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Consensus Statements Regarding the Multidisciplinary Care of Limb Amputation Patients in Disasters or Humanitarian Emergencies: Report of the 2011 Humanitarian Action Summit Surgical Working Group on Amputations Following Disasters or Conflict

Published online by Cambridge University Press:  20 March 2012

Lisa Marie Knowlton ,
James E Gosney Jr ,
Smita Chackungal ,
Eric Altschuler ,
Lynn Black ,
Frederick M Burkle Jr ,
Kathleen Casey ,
David Crandell ,
Didier Demey  and
Lillian Di Giacomo
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Lisa Marie Knowlton*
Affiliation:
Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Surgical Research Fellow Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA
James E Gosney Jr
Affiliation:
Handicap International, Takoma Park, Maryland USA
Smita Chackungal
Affiliation:
Division of General Surgery, University of Western Ontario, London, Ontario, Canada; Surgical Research Fellow, Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA
Eric Altschuler
Affiliation:
Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, New Jersey USA
Lynn Black
Affiliation:
Department of Medicine, Massachusetts General Hospital, Boston Massachusetts USA
Frederick M Burkle Jr
Affiliation:
Senior Fellow and Scientist, Harvard Humanitarian Initiative, Harvard University, Boston, Massachusetts USA
Kathleen Casey
Affiliation:
Director, Operation Giving Back, American College of Surgeons, Chicago, Illinois USA
David Crandell
Affiliation:
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts USA
Didier Demey
Affiliation:
Physical Therapist, Technical Advisor for Emergency and Rehabilitation, Handicap International, Brussels, Belgium
Lillian Di Giacomo
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA; Division of General Surgery, University of California at Davis Medical Center, Sacramento, California USA
Lena Dohlman
Affiliation:
Assistant Professor, Harvard Medical School, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts USA
Joshua Goldstein
Affiliation:
Principal Director for Economic Citizenship & Disability Inclusion, Center for Financial Inclusion at ACCION International; Lecturer, Boston University, Boston, Massachusetts USA
Richard Gosselin
Affiliation:
Institute for Global Orthopedics and Traumatology, University of California at San Francisco, San Francisco, California USA
Keita Ikeda
Affiliation:
Post Doctorate Fellow, Duke University Medical Center, Department of Anesthesia, Raleigh, North Carolina USA
Andree Le Roy
Affiliation:
Physiatrist, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA; Instructor, Harvard Medical School, Boston Massachusetts, USA
Allison Linden
Affiliation:
Harvard School of Public Health, Boston, Massachusetts USA; Georgetown University Hospital, Washington, District of Columbia USA
Catherine M Mullaly
Affiliation:
Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts USA; Instructor, Harvard Medical School, Boston Massachusetts USA
Jason Nickerson
Affiliation:
Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
Colleen O'Connell
Affiliation:
Research Chief, Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada
Anthony D Redmond
Affiliation:
Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
Adam Richards
Affiliation:
American Heart Association-Pharmaceutical Outcomes Research Center, UCLA Department of Neurology, Los Angeles, California USA; Global Health Access Program, Berkeley, California USA
Robert Rufsvold
Affiliation:
Medical Director, International Medical Corps Emergency Response, Libya
Anna LR Santos
Affiliation:
Delft University of Technology, Delft, Netherlands
Terri Skelton
Affiliation:
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
Kelly McQueen
Affiliation:
Fellow, Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA; Valley Anesthesiology Consultants, Phoenix, Arizona USA
*
Corresponding Author: Lisa Marie Knowlton, MD, MPH Division of General Surgery, University of British Columbia, 910 West 10th Avenue, Room 3100, Vancouver, British Columbia Canada V5Z 4E3, E-mail: [email protected]
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Abstract

Limb amputations are frequently performed as a result of trauma inflicted during conflict or disasters. As demonstrated during the 2010 earthquake in Haiti, coordinating care of these patients in austere settings is complex. During the 2011 Humanitarian Action Summit, consensus statements were developed for international organizations providing care to limb amputation patients during disasters or humanitarian emergencies. Expanded planning is needed for a multidisciplinary surgical care team, inclusive of surgeons, anesthesiologists, rehabilitation specialists and mental health professionals. Surgical providers should approach amputation using an operative technique that optimizes limb length and prosthetic fitting. Appropriate anesthesia care involves both peri-operative and long-term pain control. Rehabilitation specialists must be involved early in treatment, ideally before amputation, and should educate the surgical team in prosthetic considerations. Mental health specialists must be included to help the patient with community reintegration. A key step in developing local health systemsis the establishment of surgical outcomes monitoring. Such monitoring can optimizepatient follow-up and foster professional accountability for the treatment of amputation patients in disaster settings and humanitarian emergencies.

Keywords

Surgical burden of diseaseSurgical standardsDisaster medicineHumanitarian emergenciesRehabilitationAmputationHaiti
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 26 , Issue 6 , December 2011 , pp. 438 - 448
Copyright
Copyright Knowlton © World Association for Disaster and Emergency Medicine 2012

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