Posted on 09/10/2005 6:44:00 AM PDT by wjersey
ABOARD THE USNS COMFORT - Most of this hospital ship's crew bunked down Thursday night thinking they were headed for New Orleans.
They didn't know that Trent Lott had other thoughts.
As the ship approached the mouth of the Mississippi River, it was turned around. Yesterday afternoon, the crew docked at Pascagoula, in the Republican senator's home state of Mississippi, waiting to receive victims of Hurricane Katrina.
The former Senate majority leader had pressed leaders of the relief effort late Thursday night to have the ship go to his state, saying three naval vessels were already in New Orleans and able to meet its medical needs now that so many people had been evacuated.
Susan Irby, Lott's communications director, defended the move. "All of our hospitals have been destroyed or damaged," she said. "Our folks in Mississippi are coming back in" to their homes.
Capt. Thomas A. Allingham, commander of the ship's medical units, said as the ship docked that he did not know when the first patients would arrive.
Four hours later, he said he had "sent messages up and down the line trying to get clarity on our mission here." His second-in-command was meeting with local leaders last night, and he plans to attend more such meetings early today, to get a clear view of the needs in Southern Mississippi.
The ship's dermatologist, Lt. Cmdr. Robert Guardiano, of Annapolis, Md., expects to be one of the busiest on board. Even minor scratches and sunburns, he said, can become infected in the conditions that exist in the hurricane-affected area.
The staff also expects large numbers of cases of dehydration and complications from going without medications for extended periods. There will also be injuries and instances of heat exhaustion among those working to clean up the area.
The Comfort is one of two fully equipped acute-care hospital ships in the fleet of the Navy's Military Sealift Command. It has 1,000 beds and 12 operating rooms and is currently staffed by virtually all medical specialties, assembled from nine Navy medical centers and the volunteer relief organization Project HOPE (Health Opportunities for People Everywhere). When on full operational status, as it is now, the daily cost exceeds $700,000 a day, according to the Navy.
The ship sailed from its base in Baltimore shortly before midnight Sept. 2. Since Monday, when the ship picked up supplies and additional crew in Naval Station Mayport, near Jacksonville, Fla., the crew has been participating in drills - such as walking blindfolded, practicing how to abandon ship in total darkness.
The early part of the day yesterday was tinged with mystery. Those who rose early expecting to see New Orleans saw only open water, and the sun was rising from the direction the ship was steaming - east - instead of off the starboard side as it would be approaching New Orleans.
Lt. j.g. Bashon Mann, public-affairs officer for the medical units aboard ship, said about 6:30 a.m. Central time (7:30 a.m. in Philadelphia) that the ship was standing by at sea, with no specific destination, because commanders of the relief effort on land had said there was no immediate need in New Orleans. It would remain at sea, Mann said, where it could keep drinking-water tanks full with purification equipment that cannot be used when the ship is in polluted harbors.
An hour later, according to a reporter's handheld global-positioning-satellite receiver, the ship changed course and was pointed at Pascagoula.
Actually there aren't that many. But what they do have are ships with extensive medical and berthing facilities. One is the USS Bataan, about the size of a WW-II aircraft carrier, and designed to carry and support a Marine Expeditionary force. It operates helicopters and Harrier jump jets, and the V-22 Osprey can also be deployed on it. One is the Iwo Jima, of the same class, , while the third is a command ship, IIRC, but still with considerable medical facilities.
Since there are only 10-20,000 people left in New Orleans, they clearly no longer have as much need as the Mississippi and Alabama coasts.
That's our call, not yours.
I can post pictures of patients with vibrio vulnificus infections if you would like.
Let's see...it's 3 pm...your lunch is probably out of the fundus of your stomach by now so it should be ok.
TAW
Pictures? A total of 65 cases documented among the general population would statistically equate to 1:5,000,000; how many such horrible cases have you personally seen, treated?
As in all bacterial diseases, antibiotics are effective except in those who are immuno-deficient.
My fundus is a firmament unto itself, I do not vomit.
Good grief all we've seen is The New Orleans Plantation of the Gulf Coast.
TAW
Yes, but the treatment is well within the scope of what we used to call a general practitioner.
Trent did himself proud this time.
It's racism against whites by CNN! We should have congressional hearings.
Where's Jesse Jackson?
Yes, a mild case of gastroenteritis caused by ingesting undercooked shellfish could be treated by a general practitioner. However, the necrosis associated with a wound infection caused by any of the bacteria in the genus Vibrio should be treated by an ID specialist and a dermatologist. Furthermore these infections carry a 100% mortality rate if not treated properly.
Would you let your GP debride a wound?
One last point if I may. Because of their asymptomatic progression, most of the two percent of the U.S. population that has chronic liver disease caused by Hepatitis B and C don't even know that they have it. The percentage of the population with CLD due to other etiologic factors escapes me at the moment. I make this point because when a person with CLD becomes symptomatic from a Vibrio infection it's usually too late to provide curative therapy.
If you were dying with necrotizing skin lesions, you would probably want someone who specializes in the skin to be treating you.
Hope the following helps.
CLINICAL PRESENTATION
Q. INFECTION, VIBRIO
1. ETIOLOGY: Cellulitis and necrotizing soft-tissue infections can be caused by marine Vibrios. Infection with V parahaemolyticus, V vulnificus, and V alginolyticus are most frequent, but all Vibrio species have caused infections (Kumamoto, 1998; Kaye, 1990; Plotkin, 1990; Park, 1991; Levine,1993; Howard, 1993; Shin, 1996; Hlady, 1996).
2. EPIDEMIOLOGY (Hlady, 1996; Howard, 1985; Pessa, 1985; Jenkins, 1986; Klontz, 1988; Kaye, 1990; Park, 1991; Warnock, 1993; Howard, 1993; Levine, 1993):
a. In US, most marine Vibrio infections occur along the Atlantic and the Gulf seaboards; most cases occur in summer months.
b. High risk of rapid spread of infection in patients with underlying illness, especially cirrhosis and alcoholic hepatic disease. Higher incidence in patients with liver disease may reflect a preference of Vibrios for an environment rich in saturated transferrin, either from an excess of iron or a relative lack of transferrin (Hlady, 1996).
3. PREDISPOSING FACTORS:
a. Infection results from contact of a wound with saltwater harboring a marine Vibrio or from a puncture wound or small laceration acquired by handling shellfish harvested from such environments. Primary sepsis is caused by ingestion of contaminated raw shellfish (usually oysters) (Howard, 1985; Pessa, 1985; Jenkins, 1986; Klontz, 1988; Kaye, 1990; Plotkin, 1990).
b. Has been reported following catfish spine puncture wounds (Midani, 1994), shark attacks (Klontz, 1993), and injury inflicted by a stingray (Ho, 1998).
4. CHARACTERISTICS (Kumamoto, 1998; Howard, 1985; Pessa, 1985; Jenkins, 1986; Klontz, 1988; Kaye, 1990):
a. Tend to present within 24 hours of marine contact; manifested by fulminant signs and symptoms.
b. The site of infection (usually on an extremity) is initially erythematous and extremely edematous or ecchymotic, then rapidly progresses to vesicles and bullae and finally to necrosis involving skin and subcutaneous fat.
c. Vibrio infections also can cause gastroenteritis and primary septicemia. Primary septic form is virulent, with symptoms appearing within 24 hr of consuming raw seafood. Secondary skin lesions, including vesicles or bullae, gangrene, purpura macules, papules or wheals are concurrent with septemic symptoms. Requires early empiric therapy, without awaiting confirmation of the diagnosis (Warnock, 1993; Shin, 1996).
5. LABORATORY:
a. Cultures from a single wound may reveal single or multiple Vibrio species and single or multiple strains of those species (Plotkin, 1990).
b. Most common species isolated in primary septic form is V vulnificus (Kumamoto, 1998; Parks, 1991).
6. MORTALITY:
a. Primary wound infection in otherwise healthy patients has good prognosis with minimal mortality if treated promptly. In patients with underlying disease, mortality is 25% if the wound is debrided, 60% to 100% if not debrided (Halow, 1996).
b. Primary septic form has mortality of nearly 100% despite aggressive treatment (Kumamoto, 1998; Warnock, 1993).
So you are saying that it requires a dermatologist to properly debride the necrotic tissue in order to effect the recovery of the patient?
Yes.
I think the tens of thousands came from a democrat and he was refering to registered voters, not necessarily live people with one name on election day....
Then I am convinced; it just struck me as odd, but I was thinking in terms of treating the sailors on board rather than the whole patient load a hospital ship might have.
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