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Published 8/1/2011
Christopher T. Born, MD; David Teuscher, MD; Lynne Dowling

AAOS approves disaster preparedness plan

Education, credentialing process established

Earthquakes in Haiti and Chile, a tsunami in Japan, and a tornado in Missouri—these natural disasters result in multiple orthopaedic injuries. And when such disasters occur, AAOS members are always more than willing to help.

The 2010 Haitian earthquake, for example, triggered an unparalleled response from AAOS members. More than 500 fellows traveled to the devastated island as volunteers. Although that initiative was largely a success, both the AAOS and the Orthopaedic Trauma Association (OTA) realized that not all volunteers were adequately prepared or knew what to expect and how to cope in such an austere environment.

In their haste to help, some volunteers traveled alone, without an affiliation or pre-arranged mission through established networks. They arrived in Haiti without personal security, shelter, food, equipment, or an assignment. Some turned around and flew home; others stayed, but were frustrated with their inability to help or to connect with aid groups on the ground. Even volunteers who were connected faced “red tape” issues that delayed the delivery and availability of skilled assistance.

For example, the USNS Comfort hospital ship was desperate for civilian, trauma-trained orthopaedic surgeons to bolster their beleaguered ranks of orthopaedic personnel. But the lack of a pre-existing Memorandum of Understanding between the OTA and the US Navy delayed the process; ultimately, OTA had to assume all liability so that its members could serve aboard the floating hospital.

From project team to plan
These situations, plus concern for the safety and welfare of member volunteers during disaster service, prompted the AAOS and OTA boards of directors to establish a joint Haiti Relief and Disaster Preparedness Project Team. The two organizations agreed it was essential to have a more organized approach to disaster response for future events, including appropriate medical, disability, and liability protection for volunteers.

In June 2011, the project team presented its plan to the AAOS Board of Directors, which voted its approval. The Disaster Preparedness Plan outlines a training and certification program for members, enabling them to qualify as AAOS-registered Disaster Responders. Qualified volunteers will be included in an AAOS database of ready responders for future disasters.

The plan focuses on the pathways and requirements for AAOS fellows to become disaster-response–trained, certified, and credentialed (Fig.1). It calls for three types of responders. Type I responders are trauma-trained surge responders, designated for immediate deployment. Type II responders are acute phase responders, who can be deployed in the aftermath of the disaster. Type III responders would be deployed during the reconstruction/maintenance phase.

Two credentialing pathway options—one for civilian surgeon volunteers providing service through nongovernmental healthcare aid organizations and one for volunteers providing service as temporary government employees through a branch of the U.S. military—are included. Federal precredentialing through the Departments of Defense (DoD) or Health and Human Services (HHS) National Disaster Medical System is significantly more complex and difficult to attain; project team members are continuing to work with both the DoD and HHS to streamline and simplify civilian credentialing.

Due to the complexity of certification and credentialing required for Type I responders, it is anticipated that most interested AAOS members will elect to train and certify as Type II or Type III responders.

Disaster response course
As part of the training requirements, AAOS and OTA have partnered with the Society of Military Orthopaedic Surgeons (SOMOS) to develop a Disaster Response Course for interested members. Based on the SOMOS Extremity War Injuries course, the course goes beyond core combat care to apply techniques appropriate for austere environments.

The plan also calls for a dedicated disaster preparedness information section on the AAOS website and a tracking and reporting mechanism to help members track continuing medical education credits associated with disaster training, as they meet qualifications for recognition as AAOS-registered responders.

AAOS members who already have completed some required disaster training and would like to begin tracking their progress should contact the AAOS international department staff at aaos-international@aaos.org

AAOS members who may already have federal or military training and are credentialed through those organizations may be eligible for waivers of some or all of the training prerequisites. The AAOS international department staff can help these members determine their status.

Disclosure information: Dr. Born—Stryker; Illuminoss; Biointraface; Journal of the AAOS; Clinical Orthopaedics and Related Research; Journal of Orthopaedic Trauma; Journal of Trauma; Dr. Teuscher—No conflicts

Christopher T. Born, MD, and David Teuscher, MD, cochaired the AAOS-OTA Disaster Preparedness Project Team. Lynne Dowling is the director of the AAOS international department.

The AAOS-OTA Disaster Preparedness Project Team
Members of the project team included representatives from AAOS, OTA, and SOMOS. Invited consultants to the team included members of SOMOS and a representative of the International Medical Corps, one of the four nongovernmental organizations that received Haiti relief donation funding from AAOS.

Christopher T. Born, MD, and David Teuscher, MD, cochaired the project team. Other team members included David S. Feldman, MD; Roman Hayda, MD; David Teague, MD; David Templeman, MD; Lt. Col. John Tokish, MD; and Kaye Wilkins, MD. Lynne Dowling, director of the AAOS international department, and Kathleen Caswell, OTA society director, served as staff liaisons. Col. James Ficke, MD; Lt. Col. Warren Kadrmas, MD; Todd Ulmer, MD; and Agron Ferati, of the International Medical Corps, served as consultants.