Members of an HHS-sponsored disaster relief team in Haiti treat an earthquake patient in a makeshift surgical tent.
Courtesy of Christopher T. Born, MD


Published 3/1/2010

Disasters offer lessons, opportunities

In response to recently published reports by orthopaedic surgeons who have responded to the disaster in Haiti, we would like to offer an alternative perspective.

Immediately following the earthquake on Jan. 12, 2010, there was a massive outpouring of medical response by orthopaedic practitioners in the United States. This was all well-intentioned and included privately funded individuals, ad hoc “teams,” and teams associated with established nongovernmental organizations.

Unfortunately, many of these individuals and ad hoc teams merely added to an already chaotic situation because of a lack of fundamental disaster education and preparedness. Examples include issues with security, accountability, inadequate provisions and equipment, and no plan for patient follow-up or for backfill by another team. All too frequently, there was evidenced an insensitivity to the [Haitian] people themselves and to the well-established organizations that have been on the ground for many years. They operated in a vacuum created by the chaos of the situation and compounded by the loss of a minimally existent infrastructure.

Prior lessons learned in the disaster medical community have shown that well-intentioned, highly educated individuals operating outside a well-coordinated response framework in the early chaos of a disaster will experience frustration and ineffectiveness. Untrained responders are subject to injury and even death, as evidenced by the loss of life in both the Oklahoma City bombing and 9/11 terrorist attack.

Even when well-equipped to do sophisticated surgical procedures, these individual responses cannot function without support that includes food, water, shelter, security, medical equipment, capacity for resupply, and the ability to manage patients in a medically safe environment with capacity for disposition. This requires planning, preparation, and training before a disaster occurs, not after. Organizations that are prepared in advance—whether volunteer or governmental—may appear to be less nimble but ultimately are more effective because of advance preparation, training, and systematic support.

The National Disaster Medical System (NDMS) of the Department of Health and Human Services (HHS) is one such example. It is capable of this response and is composed of disaster medical assistance teams (DMATs), disaster mortuary teams (DMORTs), and international medical and surgical urgent response teams (IMSuRTs). The HHS team response was activated within 24 hours of the quake. Between Jan. 17 and Feb. 2, these HHS-sponsored teams performed more than 100 surgeries and delivered more than 30 babies—in addition to seeing more than 24,500 patients, including approximately 1,300 on Feb. 1 alone. HHS is utilizing additional components of the NDMS to provide critical care to survivors within the United States.

Members of an HHS-sponsored disaster relief team in Haiti treat an earthquake patient in a makeshift surgical tent.
Courtesy of Christopher T. Born, MD
The cities most affected by the earthquake include Port-au-Prince, Carrefour, and Gressier, which were 40 percent to 50 percent destroyed; Jacmel (more than 50 percent destroyed); and Léogâne (nearly 90 percent destroyed)

A similar example of a coordinated response is occurring on the USNS Comfort where state-of-the-art medical and surgical care are being offered.

In the days following the earthquake, efforts put forth by the Orthopaedic Trauma Association (OTA) and the AAOS to backfill these coordinated responses has been remarkable and effective.

We suggest in the future that the days following a disaster are not the time to become first involved in these efforts. Those who wish to be involved should attend disaster management courses, become involved in disaster planning locally, and join NDMS. Disaster response has been the subject of Instructional Course Lectures and OTA forums. As stated recently on the AAOS Web site in summarizing the response:

“Conditions in Haiti or other disaster zones are extremely austere and constantly changing, and may best be handled by people with previous war time or disaster experience.”

Much remains to be done. The number of malunions, nonunions, and necessary reconstructions are large. We encourage members of the AAOS to become involved in this recovery/restoration period.

Christopher T. Born, MD
Providence, R.I.
John C. France, MD

Morgantown, W.Va.
James C. Krieg, MD

Mercer Island, Wash.
Mark P. McAndrew, MD

Springfield, Ill.
Keith O. Monchik, MD

Providence, R.I.

Editor’s note: The letter writers are all members of NDMS DMAT or IMSuRT teams who served in Haiti. For more on Haiti, see "Orthopaedic surgeons bring healing to Haiti".