Tuesday, January 26, 2010

What is the Role of Palliative Care in Haiti After the Earthquake?

In hearing about all the tragedy and occasional stories of hope and amazement with the recent earthquake in Haiti, I have been wondering about the role for a hospice/palliative care philosophy in the treatment of those injured and killed during and after the earthquake. Locally, I have not heard of any hospice or palliative care staff taking leave of work to embark to Haiti. (And if anyone does know of someone with a palliative background who has recently gone to Haiti I would love to interview him/her for Pallimed.)



I have also considered how my skill set might be best applied if I myself had decided to go to Haiti with the relief efforts. Would I fall back to my Internal Medicine training or would the specialized palliative care training be helpful? NPR's health blog 'Shots' recently covered some of the triage dilemmas being dealt with by health care staff on the ground. An excerpt:
A pediatric surgeon raised a tough question about when people should be taken off equipment to help them breathe. "Today the issue was ventilators. We ran out," he said. "What do you do then? We need a reality check. Some people might have to get off the ventilator before you would take them off elsewhere. That ventilator could save the life of someone who is much more salvageable."

But other doctors appeared incensed at the idea of stopping short of using every tool available on even the chance to save a life.

Palliative care staff help families and other medical staff sort through these tough decisions all the time in hospitals across the country, so maybe we as a field should make a concerted effort to be included in the 'essential' staff that might be needed in the next major disaster. Imagine an administrator making a list of the 'expertise' she would like to have in the field. As I think/write more, it does not appear to be such a stretch to consider having medical staff with a hospice or palliative care background on the ground in a major trauma/disaster zone.
  • Pain and symptom control
  • Skillful communication to traumatized/grieving families and patients
  • Whole patient/family approach to care, support to other staff
  • Prognostication awareness/skill
  • Grief and bereavement counseling (like Alive Hospice and Hope Hospice (Florida) are already doing)
  • Ability to engage with one's spiritual support
  • Willingness to think outside the box and work in conditions that are not considered ideal medically (i.e. like hospice staff do daily in patient's homes).

Sounds like a good skill set in a disaster zone to me.



In the NPR story, they even mentioned palliative care but it was quickly shot down. (Guess which specialty shot it down?)

Referring to the patients likely to die, one medical planner offered a solution, "What about having palliative care facilities at the intake sites on shore?" A surgeon responded, "And have five hundred tents of dying people in a field right next to a medevac site? We can't do that."

But surely something is better than nothing. "Even if we just give them some painkillers and a comfortable bed, it'll be better than them dying in the street under the sun like a dog," a nurse offered.

But a surgeon argued that easing the death of a doomed person would take a bed that could be used for someone with a real chance of being saved.

Shouldn't we make a more concerted effort to be included in the list of specialists available to help in a disaster? Would we be welcomed or instead shunned given our comfort in discussing issues around death and dying when everyone else is in rescue mode? And what about the patients who were already on hospice. They still need specialized care as well.

(Pictures via Boston.com Big Picture)
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