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SICOT e-Newsletter

Issue No. 20 - May 2010

Editorial by Cody Bünger - SICOT President

Earthquakes and Natural Disasters – How can the world orthopaedic community coordinate help?

SICOT was recently invited by AAOS to debate the tragedy in Haiti under the above title. Haiti was hit by a magnitude 7.0 earthquake on 12 January 2010, killing more than 210,000 people and wounding over 300,000 more. The earthquake epicentre was less than 10 miles from Port au Prince, Haiti's impoverished capital. Lack of internal infrastructure and medical supplies compounded the disaster. Local roads were destroyed making it difficult to help those in need. International rescue teams from several countries participated, including teams from European and Asian countries worked hard to find survivors during the first weeks. Foreign emergency teams of health personnel established provisional hospitals. A team from Israel built a temporary container hospital within 48 hours. The US navy established a major hospital facility on board a naval vessel, with transport by helicopter.

Many doctors, emergency physicians and orthopaedic surgeons volunteered to work at the scene, but had difficulties getting through. The AAOS coordinated travel for more than 200 orthopaedic surgeons to the spot and Médecins sans Frontières sent doctors from Europe as well. The emergency service changed over time. The need for help in Haiti ranged from rebuilding the health system to taking care of thousands of debilitated people in the first weeks, when up to 10,000 victims required amputations for crush injuries. More than 2 million people lost their homes and needed emergency shelter. Unidentified victims were buried in mass graves. Rebuilding Haiti and its medical service is expected to take several years. With this in mind, SICOT wishes to contribute to a coordinated task force in the future.

The Earth is hit by more than 200 earthquakes every week, which are depicted and updated every hour on the internet. Earthquakes hit many areas of the world, with differing infrastructures and political systems. Earthquake injuries may cause death by asphyxia due to collapsed buildings. The survivors suffer crush injuries of the extremities, and a large proportion, up to 15% (New England J of Medicine), have spine injuries and pelvic injuries. The complication rates from primary surgical care are high, due to poor diagnostic and surgical facilities together with a lack of consensus on which limb preservation procedures to use. The destruction of infrastructure also affects the surviving population, who continuously present with trauma and other emergency conditions needing care.

SICOT members also worked at the scene in Haiti. The reports of Dr N.S. Harshavardhana, Dr Kuldeep Sain and Dr Nick Wolfson will be published in the June 2010 issue of the SICOT Newsletter. We believe that these experiences should be assessed and analysed, as they were after the earthquake in Sichuan, China, in 2008 (New England J of Medicine 2008), and used in an international effort to improve multinational trauma care in future disasters. SICOT cannot accomplish much alone but, united with other international societies and health authorities, great advancements are possible in the future.

The agenda could include:

WHO and UN endorsed work packages to define:

  1. Regional leadership
  2. Interaction with established rescue teams
  3. Interaction with existing disaster control systems
  4. Preservation of access to epicentres
  5. Definition of mobile units of independent emergency facilities (container hospitals & equipment, etc.)
  6. Algorithms of intervention
  7. Re-establishment of local health systems
  8. Public media support and prophylaxis