Editorial opinionFacilitating safer surgery and anesthesia in a disaster zone
Section snippets
Environmental and Supply Considerations
The austere environment posed a unique set of challenges. First among them was infection control. Because there was no running water in the hospital, we used hand-scrub solutions, primarily chlorhexidine and alcohol-based solutions.4 Surgical equipment was cleaned and then disinfected with bleach, ortho-phthalaldehyde, or 2% hydrogen peroxide solution.4 A small steam autoclave that became available was used for sterilization. Additionally, with regard to sanitation, given limited personnel, the
Anesthesia Safety Considerations
The austere environment posed several obstacles to the provision of anesthesia. Given the limited supply of supplemental oxygen, inhaled anesthetics, paralytics, narcotic analgesics, difficult airway equipment, anesthetic machines, mechanical ventilators, monitors, and restricted perioperative monitoring capabilities, general anesthesia (GA) use was initially minimized. Specifically, there were four GA machines at the hospital that needed servicing. Biomedical personnel from the US Armed Forces
Surgical Safety Considerations
There were several surgical safety considerations. As the initial massive influx of patients subsided, verbal patient safety checklists, similar to those recommended by the World Health Organization, were further used.7 Their components included verifying the correct patient, site, and procedure. Informed consent, usually verbal, was obtained from the patient or family, with the assistance of interpreters. Preoperative antibiotics were administered, although the choice of antibiotic was
Communication Considerations
Constant communication among providers at the hospital was necessary for the optimal use of scarce resources. To this end, there were daily “chiefs” meetings, at which representatives from various health care groups, such as anesthesiology and nursing, participated. This meeting determined the hospital's intake capability for the day, identified shortages in personnel and supplies, and communicated perceived challenges to Project Medishare headquarters in Miami. When critical shortages of
Conclusions and Future Directions
The Project Medishare field hospital was able to overcome many obstacles in postearthquake Haiti in large part because of teamwork, and provide an invaluable service. The hospital has since been relocated to the Bernard Mevs Hospital and continues to provide an critical service to the people in the Port-au-Prince area. The experiences in postearthquake Haiti provide valuable insight into safely facilitating surgery and anesthesia in a future mass disaster in an austere environment. To
References (12)
Post-earthquake injuries treated at a field hospital—Haiti
Morbid Mortal Wkly Rep
(2010)- et al.
Rapid medical relief—Project Medishare and the Haitian earthquake
N Engl J Med
(2010) - et al.
An academic center's delivery of care after the Haitian earthquake
Ann Intern Med
(2010) - et al.
Infection control in field hospitals after a natural disaster: lessons learned after the 2010 earthquake in Haiti
Infect Control Hosp Epidemiol
(2010) - et al.
Anesthetic practice in Haiti after the 2010 earthquake
Anesth Analg
(2010) Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters
Anesthesiology
(2011)
Cited by (6)
Disaster Surgery
2021, Physician Assistant ClinicsCitation Excerpt :They could tell us a patient’s name and their medical history, occasionally act as translators, help carry patients, do wound care once trained by us, and once discharged help ensure that the patient was able to return to us for follow-up care. Patient families even helped with waste removal in Haiti.20 It was very difficult when families are not identified, as when transferring patients to the United States from Haiti, and little information was known about the patient.
On the Challenges of Anesthesia and Surgery during Interplanetary Spaceflight
2021, AnesthesiologyEarthquakes
2016, Koenig and Schultz's Disaster Medicine: Comprehensive Principles and PracticesPlastic surgery response in natural disasters
2015, Journal of Craniofacial Surgery
The January 12, 2010, earthquake in Haiti destroyed the nation's fragile health care infrastructure. The authors present their experiences at a field hospital as both a description of these experiences and a guide for future aid workers.
This work was presented in part at the 63rd annual meeting of the Southwestern Surgical Congress in Hawaii in 2011.