Clinicians working in high-resource settings, like Children’s Hospital Boston, rely on the availability of certain equipment to do their jobs, like ventilators, specially sized needles and tubes and a fully stocked pharmacy. But when they’re forced to perform without their gear—like in Haiti in the immediate aftermath of the January earthquake—many find it bewildering and even paralyzing. “We fall into these patterns of providing care,” says David Mooney, MD, MPH, director of the Trauma Program, who was one of the first medical responders to respond after the disaster. “One of the things I noticed in Haiti was that many doctors really fixated on what they didn’t have.”
That mental block can waste time and be counterproductive, so Children’s is developing a training program to prepare the doctors, surgeons, nurses, pharmacists and other volunteers who are going to Haiti to continue relief efforts in the coming months for the conditions they’re likely to find. Mooney, along with Shannon Manzi, PharmD, and Debra Weiner, MD, PhD, worked with Children’s Simulator Program to create the special training, in which clinicians reenact challenging situations on robotic mannequins. Peter Weinstock, MD, PhD, director of the Simulator program, hopes that by practicing in an environment with limited supplies, clinicians will be encouraged to think outside of the box to find the resources they need, and will be better prepared for a disaster zone.
(Listen to a WBUR story about Children’s new simulation program and read The Boston Globe’s White Coat Notes report of it.)
During the first simulation, a team of clinicians tried to save a 34-year-old “patient” who’d been in a motorcycle accident. As the mannequin shrieked in Haitian Creole (a nearby nurse provides realistic sounds using a microphone), the team members tried to ascertain which of the patient’s wounds needed immediate attention. A nurse who speaks Haitian Creole translated while also putting in an IV. Tyler Hartman, MD, a NICU fellow who orchestrated the care, says that without any patient history he felt completely out of his comfort zone. “I felt uncomfortable not knowing what people did, whether they were a nurse, a pharmacist, and what resources were available,” he says. During the next scenario, clinicians took the time to clearly explain who they were and their expertise, which helped the team work together more fluidly.
Another scenario involved a baby suffering from shock and dehydration. While the clinicians attempted to rehydrate the baby and stabilize breathing, the baby’s mom, played by Children’s nurse Kierrah Joseph, yelled and cried out in Haitian Creole, pushing the clinicians aside to get closer to her child. Chris Hopkinson, a post-op nurse, expertly calmed her down and maneuvered her out of the way. Hopkinson, who is heading to Haiti in the beginning of April, says that offering support to parents is an extremely important role in emergency situations. Despite the language barrier, he was able to defuse the situation and reassure the mom that her child was in good hands.
During the debrief after the simulations, all the participants expressed how helpful it was to go through the mock training. “We’re so conditioned to having all these things at our fingertips,” says Pat Lisle, who’s been a nurse for 24 years. “This is a real shifting of gears.” The most important lesson for most people: communication. Weinstock stressed the “10 seconds for 10 minutes” rule — taking a 10-second break at the beginning of an emergency to communicate who is doing what can save 10 minutes of time in the long run. Repeating things back to each other and using each other’s names are also time-saving strategies.
In the coming weeks, months and years, all of the participants will move from the simulator unit at Children’s to the confusing and chaotic streets of Port au Prince and other disaster-struck locations. The clinicians who are veterans of these challenging situations hope the lessons they learned and are passing on to their colleagues will ease their transitions so they can provide even better care to those who are so desperately in need. “(Haiti) was my seventh deployment and was by far the most austere and most difficult,” says Manzi, who has responded to many disasters over the years, including Hurricane Katrina. “You have to make hard choices and think outside of the box, so having a chance to see, think about and practice some of the things you’re likely to face is absolutely invaluable.”
This is the first in a series of blog posts that I’ll be writing for Thrive about Children’s Hospital Boston’s ongoing relief efforts in Haiti. This Saturday I’m flying to Haiti with a team from Children’s and Partners in Health. We’ll be there for a week, and I and others will be sending back blog posts, photos and (hopefully) some videos. Check in with Thrive all next week for our updates. – Melissa Jeltsen