BETHESDA, MD 01 February 2010—Emergency department pharmacist Shannon Manzi said she often finds a creative way to make a drug delivery device designed for adults suitable for the patients she sees at Children`s Hospital Boston. That type of out-of-the-box thinking by Manzi helped hundreds of Haitians who sought medical attention in the first two weeks after the 7.0-magnitude earthquake struck on January 12.
Manzi, a member of the Massachusetts-1 Disaster Medical Assistance Team (DMAT), worked in Port-au-Prince alongside Boston-based International Medical Surgical Response Team (IMSuRT)-East.
The IMSuRT program is a cooperative effort of the Department of State and the National Disaster Medical System.
While the mission of the National Disaster Medical System is to temporarily supplement federal, tribal, state, and local response efforts, Manzi said it has recently started sending DMATs in response to disasters outside the United States.
"Wednesday morning [January 13] we got the notification that we were `on alert,` which means don`t drop everything yet but be packed," Manzi said recently from her home in Rhode Island. "And then we got the notice . . . a few hours after that that we were activated, and that means you`ve got anywhere between two and four hours to get to the airport."
She flew to Port-au-Prince by way of Newark, New Jersey; Atlanta; and Turks and Caicos Islands.
That third stop was an emergent landing after a "near incident" in the crowded airspace above Port-au-Prince, Manzi said.
More than 200 U.S. medical personnel—members of the IMSuRT and five DMATs—and 22,000 pounds of medical equipment and supplies arrived in Haiti on January 15, according to the U.S. Department of Health and Human Services (HHS).
The teams, HHS said, started providing patient care on January 17.
Manzi said a DMAT or IMSuRT, when deployed, is supposed to be self-sufficient with regard to food, water, medications, tents, and generators for 72 hours. During that time, a team should be able to treat 100–200 patients a day, depending on the seriousness of their medical conditions.
But the earthquake had devastated Haiti`s infrastructure, and the teams` members knew that resupplies—which would have to arrive by aircraft—could not reach the work site by hour 72, she said.
"Our main problem was that we had very few small-size syringes and needles," Manzi said.
The medical conditions in greatest need of treatment by the team were traumatic injuries, infections, and gastrointestinal problems, not chronic diseases, she said.
Only one patient received insulin.
"I had hundreds of insulin syringes I didn`t need," Manzi said.
What Manzi needed were syringes to administer morphine. The relatively few small syringes and needles that she had available were needed to administer antibiotics.
With the chief medical officer`s approval, Manzi told the medical personnel to administer all morphine injections subcutaneously.
"It actually worked out very well for the patients because it lasted longer for them," she said.
Some of the nurses, on learning of the shortage of small syringes, figured out how to use insulin syringes to deliver medications into the i.v. administration sets, Manzi said.
Ongoing drug shortages in the United States resulted in no paralytic agent for patients who had been intubated and no erythromycin ophthalmic ointment for the many newborn babies, she said.
"Luckily, between my [DMAT] cache and the IMSuRT cache, we were able to make do with what we had."
One unavailable drug for which there was no alternative agent was tetanus immune globulin, Manzi said.
Two patients had tetanus. Manzi said the team borrowed a supply of French-labeled, equine-derived tetanus immune globulin from a local clinic. She translated the product`s labeling, which recommended a dosage different from that for the U.S.-licensed immune globulin derived from human plasma.
Another unavailable drug without an alternative was vitamin K injection.
Other Pharmacists` Experiences
William C. Drake of Advanced Care Pharmacy Services in Michigan recently served as the chief pharmacist for Incident Response Coordination Team Haiti, based at the U.S. embassy in Port-au-Prince. Read his online diary.
Lieutenant Commander Fortin S. Georges of the U.S. Public Health Service, normally on assignment at the National Institutes of Health Clinical Center pharmacy in Maryland, is working at the medications and supplies warehouse. View him on YouTube.
Of the many babies being born at the work site, one had hemorrhagic disease of the newborn, Manzi said. Fortunately, the local clinic had vitamin K injection, albeit with labeling in Italian.
Personnel from that clinic, she said, offered to supply the teams with whatever medications were needed. The clinic`s building had been partially destroyed by the earthquake.
Manzi said she met twice daily with the medical staff or the chief medical officer to discuss inventory shortages and decide how to deal with the situation.
"A lot of my job is, one, [devising] creative dosage forms, and the other is talking about what we have and don`t have and what`s most appropriate for this type of infection or this type of pain management," Manzi said.
The work site had about seven clinical areas, including a wound-care station, a procedural tent, treatment tents, an operating room, an intensive care area, and triage.
Manzi said she participated in all "codes." She carried a radio and would break away from drug preparation to respond to a medical emergency.
With the high number of pediatric patients needing treatment, primarily because about half of Haiti`s residents are children, Manzi said she found herself working with the patient population with whom she feels most comfortable.
In all, there were about 98 medical personnel at the work site, she said. The 35-member Massachusetts-1 DMAT and 50-member IMSuRT-East were joined by other personnel, including surgeon Henri Ford, who spoke Haitian Creole.
Manzi worked as the day-shift pharmacist. She said IMSuRT-East`s pharmacist and pharmacy technician—Ray Mitrano and Claudio Pontoriero—"graciously volunteered" to work the night shift.
They departed Haiti on January 26 when replacements arrived.
Manzi said the National Disaster Medical System, because of the physical ailments that medical personnel incurred during the initial two-week deployment, did not give anyone the option of an extension.
HHS said it had about 270 medical personnel in Haiti as of January 30.
