title: Critically assessing the Haiti earthquake response and the barriers to quality orthopaedic care.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Weill Cornell Medical College, New York, NY, USA. sonshined@orthosurg.ucsf.edu
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Sonshine
authors.forename: Amber
authors.initials: A
authors.lastname: Caldwell
authors.forename: Richard A
authors.initials: RA
authors.lastname: Gosselin
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Born
authors.forename: R Richard
authors.initials: RR
authors.lastname: Coughlin
mesh_terms: D000328:Adult; D055866:Earthquakes; D005260:Female; D006205:Haiti; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000592:standards*; D011785:Quality Assurance, Health Care; D018635:Rescue Work / Q000592:standards*; D013997:Time Factors