Haiti Case Study - The Department of Global Health and Social ...

Developing fair, effective patient triage and referral systems
35. In the initial chaotic situation, a large influx of patients reached the few medical facilities
still available. There was no readily-accessible overarching database to help catalogue the
massive pool of patients, in order to effectively triage on a systemic scale; while various
software and communications tools exist, none was in place for such coordination. MSF
described the situation well: “There was no let-up in the work and thus no time for reflection
and planning; only responding”. 141
36. Triage involves health care professionals who carefully assess the patient and then
refer them for the services and the care they require. After the earthquake, this function was
compromised due the overwhelming numbers of patients, the severity of many of the
emergency cases, and the lack of adequate triage resources—e.g. physician or nursing
personnel, space to exam patients efficiently, medical records to assess history and status.
37. Almost all the facilities used different triage parameters, in accordance with their own
capabilities. For example, MSF could not carry out systematic triage due to the sheer
numbers of patients. It ended up giving priority to patients, not necessarily with the greatest
need, but who had the highest chance of survival. 142 The IDF field hospital created a
procedure on the basis of casualties’ urgency and care’s cost/effectiveness ratio.
38. Different referral systems were built from scratch, in the middle of an emergency, with
limited communications, records storage or access, and poor formal relationship with any
care organizations in Haiti. Informal personal contacts and trusted relationships with
organizations were the backbone of the referral system used.
Patient transport by helicopter
39. Helicopters were essential to transfer patients from rural regions. Military helicopters
were instrumental in this respect. However arranging patient transfers by military helicopter
challenged staff in humanitarian organizations to learn how to work with military helicopter
request procedures.
Keeping track of patients and relatives passing through their care
40. Before the earthquake, Haitian authorities lacked a mechanism for patient registration
and had a very poor patient database. The earthquake caused the loss of key information
that had been available (birth registrations, personal records, prior medical history, etc.). A
study by Operational Medicine Institute reported the main issue faced in Haiti was the lack of
a patient identification and tracking system, especially with respect to orphans and
unaccompanied minors. 143 Many patients were unable to maintain contact with their families
(due to communication system shutdown), causing additional anxiety among the Haitian
population, and resulting in an administrative burden to medical staff who had to respond to
many information requests from patients' relatives.
Discharging patients with on-going medical needs
41. The decision of how to discharge patients represented the final challenge to providing
responsible care. Field hospitals are equipped to provide immediate care, while the facilities
for follow-up or post-operative care are not available or overburdened. Immediate care
facilities somehow need to plug into an outpatient network that can provide long-term postoperative
care. The lack of outpatient facilities in Haiti was noted as a problem by both the
International Federation of the Red Cross (IFRC) Rapid Deployment Emergency Hospital –
Emergency Response Unit (RDEH ERU) and University of Miami Global Institute/Project
Medishare (UMGI/PM) field hospital. However, they each offered different solutions:
a. RDEH ERU set up an outpatient clinic with expatriate paramedics, providing postoperative
care, but suggested that, “future deployments require better staffing for postoperative
nursing care” 144 .
B-7