Nobody knows how many Haitians were killed in the earthquake. The current estimate of 100,000-200,000 is beyond understanding. Though aid is pouring in from around the world, lack of government, communications, roads, heavy equipment, and gasoline prevents it from reaching the people.

Captain Bruce Lindsey, commander of the USS Carl Vinson, anchored off Haiti’s coast, is quoted in the January 16-17 issue of “The Wall Street Journal” as saying, “Speed is of the essence in a crisis like this, but with the airport and harbor so badly damaged, there are clear limits to the amount of supplies that can be brought in at one time.”

Thanks to the U.S. military, the airport is operating. One rescue group had to unpack pallets of supplies and make smaller ones because trucks could not handle big loads. Lack of safe water, food, and shelter is also hindering rescue efforts. Doctors want to help, but right now, about all they can do is dispense pain medication and antibiotics.

When medical teams reach the trapped and wounded, they will triage the victims. Triage has one goal, to save as many patients as possible. The U.S .State Department defines it as sorting patients immediately according to the “type and seriousness of injury” and the likelihood of survival. Seriously injured patients and those near death are made as comfortable as possible and treated last.

Melissa Conrad Stoppler, MD, describes the approach in a Medicine Net article, “Medical Triage: Code Tags and Triage Terminology.” START (Simple Triage and Rapid Treatment) is one triage approach. Doctors group patients into categories: deceased, injured, severely injured, and patients with minor injuries that do not require urgent care.

Advanced Triage is the second system and it is based on colored tags. Stoppler says this system is “implemented by a nurse or other skilled personnel.” Red tags are used for patients who cannot survive without immediate care. Yellow tags are used for patients in stable condition. Green tags are used for the “walking wounded.” White tags are used for patients with minor injuries, and black tags for the deceased.

Medical triage can be a challenge for health professionals. Haitians unfamiliar with the approach may be offended, and even traumatized, by it. If your child has a broken leg, you want immediate medical care.

Television news shows public frustration with the relief efforts, which could be an indication of Post Traumatic Stress Disorder. The National Institutes of Health defines the disorder as a response to sudden and unanticipated loss. Symptoms include flashbacks, bad dreams, frightening thoughts, and depression.

While Haitians are dealing with mass casualties and medical triage, they are also dealing with the lack of rituals. Most families have a memorial service after a loved one dies. But the roof of the national cathedral has collapsed and, to prevent the spread of disease, the dead are being buried in mass graves. Other than public wailing, there seems to be an absence of grief rituals.

Russell Friedman and John W. James, of the Grief Recovery Institute, think humans need a visual proof of death. In their website article, “Conclusionary Rituals,” they say mourners who do not have this proof may get stuck in “incomplete” limbo. Rescue workers can help earthquake victims by giving them water, food, and shelter. They can also help by being patient, explaining triage, and providing grief counseling. Listening to the survivors’ stories will also help them.

Copyright 2010 by Harriet Hodgson