Proposed Coalition Could Improve Surgical Delivery in Disasters

Members of Médecins sans Frontières (MSF; Geneva, Switzerland) call for the establishment of an Emergency Surgery Coalition (ESC) of organizations with extensive experience in humanitarian emergencies that will work together to support the rapid deployment of emergency surgical services.

The proposal sets the role for the ESC in keys moments involved in humanitarian disasters. Thus, before potential disasters, the ESC would maintain emergency supplies worldwide; ideally, small-scale projects in "hotspots” would be maintained in order to establish local relationships and supply chains. The ESC would work with governments and the World Health Organization (WHO; Geneva, Switzerland) to minimize administrative delays to the importation of surgical, anesthetic, and related medical supplies. The ESC would also facilitate surgical training for humanitarian settings and share lists of qualified personnel among its members, and define a surgical mass-disaster plan.

During the disaster, the ESC would coordinate emergency and referral care in a manner that will reduce duplication and fragmentation among providers. It would also work with the WHO and government to ensure the timely delivery of humanitarian supplies, according to collective needs assessments. After the disaster, ESC members would use a standardized database to collect data on demographics and procedures to analyze the quality and expediency of the surgical care delivered; lessons learned would be shared among members to prepare for the next disaster. The proposal for the establishment of the ESC was published on April 26, 2011, in PLoS Med.

"Improved surgical delivery will require preemptive planning and inter-agency coordination. The ESC, comprising key players from major surgical humanitarian agencies, is a proposal to improve surgical delivery in disasters and could support the work ahead,” concluded lead author Kathryn Chu, MD, MPH.

In response to the 2010 Haiti earthquake, MSF deployed the largest surgical team in the organization's 40-year history; in 10 weeks, over 55,000 patients were treated and over 4,000 surgical interventions performed. However, the delivery of care was fraught with supply delays, a lack of appropriately experienced surgeons and anesthesiologists, and challenges in coordinating with other agencies--governmental, military, and nongovernmental--whose priorities and motives did not always agree. The ESC proposal is based on the challenges the MSF faced and suggests ways forward to support an effective surgical humanitarian response to future major disasters.

Related Links:
Médecins sans Frontières
World Health Organization