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Wednesday, March 23, 2011

Resurrecting Global RN for "X24 Europe"

After a very long hiatus, and many twists and turns like a lot of us these days, I've finally gotten back to what I love. Talking about global healthcare, humanitarian assistance, and disaster response. I want to apologize to my followers for not getting back to this column, and wanted to thank them for their insight and comments.

Please feel free to send stories, comments, whatever you can do to share knowledge in this field, whether you are civilian, government, non-goverment, or just an interested individual.

I am excited to report that I will be going to Montenegro for participation in an international on-line disaster exercise next week, utilizing social networking capabilities such as Facebook, Twitter, Ushaidi, and many more, to get people engaged in sharing their knowledge and ideas for humanitarian assistance and disaster response. X24 Europe is an outgrowth of X24 which was our first online disaster exercise which was highly successful. We had 89 countries check in and over 10,000 messages from texts to Twitter messages. It is open to all to view or participate. You can find the information on Facebook under "X24 Europe" It will be conducted March 30-31. I will hopefully be posting pictures from the drill as we go along, or, if it gets too busy, I will catch up when I get back. Take care all,

Wednesday, January 27, 2010

Call for stories

I would really like to hear stories from the field, so if you are there, please send us your experiences.

Our local DMAT team meeting was tonight, the house was packed, we even had several new people who came to apply to join. We went through the health and security issues involved in deploying to Haiti and heard bits and pieces of our sister team CA-6 who was one of the first teams there. They had to sleep out in the open for nine days. That's rugged.

I've been getting more communications about doctors and nurses who spontaneously went there and are having problems because they are expecting some agency or organization to put them up or have an assignment for them. Or, they are getting overwhelmed. Evacuating them takes up air time, flight space, fuel, manpower, etc. Don't do it!

Saturday, January 23, 2010

Passion and Good Intentions are Not Enough

Great article from MSNBC the other day regarding the hazards of unsolicited help, and the burden it can put on a response. Every unnecessary person, politicians included, takes away resources needed from victims who so desperately need them. I know first-hand how resources get diverted for some unplanned arrival of volunteers, politicians or military officials that have neither the self supporting resources for their purpose, or have no good reason being their other than morbid curiosity and the chance to say they were there. This includes security, transportation, health care, billeting, etc. Enough of my rant, here's the article.
If the link doesn't work, I apologize.

Friday, January 22, 2010

Watching out for "Responder Envy"

It's been said before, that disaster responders are the type of people that when something happens, they run to a situation rather than away from it. I very much agree. Whenever a disaster happens we automatically go into alert mode and watch for an opportunity to be called upon to help. Once you've been to a few disasters, and another disaster happens, friends and family automatically ask if you are going, most expect you will. When you don't they may ask "Why not, don't they need help, isn't that what you guys do?" With the DMAT teams, there is an order and process to go through in order to have an effective response. Sometimes these regulations make sense and sometimes they don't. As I may have explained earlier, each team is "first up" to respond during certain months of the year. When a disaster happens and your team doesn't deploy, it is easy to become a little envious, frustrated, or disappointed. I half-jokingly refer to this as "Responder Envy", "Non-Deployment Depression, or "I Can't Deploy Blues". It can be hard for people who have good skills, experience and willingness, to sit back and wait for the call to go. We are an ingenious bunch and can often figure ways to get in on a response through other NGOs or agencies. Each person does what he or she feels best, but this may not always be the best choice. I like deploying with my DMAT team as we train together, and have the resources and protocols to keep ourselves safe and render more effective aid. Whether or not I will be able to deploy through DMAT is in question as I was trained by the CDC to help with H1N1 issues if needed. The commitment is through August, so I'm not sure if I will be released by one agency to serve with the other. Frustrating but the reasoning behind it does have some logic. We cannot send all of our resources to one disaster. As I speak, here in Southern California we are having torrential rains, trees toppling on to cars and buildings, we had at least one woman lose her life due to a tree coming down on her trailer. So, we must keep some resources here in case of a domestic emergency.
When I feel that angst at not being able to go, I have to check myself out. Is it my ego? Or, is it a genuine frustration at circumstances beyond one's control? Maybe a little of both. What I do know, is to be careful of what you pray for. I'm learning to find out how I can contribute to the response in ways other than hands-on nursing care, thus avoiding those "I Can't Deploy Blues". This time I've become involved in monitoring communication and logistics efforts on-line, and helping connect resources through different networks via the university and the National Institute of Urban Search and Rescue. Small efforts, but it helps me learn more about all the things that go into and behind my nursing care in the field.

The following was written by my friend Sam Bradley (links on side). She captured so much of what I wished to say. I feel about my DMAT team and our commander the way she feels about hers.

A week ago Tuesday I was driving from Northern to Southern California to meet with a representative from Washington DC to work on a national training project. Car travel for me generally assumes being firmly entrenched in the iPod zone. I actually look forward to long drives as it’s an opportunity for me to catch up on my favorite podcasts and audiobooks. That might explain my complete mystification when I dropped into the hotel bar at 7:30 to see news footage of the Haiti earthquake on the TV. Me: “So, when did that happen?” Bartender: “Oh, about 3:00 this afternoon.” That’s when my iPhone came to life with e-mails from the team speculating about a possible deployment. Deploying to Haiti would be our first international mission. So, there I was, sitting at the other end of the state with an all day meeting scheduled the following day. The next morning we met for breakfast and guessed that my team would probably not be deployed before the end of the week. International travel creates a whole new set of complexities to the already daunting task of sending multiple teams of thirty-five people into a disaster area. We were wrong. DMAT CA-6 and other teams were moving out by the end of the day. Even though I wasn’t on the current roster, I was disappointed about being left behind. Disaster medical people are a unique bunch and thrive on working in the worst of circumstances. The extremely austere conditions in Haiti would provide an especially challenging opportunity.
Who are these people? In 2008, I was doing an article for JEMS magazine that was ready to go when my (then) employer decided I wasn’t high enough in the food chain to author the article. The magazine liked it, but it didn’t see print. In the process of creating it, I interviewed some of my team members to try and explain what drives them to do what they do. This is a chance for their thoughts to come off my hard drive and to be shared with you.
David Lipin went from being a partner in a computer networking business to joining DMAT CA-6 as an EMT. Within a few years, he became the commander of our team. In our opinion, he’s the best in the system. (No bias, here!) I asked Dave what attracted him to disaster medicine.
“I got into disaster work because it's so different than my ‘day job’. It works a different part of my brain, is almost like a vacation, and ultimately, is just so darned satisfying. The best part is the grateful responses of patients we treat at disasters. No bills, no insurance, no worries -- just medicine”. Dave devotes himself to this work full time now, and states that he’s “living his dream”. When asked about his best memories of deployments, he told me: “Watching a baby girl being born at the Superdome, and seeing my wife at the airport upon returning from Ground Zero”. I’m anxious to hear what experiences he brings home from Haiti.
Annie Bustin is an experienced RN who is a triage nurse in San Francisco, and the Disaster Coordinator for her hospital. In my opinion, she exemplifies what a nurse should be. (No bias here, either!) She is also the Operations Chief for DMAT CA-6. When asked what attracts her to disaster work, Annie said, “Being an RN in the emergency department allows me to use my critical thinking skills. I can be creative, go outside the box, and actually do something for a patient to make them feel cared for. It’s incredibly satisfying. Disaster work is that same feeling, but a thousand fold. It’s knowing that you're right where you're supposed to be, that you can give your blood, sweat and tears to a stranger without them ever knowing it; without the world ever knowing it.”
Annie is motivated by the fact that she has the skills to make a positive difference in someone’s life during the worst of circumstances. “I can give back to the human race. I can give a piece of myself to healing the injured, ill, broken and destroyed victims of a disaster. I can give hope where there is none. How can you turn down a job like that?” Deployments aren’t always easy, and Annie described her most memorial moments of Katrina as too private to share. “It's an emotional moment that’s as strong now as it was then.” But, she’s treating people in Haiti as we speak. Her words reflect beautifully how many of us feel, “At the end of the day, when you can finally lay your head down somewhere, a sense of peace and mercy falls upon your breaking heart. And you know then, that you've come home”.
A DMAT or any disaster medical team is not just about the medical personnel. The team can’t function without a place to practice and sleep; the use of electricity, water and sanitation; and certainly, communications. Critically important team members include the logisticians or, as we affectionately call them, the “loggies”. In answer to the question, “Why do you do this”, a loggie told me; “Because I have a screw loose in my head. Who in their right mind pursues a career and a hobby where you run toward a situation that other people are screaming and running away from? The best part is the feeling of accomplishment that you've done something to help, that you gave them your best shot, and you got people through it. It’s the satisfaction of having to improvise and create something that helps the team or a patient, by using non-standard thinking and a creative skills set to make a piece of chewing gum and a Band-Aid into a heart monitor. It’s what “loggies” do best.” He’s right … loggies are the most creative and resourceful people on the planet.

We see an amazing number of people in the few weeks we’re in a disaster area. We suture, hydrate, cleanse and salve their wounds. We comfort them the best we can. What makes a deployment difficult is never having closure on the stories of the people we treat: parents separated from kids; loved ones floating away after a hurricane or flood; people missing under the rubble of an earthquake; the loss of beloved animals and everything they own. We can’t tell them, “It will be all right” because we know it won’t be. We don’t know where the homeless will go or whether they’ll ever see their families again. We can tend to their wounds and replace their meds, but we can’t repair the psychological devastation that will remain long after we’re gone. It almost leaves us feeling guilty for having an intact family and home to return to.
Yet, we love to remember the moments when something happens that brings a little light to the darkness: a family is reunited, a baby is born, or a life is saved. At Ground Zero we met the family of a lost FDNY firefighter that we still remain in contact with. I wrote about Christian Regenhard in the story about my Ground Zero experience in the book, “To the Rescue, Stories of Healthcare Workers at the Scene of Disaster.” After Katrina, CNN profiled a story about a woman whose mother still hadn’t been located many months after the hurricane. Dave recognized the missing woman as one they had seen when the team was trying to make their way to the Superdome and some people were pushing her up the freeway on a gurney-like device. The team stopped and attended to her then provided for her evacuation. Even though the prognosis for her was certainly not good, Dave was able to provide some much needed closure for that family … all recorded on CNN. Now the team is back in the lights of the CNN cameras doing the good work that they do. They are there with the USARs, religious and non-governmental organizations; the American military, and the Comfort hospital ship to name just a few.
Okay, here comes the rant … It’s my blog, I can say what I think. Every time I hear negative comments about the US response to Haiti being too slow or not good enough, it annoys the crap out of me. To those people: before you criticize, know the facts. First of all, there is no mandate for us to be there. We are a humanitarian nation and choose to be there. When the call comes, team members have to get off work and prepare their families, while the government processes a deluge of travel orders. They have to determine how to safely get them into the disaster area, especially when there are issues like damaged ports, lack of aircraft fuel, and a semi-functional and overloaded airport. Then, there are the issues of security for the personnel and getting huge caches of equipment to the teams. News flash: There is no means of instantly transporting people and equipment and have them land in a light beam in an affected area an hour after a disaster … end of rant.
So, am I going to Haiti? I don’t know. If the call comes, I’ll be ready as will many of us who missed the boat ... or plane, the first time. I’ll remove the down jacket and fleece I packed for a trip to Alaska and replace them with bug spray and mosquito netting. If I don’t go to Haiti, there will always be another disaster somewhere ... sometime …

I'm hoping that I can focus my next posts on updates from the field and ideas regarding what to take and how to prepare for a disaster response. Take care and stay safe.

Wednesday, January 20, 2010

Short post tonight, but I did want to introduce a colleague of mine from our sister DMAT CA-6 out of Northern California, Sam Bradley, responder extraordinaire. She's recently published a book about disaster responders, detailing their experiences at disasters such as Ground Zero and Hurricane Katrina. Well worth checking out.

"To the Rescue - Stories of Healthcare Workers at the Scene of Disaster" at Barnes and Noble, Amazon, etc. There's also a summary at

Hopefully the military issues with security will be satisfied soon so that aid teams can get in there and do their job! I'm too tired to go on my tirade about the lack of interagency collaboration, agencies culture clashes, civ/mil culture class, administrative turf wars, etc. Great warriors trying to manage a humanitarian mission without a whole lot of life experience or training in that field. There has to be more civ/mil research in to lessons learned or at least really put the lessons learned from past missions into effect instead of starting from square one each time. The Israeli's had it down. Set up and operational in 48 hours. Mmmmm....

Tuesday, January 19, 2010

Notes from the field

Tonight I'm posting a field report from Steve Hailey passed on to me from Lois Clark-McCoy, President of the National Institute of Urban Search and Rescue.
Steve was the Emergency Services Director for American Red Cross in Austin TX.
He has over 50 Disaster Response assignments plus 6 international deployments.
His note below. He is currently working as a contractor (Technology and communications response) for a group of doctors from Orlando FL.

-----Original Message-----
From: Steve Hailey
Sent: Monday, January 18, 2010 11:00 PM

Just a quick update. I made it to Haiti and am supporting doctors at the main general hospital as well as an International Red Cross team who have setup a mobile hospital on the general hospital grounds to help with the overflow. Without going into all the gory details I guess I can only say that with all the disasters I've been on this is 1000 times worse. It is really bad here the people need help and I fear it will only get worse. I'm just glad I am able to help. My family is doing well back home thanks for asking.

Let me give you just few highlights from my first 24hrs.:

1. Flight over was a chartered jet and the air traffic control was so overloaded that my plane was not able to reach ground control at Port au Prince for nearly an hour and we had to basically fly in a circle to get them to recognize us. So we were flying by the seat of our pants. After landing I paid a local with a truck to haul people and personnel to the hospital and had him drive right up to the plane on the grass and didn't go through customs or anything. Very interesting.

2. Driving around is by far the most dangerous activity. You can get shot, a telephone pole came within feet of fallling on the car I was riding in. Note to self...stay off the street because its dangerous.

3. Now I know what wartime medicine is. Its dirty, nasty, and that is all I can say right now.

4. Provided comms for Intl. Red Cross Hosp. AND the main general hospital.

Not bad for the first 24 hours. I need to turn the genset off now take care and please pass this on if you wish.

I hope to post more field reports from various teams as more teams get up and running.
Kudos to the Israeli team for such quick and efficient hospital set up. Take note emergency response administrators, we could learn a thing or two.

Monday, January 18, 2010

Bits and Pieces

A case in point about helping responders: Yesterday I was trying to do chores amongst e-mails, blogging and all of the assorted bits and pieces of what we do. I was chagrined to say the least, to find out that I absent-mindedly used bleach instead of detergent in my load of dark clothes. Of course, some of my favorite things were in there. Oh well, I'd rather goof on my laundry than actions related to the response. Tonight my daughter-in-law cooked a fabulous dinner while I played a short game of monopoly with my granddaughter. We need to take those breaks, most of us are a very driven bunch when it comes to disaster response.

As far as Haiti, situation reports have been from one extreme to the other. Reports of a communication team trying to set up a communication system, being attacked and having to retreat into Santo Domingo. While on the other end, I got a message of a hospital that wasn't in the damage area which was able to take patients, but no one knew because of the lack of communications. This was great news, and in this area things were calm and the community trying to help as much as they could. The beauty of the networking, social and technical, is they were hooked up with people on the ground in Haiti who need to know this. Fuel is still very difficult to obtain and anything that runs off of a generator, from lights to communications is affected. This alone slows the process. It is diligently being worked on by a number of people from all over the world. People wonder why the heavy equipment isn't getting there, if they could only have a fly on the wall perspective they would understand the numerous logistical issues involved, the ports heavily damaged, roads damaged or impassable, or no roads at all, and poor communications. However, it is getting somewhat better as we speak, thousands of people communicating through various networks to come up with solutions.
Meanwhile medical personnel are trying to manage the best they can as supplies trickle in. Last night on 60 Minutes they showed doctors having to use a hack saw for amputations and vodka for sterilization as that is what they have at hand.
Hopefully tomorrow I can post a little of what responders are encountering if I can get some reports from the field from one of our teams that just arrived in Port Au Prince today.

One of the security issues they are dealing with is the escape of several hundred felons from their collapsed prison. Port Au Prince has had a long history of gang violence. Haiti is one of the main portals for cocaine to the U.S. Fighting for turf is going to be an issue especially with the escaped criminals many who were in for drug or violence charges. Couple this with people not being able to get food, water, and medical care and it all contributes to the risk of violence. When I responded to the Nias earthquake, a helicopter was shot at trying to deliver food. Who is responsible for establishing security? Especially with a collapsed government. While the UN may send in some peacekeeping forces it is not enough. The U.S. while trying to help may be perceived as trying to take over. So many political, administrative, logistical issues that slow these responses, yet, I still see the progress of Civilian/Military and International cooperation better than it has been in previous responses. I think the world finally realizes we are all on this planet together and we better help each other, as what happens in a disaster affects everyone. Take care all.