CDP Student Puts Specialized Training To Use Following Haiti Earthquake

My Name is Nathan Paddock. I work for the Unity Health System Emergency Center in Rochester, N.Y. In 2009 I attended the Hospital Emergency Response Training for Mass Casualty Incidents (HERT) course, Hands-On Training for CBRNE Incidents (HOT) course, and most recently graduated from the Hazard Assessment and Response Management for CBRNE Incidents (HARM) course. In February 2010, I had the opportunity to participate in a medical mission to Haiti. We arrived about 10 days after the earthquake.

Upon arrival we received a brief on current conditions that was parallel to briefings we received at the beginning of HARM-it was eerie. Although not a CBRNE event, the training I received from the CDP was definitely helpful.

I've worked as a firefighter-paramedic for six years and as a physician assistant in emergency medicine for the past seven years. I am a member of my hospital's emergency department disaster committee and on the hospital decontamination team.

Essentially thank you for offering a course realistic to real-world response. The country's infrastructure was destroyed, I was introduced to members of my team I had never known, security issues played a large factor, and logistics was never more important. The "let's get to work" attitude demonstrated during my CDP experience was key to our success and my contributions to the effort.

Although not called incident command, the leadership structure in Haiti mirrored an Incident Command (IC) system. The organization was complete with medical, logistics, and a group who procured supplies and food from the United Nations when possible, and donations from the United States and Canada. There was also a back-up command structure in the event the team leaders were unavailable.

HERT taught about multiple methods of communication. We had no radios and the satellite phones rarely worked. However, cell phones would work for a few hours each day, and surprisingly, one person in the group had a Blackberry that could send out e-mails. Once we had medevac helicopters available, we would e-mail them with our coordinates and then wait to hear them flying in. Now that's using your options and ears.

The CDP exercise scenarios focus on mass casualty response, and simulated non-stop patients who required some sort of treatment. This was a great learning experience I thought I may never have to truly put into action. The never-endinginflux of patients was exhausting, everyday/all day.

Just as in HARM, we were housed in an area away from where we were working. This allowed for the nightly debriefing among the teams and planning for the next day. The interdisciplinary debriefings were very valuable for adapting our plans. It also allowed us to mentally recharge. If we did not have the forced breaks and separate areas we would not have been able to work as well as we did.

During the incident at HARM, there were specific mission goals. These goals allowed you to have an endpoint for the day's mission. This sounds simple, but when you have to leave a treatment area and there are a few hundred people still waiting to be treated this is emotionally very difficult. In Haiti, the "worried well" still had very legitimate medical needs that needed to be met, but we had to focus on those who had more severe and immediate needs. Knowing that we had met the day's objectives allowed us to leave knowing that this served the greater good. We also had to return to the base camp before dark. Driving at night was a safety issue for us and for the local people. The risk of us getting lost or injured was much worse at night and also many Haitians slept in the streets to avoid other building collapses which led to the potential of running someone over.

The rapid triage taught in HERT, and repeated multiple times, helped me a lot. Even though I knew these criteria as a former paramedic, doing it on huge groups (like at the CDP) helped. At one camp I triaged a group of about 100 people in a few minutes (we did not have cards but the concepts apply). In HERT they talked about writing on splints and bandages to document treatment. We did this and occasionally found patients who needed follow up with the same type of documentation. It worked well.

Thanks for the knowledge,

Nate Paddock,

CDP Graduate Rochester, N.Y.