It had been only a few days since the earthquake had struck Haiti. David Callaway MC/MPA 2009, an emergency medicine doctor and director of the Operational Medicine Institute (OMI), was conducting a rapid needs assessment when he came across a surgeon walking out of the operating room.
“I have done 20 amputations in the past 24 hours,” the exhausted surgeon told him.
“So how do you know where the patients go after you operate on them?” Callaway asked.
The surgeon looked blankly at him, Callaway remembers. It was in part profound fatigue. It was also a realization that the huge volume of victims and ever-growing pool of volunteers were creating a devastating operational gap. Surgery was merely the first step required to treat amputees and many others with serious injuries who would need ongoing medical attention—a complex challenge in a desperately poor country reeling from a natural disaster.
In many ways, it was the moment that OMI had been preparing for. Founded in 2006 by Callaway and fellow physicians Alejandro Baez and Greg Ciottone—and with several volunteers who are alumni and students of the Kennedy school—OMI provides support and training to medical personnel, humanitarians, first responders, and disaster response teams in international crises.
At the request of representatives from the Dominican government and the Pan American Health organization, an OMI team of seven volunteers arrived at the Haiti-Dominican border by January 18, less than a week after the earthquake, to meet with local and international response agencies. Though every member of OMI had worked individually in various crisis zones, the Haiti earthquake response represented the institute’s first full-scale deployment.
“We recognized the challenges,” says Seth Moulton MC/MPA 2010, a volunteer with OMI in Haiti who had previously served as a U.S. marine in Iraq. “There are technical limitations to operating in a disaster zone and political sensitivities related to coordinating international response agencies.”
So members of the OMI team set to work devising a way to account for high- risk earthquake victims, specifically unaccompanied minors, amputees, pregnant women, and the elderly. They launched the Haiti information Technology (HIT) Rescue project, which created a novel electronic patient tracking system—a medical record application for the iPhone—that was used to monitor the location and disposition of at-risk patients. With the application in hand, OMI worked with volunteers from more than 20 international agencies to create standard operating procedures for patient data entry, tracking, information security, volunteer training, and quality improvement. In addition to tracking vulnerable populations, health providers in the field would be able to view patients’ X-rays directly on their mobile devices and record daily assessments and plans for each patient.
The application was first deployed at the Harvard Humanitarian initiative disaster Recovery center (DRC) at Fond Parisien. Staffed by an international group of disaster workers, the DRC served as the major referral and receiving center for patients being repatriated from the Dominican Republic and being discharged from the United States Naval Ship Comfort, a medical treatment facility. Rescue workers eventually registered more than 1,000 patients, including 43 amputees at three clinical sites and nearly 50 unaccompanied minors.
For children, the system compiled photographic identification, injury characteristics, and geographic tagging. According to OMI team member Dr. Elizabeth Cote MPP 2009, of Massachusetts General Hospital, the stored data facilitated the reunification of families, placement in designated treatment facilities, and transfer of temporary custody to UN-approved orphanages.
“We began with the idea that to protect the children we had to know who they were, where they were from, and to whom they belonged,” Cote said. “For 36 hours straight, we searched the camp, finding and registering every child. We kept a family together during medical transfer, reunited a pair of sisters, and identified a vulnerable unaccompanied minor in the care of a questionable guardian. Asking the right questions and making that information easily accessible in the early days after the earthquake helped us keep families who’d lost their homes, their livelihoods, and often their limbs from losing each other.”
To date, OMI has run five missions in Haiti and deployed 25 staff members to lead local teams. Collaborative efforts are ongoing with private industry, non-governmental organizations, and federal response agencies to create the next generation of information technology to assist during catastrophic disasters. Product developments are also geared toward adapting the system to address the public health challenges brought about by the hurricane season in the United States and other high-risk natural disasters across the globe.
According to Callaway, who outside of OMI works as an attending physician in emergency medicine at Carolinas Medical Center in Charlotte, North Carolina, members of the OMI HIT Rescue project applied concepts studied at HKS to their work in Haiti and continue to translate theory into practice during the ongoing work in supporting this technology project.
“I certainly could not have asked for a better community with whom to train,” says Callaway. "Nor could I have asked for a better team to take into a crisis zone. The legacy of HIT Rescue is a technology tool to support those in greatest need and an example of the HKS mission when individuals are asked what they can do to serve.”