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Anshori F, Kamal AF, Prabowo Y, Kekalih A, Febrianto R, Purnaning D, Dilogo IH. The Outcome of Orthopedics Treatment of Lombok Earthquake Victim 2018: A Cohort of One-Year Follow-Up Study-Lesson Learned After Lombok Earthquake. Orthop Res Rev 2023; 15:91-103. [PMID: 37193319 PMCID: PMC10182807 DOI: 10.2147/orr.s387625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/25/2023] [Indexed: 05/18/2023] Open
Abstract
Introduction There was a magnitude 7 on the Richter scale earthquake on Lombok Island in 2018, causing more than 500 deaths. In the event of earthquakes, there is often an imbalance between overcrowding in hospitals and inadequate resources. The initial management of earthquake victims with musculoskeletal injuries is controversial, arguing over whether to utilize debridement, external or internal fixation, or conservative or operative treatment in an acute onset disaster situation. This study aims to determine the outcome of initial management after the 2018 Lombok earthquake, between immediate open-reduction and internal fixation (ORIF) and Non-ORIF procedures after one year follow-up. Methods This is a cohort study to evaluate radiological and clinical outcomes one year after orthopedic treatment in the Lombok earthquake 2018. The subjects were recruited from eight public health center and one hospital in Lombok in September 2019. We evaluate radiological outcomes (non/malunion and union) and clinical outcomes (infection and SF-36 score). Results Based on 73 subjects, the ORIF group has a higher union rate than the non-ORIF group (31.1% vs. 68.9%; p = 0.021). Incidence of infection only appeared in the ORIF group (23.5%). Clinical outcome as measured by SF36 showed the ORIF group had a lower mean of general health (p = 0.042) and health change (p = 0.039) clinical outcomes than the non-ORIF group. Discussion The most affected public group is the productive age with significant impact on social-economy. ORIF procedure is a major risk factor of infection in initial treatment after earthquake. Therefore, definitive operation with internal fixation is not recommended in the initial phase of a disaster. Damage Control Orthopedic (DCO) surgery protocol is the treatment of choice in acute disaster setting. Conclusion The ORIF group had better radiological outcomes than the non-ORIF group. However the ORIF group had higher cases of infection and lower SF-36 than the non-ORIF group. Definitive treatment in acute onset disaster setting should be prevented.
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Affiliation(s)
- Fahmi Anshori
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Achmad Fauzi Kamal
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yogi Prabowo
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Aria Kekalih
- Community Medicine Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rudi Febrianto
- Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine University of Mataram -Regional General Hospital of West Nusa Tenggara, Mataram, Indonesia
| | - Dyah Purnaning
- Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine University of Mataram -Regional General Hospital of West Nusa Tenggara, Mataram, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Scaling Surgical Resources: A Capacity Analysis of C-arm Machines in Haiti Following the 2021 Earthquake. World J Surg 2023; 47:1419-1425. [PMID: 36884082 PMCID: PMC10156824 DOI: 10.1007/s00268-023-06958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND In 2021, a 7.2 magnitude earthquake struck Haiti resulting in a surge of orthopaedic trauma requiring immediate surgical treatment. Safe and efficient operative management of orthopaedic trauma injuries requires intraoperative fluoroscopy through C-arm machines. The Haitian Health Network (HHN) received a philanthropic donation of three C-arm machines and considered an analytical tool may guide efficacious placement of those machines. The study objective was to develop and apply a clinical needs and hospital readiness measuring tool relevant to C-arm machines, which may guide decision-makers, such as HHN, in response to an emergency situation with a surge in need for orthopaedic treatment. METHODS An online survey to assess surgical volume and capacity was created and then completed by a senior surgeon or hospital administrator based at hospitals within the HHN. Multiple-choice and free-text answer data were collected and classified into five categories: staff, space, stuff, systems, and surgical capacity. Each hospital received a final score out of 100, calculated by equal weighting of each category. RESULTS Ten out of twelve hospitals completed the survey. The average weighted score for the staff category was 10.2 (SD 5.12), the space category was 13.1 (SD 4.09), the stuff category was 15.6 (SD 2.56), the systems category was 12.25 (SD 6.50), and the surgical capacity category was 9.5 (SD 6.47). The average final hospital scores ranged from 29.5 to 83.0. CONCLUSION This analysis tool provided data as to the clinical demand and capabilities of hospitals within the HHN to receive a C-arm machine and reaffirmed the critical need for more C-arms in Haiti. This methodology may be utilised by other health systems to provide data to distribute orthopaedic trauma equipment, which would benefit communities during periods of surge capacity, such as natural disasters.
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Waloejo CS, Sulistiawan SS, Semedi BP, Dzakiyah AZ, Stella MA, Ikhromi N, Nahyani , Endriani E, Rahardjo E, Pandin MGR. The Anesthetic Techniques for Earthquake Victims in Indonesia. Open Access Emerg Med 2022; 14:77-84. [PMID: 35250317 PMCID: PMC8888197 DOI: 10.2147/oaem.s331344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/10/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction In Lombok, three-large magnitude earthquakes occurred in July 2018 and caused major losses: 564 victims died, 1684 were injured, 445,343 people became refugees, and 215,628 houses were damaged. It damaged 408 health facilities, consisting of 89 public health centers, 13 hospitals, 174 auxiliary public health centers, 132 village health posts. Aim The purpose of this study is to describe the anesthetic techniques that were used to treat earthquake victims. Methods This study was a descriptive cross-sectional study that was conducted by collecting total sampling from all earthquake victims treated in the emergency room (ER) of the regional public hospital (RSUD NTB) on August 6th and 7th, 2018, and all victims who underwent surgery during August 5th–25th, 2018. The data that were collected were surgery type, anesthetic techniques, and anesthesia drugs that were used. Results The results show that the highest number of patients were treated in the ER during the first seven days after the earthquake and that this number then decreased over several weeks. The majority of patients treated were trauma patients who needed orthopedic surgery. General anesthesia was more widely used than regional anesthesia, but the difference was not significant. The most commonly used regional anesthetic was lidocaine hyperbaric 75–100 mg and clonidine 30–50 mcg combination. Regional anesthesia techniques have better results in cases of lower limb injury, but it is difficult to be applied in earthquake victims who present with complex injuries and limited resources.
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Shapiro LM, Park MO, Mariano DJ, Welch JM, Kamal RN. Candidate Quality Measures for Orthopaedic Surgery Outreach Trips: A Systematic Review. J Am Acad Orthop Surg 2021; 29:e1068-e1077. [PMID: 34525479 PMCID: PMC8443848 DOI: 10.5435/jaaos-d-20-00263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/15/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Up to 30% of the global burden of disease is secondary to surgical conditions, most of which falls on those in low- and middle-income countries (LMICs). Ensuring that the quality of care delivered during outreach trips to address these conditions is foundational. Limited work has been done to develop and implement tools to assess and improve the quality of care for these trips. The purpose of this study was to identify candidate quality measures that address orthopaedic surgery outreach trips in LMICs. METHODS We conducted a systematic review of MEDLINE/PubMed, EMBASE, Web of Science, Google Scholar, and other databases to identify candidate quality measures relevant to orthopaedic surgery outreach to LMICs. Quality measures were then categorized by system management, sustainability, or both system management and sustainability according to the framework and structures, processes, and outcomes of Bido et al according to the Donabedian domains. RESULTS Our initial search yielded 3,891 articles, 22 of which met the inclusion criteria. Seventy-nine candidate quality measures were identified. Regarding the framework of Bido et al, 55 of 79 (70%) were related to system management, 8 (10%) were related to sustainability, and 16 (20%) were related to both system management and sustainability. According to Donabedian domains, 43 of 79 (54%) were structure measures, 25 (32%) were process measures, and 11 (14%) were outcome measures. DISCUSSION Quality measures addressing orthopaedic surgery outreach trips are lacking in quantity and breadth, limiting the ability to assess and improve the safety and quality of care provided. The candidate quality measures identified disproportionately focus on systems management and structures, with few related to sustainability and few addressing outcomes. Patients receiving care on outreach trips would benefit from the implementation of the measures identified in this review and from the development of quality measures that capture all domains of care and emphasize outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Lauren M Shapiro
- From VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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5
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Turcotte JJ, Gelfand JM, Jones CM, Jackson RS. Development of a Low-Resource Operating Room and a Wide-Awake Orthopedic Surgery Program During the COVID-19 Pandemic. Surg Innov 2021; 28:183-188. [PMID: 33780646 DOI: 10.1177/15533506211003530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. The COVID-19 pandemic resulted in significant medication, supply and equipment, and provider shortages, limiting the resources available for provision of surgical care. In response to mandates restricting surgery to high-acuity procedures during this period, our institution developed a multidisciplinary Low-Resource Operating Room (LROR) Taskforce in April 2020. This study describes our institutional experience developing an LROR to maintain access to urgent surgical procedures during the peak of the COVID-19 pandemic. Methods. A delineation of available resources and resource replacement strategies was conducted, and a final institution-wide plan for operationalizing the LROR was formed. Specialty-specific subgroups then convened to determine best practices and opportunities for LROR utilization. Orthopedic surgery performed in the LROR using wide-awake local anesthesia no tourniquet (WALANT) is presented as a use case. Results. Overall, 19 limited resources were identified, spanning across the domains of physical space, drugs, devices and equipment, and personnel. Based on the assessment, the decision to proceed with creation of an LROR was made. Sixteen urgent orthopedic surgeries were successfully performed using WALANT without conversion to general anesthesia. Conclusion. In response to the COVID-19 pandemic, a LROR was successfully designed and operationalized. The process for development of a LROR and recommended strategies for operating in a resource-constrained environment may serve as a model for other institutions and facilitate rapid implementation of this care model should the need arise in future pandemic or disaster situations.
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Affiliation(s)
- Justin J Turcotte
- Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Jeffrey M Gelfand
- Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD, USA
| | | | - Rubie S Jackson
- Department of Surgery, Fortney Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA
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Jordan K, Lewis TP, Roberts B. Quality in crisis: a systematic review of the quality of health systems in humanitarian settings. Confl Health 2021; 15:7. [PMID: 33531065 PMCID: PMC7851932 DOI: 10.1186/s13031-021-00342-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00342-z.
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Affiliation(s)
- Keely Jordan
- Department of Health Policy, New York University School of Global Public Health, 665 Broadway, New York, NY, 10012, USA.
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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7
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Coventry CA, Dominguez L, Read DJ, Trelles M, Ivers RQ, Montazerolghaem M, Holland AJA. Comparison of Operative Logbook Experience of Australian General Surgical Trainees With Surgeons Deployed on Humanitarian Missions: What Can Be Learnt for the Future? JOURNAL OF SURGICAL EDUCATION 2020; 77:131-137. [PMID: 31451427 DOI: 10.1016/j.jsurg.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE General surgical training in Australia has undergone considerable change in recent years with less exposure to other areas of surgery. General surgeons from many high-income countries have played important roles in assisting with the provision of surgical care in low- and middle-income countries during sudden-onset disasters (SODs) as part of emergency medical teams (EMTs). It is not known if contemporary Australian general surgeons are receiving the broad surgical training required for work in EMTs. DESIGN Logbook data on the surgical procedures performed by Australian general surgical trainees were obtained from General Surgeons Australia (GSA) for the time period February 2008 to February 2017. Surgical procedures performed by Médecins sans Frontières (MSF) surgeons during 5 projects in 3 SODs (the 2010 Haiti earthquake, the 2013 Philippines typhoon and the 2015 Nepal earthquake) were obtained from previously published data for 6 months following each disaster. SETTING AND PARTICIPANTS This was carried out at the University of Sydney with input from MSF Operational Centre Brussels and GSA. RESULTS Australian general surgical trainees performed a mean of 2107 surgical procedures (excluding endoscopy) during their training (10 6-month rotations). Common procedures included abdominal wall hernia repairs (268, 12.7%), cholecystectomies (247, 11.8%), and specialist colorectal procedures (242, 11.5%). MSF surgeons performed a total of 3542 surgical procedures across the 5 projects analyzed. Common procedures included Caesarean sections (443, 12.5%), wound debridement (1115, 31.5%), and other trauma-related procedures (472, 13.3%). CONCLUSIONS Australian general surgical trainees receive exposure to both essential and advanced general surgery but lack exposure to specialty procedures including the obstetric and orthopedic procedures commonly performed by MSF surgeons after SODs. Further training in these areas would likely be beneficial for general surgeons prior to deployment with an EMT.
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Affiliation(s)
- Charles A Coventry
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.
| | - Lynette Dominguez
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - David J Read
- National Critical Care and Trauma Response Centre, Darwin, NT, Australia
| | - Miguel Trelles
- Médecins sans Frontières- Operational Centre Brussels, Brussels, Belgium
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Andrew J A Holland
- The Children's Hospital at Westmead Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia; Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Cuesta JG, Trelles M, Naseer A, Momin A, Mulamira LN, Caluwaerts S, Guha-Sapir D. Does the presence of conflict affect maternal and neonatal mortality during Caesarean sections? Public Health Action 2019; 9:107-112. [PMID: 31803582 DOI: 10.5588/pha.18.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 06/21/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings. Objective To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections. Methods We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care. Results During 2008-2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38). Conclusions Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.
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Affiliation(s)
- J Gil Cuesta
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - M Trelles
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - A Naseer
- Timurgara Hospital, Operational Centre Brussels, Médecins Sans Frontières, Timurgara, Pakistan
| | - A Momin
- Operational Centre Brussels, Médecins Sans Frontières, Ahmad Shah Baba Hospital, Kabul, Afghanistan
| | - L Ngabo Mulamira
- Masisi Hospital, Operational Centre Brussels, Médecins Sans Frontières, Masisi, Democratic Republic of Congo
| | - S Caluwaerts
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - D Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, Brussels, Belgium
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Scarlat MM, Pećina M, Quaile A. High-volume surgeons and high-volume journals in a multivariate orthopedic environment. INTERNATIONAL ORTHOPAEDICS 2018; 42:2011-2014. [PMID: 30066100 DOI: 10.1007/s00264-018-4073-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Marius M Scarlat
- Clinique Chirurgicale St Michel, Toulon, France. .,International Orthopaedics - SICOT Official Journal, Brussels, Belgium.
| | - Marko Pećina
- International Orthopaedics - SICOT Official Journal, Brussels, Belgium.,Department of Orthopaedic Surgery, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Andrew Quaile
- International Orthopaedics - SICOT Official Journal, Brussels, Belgium.,FRCS, Spineworks, London, UK
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Goudard Y, Butin C, Carfantan C, Pauleau G, Soucanye de Landevoisin E, Goin G, Clement D, Bordes J, Balandraud P. The 7th French Airborne Forward Surgical Team experience of surgical support to the population of a low-income country: a prospective study on 341 patients with short-term follow-up. J ROY ARMY MED CORPS 2018; 164:423-427. [PMID: 29886451 DOI: 10.1136/jramc-2018-000952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The 7th Airborne Forward Surgical Team (FST) has deployed to Chad in 2015 and 2016, in support of French military forces. Humanitarian surgical care is known to represent a significant part of the surgical activity in such missions, but to date limited data have been published on the subject. METHODS All surgical patients from a civilian host population treated by the FST during these missions have been prospectively included. Indications, operative outcomes and postoperative outcomes were evaluated. RESULTS During this period, the FST operated on 358 patients. Humanitarian surgical care represented 95% of the activity. Most patients (92.7%) were operated for elective surgery. Emergencies and infectious diseases represented, respectively, 7.3% and 9.1% of cases. The mean length of stay (LOS) was three days (2-4), and the median follow-up was 30 days (22-34). Mortality rate was 0.6% and morbidity was 5.6%. Parietal surgery had no significant complication and had shorter LOS (p<0.001). Emergent surgeries were more complicated (p<0.01) and required more reoperations (p<0.05). Surgical infectious cases had longer LOS (p<0.01). CONCLUSIONS Humanitarian surgical care can be provided without compromising the primary mission of the medical forces. Close surveillance and follow-up allowed favourable outcomes with low morbidity and mortality rates. Humanitarian care is responsible for a considerable portion of the workload in such deployed surgical teams. Accounting for humanitarian care is essential in the planning and training for such future medical operations.
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Affiliation(s)
- Yvain Goudard
- 7th Airborne Forward Surgical Team, Marseille, France.,Visceral and Digestive Surgery Unit, Laveran Military Hospital, Marseille, France
| | - C Butin
- 7th Airborne Forward Surgical Team, Marseille, France.,Orthopedic Surgery Unit, Saint-Anne Military Hospital, Toulon, France
| | - C Carfantan
- Operational Headquarters, French Military Health Service, Paris, France
| | - G Pauleau
- 7th Airborne Forward Surgical Team, Marseille, France.,Visceral and Digestive Surgery Unit, Laveran Military Hospital, Marseille, France
| | - E Soucanye de Landevoisin
- 7th Airborne Forward Surgical Team, Marseille, France.,Orthopedic Surgery Unit, Laveran Military Hospital, Toulon, France
| | - G Goin
- Visceral and Digestive Surgery Unit, Laveran Military Hospital, Marseille, France.,5th Forward Surgical Team, Marseille, France
| | - D Clement
- 7th Airborne Forward Surgical Team, Marseille, France.,Anesthesiology and Intensive Care Unit, Begin Military Hospital, Saint-Mande, France
| | - J Bordes
- 7th Airborne Forward Surgical Team, Marseille, France.,Anesthesiology and Intensive Care Unit, Saint-Anne Military Hospital, Toulon, France
| | - P Balandraud
- Visceral and Digestive Surgery, Saint-Anne Military Hospital, Toulon, France
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Trelles Centurion M, Crestani R, Dominguez L, Caluwaerts A, Benedetti G. Surgery with Limited Resources in Natural Disasters: What Is the Minimum Standard of Care? CURRENT TRAUMA REPORTS 2018; 4:89-95. [PMID: 29888165 PMCID: PMC5972172 DOI: 10.1007/s40719-018-0124-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose of Review In a challenging scenario, such as in the aftermath of a natural disaster, minimum standards of care must be in place from the moment surgical care activities are launched. Recent Findings Natural disasters cause destruction and human suffering, especially in low- and middle-income countries, which suffer the most when exposed to their consequences. Health systems can quickly get overwhelmed and can collapse under the burden of injured patients during this event, while qualified surgical care remains crucial. Medécins Sans Frontières (MSF) has a vast experience providing surgical care after natural disasters, and quality is assured through the Donabedian model. Minimum structure standards are put in place from the beginning of an emergency response, together with standard operating procedures providing guidance to professionals working in challenging conditions. Summary MSF believes that it is always possible to deliver surgical care, ensuring the best possible quality guaranteeing adequate levels of structure and process. The "do no harm" principle must always be respected as adherence to medical ethics is a must in any context, even a challenging one.
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Affiliation(s)
| | - Rosa Crestani
- 2Emergency Medical Unit, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - Lynette Dominguez
- 1Surgical Care Unit, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - An Caluwaerts
- 3Health Structure Unit, Médecins Sans Frontières, Rue de l'Arbre Bénit 46, 1050 Brussels, Belgium
| | - Guido Benedetti
- 4Operational Research Unit, Médecins Sans Frontières, 68, Rue de Gasperich, L-1617 Luxembourg, Luxembourg
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12
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Gutnik L, Yamey G, Riviello R, Meara JG, Dare AJ, Shrime MG. Financial contributions to global surgery: an analysis of 160 international charitable organizations. SPRINGERPLUS 2016; 5:1558. [PMID: 27652131 PMCID: PMC5021658 DOI: 10.1186/s40064-016-3046-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 08/11/2016] [Indexed: 11/23/2022]
Abstract
Background The non-profit and volunteer sector has made notable contributions to delivering surgical services in low-and middle-income countries (LMICs). As an estimated 55 % of surgical care delivered in some LMICs is via charitable organizations; the financial contributions of this sector provides valuable insight into understanding financing priorities in global surgery. Methods Databases of registered charitable organizations in five high-income nations (United States, United Kingdom, Canada, Australia, and New Zealand) were searched to identify organizations committed exclusively to surgery in LMICs and their financial data. For each organization, we categorized the surgical specialty and calculated revenues and expenditures. All foreign currency was converted to U.S. dollars based on historical yearly average conversion rates. All dollars were adjusted for inflation by converting to 2014 U.S. dollars. Results
One hundred sixty organizations representing 15 specialties were identified. Adjusting for inflation, in 2014 U.S. dollars (US$), total aggregated revenue over the years 2008–2013 was $3·4 billion and total aggregated expenses were $3·1 billion. Twenty-eight ophthalmology organizations accounted for 45 % of revenue and 49 % of expenses. Fifteen cleft lip/palate organizations totaled 26 % of both revenue and expenses. The remaining 117 organizations, representing a variety of specialties, accounted for 29 % of revenue and 25 % of expenses. In comparison, from 2008 to 2013, charitable organizations provided nearly $27 billion for global health, meaning an estimated 11.5 % went towards surgery. Conclusion Charitable organizations that exclusively provide surgery in LMICs primarily focus on elective surgeries, which cover many subspecialties, and often fill deep gaps in care. The largest funding flows are directed at ophthalmology, followed by cleft lip and palate surgery. Despite the number of contributing organizations, there is a clear need for improvement and increased transparency in tracking of funds to global surgery via charitable organizations.
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Affiliation(s)
- Lily Gutnik
- Department of Surgery, University of Utah, Salt Lake City, UT USA ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Tidziwe Center, UNC Project Malawi, Privae Bag A-104, Lilongwe, Malawi
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, NC USA
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Department of Surgery, Brigham and Women's Hospital, Boston, MA USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Department of Plastic Surgery, Boston Children's Hospital, Boston, MA USA
| | - Anna J Dare
- King's Centre for Global Health, King's Health Partners, King's College London, London, England, UK
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Harvard University Interfaculty Initiative in Health Policy, Boston, MA USA ; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA USA ; Department of Otology and Laryngology, Harvard Medical School, Boston, MA USA
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13
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Successful implementation of thirty five major orthopaedic procedures under poor conditions after the two thousand and fifteen Nepal earthquake. INTERNATIONAL ORTHOPAEDICS 2016; 40:2469-2477. [DOI: 10.1007/s00264-016-3284-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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14
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Trelles M, Dominguez L, Tayler-Smith K, Kisswani K, Zerboni A, Vandenborre T, Dallatomasina S, Rahmoun A, Ferir MC. Providing surgery in a war-torn context: the Médecins Sans Frontières experience in Syria. Confl Health 2015; 9:36. [PMID: 26674297 PMCID: PMC4678579 DOI: 10.1186/s13031-015-0064-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/08/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Since 2011, civil war has crippled Syria leaving much of the population without access to healthcare. Various field hospitals have been clandestinely set up to provide basic healthcare but few have been able to provide quality surgical care. In 2012, Medecins Sans Frontieres (MSF) began providing surgical care in the Jabal al-Akrad region of north-western Syria. Based on the MSF experience, we describe, for the period 5th September 2012 to 1st January 2014: a) the volume and profile of surgical cases, b) the volume and type of anaesthetic and surgical procedures performed, and c) the intraoperative mortality rate. METHODS A descriptive study using routinely collected MSF programme data. Quality surgical care was assured through strict adherence to the following minimum standards: adequate infrastructure, adequate water and sanitation provisions, availability of all essential disposables, drugs and equipment, strict adherence to hygiene requirements and universal precautions, mandatory use of sterile equipment for surgical and anaesthesia procedures, capability for blood transfusion and adequate human resources. RESULTS During the study period, MSF operated on 578 new patients, of whom 57 % were male and median age was 25 years (Interquartile range: 21-32 years). Violent trauma was the most common surgical indication (n-254, 44 %), followed by obstetric emergencies (n-191, 33 %) and accidental trauma (n-59, 10 %). In total, 712 anaesthetic procedures were performed. General anaesthesia without intubation was the most common type of anaesthesia (47 % of all anaesthetics) followed by spinal anaesthesia (25 %). A total of 831 surgical procedures were performed, just over half being minor/wound care procedures and nearly one fifth, caesarean sections. There were four intra-operative deaths, giving an intra-operative mortality rate of 0.7 %. CONCLUSIONS Surgical needs in a conflict-afflicted setting like Syria are high and include both combat and non-combat indications, particularly obstetric emergencies. Provision of quality surgical care in a complex and volatile setting like this is possible providing appropriate measures, supported by highly experienced staff, can be implemented that allow a specific set of minimum standards of care to be adhered to. This is particularly important when patient outcomes - as a reflection of quality of care - are difficult to assess.
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Affiliation(s)
- Miguel Trelles
- />Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB), Surgery, Anaesthesia, Gynaecology, and Emergency Medicine Unit, Brussels, Belgium
| | - Lynette Dominguez
- />Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB), Surgery, Anaesthesia, Gynaecology, and Emergency Medicine Unit, Brussels, Belgium
| | - Katie Tayler-Smith
- />MSF-OCB, Operational Research Unit, MSF-Luxembourg, Luxembourg, Luxembourg
| | | | | | | | | | - Alaa Rahmoun
- />MSF-OCB, MSF Syria project, Latakia Governorate, Syria
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15
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Hinsenkamp M. SICOT contribution to natural disaster assistance: the pre-requisite. INTERNATIONAL ORTHOPAEDICS 2015; 39:1885-6. [PMID: 26183141 DOI: 10.1007/s00264-015-2877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/01/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Maurice Hinsenkamp
- Department of Orthopaedic Surgery, Hôpital Erasme, Université Libre de Bruxelles - ULB, Route de Lennik 808, Brussels, B-1070, Belgium.
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