Surgical Support & Surgical Interventions:          2010 Haiti Earthquake           David L. Helfet, M.D.        Emergency...
Hispaniola —            Background              • Native Taino Amerindians                → Discovered/Columbus 1492      ...
Haiti —            Background              • Statistics                  – Haiti is the poorest country in the Western Hem...
Haiti —            2010 Earthquake              • 7.0 Magnitude Earthquake → January 12, 2010 (16:53 local time)          ...
Presidential PalaceOrthopaedic Trauma Service   Port-au-Prince Cathedral
Haiti Medical Relief —            Planning & Logistics              • David L. Helfet M.D.                   — Team Leader...
Haiti Medical Relief —                • David L. Helfet, M.D. (Team Leader)                       – 3 Orthopaedic Trauma F...
Haiti Medical Relief —            Donated Supplies                             • Synthes                                – ...
Haiti Medical Relief TeamOrthopaedic Trauma Service
Air Transportation:                             Provided by SynthesOrthopaedic Trauma Service
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Hopital de la Communaute Haitienne                                (Community Hospital of Haiti)Orthopaedic Trauma Service
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Amputations —                             •   AKA        2                             •   BKA       19                   ...
Orthopaedic Trauma Service
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External Fixation —                             •   Humerus         3                             •   Elbow           1   ...
Orthopaedic Trauma Service
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Haiti —            2010 Earthquake Revisted            • Two years later               – Cholera epidemic still threatens ...
Haiti —            2010 Earthquake                  – 5% rubble cleared; 15% of required temporary housing built          ...
“ Partnered disaster preparedness:              Lessons learned from international events”             • Military, governm...
Our Scenario ─                             • MISSION WAS SUCCESSFUL!                               → There was a significa...
DISASTER’S                   FAILING TO PLAN is a                   PLAN TO FAIL!”Orthopaedic Trauma Service
“The value of a man resides in              what he gives and not in what                   he is capable of receiving.”Or...
Orthopaedic Trauma Service                             Lorich, Jeffcoat, MacIntyre, Chan, Helfet, Tech Hand Up Extrem Surg...
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Surgical Support & Surgical Interventions: 2010 Haiti Earthquake

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Emergency Surgery Workshop Davos 2011: Presentation by David L. Helfet, MD

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Transcript of "Surgical Support & Surgical Interventions: 2010 Haiti Earthquake"

  1. 1. Surgical Support & Surgical Interventions: 2010 Haiti Earthquake David L. Helfet, M.D. Emergency Surgery Workshop AO Foundation Davos, 2011
  2. 2. Hispaniola — Background • Native Taino Amerindians → Discovered/Columbus 1492 – Virtually annihilated by Spanish settlers in 25 years – French established presence (early 17th century) – Spain ceded western ⅓ of the island to the French (Later became Haiti) – The French colony, based on forestry & sugar-related industries, became one of the wealthiest in the Caribbean (reliance on African slaves & environmental degradation) – Haitis nearly half million slaves revolted under Toussaint LOuverture (Late 18th century) – Became 1st black republic to declare independence (1804)Orthopaedic Trauma Service
  3. 3. Haiti — Background • Statistics – Haiti is the poorest country in the Western Hemisphere (80% population below poverty line & 54% in abject poverty) – Most densely populated country in Western Hemisphere; population density in 2002 was 254 per sq km – Plagued by political violence for most of its history – Armed rebellion and forced resignation/exile of President Jean-Bertrand Aristide (2004) – Interim government took office to organize new elections under the auspices of the UN – Continued violence & technical delays prompted repeated postponements, but Haiti finally inaugurated elected president & parliament (2006)Orthopaedic Trauma Service
  4. 4. Haiti — 2010 Earthquake • 7.0 Magnitude Earthquake → January 12, 2010 (16:53 local time) – Epicentered near large population center at ~15 km southwest of the capital, Port-au-Prince (Depth 13 kilometers / 8.1 miles) – ~2 million within zone of heavy-moderate structural damage – Assessed as worst earthquake in region over last 200 years – ~52 aftershocks >4.5 magnitude – Damage ‘magnified’ lack of building codes & zoning restrictions flimsy multistory buildings on unstable hillsides → 217,000 - 316,000 people dead; 300,000 injured – Including aid workers and embassy staff → 1,000,000 – 1,800,000 homeless → 250,000 residences & 30,000 commercial buildings collapsed or severely damagedOrthopaedic Trauma Service
  5. 5. Presidential PalaceOrthopaedic Trauma Service Port-au-Prince Cathedral
  6. 6. Haiti Medical Relief — Planning & Logistics • David L. Helfet M.D. — Team Leader • Contacted key leaders → Government, outreach/ NGO’s, corporate sector — Hospital for Special Surgery — New York Presbyterian Hospital — Synthes Global — William J. Clinton Foundation — Partners in Health (PIH) / Stand with Haiti — NYC Office of Emergency Management — NYPD / NYFDOrthopaedic Trauma Service
  7. 7. Haiti Medical Relief — • David L. Helfet, M.D. (Team Leader) – 3 Orthopaedic Trauma Fellows – 3 Orthopaedic Attendings – 2 Anesthesiologists – 1 General Trauma Surgeon – 2 nurses/ 1 Nurse Practitioner – 2 scrub techs – Synthes – Provision of air transport – Donated mission supplies / power equipment (& supplies USNS Comfort) – HSS & NYP Hospitals – Donated soft goods & disposablesOrthopaedic Trauma Service
  8. 8. Haiti Medical Relief — Donated Supplies • Synthes – Ex-fix equipment; large & small (Enough for 150 trauma frames) – Battery-operated power equipment – Large & small fragment sets – Intramedullary nails – Basic fracture tools & reduction clamps • Hospital for Special Surgery/ NY Presbyterian Hospital – Saline – Pulse lavages – Anesthesia and related supplies – OR soft goods & disposablesOrthopaedic Trauma Service
  9. 9. Haiti Medical Relief TeamOrthopaedic Trauma Service
  10. 10. Air Transportation: Provided by SynthesOrthopaedic Trauma Service
  11. 11. Orthopaedic Trauma Service
  12. 12. Orthopaedic Trauma Service
  13. 13. Orthopaedic Trauma Service
  14. 14. Orthopaedic Trauma Service
  15. 15. Orthopaedic Trauma Service
  16. 16. Orthopaedic Trauma Service
  17. 17. Orthopaedic Trauma Service
  18. 18. Orthopaedic Trauma Service
  19. 19. Hopital de la Communaute Haitienne (Community Hospital of Haiti)Orthopaedic Trauma Service
  20. 20. Orthopaedic Trauma Service
  21. 21. Orthopaedic Trauma Service
  22. 22. Orthopaedic Trauma Service
  23. 23. Orthopaedic Trauma Service
  24. 24. Orthopaedic Trauma Service
  25. 25. Orthopaedic Trauma Service
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  27. 27. Orthopaedic Trauma Service
  28. 28. Orthopaedic Trauma Service
  29. 29. Orthopaedic Trauma Service
  30. 30. Orthopaedic Trauma Service
  31. 31. Orthopaedic Trauma Service
  32. 32. Orthopaedic Trauma Service
  33. 33. Amputations — • AKA 2 • BKA 19 • Forearm 3 • Feet 4 28Orthopaedic Trauma Service
  34. 34. Orthopaedic Trauma Service
  35. 35. Orthopaedic Trauma Service
  36. 36. Orthopaedic Trauma Service
  37. 37. Orthopaedic Trauma Service
  38. 38. Orthopaedic Trauma Service
  39. 39. Orthopaedic Trauma Service
  40. 40. Orthopaedic Trauma Service
  41. 41. External Fixation — • Humerus 3 • Elbow 1 • Radius 4 • Pelvis 1 • Femoral Neck 1 • Femur 23 • Tibia 32 • Pilon/Ankle 4 69Orthopaedic Trauma Service
  42. 42. Orthopaedic Trauma Service
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  44. 44. Orthopaedic Trauma Service
  45. 45. Orthopaedic Trauma Service
  46. 46. Orthopaedic Trauma Service
  47. 47. Orthopaedic Trauma Service
  48. 48. Haiti — 2010 Earthquake Revisted • Two years later – Cholera epidemic still threatens Haitian population – Measures to prevent spread ineffective – Clean water / improved sanitation systems desperately needed – To date 465,000 stricken, 6500 dead – Lack of leadership from Haitian government – $1.4 billion donated by US (essentially relying on ‘blind trust) Only 38% designated to help survivors – Infrastructure destroyed including presidential palace – Incompetence & corruption remain – Gang violence & sexual attacks in camps is pervasive – State Department report details widespread corruption in all branches of government in Haiti; only 7 of 180 countries have a worse ranking then HaitiOrthopaedic Trauma Service US Institute for Peace / UN Childrens Fund, 2010 Refugees International, 2010
  49. 49. Haiti — 2010 Earthquake – 5% rubble cleared; 15% of required temporary housing built – Aid agencies “ineffective and inexperienced” • Lessons learned – 4 phases to Emergency Preparedeness (EP) Mitigation / prevention, preparedness, response, & recovery – Periods of normalcy Best times to develop disaster preparedness plans Proactive intervention by international community to all phases of EP in developing countries, including in mitigation / preparedness, not just response and recovery! Should be minimum standard of preparedness every country has to maintain and international assistance to achieve itOrthopaedic Trauma Service Benjamin E, Bassily Marcus AM, Mount Sinai J Med, 2011 United Nations Childrens Fund, 2010
  50. 50. “ Partnered disaster preparedness: Lessons learned from international events” • Military, governmental, & civilian agencies routinely respond to worldwide disasters, including large-scale mass casualty events Examples include Pakistan earthquake (2005), US Hurricane Katrina (2005), Haiti earthquake (2010) • Lessons Learned… – Potential exists for improved coordination of medical response between civilian & military sectors And for the creation of a planned & practiced interface – Disaster preparedness could be enhanced with More robust disaster education for civilian responders Database of pre-credentialed, pre-certified medical specialists Implementation of a communication bridge Establishment of agreements between military & civilian medical/surgical groups prior to major catastrophic eventsOrthopaedic Trauma Service Born, Cullinson, Dean, Hayda, McSwain, Riddles, Shimkus J AAOS, 2011
  51. 51. Our Scenario ─ • MISSION WAS SUCCESSFUL! → There was a significant need! – Patients – Triaged 500 – Successfully Surgically Treated 100 – No easy access to Haiti despite proximity (From US; 710 miles, 1142 kilometers) – No command structure operational support – No local security presence – No supplies / supply line – No basic infrastructure → MISSION INCOMPLETE! HAD to LEAVE after 5 DaysOrthopaedic Trauma Service
  52. 52. DISASTER’S FAILING TO PLAN is a PLAN TO FAIL!”Orthopaedic Trauma Service
  53. 53. “The value of a man resides in what he gives and not in what he is capable of receiving.”Orthopaedic Trauma Service Albert Einstein (1879-1955)
  54. 54. Orthopaedic Trauma Service Lorich, Jeffcoat, MacIntyre, Chan, Helfet, Tech Hand Up Extrem Surg, 2010 MacIntyre, Jeffcoat, Chan, Lorich, Helfet, Am J Orthop, 2010

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