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ACEP Now: Vol 34 – No 07 – July 2015Group of international volunteers with the HRA staff after the last patient was evacuated from Pheriche.
KK: How do you manage airways without equipment?
RS: You don’t. While we had a GlideScope that someone had donated and we had endotracheal tubes, there was no vent, we didn’t have the resources to bag anyone we intubated, and there were no medical personnel on the helicopters. The patients are all lying in the back of this giant cargo bay.
The Sherpa with head trauma was protecting his airway. The only alternative I considered was putting in a nasopharyngeal airway, but I didn’t feel he warranted that. It came down to easy interventions you can do that don’t require any further monitoring because that wasn’t going to happen.
We ended up having to manage his combativeness; if you stimulated him, he tended to get a bit more combative. He came down with his hands tied together for safety reasons for a helicopter transport. We untied his hands while he was on the floor in our sunroom, a staging area for patients, but then we ended up having to apply the physical restraints again when we evacuated him. Unfortunately, he later died.
KK: How long after all this was done did you come home?
RS: We ended up closing the clinic on May 5. We were supposed to close on May 22, so we closed a couple of weeks early. After we closed, it took about two days for us to hike out.
KK: I can’t thank you enough for taking the time to do this. I wasn’t sure how sensitive you were at this point because it has to be incredibly difficult.
RS: It was probably one of the most powerful experiences I’ve had: watching both the local and international trekking community come together and rally, caring for these 73 patients and giving them the best care that we could.
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