2010 Haiti Earthquake

The 2010 Haiti Earthquake is presented not only as a catastrophe that overwhelmed medical capacity but as a test of how emergency teams ration lifesaving care. At a field hospital in Port-au-Prince, staff weighed Nathalie LeBrun’s continuing need for oxygen against scarce supplies intended for other patients. Their decision to withdraw her oxygen and transfer her without telling her was later complicated by an unexpected treatment that stabilized her. Her case makes the human consequences of triage visible while showing how an apparently settled decision can change when care, information, and resources meet in practice.

Disaster setting and the problem of scarcity

In January 2010, the narrator traveled to Haiti with US federal disaster medical teams to examine what had been learned from Katrina and how prepared responders were for another American disaster. The earthquake had created a setting in which critically injured patients greatly exceeded the medical system’s initial capacity. The American team established a tent field hospital on a college campus in Port-au-Prince. Staff had difficulty recording unfamiliar names and used numbers in medical records, so LeBrun was initially identified as Jane Doe 326.

LeBrun was thirty-eight and arrived the week after the earthquake in a white nightgown with lacy trim. Through a translator, she described health problems that predated the disaster and had worsened since it. The earthquake did not create her underlying condition, but it placed her continuing care inside a system short of oxygen, fuel, and reliable equipment. That distinction shaped the triage decision: her need was chronic, while other patients were understood to need oxygen temporarily, including during surgery.

LeBrun’s oxygen and the allocation decision

The team first found an oxygen tank and connected it to LeBrun. When it ran out overnight, her blood oxygen fell to a dangerously low level. A nurse who believed LeBrun was dying stayed beside her in tears, having been told that no oxygen remained. Doctors and staff searched for another tank, restored the oxygen, and eased her breathing. This initial rescue was provisional: the supply chain was failing, and access to more oxygen remained uncertain.

A portable oxygen concentrator offered another possible source, but it repeatedly overheated and shut down. Because it required electricity, it also depended on generators and fuel, which were scarce. At a morning meeting, staff were told there was only one can of diesel per generator left. Although more fuel was eventually found, bottled oxygen—the backup supply for LeBrun—was still limited the next day. The field hospital’s liaison officer therefore faced a choice about whether to continue reserving oxygen for someone whose need might be indefinite.

He reasoned that scarce oxygen would do more good for people who needed it only briefly, such as earthquake victims requiring it during surgery. He discussed the decision with the head doctor, who agreed. Their plan was to reduce LeBrun’s oxygen gradually and transfer her to a partially destroyed Haitian hospital where they believed no oxygen was available. LeBrun was not consulted or informed about the plan. She was told only that she would be transferred, and that afternoon she smiled and spoke hopefully about her future. The contrast between her understanding and the staff’s decision underscores that the allocation was not simply a technical calculation: the patient whose care was being withdrawn was excluded from the conversation.

Transfer and unexpected stabilization

When US Army medics arrived to take LeBrun away, a staff member abruptly unplugged her oxygen concentrator. The medics did not know the plan and tried to reassure her that she would be cared for elsewhere. During the transfer she began struggling to breathe. An oxygen tank was available in the ambulance, but a member of the field hospital’s command staff described her difficulty as chronic; in keeping with the triage decision, she was given no oxygen. The case thus moved from an abstract judgment about how to distribute supplies to the immediate consequences of withholding a resource from a patient who needed it.

At the receiving hospital, Dr. Paul Auerbach happened to be volunteering. He found a tank with a small amount of oxygen remaining and treated LeBrun with low-cost diuretics to reduce fluid in her lungs. The treatment stabilized her to the point that she did not need oxygen, at least for a time. This outcome did not establish that the earlier concern about scarcity was unreal; it showed instead that the predicted course was not certain and that an alternative intervention could make a difference. The transfer, intended for a facility thought to have no oxygen, became the place where another doctor found a way to stabilize her.

Katrina, consent, and the limits of protocols

The episode returns the book’s disaster-ethics inquiry to New Orleans. During Katrina, officials ordered residents to evacuate even though many lacked cars, transport plans had too few drivers, and ambulances were trapped in traffic or diverted to the Superdome. Around 2,500 hospital patients remained in the city. At Memorial Medical Center, known weaknesses in the backup electrical distribution system threatened care: Eric Yancovich had calculated that less than four feet of street flooding could send water over the loading dock, and warned that the resulting damage could disable most of the medical center. The earthquake scene therefore echoes a larger concern in the book: emergency decisions are made inside systems whose shortages and vulnerabilities often precede the disaster.

Memorial’s evacuation decisions also show how a medical label can acquire consequences beyond its intended meaning. Doctors placed patients with Do Not Resuscitate orders last in the evacuation sequence, although a DNR order concerned resuscitation after breathing or heartbeat stopped, not whether the patient should be rescued. When one patient’s daughter learned that her mother’s DNR status was being treated as a reason to leave her behind, she asked for the order to be canceled. Her response makes the distinction between a patient’s consent to forgo resuscitation and consent to forgo evacuation unmistakable. LeBrun’s case raises a related question: whether a patient facing withdrawal of potentially lifesaving support should be informed and involved in that decision.

The book does not present the Haiti decision as a simple proof that rationing is wrong or that every scarce resource can be supplied to everyone. It examines the gap between a utilitarian calculation and its implementation: staff were prepared to authorize the withdrawal, yet they did not tell LeBrun what the plan meant or carry it out in her presence. Her subsequent stabilization complicates the calculation without erasing the shortage that prompted it. The episode makes consent, communication, and the uncertainty of clinical predictions part of disaster triage itself, rather than matters that can be set aside once resources become scarce.