquake in January, 2010. An historical overview of the impact of earthquakes is presented along with a review of the management of common earthquake-related injuries. The experience of the IMSuRT deployment is summarized, and valuable lessons learned by the surgeons who responded are included. These lessons provide valuable considerations for any surgeon considering responding to a major international disaster event.