When disasters come, UCSD Medical Center’s Dr. Irving “Jake” Jacoby waits for the call. He commands one of 50 emergency response teams that the federal government calls upon when there are disasters or other medical emergencies here and abroad.
Jacoby has been doing this since 1991, responding to Hurricane Katrina, the 1994 Northridge Earthquake and the Sept. 11 attacks, among other emergencies. He hasn’t been called to serve in Haiti yet, but his team might be assigned there within the next few weeks. (Three emergency-room doctors from UCSD Medical Center are already assisting earthquake victims in Haiti.)
In an interview at UCSD’s Hillcrest hospital complex, where Jacoby is an emergency physician, he talked about the challenges and rewards of serving those in need, many of whom have never had proper health care in the first place.
What disaster was the most challenging?
Katrina. It was the first time we had to run our own morgue and deal with those issues as well being overwhelmed with sheer numbers of patients. We were one of the first teams into the airport and had to set up a treatment facility and stage an evacuation area.
Remember all those helicopters rescuing people from rooftops? They started bringing them to the airport. We triaged those patients and treated them for dehydration, for injuries they’d sustained and gave them medications. And all the hospitals who evacuated sent all those patients to the airport. We managed them until the military got there and started the medical evacuation.
We also trained the volunteers who came to the site from faith-based organizations.
We slept in sleeping bags on the baggage carousels in the airport or on the floor.
What was it like sleeping on a baggage carousel?
Fortunately, they were flat. They’re a little bit off the floor, and they’re not as cold. The rubberized material is not as hot or cold as the floor would be.
The whole thing in a disaster site is to be imaginative, inventive and solve the problems. If you concentrate on criticism and things you don’t have, then all you will see are the things you don’t have.
What’s an example of creative thinking that you saw?
At Katrina, we had patients delivered to us by helicopter down on the tarmac at the heliport. The patient setup we had was on the second floor of the departure level, and we had to get them up.
So we used the baggage tugs that they use to drag the baggage from airplanes and take them to the airport. We put patients on those and drove them up.
We also had to go around and borrow all the wheelchairs from all the different gates and airlines.
What are some special challenges that you’d see in trauma elsewhere but not here?
In the United States, most people are up to date on their tetanus shots, and in Haiti they’re not. In Haiti, I think there will be a surge of tetanus from all the wounds people have.
We update tetanus boosters routinely for people in the emergency department, and I’ve only seen two cases of tetanus in five years here in San Diego.
What kind of injuries do you see in an earthquake?
Earthquakes generate lots of crushing injuries and head injuries. You may have seen on CNN that girl who was rescued but died on the way to hospital.
That’s not an unusual circumstance. Unless you’re ready to immediately start treating them before you transport them, many of the patients will die.
The child was rescued by the locals, but they didn’t have the medical support afterward. That’s part of the heartbreak of all of this happening.
What will be some of the challenges facing doctors in Haiti?
In addition to injuries that occurred during the earthquake, all the medical needs that people have on a daily basis will still exist. People will still have kidney infections, heart attacks, they’ll be pregnant and need to deliver and may have complicated deliveries. All of those things that normally happen on an everyday basis, strokes and development of diabetes and respiratory and gastrointestinal problems, those will be occurring.
Then there are illnesses that are caused after disasters, things that occur with crowding that are already present in the population — measles, cholera.
How long do you think the emergency teams will be in place?
I think easily three to six months.
How long is your typical deployment?
How do the doctors deal with the emotional strain of doing this work?
The stress of being in a disaster affects both the victims and the health-care providers. This is a very complex issue to study, since everybody at that disaster site has their own accumulation of experiences or non-experiences in life.
Organized teams have a mental-health provider or somebody else [monitoring] responders for signs of stress and making sure people have adequate personal protective equipment and adequate rest time and sleep.
What are the symptoms of stress that affect health-care workers?
The big symptoms are lack of concentration, emotional numbing and development of flashbacks later on. So people start to make mistakes, people start to think they can’t stop working.
Who takes care of you?
We have a buddy system. Everybody gets a buddy, who is supposed to look out for you. If you need to move or evacuate a site, they know where you are at all times.
Why do you do this?
The bottom line is a lot of people go into medicine to help people with medical issues in a time of need. It’s part of being an emergency physician.
— Interview conducted and edited by RANDY DOTINGA