Weill Cornell Medical College, New York, NY, USA.
Clin Orthop Relat Res. 2012 Oct;470(10):2895-904. doi: 10.1007/s11999-012-2333-4. Epub 2012 Apr 10.
Although numerous authors have described surgical experiences following major disasters, little is known regarding the needs of and barriers to care faced by surgeons during such disasters.
QUESTIONS/PURPOSES: We therefore (1) identified and compared recurrent interview themes essential to the disaster response following the 2010 Haiti earthquake; (2) determined the difference in reported disaster equipment management task difficulty between disaster-trained and untrained volunteers; and (3) approximated the quantity of various procedures performed.
We conducted 14 interviews with selected orthopaedic surgeon volunteers. We also invited the 504 members of the American Academy of Orthopaedic Surgeons (AAOS), who registered as Haiti earthquake volunteers, to complete an online survey; 174 (35%) completed the survey and 131 (26%) were present in Haiti during the 30 days after the earthquake. Recurrent interview themes were identified, quantified, and compared using Poisson regression analysis. The difference in disaster equipment management difficulty scores was determined with a Wilcoxon rank-sum test.
Of 10 recurrent interview themes, group organization (31 occurrences) was mentioned much more often than all but two of the remaining nine themes. Compared with disaster-untrained respondents, equipment management tended to be less challenging for disaster-trained respondents. Transporting to the treatment site and security during storage at the site were less challenging (19.5% and 16.5% decreases, respectively). Revision surgeries, guillotine amputations, fasciotomies, and internal fixations, suggestive of inappropriate disaster care, were frequently reported.
Organizational and training barriers obstructed orthopaedic care delivery immediately after the Haiti earthquake. Disaster training and outcomes require further study to improve care in future catastrophes.
尽管许多作者都描述过重大灾难后的外科手术经验，但对于外科医生在灾难中面临的护理需求和障碍却知之甚少。
问题/目的：因此，我们（1）确定并比较了 2010 年海地地震后灾难应对中至关重要的反复出现的访谈主题；（2）确定了受过灾难培训的和未受过培训的志愿者报告的灾难设备管理任务难度之间的差异；（3）估计了各种手术的数量。
我们对选定的骨科外科医生志愿者进行了 14 次访谈。我们还邀请了 504 名美国骨科医师学会（AAOS）的海地地震志愿者注册会员完成在线调查；有 174 人（35%）完成了调查，其中 131 人（26%）在地震发生后的 30 天内在海地。使用泊松回归分析确定、量化和比较反复出现的访谈主题。使用 Wilcoxon 秩和检验确定灾难设备管理难度评分的差异。
在 10 个反复出现的访谈主题中，团队组织（31 次）比其余 9 个主题中的两个主题被提及的频率更高。与未受过灾难培训的受访者相比，受过灾难培训的受访者在设备管理方面的难度往往较低。运往治疗地点以及在现场存放时的安全性方面的难度降低（分别降低了 19.5%和 16.5%）。经常报告的是 Revision surgeries、guillotine amputations、fasciotomies 和 internal fixations 等提示不适当灾难护理的手术。
组织和培训障碍阻碍了海地地震后骨科护理的开展。灾难培训和结果需要进一步研究，以改善未来灾难中的护理。
