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Demographic Study of The Trauma Patients in The Earthquake Disasters

Demographic Study of The Trauma Patients in The Earthquake Disasters. Yi-Kung Lee MD. Depart. of Emergency Medicine Shin Kong Wu Ho-Su Memorial Hospital. Casuality Severity. Although disasters can occur where there are many severe injuries

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Demographic Study of The Trauma Patients in The Earthquake Disasters

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  1. Demographic Study of The Trauma Patients in The Earthquake Disasters Yi-Kung Lee MD. Depart. of Emergency Medicine Shin Kong Wu Ho-Su Memorial Hospital

  2. Casuality Severity • Although disasters can occur where there are many severe injuries • Most victims in disasters will have minor injuries and illnesses • Many of these can be treated in LMD • Most do not need to be kept in the hospital

  3. 1989 San Francisco Earthquake Injuries in Santa Cruz County No. Percent Self-treatment 44 13.8% Physician’s Office or Clinic 143 45.0% Treated at Hospital and Released 106 33.3% the Same Day* Admitted to Hospital 25 7.9% *About 1/2 could have been treated in a less sophisticated setting Durkin ME et al: Injuries & emergency medical response in the Loma Prieta Earthquake. Bulletin of the Seismological Society of America. Oct, 1991 p2121

  4. 1995 Oklahoma City Bombing 168 Deaths, >700 Injuries Soft tissue injury 328(49.2%) Contusion 62(9.3%) Fracture 49(7.4%) Head injury 41(6.2%) Orbital injury 28(4.2%) Chest injury 23(3.5%) Burn 4(0.6%) Crush injury 2(0.3%) Others 129(19.4%) n=666 Hogan DE et al. Emergency Department Impact of the Oklahoma City Terrorist Bombing. Ann of Emerg Med, 34(2);1999

  5. Rescue And Transport • Most of victims is rescued and transported by laypersons in disasters • Survival rate of trapped victims sharply decreases after 1 day • Most of victims only needs simple first-aid in the disaster field

  6. 1976 Tangshan Earthquake • 250,000 Fatalities • 2000,000~300,000 rescued themselves • Then did 80% of rescue

  7. Survival Versus Time For Trapped Earthquake Victims  1/2 1 Day 2 3 4 5 hour Days Days Days Days S. Italy 1980 88% 35% 9% 9% 0% Tangshan 1976 99% 81% 34% 37% 19% 7% Sheng 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;1987 de Bruycker M et al: The 1980 earthquake in southern Italy: rescue of trapped victims and mortality. Bullentin of the WHO. 61:1021-5;1083

  8. 1995 Oklahoma City Bombing Transport Mode Privately owned vehicle 152(55.8%) EMS 90(33.0%) Carried or Walked 27(9.9%) Other Modes 3(1.1%) Unknown modes=116 Hogan DE et al. Emergency Department Impact of the Oklahoma City Terrorist Bombing. Ann of Emerg Med, 34(2);1999

  9. 1995 Oklahoma City Bombing Prehospital Treatment Spinal immobilization 64(71.1%) Field dressing 40(44.4%) IV fluids 32(35.5%) ETT 3(3.3%) Medication 3(3.3%) Field amputation 1(1.1%) CPR 0 cases=90 Hogan DE et al. Emergency Department Impact of the Oklahoma City Terrorist Bombing. Ann of Emerg Med, 34(2);1999

  10. Hospitalization • Study of 29 U.S. disasters • An average of 20% hospitalized 1day • Half admitted more because they had been in a disaster than because of injury severity, and were discharged the next day Quarantelli EL:Delivery of Emergency Medical Care in Disasters: Assumptions And Realities, 1983, Irvington Press, New York

  11. Hurricane Gloria 1985 Four Rhode Island Coastal Hospitals September 20 21 22 27 28 29 impact Patients 342 423 405 347 533 482 Admitted 11.4% 8.7% 11.1% 14.7% 10.1% 11.6%

  12. Types of Casualities • Whiles most disaster Planning focuses on injuries …… • Many casualities need treatment for other conditions

  13. 1995 Kobe Earthquake 5,500 Deaths, 41,000 Injuries No. of patients No. of Deaths(%) Crushing Syndrome 372 50(13.4) Other Trauma 2,346 128(5.5) Illness3,389 349(10.3) Total 6,170 527( 8.6) (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)1999

  14. Injury Types in Earthquake

  15. Occurrence of Specific type of Thoracic Organ Injury Injury % Chest Wall 45 Pulmonary 26 Hemothorax 25 Pneumothorax 20 Heart 9 Diaphragm 7 Aorta and Great Vessel 4 Esophagus 1.5 Miscellaneous 21 15047 patients, Vehicle accident

  16. Mortality Due to Thoracic Injury Immediate Heart Death Great vessels Early Death Cardiac Tamponade (30min-3hrs) Airway Obstruction Hemorrhage Late Death Respiratory Complications Infection

  17. 1995 Kobe Earthquake Type No. of Injury (death rate) Crushing syndrome 372(13%) Head 50(11%) Chest 79(5%) Abdomen 67(28%) Fracture 1,489(0.7%) Spinal 29(3%) 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)1999

  18. 1995 Kobe Earthquake Type No. of Injury (death rate) Burn 51(2%) Poisoning 16(0%) Traumatic asphyxia 7 (71%) Peripheral nerve 131(0.8%) Others 117(57%) Tanaka H et al. Morbidity and Mortality of Hospitalized Patients after the Hanshin-Awaji Earthquake. Ame J Emerg Med;!7(2)1999

  19. 1995 Kobe Earthquake Kobe University Hospital (487 patients) • Extremities:147(30%) • Burn: 21(4%) • Multiple: 74(15%), included 24 with chest injuries • Unknown: 7(2%) • Head : 123(25%) • Chest : 39(8%) • Abdomen : 3(1%) • Pelvic&Waist: 35(7%) • Spine: 38(8%) Naoki Y et al.Profile of Chest Injuries Arising From the !995 Southern Hyogo Prefecture Earthquake.Chest.110(3);759161,1996

  20. 1995 Kobe Earthquake Chest Injuries: 63(12.9%) • DOA, Severe Chest Compression : 8 • Admission: 8 ( 2 Crushing Syndrome) • Light to Moderate Injuries: 47(74.6%) Naoki Y et al.Profile of Chest Injuries Arising From the !995 Southern Hyogo Prefecture Earthquake.Chest.110(3);759161,1996

  21. 1995 Kobe Earthquake Chest 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

  22. 921 Chi-Chi Earthquake 2,347 Deaths, 10,718 injuries, 1000 admissions • 9/21 ~ 9/23 : 2,199 deaths (93%) • 9/21: 2,138 deaths (91%) First 2 hours: 1,304 (55%) 2~3 hours: 41 (1%) >4 hours: 57 (2%) Unknown: 736 (31%)

  23. 921 Chi-Chi Earthquake Age No. of Death(%) RR 0~5 152 (6.47%) 1.2 5~14 255 (10.86%) 0.94 14~65 1268 (54.02%) 1 >65 672 (28.63%) 4.48

  24. 921 Chi-Chi Earthquake Age No. of Death RR 65~70 172 (7.32%) 3.12 70~75 181 (7.71%) 4.02 75~80 143 (6.09%) 5.18 >80 149 (6.34%) 6.76

  25. 921 Chi-Chi Earthquake • 1348 useful injury reports from effected and uneffected hospitals from 9/21 ~ 9/23, collected by DOH DOA: 40 (3%) MBD: 933(71%) Admission: 271(20%) Transfer: 62(4%)

  26. 921 Chi-Chi Earthquake Triage (1272) I : 85 (6%) II : 444 (34%) III: 632 (49%) IV: 111 (8%)

  27. 921 Chi-Chi Earthquake 21 September, 1999 Ambulance Triage I + II 187(65%) Yes 297(43%) III + VI 100(35%) I + II 166(44%) No 394(57%) III +IV 214(56%) p< 0.01

  28. 921 Chi-Chi Earthquake Sites of Injuries(1438) Head and Neck 215 (14.95%) Trunk 143(9.94%) Upper Ext 158 (10.99%) Lower Ext 442(30.74%) Multiple 441(30.67%) DOA 39(2.71%)

  29. 921 Chi-Chi Earthquake Type of Injuries (1,639) Fracture 207(12%) Contusion 573 (35%) Soft tissue injury 756(46%) Crushing 32 (2%) Brain Injury 49(2%) Burn 38 (2%) Injury of Internal 15 (0.9%) Shock 13 (0.8%) Organs Others 5 (0.3%)

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