Originally posted in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Two days after a powerful earthquake shattered Haiti’s capital city, relief workers are finding it tough to provide needed medical care, coordination for the efforts is lacking, and time is running out for those trapped in the rubble.

“The window they talk about is 48 to 72 hours,” said Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health.

“Every passing hour is going to see people dying who if they had been pulled from the rubble yesterday would have made it,” Redlener told MedPage Today.

The stark reality is that — despite a global response to the plight of battered Port-au-Prince — aid is only slowly getting to reach those most in need and many will die before it comes, he said.

The airport in Port-au-Prince is reported to be operating but it has only a single working airstrip, which limits the speed with which supplies and manpower can arrive, Redlener said.

And the Federal Aviation Administration stopped flights heading for Haiti Thursday after the Haitian government said the airport was jammed and running out of jet fuel.

About 5,500 U.S. soldiers and marines are en route, as well as six military vessels, including the aircraft carrier the USS Carl Vinson. However, the port is badly damaged and ships already in the harbor are unable to unload.

Travel through the city is hampered by the remains of collapsed buildings, making it difficult to get patients to care and care to patients. And many people are afraid to go inside, even if their homes are intact, so they remain in the streets blocking traffic.

“Even as we speak there has been a significant influx” of both medical providers and supplies such as portable hospitals, Redlener said, with countries as disparate as China and Iceland sending help.

However, “the scale of the relief effort (that is arriving) is still very, very small compared to the level of need,” he said.

But even as supplies and manpower grow, new problems are likely to arise.

“There’s a huge global effort, but that response has to be coordinated,” according to Michael Anderson, MD, of Rainbow Babies & Children’s Hospital in Cleveland.

“People just want to land at Port-au-Prince airport and set up and save lives,” he told MedPage Today. “And that’s a wonderful goal.”

Indeed, many people have offered to do just that. More than 4,000 nurses have responded to a call for volunteers by National Nurses United, the organization said.

At the other end of the scale, six physicians from Brooklyn Hospital Center flew this morning to the Dominican Republic, intending to drive through mountain roads to reach Port-au-Prince. (Haiti and the Dominican Republic share the island of Hispaniola, which lies between Cuba and Puerto Rico.)

But those volunteers will need safe places to perform triage and to deliver definitive care, said Anderson, who is also a senior medical officer with the National Disaster Medical System.

And those places don’t exist yet, he said.

Anderson said U.S. military officials in the country might have to secure safe areas so that medical care can be delivered.

It may even be desirable, Anderson said, to perform triage in Haiti and medevac patients out of the country — to the Dominican Republic, Puerto Rico, or even Florida — for definitive care.

Those decisions will have to be made in the next few hours, he said.

But who should be running the show? Redlener said there are two options and neither involves the traumatized Haitian government.

One option is the United Nations, he said, and the other is the U.S., which will be the “largest donor and biggest presence” in the relief effort.

“But all these agencies that are coming in from other countries are basically independent and there’s no real jurisdictional authority over them,” he said. “The coordination and deployment of these so-called assets is going to be very, very complicated.”

Redlener said the key lesson is that the scale of the disaster could have been much less severe.

“We should have been, we could have been bolstering the resilience of the infrastructure of a place like Haiti for decades,” he said. “Obviously, it’s too late now.”

It will take at least a decade to rebuild the city, he said. “The question is . . . will it be rebuilt better?”

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