In response to our story, “Cry, The Beloved Surgeon” (Feb 1, 2010), one of our readers, Glenn Taylor left this comment:
“Undoubtedly noble and altruistic, the HSS orthopedic team nonetheless stumbled naïvely into a real life mass casualty situation with challenges beyond their capabilities. The military was correct in their criticism of the civilian doctors, given lessons learned from the battlefields of the Civil War to Iraq.
Saving life and limb in such dire circumstances depends on a coordinated infrastructure with rapid transport to disciplined, secure and properly equipped field hospitals with a triage structure. Such organization is not available in the immediate aftermath of a natural disaster. Instead of ex-fixators and IM rods, the team might have been better off bringing lots of plaster of paris and a copy of Dr. Paul Brown’s article on his Vietnam War experience in managing open tibia fractures published in JBJS 1969.”
Dean Lorich, M.D., one of the surgeons from HHS (Hospital of Special Surgery) that rushed to Haiti before security was established responded to Mr. Taylor:
Dean Lorich, M.D.“This response is offensive. If it weren’t for civilians like us there would have been no one treating these patients. We were not bellyaching because of our plight. We were pointing out the complete lack of any organization on the ground to the point that none of the 1, 000 patients we saw at the hospital we worked or at the general hospital we originally arrived had any significant medical treatment.
Our ‘naïveté’ was that the military was there in force or would be there in force as first responders and we would be supportive to them. Not that they would be essentially nonexistent in the medical care initially after the earthquake.
I believe one question remains unanswered. Why did we not see one military person during our period in Haiti, with the exception of our departure when we saw them at the U.S. Embassy? If they can give an account that is different, as we were at a hospital that was taking care of a significant # of patients very early and would have expected to see some “official medical team”, then I stand corrected.
If I sound angry now I am getting there, as I hate when ‘cover your ass’ politics and excuses, detracts from the real message. There was NO organization of medical units on the ground by the U.S. ‘official contingent’ for at least the 1st week and the military should be accountable for their inadequate response to this disaster of unimaginable proportions.”
The criticism leveled by Dr. Lorich at the U.S. government’s response to the Haitian earthquake and Mr. Taylor’s defense of military surgeons who criticized Dr. Lorich and other civilian surgeons for entering a chaotic mass casualty situation, begs the question of what exactly was the immediate U.S. government’s and military’s role and response to the catastrophe.
Government Response to Crisis
On January 13, the U.S. Southern Command announced that it was immediately deploying a team of 30 people to Haiti to support U.S. relief efforts. The team included U.S. military engineers, operational planners, and a command and control group and communication specialists. They arrived on two C-130 Hercules aircraft.
The team was to work with U.S. Embassy personnel as well as Haitian, United Nations and international officials to assess the situation and facilitate follow on U.S. military support.
On January 19, Major General Daniel Allyn, deputy commander of Joint Task Force Unified Response held a press briefing to describe the military efforts underway to that point.
This was the same day civilian surgeons from HSS were already returning to the United States.
Allyn made it very clear that the United Nations had the primary responsibility for securing order in Haiti and the U.S. military’s top priorities were to increase the distribution capacity to get humanitarian aid into the country, bring in ground vehicles to distribute water and begin efforts to open the port.
The primary military medical effort was to facilitate the arrival of the navy hospital ship, the Comfort, which arrived on the 20th.
Allyn told reporters that the military was “employing as fast as we can.” He noted that 800 Marines would arrive within the next few hours and that 1, 000 airborne soldiers would be added to facilitate the distribution of food and water.
When asked about medical relief efforts, Allyn responded that those efforts were continuing to grow with the arrival of international fields hospitals. He added that the military’s efforts were to loosen the “supply logjam”. He said the military’s understanding was growing of where the need was the greatest. He also stated that the World Health Organization was leading medical relief efforts.
On Wednesday January 20, eight days after the earthquake, the White House held a press briefing on the U.S. government’s response to the earthquake. The briefing was conducted from Haiti by Captain Andrew Stevermer, Commander of the Incident Response Coordinating Team, National Disaster Medical System.
In this role, Captain Stevermer was in charge of all on-the-ground assets in Haiti for the Department of Health and Human Services in order to provide medical response to this disaster.
Said Stevermer:
“We are just a part of the international medical response…. We currently have more than 270 medical personnel in Port-au-Prince, which include doctors, nurses, paramedics, emergency medical technicians, and others. These members work for the United States Public Health Service Commissioned Corps and the National Disaster Medical System. They have taken time out of their daily jobs in the U.S. to come here and to assist with the relief efforts.
To date, these medical teams have been seeing patients beginning on Sunday and since that time have seen 5, 100 people. We currently have five disaster medical assistance teams and one international medical surgical response team in Port-au-Prince.”
Defining The Mission
Given these briefings by military leaders on the ground, it seems clear that the military’s immediate mission and priorities were not focused on medical relief and provides some explanation for the questions asked by Dr. Lorich.
Presumably, the military was executing a mission defined by civilian leaders. It’s also worth noting that America’s military resources, which are not infinite, are focused on other places at the moment.
The Next Crisis
The criticism from the HSS team of our nation’s response the Haitian catastrophe raises important questions about how the U.S. government and orthopedic surgeons will respond to the next mass casualty situation that is sure to come.
The American Academy of Orthopaedic Surgeons (AAOS) has indicated it would follow-up on working on ways for civilian surgeons and the military to work together in the future. We hope there will be a lot of discussion about this at the upcoming annual AAOS meeting in New Orleans next month.
So what now?
We asked the United States Agency for International Development (USAID) what they would tell civilian surgeons who want to offer their services and supplies in the immediate aftermath of a catastrophe and whether there were plans to create a more coordinated response in the future that utilizes civilian surgeons.
The Agency responded via email to our questions on February 11.
“…There are hundreds of volunteer physicians from the United States currently serving the medical needs the people of Haiti.
USAID is the lead federal agency for the U.S. response and has set up a Web site where individuals can learn more about current needs and how to help. Please visit http://www.USAID.gov/helphaiti/ for more information.
The immediate and long-term health and medical needs of Haiti are currently being assessed by the United Nations and the Pan American Health Organization with the Haitian government.
Health and Human Services (HHS) has set up an email where medical professionals can send offers of volunteer medical care services. Medical professionals interested in volunteering, can send an email to Haiti.volunteer@hhs.gov. Include your name, clinical area, specialty skills, degrees, and language capabilities (in particular, whether you speak Haitian Creole or French and if so, your level of fluency).
HHS would like to make it easier to take advantage of medical skills and willingness of medical professionals to volunteer in future health emergencies, whether domestic or international.
There are two important disaster relief programs that would greatly benefit from medical personnel expertise, the Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) (esarvhp@hhs.gov) and the Medical Reserve Corps.)”
Whether or not the experience of Haiti will change how our government and civilian surgeons work together in the immediate aftermath of a mass casualty crisis in the future is unknown for now. We do know that in the next crisis, surgeons will pack up their supplies and rush into the fray regardless of what governments do. Let’s hope they do it together.
