AACN News—March 2004—People

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Vol. 21, No. 3, MARCH 2004

Nurses Have Key Role in International Response Team

Members of the International Medical Surgical Response Team, including critical
care nurses, responded to the need for medical care following the Iranian earthquake
in December.

When a major disaster strikes, regardless of where, a special medical team out of Boston, Mass., stands ready to respond. Critical care nurses are a vital component.

Katie Brush, RN, MS, BCRN, FCCM, a surgical critical care clinical nurse specialist at Massachusetts General Hospital, has been part of the effort since 1999. She is supervising nurse for the International Medical Surgical Response Team, a Federal Emergency Management Agency asset operating under the Department of Homeland Security in conjunction with the U.S. State Department.

The team was formed after the 1998 bombings of U.S. embassies in Tanzania and Kenya. The idea, Brush explained, was to make available a rapid-response team that could leave, be on the ground and evacuate critically ill personnel in a two- to three-day time period. Today, the goal has expanded. The effort has evolved into an on-call team that operates under a memorandum of understanding with Massachusetts General Hospital. Two additional teams�one operating out of Miami, Fla., and the other out of Seattle, Wash.�will soon be added. Previously, the Boston-based team has responded to the 2001 9-11 terrorist attacks in New York City and to a super typhoon that hit Guam in December 2002.

Most recently the team was deployed to assist earthquake victims in Bam, Iran.

Brush said the call to action in Iran came less than 24 hours after the first of three earthquakes hit the morning of Dec. 26. The team, she explained, has to be prepared to be self-sustainable for at least 72 hours.

�We have to go be ready to go out the door with whatever we need,� she said.

What they found when they arrived was total devastation, Brush said.

�Essentially everything fell down,� Brush said. �Entire neighborhoods were just piles of rubble extending for hundreds of yards.�

All three hospitals were destroyed and 50% of the healthcare workers were lost,� she said. �They had lost all their infrastructure and couldn�t respond to their own disaster.�

An ICU nurse for 20 years, Brush said she fills many different roles during deployment, including pharamacist and emergency department nurse.

�I�ve erected tents, moved gear, picked up garbage,� she said. �Everybody does it. �Everybody is in the same boat. Everybody has to multitask in a variety of ways.�

Using a system of tents, the hospital was up and running for five days, Brush said. In the deployable rapid-assembly shelter hospital, there were an ICU, operating room, a resuscitation area and a six-bed holding unit. Three separate areas were set up for men, women and children to provide primary care while respecting cultural norms.

The team arrived in Bam on Dec. 29 and left nine days later. Most of the patients the team treated during that time had lost multiple family members, most as many as 10 to 12, Brush said. One man had lost seven children, and one 18-year-old was the only one left in his family.

�Another man, who had been married just the day before the earthquake, arrived with a core body temperature of 90 after spending days lying across his wife�s grave.

�All were overwhelmed by incredible grief so big that we didn�t know how to get our arms around it,� Brush said.

However, in the midst of such enormous devastation, there were bright spots.

�We had some incredible saves,� said Brush.

For example, one patient was in renal failure after sustaining a crush injury.

�He had a potassium level of 8.9 secondary to rhabodomyolysis. We were able to stabilize him and get him out the door for the two-hour ambulance ride for dialysis care. Another 30 minutes without acute intervention and he most certainly would have died.�

In another case, three respiratory therapists had to hand-ventilate a 37-day-old baby who was suffering from ARDS, because the ventilator wouldn�t read such low tidal volumes. The baby was treated and transferred to a pediatric ICU in another city.

And, the team delivered six babies�four vaginal and two cesarian. One mother even named her baby �Imsurt,� the acronymic term by which the team is referred.

Remarkably, there were no mortalities.

�We brought our standards into the field,� Brush said. �We provided care we would have been happy to receive.

�The appreciation these people showed was enough to make you want to go out the door and do it all again,� said Brush. �In their massive pain, they were so kind and grateful to us from the minute we arrived.
Yet, the thanks is due them for allowing us in.�

They stood at the gate and cried when the team shut down, Brush said.

�We left behind everything we took in,� she added.

The entire field hospital and its contents were donated to the Federation of the Red Crescent and Red Cross Hospital. This 50-tent field hospital will provide the acute healthcare for Bam for the next 24 months.

Normally, the team would be composed of 26 people, Brush said. However, this time, double teams were deployed for a total of 58, including 20 nurses. Pulled in were the Pediatric Specialty Team sponsored by Children�s Hospital of Boston and Burn Specialty Team sponsored by the Shriners Hospital of Boston, as well as members of the Massachusetts Disaster Medical Assistance Team (MA-1), which is sponsored by Boston EMS.

Most of the nurses deployed are critical care nurses. They are Jennifer Albert, RN, Allen Bouchard, RN, Sheila Burke, RN, Dottie Cappola, RN, Lin-Ti Chang, RN, Renee Charbonneau, RN, Tony Forgione, LPN, Pamela Griffin, RN, Patrick Kadilak, RN, Barbara Goll-McGee, Leandra McLean, RN, Jacqueline Nally, RN, Patricia Owens, RN, Joseph Roche, RN, MaryAlyce Romano, RN, Joan Tafe, RN, Jack Twomey, RN, Barbara Walsh, RN, Brenda Whelan, RN.

Why do Brush and her colleagues do what they do?

�Because people need help,� was Brush�s simple reply.

�This is something I can contribute back to the world,� she said. �I have skills to offer. There are things I can�t do, but I can do this.

�I don�t think it is a big deal, nor does anybody else on the team.

I simply went to work, I took care of patients�but I went camping in Iran,� she added.

Brush believes that her colleagues at Massachusetts General Hospital are as valuable to the cause as any of the active team members.

�We can�t do this without the support of our colleagues at home,� she commented, noting that her 20-bed ICU gave up four full-time nurses and herself and absorbed the burden during their absence.

�These people pick up the pieces for us,� she said.

Katie Brush consults about a patient during
her deployment with the International Medical
Surgical Response Team in Bam, Iran.

For the Record

AACN members recently inducted into the American Academy
of Nursing include (from left) Alyce Schultz, Eleanor Bond,
Susan Bennett, Debra Lynn-McHale Wiegand and Karen Giuliano.
Their names were transposed in a photo caption identifying
them in the January 2004 issue of AACN News.

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