As the last members of our field team prepare for the trip home, I hope that Dr. Reed and Dr. Baldisseri have a safe trip.  I am certain your family, friends and colleagues will be glad to hear when you have arrived home.

It is very clear to me that our mission is not over.  I am very proud of the SCCM response to the initial request for help from Dr. Baez on behalf of the Dominican Republic health system to respond to the earthquake induced surge in critical care demand.  I must say that I have learned more from Dr. Baez and his amazing leadership performance during this crisis than I could have ever imagined.  Navigating the politics in any health care system under crisis is challenging, however this situation remains more difficult than anyone on the outside could imagine.  Dr. Victor Matos and Dr. Pablo Smester are clearly part of the leadership team for critical care in the DR, and I am grateful for their friendship and support during my stay in the DR. 

The international family of critical care professionals seems small in the age of instant electronic communication.   Our ability to create an instant connection with Dr. Baez and his team in the DR led to rapid activation of the response from SCCM, recruitment of team members, performance of the need assessment, obtaining material to perform educational interventions, delivery of the education and creation of instructor and course administration infrastructure.  I believe we have helped the medical system in the DR move forward towards its own vision of multidisciplinary critical care led by intensivists and other experienced professionals.  The establishment of a training centre for FCCS, and soon PFCCS and FDM, will lead to an increase in the quality of care of patients from this disaster and for those patients in the DR with their usual needs for critical care.  Beyond this, the strengthening of links between the critical care community in the DR with SCCM, and our own institutions in the United States and Canada, will likely bear further fruit in the near future.  For example, we have already begun discussions on linking future stars in Critical Care in the DR with international critical care fellowships in Canada, along with opportunities to have our trainees spend time learning about critical care in the DR. 

I am grateful for the opportunity to have made new friends, learned many lessons, and contributed in some way to the humanitarian and medical relief effort for the victims of this disaster.  Just as Dr. Marie Baldisseri stated in her recent blog entry, I too was feeling pulled to the bedside, and wanted to get hands dirty in patient care.  However, as Dr. Baez and Dr. Ian Butler taught us in their efforts, sometimes the most important thing a critical care professional can do in a crisis is step back, take a breath, and get the team organized.  Teaching leadership, communication, personal survival strategies and other non-medical skills to our trainees is absolutely necessary if we are to save more lives in similar circumstances.

My thanks to my friends in the Dominican Republic, my teammates Marie Balidsseri, MJ Reed, Dana Braner, Bruce Sawadsky, Gervaise Nicklas, Mike Huerta.  The support from SCCM as an organization, and in particular from Judi Jacobi, David Martin, Chris Farmer, and the whole SCCM staff was so important to the success of our mission so far.

Now we all need some time to reflect further on the lessons learned.  In the meantime, many of our friends are still engaged in active disaster relief, and I wish them success and safety in their efforts.  I have to admit I feel a little guilty being home while there is still so much work to do.   I know I will be back in the DR soon, and in the meantime the victims of this disaster and those still remaining on the ground to help are in my thoughts.

Randy Wax, MD, FCCM