After 24 years in family practice, Dan Diamond, MD, decided it was time to travel the world — only not as a retiree. Rather, Diamond joined Medical Teams International, a role that has taken Diamond to both Haiti and New Orleans in the days immediately after the earthquake and Hurricane Katrina.
Government Health IT Editor Tom Sullivan spoke with Diamond about how the kit of IT tools he carries in disaster response situation has improved in recent years, between Haiti and Katrina even, his dream app for the future, and what he’s doing to prepare for the inevitable next natural disaster.
Q: We have these overly-broad phrases in healthcare, health IT is one, mHealth or mobile health being another. So, particular to natural disasters, what are the mobile technologies we’re talking about? Which have become indispensible to you?
A: In Haiti we ended up using Google Maps because having GPS down there was incredibly helpful. There were no landmarks anymore. Even our driver, who was from Haiti, didn’t know where he was most of the time. Google Maps and GPS were the two most important. And being able to blog from Haiti was really helpful. That and the occasional email, but we were blogging every day.
Q: You mentioned GPS and Google Maps. How effective were the maps under such dramatic destruction to the infrastructure?
A: It was really helpful because at least we knew where we were because we could use the GPS. For example, when we were trying to find the World Health Organization depot so we could go get supplies, we were able to figure out where they were, look and see where we were, see where the roads used to be — the roads were still there but all the buildings were toast, and the street signs were gone. Everything was demolished, it was kind of like driving around in a pile of rubble.
Q: How soon after the earthquake hit did you arrive?
A: We were in-country on day three, I think, or four. We had gotten diverted because we couldn't fly into the capitol so we landed up north then drove down. During disasters everybody sends planes to carry supplies, not realizing there isn’t any fuel for them to leave, so they sit on the runways and clog them up.
Q: In terms of mobile apps, you mentioned GPS and Google Maps. Which others were critical in Haiti?
A: E-mail and blogging. From an NGO perspective, when you’re in a disaster if you can keep people back home abreast of what’s happening it’s much easier to raise the funding that we need. The Epocrates application has a lot of things that I use in a disaster. So those are the big four: blogging, email, Epocrates, and mapping. It’s one of those things that if I forget my iPhone at home, I’ll go back and get it because I depend on it now for information that I need to do my job — kind of like if I forget my stethoscope, of course I’ll go back.
Especially in a disaster because I’m in a different part of the world and trying to find out what medications are is difficult. It was easier in Katrina. I ran medical triage in the convention center and we had a lot of people that would show up with their pills in baggies saying ‘my pills got wet so I dried them out on my bed and then put them in a baggie.’ When we asked what they’re taking a lot of them didn’t know what the pills were. So we could look up, by size, shape and markings, to find out what the pill is. Really, really helpful. And then being able to look at dosing for those medications that I am not as familiar with because in disaster or urgent care settings I come across medications that are not on my typical use list.
Q: What were the differences between Haiti and Katrina, from your perspective?
A: Oh, huge differences. For one, during Katrina I was working with a Palm Treo. So we had no GPS. I had my external keyboard that plugged in so it looked like I was on the cutting edge of technology and I was. But it was not a great screen, not great access to information and it was primarily email.
We saved lives because of it. The CDC did a phenomenal job during Katrina of monitoring care. There was a disease, a skin infection and if we treated it early on when it was just a rash we could get rid of it. But if we let it go it would have a higher mortality rate. Because we were able to get updates from the CDC we alerted our whole team and everybody was watching for this and we started treating the rash as soon as we saw it. It was simple email and I know it saved lives.
In Haiti we were blogging everyday and having an iPhone was a game-changer because I had GPS, I had access to the Web and its wealth of information. I would say the difference was like the wizard of Oz when you go from black-and-white to color. Katrina was black-and-white, better than a still picture but not as good as the technology we had in Haiti, which was a real night-and-day difference.
Q: Now, were you involved with recovery efforts after Superstorm Sandy?
A: They didn’t deploy those of us at Medical Teams International. We don’t go into an area unless we’re invited and that was a disaster where they were still able to handle it with traditional resources of FEMA. Katrina was a whole different deal. The systems were completely overwhelmed, they needed that triage unit so we were just in the right place at the right time. Katrina was by far the wildest thing I’ve ever seen in my life.
Q: And by wildest thing you’ve ever seen what exactly do you mean?
A: There were just so many bizarre things happening during Katrina that it was strange to see our country on its knees. The disaster was so big that there was no way any one person could get their head around the magnitude of it all. We saw so many strange things even just in the parking lot across the street from the convention center where we set up our triage unit. There were as many as 6 helicopters at a time right in front us, blowing our stuff all over the place. It was kind of like some post-apocalyptic dream being mashed with an episode of MASH. Helicopters everywhere. Generals coming through, meeting all kinds of people. We were the only evacuation pad for the whole city. This was after they shut down the Superdome. They evacuated that right away, the convention center became the place and it was just crazy.
Haiti, on the other hand, was just emotionally devastating. My whole team came back from Haiti sad and we were sad for months afterward. The amount of human devastation was so overwhelming. And the lack of resources to be able to fix things, it was just sad.
Q: Was that lack of resources what made it even sadder than Katrina?
A: Yes. And the injuries were different. Katrina was a lot of displaced people — now there were really sick people like patients who came in and had not been on dialysis for a week or more. And the highest blood pressure I’ve ever seen in my whole career: 260 over 190. But in Haiti there were a lot of people really, really hurt. A lot of children hurt, many amputations and facial crush injuries. It was just bad.
Q: Sorry to interrupt but did you just say 260 over 190?
A: Yeah, that’s what I said. It was like ‘run, she’s gonna blow.’ One of the local doctors said ‘No, get her back on medication and she’ll be fine.’
Q: Wow. Is there a theoretical limit to blood pressure?
A: Oh yeah, I’m sure there is. But what the local ER doc told me is that the Cajun population tends to run really high when they have high blood pressure. It was shocking to me and kind of redefines blood pressure.
Q: So for your mobile toolbox, in addition to what you already use is there anything you would love to have but do not?
A: Yes. I would love to have a bar code scanner for my iPhone. With that, I could keep inventory of all my equipment, bar code everything so I have expiration dates, and restock more easily. That would be great. Another thing we talked about at SXSW is right now we have the ability to watch the Twitter cloud by region, so we can go out however many miles we want but what we can’t do is vet the tweeters. It would really be nice for me to be able to look at an earthquake epicenter, poll a region 60 miles out from the earthquake, then filter so I only have to look at tweets from first responders and medical people. That would be really, really helpful but I’m not aware that anyone has figured that out.
Q: That’s one of the things I wanted to ask about: If you used Twitter during Katrina or Haiti and what role it might play for you in the future?
A: It didn't for our organization because we were working at one hospital and we went in and we were able to get it back up and functioning. That was our big project during those first two weeks that I was down there. I would think from the mothership it would be very helpful but that’s not my role. I’m not looking at the whole picture. My role is boots on the ground, first EMT.
The reason I bring that up is because we responded to Hurricane Mitch, back in 1998. We got to Honduras and spent 2 days sleeping on the carpet because they didn’t know where to put us. We left out jobs, uprooted instantly, deployed down there and wasted 2 days. Then they finally sent us to a town buried in mud — I mean like Pompeii buried in mud, little spires sticking out. So it took us a day and half to get there and we had to be four-wheeling because the roads were all washed out. So we were driving along this hillside, the trees were all uprooted. At one point I got out of the truck because I thought it would roll over and I didn’t want to be impaled on a tree trunk. Then when we got there we found the Mexican government had already sent a team, so we were done. That’s five days of a wasted medical team. It would have been really helpful to know that there was a team already up there.
Q: Looking ahead, how are you planning for the next natural disaster?
A: After Haiti, one of the things I bought is a little solar panel for charging my batteries. So I can hide it someplace on top of a building so I can recharge my iPhone while I’m sleeping during the night. Solar power is a big deal. Next time I’ll take an iPad with me as well as my iPhone. I’d like to be using some online or mobile electronic medical records. We’re doing that now with Practice Fusion when working with the homeless but we haven’t used it in disasters.
See also:
Commentary: EHR usability must amplify human potential
Q&A: On health data 'we can't dream big enough'
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