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Anshori F, Kamal AF, Prabowo Y, Kekalih A, Febrianto R, Purnaning D, Dilogo IH. The Outcome of Orthopedics Treatment of Lombok Earthquake Victim 2018: A Cohort of One-Year Follow-Up Study-Lesson Learned After Lombok Earthquake. Orthop Res Rev 2023; 15:91-103. [PMID: 37193319 PMCID: PMC10182807 DOI: 10.2147/orr.s387625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/25/2023] [Indexed: 05/18/2023] Open
Abstract
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.
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Affiliation(s)
- Fahmi Anshori
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Achmad Fauzi Kamal
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yogi Prabowo
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Aria Kekalih
- Community Medicine Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rudi Febrianto
- Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine University of Mataram -Regional General Hospital of West Nusa Tenggara, Mataram, Indonesia
| | - Dyah Purnaning
- Orthopaedic and Traumatology Division, Department of Surgery, Faculty of Medicine University of Mataram -Regional General Hospital of West Nusa Tenggara, Mataram, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Disaster Preparedness: Hospital Pharmacy Strategy for Prioritized Inventory Management and Drug Procurement on Vancouver Island. Disaster Med Public Health Prep 2022; 17:e235. [PMID: 36047249 DOI: 10.1017/dmp.2022.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Disaster events can increase demand for medication supplies and interfere with supply chains, leading to compromised care in hospitals. Providing an organized response to an additional surge of disaster-related patients requires pre-planned emergency management procedures. Hospital pharmacists can address this with prioritized drug procurement and inventory management strategies which may improve the availability of key medications for a disaster response. Previous disaster events have provided insight on medications used to treat disaster-related injuries and exacerbations of medical conditions in emergency departments. This article provides a detailed description of Vancouver Island's hospital pharmacy strategy for the procurement and minimum stock levels of high priority medications in preparation for a disaster.
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Shapiro LM, Park MO, Mariano DJ, Welch JM, Kamal RN. Candidate Quality Measures for Orthopaedic Surgery Outreach Trips: A Systematic Review. J Am Acad Orthop Surg 2021; 29:e1068-e1077. [PMID: 34525479 PMCID: PMC8443848 DOI: 10.5435/jaaos-d-20-00263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/15/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Up to 30% of the global burden of disease is secondary to surgical conditions, most of which falls on those in low- and middle-income countries (LMICs). Ensuring that the quality of care delivered during outreach trips to address these conditions is foundational. Limited work has been done to develop and implement tools to assess and improve the quality of care for these trips. The purpose of this study was to identify candidate quality measures that address orthopaedic surgery outreach trips in LMICs. METHODS We conducted a systematic review of MEDLINE/PubMed, EMBASE, Web of Science, Google Scholar, and other databases to identify candidate quality measures relevant to orthopaedic surgery outreach to LMICs. Quality measures were then categorized by system management, sustainability, or both system management and sustainability according to the framework and structures, processes, and outcomes of Bido et al according to the Donabedian domains. RESULTS Our initial search yielded 3,891 articles, 22 of which met the inclusion criteria. Seventy-nine candidate quality measures were identified. Regarding the framework of Bido et al, 55 of 79 (70%) were related to system management, 8 (10%) were related to sustainability, and 16 (20%) were related to both system management and sustainability. According to Donabedian domains, 43 of 79 (54%) were structure measures, 25 (32%) were process measures, and 11 (14%) were outcome measures. DISCUSSION Quality measures addressing orthopaedic surgery outreach trips are lacking in quantity and breadth, limiting the ability to assess and improve the safety and quality of care provided. The candidate quality measures identified disproportionately focus on systems management and structures, with few related to sustainability and few addressing outcomes. Patients receiving care on outreach trips would benefit from the implementation of the measures identified in this review and from the development of quality measures that capture all domains of care and emphasize outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Lauren M Shapiro
- From VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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Del Papa J, Vittorini P, D'Aloisio F, Muselli M, Giuliani AR, Mascitelli A, Fabiani L. Retrospective Analysis of Injuries and Hospitalizations of Patients Following the 2009 Earthquake of L'Aquila City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101675. [PMID: 31091681 PMCID: PMC6571652 DOI: 10.3390/ijerph16101675] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/04/2019] [Accepted: 05/09/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the injury patterns and the hospitalizations of patients who were admitted to hospital following the 2009 earthquake in the city of L’Aquila, Central Italy. To the best of our knowledge, this is the first study to analyze the patterns of earthquake-related injuries in Italy. We reviewed the hospital discharge data of 171 patients admitted to hospital within the following 96 h from the mainshock. This is an observational and descriptive study: We controlled for variables such as patient demographics, primary and secondary ICD-9-CM (International Classification of Diseases) diagnosis codes in order to identify the multiple injured patients, main type of injury that resulted in the hospital admission, discharge disposition, and average length of stay (LOS). Seventy-three percent of the 171 patients were admitted to hospital on the first day. Multiple injuries accounted for 52% of all trauma admissions, with a female to male ratio of 63% versus 37%. The most common type of injuries involved bone fractures (46.8%), while lower extremities were the most frequently affected sites (38.75%). The average LOS was 12.11 days. This study allows the evaluation of the impact of earthquake-related injuries in relation both to the health needs of the victims and to the use of the health care resources and assistance.
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Affiliation(s)
- Jacopo Del Papa
- Postgraduate Schools of Hygiene and Public Health-Department of Life, Health and Environmental Sciences, University of L'Aquila, P.le S. Tommasi, 1, 67100 Coppito, L'Aquila, Italy.
| | - Pierpaolo Vittorini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, P.le S. Tommasi, 1, 67100 Coppito, L'Aquila, Italy.
| | - Francesco D'Aloisio
- Postgraduate Schools of Hygiene and Public Health-Department of Life, Health and Environmental Sciences, University of L'Aquila, P.le S. Tommasi, 1, 67100 Coppito, L'Aquila, Italy.
| | - Mario Muselli
- Postgraduate Schools of Hygiene and Public Health-Department of Life, Health and Environmental Sciences, University of L'Aquila, P.le S. Tommasi, 1, 67100 Coppito, L'Aquila, Italy.
| | - Anna Rita Giuliani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, P.le S. Tommasi, 1, 67100 Coppito, L'Aquila, Italy.
| | - Alfonso Mascitelli
- Regional Health Agency of Abruzzo Region (Italy)-Via Attilio Monti, 9, 65127 Pescara PE, Italy.
| | - Leila Fabiani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, P.le S. Tommasi, 1, 67100 Coppito, L'Aquila, Italy.
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McQuillan TJ, Cai LZ, Corcoran-Schwartz I, Weiser TG, Forrester JD. Surgical Site Infections after Open Reduction Internal Fixation for Trauma in Low and Middle Human Development Index Countries: A Systematic Review. Surg Infect (Larchmt) 2018; 19:254-263. [DOI: 10.1089/sur.2017.273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Lawrence Z. Cai
- Stanford University School of Medicine, Stanford, California
| | - Ian Corcoran-Schwartz
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Thomas G. Weiser
- Department of General Surgery, Stanford University, Stanford, California
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, Scotland
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Abstract
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.
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Kang P, Tang B, Liu Y, Liu X, Shen Y, Liu Z, Yang H, Zhang L. Profile and procedures for fractures among 1323 fracture patients from the 2010 Yushu earthquake, China. Am J Emerg Med 2016; 34:2132-2139. [DOI: 10.1016/j.ajem.2016.07.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/29/2022] Open
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Clover AJP, Jemec B, Redmond AD. The Extent of Soft Tissue and Musculoskeletal Injuries after Earthquakes; Describing a Role for Reconstructive Surgeons in an Emergency Response. World J Surg 2014; 38:2543-50. [DOI: 10.1007/s00268-014-2607-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Missair A, Pretto EA, Visan A, Lobo L, Paula F, Castillo-Pedraza C, Cooper L, Gebhard RE. A Matter of Life or Limb? A Review of Traumatic Injury Patterns and Anesthesia Techniques for Disaster Relief After Major Earthquakes. Anesth Analg 2013; 117:934-941. [DOI: 10.1213/ane.0b013e3182a0d7a7] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Guner S, Guner SI, Isik Y, Gormeli G, Kalender AM, Turktas U, Gokalp MA, Gozen A, Isik M, Ozkan S, Turkozu T, Karadas S, Ceylan MF, Ediz L, Bulut M, Gunes Y, Gormeli A, Erturk C, Eseoglu M, Dursun R. Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study. INTERNATIONAL ORTHOPAEDICS 2012; 37:119-24. [PMID: 23232655 DOI: 10.1007/s00264-012-1736-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE This is a descriptive analysis, of victims of Turkey's October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma. METHODS We retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome. RESULTS The patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively. CONCLUSIONS The results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.
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Affiliation(s)
- Savas Guner
- Department of Trauma and Orthopedic Surgery, Yuzuncu Yil University Medical School Hospital, Van, Turkey.
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Rathore FA, Gosney JE, Reinhardt JD, Haig AJ, Li J, DeLisa JA. Medical rehabilitation after natural disasters: why, when, and how? Arch Phys Med Rehabil 2012; 93:1875-81. [PMID: 22676904 DOI: 10.1016/j.apmr.2012.05.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
Abstract
Natural disasters can cause significant numbers of severe, disabling injuries, resulting in a public health emergency and requiring foreign assistance. However, since medical rehabilitation services are often poorly developed in disaster-affected regions and not highly prioritized by responding teams, physical and rehabilitation medicine (PRM) has historically been underemphasized in global disaster planning and response. Recent development of the specialties of "disaster medicine" and "disaster rehabilitation" has raised awareness of the critical importance of rehabilitation intervention during the immediate postdisaster emergency response. The World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine has authored this report to assess the role of emergency rehabilitation intervention after natural disasters based on current scientific evidence and subject matter expert accounts. Major disabling injury types are identified, and spinal cord injury, limb amputation, and traumatic brain injury are used as case studies to exemplify the challenges to effective management of disabling injuries after disasters. Evidence on the effectiveness of disaster rehabilitation interventions is presented. The authors then summarize the current state of disaster-related research, as well as lessons learned from PRM emergency rehabilitation response in recent disasters. Resulting recommendations for greater integration of PRM services into the immediate emergency disaster response are provided. This report aims to stimulate development of research and practice in the emerging discipline of disaster rehabilitation within organizations that provide medical rehabilitation services during the postdisaster emergency response.
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Affiliation(s)
- Farooq A Rathore
- International Society of Physical and Rehabilitation Medicine, Rehabilitation Disaster Relief Committee, Geneva, Switzerland.
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