AO Foundation Course

08. February 2018

AO teams up with WHO and ICRC to prepare surgeons for disaster situations

Faculty demonstrating the procedure

The AO Foundation has launched its first-ever course designed to equip surgeons with the skills they need to perform successful limb surgery in disaster and conflict zones. 

The AO Foundation Course—Limb Surgery in Disaster and Conflicts for Emergency Medical Teams, launched at the 2017 Davos Courses, is the result of a collaboration between the AO, the International Committee of the Red Cross (ICRC), and the World Health Organization (WHO), and brings together a group of world renowned specialists and surgeons with years of experience in disaster and conflict situations. 

"Disasters come in many varieties, and the needs are immense," said Elhanan Bar-On, Director of the Israel Center for Humanitarian, Emergency and Disaster Medicine, introducing the pilot course.  "What prompted our course was really the mother of all disasters, Haiti, where 200,000 people were killed and up to 1 million injured." A major contribution to this effort is provided by the WHO's Emergency Medical Team (EMT) Initiative, which coordinates the emergency deployment of trained medical teams conforming to minimum quality standards. As Ian Norton, who manages the EMT Initiative for the WHO in Geneva, explained in his introduction: "There are principles in disasters and conflict zones that need to be observed. Correct procedures and high coordination is essential to achieve the desired results."

Elhanan Bar-On introducing core EMT concepts 

Part of a global response to the humanitarian community's failure to provide adequate life- and limb-saving care following the Haiti earthquake and Pakistan floods, the idea for a collaboration between AO Foundation and the humanitarian community was first raised by David Helfet in 2013 and later made possible by an AO Foundation grant. The resulting consensus guidelines and “Field Guide for the Management of Limb Injuries in Disasters and Conflicts​", launched in 2016 plus a growing set of open-source educational resources culminated in this year's face-to-face course.

The EMT team

In an intensive 1.5 days, participants from a variety of backgrounds experienced how to adapt their practice and techniques for limb injury care in the context of a disaster or conflict setting—whether in a field hospital or local hospital. Participants were presented with cases and insights into surgical practice in austere environments that differ hugely from their normal daily practice. Topics such as ballistics and blast injuries highlight how wounds and fractures typically differ in disaster or conflict situations. 

On day two, in the hands-on anatomical specimen labs, participants had the opportunity to practice many of the techniques described in the aforementioned Field Guide​, including wound debridement and soft-tissue management, flaps, skin grafts, amputation, and fasciotomy. The practical part was complemented by an interactive discussion session covering logistics, ethical dilemmas, and team dynamics—all of which present their specific challenges. These "soft" topics were also deemed very important by the participants with a suggestion for future courses to integrate more in-depth discussion as an evening fireside chat. 

Most of the participants assessed the hands-on aspect of the course as extremely effective with various comments highlighting of particular value the demonstrations and the opportunities to practice uncommon procedures (eg, flaps) confronted primarily in austere environments.

More information on the course held in December ​can be found on the AOTrauma website.​​​​


Icon Adapting to the disaster situation - power tools may not be available
Icon Michael Schütz providing feedback to learners