When mass-casualty events occur, orthopaedic surgeons travel throughout the world to treat wounded patients in countries devastated by war, natural disaster and poverty. In 2010, 500 U.S. orthopaedic surgeons traveled to Haiti to help treat hundreds of thousands of victims following a catastrophic earthquake on that Caribbean island. And while the effort was generally successful in treating the broken bones, fractures and other orthopaedic injuries associated with earthquakes, not all of the volunteers were adequately prepared to work in a devastated country.
"Individual physicians arrived without food, equipment, transportation and personal security, or an assignment," said Christopher T. Born, MD, who co-chaired the American Academy of Orthopaedic Surgeons (AAOS)/Orthopaedic Trauma Association (OTA) Disaster Preparedness Project Team.
To ensure that orthopaedic surgeons are appropriately trained and optimally utilized under grueling conditions, AAOS has established a new credentialing process for doctors who plan to travel internationally to disaster sites. The new Disaster Responders Certification Program for Orthopaedic Surgeons, formally announced during the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), is a partnership between AAOS, OTA, and the Society of Military Orthopaedic Surgeons (SOMOS). The program is the first medical association-led effort to officially train and certify physicians to treat the victims of international disasters.
The first Disaster Responders training was held in December 2011 at the SOMOS meeting in San Diego. A second session is scheduled for February 6 and 7, 2012 at the AAOS Annual Meeting. Subsequent trainings will be held throughout the year.
About the Certification Program
AAOS will maintain a database of AAOS-certified Disaster Responders, as well as a page on the Academy's website with pertinent and ongoing program updates.
Three types of "Orthopaedic Responder" certifications are available, each requiring specific training and experience, and either civilian surgeon volunteer or temporary government employee credentials.
- Trauma-Trained Surge Responders ("Responder I") have extensive trauma experience and upon completing training are certified to immediately deploy to a disaster site.
- Acute Phase Responders ("Responder II") are certified to immediately deploy to a disaster site.
- Sustaining Phase Responders ("Responder III) are surgeons who may or may not have significant trauma experience, who arrive during the reconstruction/maintenance phase of a disaster.
Two Other Sessions at the AAOS' Annual Meeting Address Disaster Preparedness
First, a general session on Tuesday, Feb. 7, entitled "Disaster Response Orthopaedics: Pearls from the Frontline," featured a panel discussion with five orthopaedic surgeons who have treated patients in Haiti, Afghanistan, on U.S. medical ships, and in other countries devastated by war or disaster. Discussions will center upon how to prepare, work with and build an orthopaedic team, as well as how to anticipate and overcome challenges of orthopaedic care in countries that often are chaotic, devastated and without appropriate medical equipment.
"We're sharing what we've learned through our experiences," said Col. Tad L. Gerlinger, MD, the session moderator and an orthopaedic surgeon at San Antonio Military Medical Center, Fort Sam Houston ,Texas, "and to give other orthopaedic surgeons, who might be interested in volunteering their time, a taste of what to expect. We hope the discussion, sparks an interest in disaster care."
Dr. Gerlinger said "one of the most rewarding things we do when we go to these countries is to take care of injured civilians, and to train the local surgeons in their hospitals."
After the Crisis
In the second session, Improving Orthopaedic Care Delivery at a Referral Hospital in Haiti: The Legacy of the 2010 Earthquake, presented February 10, authors will report the findings of a study on the long-term positive effects of international orthopaedic assistance during and immediately following the Earthquake in Haiti.
Investigators reviewed operating room records at a hospital approximately one hour outside of Port au Prince, the epicenter of the earthquake, during the 16 weeks that preceded the Haitian earthquake in 2010, as well as patient records from the 15 weeks that followed, to compare patient procedures and care.
"With any kind of disaster, especially an earthquake-related disaster, there's going to be a lot of orthopaedic injuries," said lead investigator Charles S. Day, MD, MBA, chief of the Division of Hand and Upper Extremity Surgery in the Department of Orthopaedic Surgery at Beth Israel Deaconess Medical Center in Boston, and associate professor of orthopaedics at Harvard Medical School. "The number of major orthopaedic procedures jumped from 10 to 455 immediately following the earthquake."
In the disaster response to the earthquake, visiting orthopaedic surgeons aided and trained the Haitian surgeons in a broad range of techniques and care. These clinicians are now "providing orthopaedic care for the local community; care that wasn't available before the earthquake. We were able to provide care, and impact future care in that region."
Additionally, the authors report:
- During the 31-week study period, 465 orthopaedic surgeries were performed (2 percent pre-earthquake and 98 percent post-earthquake).
- After the quake, only 10 percent of the orthopaedic surgeries were amputations.
- Patients treated after the earthquake were significantly older than patients treated prior to the earthquake (average age 61 versus 25).
- There also were significantly fewer patients diagnosed with gangrene (due to lack of blood flow to an extremity) post-earthquake (5.3 percent post earthquake versus 60 pre-earthquake).
Prior to the earthquake, the only orthopaedic surgeries conducted at this hospital were amputations, said investigator Thierry Pauyo, MD, a resident at McGill University. "In the developing world, manual labor is, for the majority of people, the only way to survive. Amputation as the sole treatment for musculoskeletal injury is simply unacceptable. If you lose a limb, you can't work; it affects the entire family you are providing for."