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Thursday, January 21, 2010

Down Coat or Mosquito Netting?

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 …
If you read this far, you might be interested in another disaster blog by a friend of mine, Deanna Polk, called “Global RN” at
Well, it’s time to turn on CNN and see if I can find my team. We had given ourselves a motto of “Caregivers to the Nation.” I guess we need to change it now to, “Caregivers to the World”. Stay safe, my friends.

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