Emergency Surgery Workshop Davos 2011: Presentation by David L. Helfet, MD

1. Surgical Support & Surgical Interventions:
2010 Haiti Earthquake
David L. Helfet, M.D.
Emergency Surgery Workshop
AO Foundation
Davos, 2011

2. 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

3. 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)
Orthopaedic Trauma Service

4. 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
Orthopaedic Trauma Service

5. Presidential Palace
Orthopaedic Trauma Service Port-au-Prince Cathedral

6. 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
Orthopaedic Trauma Service

7. Haiti Medical Relief —
• 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
Orthopaedic Trauma Service

8. Haiti Medical Relief —
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
Orthopaedic Trauma Service

9. Haiti Medical Relief Team
Orthopaedic Trauma Service

10. Air Transportation:
Provided by Synthes
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19. Hopital de la Communaute Haitienne
(Community Hospital of Haiti)
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33. Amputations —
• AKA 2
• BKA 19
• Forearm 3
• Feet 4
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41. External Fixation —
• Humerus 3
• Elbow 1
• Radius 4
• Pelvis 1
• Femoral Neck 1
• Femur 23
• Tibia 32
• Pilon/Ankle 4
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48. 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
Orthopaedic Trauma Service
US Institute for Peace / UN Children's Fund, 2010
Refugees International, 2010

49. 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
Orthopaedic Trauma Service
Benjamin E, Bassily Marcus AM, Mount Sinai J Med, 2011
United Nations Children's Fund, 2010

50. “ 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
Orthopaedic Trauma Service
Born, Cullinson, Dean, Hayda, McSwain, Riddles, Shimkus
J AAOS, 2011

51. 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
Orthopaedic Trauma Service

52. DISASTER’S
FAILING TO PLAN is a
PLAN TO FAIL!”
Orthopaedic Trauma Service

53. “The value of a man resides in
what he gives and not in what
he is capable of receiving.”
Orthopaedic Trauma Service
Albert Einstein (1879-1955)

54. Orthopaedic Trauma Service
Lorich, Jeffcoat, MacIntyre, Chan, Helfet, Tech Hand Up Extrem Surg, 2010
MacIntyre, Jeffcoat, Chan, Lorich, Helfet, Am J Orthop, 2010