Orthopaedic surgeons responded overwhelmingly to the humanitarian need in Haiti resulting from the devastating earthquake that rocked the capital city of Port-au-Prince on Jan. 12, 2010. Within the first 48 hours, hundreds of AAOS fellows had contacted the Academy about volunteering, and scores more were working directly through their own institutions or local disaster aid organizations to organize medical missions. Fellows like Scott C. Nelson, MD, who happened to be in Haiti when the quake occurred, reacted quickly to provide emergency surgeries.

Responding to the crisis, AAOS President Joseph D. Zuckerman, MD, pledged, “The AAOS will provide whatever support we can to assist in the relief efforts.” Although the Academy did not have an operational disaster-response mechanism, staff quickly established a coordinating team. Calls from volunteers were logged in, aid agencies identified, transportation and storage facilities located, outreach to U.S. and international government agencies initiated, lines of communication established, needs identified, and links to resources connected.

“The sheer volume of everything that had to be learned and managed quickly was incredible,” said Lynne Dowling, director of the AAOS international department. But within 48 hours, many details had been addressed and relief efforts were underway.

Top priority
Coordinating aid in the wake of a natural disaster is a complex undertaking that presents innumerable challenges. Conditions in Haiti—the poorest country in the hemisphere—exacerbated these challenges. Despite the difficulties, AAOS members and staff worked tirelessly to help get orthopaedic surgeons and medical supplies to the people of Haiti as quickly as possible.

The AAOS “key contacts” program was used to encourage the U.S. government to give higher prioritization to orthopaedic organizations, such as Operation Walk/Haiti and SIGN (the Surgical Implant Generation Network), and to orthopaedic surgeons with experience dealing with disasters and traumatic injuries. Within the first week after the quake, Academy staff processed more than 100 volunteer applications for member travel to Haiti under the auspices of several established disaster relief and medical aid groups. Within a month, nearly 600 members had volunteered, and more than 300 had been deployed, including many from specialty societies such as the Orthopaedic Trauma Association and the Pediatric Orthopaedic Society of North America.

“The response to this disaster from our members has been outstanding, and the depth of their compassion and caring is remarkable,” said AAOS CEO Karen Hackett.

In any disaster, communication is key to a coordinated response. A series of daily updates—many from Dr. Zuckerman—kept members informed about the situation on the ground, provided tips for those planning to volunteer, and delivered “calls to action” when needed. In addition, the AAOS established a dedicated Web site to serve as a central resource and point of information.

Members in action
As reports of injuries—including crush injury compartment syndromes, extremity fractures (most open and many complicated by the presence of compartment syndrome), pelvis fractures, spinal cord injuries, and more—began to trickle in from members already positioned in Haiti, AAOS efforts expanded to facilitate the transport of medical supplies and to educate those volunteering on what to expect.

Despite sporadic e-mail access, Jan Pieter Hommen, MD, managed to relay to his colleague, Carlos Lavernia, MD, Haiti’s urgent need for pediatric orthopaedic surgeons and equipment such as Gigli saws, vacuum-assisted closure wound dressings, tourniquets, antibiotics, anesthesia machines, endotrachael or laryngeal mask airway (LMA) equipment, lavage irrigation devices, miniature flouroscopy machines, and electrosurgery generators (Bovie® machines).

The Academy had already been working with industry to encourage much needed equipment donations. Dr. Lavernia offered the use of a large warehouse in Florida to house additional donations in preparation for transport to Haiti. As materials were gathered across the country, they were shipped to the Miami warehouse and stored until clearance into Haiti was granted.

In some areas, the earthquake left no hospitals standing. The lack of electricity and running water, a crumbling infrastructure, extremely limited healthcare facilities, and tropical diseases challenged volunteers. Without the use of proper equipment, physicians in Haiti were performing what Dr. Hommen referred to as “Civil War medicine.” It was clear that getting the right tools into the right hands would save lives and limbs, but nearly 2 weeks after the quake, essential supplies were still not reaching the doctors.

“We are in desperate need of supplies,” wrote Brian Parsley, MD, who arrived in Haiti Jan. 23. “We have an unbelievable team of expertise that is limited by the lack of supplies.”

Dr. Parsley’s was a familiar plight; orthopaedic surgeons had arrived before many healthcare facilities were established and before supplies had been shipped. As a result, they were treating patients in makeshift facilities with limited equipment. Dr. Hommen and his team performed more than 14 surgical procedures, including amputations, in 24 hours—without anesthesia machines, oxygen, tourniquets, power saws, or sterilization solution—in an “operating room” that consisted of two picnic tables.

As time passed, some members focused on bringing stabilized patients from Haiti to the United States for treatment and follow-up. Patients have been flown to Florida, Georgia, Illinois, New York, New Jersey, and Pennsylvania, among other states. The AAOS worked with staff at the Department of Health and Human Services to establish criteria and issue instructions to facilitate these efforts.

Long road to recovery
Although it is now nearly 2 months since the earthquake, the long-term need continues and orthopaedic surgeons are among those most vocal for change.

“The work in Haiti is just beginning,” wrote Dr. Parsley. “The need for hand, foot, trauma, and plastic surgeons will continue into the foreseeable future. The needs will then change to reconstructive trauma, infection management, and prosthetics.”

In addition, the lessons learned during the initial response efforts are being used to develop a blueprint for a more permanent disaster response plan by the Academy.

All too familiar with poverty and anguish, Haiti’s recent disasters, including four hurricanes in 2008, had already pushed it to the brink. But the tremendous outpouring of financial and humanitarian support in the wake of the earthquake represents a silver lining in Haiti’s latest tragedy. It is the opportunity for Haiti to rebuild its spirit along with its infrastructure to become a more resilient and independent nation. The recent and ongoing efforts of orthopaedic surgeons—and the AAOS—will certainly go a long way to making that hope a reality.

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org