Practicing Internal Medicine Onboard the USNS COMFORT in the Aftermath of the Haitian Earthquake

Abstract

On 12 January 2010, a 7.0-magnitude earthquake devastated the island nation of Haiti, leading to the world's largest humanitarian effort in over 6 decades. The catastrophe caused massive destruction of homes and buildings and overwhelmed the Haitian health care system. The United States responded immediately with a massive relief effort, sending U.S. military forces and civilian volunteers to Haiti's aid and providing a tertiary care medical center aboard the USNS COMFORT hospital ship. The COMFORT offered sophisticated medical care to a geographically isolated population and helped to transfer resource-intensive patients from other treatment facilities. Working collaboratively with the surgical staff, ancillary services, and nursing staff, internists aboard the COMFORT were integral to supporting the mission of the hospital ship and provided high-level care to the casualties. This article provides the perspective of the U.S. Navy internists who participated in the initial response to the Haitian earthquake disaster onboard the COMFORT.

Renal Replacement Therapy in Austere Environments

“…One would presume, in this situation, that dialysis resources would have to be brought to the area, but this is not clear-cut. After the Haitian earthquake of 2010, although limited dialysis resources were “brought” to the area aboard the USNS Comfort, which had 2 standard hemodialysis machines and provided 15 treatments within the first 9 days [41], the ISN RDRTF repaired the existing infrastructure of the University Hospital dialysis unit in Port au Prince to support the care of both patients with AKI due to crush injury and 30 of the 100 Haitian chronic dialysis patients [8, 34]. …”

“…Available supplies (especially dialyzers) may not be the type used before the disaster, or may be in short supply. Dialyzer reuse may not be feasible or safe in many situations, but in scenarios where patient numbers are low, and resupply is totally disrupted, reuse should be considered [34]. …”

Special Populations

“…Dual-lumen catheters were not available; therefore, separate central venous cannulae were used. 40 Th ere did not appear to be any long-term sequelae of this approach. It would be advantageous to have professional societies and stakeholders in the care of the special populations outlined in this article develop crisis standard of care guidelines based on the Institute of Medicine's tenets.…”

1 Canadian Field Hospital in Haiti: surgical experience in earthquake relief

“…11 The USNS Comfort, an American hospital ship, started receiving patients 7 days after the earthquake; many patients had severe trauma. 12 Our main surgical contribution was to treat neglected chronic conditions in an area where the medical infrastructure had been destroyed by the earthquake.…”