Journal Article > CommentaryFull Text
PLOS Med. 2014 April 22; Volume 11 (Issue 4); DOI:10.1371/journal.pmed.1001632
Gerdin M, Clarke M, Allen C, Kayabu B, Summerskill W, et al.
PLOS Med. 2014 April 22; Volume 11 (Issue 4); DOI:10.1371/journal.pmed.1001632
Journal Article > ResearchFull Text
Disaster Med Public Health Prep. 2016 December 15; Volume 11 (Issue 3); 285-289.; DOI:10.1017/dmp.2016.135
Ali E, Ferir MC, Reid AJ, Gray H, van den Boogaard W, et al.
Disaster Med Public Health Prep. 2016 December 15; Volume 11 (Issue 3); 285-289.; DOI:10.1017/dmp.2016.135
OBJECTIVES
Typhoon Haiyan hit the Philippines in November 2013 and left a trail of destruction. As part of its emergency response, Médecins Sans Frontières distributed materials for reconstructing houses and boats as standardized kits to be shared between households. Community engagement was sought and communities were empowered in deciding how to make the distributions. We aimed to answer, Was this effective and what lessons were learned?
METHODS
A cross-sectional survey using a semi-structured questionnaire was conducted in May 2014 and included all community leaders and 269 households in 22 barangays (community administrative areas).
RESULTS
All houses were affected by the typhoon, of which 182 (68%) were totally damaged. All households reported having received and used the housing material. However, in 238 (88%) house repair was incomplete because the materials provided were insufficient or inappropriate for the required repairs.
CONCLUSION
This experience of emergency mass distribution of reconstruction or repair materials of houses and boats led by the local community was encouraging. The use of "standardized kits" resulted in equity issues, because households were subjected to variable degrees of damage. A possible way out is to follow up the emergency distribution with a needs assessment and a tailored distribution. (Disaster Med Public Health Preparedness. 2017;11:285-289).
Typhoon Haiyan hit the Philippines in November 2013 and left a trail of destruction. As part of its emergency response, Médecins Sans Frontières distributed materials for reconstructing houses and boats as standardized kits to be shared between households. Community engagement was sought and communities were empowered in deciding how to make the distributions. We aimed to answer, Was this effective and what lessons were learned?
METHODS
A cross-sectional survey using a semi-structured questionnaire was conducted in May 2014 and included all community leaders and 269 households in 22 barangays (community administrative areas).
RESULTS
All houses were affected by the typhoon, of which 182 (68%) were totally damaged. All households reported having received and used the housing material. However, in 238 (88%) house repair was incomplete because the materials provided were insufficient or inappropriate for the required repairs.
CONCLUSION
This experience of emergency mass distribution of reconstruction or repair materials of houses and boats led by the local community was encouraging. The use of "standardized kits" resulted in equity issues, because households were subjected to variable degrees of damage. A possible way out is to follow up the emergency distribution with a needs assessment and a tailored distribution. (Disaster Med Public Health Preparedness. 2017;11:285-289).
Journal Article > ResearchAbstract Only
Prehosp Disaster Med. 2014 January 15; Volume 29 (Issue 1); 21-26.; DOI:10.1017/S1049023X13009278
Teicher CL, Alberti KP, Porten K, Elder G, Baron E, et al.
Prehosp Disaster Med. 2014 January 15; Volume 29 (Issue 1); 21-26.; DOI:10.1017/S1049023X13009278
INTRODUCTION
During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting.
PROBLEM
There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program.
METHODS
Surgeries described in this report were limited to orthopedic procedures carried out under general anesthesia for all surgical patients. Exclusion factors included simple fracture reduction, debridement, dressing changes, and removal of hardware. This data was collected using both prospective and retrospective methods; prospective inpatient data were collected using a data collection form designed promptly after the earthquake and retrospective data collection was performed in October 2010.
RESULTS
Of the 264 fractures, 204 were fractures of the major long bones (humerus, radius, femur, tibia). Of these 204 fractures of the major long bones, 34 (16.7%) were upper limb fractures and 170 (83.3%) were lower limb fractures. This cohort demonstrated a large number of open fractures of the lower limb and closed fractures of the upper limb. Fractures were treated according to their location and type. Of the 194 long bone fractures, the most common intervention was external fixation (36.5%) followed by traction (16.7%), nailing (15.1%), amputation (14.6%), and plating (9.9%).
CONCLUSION
The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings.
During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting.
PROBLEM
There is not a large body of data that describes larger orthopedic cohorts, especially those focusing on internal fixation surgeries in resource-poor settings in postdisaster regions. This article describes 248 injuries and over 300 procedures carried out in the Médecins Sans Frontières-Orthopedic Centre Paris orthopedic program.
METHODS
Surgeries described in this report were limited to orthopedic procedures carried out under general anesthesia for all surgical patients. Exclusion factors included simple fracture reduction, debridement, dressing changes, and removal of hardware. This data was collected using both prospective and retrospective methods; prospective inpatient data were collected using a data collection form designed promptly after the earthquake and retrospective data collection was performed in October 2010.
RESULTS
Of the 264 fractures, 204 were fractures of the major long bones (humerus, radius, femur, tibia). Of these 204 fractures of the major long bones, 34 (16.7%) were upper limb fractures and 170 (83.3%) were lower limb fractures. This cohort demonstrated a large number of open fractures of the lower limb and closed fractures of the upper limb. Fractures were treated according to their location and type. Of the 194 long bone fractures, the most common intervention was external fixation (36.5%) followed by traction (16.7%), nailing (15.1%), amputation (14.6%), and plating (9.9%).
CONCLUSION
The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings.
Journal Article > ResearchFull Text
Int Orthop. 2014 July 20; Volume 38 (Issue 8); 1555-1561.; DOI:10.1007/s00264-014-2451-6
Bertol MJ, Van der Bergh R, Trelles M, Kenslor H, Basimuoneye JP, et al.
Int Orthop. 2014 July 20; Volume 38 (Issue 8); 1555-1561.; DOI:10.1007/s00264-014-2451-6
PURPOSE
While the orthopaedic management of open fractures has been well-documented in developed settings, limited evidence exists on the surgical outcomes of open fractures in terms of limb salvage in low- and middle-income countries. We therefore reviewed the Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB) orthopaedic surgical activities in the aftermath of the 2010 Haiti earthquake and in three non-emergency projects to assess the limb salvage rates in humanitarian contexts in relation to surgical staff skills.
METHODS
This was a descriptive retrospective cohort study conducted in the MSF-OCB surgical programmes in the Democratic Republic of Congo (DRC), Afghanistan, and Haiti. Routine programme data on surgical procedures were aggregated and analysed through summary statistics.
RESULTS
In the emergency post-earthquake response in Haiti, 81% of open fracture cases were treated by amputation. In a non-emergency project in a conflict setting in DRC, relying on non-specialist surgeons receiving on-site supervision and training by experienced orthopaedic surgeons, amputation rates among open fractures decreased by 100 to 21% over seven years of operations. In two trauma centres in Afghanistan (national surgical staff supported from the outset by expatriate orthopaedic surgeons) and Haiti (national musculoskeletal surgeons trained in external fixation), amputation rates among long bone open fracture cases were stable at 20% and <10%, respectively.
CONCLUSIONS
Introduction of and training on the proper use of external fixators reduced the amputation rate for open fractures and consequently increased the limb salvage rates in humanitarian contexts where surgical care was provided.
While the orthopaedic management of open fractures has been well-documented in developed settings, limited evidence exists on the surgical outcomes of open fractures in terms of limb salvage in low- and middle-income countries. We therefore reviewed the Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB) orthopaedic surgical activities in the aftermath of the 2010 Haiti earthquake and in three non-emergency projects to assess the limb salvage rates in humanitarian contexts in relation to surgical staff skills.
METHODS
This was a descriptive retrospective cohort study conducted in the MSF-OCB surgical programmes in the Democratic Republic of Congo (DRC), Afghanistan, and Haiti. Routine programme data on surgical procedures were aggregated and analysed through summary statistics.
RESULTS
In the emergency post-earthquake response in Haiti, 81% of open fracture cases were treated by amputation. In a non-emergency project in a conflict setting in DRC, relying on non-specialist surgeons receiving on-site supervision and training by experienced orthopaedic surgeons, amputation rates among open fractures decreased by 100 to 21% over seven years of operations. In two trauma centres in Afghanistan (national surgical staff supported from the outset by expatriate orthopaedic surgeons) and Haiti (national musculoskeletal surgeons trained in external fixation), amputation rates among long bone open fracture cases were stable at 20% and <10%, respectively.
CONCLUSIONS
Introduction of and training on the proper use of external fixators reduced the amputation rate for open fractures and consequently increased the limb salvage rates in humanitarian contexts where surgical care was provided.
Journal Article > CommentaryFull Text
Lancet Child Adolesc Health. 2018 October 5; Volume 2 (Issue 12); DOI:10.1016/S2352-4642(18)30284-0
Umphrey L, Brown AL, Hiffler L, Lafferty N, Garcia DM, et al.
Lancet Child Adolesc Health. 2018 October 5; Volume 2 (Issue 12); DOI:10.1016/S2352-4642(18)30284-0
Journal Article > CommentarySubscription Only
Med J Aust. 2014 May 1; Volume 200 (Issue 9); 512-512.; DOI:10.5694/mja14.00143
Martinez Garcia D, Brown AL
Med J Aust. 2014 May 1; Volume 200 (Issue 9); 512-512.; DOI:10.5694/mja14.00143
Journal Article > ResearchFull Text
PLoS Curr. 2016 November 16; Volume 8; ecurrents.dis.e75f9f9d977ac8adededb381e3948a04.; DOI:10.1371/currents.dis.e75f9f9d977ac8adededb381e3948a04
Aluisio AR, Teicher CL, Wiskel T, Guy A, Levine AC
PLoS Curr. 2016 November 16; Volume 8; ecurrents.dis.e75f9f9d977ac8adededb381e3948a04.; DOI:10.1371/currents.dis.e75f9f9d977ac8adededb381e3948a04
BACKGROUND
Lower extremity trauma during earthquakes accounts for the largest burden of geophysical disaster-related injuries. Insufficient pain management is common in disaster settings, and regional anesthesia (RA) has the potential to reduce pain in injured patients beyond current standards. To date, no prospective research has evaluated the use of RA in a disaster setting. This cross-sectional study assesses knowledge translation and skill acquisition outcomes for lower extremity RA performed with and without ultrasound guidance among a cohort of Médecins Sans Frontières (MSF) volunteers who will function as proceduralists in a planned randomized controlled trial evaluating the efficacy of RA for pain management in an earthquake setting.
METHODS
Generalist humanitarian healthcare responders, including both physicians and nurses, were trained in ultrasound guided femoral nerve block (USGFNB) and landmark guided fascia iliaca compartment block (LGFICB) techniques using didactic sessions and interactive simulations during a one-day focused course. Outcome measures evaluated interval knowledge attainment and technical proficiency in performing the RA procedures. Knowledge attainment was assessed via pre- and post-test evaluations and procedural proficiency was evaluated through monitored simulations, with performance of critical actions graded by two independent observers.
RESULTS
Twelve humanitarian response providers were enrolled and completed the trainings and assessments. Knowledge scores significantly increased from a mean pre-test score of 79% to post-test score of 88% (p<0.001). In practical evaluation of the LGFICB, participants correctly performed a median of 15.0 (Interquartile Range (IQR) 14.0-16.0) out of 16 critical actions. For the USGFNB, the median score was also 15.0 (IQR 14.0-16.0) out of 16 critical actions. Inter-rater reliability for completion of critical actions was excellent, with inter-rater agreement of 83.3% and 91.7% for the LGFICB and USGFNB evaluations, respectively.
DISCUSSION
Prior to conducting a trial of RA in a disaster setting, providers need to gain understanding and skills necessary to perform the interventions. This evaluation demonstrated attainment of high knowledge and technical skill scores in both physicians and nurses after a brief training in regional anesthesia techniques. This study demonstrates the feasibility of rapidly training generalist humanitarian responders to provide both LGFICB and USGFNB during humanitarian emergencies.
Lower extremity trauma during earthquakes accounts for the largest burden of geophysical disaster-related injuries. Insufficient pain management is common in disaster settings, and regional anesthesia (RA) has the potential to reduce pain in injured patients beyond current standards. To date, no prospective research has evaluated the use of RA in a disaster setting. This cross-sectional study assesses knowledge translation and skill acquisition outcomes for lower extremity RA performed with and without ultrasound guidance among a cohort of Médecins Sans Frontières (MSF) volunteers who will function as proceduralists in a planned randomized controlled trial evaluating the efficacy of RA for pain management in an earthquake setting.
METHODS
Generalist humanitarian healthcare responders, including both physicians and nurses, were trained in ultrasound guided femoral nerve block (USGFNB) and landmark guided fascia iliaca compartment block (LGFICB) techniques using didactic sessions and interactive simulations during a one-day focused course. Outcome measures evaluated interval knowledge attainment and technical proficiency in performing the RA procedures. Knowledge attainment was assessed via pre- and post-test evaluations and procedural proficiency was evaluated through monitored simulations, with performance of critical actions graded by two independent observers.
RESULTS
Twelve humanitarian response providers were enrolled and completed the trainings and assessments. Knowledge scores significantly increased from a mean pre-test score of 79% to post-test score of 88% (p<0.001). In practical evaluation of the LGFICB, participants correctly performed a median of 15.0 (Interquartile Range (IQR) 14.0-16.0) out of 16 critical actions. For the USGFNB, the median score was also 15.0 (IQR 14.0-16.0) out of 16 critical actions. Inter-rater reliability for completion of critical actions was excellent, with inter-rater agreement of 83.3% and 91.7% for the LGFICB and USGFNB evaluations, respectively.
DISCUSSION
Prior to conducting a trial of RA in a disaster setting, providers need to gain understanding and skills necessary to perform the interventions. This evaluation demonstrated attainment of high knowledge and technical skill scores in both physicians and nurses after a brief training in regional anesthesia techniques. This study demonstrates the feasibility of rapidly training generalist humanitarian responders to provide both LGFICB and USGFNB during humanitarian emergencies.
Journal Article > EditorialFull Text
Int Orthop. 2024 January 11; Online ahead of print (Issue 2); 323-330.; DOI:10.1007/s00264-024-06089-5
Hernigou P, Homma Y, Herard P, Scarlat MM
Int Orthop. 2024 January 11; Online ahead of print (Issue 2); 323-330.; DOI:10.1007/s00264-024-06089-5
Other > Journal Blog
Ramirez TL
2014 March 7
Journal Article > ResearchFull Text
Nephrol Dial Transplant. 2012 April 1; Volume 27; DOI:10.1093/ndt/gfs156
Sever MS, Vanholder R
Nephrol Dial Transplant. 2012 April 1; Volume 27; DOI:10.1093/ndt/gfs156
"Recommendations for the management of crush victims in mass disasters" aims to assist medics, paramedics and rescue team members who provide care during disasters. Development of the recommendations followed an explicit process of literature review and, also internet and face-to-face discussions. The chapters cover medical and logistic measures, to be taken both at the disaster field and in the hospitals, to cope with the problems created by a catastrophe. Recommendations were based on retrospective analyses and case reports on past disasters, and also expert judgment or opinion. Since there are no randomized controlled trials, no GRADE approach was used to develop the recommendations, and no strengths of recommendations or levels of evidence are provided.