A note from Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
"It's only been a week since we spent our first night in Haiti at this facility, yet it seems much longer...in a good way."
Sunday, January 31, 2010
January 31, 2010 - Homeward Bound
The Sutter Health team departed St. Marc at 5 AM. After a three hour bus ride to Port au Prince, the team divided in two. One half is flying back to the U.S. immediately and the other half is spending the night in Port au Prince in "rustic" accommodations.
A note from Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
"It's only been a week since we spent our first night in Haiti at this facility, yet it seems much longer...in a good way."
A note from Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
"It's only been a week since we spent our first night in Haiti at this facility, yet it seems much longer...in a good way."
Saturday, January 30, 2010
January 30, 2010 - A New Phase of Surgery
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
Canadian plastic surgeon, Dan Durand M.D. closes a large wound with Taylor Smith M.D. (orthopedic surgeon, California Pacific Medical Center), This is one of several reconstructive procedures performed recently as the focus of surgery shifts into a new phase.
Canadian plastic surgeon, Dan Durand M.D. closes a large wound with Taylor Smith M.D. (orthopedic surgeon, California Pacific Medical Center), This is one of several reconstructive procedures performed recently as the focus of surgery shifts into a new phase.
Friday, January 29, 2010
January 29, 2010 – More Medical Evacuations
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
“We continue to evacuate critically ill orthopedic patients. If we are unable to secure a helicopter transport, our next option is to take the patient via ambulance. It’s a long ride to Port au Prince and patients with painful fractures may not be able to tolerate the bumpy ride.
For several days we have been attempting to evacuate a woman with a severe femur fracture, which had become infected. We were determined to evacuate her, so we prepared to drive the patient to Port au Prince accompanied by an anesthesiologist.
Above Liz Petruzzella R.N. (California Pacific Medical Center) helps John Donovan M.D. (anesthesiologist, Alta Bates Summit Medical Center) perform a peripheral nerve block. The nerve block is used for hip surgery and helps manage the pain associated with transport.
While waiting for the ambulance, we suddenly learned that a helicopter was arriving to take her by air. We improvised, quickly folding down the seats of an SUV and driving to the landing zone with her legs sticking out the back (see photo below).”
“We continue to evacuate critically ill orthopedic patients. If we are unable to secure a helicopter transport, our next option is to take the patient via ambulance. It’s a long ride to Port au Prince and patients with painful fractures may not be able to tolerate the bumpy ride.
For several days we have been attempting to evacuate a woman with a severe femur fracture, which had become infected. We were determined to evacuate her, so we prepared to drive the patient to Port au Prince accompanied by an anesthesiologist.
Above Liz Petruzzella R.N. (California Pacific Medical Center) helps John Donovan M.D. (anesthesiologist, Alta Bates Summit Medical Center) perform a peripheral nerve block. The nerve block is used for hip surgery and helps manage the pain associated with transport.
While waiting for the ambulance, we suddenly learned that a helicopter was arriving to take her by air. We improvised, quickly folding down the seats of an SUV and driving to the landing zone with her legs sticking out the back (see photo below).”
Helicopter transports are usually done by the U.S. Navy. Here a corpsman accepts our critically ill patient.
Thursday, January 28, 2010
January 28, 2010 - A Blood Transfusion Makes the Difference
From Dr. Vernon Huang, anesthesiologist (Mills-Peninsula Health Services):
We were able to give her a blood transfusion her and her condition has much improved.
A young patient who sustained severe leg injuries in the earthquake. Although we have no lab capability, her pulse was registering 180 and the condition of her nailbeds allowed us to make the clinical diagnosis of anemia.
We were able to give her a blood transfusion her and her condition has much improved.
January 28, 2010 - Training Local Providers
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
We’ve noticed a chance here in Haiti. "The acute phase of the crisis has passed but we are now entering a phase where patients are at significant risk of serious tissue infections. We had hoped to evacuate a critically ill adult patient in this condition – but were unable. There are countless cases such as this overwhelming the system.
To continue to help our patients here in Haiti, two Sutter Health-affiliated nurses are staying overnight at the hospital with patients that have major infections.
In the morning [January 28, 2010] I will be riding in an ambulance to Port au Prince with two patients. The roads are so rough and their wounds so painful that they need an anesthesiologist to go with them."
Our team’s time here is short but the people of Haiti will continue to need medical care for months to come.
Below, "while Taylor Smith M.D. (orthopedic surgeon, California Pacific Medical Center) operates, Isais Comacho R.N. (surgical technician CPMC) teaches a Haitian technician how to assist in orthopedic cases. St. Marc's techs have significant experience assisting on cesarean sections but have very little exposure to other cases.
Given the long road ahead for our patients, it is critical to bring local providers into the process."
We’ve noticed a chance here in Haiti. "The acute phase of the crisis has passed but we are now entering a phase where patients are at significant risk of serious tissue infections. We had hoped to evacuate a critically ill adult patient in this condition – but were unable. There are countless cases such as this overwhelming the system.
To continue to help our patients here in Haiti, two Sutter Health-affiliated nurses are staying overnight at the hospital with patients that have major infections.
In the morning [January 28, 2010] I will be riding in an ambulance to Port au Prince with two patients. The roads are so rough and their wounds so painful that they need an anesthesiologist to go with them."
Our team’s time here is short but the people of Haiti will continue to need medical care for months to come.
Below, "while Taylor Smith M.D. (orthopedic surgeon, California Pacific Medical Center) operates, Isais Comacho R.N. (surgical technician CPMC) teaches a Haitian technician how to assist in orthopedic cases. St. Marc's techs have significant experience assisting on cesarean sections but have very little exposure to other cases.
Given the long road ahead for our patients, it is critical to bring local providers into the process."
January 28, 2010 - A Long, Difficult Day
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
"We started the day off with a relatively light day on the schedule. The thought crossed our mind that we might actually leave the hospital with daylight.
This changed quickly when we started to see pediatric patients with medical and surgical problems. We operated on a child with a ruptured appendix.
While we were rounding on patients doing wound care, we were frantically called to the ER to evaluate a critically ill 2-week-old child. Sutter physicians worked with Canadian colleagues to resuscitate the child who suffering from dehydration, sepsis and pneumonia.
"We started the day off with a relatively light day on the schedule. The thought crossed our mind that we might actually leave the hospital with daylight.
This changed quickly when we started to see pediatric patients with medical and surgical problems. We operated on a child with a ruptured appendix.
While we were rounding on patients doing wound care, we were frantically called to the ER to evaluate a critically ill 2-week-old child. Sutter physicians worked with Canadian colleagues to resuscitate the child who suffering from dehydration, sepsis and pneumonia.
Resources to manage a critical care case like this were scarce even prior to the earthquake – now we faced even more daunting problem – how to manage a neonatal patient that required critical care after the earthquake. The U.S. Navy could no longer take intubated children and it was impossible to find a ventilator at a Haitian hospital.
Finally, we were able to set up a transfer to a larger Haitian hospital via a UN ambulance for our young patient. The vehicle was brand new and nicely armored but did not have medical staff.
Finally, we were able to set up a transfer to a larger Haitian hospital via a UN ambulance for our young patient. The vehicle was brand new and nicely armored but did not have medical staff.
Steve Lockhart M.D. (anesthesiologist, Alta Bates Summit Medical Center) and a Canadian nurse traveled with the critically child on the 2 hour trip to the other hospital. In the end it was a long difficult day."
January 28, 2010 - Canadian Surgical Team Transitions at St. Nicholas Hospital.
A surgical team from Quebec City arrives at St. Nicholas hospital in Haiti. The team, which includes a plastic surgeon, intensivist, two orthopedic surgeons and an emergency physician, will provide care for two weeks.
Above, Susan Bailey, M.D. (vascular surgeon California Pacific Medical Center) and Dan Durand, M.D. (plastic surgeon, Hopital Anna-Laberge, Quebec City) change and examine the wound of a child.
Above, plastic surgeon Dan Durand (left) finishes closure of a complex wound with assistance from Isais Comacho, while DJ Edades R.N. (CPMC) watches.
Wednesday, January 27, 2010
January 27, 2010 - Up and Walking
Christina Crane, R.N. (California Pacific Medical Center) works with a patient two days after she underwent external fixation of a serious leg fracture. The Harvard/Sutter Health Team was fortunate to have a large supply of these devices which are made by Synthes.
January 27, 2010 - Caring for Kids
Liz Petruzzella, R.N. (California Pacific Medical Center) cares for a young patient with leg injuries managed with external fixation.
January 27, 2010 - The U.S. Navy Helps Out
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
"Today [January 26, 2010] we evacuated two patients with orthopedic injuries that could not be managed at our hospital. One patient had an intratrochanteric hip fracture and the other had a serious pelvic fracture.
Since transporting patients by ambulance to Port au Prince is extremely difficult, the Navy's USS Nassau sent a helicopter to pick up the patients. The Navy gave us a 10 minute lead time to get our patients to the 'LZ' or landing zone – a nearby soccer field.
Typically getting around town is relatively low key...but this changes when a helicopter lands in town.
Since transporting patients by ambulance to Port au Prince is extremely difficult, the Navy's USS Nassau sent a helicopter to pick up the patients. The Navy gave us a 10 minute lead time to get our patients to the 'LZ' or landing zone – a nearby soccer field.
Typically getting around town is relatively low key...but this changes when a helicopter lands in town.
Above, the helicopter draws a crowd, which blocked our way to the “LZ”. We eventually get through.
Once at the landing zone, Malcolm Smith M.D., (surgeon, Massachusetts General Hospital, Boston) watches our patients being loaded onto the helicopter.
Above, local residents gather with interest around our vehicle as we try to exit the soccer field.
The US Military has really stepped up to help with the medical situation. We hope to MEDEVAC several more patients in the coming days."
The US Military has really stepped up to help with the medical situation. We hope to MEDEVAC several more patients in the coming days."
January 27, 2010 - Multinational Teams Help Patients
Multinational, multidisciplinary teams are helping patients in Haiti. Above the team of Susan Bailey,M.D. (California Pacific Medical Center), Maxime Amar M.D. (Anna la Berge Hospital, Quebec City), and Henry Sazarella, M.D. (anesthesiologist, Partners in Health) take care of a patient with a serious leg wound.
Tuesday, January 26, 2010
January 26, 2010 - Local Haitian Cares for a Patient
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
“Local Haitian providing care.”
January 26, 2010 - Photos of Team Members in Haiti
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
Above Sergeline Lucien R.N. (Brigham and Women’s Hospital, Massachusetts), Christina Crane, R.N. (California Pacific Medical Center) and Joanne Squire R.N. (California Pacific Medical Center) on a female surgical ward.
Above Joanne Squire R.N. (California Pacific Medical Group), Guirlene (St. Nicholas, St. Marc Haiti) and Joan Chamberlain, R.N. (Alta Bates Summit Medical Center) after a long, productive day.
January 26, 2010 - Saving Limbs
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
“The Partners in Health team has an extensive supply of external fixators, which have been used by the orthopedic teams [to help save the limbs of patients injured by the earthquake (external fixators are tools that help immobilize a bone to allow a fracture to heal.)] The patient recovers from a surgery performed by Massachusetts General Hospital orthopedists Brian Dwyer M.D., Malcolm Smith M.D. The patient had been told that he would need to have his leg amputated.”
January 26, 2010 - Everyone Helps Transport Patients
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
“Everybody helps to transport patients. Above Scott Taylor M.D. (orthopedic surgeon Alta Bates Summit Medical Center) goes to pick up an evening patient.”
“Everybody helps to transport patients. Above Scott Taylor M.D. (orthopedic surgeon Alta Bates Summit Medical Center) goes to pick up an evening patient.”
January 26, 2010 - Update from Haiti
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
Above is the Partners in Health hospital in St. Marc where the Sutter team has been collaborating with other medical teams to care for patients in Haiti.
“Partners in Health provides food and housing for all the medical volunteers. Above is a photo of the medical teams from Harvard and Sutter Health having dinner at 9 p.m. (Haiti time) after a long day in the operating room.”
January 26, 2010 - "We Have Electricity ... Most of the Time"
From Dr. John Donovan, anesthesiologist (Alta Bates Summit Medical Center):
“We have electricity most of the time [but still experience] period power outages. Below Susan Bailey M.D. (ABSMC) tends to a wound with a camping headlamp during one of the outages. The room was otherwise pitch black.”
“While days can go well into the evening, the hospital is not structured to enable us to operate day and night. We have to be sensitive to the volume of cases that the hospital can handle, particularly given that, despite our best efforts, we still must perform amputations.”
“We have electricity most of the time [but still experience] period power outages. Below Susan Bailey M.D. (ABSMC) tends to a wound with a camping headlamp during one of the outages. The room was otherwise pitch black.”
“While days can go well into the evening, the hospital is not structured to enable us to operate day and night. We have to be sensitive to the volume of cases that the hospital can handle, particularly given that, despite our best efforts, we still must perform amputations.”
Above is “one of seven surgical wards.”
January 26, 2010 - The Work Continues
Above Brian Dwyer M.D., Malcolm Smith M.D. and James Tussaint M.D. (Massachusetts General Hospital orthopedic surgeons) wait for ride back to their sleeping quarters after a long day. Drs. Dwyer and Smith lead the Harvard/Partners in Health team that managed the difficult situation in the first week after the earthquake.
Monday, January 25, 2010
January 25, 2010 - Making Rounds with Family Members
James Tussaint M.D. (orthopedic resident, Massachusetts General Hospital) talks with family members while conducting rounds with one of our two wound care teams.
January 25, 2010 - Operating Day and Night
Medical teams are working in two operating theatres day and night.
Above James Tussaint M.D. (Massachusetts General orthopedic resident,), operates with Susan Bailey M.D., chief of surgery at Sutter-affiliated California Pacific Medical Center (St. Luke’s campus), Cassie Kinser, R.N. also from CPMC.
Above James Tussaint M.D. (Massachusetts General orthopedic resident,), operates with Susan Bailey M.D., chief of surgery at Sutter-affiliated California Pacific Medical Center (St. Luke’s campus), Cassie Kinser, R.N. also from CPMC.
January 25, 2010 - Bedside Wound Care
We are reassured to learn that the medical volunteers are now able to provide bedside wound care. Teams made up of a surgeon, nurse and anesthesiologist visit a patient at the bedside to perform wound debridement (removal of damaged/infected tissues) and dressing changes using moderate sedation. This is a very important treatment for the types of injuries many Haitians sustained in the earthquake.
Above David Chang M.D. (Sutter's Alta Bates Summit Medical Center) and James Tussaint M.D. (orthopedic resident Massachusetts General Hospital) care for a patient.
Stay tuned as our busy team gives us more details of their mission and work. And thank you again to everyone in the Sutter Health family who continues to volunteer, fundraise and offer their skills for our efforts in helping Haiti.
Stay tuned as our busy team gives us more details of their mission and work. And thank you again to everyone in the Sutter Health family who continues to volunteer, fundraise and offer their skills for our efforts in helping Haiti.
January 25, 2010 - Working 20 hours a day.
From Toni Brayer, M.D., Sutter Health West Bay Region Chief Medical Officer and Leader for Sutter Health Helping Haiti.
The Sutter Health team continues to treat patients and perform surgeries at St. Nicholas Hospital in St. Marc – working an average of 20 hours a day.
Above Stephen Lockhart M.D., anesthesiologist and chief medical officer for Sutter Health’s East Bay Region, stands by the list of patients awaiting surgery. At 4:30 p.m. (Haiti time) there are 17 patients who still need treatment today.
We learned today that the hospital is two hours west of the Haitian capital of Port-au-Prince and has been flooded with patients seeking refuge. Before the earthquake, the hospital had 150 beds. After the quake, the number of patients seeking care surged to 300.
We learned today that the hospital is two hours west of the Haitian capital of Port-au-Prince and has been flooded with patients seeking refuge. Before the earthquake, the hospital had 150 beds. After the quake, the number of patients seeking care surged to 300.
Sunday, January 24, 2010
January 24, 2010 - 20+ Surgeries in a Single Day
From Toni Brayer, M.D., Chief Medical Officer Sutter Health West Bay Region, Leader for Sutter Health's Help for Haiti
Sutter Health’s surgical team has now gone two full days without an amputation. The newly donated equipment and anesthesia from our network and others are allowing the volunteers to perform surgeries equivalent to modern standards. They’re saving the limbs of Haiti earthquake victims.
At last report, the team performed over 20 surgeries today in two operating rooms.
Working with surgical colleagues from Mass General Hospital at Harvard and a local Haitian physician, Surgical Tech Isaias Camacho, R.N. (above at right) from Sutter-affiliated California Pacific Medical Group, performed an external fixation on a broken leg.
Dr. John Donovan (above at right), anesthesiologist from Sutter’s Alta Bates Summit Medical Center, works with a Mass General Hospital at Harvard team to perform another successful surgery that preserves a patient’s leg.
At 5:30 p.m. Haiti time, Dr. Donovan wrote, “Yes, we are still operating. Need to get back to work. We are using teams of surgeons and anesthesiologists to round on post ops and do dressing changes. We are almost as busy on the wards as in the operating rooms.”
Dr. Steve Lockhart (above center), anesthesiologist and chief medical officer for Sutter's East Bay region, works with the team to care for a child following an operation.
January 24, 2010 - Photo of the team's housing in Haiti
The team's housing in Haiti. Electricity has been intermittently available in the country.
January 24, 2010 -- "It's a massive, logistics infrastructure and security problem."
From Toni Brayer, M.D., Chief Medical Officer Sutter Health West Bay Region, Leader for Sutter Health's Help for Haiti
I also heard from Dr. Barry Rose, a Sutter-affiliated California Pacific Medical Center anesthesiologist and Haiti volunteer with Operation Rainbow. After a week on the ground, he is discouraged with the lack of coordination and lack of security for the teams that need to go away from the medical area to help patients in the surrounding communities.
Dr. Rose reports, “It’s a massive logistics, infrastructure and security problem. The scope of the damage is big, so we need to get out into the field, but the teams cannot be sent out without very serious security. Instead, projects spring up for surgical and continuing care of the patients that have some power and safety. Our efforts are hugely centered around the church structures—like after Hurricane Katrina. This is why I went where I did (on the Dominican Republic border), to be able to do as much actual surgical and work as possible, which we have done. We’re also helping to build an ongoing avenue for care—a difficult process and something that will take time.”
January 24, 2010 - Update from the frontlines in Haiti
Report from Sutter team in Haiti -- From Toni Brayer, M.D., Chief Medical Officer Sutter Health West Bay Region, Leader for Sutter Health's Help for Haiti
Sunday morning, after the intermittent electricity came on, the Sutter Health surgical relief team was hard at work fixing a complex fracture. Now that they have equipment and pins, they can repair serious injuries previously untreated, and save the patient’s limb. Our team reports they are staying in safe housing (see photo) with good security and intermittent electricity. Communication is difficult, but as they get a break, we will hope for more on-the-ground news.Saturday, January 23, 2010
January 23, 2010 - Update from Haiti
Both Sutter Health teams are in Haiti without problems (except for a few flight snafus).
The Atlanta team is deployed to St. Marcs and the photo below is the hospital.
They are housed in a two bedroom apartment and are well rested to begin their work. They are doing post-op care, pain management and orthopedic care with multiple external fixators placed and no amputations.
The Florida contingent arrived this morning but I don't know their deployment status yet. We will keep you in the loop. All is well with our Relief team.
Toni Brayer, M.D.
Regional CMO
Lead Sutter Helping Haiti
Regional CMO
Lead Sutter Helping Haiti
The Flight to Haiti
From Toni Brayer, M.D., Chief Medical Officer Sutter Health West Bay Region, Leader for Sutter Health's Help for Haiti
Sutter Health’s surgical team deployed to Port-au-Prince after a mad scramble to get necessary documents filed with the State Department, paperwork filed with HR and travel immunizations completed. Before leaving for Haiti, the team also rounded up vital medical supplies and equipment and loaded them into suitcases, which had to meet strict weight limits.
Despite delays at San Francisco International airport, the team departed as planned on two separate flights. The first group successfully made their connection in Atlanta, boarding a small private plane provided by Med Assets to transport them to Haiti. They arrived in Port-au-Prince at 3 a.m. (Haiti time) on Friday. The second group will fly in from Fort Lauderdale and should arrive in Port-au-Prince on Saturday.
While flying to Atlanta, Dr. Stephen Lockhart, leader of the surgical team, happened to sit next to a representative from iStat. (They make small portable units for drawing blood at a patient’s bedside.)The two began talking, and Dr. Lockhart explained the team’s mission. That conversation prompted a generous offer from iStat. They would provide bedside units to Sutter Health’s team in Ft. Lauderdale to bring to Haiti. It was either a great stroke of luck or divine intervention, but we can now bring even more urgently needed equipment to Haiti’s earthquake victims.
The Sutter volunteer team is:
Anesthesiologists
Sutter Health’s surgical team deployed to Port-au-Prince after a mad scramble to get necessary documents filed with the State Department, paperwork filed with HR and travel immunizations completed. Before leaving for Haiti, the team also rounded up vital medical supplies and equipment and loaded them into suitcases, which had to meet strict weight limits.
Despite delays at San Francisco International airport, the team departed as planned on two separate flights. The first group successfully made their connection in Atlanta, boarding a small private plane provided by Med Assets to transport them to Haiti. They arrived in Port-au-Prince at 3 a.m. (Haiti time) on Friday. The second group will fly in from Fort Lauderdale and should arrive in Port-au-Prince on Saturday.
While flying to Atlanta, Dr. Stephen Lockhart, leader of the surgical team, happened to sit next to a representative from iStat. (They make small portable units for drawing blood at a patient’s bedside.)The two began talking, and Dr. Lockhart explained the team’s mission. That conversation prompted a generous offer from iStat. They would provide bedside units to Sutter Health’s team in Ft. Lauderdale to bring to Haiti. It was either a great stroke of luck or divine intervention, but we can now bring even more urgently needed equipment to Haiti’s earthquake victims.
The Sutter volunteer team is:
Anesthesiologists
- Steve Lockhart, M.D., Chief Medical Officer Sutter Health East Bay Region
- John Donovan, M.D., Alta Bates Summit Medical Center
- Vernon Huang, M.D., Mills-Peninsula Health Services
- Susan Bailey, M.D., California Pacific Medical Center
Orthopedic Surgeons
- Taylor Smith, M.D., California Pacific Medical Center
- Scott Taylor, M.D., Alta Bates Summit Medical Center
- David Chang, M.D., Alta Bates Summit Medical Center
- Joan Chamberlain, R.N., Alta Bates Summit Medical Center
- Cassie Kinser, R.N., California Pacific Medical Group
- DJ Eadades, R.N., California Pacific Medical Group
- Isaias Camacho, R.N., California Pacific Medical Group
- Joanne Squire, R.N., California Pacific Medical Group
- Elizabeth Petruzzella, R.N., California Pacific Medical Group
- Christina Crane, R.N., California Pacific Medical Group
- Scott Callaghan, R.N., California Pacific Medical Group
- Georgette Kearsing, technology assessment coordinator, Sutter Health Support Services
- June Quinones, administrative secretary, Sutter Health Support Services
- Pat Shepherd, director, Value Analysis & Strategic Sourcing, Sutter Health Support Services
- Jim Reich, Accounting director, Sutter Health Support Services
- Carol Ohlmeyer, Disbursements supervisor, Sutter Health Support Services
- Katie Moracco, executive assistant, Sutter Health Support Services
- James Huston, director of Materials Management, Sutter Lakeside Hospital
- Don McMann, vice president of Materials Management, Mills-Peninsula Health Services
- Annelise Wirick, project support specialist, Sutter Health Support Services
- Veronica Barnett, project support specialist, Sutter Health Support Services
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