Original Research

Best Practice Guidelines on Surgical Response in Disasters and Humanitarian Emergencies: Report of the 2011 Humanitarian Action Summit Working Group on Surgical Issues within the Humanitarian Space

Smita Chackungal^a1 c1, Jason W. Nickerson^a2, Lisa M. Knowlton^a3, Lynn Black^a4, Frederick M. Burkle Jr.^a5, Kathleen Casey^a6, David Crandell^a7, Didier Demey^a8, Lillian Di Giacomo^a9, Lena Dohlman^a10, Joshua Goldstein^a11, James E. Gosney Jr.^a12, Keita Ikeda^a13, Allison Linden^a14, Catherine M. Mullaly^a15, Colleen O'Connell^a16, Anthony D. Redmond^a17, Adam Richards^a18, Robert Rufsvold^a19, Ana L.R. Santos^a20, Terri Skelton^a21 and Kelly McQueen^a22

^a1 Division of General Surgery, University of Western Ontario, London, Ontario, Canada; Surgical Research Fellow Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA

^a2 Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada

^a3 Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Surgical Research Fellow, Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA

^a4 Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts USA

^a5 Senior Fellow & Scientist, Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA

^a6 Director, Operation Giving Back, American College of Surgeons, Chicago, Illinois USA

^a7 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts USA

^a8 Physical Therapist, Technical Advisor for Emergency and Rehabilitation, Handicap International, Brussels, Belgium

^a9 John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of General Surgery, University of California, Davis Medical Center, Sacramento, California USA

^a10 Assistant Professor, Harvard Medical School; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts USA

^a11 Principal Director for Economic Citizenship & Disability Inclusion, Center for Financial Inclusion at ACCION International; Lecturer, Boston University, Boston, Massachusetts USA

^a12 Handicap International, Takoma Park, Maryland USA

^a13 Post Doctorate Fellow, Duke University Medical Center, Department of Anesthesia, Raleigh, North Carolina USA

^a14 Harvard School of Public Health, Boston, Massachusetts, USA; Georgetown University Medical Center, Washington, D.C. USA

^a15 Instructor, Harvard Medical School; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts USA

^a16 Research Chief, Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada

^a17 Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK

^a18 American Heart Association-Pharmaceutical Outcomes Research Center, UCLA Department of Neurology, Los Angeles, California, USA; Global Health Access Program, Berkeley, California USA

^a19 Medical Director, International Medical Corps Emergency Response, Libya

^a20 Delft University of Technology, Delft, Netherlands

^a21 Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada

^a22 Fellow, Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts; Valley Anesthesiology Consultants, Phoenix, Arizona USA

Abstract

The provision of surgery within humanitarian crises is complex, requiring coordination and cooperation among all stakeholders. During the 2011 Humanitarian Action Summit best practice guidelines were proposed to provide greater accountability and standardization in surgical humanitarian relief efforts. Surgical humanitarian relief planning should occur early and include team selection and preparation, appropriate disaster-specific anticipatory planning, needs assessment, and an awareness of local resources and limitations of cross-cultural project management. Accurate medical record keeping and timely follow-up is important for a transient surgical population. Integration with local health systems is essential and will help facilitate longer term surgical health system strengthening.

(Online publication April 04 2012)

Keywords

• Surgical burden of disease;
• Surgical standards;
• Disaster medicine;
• Humanitarian emergencies;
• Trauma rehabilitation

Correspondence:

^c1 Corresponding Author: Smita Chackungal, MD, MPH Division of General Surgery University of Western Ontario 339 Windermere Road London, Ontario Canada N6A 5A5 E-mail: schackun@uwo.ca