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
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
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
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
�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
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
�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
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
�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
of Nursing include (from left) Alyce Schultz,
Susan Bennett, Debra Lynn-McHale Wiegand and
Their names were transposed in a photo caption
them in the January 2004 issue of AACN News.