The Israeli Field Hospital in Haiti – Ethical Dilemmas in Early Disaster Response
by Ofer Merin, M.D., Nachman Ash, M.D., Gad Levy, M.D., Mitchell J. Schwaber, M.D., and Yitshak Kreiss, M.D., M.H.A., M.P.A.
Within 48 hours after the massive earthquake that struck Port-au-Prince, Haiti, on January 12, the government of Israel dispatched a military task force consisting of 230 people: 109 support and rescue personnel from the Israel Defense Forces (IDF) Home Front Command and 121 medical personnel from the IDF Medical Corps Field Hospital. The force’s primary mission was to establish a field hospital in Haiti.
We landed in Port-au-Prince 15 hours after leaving Tel Aviv and began to deploy immediately. The first patients arrived at our gates and were admitted even before the hospital was fully built, within 8 hours after our equipment arrived. In its 10 days of operation, the field hospital treated more than 1100 patients.
Our mission was to extend lifesaving medical help to as many people as possible. The need to manage limited resources that fell far short of the demands continuously presented us with complex ethical issues. Every mass-casualty event raises ethical issues concerning the priorities of treatment, but the Haiti disaster was exceptional in several ways. Haiti is a poor country with minimal civil facilities, and the earthquake’s destruction of infrastructure left millions of people homeless and hundreds of thousands in need of medical assistance. When we arrived, there was no functioning authority coordinating the distribution of the available medical resources. We were faced with the challenge of establishing an ethical and practical system of medical priorities in a setting of chaos.
… To deal with the ethical aspects of decisions regarding patient placement and treatment options, we created a system of ad hoc ethics committees. The physician who was directly in charge of caring for a certain patient would present the case to a panel of three senior physicians, who would decide how to proceed – a system that relieved individual physicians of the burden of determining a given person’s fate. Decisions that were reached by the committee were recorded and became part of the patient’s file.
… From the outset, our hospital functioned at full capacity. With the exception of patients requiring urgent care, we operated on the basis of a one-to-one exchange between discharges and admissions. Given this policy and the level of activity, in order to function effectively, we also adopted a policy of very early discharge. … This policy, while necessary, clearly did not allow us to provide in-house medical care for the duration for which we are accustomed to providing it in a non-disaster setting.
… Our guidelines for triage, management, and discharge were subject to continuous reevaluation and revision, but throughout our deployment, we were guided by our objective of providing lifesaving medical care to as many people as possible.
The complete article is available in The New England Journal of Medicine.