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Implementation of an Emergency Response Protocol for Overseas Surgical Outreach Initiatives

Vyas, Raj M. M.D.; Eberlin, Kyle R. M.D.; Hamdan, Usama S. M.D.

Plastic and Reconstructive Surgery: April 2013 - Volume 131 - Issue 4 - p 631e–636e
doi: 10.1097/PRS.0b013e3182827776
Special Topic

Background: Many health organizations sponsor overseas surgical outreach initiatives, yet none has published a standardized protocol to prevent and manage unforeseen emergencies. Surgeons, anesthesiologists, nurses, and administrators—working together on a brief overseas humanitarian initiative—benefit from education and training to maximize their collective emergency responsiveness. This article outlines the emergency response protocol instituted by the Global Smile Foundation, a 501(c)(3) nonprofit global outreach organization providing comprehensive cleft care for the past 25 years.

Methods: The Global Smile Foundation emergency response protocol was constructed to provide all team members resources and training needed to emulate the high emergency response standards of developed nations. In this article, the authors share their education/training strategy, emergency “crash” cart inventory, site-specific safety checklist, and team member roles and responsibilities during various emergencies.

Results: The authors' protocol emphasizes equipment portability, location-specific adaptability, clear workflow/communication, and standardized team roles. On-site training is likewise portable, standardized, reproducible, efficient, and adaptive to each setting. These characteristics make the authors' protocol widely adoptable.

Conclusions: Most morbidity and mortality during overseas surgical outreach initiatives result from unfamiliarity with the host hospital and other team members during operative (e.g., airway, bleeding, circulatory, anesthetic) or location-based (e.g., power outage, fire, oxygen shortage) emergencies. These complications are prevented and managed with aggressive team education and training. The Global Smile Foundation protocol adapts to the uncertainties of providing medical care in underresourced settings and reflects experience accumulated over the past quarter century. It is the authors' hope that other humanitarian outreach groups will adopt, customize, and build on these basic tenets.


Boston, Mass.

From the Global Smile Foundation and the Harvard Combined Plastic Surgery Residency Program, Harvard Medical School.

Received for publication August 10, 2012; accepted August 31, 2012.

Disclosure:None of the authors has a financial interest in any of the products, devices, or services referenced in this article. None of the authors have a conflict of interest with the aforementioned products, devices, or services or with any of the recommendations made in this article.

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Raj M. Vyas, M.D.; 165 Pleasant Street, Suite 114, Cambridge, Mass. 02139,

©2013American Society of Plastic Surgeons