Transcript 184b_hrdf-emergency-training_amhe-health

“A NATIONAL-PREPAREDNESS TRIAD”
Specialized Training, Equipment and Supplies for
Medical and Community Teams
Aldy Castor, M.D.
President, Haitian Resource Development Foundation HRDF
Director, Emergency Services for
Association of Haitian Physicians Abroad (AMHE),
Haiti Medical Relief Mission
Prepared for the First Annual AMHE Conference
“Emerging Strategies Focusing on a
Comprehensive Healthcare System in Haiti”
September 22-23, 2011
Washington D.C.
“The Health system in Haiti has remained in a
precarious situation for years. In addition, the
devastating January 12, 2010 earthquake killed an
estimated 250,000 Haitians and displaced of more
than a 1.5 million individuals.
This conference will focus attention on the impact
of the earthquake and the delivery of health care
both in Haiti and abroad...in terms of delivery,
sustainability, satisfaction-proven efforts for a
community in dire need of change.”
Association of Haitian Physicians Abroad - AMHE
September 2011
PART ONE
History and Analysis: Awareness, Implementation and Gaps
Aldy Castor MD, President, Haitian Resource Development
Foundation (HRDF), Director Emergency Services, AMHE,
Haiti Medical Relief Mission
PART TWO
Case Study: Pre-hospital Emergency Response, Petit Goâve
Jason Friesen, EMT-P, Program Manager, Project HOPE Haiti
PART THREE
Case Study: Filling Two Mission Critical Gaps - Equipment and
Supplies
Tom Keefe, CEO, Internationall Medical Equipment
Collaborative (IMEC)
PART ONE
History and Analysis: Awareness, Implementation and Gaps
Rescue Exercise, HRDF
BACKGROUND - The Haitian Resource Development
Foundation (HRDF) was founded in 1987:
In the US, as a 501(c) 3 non-profit organization, with a
United States Federal Tax I.D. Number
In Haiti, as a nongovernmental organization (NGO) that is
registered in the archives of the Ministère de la
Planification et de la Coopération Externe.
Since 2008, HRDF and its partners have trained Haitians in
emergency medicine, primarily in the capital city area.
Among the students have been medical and nursing
emergency room staff of the Hôpital de la Communauté
Haitienne [HCH] and emergency units of Haiti State
University Hospital. Port-au-Prince firefighters have also
received training.
Firefighter Training, HRDF
In 2004, the United States Southern Command (USSOUTHCOM)
through its Humanitarian Assistance Program invited some
Haitian American organizations to strengthen Haiti disaster
preparedness capacity.
Among these organizations were the Association of Haitian
Physicians Abroad (AMHE), The Haitian Resource Development
Foundation (HRDF) and Mole Saint Nicolas in Action (MOTION).
MOTION
AMHE, HRDF and MOTION assessed the following institutions:
- In Port-au-Prince: the Haiti State University Hospital, the
Hôpital de la Communauté Haitienne, the Hôpital Isaïe Jeanty
- a maternity facility and the National Fire Service
- In Cap-Haitien: the Hôpital Justinien
- In Port-de-Paix: the Hôpital Immaculée Conception de Portde-Paix
- In Aquin: the Hôpital Communautaire de Référence d'Aquin
- In Les Cayes: the Hôpital Immaculée Conception des Cayes,
as well as the National Fire Service.
Hospital Assessments, 2004, HRDF
The assessment revealed:
1. Neither the hospitals nor the Fire Service provided prehospital emergency care. This service was provided by the
International Red Cross and private ambulance services.
2. The hospitals had neither intensive care units (ICUs) nor
functional and equipped emergency rooms (ERs).
3. The Fire Service did not have trained medical responders.
With a population in 2004 of 8.3 million, Haiti had a total of
189 firefighters with only 67 assigned to the fire station in
Port-au- Prince. Yet the National Fire Protection Association
(an international fire safety organization based in the United
States) recommends a ratio of one firefighter per 1,500
civilians.
As a result of the assessment:
1) United States Southern Command:
- Rehabilitated the emergency room of
Haiti State University Medical Center.
- Reconfigured and rehabilitated the emergency unit at the
Hôpital de la Communauté Haitienne in Frères a suburb of
Pétion-Ville. The new unit consists of six intensive care
beds, an operative suite, an emergency room, and a radiology
room.
USSOUTHCOM - HRDF Partnership
2) AMHE, HRDF and MOTION, through grants from governmental
and nongovernmental organizations, such as IMEC, the Rotary
Club of Pétion-Ville, the French Embassy in Haiti, were able to:
- Equipped the emergency units of both Haiti State University
Hospital and the Hôpital de la Communauté Haitienne
- Trained in emergency medicine many physicians, nurses,
firefighters and other first responders working in emergency
services of both Haiti State University Hospital and the Hôpital
de la Communauté Haitienne.
- Established and trained a community Emergency Response
Team (CERT) in Aquin.
- In June 2011, this training program was started in the
Southern Department, but is stalled for lack of funds.
Training - The theoretical and practical training curriculum was
approved by Haiti’s Ministry of Health and Population.
- Cycle of Training:
By modules
- Duration of Modules: 5 days Monday through Friday, every 6
weeks. Specialists arrived in Haiti on Sunday, and depart the
following Saturday.
-Number of Trainees:
Port-au-Prince - 25 médecins de service (attending
physicians, interns, residents), 15 nurses, 30 first-responders
(ambulance personnel and firefighters)
Southern Department - 16 médecins de service (attending
physicians, interns, residents), 8 nurses, 50 volunteers for a
Community Emergency Response Team (CERT) in Aquin
Practice Session, HRDF
Basic Evacuation Tools, HRDF
Training, continued - Tailored to the different groups of the
trainees according to their level of expertise
Module 1: Basic and Advanced Cardiopulmonary Resuscitation,
and Advanced Trauma Life Support (BLS), (ACLS)
and (ATLS)
Module 2: Cardiovascular emergencies
Module 3: Respiratory emergencies
Module 4: Accidents and traumas
Module 5: Infectious diseases
Module 6: Neurological, psychiatric, and obstetrical
emergencies.
Module 7: Mass casualty
Module 8: Search and rescue
Module 9: Principles of organization: prevention, early alert,
disaster management, and mitigation
Refugee Conditions, Time Magazine 2010
“Most of these people were not only severely injured, but had
also lost their homes and family members in their homes. Seeing
the number of people injured…it was overwhelming … we were in
a state of shock,” Louise Strickland, RN, BN, CNOR, Association of
periOperative Registered Nurses (AORN), January 2010
AMHE DISASTER RESPONSE STRATEGY FOR HAITI
AMHE recommends and offers to shape and lead the
following priorities:
1. Train, coordinate and massively dispatch rotating teams
of AMHE physicians and personnel to Haiti.
2. Require and conduct emergency medical response
training (EMT) in all communes, accompanied by their
equipping and supplies.
3. Require and conduct Community Emergency Response
Training (CERT) in all communes, accompanied by their
equipping and supplies.
AWARENESS
An ounce of prevention is worth a pound of cure.
The four phases involved The process of Emergency
Management: mitigation, preparedness, response, and
recovery
- Mitigation and preparedness will reduce the demand for
disaster response and recovery fund and assistance.
- Disaster begins long before it happens (hazard, treat, risk)
and has to recognized the time continuum.
- The cycle of Emergency Management includes short and
long-term work on infrastructure, public awareness, and
even human justice issues.
Vendors and shoppers underneath building wreckage,
Port-au-Prince, Sep 2011
Bad habits and lack of sanitary services = public health hazards,
Port-au-Prince, Sep 2011
AWARENESS
- Disasters are not only on the rise in Haiti but also around
the world
- Comparing with the 1960s, the 1990s has witnessed
threefold increase in disasters and a nine-fold increase in
economic loss.
- Factors, such as climate change, earthquakes, hurricanes,
floods, concentrations of people in vulnerable areas,
shantytowns, political instability and poverty, make Haiti a
disaster-prone country.
- The larger picture is to start with policies to recognize
Haiti as a disaster-prone country, anticipate certain
disasters' frequency and intensity, design programs and
projects to strengthen its disaster response capacity
Even apparently-good construction is no guarantee
against the forces of Nature, Port-au-Prince, Jan 2010
AWARENESS, continued:
For example, how would a Haitian hospitals respond to a
mudslide where hundreds or even a thousand or more people
are buried and suffocating?
1. This is a race against time. What is the status of the the
National Preparedness Triad - Specialized Training, Equipment
and Supplies - for Medical and Community Teams?
2. Currently, the four components of an emergency medical
response system - pre-hospital care, transportation,
communication and hospital care - are either not functioning
or inefficient in Haiti.
3. Well-equipped and -supplied emergency and operating
rooms are as important as shovels, wheelbarrows, boots and
excavating equipment.
Accident on the new Morne-Preval bypass of
Lake Miragoane, Southern Haiti, Sep 2011
DILEMMA FOR PHYSICIANS:
Perform autopsy or resuscitation?
Canape-Vert neighborhood,
Port-au-Prince
Landslide, Carrefour
IMPLEMENTATION
There have to be the willingness, expertise and resources to:
- keep threats to a low level, through prevention.
- conceive the entire course of events, i.e. to anticipate the
disaster, with appropriate medical training, communication,
transportation, equipment, supplies, search and rescue, etc.)
- maintain effective disaster response plans, management and
coordination among diverse governments agencies and
nongovernmental organizations responsible for disaster
response.
RESOURCE - Anything that Haitians can acquire from
anywhere in the world and put to good use. It could be, for
example, a computer, a doctor, a tractor, a windmill, or an
idea. These can become a resource for the country.
Haitians have not yet discovered all the resources available
to them. When they do, that will be their greatest strength.
GAPS
1. Failure to plan and put in place a comprehensive
preparedness policy to respond to catastrophe. This was
evident after the January 2010 earthquake, with more than a
half-million environmental refugees. It was again evident
during the cholera epidemic that has claimed thousands of
lives and infected more than 400,000.
The response to both was more a function of foreign NGOs and
governments. Haiti's Health Ministry lacks the resources to
provide even basics…staff, water, treatment centers, etc.
GAPS, continued
2. Lack of a regional communication system to track
available hospital beds so that emergency teams know
where to transport the sick and injured.
3. Failure to plan the management of Haitians with special
needs, e.g. children, pregnant women, elderly, those with
limited mobility, mental health problems, blindness, etc.
Flood, Haiti
CLOSING THE GAPS
1. Policy framework for faster response & better coordination,
2. Approve and fund AMHE’s Disaster Response Strategy
- Train, coordinate and massively dispatch rotating teams
of AMHE physicians and personnel to Haiti.
- Require and conduct emergency medical response training
(EMT) in all communes, then equip and supply teams.
- Require and conduct Community Emergency Response
Training (CERT) in all communes, then equip and supply
teams.
CERT Team, HRDF
CLOSING THE GAPS, continued
1. Physician's leadership - Incorporate physicians' roles and
leadership in disaster management, to increase effectiveness
of the health system's large-scale crisis response, with the
emphasis on prevention
2. Physician's training - Few physicians are adequately
trained to practice effectively in a large crisis. This
deficiency can be addressed by providing disaster and
emergency preparedness training in residency for physicians.
(Residents provide much of the day-to-day care in teaching
hospitals; moreover, they are often the only physicians onduty during off-hours.)
Aquin, South Coast, Haiti
Hillside, Port-au-Prince
Plains, Haiti
River Crossing, South East Haiti
Jacmel, Haiti
HAITIAN RESOURCE DEVELOPMENT FOUNDATION hrdf.org
Aldy Castor, M.D., President [email protected]
854 Marina Drive, Weston, Florida 33327
ph 954.659.7953. 954.873.0064 fax 954.659.7957 [email protected]
17, 2ème ruelle Wilson, Pacot, Port-au-Prince, Haiti
25, Rue Sténlo Vincent, Aquin
HAITIAN RESOURCE DEVELOPMENT FOUNDATION
www.hrdf.org
Aldy Castor, M.D., President
United States:
854 Marina Drive, Weston, Florida 33327
ph 954.659.7953. 954.873.0064
fax 954.659.7957 [email protected]
Haiti:
17, 2ème ruelle Wilson, Pacot, Port-au-Prince ph
509.3.443.3703
25, Rue Sténlo Vincent, Aquin ph/fax 509.245.4117