Monday, November 20, 2017

USNS Comfort Weathering its Own Storm off Puerto Rico

By on October 18, 2017

SAN JUAN – The USNS Comfort, the military’s state-of-the-art hospital vessel, was late in arriving to Puerto Rico’s shores and has operated at a languid rate of treatment—some 162 patients have been treated in the two weeks since it dropped anchor. Observers who point to the Comfort’s underperformance as a sign that the ship would terminate its medical mission off Puerto Rico’s shores can breath a sigh of relief; it is apparently here to stay for the duration of the island’s healthcare crisis.

“No sir, we have not received orders to terminate the mission; it is all conditions- based—that is something where the time will come and when they determine that the healthcare system is strong enough,” explained Col. José García, the Command Surgeon for the Northern Command. “I think they will be here as long as it is required, but I don’t determine that.”

Hope for Puerto Rico floats aboard the USNS Comfort

Although he is not a surgeon, nor a physician, García plays the role of a healthcare administrator, a planner who helps to coordinate operations to support the different elements when it comes to the U.S. Department of Health and Human Services (HHS), the Federal Emergency Management Agency (FEMA) and the state.

What he has seen across Puerto Rico coincides with reports in stateside and local media, which call the situation across parts of the island “post-apocalyptic,” as patients enduring severe trauma in regions where hospitals sustained catastrophic damages and were knocked off the power grid are unable to treat patients. In a separate report on CNN, Dr. Sanjay Gupta said the term “preventable death” is heard often as patients requiring basic MRIs or electricity to run intensive care units have died.

[PHOTOS] USNS Comfort: Federal aid for Puerto Rico’s health services

In the face of that chaos, the Comfort has been criticized for a languid start as only 162 patients have been treated in the two weeks since it arrived off Puerto Rico’s shores.

The slow pace is actually due to a battalion of tests being run because of the complexity of the cases. “What we should highlight is we have treated some very high acuity patients that probably wouldn’t survive anywhere else. Just to give you an example of how critical the need was for these patients—of those 162, we have executed 5,500 plus diagnostic tests aboard the Comfort,” García explained. “That means you had more than 400 diagnostic tests and labs, MRIs and everything else to provide the people the high quality of care.”

The floating  hospital with a 1,000-patient capacity currently has enough staff for only 250 patients and 50 more in intensive care. With four operating rooms, the facility is prepared to attend cases of cardiology, physical therapy, family medicine, internal and pediatric medicine, nephrology, neurology, optometry, ophthalmology, pediatric surgery, adult and pediatric critical care, obstetrics and gynecology, and mental health, among others. It does not treat neurosurgery patients.

Those state of the art facilities were used to assist in the recovery efforts after Hurricane Harvey hit Texas and after Hurricane Irma hit Florida–García said Puerto Rico is unlike those two theaters.

Here’s why: “Well, because the infrastructure there wasn’t as severely affected as it was here. Also the fact that only a portion of the state was affected and the states were able to activate the national guard and use all of their resources available to them.

“The island was completely devastated by the hurricane so it is more of a challenge that you did not have in those two other places. So going back to your question about the Comfort and how we adapted, it was a matter of making changes along the way in order to expedite and become more efficient and getting patients to the ship. Not only that, but letting people know that we were available to do that,” García explained.

When the Comfort first arrived, protocol established by the Department of Defense (DoD) in support of HHS called for patients to go to their provider, whether it was a clinic or the regional hospital, for a referral to go through Centro Médico if they needed a higher level of care. Centro Médico did all the vetting, determined which patients, and if that exceeded capacity, to send to a Combat Support Hospital in Humacao or whether to call the Medical Operation Center, which would process that request and get the people to the Comfort.

“That protocol has since changed because we learned that Centro Médico became more of a bottleneck because there was just huge demand coming to them and the Secretary of Health recognized that as well as Centro Médico,” García told Caribbean Business. “So Puerto Rico’s Health Secretary directed his regional hospitals to have the flexibility to reach out directly to us, and the beauty about the whole process when we look at the Medical Operation Center, we have people embedded there from this office, from the Department of Health, we have people from HHS as well as all of us—so we can streamline the mission analysis and determine they need to go, and coordinate the pickup and the drop-off.”

That operation, Garcia said, has helped to streamline support to areas of the island that have been most crippled by the storm.

Particularly hard-hit are the town of Humacao and neighboring municipalities in the southeast, the city of Caguas en route to central Puerto Rico and western Puerto Rico where Aguadilla is located. To address the dire state of the hospitals in those regions, the DoD sent three Combat Support Hospital (CASH) units to provide support to the overflow of patients in dire need of critical care.

“The hospitals that we brought in were to add capacity to help and move those patients from there when they ran out of room and move them into the OD until the hospitals re-established their own capacity. The DoD hospitals were brought on to really take care of the overflow.”

At this critical juncture, the Humacao CASH and the Caguas CASH are both operational; an Air Force hospital has yet to be set up in Aguadilla. Humacao was a priority.

“That was part of the analysis; HHS collaborated with the Department of Health. The hurricane devastated the hospitals in the Humacao area—Ryder, the hospital there was completely destroyed, so that was part of the strategic planning,” García added. “So we tried to absorb some of that and municipalities in the vicinity of Humacao and to provide some relief in Caguas, which was overburdened, too.”

The Comfort is now cycling back and forth along the island’s north shore and may make its way back to Ponce.

–Sandra López contributed to this report.

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