A Field Hospital - A Means to "Buy Time" Until the Rehabilitation of Local Medical Facilities
The outcome of survivors within disaster areas largely depends upon
the quick reallocation and operation of logistic and medical support
systems. Unfortunately, the response period required for the organization
of rescue systems is slow [1]. Deployment of improvized, volunteer-based,
military field hospitals is feasible within 24 hours after the decision is
made [1]. A multi-disciplinary structure enables an effective, flexible
mode of operation and reduces the dependency on meticulous, time consuming
assessment of requirements prior to deployment. Such field hospitals are
formed to provide backup for the existing primary care medical systems in
disaster areas and replace or take some pressure off of the local
hospitals, especially when local crucial facilities do not function [1-6].
With the guidance of previous experience, an IDF military field hospital
was created in the city of Adapazari where an earthquake disaster took
place. A field hospital has a role as a rapid backup which is used in
order to "buy time" needed for rehabilitation of the local medical
facilities in an earthquake disaster scene.
The fact that the earthquake zone covered a very large area created
difficulty in assessing the needed quantity of the aid teams, in
transportation of the rescue teams and heavy machinery, in evacuation of
the wounded people and also in providing basic needs for the survivors
[7].
The time needed for the restoration of the function of the medical
facilities was an important factor determining the number of
fatalities. Therefore, decision making in the context of an earthquake
disaster must be done rapidly. The high ratio of fatalities caused by the
earthquake and the large number of casualties emphasizes the neccessity
for rapid establishment of alternative medical facilities as a temporary
replacement of the local medical facilities until rehabilitation of these
medical facilities will take place [6].
Similar to the constantly changing medical nessecities in a war zone, the
medical necessities in an earthquake zone are very dynamic and change
rapidly. The field hospitals should be prepared for these changes and be
prepared for extreme conditions. What might seem as excessive help can
become very crucial aid at other times. A flexible management of the field
hospital and applying constant readjustment of the hospital structure and
size is crucial for effective response of the field hospital to the
changing medical necessities.
In the first few days the medical teams
concentrated on the treatment of the injuries directly caused by the
earthquake. Medical personnel from the surgical and orthopedic fields as
well as obstetric and gynecological emergencies are the main medical
disciplines needed at this stage. In the later stages (approximately 1
week after the earthquake) a normal distribution of diseases is
encountered and the mixture of medical specialties must provide a
substitution for the regular medical facilities seen in the earthquake
zone in the routine life. Infectious diseases such as gastrointestinal and
respiratory infections should be anticipated as well as exacerbation of
chronic illness due to lack of appropriate medical supplies. A surgical
capability of the field hospital is crucial especially in the case of
destruction of the local surgical facilities as occurred in the present
earthquake in Adapazari [8-10].
Coordination between foreign field hospitals and the local and national
authorities is the key to success. No hospital can function without proper
communication between the medical personnel and the patients. Therefore,
integration between the foreign crew and local translators, preferably of
medical background, is necessary. In the IDF Field Hospital the
collaboration between the local translators and the hospital crew created
an incredible harmony of team work. The incorporation of Turkish doctors
as an integral part of the medical staff had an important contribution to
the success of the IDF field hospital. Acquaintance with the standards of
care of the local health system, guided the Turkish physicians to suggest
long term therapy and followup program for the patients. The integration
of local personnel in the crew had also an important role in coordination
between the field hospital and other medical resources for various
reasons, e.g. transfer of a patient to the correct facility or arranging
the proper mean of transportation.
The constant team of medical personnel in the IDF field hospital in the
first two weeks enabled it to get organized in a more effective manner
than the other medical facilities, which were run by a constantly changing
medical personnel, working in shifts of 48 hours. The long stay of the IDF
team enabled the management of the IDF hospital to have a reasonable
acquaintence with the existing local medical facilities and to organize
regular meetings between the governer of the city and the managers of all
the hospitals working in the city. This enabled a correct assessment of
the advantages and the disadvantages of the local health care at any
particular time and to have a good follow up of the rate of rehabilitation
of the local medical facilities. The information gathered from these
meetings helped the IDF field hospital commanders to come to a decision
concerning the correct timing for drawing back, according to the status of
rehabilitation of the local medical facilities. The IDF field hospital
completed its mission once local medical facilities regained
responsibility and gave adequate medical care to the patients who were
previously treated by the field hospital.
In conclusion, the capability to construct rapidly a flexibly managed
field hospital is necessary to provide the needed medical backup in an
earthquake disaster scene. Such teams should be established and trained as
potential means for medical backup in case of a large-scale medical
disaster as long as the existing medical facilities are malfunctioning.
Acknowledgement
This article is devoted to the longlasting friendship between the Turkish
and the Israeli Peoples. We wish to express our condolences to the Turkish
people who have undergone this devastating disaster. We send our
appreciation to the nurses, paramedics, medics and logistic personnel as
well as to our friends - the Turkish physicians and translators for their
great contribution. Our gratitude to the Turkish parlament member Saray
Gonul who gave the spirit of life to the team work between the Israeli and
the Turkish members of the field hospital.
References
1. Heyman SN, Eldad A, Wiener M, Airborne field hospital in disaster area:
lessons from Armenia (1988) and Rwanda (1994). Prehospital Disaster Med,
1998; 13: 21-28.
2. Henderson AK, Lillibridge SR, Salinas C, Graves RW, Roth PB, Noji EK,
Disaster medical assistance teams: providing health care to a community
struck by Hurricane Iniki. Ann Emerg Med, 1994; 23: 726-730.
3. Alson R, Alexander D, Leonard RB, Stringer LW, Analysis of medical
treatment at a field hospital following Huricane Andrew, 1992. Ann Emerg
Med, 1993; 22: 1721-1828.
4. Hauber P, Catastrophic medicine: experiences with the employment of
German Federal Forces in South Italy. MMW Munch Med Wochenschr 1981; 123:
1757-1760.
5. Kirillov MM, The periodization of the archives of the treatment
specialists in rendering medical care to victims of the earthquake in
Armenia (December 1988-June 1989). Ter Arkh, 1995; 67: 42-45.
6. Kunii O, Wakai S, Honda T, Tsujimoto K, Role of external medical
volunteers after disasters. Lancet, 1996; 347: 1411.
7. Malilay J, Flanders WD, Brogan D, A modified cluster-sampling method
for post-disaster rapid assessment of needs. Bull World Health Organ,
1996; 74: 399-405.
8. Lechat MF, The epidemiology of disasters. Proc R Soc Med, 1976; 69: 421
-426.
9. Sharp TW, Yip R, Malone JD, US military forces and emergency
international humanitarian assistance. Observations and recommendations
from three recent missions. JAMA, 1994; 272: 386-390.
10. Angus DC, Pretto EA, Abrams JI, Ceciliano N, Watoh Y, Kirimli B,
Certug A, Comfort LK, Epidemiologic assessment of mortality, building
collapse pattern, and medical response after the 1992 earthquake in
Turkey. Disaster reanimatology study groop (DRSG). Prehospital Disaster
Med, 1997; 12: 222-231.
Competing interests:
No competing interests
06 September 1999
Y Bar-Dayan
IDF Field Hospital Mission Team
P Beard, D Mankuta, A Eldad, C Gruzman, P Benedek, G Martinovitz
Rapid Response:
A Field Hospital - A Means to "Buy Time" Until the Rehabilitation of Local Medical Facilities
The outcome of survivors within disaster areas largely depends upon
the quick reallocation and operation of logistic and medical support
systems. Unfortunately, the response period required for the organization
of rescue systems is slow [1]. Deployment of improvized, volunteer-based,
military field hospitals is feasible within 24 hours after the decision is
made [1]. A multi-disciplinary structure enables an effective, flexible
mode of operation and reduces the dependency on meticulous, time consuming
assessment of requirements prior to deployment. Such field hospitals are
formed to provide backup for the existing primary care medical systems in
disaster areas and replace or take some pressure off of the local
hospitals, especially when local crucial facilities do not function [1-6].
With the guidance of previous experience, an IDF military field hospital
was created in the city of Adapazari where an earthquake disaster took
place. A field hospital has a role as a rapid backup which is used in
order to "buy time" needed for rehabilitation of the local medical
facilities in an earthquake disaster scene.
The fact that the earthquake zone covered a very large area created
difficulty in assessing the needed quantity of the aid teams, in
transportation of the rescue teams and heavy machinery, in evacuation of
the wounded people and also in providing basic needs for the survivors
[7].
The time needed for the restoration of the function of the medical
facilities was an important factor determining the number of
fatalities. Therefore, decision making in the context of an earthquake
disaster must be done rapidly. The high ratio of fatalities caused by the
earthquake and the large number of casualties emphasizes the neccessity
for rapid establishment of alternative medical facilities as a temporary
replacement of the local medical facilities until rehabilitation of these
medical facilities will take place [6].
Similar to the constantly changing medical nessecities in a war zone, the
medical necessities in an earthquake zone are very dynamic and change
rapidly. The field hospitals should be prepared for these changes and be
prepared for extreme conditions. What might seem as excessive help can
become very crucial aid at other times. A flexible management of the field
hospital and applying constant readjustment of the hospital structure and
size is crucial for effective response of the field hospital to the
changing medical necessities.
In the first few days the medical teams
concentrated on the treatment of the injuries directly caused by the
earthquake. Medical personnel from the surgical and orthopedic fields as
well as obstetric and gynecological emergencies are the main medical
disciplines needed at this stage. In the later stages (approximately 1
week after the earthquake) a normal distribution of diseases is
encountered and the mixture of medical specialties must provide a
substitution for the regular medical facilities seen in the earthquake
zone in the routine life. Infectious diseases such as gastrointestinal and
respiratory infections should be anticipated as well as exacerbation of
chronic illness due to lack of appropriate medical supplies. A surgical
capability of the field hospital is crucial especially in the case of
destruction of the local surgical facilities as occurred in the present
earthquake in Adapazari [8-10].
Coordination between foreign field hospitals and the local and national
authorities is the key to success. No hospital can function without proper
communication between the medical personnel and the patients. Therefore,
integration between the foreign crew and local translators, preferably of
medical background, is necessary. In the IDF Field Hospital the
collaboration between the local translators and the hospital crew created
an incredible harmony of team work. The incorporation of Turkish doctors
as an integral part of the medical staff had an important contribution to
the success of the IDF field hospital. Acquaintance with the standards of
care of the local health system, guided the Turkish physicians to suggest
long term therapy and followup program for the patients. The integration
of local personnel in the crew had also an important role in coordination
between the field hospital and other medical resources for various
reasons, e.g. transfer of a patient to the correct facility or arranging
the proper mean of transportation.
The constant team of medical personnel in the IDF field hospital in the
first two weeks enabled it to get organized in a more effective manner
than the other medical facilities, which were run by a constantly changing
medical personnel, working in shifts of 48 hours. The long stay of the IDF
team enabled the management of the IDF hospital to have a reasonable
acquaintence with the existing local medical facilities and to organize
regular meetings between the governer of the city and the managers of all
the hospitals working in the city. This enabled a correct assessment of
the advantages and the disadvantages of the local health care at any
particular time and to have a good follow up of the rate of rehabilitation
of the local medical facilities. The information gathered from these
meetings helped the IDF field hospital commanders to come to a decision
concerning the correct timing for drawing back, according to the status of
rehabilitation of the local medical facilities. The IDF field hospital
completed its mission once local medical facilities regained
responsibility and gave adequate medical care to the patients who were
previously treated by the field hospital.
In conclusion, the capability to construct rapidly a flexibly managed
field hospital is necessary to provide the needed medical backup in an
earthquake disaster scene. Such teams should be established and trained as
potential means for medical backup in case of a large-scale medical
disaster as long as the existing medical facilities are malfunctioning.
Acknowledgement
This article is devoted to the longlasting friendship between the Turkish
and the Israeli Peoples. We wish to express our condolences to the Turkish
people who have undergone this devastating disaster. We send our
appreciation to the nurses, paramedics, medics and logistic personnel as
well as to our friends - the Turkish physicians and translators for their
great contribution. Our gratitude to the Turkish parlament member Saray
Gonul who gave the spirit of life to the team work between the Israeli and
the Turkish members of the field hospital.
References
1. Heyman SN, Eldad A, Wiener M, Airborne field hospital in disaster area:
lessons from Armenia (1988) and Rwanda (1994). Prehospital Disaster Med,
1998; 13: 21-28.
2. Henderson AK, Lillibridge SR, Salinas C, Graves RW, Roth PB, Noji EK,
Disaster medical assistance teams: providing health care to a community
struck by Hurricane Iniki. Ann Emerg Med, 1994; 23: 726-730.
3. Alson R, Alexander D, Leonard RB, Stringer LW, Analysis of medical
treatment at a field hospital following Huricane Andrew, 1992. Ann Emerg
Med, 1993; 22: 1721-1828.
4. Hauber P, Catastrophic medicine: experiences with the employment of
German Federal Forces in South Italy. MMW Munch Med Wochenschr 1981; 123:
1757-1760.
5. Kirillov MM, The periodization of the archives of the treatment
specialists in rendering medical care to victims of the earthquake in
Armenia (December 1988-June 1989). Ter Arkh, 1995; 67: 42-45.
6. Kunii O, Wakai S, Honda T, Tsujimoto K, Role of external medical
volunteers after disasters. Lancet, 1996; 347: 1411.
7. Malilay J, Flanders WD, Brogan D, A modified cluster-sampling method
for post-disaster rapid assessment of needs. Bull World Health Organ,
1996; 74: 399-405.
8. Lechat MF, The epidemiology of disasters. Proc R Soc Med, 1976; 69: 421
-426.
9. Sharp TW, Yip R, Malone JD, US military forces and emergency
international humanitarian assistance. Observations and recommendations
from three recent missions. JAMA, 1994; 272: 386-390.
10. Angus DC, Pretto EA, Abrams JI, Ceciliano N, Watoh Y, Kirimli B,
Certug A, Comfort LK, Epidemiologic assessment of mortality, building
collapse pattern, and medical response after the 1992 earthquake in
Turkey. Disaster reanimatology study groop (DRSG). Prehospital Disaster
Med, 1997; 12: 222-231.
Competing interests: No competing interests