“A NATIONAL-PREPAREDNESS TRIAD” Specialized Training, Equipment and Supplies for

1. “A NATIONAL-PREPAREDNESS TRIAD” Specialized Training, Equipment and Supplies for Medical and Community Teams Aldy Castor, M.D. President, Haitian Resource Development Foundation HRDF Director, Emergency Services for Association of Haitian Physicians Abroad (AMHE), Haiti Medical Relief Mission Prepared for the First Annual AMHE Conference “Emerging Strategies Focusing on a Comprehensive Healthcare System in Haiti” September 22-23, 2011 Washington D.C.

2. “The Health system in Haiti has remained in a precarious situation for years. In addition, the devastating January 12, 2010 earthquake killed an estimated 250,000 Haitians and displaced of more than a 1.5 million individuals. • This conference will focus attention on the impact of the earthquake and the delivery of health care both in Haiti and abroad...in terms of delivery, sustainability, satisfaction-proven efforts for a community in dire need of change.” • Association of Haitian Physicians Abroad - AMHE September 2011

3. PART ONE History and Analysis: Awareness, Implementation and Gaps Aldy Castor MD, President, Haitian Resource Development Foundation (HRDF), Director Emergency Services, AMHE, Haiti Medical Relief Mission PART TWO Case Study: Pre-hospital Emergency Response, Petit Goâve Jason Friesen, EMT-P, Program Manager, Project HOPE Haiti PART THREE Case Study: Filling Two Mission Critical Gaps - Equipment and Supplies Tom Keefe, CEO, Internationall Medical Equipment Collaborative (IMEC)

5. PART ONE History and Analysis: Awareness, Implementation and Gaps Rescue Exercise, HRDF

6. BACKGROUND - The Haitian Resource Development Foundation (HRDF) was founded in 1987: In the US, as a 501(c) 3 non-profit organization, with a United States Federal Tax I.D. Number In Haiti, as a nongovernmental organization (NGO) that is registered in the archives of the Ministère de la Planification et de la Coopération Externe. Since 2008, HRDF and its partners have trained Haitians in emergency medicine, primarily in the capital city area. Among the students have been medical and nursing emergency room staff of the Hôpital de la Communauté Haitienne [HCH] and emergency units of Haiti State University Hospital. Port-au-Prince firefighters have also received training.

7. Firefighter Training, HRDF

8. In 2004, the United States Southern Command (USSOUTHCOM) through its Humanitarian Assistance Program invited some Haitian American organizations to strengthen Haiti disaster preparedness capacity. Among these organizations were the Association of Haitian Physicians Abroad (AMHE), The Haitian Resource Development Foundation (HRDF) and Mole Saint Nicolas in Action (MOTION). MOTION

9. AMHE, HRDF and MOTION assessed the following institutions: - In Port-au-Prince: the Haiti State University Hospital, the Hôpital de la Communauté Haitienne, the Hôpital Isaïe Jeanty - a maternity facility and the National Fire Service - In Cap-Haitien: the Hôpital Justinien - In Port-de-Paix: the Hôpital Immaculée Conception de Port-de-Paix - In Aquin: the Hôpital Communautaire de Référence d'Aquin - In Les Cayes: the Hôpital Immaculée Conception des Cayes, as well as the National Fire Service.

10. Hospital Assessments, 2004, HRDF

11. The assessment revealed: 1. Neither the hospitals nor the Fire Service provided pre-hospital emergency care. This service was provided by the International Red Cross and private ambulance services. 2. The hospitals had neither intensive care units (ICUs) nor functional and equipped emergency rooms (ERs). 3. The Fire Service did not have trained medical responders. With a population in 2004 of 8.3 million, Haiti had a total of 189 firefighters with only 67 assigned to the fire station in Port-au- Prince. Yet the National Fire Protection Association (an international fire safety organization based in the United States) recommends a ratio of one firefighter per 1,500 civilians.

12. As a result of the assessment: 1) United States Southern Command: - Rehabilitated the emergency room of Haiti State University Medical Center. - Reconfigured and rehabilitated the emergency unit at the Hôpital de la Communauté Haitienne in Frères a suburb of Pétion-Ville. The new unit consists of six intensive care beds, an operative suite, an emergency room, and a radiology room.

13. USSOUTHCOM - HRDF Partnership

14. 2) AMHE, HRDF and MOTION, through grants from governmental and nongovernmental organizations, such as IMEC, the Rotary Club of Pétion-Ville, the French Embassy in Haiti, were able to: - Equipped the emergency units of both Haiti State University Hospital and the Hôpital de la Communauté Haitienne - Trained in emergency medicine many physicians, nurses, firefighters and other first responders working in emergency services of both Haiti State University Hospital and the Hôpital de la Communauté Haitienne. - Established and trained a community Emergency Response Team (CERT) in Aquin. - In June 2011, this training program was started in the Southern Department, but is stalled for lack of funds.

15. Training - The theoretical and practical training curriculum was approved by Haiti’s Ministry of Health and Population. - Cycle of Training: By modules - Duration of Modules: 5 days Monday through Friday, every 6 weeks. Specialists arrived in Haiti on Sunday, and depart the following Saturday. -Number of Trainees: Port-au-Prince - 25 médecins de service (attending physicians, interns, residents), 15 nurses, 30 first-responders (ambulance personnel and firefighters) Southern Department - 16 médecins de service (attending physicians, interns, residents), 8 nurses, 50 volunteers for a Community Emergency Response Team (CERT) in Aquin

16. Practice Session, HRDF

17. Basic Evacuation Tools, HRDF

18. Training, continued - Tailored to the different groups of the trainees according to their level of expertise Module 1: Basic and Advanced Cardiopulmonary Resuscitation, and Advanced Trauma Life Support (BLS), (ACLS) and (ATLS) Module 2: Cardiovascular emergencies Module 3: Respiratory emergencies Module 4: Accidents and traumas Module 5: Infectious diseases Module 6: Neurological, psychiatric, and obstetrical emergencies. Module 7: Mass casualty Module 8: Search and rescue Module 9: Principles of organization: prevention, early alert, disaster management, and mitigation

19. Refugee Conditions, Time Magazine 2010

20. “Most of these people were not only severely injured, but had also lost their homes and family members in their homes. Seeing the number of people injured…it was overwhelming … we were in a state of shock,” Louise Strickland, RN, BN, CNOR, Association of periOperative Registered Nurses (AORN), January 2010

21. AMHE DISASTER RESPONSE STRATEGY FOR HAITI AMHE recommends and offers to shape and lead the following priorities: 1. Train, coordinate and massively dispatch rotating teams of AMHE physicians and personnel to Haiti. 2. Require and conduct emergency medical response training (EMT) in all communes, accompanied by their equipping and supplies. 3. Require and conduct Community Emergency Response Training (CERT) in all communes, accompanied by their equipping and supplies.

22. AWARENESS An ounce of prevention is worth a pound of cure. The four phases involved The process of Emergency Management: mitigation, preparedness, response, and recovery - Mitigation and preparedness will reduce the demand for disaster response and recovery fund and assistance. - Disaster begins long before it happens (hazard, treat, risk) and has to recognized the time continuum. - The cycle of Emergency Management includes short and long-term work on infrastructure, public awareness, and even human justice issues.

23. Vendors and shoppers underneath building wreckage, Port-au-Prince, Sep 2011

24. Bad habits and lack of sanitary services = public health hazards, Port-au-Prince, Sep 2011

25. AWARENESS - Disasters are not only on the rise in Haiti but also around the world - Comparing with the 1960s, the 1990s has witnessed threefold increase in disasters and a nine-fold increase in economic loss. - Factors, such as climate change, earthquakes, hurricanes, floods, concentrations of people in vulnerable areas, shantytowns, political instability and poverty, make Haiti a disaster-prone country. - The larger picture is to start with policies to recognize Haiti as a disaster-prone country, anticipate certain disasters' frequency and intensity, design programs and projects to strengthen its disaster response capacity

26. Even apparently-good construction is no guarantee against the forces of Nature, Port-au-Prince, Jan 2010

27. AWARENESS, continued: For example, how would a Haitian hospitals respond to a mudslide where hundreds or even a thousand or more people are buried and suffocating? 1. This is a race against time. What is the status of the the National Preparedness Triad - Specialized Training, Equipment and Supplies - for Medical and Community Teams? 2. Currently, the four components of an emergency medical response system - pre-hospital care, transportation, communication and hospital care - are either not functioning or inefficient in Haiti. 3. Well-equipped and -supplied emergency and operating rooms are as important as shovels, wheelbarrows, boots and excavating equipment.

28. Accident on the new Morne-Preval bypass of Lake Miragoane, Southern Haiti, Sep 2011

29. DILEMMA FOR PHYSICIANS: Perform autopsy or resuscitation? Canape-Vert neighborhood, Port-au-Prince Landslide, Carrefour

30. IMPLEMENTATION There have to be the willingness, expertise and resources to: - keep threats to a low level, through prevention. - conceive the entire course of events, i.e. to anticipate the disaster, with appropriate medical training, communication, transportation, equipment, supplies, search and rescue, etc.) - maintain effective disaster response plans, management and coordination among diverse governments agencies and nongovernmental organizations responsible for disaster response.

31. RESOURCE - Anything that Haitians can acquire from anywhere in the world and put to good use. It could be, for example, a computer, a doctor, a tractor, a windmill, or an idea. These can become a resource for the country. Haitians have not yet discovered all the resources available to them. When they do, that will be their greatest strength.

32. GAPS 1. Failure to plan and put in place a comprehensive preparedness policy to respond to catastrophe. This was evident after the January 2010 earthquake, with more than a half-million environmental refugees. It was again evident during the cholera epidemic that has claimed thousands of lives and infected more than 400,000. The response to both was more a function of foreign NGOs and governments. Haiti's Health Ministry lacks the resources to provide even basics…staff, water, treatment centers, etc.

33. GAPS, continued 2. Lack of a regional communication system to track available hospital beds so that emergency teams know where to transport the sick and injured. 3. Failure to plan the management of Haitians with special needs, e.g. children, pregnant women, elderly, those with limited mobility, mental health problems, blindness, etc. Flood, Haiti

34. CLOSING THE GAPS 1. Policy framework for faster response & better coordination, 2. Approve and fund AMHE’s Disaster Response Strategy - Train, coordinate and massively dispatch rotating teams of AMHE physicians and personnel to Haiti. - Require and conduct emergency medical response training (EMT) in all communes, then equip and supply teams. - Require and conduct Community Emergency Response Training (CERT) in all communes, then equip and supply teams.

35. CERT Team, HRDF

36. CLOSING THE GAPS, continued 1. Physician's leadership - Incorporate physicians' roles and leadership in disaster management, to increase effectiveness of the health system's large-scale crisis response, with the emphasis on prevention 2. Physician's training - Few physicians are adequately trained to practice effectively in a large crisis. This deficiency can be addressed by providing disaster and emergency preparedness training in residency for physicians. (Residents provide much of the day-to-day care in teaching hospitals; moreover, they are often the only physicians on-duty during off-hours.)

37. Aquin, South Coast, Haiti

38. Hillside, Port-au-Prince

39. Plains, Haiti

40. River Crossing, South East Haiti

41. Jacmel, Haiti

42. HAITIAN RESOURCE DEVELOPMENT FOUNDATION hrdf.org Aldy Castor, M.D., President aldyc@att.net 854 Marina Drive, Weston, Florida 33327 ph 954.659.7953. 954.873.0064 fax 954.659.7957 aldyc@att.net 17, 2ème ruelle Wilson, Pacot, Port-au-Prince, Haiti 25, Rue Sténlo Vincent, Aquin

43. HAITIAN RESOURCE DEVELOPMENT FOUNDATION www.hrdf.org Aldy Castor, M.D., President United States: 854 Marina Drive, Weston, Florida 33327 ph 954.659.7953. 954.873.0064 fax 954.659.7957 aldyc@att.net Haiti: 17, 2ème ruelle Wilson, Pacot, Port-au-Prince ph 509.3.443.3703 25, Rue Sténlo Vincent, Aquin ph/fax 509.245.4117