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Earthquakes To The ER

Torrance Memorial ER doctors In the chaotic days following the 2010 Haitian earthquake, there was a desperate search to find one thing among the devastating ruins-live victims. With limited resources and thousands trapped in the rubble, help was urgently needed. One of the groups called to task was the Los Angeles County Urban Search and Rescue (USAR) team, a special operations unit of the LA County Fire Department. After notification from the U.S. State Department, the team mobilized in Los Angeles and flew to Haiti, arriving the second day after the 7.0 magnitude earthquake struck.

Once there, the crew-composed of firefight­ers, emergency room doctors, paramedics, team leaders, search specialists, rescue spe­cialists, dog handlers and communications people-hit the ground running. After be­ing shuttled to Port-au-Prince, they assembled at the U.S. Embassy, set up a campsite on the embassy grounds and went out to search for victims.

According to Michael Baker, MD, a Torrance Memo­rial Medical Center emergency room doctor who has worked with the USAR for 10 years, the scene on the ground in Haiti that first night was intense. People filled the streets, traffic was dense and followed no discernable pattern, and people were stacking up dead bodies on the sides of the roads, with nowhere else to take them. Driv­ing through the chaos in windowless vans, the USAR crew set out for their first two rescues, which would take them up to eight hours each to complete.

Their rescue efforts went on for days, each passing hour reducing the possibility of finding live victims as dehy­dration, critical injuries and starvation set in. But the crew, known as California Task Force 2, kept on search­ing, while the Haitians kept hope alive for finding their loved ones. And sometimes it paid off.

It's day six, and just mere blocks from the USAR search station, demolition tractors clear the rubble of what was once a bank. A man looks on after each debris pile is moved, desperate to find signs of his wife, a bank worker, who has been missing since the quake. A tractor lifts a pile of rubble and uncovers a small hole. The husband rushes over and is on his knees, calling his wife's name, "Ja­nette!" A woman's voice calls back; she's in the hole and alive.

She is about three feet down, with only the top of her head visible. No one has the right equipment to get her out, so people are relieved to see LA County USAR arrive on the scene. Medics give her water and a sugar solution through a tube and assess her situation with a scoping video camera. Her hand is pinned beneath a beam, and it will have to be unwedged in order to get her out. She is in pain, but calls out to her husband, "If I die, I love you so much. Don't forget it."

The USAR crew is able to free the woman's hand. They are confident they will be able to get her out alive. But with aftershocks a possibility, time is still ticking. During the rescue, a large crowd of onlookers has gathered, anxiously anticipating life brought forth from the devastation.

It takes about three hours to free her from the rubble. "Once we got her out, she started singing, and then the entire crowd started singing with her," recounts Baker, who was the medical team manager at the time. According to a widely-viewed YouTube video of the rescue, the words to her song were, "Don't be afraid of death."

The Sheer Will To Live

Described by the U.S. State Department as "one of the most skilled USAR teams in the world," the LA County team is one of only two national USAR teams designated to deploy internationally (the other is in Fairfax County, VA). Called to action for major national and international disasters, they have participated in rescue efforts for Hurricane Katrina, the Oklahoma City bombings, the tsunami in Japan and earthquakes in Haiti and New Zealand.

The LA County USAR has direct ties to Torrance Memorial; of the five Los Angeles emergency room doctors who work for the USAR, three also work at the medical center.

One of those doctors, Brian Miura, MD, splits his time be­tween the emergency room at Tor­rance Memorial, the Manhattan Beach Urgent Care Center, where he is the medical director, and in­ternational trips with the USAR. While on rescue missions, the physicians serve as a medical team managers, helping to lead a group of about 75 members.

"My primary responsibility is to oversee the team to make sure they're okay, their health is main­tained and to treat any injury or ill­ness," says Miura, who has worked with USAR for 10 years. This may mean everything from making sure team members are properly vacci­nated before deployment and en­suring clean drinking water while there. His secondary responsibility is to treat injured victims and sta­bilize them so they can be taken to a local hospital or treatment center.

Often working around the clock, this interdisciplinary team has a pri­mary focus on finding and extricat­ing victims. Specially trained dogs sniff out live victims, high-tech in­struments scope among the rubble, and engineers assess the structural integrity of buildings before victims are removed.

While the emergency room may have prepared the docs for treating common medical emer­gencies, Miura notes that working in a post-disaster country requires quick thinking and ingenuity. "It allows me to utilize skills in dif­ferent settings outside of the hospital. I have to think on the go, and in a limited resource setting, you have to be creative." In Haiti, they lacked stretchers, so they improvised by using salvaged doors to transport patients.

Disaster rescues also mean doctors might face situations they would not otherwise confront. In another Haitian rescue, a woman was trapped on the second floor of a collapsed five-story building. She was lying face down, pinned on her bed, with only about six inches of space to move. She had been like that for five days. The USAR team was able to reach her and bring her out alive.

"These kinds of missions impress on you the kind of fortitude people have-the sheer will to live," says Miura. During their two-week stay, the unit saved nine people from the rubble. "It's a very fulfilling experience when you are in the field and able to save lives."

A Different Kind of Doctor

Not all missions result in successful rescues, however, and the work can be both physically and mentally demanding. In Japan, the crew deployed in post-tsunami port towns, often searching in snowy conditions with the threat of a nuclear meltdown looming. There were no live victims and only body recoveries.

"When we select physicians for this work, they have to be clinically good but also work in a very unique environment; they have to be able to work collaboratively and be supportive of a team. It takes a unique attitude in an ER physician to do that well," says Frank Pratt, MD, medical director of the Torrance Memorial Lundquist Emer­gency Department and medical director for the Los Angeles County Fire Department. In his role with the fire department, Pratt helped found the LA County Urban Search and Rescue team 20 years ago and has been working with them ever since.

To become part of USAR, the doctors undergo special­ized training in addition to their emergency medical back­ground. Pratt notes that USAR medicine is unique because medical care is initiated where a person is trapped. Doctors may have to crawl into a collapsed building to do an assess­ment of a patient. Because of this, physicians have to take a number of courses to prepare them for search and rescue. "We have to have a working knowledge of what's going on so we're effective members of the team," says Pratt. Courses include special treatment for injuries sustained in collapsed buildings, starvation and dehydration cases, as well as GPS, confined space, ropes and command courses.

The training is done through the LA County Fire De­partment; once completed, team members are deployable.

Basic Training

The Torrance Memorial Lundquist Emergency Depart­ment is an ideal training ground for the doctors taking part in USAR missions. As a busy, level-2 suburban emergency room, they see about 175 to 185 patients a day, according to Mike Tarnay, MD, who has worked at Torrance Me­morial since 1999 as an emergency room doctor. Patient problems range from pediatric fevers to heart attacks and aneurysms. In addition, they have a large geriatric popula­tion, so they often treat extremely sick people.

The Torrance Memorial ER is well-equipped to han­dle the influx of urgent cases. A cadre of board-certified physicians form a tight-knit team who work well to­gether, says Tarnay. This teamwork mentality also helps in USAR trips. "In the ER, there is no doctor hierarchy; you learn a team approach in the ER, and this is vitally important in USAR. Everyone looks out for each other and watches each other's back," says Baker.

The support they receive at Torrance Memorial is critical to their success as a team and makes it feasible for doctors with full-time jobs to continue to do part-time international work. "The wonderful thing about Torrance Memorial is that if any us have to take off, we know that our clinical operations at Torrance will be covered. The fact that we can give two to three hours notice to leave is spectacular. It is a tremendous relief," says Pratt.

Though working in the field may lack the high-tech capabili­ties of a modern emergency room, helping out those in dire situa­tions travels well. Many of Torrance Memorial's emergency room doctors participate in international aid missions-from USAR to assisting at clinics in rural areas-and take the medical skills they hone every day in the ER to the world abroad.

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