Downloaded from http://emj.bmj.com/ on April 19, 2015 - Published by group.bmj.com
The view from here
Typhoon Haiyan disaster in the Philippines: paediatric field hospital perspectives Dov Albukrek,1,2 Joseph Mendlovic,1,2 Tal Marom1,3 In November 2013, super-typhoon Haiyan made several landfalls in the Philippines archipelago. It was one of the strongest cyclones ever recorded, with gusting winds and giant waves that left enormous damage in its wake: more than 6000 people were killed, almost 28 000 were injured and over four million lost their homes. Most basic infrastructure ceased to function, including electricity and water supplies, transportation and communication. Ten million Filipinos were affected overall.
We were welcomed by the local health team comprised of one part-time paediatrician and several general practitioners. Defining clear areas of responsibility was crucial to building mutual trust3: in the initial arrival meeting, we decided that the local team would take responsibility for in-house paediatric patients, while our team would be in charge of the PEU, in addition to the ambulatory clinics and the NICU, which now were fully equipped with designated medical supplies and staffed by our personnel. Patients were admitted to the hospital according to the local standards, and all medical records were executed on the local hospital’s official documents by the local staff, including signing for informed consent for surgery. Additionally, we had our own electronic charts where patients’ notes
Albukrek D, et al. Emerg Med J December 2014 Vol 31 No 12
951
Following a formal aid request from the Filipino government, the Israeli Defense Forces (IDF) mobilised a medical response team to the island of Cebu, some 10 000 kms away. Because of the immense destruction, there were many casualties and only a few injured patients alive at the scene, making trauma care less a priority than ambulatory medical services for acute and chronic diseases. Of the 148 IDF mission participants, 56 were medical personnel. Others included logistics, support and rescue personnel from the IDF Home Front Command. Among 24 physicians, there were four paediatricians (including an emergency medicine specialist) and three paediatric nurses. Portable facilities included an imaging unit ( portable digital X-ray and ultrasound machines), clinical laboratory (chemistry and haematology analyses, bacterial cultures and virology studies) and a fully supplied pharmacy.
INTEGRATED FIELD HOSPITAL In coordination with the Filipino authorities, we reached our destination of Bogo city, in the northern part of the island of Cebu. We were the first medical task force and the only paediatric multidisciplinary Israeli Defense Forces Medical Corps, Tel Hashomer, Israel; 2Israel Ministry of Health, Jerusalem, Israel; Department of Otolaryngology—Head & Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, Holon, Israel Correspondence to Dr Tal Marom, Department of Otolaryngology—Head & Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, Holon 58100, Israel; [email protected]
3
MAINTAINING STANDARD OF CARE Working in the setting of personnel and equipment shortages, with only limited access to a higher-level facility (some four long hours drive on an uneven road), created ethical and professional dilemmas. For example, although we had the equipment to set up neonatal and paediatric intensive care services, we debated whether to do so or not, given our predicted short-term stay and the lack of local capacity to continue the services. Additionally, we were uncertain about how to approach chronic cases that needed further work-up, ongoing treatment and follow-up (such as thyrotoxicosis or congenital facial malformations).4 Every day we saw nearly 100 new paediatric patients. Recognising these needs, our limited resources and planned short stay, should we prioritise giving ‘little to many’ or ‘much to few ’? We dealt with these dilemmas pragmatically by discussing them in ad hoc ethic committees, run by the hospital’s medical chief officer, with the participation of at least two senior physicians involved in the case. In each committee, we briefly presented the case, the differential diagnosis and the recommended work-up (blood tests, imaging or surgery). We also took into account the local pre-typhoon standard of care and the cultural factors introduced by the local providers. For example, for a young child with moderate head trauma from a motor vehicle accident and deteriorating level of consciousness, we consulted a general surgeon and a paediatrician. In this case, we rushed the child to the hospital in Cebu, escorted by a paediatrician, for brain imaging and continuity of intensive care (figure 1).
OUR MEDICAL TASK FORCE
1
team operating in the area, where most primary clinics were destroyed or closed. Unlike other paediatric field hospitals in disaster areas,1 2 we decided to create an integrated paediatric emergency unit (PEU), together with the staff of Bogo district hospital. This 80-bed urban hospital, staffed by four physicians (including one paediatrician) and 15 nurses, had already admitted more than 100 patients by the time of our arrival, despite having lost electricity, and was overwhelmed by the surge of patients, who crowded in the rooms and corridors. In the tents outside of the hospital, we created paediatric triage, emergency and ambulatory services. The existing paediatric department, delivery and operating rooms, neonatal intensive care unit (NICU), imaging department and laboratory were indoors. Within a day, our logistics team connected the hospital to power generators brought from home and were able to see our first patients. After a few days, we could reconnect the hospital to the local electricity system. The hospital was fully operational on the 7th post-typhoon’s landfall day, but from the beginning, we knew ours would be a short stay of days, not weeks, and the time frame would create some ethical and practical dilemmas, which will be presented in this essay.
were written. At the end of each visit, a signed printed report in English was given. We performed consultations bedside upon request, and sometimes via satellitebased telemedicine with Israel-based experts for complicated patients, such as a 2-year-old with tricuspid atresia. Our services operated 12 h a day, and care was largely given by the local team after hours. Usually, each team worked in its own facilities. However, we were called for consultations/performed ground rounds/treated patients in the NICU and paediatric intensive care units in the local hospital. On some occasions, we called the local staff to our team to discuss clinical issues/treatment options. Table 1 displays the variety of patients seen during our 11 days of operation.
JOINT WORK
Downloaded from http://emj.bmj.com/ on April 19, 2015 - Published by group.bmj.com
The view from here Table 1
Characteristics of 744 paediatric patients visiting an integrated field hospital*
Type Gender Boys Girls Age (years) 0–2 2–6 6–18 Infections Upper respiratory tract infections Skin infections Otitis Gastroenteritis Lower respiratory tract infections Urinary tract infections Meningitis Others Trauma Superficial injuries Dog bites Head injuries Fractures and dislocations Burns Others Congenital anomalies Bronchial asthma exacerbation Miscellaneous diseases Total* Critically ill diseases† Transferred to a referral centre Antibiotic treatment Surgical treatment‡
N
Per cent
373 371
50 50
193 235 316
26 31.5 42.5
287 68 33 32 27 6 3 30
36.7 8.7 4.2 4.1 3.4 0.8 0.4 3.8
45 11 8 7 6 6 15 12 187 783 6 4 94 10
5.7 1.4 1.0 0.9 0.8 0.8 1.9 1.5 23.9 100 0.8 0.5 12.6 1.3
DEPARTURE
*Data are shown for 744 unique patients. There were patients with more than one diagnosis. †Critically ill patients included: one 31-week gestation newborn, one 2-year-old girl and one 3-year-old boy with severe head injury, one 7-year-old girl deceased due to severe haemorrhagic dengue, one 3-week-old boy with severe metabolic acidosis secondary to sepsis and one 19-month-old with multiple brain abscesses. ‡Surgical treatment included exploratory laparotomy, neck explorations, removal of corneal foreign bodies and drainage of abscesses.
Most of our patients presented with minor acute conditions (table 1) and received the definitive care they might have anywhere in the world. But there were also children who presented with chronic diseases, such as untreated congenital conditions (cyanotic heart disease, cleft lip/palate, congenital glaucoma) or goiter with thyrotoxicosis. These conditions might have been highly treatable in other circumstances, but were beyond the capabilities of our facility; for these patients, we tried to tailor further care with the help of the Cebu Governor’s office. The most challenging experiences were with the critically ill patients. In the local hospital, neonates, including those who are premature and those in severe distress are cared for by their mothers in a ‘rooming in’ method. The hospital was not staffed or equipped to care for these 952
two rough days, he was stabilised. A thorough metabolic work-up done later on blood samples in Israel was negative. Since the local hospital had no capabilities to provide neonatal respiratory support and no means to correct electrolytes and acid-base balance abnormalities, our temporary facilities provided a level of care he would not have had access to prior to the typhoon. With suitable equipment and support, designated field hospitals which operate for longer periods than ours, can provide intensive care treatment for critically injured and ill children.5 By contrast, we limited care to the preexisting local standards in other cases. For example, a neonate who was accidently suffocated by his mother when she rolled over on him during sleep appeared clinically to have been severely brain damaged, despite resuscitation efforts, which included handbag-ventilation. An ethics committee including the local hospital manager, paediatrician and the medical chief, decided to adhere to the local practice of handbag ventilation by one of the parents in a separate room, though we found this challenging to accept, given that there was no availability of a higher level of care for this child. He was handbagged, because our only paediatric ventilator was already in use by another patient.
infants otherwise. In our temporary unit, we cared for a 1560 g, 31 week neonate with severe respiratory distress 3 h after delivery. We ventilated him and treated him with artificial surfactant and fluids through an umbilical vein catheter, which was improvised from a sterile nasogastric tube. Twenty-four hours later, we successfully transferred him to the nearest intensive care unit in an improvised incubator. It took more than four long hours to drive to the district hospital. The patient was discharged a few weeks later in good condition. Another example was a 3-week-old neonate with severe metabolic acidosis of uncertain aetiology. Differential diagnosis included sepsis, but also an underlying metabolic syndrome (since the patient was unresponsive to aggressive standard treatment). The challenge involved in treating such a patient in a field hospital was enormous, but after
Shortly after hitting the ground, we strived to provide continuity of care and to minimise the so-called departure vacuum. We aimed to build human capacity with short-term bedside teaching for local doctors and nurses and by reaching out to the residents in nearby villages. We also left our medical equipment, tents, furniture, generators and our pharmacy, knowing that its benefit would be timelimited, but hoping that it might help bridge the constraints of the peri-disaster period. There were many complicated cases our temporary facility could not address, such as a child with multiple brain abscesses. In many of those cases, we were able to transfer the patients safely to a referral centre in Cebu city. We were able to take two patients with type IV cleft palate to undergo repair in Israel. After 11 busy days, we passed the baton to smaller non-governmental medical organisations with 1 day of overlap training. As reported by other authors, we also felt that in resource-limited settings, survivors may require care in field hospitals for injuries or exacerbation of chronic medical conditions. Planning for sustained postearthquake response should address
Albukrek D, et al. Emerg Med J December 2014 Vol 31 No 12
Downloaded from http://emj.bmj.com/ on April 19, 2015 - Published by group.bmj.com
The view from here
Figure 1 Joint work: just before the transfer of an intubated 4-year-old boy with severe head trauma in a local ambulance ( photographed by Joe Shalmoni).
these needs and include paediatric-specific preparation and long-term critical care requirements.6 Most of those devoted volunteers were general practitioners providing basic primary care. We left with mixed emotions, grateful for the opportunity to be a part of that challenging journey. Acknowledgements The authors thank the patients and their families. We express our deep appreciations to all the IDF field hospital personnel in the Philippines, and particularly to our emergency room nurses: Orna Tsruya, RN, MHA, Sergey Nazarov, RN, MHA, and Ronen Bimbat, RN. Contributors All three authors declare that they had substantial contributions to the conception or design of the work; the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement
to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
REFERENCES
Competing interests None.
2
1
Ethics approval Medical Corps, Israel Defense Forces. Provenance and peer review Not commissioned; externally peer reviewed.
3
4
5
To cite Albukrek D, Mendlovic J, Marom T. Emerg Med J 2014;31:951–953. Received 9 March 2014 Revised 25 August 2014 Accepted 1 September 2014 Published Online First 22 September 2014 Emerg Med J 2014;31:951–953. doi:10.1136/emermed-2014-203777
Albukrek D, et al. Emerg Med J December 2014 Vol 31 No 12
6
Burnweit C, Stylianos S. Disaster response in a paediatric field hospital: lessons learned in Haiti. J Pediatr Surg 2011;46:1131–9. Martin JE, Teff RJ, Spinella PC. Care of paediatric neurosurgical patients in Iraq in 2007: clinical and ethical experience of a field hospital. J Neurosurg Pediatr 2010;6:250–6. Merin O, Kreiss Y, Lin G, et al. Collaboration in response to disaster—Typhoon Yolanda and an integrative model. N Engl J Med 2014;370:1183–4. Marom T, Dagan D, Weiser G, et al. Pediatric otolaryngology in a field hospital in the Philippines. Int J Pediatr Otorhinolaryngol 2014;78:807–11. Inwald DP, Arul GS, Montgomery M, et al. Management of children in the deployed intensive care unit at Camp Bastion, Afghanistan. J R Army Med Corps 2014;160:236–40. Dulski TM, Basavaraju SV, Hotz GA, et al. Factors associated with inpatient mortality in a field hospital following the Haiti earthquake, January–May 2010. Am J Disaster Med 2011;6:275–84.
953
Downloaded from http://emj.bmj.com/ on April 19, 2015 - Published by group.bmj.com
Typhoon Haiyan disaster in the Philippines: paediatric field hospital perspectives Dov Albukrek, Joseph Mendlovic and Tal Marom Emerg Med J 2014 31: 951-953 originally published online September 22, 2014
doi: 10.1136/emermed-2014-203777 Updated information and services can be found at: http://emj.bmj.com/content/31/12/951
These include:
References Email alerting service
Topic Collections
This article cites 6 articles, 1 of which you can access for free at: http://emj.bmj.com/content/31/12/951#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Neonatal and paediatric intensive care (5) Neonatal intensive care (2) Clinical diagnostic tests (989) Ethics (368) Legal and forensic medicine (60) Radiology (939) Radiology (diagnostics) (846)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
The view from here
Typhoon Haiyan disaster in the Philippines: paediatric field hospital perspectives Dov Albukrek,1,2 Joseph Mendlovic,1,2 Tal Marom1,3 In November 2013, super-typhoon Haiyan made several landfalls in the Philippines archipelago. It was one of the strongest cyclones ever recorded, with gusting winds and giant waves that left enormous damage in its wake: more than 6000 people were killed, almost 28 000 were injured and over four million lost their homes. Most basic infrastructure ceased to function, including electricity and water supplies, transportation and communication. Ten million Filipinos were affected overall.
We were welcomed by the local health team comprised of one part-time paediatrician and several general practitioners. Defining clear areas of responsibility was crucial to building mutual trust3: in the initial arrival meeting, we decided that the local team would take responsibility for in-house paediatric patients, while our team would be in charge of the PEU, in addition to the ambulatory clinics and the NICU, which now were fully equipped with designated medical supplies and staffed by our personnel. Patients were admitted to the hospital according to the local standards, and all medical records were executed on the local hospital’s official documents by the local staff, including signing for informed consent for surgery. Additionally, we had our own electronic charts where patients’ notes
Albukrek D, et al. Emerg Med J December 2014 Vol 31 No 12
951
Following a formal aid request from the Filipino government, the Israeli Defense Forces (IDF) mobilised a medical response team to the island of Cebu, some 10 000 kms away. Because of the immense destruction, there were many casualties and only a few injured patients alive at the scene, making trauma care less a priority than ambulatory medical services for acute and chronic diseases. Of the 148 IDF mission participants, 56 were medical personnel. Others included logistics, support and rescue personnel from the IDF Home Front Command. Among 24 physicians, there were four paediatricians (including an emergency medicine specialist) and three paediatric nurses. Portable facilities included an imaging unit ( portable digital X-ray and ultrasound machines), clinical laboratory (chemistry and haematology analyses, bacterial cultures and virology studies) and a fully supplied pharmacy.
INTEGRATED FIELD HOSPITAL In coordination with the Filipino authorities, we reached our destination of Bogo city, in the northern part of the island of Cebu. We were the first medical task force and the only paediatric multidisciplinary Israeli Defense Forces Medical Corps, Tel Hashomer, Israel; 2Israel Ministry of Health, Jerusalem, Israel; Department of Otolaryngology—Head & Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, Holon, Israel Correspondence to Dr Tal Marom, Department of Otolaryngology—Head & Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, Holon 58100, Israel; [email protected]
3
MAINTAINING STANDARD OF CARE Working in the setting of personnel and equipment shortages, with only limited access to a higher-level facility (some four long hours drive on an uneven road), created ethical and professional dilemmas. For example, although we had the equipment to set up neonatal and paediatric intensive care services, we debated whether to do so or not, given our predicted short-term stay and the lack of local capacity to continue the services. Additionally, we were uncertain about how to approach chronic cases that needed further work-up, ongoing treatment and follow-up (such as thyrotoxicosis or congenital facial malformations).4 Every day we saw nearly 100 new paediatric patients. Recognising these needs, our limited resources and planned short stay, should we prioritise giving ‘little to many’ or ‘much to few ’? We dealt with these dilemmas pragmatically by discussing them in ad hoc ethic committees, run by the hospital’s medical chief officer, with the participation of at least two senior physicians involved in the case. In each committee, we briefly presented the case, the differential diagnosis and the recommended work-up (blood tests, imaging or surgery). We also took into account the local pre-typhoon standard of care and the cultural factors introduced by the local providers. For example, for a young child with moderate head trauma from a motor vehicle accident and deteriorating level of consciousness, we consulted a general surgeon and a paediatrician. In this case, we rushed the child to the hospital in Cebu, escorted by a paediatrician, for brain imaging and continuity of intensive care (figure 1).
OUR MEDICAL TASK FORCE
1
team operating in the area, where most primary clinics were destroyed or closed. Unlike other paediatric field hospitals in disaster areas,1 2 we decided to create an integrated paediatric emergency unit (PEU), together with the staff of Bogo district hospital. This 80-bed urban hospital, staffed by four physicians (including one paediatrician) and 15 nurses, had already admitted more than 100 patients by the time of our arrival, despite having lost electricity, and was overwhelmed by the surge of patients, who crowded in the rooms and corridors. In the tents outside of the hospital, we created paediatric triage, emergency and ambulatory services. The existing paediatric department, delivery and operating rooms, neonatal intensive care unit (NICU), imaging department and laboratory were indoors. Within a day, our logistics team connected the hospital to power generators brought from home and were able to see our first patients. After a few days, we could reconnect the hospital to the local electricity system. The hospital was fully operational on the 7th post-typhoon’s landfall day, but from the beginning, we knew ours would be a short stay of days, not weeks, and the time frame would create some ethical and practical dilemmas, which will be presented in this essay.
were written. At the end of each visit, a signed printed report in English was given. We performed consultations bedside upon request, and sometimes via satellitebased telemedicine with Israel-based experts for complicated patients, such as a 2-year-old with tricuspid atresia. Our services operated 12 h a day, and care was largely given by the local team after hours. Usually, each team worked in its own facilities. However, we were called for consultations/performed ground rounds/treated patients in the NICU and paediatric intensive care units in the local hospital. On some occasions, we called the local staff to our team to discuss clinical issues/treatment options. Table 1 displays the variety of patients seen during our 11 days of operation.
JOINT WORK
Downloaded from http://emj.bmj.com/ on April 19, 2015 - Published by group.bmj.com
The view from here Table 1
Characteristics of 744 paediatric patients visiting an integrated field hospital*
Type Gender Boys Girls Age (years) 0–2 2–6 6–18 Infections Upper respiratory tract infections Skin infections Otitis Gastroenteritis Lower respiratory tract infections Urinary tract infections Meningitis Others Trauma Superficial injuries Dog bites Head injuries Fractures and dislocations Burns Others Congenital anomalies Bronchial asthma exacerbation Miscellaneous diseases Total* Critically ill diseases† Transferred to a referral centre Antibiotic treatment Surgical treatment‡
N
Per cent
373 371
50 50
193 235 316
26 31.5 42.5
287 68 33 32 27 6 3 30
36.7 8.7 4.2 4.1 3.4 0.8 0.4 3.8
45 11 8 7 6 6 15 12 187 783 6 4 94 10
5.7 1.4 1.0 0.9 0.8 0.8 1.9 1.5 23.9 100 0.8 0.5 12.6 1.3
DEPARTURE
*Data are shown for 744 unique patients. There were patients with more than one diagnosis. †Critically ill patients included: one 31-week gestation newborn, one 2-year-old girl and one 3-year-old boy with severe head injury, one 7-year-old girl deceased due to severe haemorrhagic dengue, one 3-week-old boy with severe metabolic acidosis secondary to sepsis and one 19-month-old with multiple brain abscesses. ‡Surgical treatment included exploratory laparotomy, neck explorations, removal of corneal foreign bodies and drainage of abscesses.
Most of our patients presented with minor acute conditions (table 1) and received the definitive care they might have anywhere in the world. But there were also children who presented with chronic diseases, such as untreated congenital conditions (cyanotic heart disease, cleft lip/palate, congenital glaucoma) or goiter with thyrotoxicosis. These conditions might have been highly treatable in other circumstances, but were beyond the capabilities of our facility; for these patients, we tried to tailor further care with the help of the Cebu Governor’s office. The most challenging experiences were with the critically ill patients. In the local hospital, neonates, including those who are premature and those in severe distress are cared for by their mothers in a ‘rooming in’ method. The hospital was not staffed or equipped to care for these 952
two rough days, he was stabilised. A thorough metabolic work-up done later on blood samples in Israel was negative. Since the local hospital had no capabilities to provide neonatal respiratory support and no means to correct electrolytes and acid-base balance abnormalities, our temporary facilities provided a level of care he would not have had access to prior to the typhoon. With suitable equipment and support, designated field hospitals which operate for longer periods than ours, can provide intensive care treatment for critically injured and ill children.5 By contrast, we limited care to the preexisting local standards in other cases. For example, a neonate who was accidently suffocated by his mother when she rolled over on him during sleep appeared clinically to have been severely brain damaged, despite resuscitation efforts, which included handbag-ventilation. An ethics committee including the local hospital manager, paediatrician and the medical chief, decided to adhere to the local practice of handbag ventilation by one of the parents in a separate room, though we found this challenging to accept, given that there was no availability of a higher level of care for this child. He was handbagged, because our only paediatric ventilator was already in use by another patient.
infants otherwise. In our temporary unit, we cared for a 1560 g, 31 week neonate with severe respiratory distress 3 h after delivery. We ventilated him and treated him with artificial surfactant and fluids through an umbilical vein catheter, which was improvised from a sterile nasogastric tube. Twenty-four hours later, we successfully transferred him to the nearest intensive care unit in an improvised incubator. It took more than four long hours to drive to the district hospital. The patient was discharged a few weeks later in good condition. Another example was a 3-week-old neonate with severe metabolic acidosis of uncertain aetiology. Differential diagnosis included sepsis, but also an underlying metabolic syndrome (since the patient was unresponsive to aggressive standard treatment). The challenge involved in treating such a patient in a field hospital was enormous, but after
Shortly after hitting the ground, we strived to provide continuity of care and to minimise the so-called departure vacuum. We aimed to build human capacity with short-term bedside teaching for local doctors and nurses and by reaching out to the residents in nearby villages. We also left our medical equipment, tents, furniture, generators and our pharmacy, knowing that its benefit would be timelimited, but hoping that it might help bridge the constraints of the peri-disaster period. There were many complicated cases our temporary facility could not address, such as a child with multiple brain abscesses. In many of those cases, we were able to transfer the patients safely to a referral centre in Cebu city. We were able to take two patients with type IV cleft palate to undergo repair in Israel. After 11 busy days, we passed the baton to smaller non-governmental medical organisations with 1 day of overlap training. As reported by other authors, we also felt that in resource-limited settings, survivors may require care in field hospitals for injuries or exacerbation of chronic medical conditions. Planning for sustained postearthquake response should address
Albukrek D, et al. Emerg Med J December 2014 Vol 31 No 12
Downloaded from http://emj.bmj.com/ on April 19, 2015 - Published by group.bmj.com
The view from here
Figure 1 Joint work: just before the transfer of an intubated 4-year-old boy with severe head trauma in a local ambulance ( photographed by Joe Shalmoni).
these needs and include paediatric-specific preparation and long-term critical care requirements.6 Most of those devoted volunteers were general practitioners providing basic primary care. We left with mixed emotions, grateful for the opportunity to be a part of that challenging journey. Acknowledgements The authors thank the patients and their families. We express our deep appreciations to all the IDF field hospital personnel in the Philippines, and particularly to our emergency room nurses: Orna Tsruya, RN, MHA, Sergey Nazarov, RN, MHA, and Ronen Bimbat, RN. Contributors All three authors declare that they had substantial contributions to the conception or design of the work; the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement
to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
REFERENCES
Competing interests None.
2
1
Ethics approval Medical Corps, Israel Defense Forces. Provenance and peer review Not commissioned; externally peer reviewed.
3
4
5
To cite Albukrek D, Mendlovic J, Marom T. Emerg Med J 2014;31:951–953. Received 9 March 2014 Revised 25 August 2014 Accepted 1 September 2014 Published Online First 22 September 2014 Emerg Med J 2014;31:951–953. doi:10.1136/emermed-2014-203777
Albukrek D, et al. Emerg Med J December 2014 Vol 31 No 12
6
Burnweit C, Stylianos S. Disaster response in a paediatric field hospital: lessons learned in Haiti. J Pediatr Surg 2011;46:1131–9. Martin JE, Teff RJ, Spinella PC. Care of paediatric neurosurgical patients in Iraq in 2007: clinical and ethical experience of a field hospital. J Neurosurg Pediatr 2010;6:250–6. Merin O, Kreiss Y, Lin G, et al. Collaboration in response to disaster—Typhoon Yolanda and an integrative model. N Engl J Med 2014;370:1183–4. Marom T, Dagan D, Weiser G, et al. Pediatric otolaryngology in a field hospital in the Philippines. Int J Pediatr Otorhinolaryngol 2014;78:807–11. Inwald DP, Arul GS, Montgomery M, et al. Management of children in the deployed intensive care unit at Camp Bastion, Afghanistan. J R Army Med Corps 2014;160:236–40. Dulski TM, Basavaraju SV, Hotz GA, et al. Factors associated with inpatient mortality in a field hospital following the Haiti earthquake, January–May 2010. Am J Disaster Med 2011;6:275–84.
953
Downloaded from http://emj.bmj.com/ on April 19, 2015 - Published by group.bmj.com
Typhoon Haiyan disaster in the Philippines: paediatric field hospital perspectives Dov Albukrek, Joseph Mendlovic and Tal Marom Emerg Med J 2014 31: 951-953 originally published online September 22, 2014
doi: 10.1136/emermed-2014-203777 Updated information and services can be found at: http://emj.bmj.com/content/31/12/951
These include:
References Email alerting service
Topic Collections
This article cites 6 articles, 1 of which you can access for free at: http://emj.bmj.com/content/31/12/951#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Neonatal and paediatric intensive care (5) Neonatal intensive care (2) Clinical diagnostic tests (989) Ethics (368) Legal and forensic medicine (60) Radiology (939) Radiology (diagnostics) (846)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
