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Critically Assessing the Haiti Earthquake Response and the Barriers to Quality Orthopaedic Care

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Although numerous authors have described surgical experiences following major disasters, little is known regarding the needs of and barriers to care faced by surgeons during such disasters.

Questions/purposes

We therefore (1) identified and compared recurrent interview themes essential to the disaster response following the 2010 Haiti earthquake; (2) determined the difference in reported disaster equipment management task difficulty between disaster-trained and untrained volunteers; and (3) approximated the quantity of various procedures performed.

Methods

We conducted 14 interviews with selected orthopaedic surgeon volunteers. We also invited the 504 members of the American Academy of Orthopaedic Surgeons (AAOS), who registered as Haiti earthquake volunteers, to complete an online survey; 174 (35%) completed the survey and 131 (26%) were present in Haiti during the 30 days after the earthquake. Recurrent interview themes were identified, quantified, and compared using Poisson regression analysis. The difference in disaster equipment management difficulty scores was determined with a Wilcoxon rank-sum test.

Results

Of 10 recurrent interview themes, group organization (31 occurrences) was mentioned much more often than all but two of the remaining nine themes. Compared with disaster-untrained respondents, equipment management tended to be less challenging for disaster-trained respondents. Transporting to the treatment site and security during storage at the site were less challenging (19.5% and 16.5% decreases, respectively). Revision surgeries, guillotine amputations, fasciotomies, and internal fixations, suggestive of inappropriate disaster care, were frequently reported.

Conclusions

Organizational and training barriers obstructed orthopaedic care delivery immediately after the Haiti earthquake. Disaster training and outcomes require further study to improve care in future catastrophes.

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Acknowledgments

We thank the Institute for Global Orthopaedics and Traumatology team including, Thomas Penoyar MD for his initial efforts in coordinating the study, Jesse Shantz MD for his guidance, David Tannenbaum for help with the data analysis, and Theodore Miclau III MD and Peter Trafton MD, for their manuscript revisions and advice.

Author information

Authors and Affiliations

  1. Weill Cornell Medical College, New York, NY, USA

    Daniel B. Sonshine BA

  2. Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA, USA

    Daniel B. Sonshine BA & Richard A. Gosselin MD, MSc, MPH, FRCS(C)

  3. Orthopaedic Trauma Institute, San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA

    Daniel B. Sonshine BA, Amber Caldwell BA, Richard A. Gosselin MD, MSc, MPH, FRCS(C) & R. Richard Coughlin MD, MSc

  4. Department of Orthopaedic Surgery and Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, San Francisco, CA, USA

    Amber Caldwell BA & R. Richard Coughlin MD, MSc

  5. School of Public Health at University of California, Berkeley, Berkeley, CA, USA

    Richard A. Gosselin MD, MSc, MPH, FRCS(C)

  6. Department of Orthopaedic Surgery, Brown University and Rhode Island Hospital, Providence, RI, USA

    Christopher T. Born MD

Authors
  1. Daniel B. Sonshine BA
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  2. Amber Caldwell BA
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  3. Richard A. Gosselin MD, MSc, MPH, FRCS(C)
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  5. R. Richard Coughlin MD, MSc
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Corresponding author

Correspondence to Daniel B. Sonshine BA.

Additional information

One of the authors (CTB) is a consultant for Stryker Orthopaedics (Mahwah, NJ, USA) and IlluminOss Medical, Inc (East Providence, RI, USA); owns stock from BioIntraface (Riverside, RI, USA) and IlluminOss; has received research funding from the Airlift Research Foundation (Pittsburgh, PA, USA) and the Stein-Bellet Foundation (Philadelphia, PA, USA); and has received research materials from Stryker Orthopaedics. The remaining authors certify that they, or a member of their immediate family, have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

All work was performed at the Orthopaedic Trauma Institute, San Francisco, CA, USA.

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Supplementary material 1 (DOC 761 kb)

Appendix 1. Interview questions for orthopaedic surgeon volunteers

Appendix 1. Interview questions for orthopaedic surgeon volunteers

(Expectations)

What were your predeployment expectations about your trip to Haiti?

What did you base your expectations on? (Previous experience? Peers’ experiences? What you read or heard about?)

(Preparedness)

How did you prepare yourself for departure?

What criteria did you use to identify what supplies or resources to bring?

If you brought a team, what criteria did you use to identify who to bring?

(On the Ground)

Describe the notable events, positive or negative, that occurred between your arrival and your first operation?

Who or what was serving as the “charge nurse” (ie, managing supplies, personnel, and patient flow) at the facility where you operated?

Who or what was serving as the overall command for how resources and personnel were distributed to various facilities?

(Reflections)

What would you change about your on-the-ground experience?

If not, why, or what would need to be different for you to volunteer?

What three things would you change if you could?

(Media)

Did you personally document your experience? (ie, social networking site, blog, emails?)

Was there a third-party public response associated with your experience? (ie, article published, social networking?)

  • Name (Optional): First Last

  • Email (Optional):

  • Practice type in the United States: University Faculty, Private Practice, US Military, Retired, Other

  • If you selected “other” from the previous question, please specify:

  • Affiliation while in Haiti: University, NGO, Governmental/Military, Other

  • Name of Affiliate Program:

  • Arrival date in Haiti: MM/ DD/ YYYY

  • Departure date from Haiti: MM/ DD/ YYYY

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Sonshine, D.B., Caldwell, A., Gosselin, R.A. et al. Critically Assessing the Haiti Earthquake Response and the Barriers to Quality Orthopaedic Care. Clin Orthop Relat Res 470, 2895–2904 (2012). https://doi.org/10.1007/s11999-012-2333-4

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  • DOI: https://doi.org/10.1007/s11999-012-2333-4

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