by Melissa Jeltsen on March 18, 2010
A group of clinicians worked together to stabilize the "patient."
Clinicians working in high-resource settings, like Children’s Hospital Boston, rely on the availability of certain equipment to do their jobs, like ventilators, specially sized needles and tubes and a fully stocked pharmacy. But when they’re forced to perform without their gear—like in Haiti in the immediate aftermath of the January earthquake—many find it bewildering and even paralyzing. “We fall into these patterns of providing care,” says David Mooney, MD, MPH, director of the Trauma Program, who was one of the first medical responders to respond after the disaster. “One of the things I noticed in Haiti was that many doctors really fixated on what they didn’t have.”
That mental block can waste time and be counterproductive, so Children’s is developing a training program to prepare the doctors, surgeons, nurses, pharmacists and other volunteers who are going to Haiti to continue relief efforts in the coming months for the conditions they’re likely to find. Mooney, along with Shannon Manzi, PharmD, and Debra Weiner, MD, PhD, worked with Children’s Simulator Program to create the special training, in which clinicians reenact challenging situations on robotic mannequins. Peter Weinstock, MD, PhD, director of the Simulator program, hopes that by practicing in an environment with limited supplies, clinicians will be encouraged to think outside of the box to find the resources they need, and will be better prepared for a disaster zone.
(Listen to a WBUR story about Children’s new simulation program and read The Boston Globe’s White Coat Notes report of it.) [click to continue…]
by Children's Hospital Boston staff on March 17, 2010
by Michael Agus, MD, director of Children’s Medicine Critical Care Program. Agus is currently in Port-au-Prince, Haiti, where he is treating patients and sending us updates by email.
Day 10
I wasn’t supposed to work the day today because I now have to start working nights since there is a few days’ gap in the night pediatric physician coverage. But after a good night’s sleep, and with two intubated patients in the pediatric tents with no other intensivist on site, I felt like I should go for morning rounds, set a plan for the day and then sleep on the hospital grounds to rest up for the night. [click to continue…]
by Children's Hospital Boston staff on March 15, 2010
Dr. Agus, shown here with a Haitian resident, spent hours assembling this medical supply closet in the acute pediatrics tent.
by Michael Agus, MD, director of Children’s Medicine Critical Care Program. Agus is currently in Port-au-Prince, Haiti, and sending us updates by email.
Day 7
There was a buzz around the hospital this morning that Hillary Clinton might visit, though it did not turn out to be true. It was an interesting process to consider what would be my answer to her obvious question: What one thing could the US do to make things better? My own answer would have been: nurses. Despite my tendency to focus on the physician side of the equation, it is nurses that make a hospital run. And HUEH needs more. They need more of 5,000 things, but mostly they need more nurses.
Nobody yet knows exactly how many staff were killed in the earthquake. But it’s absolutely clear what percentage had their lives destroyed in one way or another: 100%. During an informal moment with a half dozen pediatrics residents, they shared with me that all but one of them is sleeping in a tent or their car. Showering, washing clothes, finding clothes, commuting and eating all became hardships on January 12. As if residency is not difficult enough. And yet several of them came to the hospital today for the sole purpose of hearing a talk on DKA by some foreign doctor.
After the DKA talk, several opted to stay for an additional teaching session at the bedside of an intubated adolescent in the adult ICU tent. A couple of others took advantage of the mentoring by placing lines and intubating a patient in the Pediatrics tent for their first time since the quake. In fairness, even as the residents were using me for backup, I was doing the same by sharing rapid fire emails back and forth with my Children’s Hospital Respiratory Therapy colleagues. [click to continue…]
by Children's Hospital Boston staff on March 14, 2010
by Children's Hospital Boston staff on March 12, 2010
by Michael Agus, MD – director of Children’s Medicine Critical Care Program
Day 4
The day started with a proud smile and high five from the HUEH resident who wryly bragged, “I told you I wouldn’t need all that airway equipment.” The child had been safely transported and the surgeon had successfully removed the pebble from her trachea.
The routine has begun to set in at this point, but admissions were few on this Sunday. The weather, which had until now been in the 70s with scattered rain, hit the 80s with strong sun. With this change, the temperature in the interior of the medical tents rose to above 100F with extremely high humidity. Slight fevers are no longer clinically significant, standard intravenous fluid calculations no longer apply. Thanks to the NGOs, drinking water is plentiful and those patients, who are capable, work hard to maintain adequate hydration. The rest are dependent upon IVs or attentive family members to keep them hydrated. [click to continue…]
by Children's Hospital Boston staff on March 11, 2010
by Michael Agus, MD - director of Children’s Medicine Critical Care Program
A few weeks ago, multiple waves of teams from Children’s Hospital Boston left under the auspices of Project Hope for the USNS Comfort, which remains anchored in the harbor of Port-au-Prince. As Comfort’s mission began winding down, Robert Truog, MD was able to transfer and join a land-based effort already underway through Partners In Health (PIH). I was scheduled for the Comfort as well and due to Bob’s efforts was able to re-deploy to the same site right after he left.
Day 1
I boarded a plane early in the morning on Thursday, March 4 from Boston to Miami. In addition to a large pile of energy bars, mosquito netting and a camping pillow, I brought donations from my kids’ school, including stuffed animals and drawing pads from my 1st grader’s class.
The front page of The Boston Globe the prior day had pictured Cardinal O’Malley visiting sick children in a tent at a Catholic hospital in Haiti – St. Francois de Sales. I was able to use the picture to show my 3 sons (ages 13, 10 and 6) where I would be the following day. In the airport in Miami, I ran into the Cardinal and we discussed his and my trips. He expressed continued amazement at what he described as the worst human disaster of our time. [click to continue…]
by Children's Hospital Boston staff on March 7, 2010
by Children's Hospital Boston staff on March 4, 2010
Aimee Lyons instructs a mother on how to care for her baby after he leaves the Intensive Care Unit on the Comfort.
by Aimee Lyons, RN, BSN, MSN
When I got the call from Project Hope to go to Haiti, I didn’t think twice. They called me on a Monday and the next day, Tuesday, I was on a plane, heading towards devastation unlike any I’d ever seen. [click to continue…]
