In Rosemont and Washington, D.C., AAOS staff have been working on multiple fronts to help facilitate the movement of people and supplies, to prod government officials and agencies, and to establish long-term assistance plans. Staff have also been answering questions from members already on the ground in Haiti, members waiting to deploy, aid agencies requesting additional volunteer information, and the national and international press. We want to bring you up-to-date on some of those activities.

· In response to your questions, staff have investigated issues surrounding medical liability as well as personal health, life, and disability insurance coverage, particularly for claims that may relate to service in Haiti. As a general rule, you should notify your insurance carrier before you leave for service in an international disaster situation such as Haiti.

· Staff have also been communicating with international relief agencies and government agencies regarding U.S. hospitals willing to care for Haitian survivors. On Tuesday, the Department of Health and Human Services released information on how the National Disaster Medical System (NDMS) and Federal Coordinating Centers will be used to arrange for and transport survivors to appropriate hospitals. For members serving on the ground in Haiti who have critically ill patients they would like transferred to the United States for care, instructions, contact information, and patient transfer forms are available at www.aaos.org/news/whatsnew/haiti_transfer_patients.asp If you are interested in finding out more about the NDMS or if you want to contact your local team, e-mail your contact information to ndms@hhs.gov

Again and again, we have heard that the Haitian people are brave, patient, and in need of long-term assistance and care. We have heard that, despite the initial chaos, conditions are improving. We have heard that volunteer service is both highly stressful and very rewarding. Here are just a few of the other stories we have heard:

From Kaye E. Wilkins, MD: Some buildings had completely collapsed next to ones that were intact. Many temporary tent cities had been established as the citizens were afraid to stay in their previous dwellings ?[at] Hôpital de la Comunitie Haitien (HCH) in Petion-ville, Scott C. Nelson, MD, and his team had established an orthopaedic surgical treatment program; for the first few days, they were operating literally 24 hours/day. Almost all of the surgery being performed was of an orthopaedic nature ? The top priority in the first few days was to save lives and limbs. ? Many of the fractures were stabilized first with casts before undergoing surgical stabilization. Initially, there were no devices to remove these casts in the surgical area. The first casts were removed carefully with a mallet and an osteotome (a chisel-like instrument used to shape bone). ? The rebuilding effort has just begun. Most of the acute injuries from the earthquake have been stabilized. This has created a gigantic reservoir of individuals who will need the extremely vital but less glamorous post-treatment care. Thus we all need to be committed to the long-term needs of these victims.

From Michael Vitale, MD: I went down with a loose group of organizations, including the United Aid Foundation and basically had a mobile team supported by 5 anesthetists and 2 nurses. At the beginning of the week, I was overwhelmed placing quick ex-fixes at hospitals on the Dominican Republic side of the border and then in Jimani on the border. Lots of neglected/ open long bone fractures but this slowed considerably even in 7 days. As we exit the phase of fracture care, the challenge will focus on limb salvage for open tibias, conversion of suboptimal ex fixes, and wound and amputation management.

From Brian S. Parsley, MD: We completed 70 surgical procedures for the week but we touched the lives of many more. As the week progressed, we were even more efficient than at the beginning. By the 8th day, we are all aware that our trip would be ending but the work in Haiti is only beginning. ? Where do we go from here? Currently we are managing broken bones and many open wounds, trying to salvage as many as possible. There is a need for hand, foot, trauma, and plastic surgeons. This will continue into the foreseeable future. The needs will then change to reconstructive trauma, infection management, and prosthetics. This has been an incredible experience and we all can make a difference.

From Evan F. Eckman, MD: Just got back from Haiti, working at L'Hopital Lumiere in Bonne Finn up in the mountains... nonstop surgery and more than 80 patients. While it is a long trek up the mountains, the patients made it and they continue to come. We haven?t even begun on closed long bone fractures. Robert H. Belding, MD, did incredible work at this facility with minimal support in the first week. By the second week, we had 3 orthopaedic surgeons and a fabulous staff around us, and at times, still felt like we were barely making a dent. The isolation of this village makes things very difficult. If you can think of it, it is needed. We had a lady that completed an above-elbow amputation on herself to escape the rubble....WITH A ROCK. There is truly a heartbreaking story with every single patient. I have never seen anything like it.

Heartbreaking, yes. But hopeless, never?not with orthopaedic surgeons like these at work. We thank you?all of you?for your generous and caring spirits.

Joseph D. Zuckerman, MD John J. Callaghan, MD Daniel J. Berry, MD

AAOS President First Vice President Second Vice President