January 20th Update

This is an extract from the diary of Dr. Malcolm Smith (MGH)

Wednesday 1/20 St Marc Haiti
As you will know we woke to another earthquake this morning, it was a bit frightening. We were just waking and all ran outside but only felt a short tremor and no damage. Makes you feel so sorry for the people here there was clearly nothing they could do. Later in day had more patients after people jumped off buildings in fear of being trapped. Now have both rooms running at last as Akshay arrived after being stuck in Port au Prince. Even managed to bring his supplies with him, we have clean scrubs!
Did 6 more cases same problems, debride or amputate. The wounds much worse than first impression when you get them to surgery with lots of dead tissue and now with spreading infection. All have fragments of grit and grey concrete dust everywhere. All now over a week old and if open are now infected. Compartment syndromes were all too late when we arrived but judged to leave them if closed and distal pulse although all had no distal motor function.

Still working in full disaster triage mode as critical casualties overwhelm resources which creates difficult decisions. As yet have no resources to
evacuate and still have open wounds to treat

Triage scheme
A - urgent surgery for life today
B - urgent surgery for limb today
C - urgent surgery for wounds not yet life threatening can wait
D - OR care for closed fx MUA or surgery if pos (ex fix)
E - evacuate
F - observe

Today have waiting in house
8 closed pelvic ring most C types
1 open pelvic ring - big VS
6+ week old compartment syndromes they have got distal pulses but no foot /arm
function also sent several away to return later
21 Complex open fx +(22 done)
5 paraplegic/quadriplegic
21 adult closed femur
4 paed femur
2 complete open femoral epiphyseal fractures and 2 children and i 2 and 8 year
old
2 complex open knees/ tibia in 2yr old
I bad open tibia 2 year old
Lots of wounds in house and in ED
And 3 more C section babies today

Our nurses have sorted the rooms and are now working with the Haitian nurses
(who are doing great) established new patient charts and dressing stations in
each "ward". Have regular vital signs rounds and educating about rhabdo and
wound care. Very grateful for support from home outstanding from too many people
to mention.

Managed to talk to Robert Primus - thank you - who is Congressman Michael E.
Capuano‬‪'s chief of staff in DC this morning. They are hoping to help with air
support for supplies as have soccer field only 5 mins from hospital, sounds
wonderful!
Malcolm