Recently, a perfect storm of equipment failure and an influx of patients would not prevent U.S. Naval Hospital Guantanamo Bay (USNH GB) staff members from upholding the mantra of providing high quality, patient centered, world class care, anytime, anywhere.

Lt. Cdr. Derek Davies, emergency room physician, USNH GB explained a remote hospital with limited resources can create challenges some military treatment facilities never face.

In a larger facility one scanner being down is not a major issue, because staff can grab a scanner from a different area. However, if one scanner is down at USNH GB, it is a problem because it is the only scanner.

“Our CT scanner was not functioning,” Davies said.

The part needed to repair the equipment had been ordered but had not arrived. Equipment parts and all other supplies will travel via land, air, and sea before reaching the final destination. Driving to a local store, same-day nor even two-day delivery options do not exist in this remote setting.

The first patient arrived at the hospital was suspected to need a CT scan performed. Davies explained the concern for a person coming to the emergency department with the complaints of this patient was bleeding in the brain. In order to investigate, he said a CT scan would normally be the first option.

Davies said the alternative was to perform a spinal tap, which would allow him to see if there was any blood around the brain. However, it is possible to have a false positive if there is blood not from the brain, but another source such as the skin after it is punctured. He continued that blood would create a false positive and dictate the patient be medically evacuated from the island.

If these were not enough obstacles, when Davies reached out to the anesthesia team, he learned one person on the team was on another case and the other was serving as the acting executive officer.

Cmdr. Shane Lawson, acting executive officer, USNH GB, immediately shifted gears and reported to the emergency department to assist. With his help, a clean spinal tap was obtained. Davies said the successful spinal tap resulted in being able immediately rule out a life-threatening diagnosis and prevented the patient from being medically evacuated and having a battery of additional testing.

Almost immediately, the next patient arrived with severe injuries sustained in a fall. At the same time, another patient was admitted, suspected to be suffering from diabetic ketoacidosis, a life-threatening concern. Yet another patient was admitted with severe head and face injuries due to a bicycle accident. Based on the severity of the head and face injuries, it was determined to immediately medically evacuate that patient.

Team members from the patient administration were notified and began the medevac process. While attempting to coordinate the medevac, they discovered cellphone and internet service were inoperable, causing difficulties in communicating with providers and medevac companies.

Normally, a medevac is coordinated using a duty cellphone and the internet. Because neither was an option, the team quickly shifted to a viable second option.

HN David Dwyer, corpsman, USNH GB switched to a landline and established a conference call between providers and the medevac team.

 “There is a procedure, but we all understand it is not set in stone,” Dwyer said. “I call it practiced chaos because each medevac is different and presents its’ own challenges.” He said they were successful in working around substantial roadblocks to coordinate the medevac for the patient.

Through collaboration, hard work and a little creativity, each patient received the care needed.

Capt. J.C. Nicholson, commanding officer, USNH GB praised the team for all the hard work and tenacity in overcoming every obstacle to provide quality patient care.

 “I will take our team against anyone else in Navy Medicine,” Nicholson said. “It is all because of the talents you guys bring to bear at a moments’ notice and I could not be more proud to be your Skipper.”

U.S. Naval Hospital Guantanamo Bay embraces providing world-class care by maintaining a reputation for sustaining one of the highest patient satisfaction rates of any military treatment facility in the Navy. The patient population of approximately 6,000 includes military family members, government civilian employees and their families, special category residents, contractors, foreign nationals, and migrants.

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