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AAOS Now

Published 10/1/2011
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Maureen Leahy

Course prepares members for disaster service

Disaster response course readies volunteers for relief efforts

In 2010, hundreds of AAOS members volunteered to help when a massive earthquake devastated Haiti. But many were shocked by what they saw when they arrived. The lessons learned from those experiences led to the formation of an AAOS–Orthopaedic Trauma Association (OTA) Disaster Preparedness Project Team and an AAOS Disaster Preparedness Plan, which was recently approved by the AAOS Board of Directors.

“The response to the earthquake was remarkable. At the same time, the on-the-ground reality was a traumatic experience for many of our members,” said AAOS President Daniel J. Berry, MD. “Some had never served or trained in an austere environment, some had never worked in alternative cultures with language and social interaction barriers, and many were unfamiliar with the complex medical ethics issues that often accompany these events.”

To better prepare AAOS volunteers for disaster service in the future, the AAOS and OTA partnered with the Society of Military Orthopaedic Surgeons (SOMOS) to develop a disaster response training course. The course is the first step in a formalized training, certification, and credentialing program for orthopaedic surgeon volunteers responding to disasters.

Created by SOMOS and modeled after its Extremity War Injuries course, the AAOS/OTA/SOMOS Disaster Response Course (DRC) is geared specifically to civilian orthopaedic surgeons. The 2-day, highly interactive course is designed to provide orthopaedic surgeons with the knowledge and hands-on experience needed to work in austere environments during a disaster. Participants who complete and pass the DRC are eligible to be entered into the AAOS Disaster Preparedness Responder database.

“Having a database of prequalified, austere-environment disaster responders will enable us to more quickly connect AAOS volunteers with the respective government, military, or nongovernmental organizations that ask us for assistance,” said Dr. Berry. “Because all of the preliminary vetting will have been done and the insurance and liability issues will have been covered, we can ensure a much safer, more effective disaster response environment for our members. This is extremely important to us.”

Collaborative effort
The AAOS Disaster Preparedness Plan includes credentialing pathways for three types of responders serving in two phases of relief. Trauma-trained surge responders (Type I) and acute phase responders (Type II) are considered immediate-phase responders. Type III responders would be deployed in the sustained/reconstructive phase. Completion of the DRC is a training requirement for most Type I and Type II responders, and highly recommended for Type III responders. (See “AAOS approves disaster preparedness plan,” AAOS Now, August 2011).

Recognized by the U.S. Departments of Defense and Health and Human Services as a vital component of civilian physician disaster training, the DRC will be offered initially twice a year. The first DRC will take place on Dec. 16–17, 2011, during the SOMOS Annual Meeting in San Diego and will be repeated Feb. 6–7, 2012, during the AAOS Annual Meeting in San Francisco. COL Tad L. Gerlinger, MD, SOMOS first vice president, is the course director, and Christopher T. Born, MD, and Col (ret.) Theodore W. Parsons, MD, FACS, are the course’s co-directors. Together they have assembled an expert faculty composed of six OTA and 15 SOMOS members.

“People may not realize that the vast majority of surgery that military orthopaedic surgeons perform and the care that we provide in Iraq and Afghanistan is to the local population,” Dr. Gerlinger said. “We were very excited to collaborate with the AAOS and OTA to develop this course and to use our military experience in a way that benefits all the members of the AAOS.”

The basics and beyond
The DRC will include dynamic lectures and panels as well as cadaver learning components. The didactic component will be presented by orthopaedic surgeons who have served overseas in disaster and/or war zones. The cadaver lab will be conducted in an equipment-limited environment to simulate disaster conditions.

Sessions will include discussions about the spectrum and types of injuries orthopaedic surgeons will likely encounter during a disaster. For example, the session on crush injuries will address initial nonsurgical and surgical management of crush injuries and indications for fasciotomy and amputation. Other sessions will focus on the treatment of burns, compartment syndrome, axial skeleton injuries, and extremity vascular injuries.

“We’ll also talk about the challenges associated with treating more common injuries, such as open fractures and soft-tissue injuries, in an austere environment,” said Dr. Gerlinger. “Limited resources, postoperative care, and rehabilitation options will affect what you can and should safely do for patients with these injuries. You can’t treat them the same as if you were at a Level 1 trauma center.”

In addition, participants will learn about equipment and care limitations in the disaster setting, how to prepare a predisaster Relief Checklist, and how to organize and lead a team in a disaster environment. Cultural and ethical considerations of disaster care, patient care documentation, and medical logistics, including the fundamentals of safe transport, will also be explored.

On day two, participants will put what they have learned into practice in a cadaver lab. The course will cover a critical skills list that includes wound dressing/splinting in preparation for transport, wound débridement, fasciotomy, escharotomy, flaps, cut-down for vascular access, vascular stents, and Fogarty catheters.

“The participants will also place external fixators without power equipment and without the use of a C-arm,” said Dr. Gerlinger.

Upon completion of the DRC, participants should be able to meet the following goals:

  • Discuss personal and team preparation for deploying as a member of a disaster response team
  • Describe injuries commonly encountered in the disaster environment
  • Identify the challenges of caring for victims of disaster in the austere environment
  • Identify cultural and ethical considerations in caring for victims of disaster

“Development of the AAOS Disaster Preparedness Plan and AAOS/OTA/SOMOS Disaster Response Course has truly been an orthopaedic family effort and is another example of how the orthopaedic profession is leading the way,” said Dr. Berry. “The resounding orthopaedic nature of the Haiti disaster made us realize that future events that are orthopaedic–trauma intensive are likely. By being prepared ahead of time, we can have a much quicker, more effective response.”

The AAOS designates the AAOS/OTA/SOMOS Disaster Response Course for a maximum of 14.25 AMA PRA Category 1 Credits™

Registration for the AAOS/OTA/SOMOS Disaster Response Course in San Diego closes on Nov. 15, 2011. To register online, visit www.aaos.org/6808SD

Registration for the AAOS/OTA/SOMOS Disaster Response Course in San Francisco closes on Jan. 5, 2012. To register online, visit www.aaos.org/6808SF

For more information, email disasterprep@aaos.org

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