Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-18T08:34:41.341Z Has data issue: false hasContentIssue false
  • English
  • Français

Improving Management of Limb Injuries in Disasters and Conflicts

Published online by Cambridge University Press:  26 April 2019

Guy Jensen ,
Elhanan Bar-On ,
Jane Thorley Wiedler ,
Stefanie C. Hautz ,
Harald Veen ,
Alan R. Kay ,
Ian Norton ,
Richard A. Gosselin  and
Johan von Schreeb
Guy Jensen*
Affiliation:
General Surgery Resident, Department of Surgery, University of California Davis, Sacramento, CaliforniaUSA
Elhanan Bar-On
Affiliation:
Director Israel Center for Defense Medicine and Humanitarian Response, Sheba Medical Center, Tel Aviv, Israel
Jane Thorley Wiedler
Affiliation:
AO Foundation, Davos, Switzerland
Stefanie C. Hautz
Affiliation:
AO Foundation, Davos, Switzerland
Harald Veen
Affiliation:
Trauma Surgeon (Unaffiliated), Geneva, Switzerland
Alan R. Kay
Affiliation:
Consultant Military Surgeon, Royal Centre for Defence Medicine, Birmingham, United Kingdom
Ian Norton
Affiliation:
National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
Richard A. Gosselin
Affiliation:
Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California at San Francisco, El Granada, CaliforniaUSA
Johan von Schreeb
Affiliation:
Centre for Research on Health Care in Disasters, Health System and Policy Research, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
*
Correspondence: Guy Jensen, MD, MPH General Surgery Resident Department of Surgery University of California Davis Sacramento, California USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

It has become clear that disaster relief needs to transition from good intentions or a charity-based approach to a professional, outcome-oriented response. The practice of medicine in disaster and conflict is a profession practiced in environments where lack of resources, chaos, and unpredictability are the norm rather than the exception. With this consideration in mind, the World Health Organization (WHO; Geneva, Switzerland) and its partners set out to improve the disaster response systems. The resulting Emergency Medical Team (EMT) classification system requires that teams planning on engaging in disaster response follow common standards for the delivery of care in resource-constraint environments. In order to clarify these standards, the WHO EMT Secretariat collaborated with the International Committee of the Red Cross (ICRC; Geneva, Switzerland) and leading experts from other stakeholder non-governmental organizations (NGOs) to produce a guide to the management of limb injuries in disaster and conflict.

The resulting text is a free and open-access resource to provide guidance for national and international EMTs caring for patients in disasters and conflicts. The content is a result of expert consensus, literature review, and an iterative process designed to encourage debate and resolution of existing open questions within the field of disaster and conflict medical response.

The end result of this process is a text providing guidance to providers seeking to deliver safe, effective care within the EMT framework that is now part of the EMT training and verification system and is being distributed to ICRC teams deploying to the field.

This work seeks to encourage professionalization of the field of disaster and conflict response, and to contribute to the existing EMT framework, in order to provide for better care for future victims of disaster and conflict.

Jensen G, Bar-On E, Wiedler JT, Hautz SC, Veen H, Kay AR, Norton I, Gosselin RA, von Schreeb J. Improving management of limb injuries in disasters and conflicts. Prehosp Disaster Med. 2019;34(3):330–334.

Keywords

conflictdisaster responseemergency medical teamsextremity injurieslimb injuries
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 3 , June 2019 , pp. 330 - 334
Copyright
© World Association for Disaster and Emergency Medicine 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

UNISDR. UNISDR Terminology for Disaster Risk Reduction. Geneva, Switzerland: United Nations International Strategy for Disaster Reduction (UNISDR); 2009.Google Scholar
Gosselin, RA. War injuries, trauma, and disaster relief. Techniques in Orthopaedics. 2005;20(2):97–108.CrossRefGoogle Scholar
Birnbaum, ML, Daily, EK, O’Rourke, AP. Research and evaluations of the health aspects of disasters, Part III: framework for the temporal phases of disasters. Prehosp Disaster Med. 2015;30(6):628–632.CrossRefGoogle ScholarPubMed
Doocy, S, Jacquet, G, Cherewick, M, Kirsch, TD. The injury burden of the 2010 Haiti earthquake: a stratified cluster survey. Injury. 2013;44(6):842–847.CrossRefGoogle ScholarPubMed
Peranteau, WH, Havens, JM, Harrington, S, Gates, JD. Re-establishing surgical care at Port-au-Prince general hospital, Haiti. J Am Coll Surg. 2010;211(1):126–130.CrossRefGoogle ScholarPubMed
Sonshine, DB, Caldwell, A, Gosselin, RA, et al. Critically assessing the Haiti earthquake response and the barriers to quality orthopaedic care. Clinical Orthopaedics and Related Research. 2012;470(10):2895–2904.CrossRefGoogle ScholarPubMed
Noguchi, N, Inoue, S, Shimanoe, C, et al. What kinds of skills are necessary for physicians involved in international disaster response? Prehosp Disaster Med. 2016;31(04):397–406.CrossRefGoogle ScholarPubMed
Norton, I, Von Schreeb, J, Aitken, P, et al. Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters. Geneva, Switzerland: World Health Organization; 2013.Google Scholar
Giannou, C, Baldan, M, Molde, A. ICRC War Surgery: Working with Limited Resources in Armed Conflict and Other Situations of Violence - Volume 2. Geneva, Switzerland: International Committee of the Red Cross; 2013.Google Scholar
Giannou, C, Baldan, M. War Surgery: Working with Limited Resources in Armed Conflict and Other Situations of Violence - Volume 1. Geneva, Switzerland: International Committee of the Red Cross; 2009.Google Scholar
EMT Initiative Online: World Health Organization; 2018. https://extranet.who.int/emt/.Google Scholar
Williams, AB, Luchette, FA, Papaconstantinou, HT, et al. The effect of early versus late fasciotomy in the management of extremity trauma. Surgery. 1997;122(4):861–866.CrossRefGoogle ScholarPubMed
Velmahos, G, Theodorou, D, Demetriades, D, et al. Complications and non-closure rates of fasciotomy for trauma and related risk factors. World J Surg. 1997;21(3):247–253.CrossRefGoogle Scholar
Mullett, H, Al-Abed, K, Prasad, C, O’sullivan, M. Outcome of compartment syndrome following intramedullary nailing of tibial diaphyseal fractures. Injury. 2001;32(5):411–413.CrossRefGoogle ScholarPubMed
von Keudell, AG, Weaver, MJ, Appelton, PT, et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 2015;386(10000):1299–1310.CrossRefGoogle ScholarPubMed
Wolfson, N. Amputations in natural disasters and mass casualties: staged approach. International Orthopaedics. 2012;36(10):1983–1988.CrossRefGoogle ScholarPubMed
Bosse, MJ, Ficke, JR, Andersen, RC. Extremity war injuries: current management and research priorities. J Am Acad Orthop Surg. 2012;20(Suppl 1):viii–x.CrossRefGoogle ScholarPubMed
International Committee of the Red Cross, AO Foundation. Online Resource for Management of Limb Injuries during Disaster and Conflict. Online: AO Foundation; 2016. https://icrc.aoeducation.org/. Accessed August 1, 2018.Google Scholar
Brolin, K, Hawajri, O, von Schreeb, J. Foreign medical teams in the Philippines after Typhoon Haiyan 2013-who were they, when did they arrive, and what did they do? PLoS Curr. 2011;7.Google Scholar
Scott, LA, Swartzentruber, DA, Davis, CA, et al. Competency in chaos: lifesaving performance of care providers utilizing a competency-based, multi-actor emergency preparedness training curriculum. Prehosp Disaster Med. 2013;28(04):322–333.CrossRefGoogle ScholarPubMed
Meara, JG, Greenberg, SL. The Lancet Commission on Global Surgery Global Surgery 2030: evidence and solutions for achieving health, welfare and economic development. Surgery. 2015;157(5):834–835.CrossRefGoogle ScholarPubMed
Mock, CN, Donkor, P, Gawande, A, et al. Essential surgery: key messages from disease control priorities, 3rd edition. Lancet. 2015;385(9983):2209–2219.CrossRefGoogle ScholarPubMed
Lin, Y, Dahm, JS, Kushner, AL, et al. Are American surgical residents prepared for humanitarian deployment? A comparative analysis of resident and humanitarian case logs. World J Surg. 2018;42(1):32–39.CrossRefGoogle ScholarPubMed