Emergency Department Management After the 2020 Aegean Sea - Izmir Earthquake

Abstract

BACKGROUND: This article aims to provide an up-to-date resource on disaster management by reporting about the destructive features of the earthquake that occurred on October 30, 2020, and about the hospital and emergency service organization during a pandemic. METHODS:This study was carried out with a multicentered, cross-sectional retrospective design on the victims of the 2020 Aegean Sea -Izmir earthquake. Local ethics committee approval was obtained. The data obtained by obtaining permission from two hospitals and ambulance services (transport data) located in the region where earthquake-related destruction was most prominent were evaluated. Patient data including demographic data, time of arrival to the emergency department, duration of stay under the debris, triage codes (green: not urgent, slightly injured; yellow: may be delayed, injured; red: critically injured; and black: dead), type of injuries, duration of stay in the emergency department, crush syndrome, rhabdomyolysis, need for invasive procedures (e.g., surgery and dialysis), intensive care admission, hospital admission, and discharge were evaluated. RESULTS:In total, 313 patients (60.4% females) were included in the study according to the inclusion criteria. The mean age of the participants was 38.0±21.0 years, with the youngest being a 6-month-old baby and the oldest a 91-year-old individual. Approximately 41.5% of the earthquake victims presented to the emergency department within the first 3 h of the earthquake, and patients with yellow triage code were the most common in the 1 st h. Further, 35.2% of the patients who were rescued from under the debris were discharged alive. Four patients were discharged alive after being rescued from under the debris 24 h following the earthquake, of whom three were rescued after >48 h (longest duration, 91 h). Further, 32 (15.9%) patients who survived upon presentation to the emergency department had rhabdomyolysis, 4 (1.9%) underwent hemodialysis in the emergency department due to acute renal failure, and 8 (3.8%) underwent other emergency operations such as fasciotomy and amputation. In total, 122 patients died and 191 patients were discharged from the hospitals. Furthermore, 139 patients were discharged from the emergency department, 15 were admitted to the intensive care unit, 41 were hospitalized in the relevant clinics, and 112 were directly transferred to the morgue following preliminary evaluation.CONCLUSION: Emergency services should be ready in terms of accurate registration, correct data entry, correct triage assignment, sufficient resources, adequate team, sufficient equipment, and adequate treatment areas for disasters such as earthquakes. Further, adequate disaster trainings should be provided, feasible disaster relief plans should be prepared, and regular exercises should be conducted.

Demographic and Clinical Characteristics of Earthquake Victims Presented to the Emergency Department with and without Crush Injury upon the 2023 Kahramanmaraş (Turkey) Earthquake

“…The rate of female patients presented to the hospital was similar to the 2020 Turkey Aegean Sea–Izmir earthquake study 10 and higher than the male patients. The mean age of the patients in 2020 study was 38.0 (SD = 21.0) years compared to 45.94 (SD = 16.7) years in the present study.…”

“…18 Most studies suggested the patients who developed AKI had longer delays in receiving supportive treatment compared to patients without AKI. 10 During the Izmir earthquake, the longest duration under the rubble was 91 hours, 10 whereas in the present study, it was 120 hours. It was reported that the rate of development of AKI was higher in patients with longer duration of stay under the debris in the Iran Bam earthquake, similar to the results of the present study.…”

“…13 A study on the Aegean Sea–Izmir earthquake, which measured at a lower Richter scale with a shorter duration compared to the Kahramanmaraş earthquake, reported that approximately 41.5% of the patients presented during the first three hours of the earthquake. 10 For the Izmir earthquake, patients affected by the earthquake sought medical care in hospitals in the same city, and therefore, the time of presentation was earlier. The current hospital is approximately three hours by land route from Hatay Province, one of the most earthquake-affected provinces and one of the provinces where patient transfers were the most common.…”

“…A study by Uz, et al, which investigated the presentations after the Izmir earthquake, reported that patients encoded Yellow presented the most on the first day, with higher frequency of presentation during the first hour, and the patients encoded Yellow had the higher rate of presentation during the study. 10 The fact that Green encoded patients watched for their relatives under the debris, whereas Red encoded patients had difficulty in arriving by their own means and might have been transferred only by ambulance at a later stage, may account for this result.…”

Experiences of Operating Room Professionals During the 2020 Izmir Earthquake: A Qualitative Approach

“…12 Patients brought to emergency services after the Izmir earthquake typically suffered traumatic injuries that required surgical treatment, such as fasciotomy and amputation. 13 These surgeries must be performed in a sterile operating room, with access to specialized technological devices and instruments and experienced professionals.…”