Surgical Support & Surgical Interventions: 2010 Haiti Earthquake

Surgical Support & Surgical Interventions:
2010 Haiti Earthquake

David L. Helfet, M.D.
Emergency Surgery Workshop
AO Foundation
Davos, 2011

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)
– Haiti's nearly half million slaves revolted under Toussaint
L'Ouverture (Late 18th century)
– Became 1st black republic to declare independence (1804)

Orthopaedic Trauma Service

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)


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 damaged


Presidential Palace

Orthopaedic Trauma Service Port-au-Prince Cathedral

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 / NYFD


• 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 &
disposables


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 & disposables


Haiti Medical Relief Team


Air Transportation:
Provided by Synthes


Hopital de la Communaute Haitienne
(Community Hospital of Haiti)


Amputations —
• AKA 2
• BKA 19
• Forearm 3
• Feet 4
28

External Fixation —
• Humerus 3
• Elbow 1
• Radius 4
• Pelvis 1
• Femoral Neck 1
• Femur 23
• Tibia 32
• Pilon/Ankle 4
69

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 Haiti

US Institute for Peace / UN Children's Fund, 2010
Refugees International, 2010

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 it

Benjamin E, Bassily Marcus AM, Mount Sinai J Med, 2011
United Nations Children's Fund, 2010

“ 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 events

Born, Cullinson, Dean, Hayda, McSwain, Riddles, Shimkus
J AAOS, 2011

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 Days

DISASTER’S

FAILING TO PLAN is a

PLAN TO FAIL!”


“The value of a man resides in
what he gives and not in what
he is capable of receiving.”

Albert Einstein (1879-1955)

Lorich, Jeffcoat, MacIntyre, Chan, Helfet, Tech Hand Up Extrem Surg, 2010
MacIntyre, Jeffcoat, Chan, Lorich, Helfet, Am J Orthop, 2010

Surgical Support & Surgical Interventions: 2010 Haiti Earthquake

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Surgical Support & Surgical Interventions: 2010 Haiti Earthquake