Strategies in Evaluation and Management of Bam Earthquake Victims

A victim risk identification model for nature-induced urban disaster emergency response

In recent years, nature-induced urban disasters in high-density modern cities in China have raised great concerns. The delayed and imprecise understanding of the real-time post-disaster situation made it difficult for the decision-makers to find a suitable emergency rescue plan. To this end, this study aims to facilitate the real-time performance and accuracy of on-site victim risk identification. In this article, we propose a victim identification model based on the You Only Look Once v7-W6 (YOLOv7-W6) algorithm. This model defines the "fall-down" pose as a key feature in identifying urgent victims from the perspective of disaster medicine rescue. The results demonstrate that this model performs superior accuracy (mAP@0.5, 0.960) and inference speed (5.1 ms) on the established disaster victim database compared to other state-of-the-art object detection algorithms. Finally, a case study is illustrated to show the practical utilization of this model in a real disaster rescue scenario. This study proposes an intelligent on-site victim risk identification approach, contributing significantly to government emergency decision-making and response.

Changes in patient admission patterns at orthopedics and traumatology outpatient clinics before and after the earthquakes on 6 February 2023 in Turkey

BACKGROUND

The increase in orthopedic injuries after earthquakes imposes a significant burden on the health system. However, the impact of earthquakes on outpatient admissions remains unclear. This study compared patient admissions to the orthopedics and traumatology outpatient clinics before and after earthquakes.

METHODS

The study was conducted at a tertiary university hospital near the earthquake zone. In total, 8549 outpatient admissions were retrospectively analyzed. The study population was divided into pre-earthquake (pre-EQ) and post-earthquake (post-EQ) groups. Factors such as gender, age, city of origin, and diagnosis were compared between the groups. In addition, unnecessary outpatient utilization (UOU) was defined and analyzed.

RESULTS

The pre-EQ and post-EQ groups included 4318 and 4231 patients, respectively. The two groups had no significant differences in age and sex distribution. However, the proportion of non-local patients increased after the earthquake (9.6% vs. 24.4%, p < 0.001). UOU was the most common reason for admission in both groups. The distribution of diagnoses differed significantly between the pre-EQ and post-EQ groups, with an increase in the number of trauma-related diagnoses (15.2% vs. 27.3%, p < 0.001) and a decrease in UOU (42.2% vs. 31.1%, p < 0.001) after the earthquake.

CONCLUSIONS

Patient admission patterns at orthopedics and traumatology outpatient clinics changed significantly after the earthquake. The number of non-local patients and trauma-related diagnoses increased, whereas the number of unnecessary outpatients decreased. Level of evidence Observational study.

The Outcome of Orthopedics Treatment of Lombok Earthquake Victim 2018: A Cohort of One-Year Follow-Up Study-Lesson Learned After Lombok Earthquake

Introduction

There was a magnitude 7 on the Richter scale earthquake on Lombok Island in 2018, causing more than 500 deaths. In the event of earthquakes, there is often an imbalance between overcrowding in hospitals and inadequate resources. The initial management of earthquake victims with musculoskeletal injuries is controversial, arguing over whether to utilize debridement, external or internal fixation, or conservative or operative treatment in an acute onset disaster situation. This study aims to determine the outcome of initial management after the 2018 Lombok earthquake, between immediate open-reduction and internal fixation (ORIF) and Non-ORIF procedures after one year follow-up.

Methods

This is a cohort study to evaluate radiological and clinical outcomes one year after orthopedic treatment in the Lombok earthquake 2018. The subjects were recruited from eight public health center and one hospital in Lombok in September 2019. We evaluate radiological outcomes (non/malunion and union) and clinical outcomes (infection and SF-36 score).

Results

Based on 73 subjects, the ORIF group has a higher union rate than the non-ORIF group (31.1% vs. 68.9%; p = 0.021). Incidence of infection only appeared in the ORIF group (23.5%). Clinical outcome as measured by SF36 showed the ORIF group had a lower mean of general health (p = 0.042) and health change (p = 0.039) clinical outcomes than the non-ORIF group.

Discussion

The most affected public group is the productive age with significant impact on social-economy. ORIF procedure is a major risk factor of infection in initial treatment after earthquake. Therefore, definitive operation with internal fixation is not recommended in the initial phase of a disaster. Damage Control Orthopedic (DCO) surgery protocol is the treatment of choice in acute disaster setting.

Conclusion

The ORIF group had better radiological outcomes than the non-ORIF group. However the ORIF group had higher cases of infection and lower SF-36 than the non-ORIF group. Definitive treatment in acute onset disaster setting should be prevented.

Evaluation of Machine Learning and Web-Based Process for Damage Score Estimation of Existing Buildings

The seismic vulnerability assessment of existing reinforced concrete (RC) buildings is a significant source of disaster mitigation plans and rescue services. Different countries evolved various Rapid Visual Screening (RVS) techniques and methodologies to deal with the devastating consequences of earthquakes on the structural characteristics of buildings and human casualties. Artificial intelligence (AI) methods, such as machine learning (ML) algorithm-based methods, are increasingly used in various scientific and technical applications. The investigation toward using these techniques in civil engineering applications has shown encouraging results and reduced human intervention, including uncertainties and biased judgment. In this study, several known non-parametric algorithms are investigated toward RVS using a dataset employing different earthquakes. Moreover, the methodology encourages the possibility of examining the buildings’ vulnerability based on the factors related to the buildings’ importance and exposure. In addition, a web-based application built on Django is introduced. The interface is designed with the idea to ease the seismic vulnerability investigation in real-time. The concept was validated using two case studies, and the achieved results showed the proposed approach’s potential efficiency.

Reconstruction of tibial bone defect in new age using the old age Papineau technique: A case series

Introduction

Despite advances in treatment, chronic osteomyelitis and infected nonunion after trauma remain a challenge to the orthopaedic field. The Papineau technique, firstly described in 1973, is an alternative to treat such conditions in hospitals where microsurgery is not available, making closure of defect using flap is not feasible. We described our experience in treating patients with chronic osteomyelitis and infected non-union of tibial fractures using the Papineau technique.

Methods

We reviewed the records of patients with severe open tibial fractures with bone defects who were treated using the Papineau technique at Cipto Mangunkusumo Hospital, Jakarta, Indonesia during the period of January 2017 to August 2019. Those with diabetes mellitus, severe liver disease, or malignancies were excluded. All surgical procedures were performed by one senior orthopedic surgeon.

Results

A total of four subjects were enrolled in this study. All subjects were male, with a mean age of 29 ± 6.16 years of age. The mean time to granulation tissue was 21.5 ± 1.29 days, and the mean time to union was 6 ± 0 months. There were no complications.

Conclusions

The Papineau technique may provide successful eradication of infection, reconstruction of bone defect, and soft-tissue closure. In addition, this technique is feasible and safe, and it could be performed in small healthcare centres.

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Cases of chronic osteomyelitis and infected nonunion after trauma remain a challenge.

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No consensus regarding the best method.

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In Indonesia studies regarding the use of the Papineau technique never been conducted.

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The Papineau technique could be performed in small healthcare centres.

Aetiology of trauma-related acute compartment syndrome of the leg: A systematic review

BACKGROUND

Acute compartment syndrome (ACS) is characterised by abnormal pressure inside a compartment, resulting in ischemia of muscles and nerves. Most orthopaedic surgeons, especially those who work in major trauma centres, have been or will be facing a case of ACS in their clinical activity. Fortunately, complications related to untreated compartment syndrome have become less frequent thanks to a better understanding of pathogenesis and to early recognition and prompt surgical treatment. The aim of this study is to identify the existing evidence regarding aetiology of trauma-related ACS of the leg.

METHODS

A systematic review of the literature was undertaken using PubMed Medline, Ovid Medline and the Cochrane library, extended by a manual search of bibliographies. Retrieved articles were eligible for inclusion if they reported data about aetiology of trauma-related compartment syndrome of the tibia.

RESULTS

Ninety-five studies that fulfilled the inclusion criteria were identified. By dividing the studies into three groups according to the traumatic aetiology, we were able to classify traumatic ACS as fracture related, soft tissue injury related and vascular injury related. Fracture related was the most represented group, comprising 58 papers, followed by the soft tissue injury related group which includes 44 articles and vascular injury related group with 24 papers.

CONCLUSIONS

Although traditionally ACS has been associated mainly with fractures of tibial diaphysis, literature demonstrates that other localisations, in particular in the proximal tibia, are associated with an increased incidence of this serious condition. The forms of ACS secondary to soft tissues injuries represent an extremely variable spectrum of lesions with an insidious tendency for late diagnosis and consequently negative outcomes. In the case of vascular injury, ACS should always be carefully considered as a priority, given the high incidence reported in the literature, as a result of primitive vascular damage or as a result of revascularisation of the limb. Knowledge of aetiology of this serious condition allows us to stratify the risk by identifying a population of patients most at risk, together with the most frequently associated traumatic injuries.

Physical therapy needs for patients with physical function injuries post-earthquake disasters: A systematic review of Chinese and Western literature

BACKGROUND AND PURPOSE

Over the last 500 years, the most earthquakes with 10,000 or more fatalities and the most overall fatalities have occurred in China. Physical therapists must develop a better understanding of the patient and injury types that they are likely to treat post-earthquake disasters. This systematic review of Chinese and Western literature identified the primary patients treated by physical therapists post-earthquake disasters for injuries that negatively impacted physical function, activity, and participation.

METHODS

Comparisons were made between reports of earthquakes in China and reports from the rest of the world combined.

RESULTS

Sixty-seven studies of 71,986 patients (51.8% male) at 40.6 ± 15 years of age were included. Studies were mostly prospective (n = 48, 71.6%). Reports of earthquakes in China represented more recently occurring disasters (p = .003) and more prospective research designs (p = .003). Reports from China also had a higher median fracture number (p = .004). Studies from China used manual muscle testing (p = .02), visual analogue pain scales (p = .008), Barthel index or modified Barthel index (p < .0001), and joint motion assessment (p = .007) with greater frequencies.

DISCUSSION

Physical therapists from China are more likely to treat patients with a fracture; however, physical therapists from both regions are likely to treat patients with general injuries representing poly-trauma to multiple body regions, traumatic brain-closed head injuries, spinal cord injuries, peripheral nerve injuries, and soft tissue injuries.

IMPLICATIONS ON PHYSIOTHERAPY PRACTICE

These data can help improve earthquake disaster planning, infrastructure development, and resource needs assessment effectiveness. More prospective research study designs and more recent earthquake disasters in China are likely associated with greater explicit use of valid and reliable outcome measurements such as joint motion assessment, manual muscle testing, visual analogue pain scale, and the Barthel index or modified Barthel index.

Indexes of Caring for Elderly in Earthquakes According to the Iranian Experience: A Qualitative Study

OBJECTIVE

The elderly are especially susceptible to death and injury in disasters. This study aimed to identify indexes of caring for elderly people in an earthquake according to the Iranian experience.

METHODS

This qualitative study was conducted during 2014-2016 by use of the content analysis technique. Data were collected through individual deep interviews with the elderly and people with experience providing services to the elderly during earthquakes in an urban area of Iran. The data were analyzed by use of the Graneheim and Lundman method.

RESULTS

Seven categories emerged: vulnerability of elderly people, physiological indexes, psychological indexes, economic indexes, religious and spiritual indexes, health indexes, and security indexes. There were 3 uncategorized issues: "There is no specific protocol for the elderly," "The need to design plans based on age care," and "Aid organizations."

CONCLUSIONS

Implementing a comprehensive plan would not only save lives but decrease suffering and enable effective use of available resources. Due to the crucial role of the prehospital care system in disasters, there is a need for further investigation based on the results of this study to develop strategies for improving the system. (Disaster Med Public Health Preparedness. 2018;12:493-501).

Toward a Better Nutritional Aiding in Disasters: Relying on Lessons Learned during the Bam Earthquake

Introduction Examining various problems in the aftermath of disasters is very important to the disaster victims. Managing and coordinating food supply and its distribution among the victims is one of the most important problems after an earthquake. Therefore, the purpose of this study was to recognize problems and experiences in the field of nutritional aiding during an earthquake.

METHODS

This qualitative study was of phenomenological type. Using the purposive sampling method, 10 people who had experienced nutritional aiding during the Bam Earthquake (Iran; 2003) were interviewed. Colaizzi's method of analysis was used to analyze interview data.

RESULTS

The findings of this study identified four main categories and 19 sub-categories concerning challenges in the nutritional aiding during the Bam Earthquake. The main topics included managerial, aiding, infrastructural, and administrative problems.

CONCLUSIONS

The major problems in nutritional aiding include lack of prediction and development of a specific program of suitable nutritional pattern and nutritional assessment of the victims in critical conditions. Forming specialized teams, educating team members about nutrition, and making use of experts' knowledge are the most important steps to resolve these problems in the critical conditions; these measures are the duties of the relevant authorities. Nekouie Moghadam M , Amiresmaieli M , Hassibi M , Doostan F , Khosravi S . Toward a better nutritional aiding in disasters: relying on lessons learned during the Bam Earthquake. Prehosp Disaster Med. 2017;32(4):382-386.

A review of the epidemiology and treatment of orthopaedic injuries after earthquakes in developing countries

BACKGROUND

Earthquakes in developing countries are devastating events. Orthopaedic surgeons play a key role in treating earthquake-related injuries to the extremities. We describe orthopaedic injury epidemiology to help guide response planning for earthquake-related disasters.

METHODS

Several databases were searched for articles reporting primary injury after major earthquakes from 1970 to June 2016. We used the following key words: "earthquake" AND "fracture" AND "injury" AND "orthopedic" AND "treatment" AND "epidemiology." The initial search returned 528 articles with 253 excluded duplicates. The remaining 275 articles were screened using inclusion criteria, of which the main one was the description of precise anatomic location of fracture. This yielded 17 articles from which we analyzed the ratio of orthopaedic to nonorthopaedic injuries; orthopaedic injury location, type, and frequency; fracture injury characteristics (open vs. closed, single vs. multiple, and simple vs. comminuted); and first-line treatments.

RESULTS

Most injuries requiring treatment after earthquakes (87%) were orthopaedic in nature. Nearly two-thirds of these injuries (65%) were fractures. The most common fracture locations were the tibia/fibula (27%), femur (17%), and foot/ankle (16%). Forty-two percent were multiple fractures, 22% were open, and 16% were comminuted. The most common treatment for orthopaedic injuries in the setting of earthquakes was debridement (33%).

CONCLUSIONS

Orthopaedic surgeons play a critical role after earthquake disasters in the developing world. A strong understanding of orthopaedic injury epidemiology and treatment is critical to providing effective preparation and assistance in future earthquake disasters.

Earthquake-Related Orthopedic Injuries in Adult Population: A Systematic Review

Introduction Earthquake-related trauma results in crush injuries and bony- and soft-tissue trauma. There are no systematic reviews analyzing the typical injury patterns and treatments in "Mega-Mass-Casualty" earthquakes. The characterization of an injury pattern specific to disaster type, be it natural or manmade, is imperative to build an effective disaster preparedness and response system.

METHODS

The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search strategy was developed to identify all publications relating to earthquakes and the orthopedic treatment in adult patients. The following databases were searched: PubMed (Medline; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), Ovid (Ovid Technologies; New York, New York USA), Web of Science (Thomson Reuters; New York, New York USA), and The Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom).

RESULTS

The searches identified 4,704 articles: 4,445 after duplicates were removed. The papers were screened for title and abstract and 65 out of those were selected for full-text analysis. The quality of data does not permit a standard-of-care (SOC) to be defined. Scarcity and poor quality of the data collected also may suggest a low level of accountability of the activity of the international hospital teams. Qualitatively, it is possible to define that there are more open fractures during daytime hours than at night. Excluding data about open and closed fractures, for all types of injuries, the results underline that the higher the impact of the earthquake, as measured by Richter Magnitude Scale (RMS), the higher is the number of injuries. Discussion Regarding orthopedic injuries during earthquakes, special attention must be paid to the management of the lower limbs most frequently injured. Spinal cord involvement following spine fractures is an important issue: this underlines how a neurosurgeon on a disaster team could be an important asset during the response. Conservative treatment for fractures, when possible, should be encouraged in a disaster setting. Regarding amputation, it is important to underline how the response and the quality of health care delivered is different from one team to another. This study shows how important it is to improve, and to require, the accountability of international disaster teams in terms of type and quality of health care delivered, and to standardize the data collection. Bortolin M , Morelli I , Voskanyan A , Joyce NR , Ciottone GR . Earthquake-related orthopedic injuries in adult population: a systematic review. Prehosp Disaster Med. 2017;32(2):201-208.

Patient tracking in earthquake emergency response in Iran: A qualitative study

BACKGROUND

After a disaster, all victims have to be rapidly and accurately identified for locating, tracking and regulating them. The purpose of this study was to summarize people's experiences that how the patients were tracked in past earthquake disasters in Iran.

METHODS

A qualitative study was carried out in 2015. This was an interview-based qualitative study using content analysis. The interviewed people included physicians, nurses, emergency medical technicians, disaster managers, Red Crescent Society' first responders and managers. Participants were identified using a snow ball sampling method. Interviews were audiotaped, transcribed, coded, and entered into MAXQDA (version 10) for coding and content analysis.

RESULTS

Three main themes and seven categories including content (recoding data), function (identification of victims, identification of the deceased, informing the patients' relatives, patients' evacuation and transfer, and statistical reporting), technology (the state of using technology) were identified that showed the patient tracking status in past earthquakes in Iran.

CONCLUSION

Participants believed that to identify and register the data related to patients or the dead, no consistent action plan was available. So developing a consistent patient tracking system could overcome this issue and improve patient safety.

Barriers to and Facilitators of Inter-Organizational Coordination in Response to Disasters: A Grounded Theory Approach

OBJECTIVE

Coordination is a major challenge in the field of health in disasters, mostly because of the complex nature of health-related activities.

METHODS

This was a qualitative study based on the grounded theory approach. A total of 22 experts in the field of health in disasters participated in the study. The data were collected through in-depth interviews and literature review. The collected data were then analyzed by use of MAXQDA 2010 software (VERBI Software GmbH).

RESULTS

The lack of a strategic view in the field of health in disasters, a lack of coordination of necessities and infrastructures, insufficient enforcement, a higher priority given to an organizational approach rather than a national approach, and the field of disasters not being a priority in the health system were noted as barriers to inter-organizational coordination. The facilitators of inter-organizational coordination noted were the importance of public participation in the field of health in disasters, having a process and systematic view in the field of health in disasters, the necessity of understanding and managing resources and information in the field of health in disasters, and having a feedback and evaluation system in the health system after disasters.

CONCLUSION

It is recommended that developing common beliefs and goals be given priority in making plans and policies in the field of health in disasters. (Disaster Med Public Health Preparedness. 2017;11:318-325).

A Sex Disparity Among Earthquake Victims

OBJECTIVE

Understanding who is most vulnerable during an earthquake will help health care responders prepare for future disasters. We analyzed the demography of casualties from the Christchurch earthquake in New Zealand.

METHODS

The demography of the total deceased, injured, and hospitalized casualties of the Christchurch earthquake was compared with that of the greater Christchurch population, the Christchurch central business district working population, and patients who presented to the single acute emergency department on the same month and day over the prior 10 years. Sex data were compared to scene of injury, context of injury, clinical characteristics of injury, and injury severity scores.

RESULTS

Significantly more females than males were injured or killed in the entire population of casualties (P20% were injured at commercial or service localities (444/2032 males [22%]; 1105/4627 females [24%]). Adults aged between 20 and 69 years (1639/2032 males [81%]; 3717/4627 females [80%]) were most frequently injured.

CONCLUSION

Where people were and what they were doing at the time of the earthquake influenced their risk of injury.

Plastic Surgery Response in Natural Disasters

Disasters cause untold damage and are often unpredictable; however, with proper preparation, these events can be better managed. The initial response has the greatest impact on the overall success of the relief effort. A well-trained multidisciplinary network of providers is necessary to ensure coordinated care for the victims of these mass casualty disasters. As members of this network of providers, plastic surgeons have the ability to efficiently address injuries sustained in mass casualty disasters and are a valuable member of the relief effort. The skill set of plastic surgeons includes techniques that can address injuries sustained in large-scale emergencies, such as the management of soft-tissue injury, tissue viability, facial fractures, and extremity salvage. An approach to disaster relief, the types of disasters encountered, the management of injuries related to mass casualty disasters, the role of plastic surgeons in the relief effort, and resource management are discussed. In order to improve preparedness in future mass casualty disasters, plastic surgeons should receive training during residency regarding the utilization of plastic surgery knowledge in the disaster setting.

Major incident experience and preparedness in a developing country

BACKGROUND

Research shows that having previous experience of major incidents has a positive impact on awareness and preparedness of organizations. We investigated the effects of major incident experience on preparedness of health organizations on future disasters in Iran.

METHODS

A qualitative study using a semistructured interview technique was conducted with 65 public health and therapeutic affairs managers. Analysis of the data was performed used the framework analysis technique, which was supported by qualitative research software.

RESULTS

The study found that prior experience of major incidents results in better performance, coordination, and cooperation in response to future events. There was a positive effect on policy making and resource distribution and an increase in (1) preparedness activities, (2) raising population awareness, and (3) improving knowledge. However, the preparedness actions were predominantly individual-dependent.

CONCLUSIONS

Our findings showed that to increase system efficiency and effectiveness within health organizations, an appropriate major incident management system is needed. The new system can use lessons learned from previous major incidents to better equip health organizations to cope with similar events in the future.

Response to the Bam earthquake: a qualitative study on the experiences of the top and middle level health managers in Kerman, Iran

INTRODUCTION

The 2003 Bam, Iran earthquake resulted in high casualties and required international and national assistance. This study explored local top and middle level managers' disaster relief experiences in the aftermath of the Bam earthquake.

METHODS

Using qualitative interview methodology, top and middle level health managers employed during the Bam earthquake were identified. Data were collected via in-depth interviews with participants. Data were analysed using thematic analysis.

RESULTS

Results showed that the managers interviewed experienced two main problems. First, inadequacy of preparation of local health organisations, which was due to lack of familiarity of the needs, unavailability of essential needs, and also increasing demands, which were above the participants' expectations. Second, inappropriateness of delivered donations was perceived as a problem; for example, foods and sanitary materials were either poor quality or expired by date recommended for use. Participants also found international teams to be more well-equipped and organised.

CONCLUSIONS

During the disaster relief period of the response to the Bam earthquake, local health organizations were ill prepared for the event. In addition, donations delivered for relief were often poor quality or expired beyond a usable date.

Prerequisites of preparedness against earthquake in hospital system: a survey from Iran

BACKGROUND AND OBJECTIVE

Considering the history of frequent, and severe, earthquakes in Iran and the importance of health care service delivery by hospitals in these cases, having a plan to deal with disasters should be considered a priority. The aim of this study was the observance of preparedness prerequisites against earthquake in hospitals affiliated with Shahid Beheshti University of Medical Sciences (SBUMS) and its relationship with demographic and organizational characteristics.

METHODS

This was a cross- sectional study that was conducted in 15 hospitals affiliated with SBUMS, Iran in 2012. Data were collected using observation of documents and questionnaire consists of 138 questions in 8 dimensions. The content validity and reliability were confirmed. Data analysis was performed with descriptive statistic, t-test and ANOVA.

RESULTS

Results showed that 86.7% of hospitals were in good preparedness level, with the average 85.9 ± 15.5. The maximum and minimum level of preparedness was related to mitigation of construction hazards (56.6 ± 35.6) and support of vital services (97.2 ± 6.0) dimensions, respectively. According to the results, there was a significant statistical difference between mean preparedness and safety of equipment and hazardous materials, hospital evacuation and field treatment, hospital environmental health proceedings, hospital curriculum programs and support of services dimensions with management experience (P<0.05).

CONCLUSION

Although results corroborate that preparedness prerequisites against earthquake are in good level but attention to the weaknesses mitigation of construction hazards dimension and strengthening these prerequisites, which have obvious impacts on the structural vulnerability of hospitals and adjacent buildings in earthquakes, have been proposed.

The human impact of earthquakes: a historical review of events 1980-2009 and systematic literature review

Introduction. Population growth and increasing urbanization in earthquake-prone areas suggest that earthquake impacts on human populations will increase in the coming decades. Recent large earthquakes affecting large populations in Japan, Haiti, Chile and New Zealand are evidence of this trend and also illustrate significant variations in outcomes such damage and mortality levels. The objectives of this review were to describe the impact of earthquakes on human populations in terms of mortality, injury and displacement and, to the extent possible, identify risk factors associated with these outcomes. This is one of five reviews on the human impact of natural disasters. Methods. Data on the impact of earthquakes were compiled using two methods, a historical review from 1980 to mid 2009 of earthquake events from multiple databases and a systematic literature review of publications, ending in October 2012. Analysis included descriptive statistics and bivariate tests for associations between earthquake mortality and characteristics using STATA 11. Findings. From 1980 through 2009, there were a total of 372,634 deaths (range 314,634-412,599), 995,219 injuries (range: 845,345-1,145,093), and more than 61 million people affected by earthquakes, and mortality was greatest in Asia. Inconsistent reporting across data sources suggests that the numbers injured and affected are likely underestimates. Findings from a systematic review of the literature indicate that the primary cause of earthquake-related death was trauma due to building collapse and, the very young and the elderly were at increased mortality risk, while gender was not consistently associated with mortality risk. Conclusions. Strategies to mitigate the impact of future earthquakes should include improvements to the built environment and a focus on populations most vulnerable to mortality and injury.

Psychosocial needs assessment among Earthquake survivors in Lorestan province with an emphasis on the vulnerable groups

Introduction:

Iran is one of the ten most earthquake prone countries in the world. Earthquakes not only cause new psychological needs among the population but particularly so when one considers vulnerable groups. This in - depth study was conducted with the aim of assessing psychosocial needs six months after an earthquake happened in the west of the county in Lorestan province.

Methods:

This is a qualitative study using focus group discussion that focuses mainly on the vulnerable groups (women, children, elderly and disabled people) after an earthquake in Boz-azna; a village in Lorestan province in western part of Iran.

Findings:

Results of the psychosocial assessment indicated feelings of anxiety and worries in four vulnerable groups. Horror, hyper-excitement, avoidance and disturbing thoughts were observed in all groups with the exception of the elderly. Educational failures, loneliness and isolation were highlighted in children. All groups encountered socio-economic needs that included loss of assets and sense of insecurity and also reproductive problems were reported in women's group.

Discussion and Conclusion:

Modification of a protocol on psychosocial support considering the context of the rural and urban areas with emphasis on the specific needs of the vulnerable groups is an appropriate strategy in crisis management. It seems that appropriate public awareness regarding assistance programs can be effective in reducing stress and needs of disaster survivors.

Earthquake-related crush fractures and non-earthquake-related fractures of the extremities: a comparative radiological study

OBJECTIVE

To determine the features that differentiate earthquake-related crush extremity fractures from non-earthquake-related extremity fractures by using digital radiography (DR) and multidetector row computed tomography (MDCT).

METHODS

Six hundred and twenty-three consecutive victims with crush extremity fractures arising from the 2008 Sichuan earthquake, including 611 undergoing DR and 12 undergoing MDCT, entered the test group, and 316 consecutive victims with non-earthquake-related extremity fractures, including 301 undergoing DR and 15 undergoing MDCT, were enrolled in the control group. Image data were reviewed retrospectively and statistically between groups focusing on the anatomic distributions, numbers and types of extremity fractures.

RESULTS

Fractures involving multiple extremities were more likely in the test group than the control group (88/623 vs 27/316 victims, P < 0.05). Fractures involving multiple bones (336/623 vs 112/316 victims) and comminuted fractures (324/623 vs 78/316 victims) were seen more frequently in the test group than the control group with both occurring predominantly in the tibia and fibula (all P < 0.05).

CONCLUSION

Earthquake-related crush fractures of extremities are more likely than non-earthquake-related extremity fractures to involve multiple extremities, multiple bones and to be comminuted. The lower extremities, predominantly the tibia and fibula, are more likely to be involved. This has implications for emergency and disaster planning in earthquake-prone regions.

Disaster triage after the Haitian earthquake

In the aftermath of the devastating Haitian earthquake, we became the primary relief service for a large group of severely injured earthquake victims. Finding ourselves virtually isolated with extremely limited facilities and a group of critically injured patients whose needs vastly outstripped the available resources we employed a disaster triage system to organize their clinical care. This report describes the specific injury profile of this group of patients, their clinical course, and the management philosophy that we employed. It provides useful lessons for similar situations in the future.

Musculoskeletal Injuries Among Victims of the Battagram, Pakistan Earthquake in October 2005

Objective

This study was conducted to assess the type, pattern, and severity of musculoskeletal injuries, as well as the type of simple orthopedic surgical procedures, that can be performed at the site of a disaster.

Methods

This was a cross-sectional study conducted in Battagram, located in the North West Frontier Province of Pakistan after the October 2005 earthquake. Researchers arrived in the affected area during the second week after the earthquake, and remained there for one week. During this period, patients were received from distant areas of the district. These patients were admitted to a tent hospital because the district headquarters hospital was completely damaged. Those requiring orthopedic surgical intervention or closed manipulation and plaster of paris casts were included in the study.

Results

Of 110 patients, 61 were female and 49 were male, and 140 bones were involved. In this series, 92 fractures were closed, while 48 were open. A total of 67.3% of the patients were <40 years of age. The tibia was involved in 32.1% of cases and the femur 16.4%. No cases of compartment syndrome were found. Wound debridement was performed in 35 cases. An external fixator was applied to 10 cases of open tibia fractures. Four humerus fractures and a fracture to the radius and ulna were fixed with the Rashnail method. One open femur fracture was repaired with external fixation. Pre- and post-operative antibiotics were administered in all cases. Thirty patients sustained injuries in addition to orthopedic trauma: 13 vertebral injuries, eight head injuries, six fractured ribs, three blunt injuries to the abdomen, and 10 significant soft tissues injuries without bony involvement.

Conclusions

After the earthquake in Battagram, young persons, especially females, were prone to orthopedic injuries, mainly involving the extremities. A comprehensive disaster plan would have helped to manage these emergencies, and further experience is needed for on-site surgical interventions.

Kaim KhaniGM, BaigA, HumailM, MemonM, QuarashiMA. Musculoskeletal injuries among victims of the Battagram, Pakistan earthquake in October 2005. Prehosp Disaster Med.2012;27(5):1-3.

The 2003 Bam Earthquake: Overview of First Aid and Transport of Victims

Introduction:

In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city.

Problem:

The purpose of this study was to assess the status of the rescue, evacuation, and transportation of the casualties during the early stages following the earthquake.

Methods:

A cross-sectional study of 185 casualties who were transferred to and hospitalized in the university hospital during the first week period following the earthquake was conducted. Information regarding different places of settlement after being removed from the rubble, initial medical care, and the means of transportation was obtained by reviewing medical records and interviewing the victims.

Results:

The mean value of the duration of times taken for the first rescuers to reach the scene and remove the casualties from the rubble was 1.7 ±2.7 and 0.9 ±1.1 hours, respectively. Sixty-nine (37.7%) of the patients stayed within the area immediately surrounding their home for average times of 8 ±10 hours. The majority of casualties (57.6%) were transferred manually to a first place of settlement; 45.8% were taken to a second place of settlement using blankets. Of the patients studied, 159 (85.9%) did not receive any basic medical care at the first place and intravenous fluid therapy was the most common treatment provided for 24 (13%) patients at the second place of settlement. Patients received medical care at the first place of settlement for a mean time of 16.8 ±13.5 hours after escaping the rubble.

Conclusions:

These findings indicate that the emergency medical service system in Bam was destroyed and not able to respond adequately. In order to reduce the negative effects of such disasters in the future, there is an essential need for a comprehensive disaster management plan and improvement of hospital structures, healthcare facilities, and communication between the different governmental departments for better coordination and planning.

A Fundamental, National, Medical Disaster Management Plan: An Education-Based Model

During disasters, especially following earthquakes, health systems are expected to play an essential role in reducing mortality and morbidity. The most significant naturally occurring disaster in Iran is earthquakes; they have killed <180,000 people in the last 90 years. According to the current plan in 2007, the disaster management system of Iran is composed of three main work groups: (1) Prevention and risk management, (2) Education, and (3) Operation. This organizational separation has resulted in lack of necessary training programs for experts of specialized organizations, e.g., the Ministry of Health and Medical Education (MOHME).The National Board of MOHME arranged a training program in the field of medical disaster management. A qualified training team was chosen to conduct this program in each collaborating center, based on a predefined schedule. All collaborating centers were asked to recall 5–7 experts from each member university. Working in medical disaster management field for ≤2 years was an inclusion criterion. The training programs lasted three days, consisted of all relevant aspects of medical disaster management, and were conducted over a six-month period (November 2007–April 2008). Pretest and post-tests were used to examine the participants' knowledge regarding disaster management; the mean score on the pretest was 67.1 ±11.6 and 88.1 ±6.2, respectively. All participants were asked to hold the same training course for their organizations in order to enhance knowledge of related managers, stakeholders, and workers, and build capacity at the local and provincial levels. The next step was supposed to be developing a comprehensive medical disaster management plan for the entire country. Establishing nine disaster management regional collaborating centers in the health system of Iran has provided an appropriate base for related programs to be rapidly and easily accomplished throughout the country. This tree-shaped model is recommended as a cost-benefit and rapid approach for conducting training programs and developing a disaster management plan in the health system of a developing country.

Earthquake Related Injuries: Assessment of 854 Victims of the 2003 Bam Disaster Transported to Tertiary Referral Hospitals

Background:

In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed >90% of the city. After the assessment and initial treatment of injuries at national and international field hospitals, a considerable number of victims (approximately 12,000) were transferred to tertiary referral hospitals around the country. Objective: This report evaluated the injuries of 854 victims transferred to 12 referral hospitals in Tehran.

Methods:

The demographic data, injury patterns, injury severity score (ISS), diagnosis, treatment, and outcome data of 854 Bam earthquake victims were assessed.

Results:

There were 467 (54.7%) males and 387 (45.3%) females. The mean age of the patients was 29.0 years. Transportation by aircraft was the most common method used for evacuation, which was used to evacuate 555 patients (65%). Fifty-four percent of the victims required initial medical aid at field hospitals before transportation to Tehran. There were 1,322 patients with injuries, of which, fractures of the lower extremities were the most common (331; 25%). Limb fixation was the most commonly performed primary procedure in emergency wards (389 cases, 39.9%). The mean value ±SD for ISS was 6.7 ±5.2. Orthopedic operations were the most frequent surgical procedures performed (195/260 operations, 75%) and the overall mortality rate was 1.6% (n = 14).

Conclusions:

Along with the crucial importance of aid provided by national and international field hospitals in disasters, suitable triage of casualties and preparedness of tertiary referral centers in unaffected regions also play an important role in providing medical care to disaster victims. During these situations, the number of victims cannot be predicted accurately, and sufficient medical care, particularly for orthopedic problems, can be provided by referral centers.

Conditions found among pediatric survivors during the early response to natural disaster: a prospective case study

BACKGROUND

Major natural disasters may provoke a mass casualty situation, and children tend to represent an important proportion of the victims. The purpose of this study was to prospectively record medical conditions presented by pediatric survivors of a major natural disaster to determine the type of medical specialists most needed during the acute phase of relief response.

METHODS

After the 2010 Haiti earthquake, age, sex, date of presentation, diagnosis, and treatment provided were prospectively recorded for all patients less than 18 years old treated by a medical relief team. Patients were then allocated to 1 of the 2 groups: surgical (traumatism or surgical disorder) and medical (medical disorder). Medical activity lasted for 43 days.

RESULTS

Four hundred seventy-one of the 796 treated patients were less than 18 years old. Two hundred forty-four (52%) were assigned to the surgical group and 227 (48%) to the medical group. As there was a substantial decrease in the number of new surgical patients registered on day 11 of activity, we arbitrarily defined an early period (until day 10 of activity) and a late period (beginning on day 11 of activity). Data obtained from the 147 new patients registered during the early period revealed 134 (91%) surgical patients and 13 (9%) medical patients. Eighty-eight percent of patients needed specialized care for traumatic orthopaedic lesions, and procedures under anesthesia or sedation were mainly (98%) performed for traumatic conditions. Data obtained for the 324 new patients registered during the late period revealed 110 (34%) surgical patients and 214 (66%) medical patients. There was a switch from high surgical needs to more routine medical and surgical care, with less procedures (88%) for the treatment of traumatic lesions.

CONCLUSIONS

Pediatric orthopaedic surgeons have a major role to play in the acute phase of relief response to potentially minimize long-term physical and psychosocial disability associated with these complex injuries in growing patients.

LEVEL OF EVIDENCE

Economic or decision analyses, level II.

Patient influx and trauma types in a front-line hospital and a secondary referral hospital after the Wenchuan earthquake: a retrospectively comparative study

PURPOSE

To better understand the differences of patient influx and types of trauma between front-line and referral hospitals after the Wenchuan earthquake, so as to improve the efficiency of injury management.

METHODS

A retrospective and comparative study was performed in Deyang People's Hospital (a front-line hospital) and West China Hospital (a secondary referral hospital).

RESULTS

A total of 1,106 patients were admitted to the front-line hospital, and 1,775 to the secondary referral hospital. The patient flow peaked within 24 h after the quake, and decreased dramatically thereafter in the front-line hospital, while it peaked 2 days after the disaster in the referral one. Extremities were the most frequent location of all identified injuries (48.4% in the front-line hospital and 49.5% in the second-line hospital). Head and trunk injuries were more frequent in the front-line hospital than the referral hospital. Most of the deaths in the front-line hospital occurred within 24 h (6/8), whilst most in the referral hospital died more than 7 days (29/30) after the earthquake. While the total mortality in the front-line hospital was less than that in the referral hospital (0.7 vs 1.7%), the critical mortality in the former was higher (22.8 vs 9.4%).

CONCLUSIONS

There were dramatically different features in terms of quake-related patient influx and types of injury between the epicenter and less-affected hospitals.

Major earthquakes of the past decade (2000-2010): a comparative review of various aspects of management

Objectives:

This article sought to review and compare data of major earthquakes of the past decade and their aftermath in order to compare the magnitude, death toll, type of injuries, management procedures, extent of destruction and effectiveness of relief efforts.

Materials and Methods:

A retrospective study of the various aspects of management and aftermath of 5 major earthquakes of the past decade (2000–2010) was undertaken. This included earthquakes occurring in Bam Iran, Sichuan China, Port-au-Prince Haiti, Kashmir Pakistan and Ica Peru. A literature search was done via computer of published articles (indexed in Pubmed). The issues assessed included: 1)Local magnitude,2)Type of building structure 3)Time of the earthquake (day/time/season), 4)Time to rescue, 5)Triage, Transfer, and Treatment 6) Distribution of casualties (dead/ injured), 7)Degree of city damage, 8)Degree of damage to health facilities, 9)Field hospital availability, 10)International aid, 11)Air transfer, 12) Telecommunication systems availability, 13) PTSD prevalence, 14) Most common injury and 15) Most common disease outbreak.

Results:

The Bam earthquake had the lowest (6.6 Richter’s) and the Sichuan earthquake had the greatest magnitude (8.0 Richter’s). Mortality in Haiti was 212,000 and it was the deadliest earthquake of the past decade. Collapse of heavy clay roofing structures was a major cause of death in Iran and Pakistan. Earthquakes occurring at night and nonworking days carried a high death toll. The time to rescue and treat was the lengthiest in Haiti (possibly contributing to the death to injured ratio). However, the worst dead to injured ratios were in Bam (51%) and in Pakistan (47%); the best ratio was in China (15%). Iran and Pakistan suffered the highest percentage of damage to the health facilities (90%). Field hospital availability, international aid and air transfer were important issues. Telecommunication systems were best in China and worst in Pakistan. PTSD prevalence was highest in Iran. Respiratory infection was the most common infection following all 5 earthquakes.

Conclusions:

Earthquake damage, death toll, managerial protocols etc. vary in different countries and are influenced by many factors including the hour the earthquake hits and the day of the week. Additionally, social, structural and geographic factors as well as the medical, governmental and NGO respondents are influential. Engineered residential construction remains to be of importance in reducing mortality in developing countries. It is essential that hospitals, fire departments and police stations, water, telephone and electrical facilities be made earthquake proof.

Injury epidemiology after the 2001 Gujarat earthquake in India: a retrospective analysis of injuries treated at a rural hospital in the Kutch district immediately after the disaster

BACKGROUND

The number of injured far exceeds those dead and the average injury to mortality ratio in earthquakes stands at 3:1. Immediate effective medical response significantly influences injury outcomes and thus the overall health impact of earthquakes. Inadequate or mismanagement of injuries may lead to disabilities. The lack of precise data from immediate aftermath is seen as a remarkable weak point in disaster epidemiology and warrants evidence generation.

OBJECTIVE

To analyze the epidemiology of injuries and the treatment imparted at a secondary rural hospital in the Kutch district, Gujarat, India following the January 26, 2001 earthquake.

DESIGN/METHODS

Discharge reports of patients admitted to the hospital over 10 weeks were analyzed retrospectively for earthquake-related injuries.

RESULTS

Orthopedic injuries, (particularly fractures of the lower limbs) were predominant and serious injuries like head, chest, abdominal, and crush syndrome were minimal. Wound infections were reported in almost 20% of the admitted cases. Surgical procedures were more common than conservative treatment. The most frequently performed surgical procedures were open reduction with internal fixation and cleaning and debridement of contaminated wounds. Four secondary deaths and 102 transfers to tertiary care due to complications were reported.

CONCLUSION

The injury epidemiology reported in this study is in general agreement with most other studies reporting injury epidemiology except higher incidence of distal orthopedic injuries particularly to the lower extremities. We also found that young males were more prone to sustaining injuries. These results warrant further research. Inconsistent data reporting procedures against the backdrop of inherent disaster data incompleteness calls for urgent standardization of reporting earthquake injuries for evidence-based response policy planning.

Disaster health-related challenges and requirements: a grounded theory study in Iran

BACKGROUND

Despite frequent disasters caused by natural hazards, concern has been raised regarding the effectiveness of disaster health services in disaster-prone countries such as Iran. The purpose of this study was to explore, in relation to health disaster management, the experiences and perceptions of individuals who responded or were affected by a recent Iranian earthquake disaster.

METHODS

This study was conducted using grounded theory. Study participants included members of a multidisciplinary disaster response team as well as residents of the community affected by the earthquake (n = 29). Data collection included semi-structured interviews, field notes, and reviews of narratives.

RESULTS

The findings of this study indicate that the lack of planning, inadequate organizational management of resources, insufficient coordination in the provision of health services during the disaster, and the manner of participation of international relief efforts were the most important barriers to adequate disaster healthcare services delivery during the 2003 Bam Iranian earthquake.

CONCLUSIONS

This study supports the value of health service managers coordinating the appropriate use of international aid in advance. It is suggested that this can be done by better communication with local and foreign constituents. Further, this study indicates that public education and proper pre-event planning help to bring about an effective response to providing healthcare services during a disaster.

Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

Background

Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days.

Methods

The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation.

Results

The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators.

Conclusions

The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

The Motor Function and Activities of Daily Living Capacity of Seismic Wounded Patients in Intensive Care Unit Ward in 5.12 Wenchuan Earthquake of China

Objective

To describe the motor function and activities of daily living (ADL) functional status of the seismic wounded patients treated in the intensive care unit (ICU) ward, and to provide insight to the planning on their clinical rehabilitation program.

Method

A prospective study. Trained assessor applied different common testing methods to measure the motor functions of seismic wounded patients treated in ICU: (1) Manual Muscle Testing (MMT) method to evaluate muscle strength; (2) joint angle ruler to assess joint range of motion (ROM); (3) passive joint activities to assess the muscle tension; (4) Modified Ashworth Score (MAS) to assess spasm; (5) balanced response to assess sitting balance and standing balance; (6) international generic Barthel Index Scale to evaluate ADL. Complications as related to rehabilitation were also recorded. Descriptive statistics were employed to describe the epidemiology, pattern of motor function loss and type of injuries.

Results

The most common types of injuries in our sample of seismic wounded treated in ICU were: fracture (70%), nervous system injuries (20%), squeezing syndrome (5%) and pulmonary contusion (5%). The fracture proportion was higher in female than male (about 2:1). Amputation and paralysis occurred more in male than female (about 7:1 and 3:1 respectively). Lung infection as a complication in ICU stay was more common in female than male (4:1). We reported that most of the seismic wounded patient had early loss of motor function during the stay in ICU. Conclusion: Limited ROM, declined muscle strength, abnormal muscle tension, balance dysfunction, alteration of ADL capacity and lung infection are the main dysfunctions occurring among the seismic wounded in ICU ward. Loss of motor function can occur early and therefore active physiotherapy should start even during the stay in ICU.

A reassessment and review of the Bam earthquake five years onward: what was done wrong?

INTRODUCTION

An earthquake measuring 6.6 on the Richter scale on 23 December 2003 devastated the city of Bam in southeastern Iran. During the response and recovery phases, considerable shortcomings were discovered. The dire situation in the affected area, a variety of urgently required interventions, and the large number of aid organizations involved brought about difficulties in management, coordination, and communication among authorities and aid organizations. This article highlights flaws in management in the various aspects of this disaster in order to assess what was done, and what should be done to overcome these shortcomings in future disasters.

METHODS

A retrospective review of the various aspects of management related to the Bam disaster was done via the assessment of files, multi-center studies, governmental data, and available literature from 2003-2008.

RESULTS

A review of the available data relevant to search and rescue operations and short-term aid provision revealed flaws in different aspects of disaster management including personnel, the transfer of the injured, availability medical supplies, treatment planning, problems concerning the composition of treatment forces dispatched to the region, distribution of tasks among treatment workers, transferring of equipment, availability of facilities, and lack of coordination among the organizations responsible for the management of the disaster. Most of the aforementioned issues have been addressed.

CONCLUSIONS

A comprehensive disaster management plan must not be limited only to the response phase, but rather must include: preparedness, recovery with optimal legislation and budgeting, improvement of healthcare facilities, and organized communication channels between the different governmental departments. This important issue has been addressed, and a disaster management organization under the supervision of the President has been established, developing a national search and rescue strategy and protocol for unified managerial organization, an alert system, an international disaster command system (under which search and rescue and emergency medical service teams can be deployed, increasing the efficacy and coordination of the arrival of foreign teams and the construction field hospitals), and developing a flowchart to coordinate international agencies and the domestic authorities in charge. Continuous education, training of the general population, conducting periodic exercise drills, and provision for prepared task force mobilization in disaster management all are important aspects of the management of disasters due to natural hazards.

Analysis of maxillofacial fracture victims in the Wenchuan earthquake and Yushu earthquake

OBJECTIVE

To analyze retrospectively 419 patients after the Wenchuan earthquake and 46 after Yushu earthquake with maxillofacial fractures so as to provide reference on patients' treatment after an earthquake.

METHOD

We investigated 419 patients after Wenchuan earthquake and 46 after Yushu earthquake with maxillofacial fractures who were admitted to the West China Hospital of Stomatology and other 46 hospitals in 10 provinces.

RESULT

A total of 58 patients had maxillofacial fractures (13.8%) including 33 (56.9%) men and 25 (43.1%) women after the Wenchuan earthquake and 6 (13%) had maxillofacial fractures after Yushu earthquake. Most patients were injured by pressing or burying. The nasal-orbital-ethmoidal region was the most frequent site of the maxillofacial fracture (58.6% in the Wenchuan earthquake and 66.7% in the Yushu earthquake). The most prevalent pattern of maxillofacial fracture was multiple and/or comminuted fractures (87.9% in the Wenchuan earthquake and 100% in the Yushu earthquake). There were 48 (82.8%) patients with associated injuries, and the most common site was extremity injuries (58.6%) after Wenchuan earthquake. Few patients received adequate prehospital treatment, with bandages predominantly. Most patients (65.5% in the Wenchuan earthquake and 100% in the Yushu earthquake) underwent open reduction and rigid internal fixation. We failed to find any patients with generalized infection. However, all patients in our study presented the symptoms of post-traumatic stress disorder.

CONCLUSION

We analyze the characteristics of maxillofacial fractures after the two earthquakes, so as to improve our medical emergency system when such disasters happen again.

The October 2005 earthquake in Northern Pakistan: patterns of injuries in victims brought to the Emergency Relief Hospital, Doraha, Mansehra

OBJECTIVE

Knowledge of injuries of earthquake victims is important to plan relief efforts. This cross-sectional study was conducted following the 08 October 2005 earthquake in Northern Pakistan to determine the pattern of injuries sustained and their relationship with age and gender in order to identify the medical needs in an earthquake-affected zone.

METHODS

The study was conducted between 13 October and 23 October 2005 at the Emergency Relief Hospital, Doraha, Mansehra. From the 1,700 patients registered in the hospital, 310 were sampled randomly for the study. Demography and details of the patients' injuries were noted by history and physical examination. Twelve cases were omitted due to incomplete data.

RESULTS

Of the cases, 54% were female. Children less than or equal to 10 years old formed the largest age group. Isolated bone injuries were present in 41%, soft tissue injuries in 36%, and mixed injuries in 23% of the patients. The most common bone injury was lower limb fracture (52%), while the most common non-bone injury was non-infected, soft tissue wounds on the limbs (33%). Among patients with soft tissue injuries, gangrenous wounds were present in 9%, and grossly infected wounds in 30% (20% on limbs and 10% on rest of the body).

CONCLUSIONS

The population injured during the earthquake showed a higher proportion of females and children less than or equal to 10 years old, and lower limb bone injuries. The data highlight the need to address orthopedic, pediatric, and women's health issues, and for logistic arrangement of relevant diagnostic and therapeutic facilities at the initial stages of relief activities after earthquakes.

Crush extremity fractures associated with the 2008 Sichuan earthquake: anatomic sites, numbers and statuses evaluated with digital radiography and multidetector computed tomography

OBJECTIVE

To investigate features of crush extremity fractures associated with massive earthquake on digital radiography (DR) and multidetector computed tomography (MDCT).

MATERIALS AND METHODS

Six hundred and twenty-three consecutive patients with clinically confirmed crush extremity fractures arising from the 2008 Sichuan earthquake were enrolled into our study. Six hundred and eleven patients with suggested extremity fractures underwent DR, and 12 patients with possible knee fractures underwent MDCT. Image data were retrospectively reviewed, with the focus on anatomic sites, numbers, and status of the fractures.

RESULTS

Extremity fractures occurred in lower extremities in 428 patients, upper extremities in 151, and both lower and upper extremities in 44. Lower extremity fractures were more common than upper extremity fractures (P < 0.05), and the commonly involved bones were the tibia and fibula in 141 patients, femur in 102, tibia in 52, and fibula in 40. According to the numbers of bones involved, multiple bone fractures occurred in 336 patients and included lower extremity fractures in 231, upper extremity fractures in 61, and both lower and upper fractures in 44. Multiple fractures in lower extremities were seen more often than in upper extremities (P < 0.05). As for status of the extremity fractures, comminuted fractures occurred in 324 patients and included lower extremity fractures in 248, upper extremity fractures in 51, and both lower and upper extremity fractures in 25. Comminuted fractures were more common in lower extremities than in upper extremities (P < 0.05).

CONCLUSION

Multiple and comminuted fractures, predominantly in the lower extremities, could be considered as features of crush extremity fractures associated with the massive Sichuan earthquake.

Analysis of 46 maxillofacial fracture victims in the 2008 Wenchuan, China earthquake

PURPOSE

At 14:28 hours on May 12, 2008, a massive earthquake wracked most areas of Sichuan, China, causing catastrophic human loss. The aim of this study was to delineate the characteristics of victims with maxillofacial fractures in this disaster.

PATIENTS AND METHODS

A descriptive analysis was conducted based on the medical records of earthquake maxillofacial injuries casualties transferred to West China Hospital of Stomatology, Sichuan University, after the earthquake. Data regarding demographic details, psychological status, patterns, anatomic sites, etiology, concomitant injuries, and management of earthquake maxillofacial fractures were evaluated.

RESULTS

A total of 46 maxillofacial fracture patients' records of 28 (60.9%) males and 18 (39.1%) females were included in this study, with peak incidence (32.6%) in the elderly age group (older than 50 years). The most common etiology of earthquake maxillofacial fractures was building collapse (71.7%). The mandible (65.2%) was the most frequent site of the maxillofacial fracture, followed by the zygomatic complex (21.7%) and maxilla (13.0%). The most prevalent of maxillofacial fracture pattern was multiple and/or comminuted fractures (56.5%), which accounted for 72.7% (24/33) in building collapse injury group. There were 9 (19.6%) patients with significant concomitant injuries and the most common site of concomitant injuries was the head (4 cases) and extremity (4 cases). Four (8.7%) patients' maxillofacial fractures were treated conservatively, 16 (34.8%) underwent closed reduction and fixation, and 26 (56.5%) underwent open reduction and rigid internal fixation (RIF). Apart from 3 patients (6.5%) who showed infection, all patients with facial fractures achieved successful bony union with an acceptable occlusion and facial form. Additionally, it is noteworthy that all patients in our study presented the symptoms of posttraumatic stress disorder (PTSD).

CONCLUSION

There is a variation of mechanism of injuries, age group, severity, patterns, concomitant injuries, and management of earthquake maxillofacial fractures. Knowledge of these characteristics provides useful strategies for patient care and prevention of further complications. A multidisciplinary and coordinated approach is important for optimum stabilization and ongoing treatment of victims of building collapse injury. The high percentage of PTSD confirms that psychologists should form an integral part of this multidisciplinary team.

Earthquakes and trauma: review of triage and injury-specific, immediate care

Earthquakes present a major threat to mankind. Increasing knowledge about geophysical interactions, progressing architectural technology, and improved disaster management algorithms have rendered modern populations less susceptible to earthquakes. Nevertheless, the mass casualties resulting from earthquakes in Great Kanto (Japan), Ancash (Peru), Tangshan (China), Guatemala, Armenia, and Izmit (Turkey) or the recent earthquakes in Bhuj (India), Bam (Iran), Sumatra (Indonesia) and Kashmir (Pakistan) indicate the devastating effect earthquakes can have on both individual and population health. Appropriate preparation and implementation of crisis management algorithms are of utmost importance to ensure a large-scale medical-aid response is readily available following a devastating event. In particular, efficient triage is vital to optimize the use of limited medical resources and to effectively mobilize these resources so as to maximize patient salvage. However, the main priorities of disaster rescue teams are the rescue and provision of emergency care for physical trauma. Furthermore, the establishment of transport evacuation corridors, a feature often neglected, is essential in order to provide the casualties with a chance for survival. The optimal management of victims under such settings is discussed, addressing injuries of the body and psyche by means of simple diagnostic and therapeutic procedures globally applicable and available.