HAITI 2010 : Earthquake Feedback Experience of the

French Caribean rescue team

Eric FONTANILLE (Emergency MD)French West indies Defense Force coordinator

University hospital of Fort de FranceEric.fontanille@sante.gouv.fr

14 th Health Disaster Coordinators Meeting

MARTINIQUE AND GUADELOUPE ISLANDS

– Two French islands– Distance from HAITI: 1400 km – Population: 1 Million / 2 islands– French military base…– Fire Figthers with a special rescue

desaster team– Health Equipment

• 2 University hospitals (EMS)– High level of competence– 700 beds for each

• 2 X 10 General hospitals

January 12th at 8 pm The Martinique Emergency Medical Service (EMS) mobilizes :

3 Doctors . 2 Nurses The EMS Guadeloupe and French Guyane is alerted

The French Embassy sent a SOS to the regional governement disaster office

The local Radio…

The EMS integrates the FWI DICA : 84 Staffs: Military + Fire fighters specialized in desasters and a emergency medical staff (9) + 2 rescue dogs

Equipment: 2 medical devices dedicated to disasters (100 victims)

French Guyana team..

In the plane: Two missionsIn the plane: Two missions

- Rescue : search for buried victims- Medical : care to the populations

The 13 th january at 7pm the FWI Rescue team arrives in Haiti: The First? Ambassador: 4 PRIORITY

MEDICAL CARESEARCH RESCUE

1/ RESCUE AND EXCAVATION

THEY BEGIN IMMEDIATLY.

3 saved victims (Total 17) !

Dangerous site: In the night...

RESCUE EXCAVATION: ANALYSIS

Why the luxury Montana hotel choice ? We try to find local health and security

leaders to restore the chain of command

We have not lots of doctors and they are PARALIZED for a long time,What For? 3 Survivors for 78 rescuers/12 days

-A medical "Specialists' affair

First choice: The MONTANA HOTEL

2/ THE MEDICAL ACTION

• THE FIRST LEVEL1/ To manage the French nationals2/ To restore the health care capacity3/ To organize the air medical evacuation

• THE SECOND LEVEL• Medical security for the rescuers and excavation victims• Deads identification• Orphans management

French Ambassador priority !

- it decides to gather them in the Embassy near the rescuers…

- Jannuary 13 th, at 3 AM : - First Evacuation of 20 French nationals

and 6 french wounded to Fort de France

1 /  THE  FRENCH NATIONAL EVACUATION

Lots of French in Haïti !

EVACUATION of NATIONALS:ANALYSIS

A Ambassador PriorityWhere are they ? How many?

- They impacted the medical action and evacuation

- In Martinique they had a medical and a psychological exam if they needed

• Total 1300 people were evacuated to Martinique in 6 days

2/ EVALUATION OF THE HEALTH CARE CAPACITY

• The Medical Director did a medical and technical evaluation of 6 Health care establishments recommended by the French Embassy MD

• Objectives– To find the french wounded– Evaluate the accomodation capacity of

the hospital– Make a medical and technical choice

for 4 safe hospitals where the french medical team could work effectively on security

THE EVALUATION WILL LEAD TO A PERENNIAL MEDICAL STRATEGY

1/To identify a « referal hospital for the EMS »: The CDTI hospital or « sacré cœur »– To accomodate the seriously injured coming from the clearing sites – Triage and stabilization of the casualties before their medical

evacuation– Organize and control of pharmacy for the medical teams

2/ To expand to 3 others Hospitals with medical team coming from France (140 people)...

3/ To prepare the French military health mission.

PRINCIPAL STAGES OF THE MEDICAL ACTION IN EACH HOSPITAL

3/To begin the care and the post operative care

2/TRIAGE ! Alive or death …...

1/ Evaluation

THE HEALTH CARE CAPACITY After 3 days

…

The « French » were working in 4 «referral » hospitals

- A surgical team from Martinique and Haïti work together …. Every 3 days the team change

- A Tent hospital allows post operative care

THE HEALTH CARE CAPACITY HAS BEEN COMPLETED BY THE FRENCH ARMY

Started the18 and the 26 of january

MEDICAL AND SURGICAL SUPPORT 1/1/The The ESCRIM:ESCRIM: A A TentTent surgicalsurgical HospitalHospital..

-- 2174 consultations 2174 consultations -- 209 209 surgeriessurgeries--1389 hospitalisations1389 hospitalisations

2/ 2/ The The ““ SirocoSiroco ””: NAVY : NAVY hospitalhospital BOAT,BOAT,

3/ 3/ HelicoptersHelicopters

: :

THE HEALTH CARE CAPACITY : ANALYSIS

• Many request… Only 4 Hospital…

• Recurrent earthquake: Stop the activity and need new evaluation to start again...

• Environmental health: The last action but…

• 314 Health organisations on Haiti…– Who’s the Boss, who does what ?– But Thank you NGO and more…

• What’s happen for the patients after surgery ? Tents are not so bad

• French Pharmacy limited,The difficult transportation…

3/ AIR MEDICAL EVACUATION: 2 phases

No health organization« Caribean Fraternity »Other regional possibilities are limited?Airport is not on control…The French government PRIORITY…

Every day ,5 Military planes with doctors go and return to Martinique and Guadeloupe with Haiti victimsBut: No schedule, what kind of patients?…

Day 1 to 5: PHASE 1

DAY 5: AIR MEDICAL EVACUATION IS WELL ORGANIZED

PHASE 2: After 5 days

The local surgical capacity is correct.The tritement on the spot is to be supported

• The medical transportation are made according to the capacities of the Martinique and Guadeloupe hospitals

• 10 victims are sent to Martinique and Guadeloupe one day alternately

Hôpital DiquiniHôpital Diquini

Moyens :Moyens :DSC : 24 DSC : 24 ééquipes quipes

mméédicalesdicales

ActivitActivitéé JournaliJournalièèrere216 Cs216 Cs

ActivitActivitéé cumulcumuléée :e :1484 Cs1484 Cs

To summarize afterafter one one weekweek, the French , the French medicalmedical organizationorganization

Hôpital du SacrHôpital du Sacréé--CoeurCoeur

Moyens :Moyens :DSC : 6 DSC : 6 ééqu mqu méédd

SAMU : 3 SAMU : 3 ééqu mqu méédd

ActivitActivitéé JournaliJournalièèrere135 Cs135 Cs

ActivitActivitéé cumulcumuléée :e :1119 Cs1119 Cs

Hôpital du canapHôpital du canapéé vertvert

Moyens :Moyens :DSC : 8 DSC : 8 ééquipes quipes

mméédicales.dicales.

ActivitActivitéé JournaliJournalièèrere93 Cs93 Cs

ActivitActivitéé cumulcumuléée :e :1015 Cs1015 Cs

Hôpital de la Hôpital de la communautcommunautéé haitiennehaitienne

Moyens :Moyens :DSC : 3 DSC : 3 ééquipes quipes

mméédicales.dicales.

ActivitActivitéé JournaliJournalièèrere93Cs93Cs

ActivitActivitéé cumulcumuléée :e :645Cs645Cs

ESCRIMESCRIM

A.M.C.A.A.M.C.A.«« SirocoSiroco »»

TRIAGE & LITTLE CARETRIAGE & LITTLE CARE

SURGERIESURGERIE

HospitalisationHospitalisation

AéroportHôpitauxAntilles

Mission reconnaissanceMission reconnaissanceMAEMAE

Moyens :Moyens :DSC : 1 DSC : 1 ééquipe mquipe méédicaledicale

SAMU : 0 SAMU : 0 ééquipe mquipe méédicaledicale

Mission RMission RéégulationgulationEVASAN et transfert EVASAN et transfert

interhospitaliersinterhospitaliersMoyens :Moyens :

DSC : 1 DSC : 1 ééquipe mquipe méédicaledicaleSAMU : 1 SAMU : 1 ééquipe mquipe méédicaledicale

équ. méd. = équipes médicales

Cs = Consulations

AmbulanceHélico

Avion

OTHER « MEDICAL » MISSIONS

1 / MANAGEMENT of DEAD BODIES

2 / ORPHANS

FRENCH DEAD BODIES MANAGEMENT

A Forensic MD WITH THE FIRST TEAM….

Police & Technical expertise…. The french death can go back to france…

Expert near the autorities

Les ressortissants franLes ressortissants franççais !ais !500 ORPHANS TRANSFERED IN MARTINIQUE

A doctor and psychologist….. On plane reserved ...

A quick Police investigation ? Good for the rescuers brain

Day12 : THIS IS THE END OF THE FRENCH CARIBEAN FIRST RESCUE TEAM.

900 Organization

900 French RescuersFFEMS Paris

All the world is here

RESULTS

• FROM THE 13 TO THE 21 JANUARY THE FRENCH CARIBEEN FIRST RESCUE TEAM MADE:

• CONSULTATIONS : +/_4000• SURGICAL INTERVENTIONS : 300

• AIR MEDICAL EVACUATIONS: 136 X 2

CONCLUSIONS What was wrong?

Where and how to begin?

-A difficult coordination with the other health organizations and international rescue ..

-Difficult transmission (phone?) between Haiti and Martinique

A MAJOR DISASTER: « a big moment of solitude for the first rescue team » It’s not like in the plan, or in simulation exercices

The embarrasment?

« I CUT OR YOU DIE » !

What can i do?

We are Caribean !

CONCLUSIONS Positives

• A rapid and a good response by the French Caribean hospitals because of their proximity and « creole fraternity »

- For the first time the regional EMS work together

• Technical and complete surgical team is important at the begining of the rescue phase

• The French Caribean team prepare the 6 weeks French action

• Working with other Caribean countries or organization is absolutely necessary if we want to be effective.

THANK YOU AND

TOTAL RESPECT FOR MY HAITIEN FRIENDS…