Orthopaedic care provided by the 14th combat support hospital in support of humanitarian and disaster relief after hurricane Maria in Puerto Rico

Abstract

On September 20, 2017 Hurricane Maria, a category 4 hurricane, made landfall on the eastern coast of Puerto Rico. This was preceded by Hurricane Irma, a category 5 hurricane, which passed just off the coast 13 d prior. The destruction from both Hurricane Irma and Maria precipitated a coordinated federal response which included the Federal Emergency Management Agency (FEMA) and the United States military. The United States Army dispatched the 14^th Combat Support Hospital (CSH) to Humacao, a city on the eastern side of the island where Maria made landfall. The mission of the 14^th CSH was to provide medical humanitarian aid and conduct disaster relief operations in support of the government of Puerto Rico and FEMA. During the 14^th CSH deployment to Puerto Rico, 1157 patients were evaluated and treated. Fifty-seven operative cases were performed to include 23 orthopaedic cases. The mean age of the orthopaedic patients treated was 45.7 years (range 13-76 years). The most common operation was irrigation and debridement of open contaminated and/or infected wounds. Patients presented a mean 10.8 d from their initial injury (range 1-40 d). Fractures and infections were the most common diagnoses with the greatest delay in treatment from the initial date of injury. The deployment of the 14^th CSH to Puerto Rico was unique in its use of air transport, language and local customs encountered, as well as deployment to a location outside the continental United States. These factors coupled with the need for rapid deployment of the 14^th CSH provided valuable experience which will undoubtedly enable future success in similar endeavors.

Keywords: Hurricane Maria; Disaster relief; Combat support hospital; Army

Core tip: Health care providers embarking on humanitarian and disaster relief efforts should consider the following factors: What specific diagnoses or injuries can your team safely manage considering the knowledge, technical ability, equipment, and facilitates your team possesses? What was the health of the patient population pre-disaster and their access to quality health care? What can be done to help mitigate language and cultural barriers which make effective communication with patients difficult? What local providers and resources can be engaged to ensure continued care for patients after relief efforts have concluded?