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Perm J. 2010 Fall; 14(3): 86–87.
Published online Fall 2010.
PMCID: PMC2937858

First Responders: The DMAT Team

Twilight on Tuesday, January 12, 2010 in Port-au-Prince, Haiti: about 40 seconds of chaos. 7.0 magnitude. Buildings begin to crack and the sound makes people think of the gunfire that is all too frequent in the downtown area. For safety, people run inside. Buildings, shoddily constructed, crumple, trapping those inside. One of the best hotels, the Montana, on a verdant hillside overlooking the steaming plain of lowland Port-au-Prince, pancakes entombing more than 300 people. The air is thick with heat and the dust of concrete.

Afternoon on Tuesday, January 12, 2010 in Oakland, CA: news on the car radio tells me I will make my fourth trip to Haiti sooner than planned. During 2009, I had worked in and around Port-au-Prince as a volunteer anesthesiologist on three separate Smile Train-funded surgical mission trips. I had stayed at the Montana. I had walked through the Cité de Soleil. My friends and colleagues lived in Delmas, now largely destroyed. We had operated on nearly 200 children and adults with congenital cleft lips and palates, tumors, and burns, after seeing and screening several hundreds more. Because of the poverty, neglect and lack of long-needed medical services, many more adults needed our teams' attention. Despite the dire living circumstances and lack of resources, locals were unfailingly polite, helpful, and grateful for our efforts. I loved this Pearl of the Antilles with its vibrant culture and people, rara music, voodoo, and native art. Despite Haiti's turbulent history, the indigenous spirituality and resourcefulness were unparalleled by any country that I have traveled to.

figure i1552-5775-14-3-86-f1001
Field hospital operating room in tent.

I check my ready bag that evening and prepare to depart. My Disaster Medical Assistance Team (DMAT) is on call in January and all members are on standby for deployment. DMATs and International Medical Surgical Response Teams (IMSuRT) are groups available for national disasters and emergencies such as 9/11 and Hurricane Katrina. Recently the National Disaster Medical Service (NDMS) had been preparing DMAT and IMSuRT groups for work on a global scale. Months of team meetings involving disaster response and planning, equipment training and orientation, and numerous deployments have prepared team members to provide triage, evaluation, and first-response treatment of populations in times of disaster.

Wednesday, January 13, 14:53 pm: simultaneous cell phone text, e-mail, and voice mail set us in motion. By the grace of our Kaiser Permanente departmental scheduler and the generosity of my departmental chief and colleagues, I commit as a rostered team member, and leave the following day for Atlanta. After an overnight briefing, including DMAT teams from Massachusetts, Florida, and New Jersey, we board a government charter aircraft and fly directly into Touissant L'Overture airport in Port-au-Prince, landing Friday, January 15.

Long distance disaster relief is seldom smooth. Teams arrive before the equipment caches. Security cannot be guaranteed in the logical hospital sites where patients are. Infrastructure and transportation are nonexistent. Running water, electricity, cell phone, and Internet service are absent. An alphabet soup of international and federal agencies (PAHO, UN, USAID, and CDC) as well as the pre-existing nongovernmental organizations are in disarray. Air traffic control and the airport terminal are destroyed. The one runway, unlit, is not built for receiving overloaded flights.

All these issues become secondary once the teams find their sites and equipment and supply lines are established. The Petionville Country Club becomes a triage and day treatment center for the tent city that forms on the nearby golf course. The Quisquiya School in Port-au-Prince adjacent to the Ministry of Public Heath's Gheskio HIV clinic becomes a mobile field hospital with surgical and obstetric capability for the tented camp built on the neighboring soccer field. Federally deployed US teams of medical volunteers from different states are working cooperatively in a single encampment.

The teams quickly adapt to the heat and insects, the lack of running water, the MREs (“meals refused by enemy”), and to each other. Day and night shifts alternate sleeping on cots in tents and battling mosquitoes and heat rash. The US Army's 82nd Airborne establishes a helicopter landing zone across from the soccer field and ensures a steady flow of the most critical patients evacuated from the University Hospital and the surrounding neighborhood. The cases shift from week-old orthopedic crush injuries and long bone fractures to gunshot wounds and day-old babies with sepsis and respiratory failure. We deliver 11 babies and operate on 30 patients. We can run 2 simultaneous operations, but are limited by the lack of oxygen and supplies for spinal or nerve block anesthesia. There seem to be babies and children everywhere. A respiratory therapist hand-ventilates a tiny premature infant overnight before she can be helicoptered out to the USNS Comfort. A pharmacist cradles a child while dispensing medication. A warehouse supply logistician comforts a boy who has lost his leg.

figure i1552-5775-14-3-86-f1002
Thumbs up from a patient.
figure i1552-5775-14-3-86-f1003
Patients on stretchers.

The work is constant, grueling because of the heat and uncertainties, and often hopeless. Bright spots appear in the camaraderie of shared adversity and in the unexpected resilience of a particular patient. Guillame, not expected to live, gets hope in the form of an oxygen tank delivered by his brother's motorcycle. Micheline, upon being told she is paraplegic and will never walk again, finally consents to a much needed amputation of her gangrenous lower leg. Robert, a lost child, is re-united with an uncle. Patient #361 gets the next available spot for air evacuation out to Florida. At night and on Sunday morning, the hymns of prayer and gratitude from the people in the adjacent tent city rise above the generator's drone and float back to us through the warm heavy air. Arms are raised in supplication, and thanks are given for the “it could be worse” scenarios. Small groups of team members pray together. The scent of garlic and peppers being cooked mingles with the acrid smoke of burning trash and decay.

After two weeks, word arrives that a plane is to take the first teams back to the US. Landing and equipment resupply schedules remain highly variable and uncertain. However, replacement teams are en route to relieve us. The transition is rapid but thorough, with shifts overlapping and orientations completed. We had been cocooned inside the surgical field hospital where we had arrived in darkness, isolated within and guarded by the 82nd Airborne, so it was a shock to transit through the main streets of the still-ruined city. Daily activity, as I had seen in my previous travels to Haiti, is returning. Strangers were helping each other and it is good.


Articles from The Permanente Journal are provided here courtesy of Kaiser Permanente