State House News Service


By Katie Lannan

BOSTON, JAN. 10, 2018...Deployed to Puerto Rico in November after Hurricane Maria, Massachusetts General Hospital staff saw local emergency rooms "overwhelmed" with patients they knew their team could care for, but lacked the logistical capacity to do so, the team's leader said Wednesday.

"We didn't have the pharmacy resources, we didn't have the consumable or durable medical goods," said Lindsay Martin, a nurse practitioner who helmed the 26-person team. "I don't know where that disconnect occurs in the broader system, but I would certainly say that we did see that there was a need, and I certainly would say that the team was frustrated by the fact that we knew we could meet the need but we weren't able to."

Mass. General officials briefed the state Public Health Council Wednesday on their experience staffing a federal medical shelter in storm-ravaged Puerto Rico, detailing the hurdles they encountered and lessons learned.

Suggesting a potential pivot toward state and regional disaster response efforts and away from large federal teams under the Trump administration, MGH Center for Disaster Medicine director Dr. Paul Biddinger said interstate requests for aid are likely to become more frequent.

Mass. General responded to Puerto Rico's ask for a medical team through a national mutual aid system known as the Emergency Management Assistance Compact, or EMAC. The request warned of "austere conditions" and was "quite nonspecific," with many possibilities for what a team would ultimately end up working on, Biddinger said.

He compared the process to an auction, in which Puerto Rico officials could select from multiple bids to determine what best met their needs.

"We won our auction by being the only bid in our auction, so we're very proud we were the only people at the dance," he said.

State officials also responded to various requests from Puerto Rico through the EMAC system, first mobilizing a six-person National Guard communications unit. In October, Puerto Rico accepted an offer from the Massachusetts Emergency Management Agency to send 69 law enforcement officers and 13 state police cruisers. The State Police sent 14 troopers on Dec. 17 for a two-week rotation, and another 25 deployed later that month for a rotation scheduled to end Jan. 15.

Mass. General sent a team of 15 nurses, five doctors, four nurse practitioners, one physician assistant and one staff member tasked with handling logistics and security. They arrived in San Juan Nov. 25 and traveled to Ponce, where they would staff a medical shelter with 33 patients, located in a large sports stadium.

"It's our belief and our recommendation that as these kinds of requests increase...that the base institutions that send these kinds of teams need a deep bench that can speak the complex acronyms, understand the sort of byzantine administrative structure within the federal medical system, because when problems arise, as they will in a disaster, you have to be able to solve them quickly," Biddinger said.

On more than one occasion, the MGH team was concerned they might need to evacuate their shelter "because the resources might go away, and we would be unable to provide safe care," Biddinger said.

Originally told they would be augmenting the efforts of a federal disaster team, the group from Mass. General found out three days into their two-week stint that the federal team was actually leaving.

With a day's notice, the group was also informed the pharmaceutical supplies would need to leave with the federal team, and questions developed about whether other items could remain.

"No one really thought people would take the cots out from under the patients, but no one was sure how they could stay, since they were supposed to leave as well," Biddinger said. After what he characterized as "no fewer than 60, 70 phone calls in a 24-hour period," they found a local official who could sign off on the drugs and other supplies staying in place.

Another hiccup came when the facility's security contract expired midway through the mission.

"When the night shift was going home and our day shift was coming in, our seven armed security officers left, and one local police officer with a sidearm showed up instead," Biddinger said. "And as a facility with a large number of pharmaceuticals including narcotics, as well as one of the only places that had generators, fuel, food and water in the area, they felt extremely vulnerable."

With cooperation from the state Department of Public Health and the Massachusetts Emergency Management Agency, he said MGH officials were able to work out a solution with the federal government, and a new team was dispatched.

One member of the new detail was Chris Decker, a New Hampshire state trooper who coincidentally had received emergency treatment at Mass. General earlier in the year.

"He came up and said, 'I am so happy to protect you because of what you did for me,'" Biddinger said.


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