One of the big stories in the wake of the earthquake in Haiti was the inability for supplies to reach patients and field hospitals. However, while international forces experienced efficiency challenges, Israeli medical workers used the most up-to-date technologies and exhibited unmatched success in treating the injured.
The head of Israeli response teams authored an article in the latest New England Journal of Medicine that outlines Israeli’s strategy and is an incredible read. The others detail the complex triage system used to determine which patients had the best chances for survival. Patients with expected kidney problems and intense infections were proiritized below other patients that had better chances of survival.
In order to treat the maximum number of patients, the medical workers added a second operating room and used a one-in one-out system of admittance versus discharges/deaths. Even though they had only 72 beds, Israeli medical workers treated over 100 people per day.
As I’ve pointed out before, Israelis have an unfortunate skill in dealing with mass casualty incidents. Terrorist incidents throughout the country and repeated wars keep trauma-related MCI skills fresh for emergency medical workers and the country’s health care training often focuses on triage. The authors write:
“This policy, while necessary, clearly did not allow us to provide in-house medical care for the duration for which we are accustomed to providing it in a nondisaster setting. Moreover, the problematic nature of early discharge was exacerbated by the unique environment in which we were working: there was no functioning health care system in the community, many patients were homeless, and many children in our care had no adult guardian. To discharge patients effectively, staff members engaged in discharge planning. We relied on the United Nations and other relief organizations to aid in the postdischarge management of care. With time, more and more groups started to operate, some of them backed by large facilities (such as the USNS Comfort). The presence of these groups allowed us to revise our discharge policies, since some of the groups opened referral centers.”
The account of the doctors is required reading for anyone in the health profession and a fascinating read for anyone else.