Idle Operating Rooms Aboard USS Bataan (LHD-5) on First Day off Haiti

19th

Idle Operating Rooms Aboard USS Bataan (LHD-5) on First Day off Haiti

January 2010

By Jim Dolbow

With 4 operating rooms, is it unreasonable to expect for them to busy busy around given the clock given the scale of the tragedy in Haiti?

With 4 operating rooms aboard USS Bataan (LHD-5), why weren't they put to immediate use after arriving off the coast of Port-au-Prince?

Participated in a 1300 Bloggers Roundtable today with medical personnel aboard the USS Bataan (LHD-5).

Frustrating to say the least. The Bataan arrived last night and at the time of the roundtable some 12+ hours later (minimum), it still has not received one patient which is Bravo Sierra in my view. It has four operating rooms, 14 ICU beds, and 38 ward beds.

Given the number of people that are in desperate need of surgery, I am at a loss of words why patients weren’t brought aboard immediately.

Life is a real b**** if you survive being buried in a pile of rubble for a week only to due because of the lack of access to an operating room.

If I am wrong, tell me so.

About Jim Dolbow

Posted by Jim Dolbow in Soft Power

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Charley Armstrong

Too many cooks. With NGO’s and the UN apparently running amok, or perhaps competing for power, (and possibly ignoring the US capability…) it’s time for the Navy to set up a shoreside triage center to at least identify and transport some patients who can benefit from afloat OR’s and facilities.

I have no facts to back up my characterization of the NGO’s and the UN – just a feeling…
http://www.andrewlubin.com Andrew Lubin

You’re correct Jim; it’s a waste of 12 crucial hours; especially since we’re hearing credible reports of crude emergency amputations and surgical instruments being washed in vodka.

It seems that the only refugees treated on one of our ships was a few who were brought to the USS Carl Vinson, and you’ll remember that Cmdr Melanie Merreck was frustrated that their injuries were not that severe, and they should have been brought (quicker) to the Bataan.

Similar to Iraq and Afghanistan, it seems we can’t bring aid until we bring a crippling beaurocracy.
Tim

People are dying due to this bureaucratic BS.

This team self financed there way in could use the help.

http://badgerjake.blogspot.com/
RickWilmes

Just because we have the capability to help doesn’t mean we should help. Until anyone can provide a rational answer to why it is the United States responsibility to help I am at a loss at how many people are appealing to emotions and the desire to help those in need.

We have limited resources and we have to act rationally and think about what we are doing before we plunge into another fruitless quagmire. In my opinion, 12 hours is not enough to fully think this out and consider all that needs to be thought about concerning why we should get so involved in a disaster we have no control over.
Charley Armstrong

I forgot to mention the Haitian government, or non-government.
http://www.usni.org admin

Tim:

Those guys are making it happen.
Cap’n Bill

Gotta keep the chain of command in mind. First there is the broken government of Haiti that is “working” directly with the United Nations whose top two officals were killed. The US has a national interest in NOT becoming the lead dog but to remain in the position of heavy duty lifter. Better get used to responding to requests but not calling all the shots.
Byron

Here’s my take: Is there a single point, or set of points for triage ashore, patient collection, pick up points, assessment of shipboard assets yet? If not, then I suspect that there is not a system intact on the ground that A) knows about Bataan, and B) if they did, do they have a means to get comm’s with Bataan for an airlift. Last, but certainly not least, is there security set up at the medevac pickup points? If not, won’t do any good to go pick up patients and have the helo and crew get swamped by rioters.

This tragedy did not happen in Southern California. It did not happen in Indonesia. There is no sense of “pull together, get a system going,” and more importantly , no trust.
eastriver

Jim’s right. Lt Gen Keen is pitiful. The CG is essential, because they got one of his staffers and a few other Americans out?
No, folks, they are essential because they are highly educated and trained professionals who were in place early enough to transmit an accurate situation report.

My question is: who, if anyone, was listening? And why did we not respond with the full power of the United States in a timely and efficient fashion? Forget the BATAAN delay. Per the Wall Street Journal, VINSON’s facilities were unused as of Sunday, and may be today.

Don’t blame it on the Haitian gov’t; it is destroyed. Don’t blame it on the UN; they have no resources. Don’t blame it on the President; he directed all resources of the US to respond.

Let’s look to ourselves; and fix it so it never happens like this again, either outside or inside the US.
UltimaRatioReg

“Don’t blame it on the President; he directed all resources of the US to respond.”

So, now this means placing blame in the WH is off limits? Is this not precisely what was done in Katrina in 2005? (It was.) To a state and city government whose conduct leading up to the storm and in the immediate wake can be categorized as criminal negligence.

I would also remind that Vinson, Bataan, and even Comfort provide an exceedingly small capacity (around 400 total beds) for what is certainly tens of thousands, and likely hundreds of thousands of sick and injured.

I am a bit disappointed in this post, as it smacks of the same old path of criticizing those in the thick of it, trying to perform a very difficult mission on a scale that cannot be understood from the outside. Or even offshore.

Do NOT be surprised to hear stories of UN, NGO, and even Haitian officials intentionally obstructing US efforts. If there is political capital or profit to be gained by doing so, count on it.
http://www.jimdolbow.blogspot.com Jim Dolbow

I too am disappointed in this post. There should have never been a need to write it.
Charley Armstrong

A Navy officer at the PaP airport was interviewed by a News Hour reporter today, and was asked why the aid piling up at the airport was not being distributed. The officer stumbled around the question, but indicated that he has not been given any direction about what to do with the aid. When pressured by the reporter, he said that the Haitian government is in charge of its distribution. In the same piece, the reporter indicated that UN officials said that they are in charge of the relief effort. Later in the New Hour show, a retired General (who’s name I cannot remember) urged that commanders in the field use their own initiative to do what it takes to distribute the aid. In the same segment, a former director of USAID, and now a member of an NGO defended the system that is in place, and urged patience. In the next few days everything will come together. Then he started rattling off about the Incident Command System (a standardized / modular response framework used by emergency managers in the US.) I’m curious to know if the UN, International NGO’s, or the Haitian Government uses this system.
UltimaRatioReg

So, DoD has the lead? In a sovereign country? With a mandated UN presence? Interesting. And now we are to tailor our command and control efforts to reflect the Haitian government model? Or that of the UN? Or the NGOs? Huh.
UltimaRatioReg

“I too am disappointed in this post. There should have never been a need to write it.”

Jim, I think you and I would define “need” quite differently.
Robbo

Oh, Jim, don’t be a Geraldo.
We’re trying to give relief to a population and area comparable to the entire state of New Jersey. Name the 6 people you think should have been treated today…
It’s not like there are bus lines or ambulances that lead straight to BATAAN and they can take in first come first served. This place is a mess.
Any treatment of the Haitians is gravy; it’s AID! It’s all gravy — well-earned through blood, sweat, and tears of American servicemembers.
http://www.jimdolbow.blogspot.com Jim Dolbow

I am not being a Geraldo. I dont have any plans to get married 5 times.

what is your definition of need URR?
UltimaRatioReg

Jim,

Your perspective on the situation may change if it is your job to set up communications between US vessels, medical entities, and transportation assets to figure out who needs to go, how you will arrange intermodal transportation over impassable roads and through a jam-packed airhead (or a less than secure LZ), alert everyone and gain permission (they are NGOs), and then wait for the priority to go from saving 500 people with the water and food the vehicles are carrying to saving half a dozen people by using those vehicles to transport them to medical care. And oh, by the way, the doctors cannot accompany the patients because there are only a few of them and thousands needing their help.

Just sayin’.
Chuck Hill

There is a shore based triage at the old Haitian Coast Guard Base. It was set up by the Coast Guard.

Are we using French and Creole language radio to tell the people where to come for help?
Mr E

It might also have something to do with there being a fully equipped field hospital on the ground being run by the Israeli Army that’s already got operating theatres up and running, along with having an ICU, imaging suite, lab and the other things you’d expect to find in a real hospital. From the sounds of it, they’ve been pretty busy already, and you don’t need a helicopter to get there!
Jim Dolbow

@URR: Adapt and overcome. Search and Rescue trumps security.
RickWilmes

“Search an Rescue trumps security.”

This is probably the most blatant example of altruism I have seem expressed. The fact of the matter is that our armed service members are valuable and should be protected. Their well being is of utmost importance nit only for them and our country but for those who will receive aid.

It doesn’t do alot of good when a SAR team is overrun by a starving mob. I am reminded of the scene in “Band of Brothers” when the Nazi death camp was discovered. The initial reaction was to set the prisoners free; however, this immediate short term action had longer term consequences.

Same principle applies in Haiti. The oppressive government of Haiti no longer exists. You a starving injured population with no guidance or any concept of what to do next. Yes, there are some attempts at SAR but the footage on TV shows the vast majority of people roaming around aimlessly. As an American concerned for and paying for the service members being sent to provide aid their security is of primary concern for me.
UltimaRatioReg

Now Jim, that is a silly answer. SAR may not trump security. That is a commander’s call, and is situation-dependent. And even if it does, SAR is not triage, stabilization, or transportation. All of which are manpower and resource-intensive.

The relief effort may be engaged in bringing water and food to people who would die without it very shortly, and the medical assistance may be administering care to large numbers on the edge of death for lack of it.

So please, save the criticism until you know for sure what is happening at the point of contact.
http://www.jimdolbow.blogspot.com Jim Dolbow

@URR tell it to LTG Russell Honore of Hurricane Katrina fame. He is the one that said on CNN SAR trumps security not me.
UltimaRatioReg

Jim, last I checked, LtGen Honore was not commanding this operation.

LtGen P.K. Keen from CENTCOM is.
http://www.jimdolbow.blogspot.com Jim Dolbow

Last I checked LTG Keen is from SOUTHCOM. I know you know that

More importantly the last time I checked LTG Honore is a subject matter expert on HA/DR.

Good dialogue URR. We both better get back to our day jobs now
UltimaRatioReg

Yes, SOUTHCOM. Though he may have gotten PCS orders…

Here is what is coming clear: The size and scale of this dwarfs Katrina. The Western Hemisphere hasn’t seen anything like this since the quake in Managua in ’72. Lessons learned from Phuket are likely more applicable than those of Katrina.

Anyway, SWMBO tells me all the time that THIS is my day job.
http://www.jimdolbow.blogspot.com Jim Dolbow

SWMBO rocks as a boss indeed.
http://www.andrewlubin.com Andrew Lubin

seems to me that LtGen Keen should be well aware of the Bataan’s existence and her capacity (as he told me Monday night), along with that of both the Carl Vinson and Comfort, and someone on his staff should have already established a couple of casualty collection points prior to their arrival.

There’s no lack of patients, as this post from NBC’s Dr Nancy Snyderman illustrates:

“For many quake victims, it’s amputate or die

Nearly a week after the Haiti earthquake, an overflow of patients and ongoing shortage of antibiotics often means doctors have few options other than amputation to save a life, says NBC’s Dr. Nancy Snyderman”

http://www.msnbc.msn.com/id/34940404/ns/world_news haiti_earthquake/from/ET
eastriver

URR and Jim: What I meant to drive at, and did so, poorly, is that this is not a tsunami in Indonesia, or a disaster somewhere in the far Southern Hemisphere. This is about as “on-our-doorstep” as it can be. DoD has long recognized that it will be called upon to aid other nations in distress, and has done so frequently.

We have the resources. We have the means of delivery. Those that have arrived are working above and beyond. What I think is lacking is 1) preplanning, and 2) activation of the above. That does not happen in the White House. I’m sure initial CG recon gave a good picture of what we were about to face.

Think of a fire dispatcher who delays sending ladder trucks to a fire in a tall building, because the stairs are there. This is how I’m seeing the delay in sending resources like JLOTS, perhaps because the airport is there. Meanwhile, over at Eagle 1, he reports that Crowley (a commercial shipping company) plans to bring a barge in by Feb. 2 and “put it on the beach to have it serve as a makeshift dock…” doing their own JLOTS.

And I’d remind URR that Vinson’s medical officer was quoted in the Wall St Journal that he arrived with a plan for treating up to 1,000 casualties. May have been cots on the hanger deck, but probably better than a hacksaw and a bottle of vodka.
UltimaRatioReg

east,

I am not sure that what we are seeing is a lack of planning, for any of this. This, I would argue, is the first time we are seeing what hundreds of thousands of casualties looks like. Even if Vinson’s MO is ready to treat a thousand, that is a comparative drop in the bucket. Yes, far better than vodka and a hacksaw, but still a very small capacity.

But it will depend on where the cameras are when reporting the story, that will determine what the impression would be. If the media was filming and reporting on the medical staff on Vinson working furiously over the thousand patients, it would be a very different impact than if the media reported with a view of the same story showing the hundred thousand injured still waiting….
http://www.andrewlubin.com Andrew Lubin

Sorry, the cameras go to where the story is. The fact there are not a thousand patients on the Vinson – the Bataan – Comfort – Fort McHenry – USS Carter Hall…but instead who have treated less than 25 people IN TOTAL is why this is a story – and an incredibly tragic one at that.
galrahn

I see things different than some of you.

There is no way one can compare Haiti and Katrina in the political space or on the ground. In Haiti there is clearly a plan by the US, both political and in HA/DR, but like all plans it ran into trouble at first contact. US citizen evacuations are going very fast, clearly part of the plan. Where units are deploying appears clearly part of a plan.

In Katrina, there was no plan. There was no plan even when the DoD was called in to empty out New Orleans. Plan and no plan makes a world of difference, and the existence of a plan and response to a plan is the measurement of political leadership early in crisis. Obama passed.

There are plenty of problems to talk about, mostly with Command, Control, Communication, and Cooperation. General Keen needs to quit talking to the press and defer to someone who speaks for the administration, because Gen Keen does not have enough Command, Control, Communication, and Cooperation on the ground with his units and all the other partners down there to speak with authority yet what is going on – because he is saying things that are clearly inaccurate suggesting he is not very well informed what others are doing.

The challenges in communication following natural disaster are always enormous, and we are still in a chaotic phase.

We don’t know a lot, because folks on the ground don’t appear to know a lot. One thing is clear, we cannot supply enough of everything needed right now and medical supply is what is being cut short.

Why? Maybe the question will get asked one day.

Should the amphib capacity be used to take up the slack? These are valid questions, as reports on the ground by NGOs suggest many thousands of people died Monday and Tuesday due to lack of medicine. These are hard choices, and it is absolutely right to ask questions about the complexity that leads to the decisions, including who is making the decisions.
B.Smitty

I heard on NPR yesterday someone from the DoD saying that USAID was running the US response in Haiti. He believed that they were way out of their capacity, logistically, and (not surprisingly) the DoD should take over.

Has anyone else heard this?
UltimaRatioReg

“Sorry, the cameras go to where the story is. ”

I don’t think that is universally true, Andrew. Not in Iraq, not in Katrina, not here. The reporting will have a definite flavor, and the angle of the story will not always reflect perspective and reality. So, how much have we seen of what is below? THAT might be a story, too, no?

From ARC:

“A Red Cross field hospital has been set up at Hopital Universitaire d’Haiti in downtown Port-au-Prince; the first surgeries are scheduled for January 18. By this evening, three Red Cross Basic Healthcare Emergency Response Units (ERU) will be on the ground to provide care and triage in Port-au-Prince and potentially Jacmel. An additional Red Cross Referral Hospital ERU is preparing for deployment.

With the arrival of additional staff on January 17, three Water and Sanitation ERUs are now on the ground setting up equipment and initial water distributions have begun. Once at full capacity, these ERUs will provide clean water for up to 50,000 people each day.

The American Red Cross Relief ERU in Port-au-Prince is now receiving and distributing incoming relief supplies, in coordination with the Haitian National Red Cross Society (HNRCS), the International Committee of the Red Cross (ICRC) and other Red Cross partners. Relief distributions are being planned for at least 150,000 people.”
http://www.andrewlubin.com Andrew Lubin

Smitty: if DoD is telling folks that USAID is in charge, LtGen Keen is going to be surprised! Unless there was a coup, Keen’s in charge.

I agree with galrahn that Keen needs to take control. Everyone (Marines, 82nd AB, Canadians, NGO’s, etc)seems to be doing their own thing, and his appointment was supposed to solve this sort of confusion.

Ultimate Reg: Absolutely the Red Cross story is important, and it’d be good to see it on TV. You’ve got to remember that much of reporting from a disaster like Haiti is luck – unless you know about this hospital, or have the luck to be in the area, how would someone know about it? When I go to Afghanistan, or on my trips to Anbar, I report on what happens. If it’s a firefight- great; med ops – great; it’s not like I can order-up an ambush so I can get a story.

My point was that there are virtually NO Haitian patients being treated on any of the US ships – yet we hear about the crisises in the collapsed hospitals. Seems to me Keen needs to get his hands around this issue instead of chatting with the press.
USNVO

LtGen Keen is Commander of Joint Task Force Haiti. As I understand his position, he is in charge of the US Military forces in Haiti. A long way away from being in charge of anyone outside the US military and he certainly doesn’t have the authority or the ability to “take control” over any group.
eastriver

Concerning early treatment of casualties: it may be too late to be seen on this thread, but anyone looking back might find this link informative in retrospect. The blog is from Team Rubicon, a private voluntary group of mostly former military that self-organized as a rapid response post-disaster team:
http://blog.teamrubiconhaiti.org/2010/01/clarification-of-criticisms.html

Idle Operating Rooms Aboard USS Bataan (LHD-5) on First Day off Haiti

By Jim Dolbow

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