Prehospital and Disaster Medicine

Original Research

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

Lisa Marie Knowltona1 c1, James E Gosney Jra2, Smita Chackungala3, Eric Altschulera4, Lynn Blacka5, Frederick M Burkle Jra6, Kathleen Caseya7, David Crandella8, Didier Demeya9, Lillian Di Giacomoa10, Lena Dohlmana11, Joshua Goldsteina12, Richard Gosselina13, Keita Ikedaa14, Andree Le Roya15, Allison Lindena16, Catherine M Mullalya17, Jason Nickersona18, Colleen O'Connella19, Anthony D Redmonda20, Adam Richardsa21, Robert Rufsvolda22, Anna LR Santosa23, Terri Skeltona24 and Kelly McQueena25

a1 Division of General Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Surgical Research Fellow Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA

a2 Handicap International, Takoma Park, Maryland USA

a3 Division of General Surgery, University of Western Ontario, London, Ontario, Canada; Surgical Research Fellow, Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA

a4 Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, New Jersey USA

a5 Department of Medicine, Massachusetts General Hospital, Boston Massachusetts USA

a6 Senior Fellow and Scientist, Harvard Humanitarian Initiative, Harvard University, Boston, Massachusetts USA

a7 Director, Operation Giving Back, American College of Surgeons, Chicago, Illinois USA

a8 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts USA

a9 Physical Therapist, Technical Advisor for Emergency and Rehabilitation, Handicap International, Brussels, Belgium

a10 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA; Division of General Surgery, University of California at Davis Medical Center, Sacramento, California USA

a11 Assistant Professor, Harvard Medical School, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts USA

a12 Principal Director for Economic Citizenship & Disability Inclusion, Center for Financial Inclusion at ACCION International; Lecturer, Boston University, Boston, Massachusetts USA

a13 Institute for Global Orthopedics and Traumatology, University of California at San Francisco, San Francisco, California USA

a14 Post Doctorate Fellow, Duke University Medical Center, Department of Anesthesia, Raleigh, North Carolina USA

a15 Physiatrist, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA; Instructor, Harvard Medical School, Boston Massachusetts, USA

a16 Harvard School of Public Health, Boston, Massachusetts USA; Georgetown University Hospital, Washington, District of Columbia USA

a17 Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts USA; Instructor, Harvard Medical School, Boston Massachusetts USA

a18 Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada

a19 Research Chief, Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada

a20 Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK

a21 American Heart Association-Pharmaceutical Outcomes Research Center, UCLA Department of Neurology, Los Angeles, California USA; Global Health Access Program, Berkeley, California USA

a22 Medical Director, International Medical Corps Emergency Response, Libya

a23 Delft University of Technology, Delft, Netherlands

a24 Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada

a25 Fellow, Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA; Valley Anesthesiology Consultants, Phoenix, Arizona USA

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.

(Online publication March 20 2012)

Correspondence:

c1 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: drlisaknowlton@gmail.com