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Health See other Health Articles Title: Earthquakes Linked to Unique Pattern of Morbidity, Mortality Authors and Disclosures Print This Print This Email This Email this ShareShare November 3, 2011 — Earthquakes are associated with a unique epidemiologic pattern of often devastating health complications. These include traumatic injuries and death, as well as effects on multiple organ systems, according to the results of a literature review published online November 4 in The Lancet. The investigators limited their review to those papers published between 1990 and 2010 that included data on 50 or more patients. They ultimately used 123 papers in their analysis. "Because earthquakes frequently affect populous urban areas with poor structural standards, they often result in high death rates and mass casualties with many traumatic injuries," write Susan A. Bartels, MD, MPH, from Beth Israel Deaconess Medical Center, and Michael J. Van Rooyen, MD, MPH, from Brigham and Women's Hospital, both in Boston, Massachusetts. "These injuries are highly mechanical and often multisystem, requiring intensive curative medical and surgical care at a time when the local and regional medical response capacities have been at least partly disrupted," write Dr. Bartels and Dr. Van Rooyen, who are also affiliated with the Harvard Humanitarian Initiative in Boston. "Many patients surviving blunt and penetrating trauma and crush injuries have subsequent complications that lead to additional morbidity and mortality." Millions of people worldwide are exposed to earthquakes because many densely populated cities, including Los Angeles, Tokyo, New York, Delhi, and Shanghai, are on fault lines. Nearly 60% of all disaster-related mortality has been earthquake-related during the past decade, with more than 780,000 deaths overall and more than 200,000 deaths during the 2004 tsunami in Indonesia. Casualty rates of earthquakes vary from 1% to 8% of those at risk and the ratio of death to injury was approximately 1:3. Death is immediate for many. A second peak in mortality occurs a few hours later, corresponding to deaths from critical injuries including liver or spleen lacerations, pelvic fractures, and subdural hematomas. A third mortality peak occurs days to weeks later due to sepsis, multiorgan failure, and disseminated intravascular coagulation.. Earthquakes typically disrupt both delivery of surgical and medical care and medical supply chains as medical facilities, roads, and bridges are destroyed. People with diabetes, heart disease, and other chronic conditions are therefore also at greater risk for death. Earthquake-Related Injuries Lacerations are the most prevalent earthquake-related musculoskeletal injury (65%), followed by fractures (22%) and soft-tissue contusions or sprains (6%). Burst fractures account for about half of all spinal fractures. Crush injuries affect 2% to 15% of those exposed to earthquakes, and may result in electrolyte imbalances, renal failure, and/or amputation. Aggressive hydration with fluids not containing potassium or calcium is indicated, even in patients with apparently normal electrolytes. Acidosis, hypovolemic shock, and rhabdomyolysis associated with crush injury also contribute to renal failure, which occurs in 50% of patients with crush syndrome. About 50% of these patients need dialysis. In earthquake settings, mortality of renal failure is about 14% to 48%. Other medical complications of crush injuries include sepsis, disseminated intravascular coagulation, and acute respiratory distress syndrome, all of which may be fatal. The lower limbs are affected in 74% of persons with earthquake-related crush injuries. Fasciotomy, which may lead to sepsis, and amputation are controversial. Timely amputation may relieve and prevent electrolyte and other imbalances leading to renal failure, but some experts advocate conserving a crushed extremity because even severely crushed limbs may recover full function. In the 1999 Taiwan earthquake, 30% of people affected reportedly died from head injuries. In the 2008 China earthquake, head trauma was the second leading cause of trauma after lower-limb injuries. Chest injury, particularly rib fracture and pneumothorax, is also common and may be a predictor of mortality. Other Earthquake-Related Complications The rate of myocardial infarction increased by 35% during the week after the 1994 Northridge, California, earthquake but remained stable after the 1989 Loma Pietra, California, earthquake. Arrhythmias increased 6- to 9-fold after the 2008 Chinese earthquake. Among elderly patients wearing ambulatory blood pressure monitoring devices, systolic blood pressure increased by 14 to 16 mm Hg, and diastolic by 6 to 10 mm Hg, for 2 weeks after the 1995 Japanese earthquake. As people are displaced from their damaged homes, overcrowding in shelters with poor sanitation also can trigger infectious disease outbreaks and sepsis, which increases mortality 2.5-fold. However, the reviewers note that the role of corpses in such outbreaks tends to be exaggerated, except in the transmission of cholera. Earthquakes often trigger psychiatric conditions, particularly depression (which may affect from 6% to 72% of the exposed population) and posttraumatic stress disorder (which may affect from 3.3% to 81% of the exposed population). Suicidal ideation was reported in 17% of the population after the 1999 Turkey earthquake. Vulnerable Populations Compared with adults, children are usually at greater risk for injury and death. In the major Haitian earthquake, 53% of patients were younger than 20 years, and 25% were younger than 5 years. The elderly also tend to have higher mortality than younger individuals and are at increased risk for social isolation. "Understanding of the medical effects of earthquakes, especially in large urban centres, necessitates awareness of the regional seismic risk, structural vulnerability, local response capacity, and resilience of the curative medical services," Dr. Bartels and Dr. Van Rooyen write. "A multidisciplinary approach is needed to create a mechanism for prevention, search and rescue, and medical response." Post Comment Private Reply Ignore Thread
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