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Medical personnel triage a patient aboard the USS Bataan.
Courtesy of V. Franklin Sechriest II, MD

AAOS Now

Published 3/1/2013
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Jennie McKee

U.S. Navy Provides Life-Saving Care after Disasters

Military, civilian surgeons deploy together to treat patients

U.S. Navy medical ships were vital centers for disaster relief efforts after the devastating earthquakes that struck Indonesia in 2004 and 2005. Medical staff aboard these vessels also provided care to those affected by the massive earthquake that rocked Haiti in 2010. With many land-based hospitals out of commission, the medical facilities and staff members aboard these ships were key in saving the lives of critically injured patients in the aftermath of these disasters.

V. Franklin Sechriest II, MD, of the Orthopaedic Medical Group of San Diego, served in the U.S. Navy for 7 years and is a veteran of four humanitarian aid/disaster relief missions aboard U.S. Navy ships. His article about ship-borne medical assistance provided by the U.S. Navy appeared in the American Journal of Disaster Medicine (Fall 2012).

AAOS Now recently interviewed Dr. Sechriest, who is currently serving in the U.S. Navy Individual Ready Reserve, and two of his coauthors—Vern Wing, MS, and Michael Galarneau, MS, NREMT—both of the Naval Health Research Center in San Diego, to learn more about the study and the musculoskeletal injuries treated by civilian and military crew members during these missions.

AAOS Now: Can you provide some background on why you conducted this study?

Dr. Sechriest: In all three of the disasters studied, a combined military/civilian crew was deployed to a natural disaster area. We wanted to analyze and compare the missions to better shape future operations based on lessons learned.

AAOS Now: What kind of data did you collect?

Dr. Sechriest: For this study, we relied heavily on surgical records and logs to obtain consistent, comprehensive data on the kinds of injuries and conditions treated, as well as patient demographics.

Mr. Galarneau: Data from these missions are very valuable in improving processes; they also serve as a historical record to help develop models and simulations to prepare for future missions.

Mr. Wing: To respond appropriately, we need to know the likely occurrence of patient conditions. Dr. Sechriest’s data provide excellent visibility into that distribution in the orthopaedic arena.

AAOS Now: U.S. Navy hospital ships responded to the first two disasters, while a hospital ship as well as a Casualty Receiving and Treatment Ship (CRTS) responded to the disaster in Haiti. How different are these vessels?

Dr. Sechriest: We refer to ships in terms of “echelons of care.” Echelon I is a battle aid station, while Echelon II is a forward surgical hospital. Echelon III is a combat/surgical hospital.

The USS Bataan, which is the CRTS that responded to the disaster in Haiti, is an Echelon II vessel. Compared to a hospital ship, it has more limited medical facilities, including fewer operating rooms. Medical staff members aboard a CRTS can provide urgent medical and surgical care, but routinely triage and transfer severely injured patients to a facility with a higher echelon of care. On the USS Bataan, urgent care—including life- and limb-saving procedures—was provided. Patients were stabilized and, where appropriate, transferred to the hospital ship USNS Comfort, an Echelon III, 1,000-bed medical treatment facility, which was off the coast of Port-au-Prince.

AAOS Now: Overall, what were the most common injuries?

Dr. Sechriest: Earthquakes are what I call epidemics of orthopaedic injuries. These disasters involve falling debris, which leads to crush injuries. According to the mission data from the three earthquake relief missions using U.S. Navy ships in Indonesia and Haiti, approximately 50 percent of disaster-related diagnoses encountered aboard hospital ships were fractures. Furthermore, our data suggest approximately half of these fractures were “open,” associated with significant soft tissue injury. The orthopaedic care provided on hospital ships, including fluoroscopy, digital radiography, computed tomography scans, and advanced surgical treatment, with internal fixation and complex wound care, is highly valued.

In the nations where these natural disasters occurred, it’s important to note that everyday orthopaedic care is not well-established. So, when an earthquake hits, the lack of medical infrastructure is magnified greatly. The limited healthcare resources mean that the need for basic medical care is always present. In orthopaedics, that means treating tumors, deformities, neglected fractures, and trauma injuries not caused by the disaster.

Beyond orthopaedists, other specialists were also engaged in these missions, treating typical emergency department-type injuries. Patients were often escorted by a family member, who might require care as well. Two of the premier services provided are dental and optometry care. Thousands of pairs of eyeglasses are created during these missions for people in need.

These ships serve as referral centers or tertiary care centers. They augment care provided by the forward surgical hospitals and tent hospitals that have already been established on land.

Mr. Wing: Because patients with more serious conditions are triaged and transferred from a CRTS to a hospital ship, the patient distribution aboard hospital ships is heavily skewed toward patients who need orthopaedic care.

AAOS Now: What did you find regarding patient demographics?

Dr. Sechriest: A good understanding of patient demographics is important because it dictates the kind of medical expertise needed during these missions. In the Indonesian and Haiti missions, roughly one-third of the patients were children, who have unique physiological and psychological attributes that make them particularly vulnerable after a natural disaster. From an orthopaedic standpoint, surgical treatment of children requires specialized equipment, such as pediatric IVs, endotracheal tubes, and implants.

On the other end of the spectrum, a small but distinct percentage of patients—around 5 percent—were elderly. Like the pediatric population, this population has different needs and medical profiles than the normal population served by Navy ships, and may require expertise not routinely available on a typical combat-related mission.

AAOS Now: How can the study results be applied to future missions?

Dr. Sechriest: The Navy is always looking to improve its response to disasters. This study evaluated what each mission accomplished and analyzed how it might be better. A key finding was how equipment and personnel must be configured to meet the goals of future disaster relief missions.

These ships are well-staffed and well-supplied for their main combat support medical mission, but when it comes to disaster relief, flexibility is key. This evidence-based analysis can improve what is already an outstanding contribution regarding disaster relief. Our data identify areas for potential improvement—the staff members who will be needed most urgently and the types of equipment and supplies that will be needed, based on where the mission is, how long it will take to arrive at the destination, and how long the mission will last.

AAOS Now: You also call for continued assistance from civilian medical personnel and other organizations to respond to disasters. In your experience, why is their assistance so vital?

Dr. Sechriest: Civilians from nongovernmental organizations (NGOs), many of whom may be former military, often have expertise in humanitarian aid and disaster relief operations. Civilian medical personnel from these independent relief agencies can provide critical subspecialty care and wisdom.

In Banda Aceh, Indonesia, I was partnered with one of my coauthors, David W. Lhowe, MD, an orthopaedic traumatologist and veteran of numerous humanitarian aid and disaster relief operations. Dr. Lhowe was affiliated with Project Hope, which was the first NGO whose members served aboard a U.S. Navy vessel. These volunteers have served thus far as critical force multipliers and outstanding medical colleagues. Based on the evidence from these missions, this model works well and should continue.

AAOS Now: What else do you want orthopaedists and others to take away from your study?

Dr. Sechriest: You don’t have to be a member of the military to contribute to these missions. The combined military/civilian paradigm for these operations clearly works well and will continue to be successful. Avenues for civilian orthopaedic surgeons and other physicians to join these missions have been and are currently being developed.

In Haiti, for example, members of the Orthopaedic Trauma Association (OTA) provided surgical support. Orthopaedists can contact the OTA online at www.ota.org or the AAOS online at www.aaos.org to find opportunities to help in humanitarian and disaster relief efforts. They can also find information about participating in a humanitarian assistance or disaster relief mission with the U.S. Navy by visiting www.med.navy.mil/sites/usnsmercy or www.comfort.navy.mil

Additional coauthors of “Healthcare Delivery Aboard U.S. Navy Hospital Ships Following Earthquake Disasters: Implications for Future Disaster Relief Missions” include G. Jay Walker, BA; Maureen Aubuchon, BS; and David W. Lhowe, MD.

Disclosure information: Dr. Sechriest, Mr. Wing, Mr. Galarneau, and Dr. Lhowe—no conflicts. Mr. Walker, Ms. Aubuchon—no information available.

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org

Disaster preparedness
The AAOS, together with the Orthopaedic Trauma Association and the Society of Military Orthopaedic Surgeons, has developed a comprehensive disaster preparedness plan to enable an effective and efficient volunteer response when a disaster strikes and the orthopaedic community is called upon to help. For more information, visit
www.aaos.org/disaster