Improvisation and the Possibility of Rescue

Five Days at Memorial

Stories from the airport, Haiti, and Bellevue develop the theme that improvisation can preserve life and prevent desperate triage choices.

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Bearing strength in each event

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Improvisation at Memorial Improvisation at Memorial from "Five Days at Memorial". Improvisation at Memorial Small Solutions Hospital staff used hand ventilation, gravity-fed fluids, improvised routes, and later small generators.

Improvisation at Memorial from "Five Days at Memorial". Improvisation at Memorial Small Solutions Hospital staff used hand ventilation, gravity-fed fluids, improvised routes, and later small generators.

Improvisation at Memorial Small Solutions Hospital staff used hand ventilation, gravity-fed fluids, improvised routes, and later small generators. These acts showed that care could continue in limited forms after major systems failed. Missed Possibilities Some useful resources were discovered late or were not integrated into patient care. The difference between a scarce resource and an unavailable one depended partly on whether staff kept looking for alternatives.

The Airport’s Limits The Airport’s Limits from "Five Days at Memorial". The Airport’s Limits Evacuees Arrive Patients reached the airport without a reliable system for onward transport.

The Airport’s Limits from "Five Days at Memorial". The Airport’s Limits Evacuees Arrive Patients reached the airport without a reliable system for onward transport.

The Airport’s Limits Evacuees Arrive Patients reached the airport without a reliable system for onward transport. Disaster teams were overwhelmed, short on supplies, and unable to absorb the number of people arriving. Moving Is Not Enough An evacuation can relocate danger rather than end it. The absence of resupply and continuity of care turned rescue into another crisis.

LeBrun’s Oxygen Crisis LeBrun’s Oxygen Crisis from "Five Days at Memorial". LeBrun’s Oxygen Crisis A Scarce Supply After the Haiti earthquake, responders considered withdrawing oxygen from Nathalie LeBrun because her chronic need…

LeBrun’s Oxygen Crisis from "Five Days at Memorial". LeBrun’s Oxygen Crisis A Scarce Supply After the Haiti earthquake, responders considered withdrawing oxygen from Nathalie LeBrun because her chronic need…

LeBrun’s Oxygen Crisis A Scarce Supply After the Haiti earthquake, responders considered withdrawing oxygen from Nathalie LeBrun because her chronic need competed with temporary needs. The decision was made without informing her. Improvisation Changes the Outcome A physician at another hospital found oxygen and treated her condition with inexpensive medication. LeBrun stabilized, showing that an apparent resource dilemma may have alternatives not yet considered.

Bellevue’s Fuel Chain Bellevue’s Fuel Chain from "Five Days at Memorial". Bellevue’s Fuel Chain A Power Threat Floodwater threatened Bellevue’s generator fuel system, and officials feared that power would fail.

Bellevue’s Fuel Chain from "Five Days at Memorial". Bellevue’s Fuel Chain A Power Threat Floodwater threatened Bellevue’s generator fuel system, and officials feared that power would fail.

Bellevue’s Fuel Chain A Power Threat Floodwater threatened Bellevue’s generator fuel system, and officials feared that power would fail. Laura Evans and colleagues considered which patients could use a handful of outlets. Carrying Fuel Upstairs Volunteers passed fuel up stairwells, helping generators continue running. The physical labor prevented the projected power loss and preserved options for patients who otherwise might have faced rationing.

Inventive Respiratory Care Inventive Respiratory Care from "Five Days at Memorial". Inventive Respiratory Care A Low-Cost Alternative In Pune, Aarti Kinikar adapted bubble CPAP, an inexpensive breathing-support technique, for children with…

Inventive Respiratory Care from "Five Days at Memorial". Inventive Respiratory Care A Low-Cost Alternative In Pune, Aarti Kinikar adapted bubble CPAP, an inexpensive breathing-support technique, for children with…

Inventive Respiratory Care A Low-Cost Alternative In Pune, Aarti Kinikar adapted bubble CPAP, an inexpensive breathing-support technique, for children with influenza when ventilators were scarce. Her team tested a practical alternative rather than accepting that nothing could be done. Resources Freed for Others As children improved, ventilators could be used for other patients. The episode suggests that technical creativity can reduce scarcity instead of merely deciding who must bear it.

August 31–September 1, 2005

September 1–2, 2005

January 2010

October 29, 2012

2009 H1N1 outbreak