140 year of Shriners

140 year of Shriners

Friday, June 12, 2009

Ralph W. Semb-Updates on Mexico Fire


Our system must be very proud of the time and effort of our Staff. This has been extremely difficult for them when such a disaster of this magnitude strikes. To lay aside their normally schedule of surgeries, and in some cases, reschedule surgeries in Boston for example, to make available more beds for the extremely ill children has to be recognized by all of us as members of such a great Fraternity. I ask you, should the occasion arise, to thank them and or even send a card showing your appreciation for what they are attempting to do to help these children I am sure would be appreciated.

There was excellent collaboration by the medical teams from the NCH and LA hospitals on the ground for triage purposes in Hermosillo.

Status as of 6/11/09 Reviewed with Disaster Response Coordinator, Dr. Tina Palmieri: (more certain but still evolving)

Hermosillo - the Burn Team reviewed children still hospitalized - 1 serious upper extremity burn triaged to Northern California by commercial travel.

No new referrals for critical inpatient care are necessary. Follow-up appointments scheduled in outreach clinics for a small number of patients.

(While in Hermosillo, the Northern California team was contacted by the Governor of Sonora and asked to evaluate the remaining 10 disaster related inpatients in Guadalajara, and 3 in Obregon. He offered his private plane for the team travel to both cities.)

Guadalajara - 4 critical intubated patients were identified for transport - 2 triaged by Dr. Palmieri to Cincinnati and 2 triaged to Boston. (Transport of 1 intubated, child to Cincinnati is planned for later tonight or tomorrow. Transport of other children is in a holding pattern for now.)

1 major burn, non-critical, has been triaged to Northern California.

Obregon - 1 major burn, non-critical, has been identified and triaged to Northern California.

The proactive effort to ascertain remaining demand for critical and serious burn care has been extremely useful. Dr. Palmieri is satisfied that she is now fully informed of the potential needs.

6/11/09 Total Triage Status Summary:

Northern California: 4 Critical, intubated

2 Major Burn, non-critical

l Serious Upper Extremity

7 Ambulatory, Outreach Clinic Appts.

Cincinnati: 2 Critical, Intubated

Boston: 2 Critical, Intubated

Los Angeles: Outreach Clinic and Telemedicine Appts.

From the LA Shrine Hospital team in Mexico:

The tragedy in Hermosillo that occurred in a Day Care facility last Friday, June 5, 2009 involved well over 100 infants and toddlers. To date 44 children have died and a multitude has serious, life threatening burns and inhalation injuries. As with any disaster, the various branches of government are involved in handling this tragedy, with communication being key to a successful outcome. Noble Alberto Barrera Robinson, President of the local Shrine has been remarkably effective at bringing focus to leadership at both regional and national levels to areas of need. Both Shrine hospitals in California responded immediately to his request for assistance, each bringing their specialized capabilities to Sonora, Mexico to provide needed assistance to the community. While physicians were in frequent meetings with the local & regional leadership to facilitate providing supportive care, Social work instantly able to engage the healthcare workers – nurses, doctors, paramedics, emergency room personnel - providing much needed guidance. The original schedule of hourly sessions was doubled based upon requests for assistance from other facilities, and then doubled again.

The Shrine teams collaborated and strategized to provide optimal coverage of the far reaching needs. The Hermosillo hospital system was rapidly over whelmed with a need for specialized care of this unique pediatric population and families. A team of pediatric intensivists from Mexico City arrived and provided much needed relief. Triage networks were established and gravely ill patients – if transportable – went to larger centers in Obregon and Guadalajara. Simultaneously, the local Shriners were able to communicate with the Shrine Burn Centers and Dr Tina Palmieri was responsible for the triage of the patients with large burn and inhalation injuries. The Shrine team traveled to each local hospital reviewing patients, charts and meeting with physicians, families and administrators. Once all inpatients were evaluated, the team reported findings back to Dr Palmieri and recommended a second phase that required two task forces – one to travel to the other cities to assess the critically ill patients and the second to continue to work with local agencies and the Shrine Center to establish an Outpatient Outreach. With the tremendous assistance of the local Shrine center a Shrine clinic was conducted in collaboration with the Hospital Infantil, to address the needs of burn victims and families that are not inpatients. Again collaboration and communication was key to the success, including assistance of the Governor providing his aircraft to transport the Shrine team as rapidly as possible to each site for evaluation.

Once the two task forces have completed the second phase of evaluation and care, they will provide a debriefing to Dr Palmieri for final phase prior to leaving. Follow-up care is planned via Telemedicine during the next few weeks, followed by Outreach clinics in July be the Los Angeles unit and September by the Northern California unit. It is a rare circumstance where more than one Shrine team is called upon to provide support in a disaster. Impressive is the continued collaboration among the Shrine team members, each bringing a unique area of specialty that is thoroughly appreciated by the community, highlighting the value of the Shriners de Sonora, IAP.

As always, I remain your servant,

Ralph W. Semb, President and Chief Executive Officer, Shriners Hospitals for Children
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