Subscribe
SAN JUAN, Puerto Rico– When the Military Sealift Command hospital ship USNS Comfort (T-AH 20) carries out surgical operations underway, the ship adjusts its course and speed to avoid excessive rocking—but that is only one example of the sophisticated adjustments the crew must make to perform treatments at sea.
Mental health on the 861-foot afloat hospital, like the other medical disciplines, must be adapted shipboard as well.
“The safest answer would have been to give her medications to sedate her, to put her in a stretcher, and tie her down, so that we knew for sure she wouldn’t get agitated on the helicopter ride,” said Lt. Cmdr. David A. Nissan about a patient. Nissan is a psychiatrist who is aboard the ship while it is assisting the Hurricane-Maria recovery efforts in Puerto Rico. “To be able to do the same standard of care—the gold standard of care of treatment of delirium, which is redirection as opposed to medication, is a beautiful thing.”
Patients who suffer from cognitive ailments at home are at risk for delirium when they visit hospitals. The mental health staff on Comfort is aware that a ship can be even more alien than a typical shore-based hospital.
“Delirium is an acute state where someone or somebody becomes really confused and disoriented, and/or inattentive to their environment. It will vary over the course of a day or over the course of hours,” said Nissan. “It can be really challenging in a hospital environment. It’s one big room. There are no distinct areas. There are no windows. And then the hospital room is moving. It’s really disorienting.”
Patients who become confused can seriously hurt themselves and sometimes must be sedated. But when Dr. Nissan instructs residents at his home command, back at Naval Medical Center Portsmouth, he stresses that medication should only be used sparingly.
“You drill home that the treatment of last resort is the use of medications to calm the person. The medicines that we use—anti-psychotics or benzodiazepine—have a lot of real negative side effects and can, in the short term, make the patient tired and less likely to be agitated, but in the longer term can have negative consequences,” Nissan said. “There is a black box warning on anti-psychotics that there is a risk of sudden death in elderly patients.”
Yet, according to Dr. Rafael Rodriguez Mercado, Puerto Rico Secretary of Health, mental health is a critical component of the Hurricane Maria recovery effort. He emphasized its importance when he first visited Comfort.
“We are Americans like you,” said Rodriguez Mercado. “Some of them maybe lost everything. We are here, not only to give medicine, but to give hope. Like the priest, sit down with them and give them Comfort.”
Dr. Nissan sits down with patients instead of using medicine whenever possible. Recently, he even accompanied a patient on a helicopter.
“I went with her, I did nothing more than serve as a reminder of what was happening, what was going on, and she stayed completely calm the whole time,” Nissan said about redirecting a patient instead of using medication.
Nissan credits the Navy with enabling him to employ redirection by having the foresight to include a mental health team. “It’s a really beautiful testament to the United States Navy and the military in general that we’ve included this in our humanitarian aid package,” said Nissan.
Comfort is configured for humanitarian assistance and disaster relief with a psychiatrist, psychologist, three psych techs and four nurses aboard with psychiatric training. It is currently moored pier side in San Juan, Puerto Rico providing care. The Department of Defense is supporting the Federal Emergency Management Agency, the lead federal agency, in helping those affected by Hurricane Maria to minimize suffering and is one component of the overall whole-of- government response effort.
Comfort is a seagoing medical treatment facility that currently has more than 850 personnel embarked for the Puerto Rico mission including Navy medical and support staff assembled from 22 commands, as well as over 70 civil service mariners.
Comfort’s primary mission is to provide an afloat, mobile, acute surgical medical facility to the U.S. military that is flexible, capable, and uniquely adaptable to support expeditionary warfare. Comfort’s secondary mission is to provide full hospital services to support U.S. disaster relief and humanitarian operations worldwide.
| Date Taken: | 10.30.2017 |
| Date Posted: | 10.30.2017 19:00 |
| Story ID: | 253494 |
| Location: | PR |
| Web Views: | 240 |
| Downloads: | 0 |
This work, Comfort Provides Mental Health Care to Puerto Rico, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
LEAVE A COMMENT