Demographic Study of The Trauma Patients in The Earthquake Disasters

Yi-Kung Lee MD.Yi-Kung Lee MD.Depart. of Emergency MedicineDepart. of Emergency Medicine

Shin Kong Wu Ho-Su Memorial HospitalShin Kong Wu Ho-Su Memorial Hospital

Casuality Severity

Although disasters can occur where Although disasters can occur where there are many severe injuriesthere are many severe injuries

Most victims in disasters will have minor Most victims in disasters will have minor injuries and illnessesinjuries and illnesses

Many of these can be treated in LMDMany of these can be treated in LMD Most do not need to be kept in the Most do not need to be kept in the

hospitalhospital

1989 San Francisco Earthquake Injuries in Santa Cruz County

No. PercentNo. PercentSelf-treatment 44 Self-treatment 44 13.8%13.8%Physician’s Office or Clinic 143 Physician’s Office or Clinic 143 45.0%45.0%Treated at Hospital and Released 106 33.3%Treated at Hospital and Released 106 33.3%the Same Day*the Same Day*Admitted to Hospital 25 7.9%Admitted to Hospital 25 7.9%**About 1/2 could have been treated in a less sophisticated settingAbout 1/2 could have been treated in a less sophisticated settingDurkin ME et al: Injuries & emergency medical response in the Loma Prieta Earthquake. Bulletin of the Seismological Society of Durkin ME et al: Injuries & emergency medical response in the Loma Prieta Earthquake. Bulletin of the Seismological Society of America. Oct, 1991 p2121America. Oct, 1991 p2121

1995 Oklahoma City Bombing168 Deaths, >700 Injuries168 Deaths, >700 Injuries

Soft tissue injury 328(49.2%)Soft tissue injury 328(49.2%) Contusion 62(9.3%)Contusion 62(9.3%) Fracture 49(7.4%)Fracture 49(7.4%) Head injury 41(6.2%)Head injury 41(6.2%) Orbital injury 28(4.2%)Orbital injury 28(4.2%) Chest injury 23(3.5%)Chest injury 23(3.5%) Burn 4(0.6%) Burn 4(0.6%) Crush injury 2(0.3%)Crush injury 2(0.3%) Others 129(19.4%) Others 129(19.4%) n=666n=666Hogan DE et al. Emergency Department Impact of the Oklahoma City Terrorist Bombing. Ann of Emerg Med, 34(2);1999Hogan DE et al. Emergency Department Impact of the Oklahoma City Terrorist Bombing. Ann of Emerg Med, 34(2);1999

Rescue And Transport

Most of victims is rescued and Most of victims is rescued and transported by laypersons in disasterstransported by laypersons in disasters

Survival rate of trapped victims Survival rate of trapped victims sharply decreases after 1 daysharply decreases after 1 day

Most of victims only needs simple Most of victims only needs simple first-aid in the disaster fieldfirst-aid in the disaster field

1976 Tangshan Earthquake

250,000 Fatalities250,000 Fatalities 2000,000~300,000 rescued themse2000,000~300,000 rescued themse

lveslves Then did Then did 80%80% of rescue of rescue

Survival Versus Time For Trapped Earthquake Victims

1/2 1 Day 1/2 1 Day 22 3 4 5 3 4 5 hour hour DaysDays Days Days Days Days Days DaysS. Italy S. Italy 1980 88% 1980 88% 35%35% 9% 9% 0% 9% 9% 0%TangshanTangshan1976 99% 81% 1976 99% 81% 34%34% 37% 19% 7% 37% 19% 7%

Sheng ZY: Medical support in the Tangshan earthquake: A review of the management of mass casualities and certainSheng ZY: Medical support in the Tangshan earthquake: A review of the management of mass casualities and certain major injuries. J of Trauma. 27:1130-5;1987major injuries. J of Trauma. 27:1130-5;1987de Bruycker M et al: The 1980 earthquake in southern Italy: rescue of trapped victims and mortality. Bullentin of thede Bruycker M et al: The 1980 earthquake in southern Italy: rescue of trapped victims and mortality. Bullentin of theWHO. 61:1021-5;1083WHO. 61:1021-5;1083

1995 Oklahoma City Bombing

Transport ModeTransport ModePrivately owned vehicle 152(55.8%)Privately owned vehicle 152(55.8%)EMS EMS 90(33.0%)90(33.0%)Carried or Walked 27(9.9%)Carried or Walked 27(9.9%)Other Modes 3(1.1%)Other Modes 3(1.1%)

Unknown modes=116Unknown modes=116Hogan DE et al. Emergency Department Impact of the Oklahoma City Terrorist Bombing. Ann of Emerg Med, 34(2);1999Hogan DE et al. Emergency Department Impact of the Oklahoma City Terrorist Bombing. Ann of Emerg Med, 34(2);1999

1995 Oklahoma City Bombing

Prehospital TreatmentPrehospital TreatmentSpinal immobilization Spinal immobilization 64(71.1%)64(71.1%)Field dressing Field dressing 40(44.4%)40(44.4%)IV fluids 32(35.5%)IV fluids 32(35.5%)ETT 3(3.3%)ETT 3(3.3%)Medication 3(3.3%)Medication 3(3.3%)Field amputation 1(1.1%)Field amputation 1(1.1%)CPR 0 CPR 0 cases=90cases=90Hogan DE et al. Emergency Department Impact of the Oklahoma City Terrorist Bombing. Ann of Emerg Med, 34(2);1999Hogan DE et al. Emergency Department Impact of the Oklahoma City Terrorist Bombing. Ann of Emerg Med, 34(2);1999

Hospitalization

Study of 29 U.S. disastersStudy of 29 U.S. disasters An average of 20% hospitalized An average of 20% hospitalized 1day1day Half admitted more because they had beHalf admitted more because they had be

en in a disaster than because of injury seen in a disaster than because of injury severity, and were discharged the next dayverity, and were discharged the next day

Quarantelli EL:Delivery of Emergency Medical Care in Disasters: Assumptions AndQuarantelli EL:Delivery of Emergency Medical Care in Disasters: Assumptions AndRealities, 1983, Irvington Press, New YorkRealities, 1983, Irvington Press, New York

Hurricane Gloria 1985 Four Rhode Island Coastal Hospitals

September 20 21 22 September 20 21 22 2727 28 29 28 29 impactimpactPatients 342 423 405 Patients 342 423 405 347347 533 482 533 482Admitted 11.4% 8.7% 11.1% Admitted 11.4% 8.7% 11.1% 14.7%14.7% 10.1% 11.6% 10.1% 11.6%

Types of Casualities

Whiles most disaster Planning focuWhiles most disaster Planning focuses on ses on injuries injuries …………

Many casualities need treatment for Many casualities need treatment for other conditionsother conditions

1995 Kobe Earthquake

5,500 Deaths, 41,000 Injuries5,500 Deaths, 41,000 Injuries No. of patients No. of Deaths(%) No. of patients No. of Deaths(%) Crushing Syndrome 372 50(13.4)Crushing Syndrome 372 50(13.4)Other Trauma 2,346 128(5.5)Other Trauma 2,346 128(5.5)IllnessIllness 3,389 349(10.3)3,389 349(10.3)Total 6,170 527( 8.6)Total 6,170 527( 8.6) (Morbidity and Mortality in Survey Hospitals)(Morbidity and Mortality in Survey Hospitals)

Tanaka H et al. Morbidity and Mortality of Hospitalized Patients after the Hanshin-Awaji Earthquake. Ame J Emerg Med;!7(2)1999Tanaka H et al. Morbidity and Mortality of Hospitalized Patients after the Hanshin-Awaji Earthquake. Ame J Emerg Med;!7(2)1999

Injury Types in Earthquake

Occurrence of Specific type of Thoracic Organ Injury

Injury Injury %%Chest Wall 45 Chest Wall 45 Pulmonary 26Pulmonary 26Hemothorax 25Hemothorax 25Pneumothorax 20Pneumothorax 20Heart 9Heart 9Diaphragm 7 Diaphragm 7 Aorta and Great Vessel 4Aorta and Great Vessel 4Esophagus 1.5Esophagus 1.5Miscellaneous 21Miscellaneous 2115047 patients, Vehicle accident15047 patients, Vehicle accident

Mortality Due to Thoracic Injury

Immediate HeartImmediate HeartDeath Great vesselsDeath Great vesselsEarly Death Cardiac TamponadeEarly Death Cardiac Tamponade(30min-3hrs) Airway Obstruction(30min-3hrs) Airway Obstruction HemorrhageHemorrhageLate Death Respiratory ComplicationsLate Death Respiratory Complications InfectionInfection

1995 Kobe Earthquake

Type No. of Injury (death rate)Type No. of Injury (death rate)Crushing syndrome 372Crushing syndrome 372(13%)(13%)Head 50(11%)Head 50(11%)Chest Chest 79 79(5%)(5%)Abdomen 67Abdomen 67(28%)(28%)Fracture 1,489(0.7%)Fracture 1,489(0.7%)Spinal 29(3%)Spinal 29(3%)Soft tissue 955(0.7%)Soft tissue 955(0.7%)Tanaka H et al. Morbidity and Mortality of Hospitalized Patients after the Hanshin-Awaji Earthquake. Ame J Emerg Med;!7(2)1999Tanaka H et al. Morbidity and Mortality of Hospitalized Patients after the Hanshin-Awaji Earthquake. Ame J Emerg Med;!7(2)1999

1995 Kobe Earthquake

Type No. of Injury (death rate)Type No. of Injury (death rate)Burn 51(2%)Burn 51(2%)Poisoning 16(0%)Poisoning 16(0%)Traumatic asphyxia 7 (71%)Traumatic asphyxia 7 (71%)Peripheral nerve 131(0.8%) Peripheral nerve 131(0.8%) Others 117(57%)Others 117(57%)

Tanaka H et al. Morbidity and Mortality of Hospitalized Patients after the Hanshin-Awaji Earthquake. Ame J Emerg Med;!7(2)1999Tanaka H et al. Morbidity and Mortality of Hospitalized Patients after the Hanshin-Awaji Earthquake. Ame J Emerg Med;!7(2)1999

1995 Kobe Earthquake

Kobe University Hospital (487 patients)Kobe University Hospital (487 patients)

•Head : 123(25%)•Chest : 39(8%)•Abdomen : 3(1%)•Pelvic&Waist: 35(7%)•Spine: 38(8%)

• Extremities:147(30%)• Burn: 21(4%)• Multiple: 74(15%), included 24 with chest injuries

• Unknown: 7(2%)Naoki Y et al.Profile of Chest Injuries Arising From the !995 Southern Hyogo Prefecture

Earthquake.Chest.110(3);759161,1996

1995 Kobe Earthquake

Chest Injuries: 63(12.9%)Chest Injuries: 63(12.9%)

DOA, Severe Chest Compression : 8DOA, Severe Chest Compression : 8 Admission: 8 ( 2 Crushing Syndrome)Admission: 8 ( 2 Crushing Syndrome) Light to Moderate Injuries: 47(74.6%)Light to Moderate Injuries: 47(74.6%)

Naoki Y et al.Profile of Chest Injuries Arising From the !995 Southern Hyogo PrefectureNaoki Y et al.Profile of Chest Injuries Arising From the !995 Southern Hyogo Prefecture

Earthquake.Chest.110(3);759161,1996Earthquake.Chest.110(3);759161,1996

1995 Kobe Earthquake

Chest InjuriesChest Injuries

•Superficial Trauma 29•Fracture of Ribs 17•Dead on Arrival Rupture of CV System 6 Suffocation 2

•Fracture of Clavicle 5•Pneumothorax 2•Others 2 •Total 63

Naoki Y et al.Profile of Chest Injuries Arising From the !995 Southern Hyogo Prefecture

Earthquake.Chest.110(3);759161,1996

921 Chi-Chi Earthquake

2,347 Deaths, 10,718 injuries, 2,347 Deaths, 10,718 injuries, 1000 admissions1000 admissions

9/21 ~ 9/23 : 2,199 deaths (93%)9/21 ~ 9/23 : 2,199 deaths (93%) 9/21: 2,138 deaths (91%)9/21: 2,138 deaths (91%) First 2 hours: 1,304 (55%)First 2 hours: 1,304 (55%) 2~3 hours: 41 (1%) 2~3 hours: 41 (1%) >4 hours: 57 (2%)>4 hours: 57 (2%) Unknown: 736 (31%)Unknown: 736 (31%)

921 Chi-Chi Earthquake

Age No. of Death(%) RRAge No. of Death(%) RR0~5 152 (6.47%) 1.20~5 152 (6.47%) 1.25~14 255 (10.86%) 0.945~14 255 (10.86%) 0.9414~65 1268 (54.02%) 114~65 1268 (54.02%) 1>65 672 (28.63%) 4.48>65 672 (28.63%) 4.48

921 Chi-Chi Earthquake

Age No. of Death RRAge No. of Death RR65~70 172 (7.32%) 3.12 65~70 172 (7.32%) 3.12 70~75 181 (7.71%) 4.0270~75 181 (7.71%) 4.0275~80 143 (6.09%) 5.1875~80 143 (6.09%) 5.18>80 149 (6.34%) 6.76>80 149 (6.34%) 6.76

921 Chi-Chi Earthquake

1348 useful injury reports from effected 1348 useful injury reports from effected and uneffected hospitals from 9/21 ~ 9/and uneffected hospitals from 9/21 ~ 9/23, collected by DOH23, collected by DOH

DOA: 40 (3%) DOA: 40 (3%) MBD: 933(71%)MBD: 933(71%) Admission: 271(20%) Transfer: 62(4%)Admission: 271(20%) Transfer: 62(4%)

921 Chi-Chi Earthquake

Triage (1272)Triage (1272) I : 85 (6%)I : 85 (6%) II : 444 (34%)II : 444 (34%) III: 632 (49%)III: 632 (49%) IV: 111 (8%)IV: 111 (8%)

921 Chi-Chi Earthquake 21 September, 199921 September, 1999 Ambulance TriageAmbulance Triage I + II 187(65%) I + II 187(65%) Yes 297(43%) III + VI 100(35%) Yes 297(43%) III + VI 100(35%) I + II 166(44%)I + II 166(44%) No 394(57%) III +IV 214(56%)No 394(57%) III +IV 214(56%) p< 0.01p< 0.01

921 Chi-Chi Earthquake

Sites of Injuries(1438)Sites of Injuries(1438) Head and Neck 215 (14.95%)Head and Neck 215 (14.95%) Trunk 143(9.94%)Trunk 143(9.94%) Upper Ext 158 (10.99%) Upper Ext 158 (10.99%) Lower Ext 442(30.74%)Lower Ext 442(30.74%) Multiple 441(30.67%)Multiple 441(30.67%) DOA 39(2.71%)DOA 39(2.71%)

921 Chi-Chi Earthquake

Type of Injuries (1,639)Type of Injuries (1,639)

Fracture 207(12%) Contusion 573 (35%)Fracture 207(12%) Contusion 573 (35%)Soft tissue injury 756(46%)Soft tissue injury 756(46%) Crushing 32 (2%) Crushing 32 (2%)Brain Injury 49(2%) Burn 38 (2%)Brain Injury 49(2%) Burn 38 (2%)Injury of Internal 15 (0.9%) Shock 13 (0.8%)Injury of Internal 15 (0.9%) Shock 13 (0.8%)OrgansOrgansOthers 5 (0.3%)Others 5 (0.3%)