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PubMed2005

Risk factors for death and injuries in earthquake: cross-sectional study from Afyon, Turkey.

AIM: To assess the risk factors for deaths and injuries caused by earthquakes in a high-risk earthquake zone. METHODS: A cross-sectional study was carried out in Eber town, Cay County, following the earthquake of February 3, 2002 in Afyon, Turkey. This area was particularly affected by the earthquake, with high number of casualties, including many fatalities. The study included 812 persons living in Eber at the time of the earthquake. The study population was interviewed at their homes to obtain information on the deaths and non-fatal injuries, along with potential risk factors for death and injuries. These included the type and degree of the damage to the building, precise location and the initial actions of victims at the moment of the earthquake, and socio-demographic data. RESULTS: Earthquake-related mortality rate was 16 per 1,000 people, injury rate was 22 per 1,000 people, and death/injury ratio was 1:1.4. During the earthquake, 60% of the buildings collapsed or were heavily damaged. Risk factors for death and injury were higher among those who lived in collapsed or heavily damaged buildings, wooden type buildings, or those who were near the outer walls during the earthquake. CONCLUSION: The most important risk factor for earthquake-induced mortality and morbidity was the degree of damage to the building. Another important risk factor was the location of the individual inside the room at the time of the quake.

Cross-Sectional Studies↗
PubMed1989

Mechanism of death in avalanche victims.

The autopsies of 12 victims from two snow avalanches in North-Norway are reported. Supportive evidence from non-autopsied and surviving victims is included. Consistent autopsy findings were prominent lung oedema, moderate cerebral oedema, extreme contraction of the left ventricle, petechiae in the superior vena cava drainage area, and acute congestion in lungs and kidneys. In four cases in whom no resuscitation was attempted, aortic oxygen pressure was in the range expected in pure asphyxial-type deaths in one and in pure cardiac-type deaths in three. No air pocket was seen in front of the mouth and nose in any of the fatal cases. Three fatal cases had fractures. It is concluded that the immediate cause of death in most cases was general body compression with acute respiratory and circulatory failure.

Adolescent↗
PubMedDate not supplied

Mass-casualty victim "surge" management. Preparing for bombings and blast-related injuries with possibility of hazardous materials exposure.

Bombings and other blast-related events place severe demands on pre-hospital and in-hospital systems. The resulting surge of victims can overwhelm the resources of any facility not prepared for such an event. The September 11 terrorist attacks underscore the urgency of our need for preparedness. The challenges become even more daunting when there is possible hazmat exposure as well; this means that adequate and rapid disposition of victims is even more critical in order to avoid contamination of hospitals systems or whole communities. Federal agencies have been designated and federal mandates have been issued to address mass casualty events, but federal or even regional systems cannot respond in time to address the massive and immediate needs generated by an explosion. Local communities must take the lead in developing incident command systems for initial management of such events. Hospital and pre-hospital providers play a key role in such planning. Ultimate management and disposition of large numbers of casualties, especially if contaminated, cannot follow standard patient management protocols; new protocols are needed. To avoid a total, overwhelming break down of in-hospital resources, hospitals need to assume a lead role in addressing such issues in their local communities.

Blast Injuries↗
PubMed2007

The radiological management of bomb blast injury.

A need to understand the nature and patterns of bomb blast injury, particularly in confined spaces, has come to the fore with the current worldwide threat from terrorism. The purpose of this review article is to familiarize the radiologist with the imaging they might expect to see in a mass casualty terrorist event, illustrated by examples from two of the main institutions receiving patients from the London Underground tube blasts of 7 July 2005. We present examples of injuries that are typical in blast victims, as well as highlighting some blast sequelae that might also be found in other causes of multiple trauma. This should enable the radiologist to seek out typical injuries, including those that may not be initially clinically apparent. Terror-related injuries are often more severe than those seen in other trauma cases, and multi-system trauma at distant anatomical sites should be anticipated. We highlight the value of using a standardized imaging protocol to find clinically undetected traumatic effects and include a discussion on management of multiple human and non-human flying fragments. This review also discusses the role of radiology in the management and planning for a mass casualty terrorist incident and the optimal deployment of radiographic services during such an event.

Adult↗
PubMed2003

Extremity injuries in children resulting from the 1999 Marmara earthquake: an epidemiologic study.

The purpose of this study was to determine the clinical features, type and severity of musculoskeletal injuries in paediatric age groups in comparison with adult victims of the Marmara earthquake, which occurred on 17 August 1999. Of 151 injured patients hospitalized due to musculoskeletal trauma, 31 (20.5%) were under 16 years of age. The most important problems in the patients were extremity trauma, crush syndrome, acute renal failure and other ensuing medical complications. Five (18.5%) out of 27 children with crush syndrome required haemodialysis because of acute renal failure and three (11.1%) required amputation. Haemodialysis was needed in 54 (93.1%) of 58 adult patients with crush syndrome; amputation was necessary in 12 (20.7%) of them. Although the types of injuries resulting from the earthquake were similar in adults and children, the orthopaedic consequences of these injuries showed significant differences, especially in the rates of crush syndrome leading to acute renal failure and amputation.

Acute Kidney Injury↗
PubMedDate not supplied

Irradiated trauma victims: the impact of ionizing radiation on surgical considerations following a nuclear mishap.

The combination of conventional traumatic injuries and radiation exposure has synergistic consequences, the full extent of which may take days to weeks to become apparent. Our understanding of such is derived from a variety of laboratory and clinical scenarios involving both therapeutic and accidental exposures. When presented with such an individual one must discern whether the victim has been bodily contaminated versus exposed to a source or both. The former will necessitate decontamination procedures which may be as simple as declothing and showering the individual. Simply removing the victim from the source will suffice to halt further radiation induced injury. In the vast majority of cases basic life support and other emergency medical procedures should be expeditiously instituted as warranted and without fear of personal hazard for health care teams. Following stabilization, further medical/surgical support must be predicated upon the extent of the radiation injury with the circulating absolute lymphocyte count serving as both a reliable and readily accessible indicator of the degree of underlying radiation injury. As radiation has profound consequences on immune and wound healing systems, therapies must be tempered by an understanding of the impact of radiation upon these systems. Overall, the consequences of irradiation injury will be the potential for an exacerbation of the effects of conventional traumatic injuries with a higher than expected morbidity and mortality.

Accidents↗
PubMed2002

Acute renal failure due to crush syndrome during Marmara earthquake.

During the earthquake in Marmara, Turkey (August 17, 1999), 87 of 476 victims (18.3%) admitted to Marmara University Hospital (Istanbul, Turkey) experienced renal failure caused by crush injuries. Fifty-nine patients (68%; 40 men, 19 women) required renal replacement therapy (RRT), whereas 28 patients (32%; 20 men, 16 women) recovered renal function under conservative treatment. The aim of the present study is to compare clinical and laboratory data from patients with crush syndrome who needed RRT with those who could be maintained on conservative medical treatment. Data for demographic, clinical, and laboratory findings of patients who had renal problems were collected retrospectively and analyzed. The proportion of men was significantly greater (68% versus 42%; P < 0.05), and time spent under the rubble was significantly shorter (9.4 +/- 6.9 versus 19.1 +/- 22.5 hours; P < 0.05) among patients who required RRT compared with those who recovered under conservative treatment. Patients who required RRT had significantly less urine output in the first 24 hours, underwent more fasciotomies, and needed more blood and fresh frozen plasma transfusions (P < 0.05). Blood urea nitrogen, creatinine, potassium, creatine kinase, and aspartate aminotransferase levels were significantly greater compared with patients managed conservatively both on admission and for the mean of values obtained during the first 2 weeks (P < 0.05). Furthermore, fasciotomies were the most powerful predictors of a later need for RRT. In a similar disaster in the future, these factors should be taken into consideration for priority in referral to medical centers with dialysis facilities.

Acute Kidney Injury↗
PubMed2004

Hospital response to chemical terrorism: personal protective equipment, training, and operations planning.

BACKGROUND: Hospitals distant from the immediate site of an incident involving a hazardous materials (HAZMATs) release which could include chemical warfare agents, must develop emergency response plans (ERPs) to protect healthcare professionals if they receive potentially contaminated victims. The ERP must address OSHA, EPA, and JCAHO requirements. METHODS: The VHA convened groups to develop a hazard and exposure assessment, identify actions for compliance with existing regulatory standards, and review site and operational planning issues. Exposure modeling results were used to derive relationships between operational parameters (time and distance from sites/sources) and potential exposure for healthcare workers. RESULTS: According to exposure modeling, level C personal protective equipment is adequate to protect hospital staff distant from the chemical release site. Decontamination runoff and contaminated clothing should also be controlled to limit exposure. CONCLUSIONS: Development and coordination of ERPs must include the local emergency planning committee, with clear assignment of tasks, locations, and training in order to prevent exposures to healthcare workers.

Chemical Warfare↗
PubMed1996

Spinal fractures resulting from the 1995 Great Hanshin Earthquake of the Kobe-Osaka area of Japan.

One of the worst earthquakes hit the Hanshin area between Kobe and Osaka, in the early morning at 5:46 AM on January 17th 1995. The destructive force with MG 7.2 severely damaged buildings, houses, roads and railways, leaving 6500 dead, and 34,900 injured. Hyogo College of Medicine located in this area was also severely damaged, thus there was a major challenge to provide post-quake medical support. A post-quake investigation in this area was done by 50 affiliated hospitals. More than 15,000 victim-patients were treated at these hospitals during the first 3 days after the quake. Major injuries were spinal fractures, and other trunk fractures, including rib or pelvis fractures, but fractures of long bones were uncommon, because the quake hit this area in the early morning when most people were asleep. In this study, the mechanisms of these major injuries were analysed by direct interview soon after the quake, with 230 victim-patients who had 140 spinal fractures, and 100 with rib or pelvis fractures. Most of those who had a spinal fracture had either sat up or stood up on their 'Futon' mattresses without bed frames and were struck on their backs by falling furniture or ceilings. On the other hand, patients who had fractures of the ribs or the pelvis had been lying in the supine or lateral position and were hit on their chest or pelvis. This characteristic lifestyle pattern of the Japanese people to lie down on the floor directly beside furniture, resulted in these injuries. From these results, we will emphasize the following precautions:- If an earthquake occurs during sleeping hours at home, do not stand up or sit up. The best position is to crouch on the 'Futon' mattress.

Adult↗
PubMed1999

Peripheral nerve palsies in victims of the Hanshin-Awaji earthquake.

On January 17, 1995, the Hanshin-Awaji earthquake directly hit a metropolis and destroyed approximately 120,000 houses. Many people were buried under the debris of the Japanese style wooden houses or were injured by falling furniture. Twenty-five patients (35 extremities) with earthquake associated peripheral nerve palsy were studied and followed up for 2 years. The characteristic feature of earthquake associated palsies was combined nerve palsy induced by prolonged compression. There were 11 extremities with brachial plexus palsy; two extremities with combined radial, median, and ulnar nerve palsy; two extremities with combined median and ulnar nerve palsy; two extremities with radial nerve palsy; two extremities with ulnar nerve palsy; 10 extremities with combined femoral and sciatic nerve palsy; one extremity with combined tibial and peroneal nerve palsy; and five extremities with compartment syndrome of the leg. Many peripheral nerve palsies were induced by nerve ischemia. Most patients had good spontaneous recovery. The prognosis of these palsies generally was good.

Adolescent↗
PubMed1989

[Treatment of open injuries in the victims of the earthquake in Armenian SSR].

The results of treatment of 36 patients injured during the earthquake in Armenia are analyzed. The patients had severe traumas: open injuries to the limbs, complicated by nephro- and hepatopathies. The periods of the limb crushing with fragments of ruined buildings varied from 3 hours to 3 days. The treatment modalities included conservative and operative detoxication (hemoperfusion, hemodiafiltration, hemofiltration, prolonged endolymphatic infusions of drugs), active surgical strategy, rehabilitation of patients. Seven amputations, 7 reamputations, and 21 necrectomies were performed in 36 patients by vital indications; no lethal outcomes were recorded. Restorative skin plasty was performed in 14 patients with 19 limb stumps, with good functional outcomes. The patients were directed to the Central Research Institute of Prosthetics to be supplied with prostheses. Only in 3 patients with the upper limb crushing the development of stable ischemic contractures could not be prevented.

Amputation Stumps↗
PubMedDate not supplied

The Gujarat earthquake (2001) experience in a seismically unprepared area: community hospital medical response.

BACKGROUND: At 08:53 hours on 26 January 2001, an earthquake measuring 6.9 on the Richter scale devastated a large, drought-affected area of northwestern India, the state of Gujarat. The known number killed by the earthquake is 20,005, with 166,000 injured, of whom 20,717 were "seriously" injured. About 370,000 houses were destroyed, and another 922,000 were damaged. METHODS: A community health worker using the local language interviewed all of the patients admitted to the Gandhi-Lincoln hospital with an on-site, oral, real-time, Victim Specific Questionnaire (VSQ). RESULTS: The census showed a predominance of women, children, and young adults, with the average age being 28 years. The majority of the patients had other family members who were also injured (84%), but most had not experienced deaths among family members (86%). Most of the patients (91%) had traveled more than 200 kilometers using their family cars, pick-ups, trucks, or buses to reach the buffer zone hospitals. The daily hospital admission rate returned to pre-event levels five days after the event, and all of the hospital services were restored by nine days after the quake. Most of the patients (83%) received definitive treatment in the buffer zone hospitals; 7% were referred to tertiary-care centers; and 9% took discharge against medical advice. The entrapped village folk with their traditional architecture had lesser injuries and a higher rescue rate than did the semi-urban townspeople, who were trapped in collapsed concrete masonry buildings and narrow alleys. However, at the time of crisis, aware townspeople were able to tap the available health resources better than were the poor. There was a low incidence of crush injuries. Volunteer doctors from various backgrounds teamed up to meet the medical crisis. International relief agencies working through local groups were more effective. Local relief groups needed to coordinate better. Disaster tourism by various well-meaning agencies took a toll on the providers. Many surgeries may have contributed to subsequent morbidity. CONCLUSIONS: The injury profile was similar to that reported for most other daytime earthquakes. Buffer zone treatment outcomes were better than were the field and damaged hospital outcomes.

Adolescent↗
PubMed1990

Health aspects of resettlement in Ethiopia.

The literature on health implications and effects of government-sponsored resettlement in Ethiopia is reviewed with the objective of providing an initial evaluation of the health status of settlers and the health hazards of resettlement in western Ethiopia. Emphasis is on the 1984/85 resettlement program, which resulted in the movement of about 600,000 drought victims from northern and central Ethiopia to the western part of the country. Malaria, trypanosomiasis, onchocerciasis, yellow fever, nonfilarial elephantiasis, sand-flea infestation, and psychological stress are identified as immediate and greater health hazards than in the areas of settler origin, based on the geographic distribution and ecology of the major communicable, nutritional, and geochemical diseases in Ethiopia, and on the impact of program deficiencies on settler health. More studies are needed on the epidemiology and ecology of bancroftian filariasis, visceral leishmaniasis, dracunculiasis, eye and skin diseases, tuberculosis, meningitis, intestinal parasitism, diarrhea, and calorie/protein malnutrition before their public health and economic significance in settlements can be evaluated. Schistosomiasis appears to be less common, for the time being, in resettlement areas than in the areas of outmigration. Research needs and constraints in resettlement planning, implementation, and operation are identified, and some recommendations made for disease control programs.

Adult↗
PubMed2001

Renal Doppler ultrasonographic findings in earthquake victims with crush injury.

OBJECTIVE: In the Marmara earthquake, which occurred on August 17, 1999, 639 people had renal complications, and 477 needed hemodialysis treatment because of acute renal failure due to crush injury. Our objective was to use Doppler ultrasonography as a noninvasive procedure to provide renal hemodynamic information. METHODS: We evaluated 9 patients with severe crush injury by using Doppler ultrasonography to measure renal resistive indexes within 16 to 32 hours after the earthquake and 6 weeks later. All patients had acute renal failure and underwent hemodialysis. RESULTS: All measured initial resistive indexes were high (mean +/- SD, 0.83 +/- 0.08), and they were correlated with the number of hemodialysis sessions (r = 0.703; P = .034), the duration of hemodialysis treatment (r = 0.819; P = .007), and oligoanuria (r = 0.937; P < .0001). All patients recovered from the acute renal failure, and repeated Doppler ultrasonography showed significant decreases in resistive indexes (0.59 +/- 0.07; P < .01) and renal lengths (P < .05). CONCLUSIONS: In crush injury, measurement of renal resistive indexes can be useful for the prognosis of recovery from acute renal failure.

Adolescent↗
PubMed1993

[A resuscitation aid in the first aid and medical care for the victims of severe trauma received in emergency situations].

On the basis of their own experience in combat casualty staging, emergency situations and various publications the authors theoretically substantiate the necessity to reinforce the structures of pre-medical and medical care with reanimation teams which must be equipped with adequate assets capable to meet with emergency situations. The article contains information about training, equipment and organic structure of these teams. Taking into account the pathophysiological mechanism of severe injuries the authors give characteristics of the volume of medical care provided by these teams at various periods of casualty staging. The article stresses the necessity to combine the conduction anesthesia with central analgesia. The authors substantiate the necessity of the quest for a new analgetic as a drug of choice at the pre-hospital period, and describe its desired characteristic features: effective analgesia without breathing depression or circulatory iatrogenic disorders; long-term analgetic effect which gives the possibility to perform evacuation to the secondary care medical unit; possibilities for national fabrication of this drug in large quantities, impossibility of addiction to this drug.

Combined Modality Therapy↗
PubMed2006

Terrorism preparedness: Web-based resource management and the TOPOFF 3 exercise.

BACKGROUND: The bombings of London on July 7, 2005 highlight the need for continued vigilance and readiness to respond to terrorist attacks. Trauma centers need to be at the core of preparedness activities. The State of Connecticut has taken a lead in preparedness and was selected as a site for the US Department of Homeland Security's Top Officials Three Exercise (TOPOFF 3), the largest and most extensive antiterrorism drill ever conducted. METHODS: All 32 acute care hospitals in Connecticut took part in the drill. The simulated attacks were designed to test all aspects of emergency preparedness including the ability of hospitals to treat large numbers of victims and effectively monitor and implement mechanisms for surge capacity. In Connecticut, TOPOFF 3 tested the Bioterrorism Preparedness Web Application that was designed to be the primary communication and resource management tool during a terrorist event or public health emergency. This paper describes: 1) the impetus for the State of Connecticut Department of Public Health's Bioterrorism Preparedness Web Application; 2) the strategies used to ensure its readiness and appropriate utilization during a public health emergency; and 3) its use for communication and resource management by the Department of Public Health and the acute care hospitals during TOPOFF 3. RESULTS: The Bioterrorism Preparedness Web Application was successfully implemented and used during TOPOFF 3 to assess surge capacity and other resources. CONCLUSIONS: Careful development and implementation of the Web application, or any communication system, as well as training and regular practice are required to ensure effective use during a public health emergency.

Bioterrorism↗
PubMed2000

Computerization of patient tracking and tracing during mass casualty incidents.

The admission of a large number of victims in a hospital after a mass casualty incident can easily lead to chaos and disruption of the hospital's regular organization. To ensure that this chaos does not continue, a correct way of registration and continuous overview of registered patients can be very helpful. The Emergency Hospital, which is part of the University Medical Centre Utrecht and the Central Military Hospital, was confronted several times with groups of patients who had to be admitted immediately. A computerized system was developed using bar codes of the International Article Numbering Association. The Commanding Team uses this system to overview the situation continuously. The system also registers urgency classes and primary diagnoses. It appeared that fewer errors were made in comparison with manual registration, while more information was stored and easily retrievable. Pilot studies are being performed to extend the usefulness of this method in a prehospital environment.

Disaster Planning↗
PubMed2003

The Army chemical/biological SMART (SMART-CB) team: the nurse's role.

A chemical or biologic attack probably will be covert, rather than overt. Because presenting signs and symptoms may mimic minor nonspecific illnesses or naturally produced disease syndromes and may not appear for several days, it is likely that nurses in emergency rooms and primary care settings will be among the first to come into contact with victims of a chemical or biologic agent exposure. Early recognition, reporting, decontamination, self-protection, prophylaxis, and treatment are imperative. After the terrorist attack on September 11, 2001, the anthrax incidents, and the heightened publicity of chemical and biologic agent attacks brought on by media coverage, the need for highly trained and well-prepared medical personnel has increased dramatically. Army nurses have led the way in training and expanding the capabilities of specialized medical response teams. Team members require ongoing training, state-of-the-art protective equipment and medical supplies, and constant practice to maintain the high state of readiness required to respond rapidly and effectively to chemical or biologic threats. Army SMART-CB nurses and their team members are well prepared to provide lifesaving care in highly contaminated areas. It is no longer a question of if but rather when and where the next attack will occur.

Biological Warfare↗