Although no one can predict the next terror attack or natural disaster, when a crisis does strike, the demand for orthopaedic care will be inevitable. And, as shown in the orthopaedic response to the Haitian earthquake in 2009 or the Joplin, Mo., tornado in 2011, humanitarian volunteers are always at the ready.

Do no harm
Austere environments present a unique set of demands that are typically not seen in civilian settings. According to Dr. Tokish, “Training is critical to effectively managing mass casualties and preventing patient harm in these challenging situations.”

In his presentation, Dr. Tokish highlighted several education opportunities available to surgeons who want to become disaster-response trained, including the following:

• Pathways to Preparedness, a program provided by AAOS and the Orthopaedic Trauma Association
• Trauma Care Toolbox, provided by SOMOS, Stryker, and DT MedSurg, LLC
• SOMOS Disaster Preparedness Response Course

Receiving proper trauma training will expose surgeon volunteers to the complexity of wounds and the unique challenges they will face during such a mission. In addition, it will also help to build the necessary cadre of trauma-trained surgeons that is integral to ensuring disaster readiness at home and abroad.

Don’t go alone
Once trained, surgeons must be prepared for the arduous but rewarding journey ahead. In his remarks, Dr. Berrey, who volunteered his services in Haiti, illustrated key steps that every surgeon should take prior to his or her departure.

“The number one mistake in volunteering overseas is going alone,” said Dr. Berrey. “You waste your time and the time of others when you go at it alone. Not being a part of a team just contributes to the chaos.”

Collaborating with organizations such as the International Red Cross or Red Crescent, the U.S. military, or a local nonprofit organization that is already involved overseas will help ensure that your skills are appropriately utilized. More importantly, being part of a group guarantees that volunteers have access to food, equipment, and safe housing.

He also encouraged individuals to do a “personal assessment” and to investigate any special requirements they must meet for the destination country. These include issues such as immunizations, other documents, and unique materials, such as mosquito nets, that would be helpful to have before leaving on their mission.

Do be a team player
Delivering orthopaedic care in an austere environment is certainly an “all-hands-on-deck” situation. However, those hands must be organized to maximize efficiency. According to Dr. Berrey, assigning a team leader, defining tasks, holding daily meetings, and using checklists will facilitate the communication and organization that is critical to a successful mission.

Dr. Berrey also emphasized the importance of humility within a team. “Recognize your strengths and weaknesses…it is important to give suggestions but it is just as important that you be willing to accept the plan.”

According to Dr. Covey, collaborating with nongovernmental organizations (NGOs) and intergovernmental organizations (IGOs) stationed in a country is also important. Training and working with these organizations will help break language and culture barriers that volunteers often face and ensure that a qualified follow-up team remains in place when volunteers depart.

Don’t overcomplicate
Rudimentary facilities and limited resources in austere environments are major obstacles to providing optimal care. To maximize survival of the most patients, physicians are often forced to perform rapid and effective triage.

“These decisions are difficult, but they have to be made,” said Dr. Hayda. “Improper triage will do more harm and cost more lives.”

Being able to think outside the box and deviate from standard practice is also essential. Both Dr. Hayda and Dr. Provencher reviewed some “in-a-pinch” remedies, including Dakin’s solution, granulated sugar dressings, skin glue, and absorbable sutures that can be used when advanced therapy methods are unavailable.

In a disaster response scenario, they noted, it is vital to focus on restoring a patient to a sustainable level of function that will yield the least amount of harm. According to Dr. Hayda, when volunteers are faced with limited resources and tools, simplicity is the key.

“If a procedure involves numerous follow-ups and several specialties, don’t do it,” he said. “Do what will work in the environment you’re in.”

For more information about volunteering for disaster relief efforts and requirements for registering to serve through the National Disaster Medical System, see the links below or email disasterprep@aaos.org

Madeleine Lovette is the communications specialist in the AAOS office of government relations; she can be reached at lovette@aaos.org

Additional Information:
AAOS approves disaster preparedness plan

Course prepares members for disaster service

Disaster Preparedness Project Team