Role of regional anaesthesia in disaster medicine

Lehavi, Amit; Meroz, Yuval; Maryanovsky, Michael; Merin, Ofer; Blumberg, Nehemia; Bar‐On, Elhanan; Yitzhak, Avraham

doi:10.1097/eja.0000000000000424

Cited by 50 publications

(6 citation statements)

References 8 publications

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“…The majority of the literature describing the profiles of treated victims from the Nepal earthquake is from foreign field teams, who usually arrive on site several days after the event [13, 18–20]. The experiences of such teams, albeit relevant, do not reflect the reality of the country’s health system and services, and fail to report on the difficult conditions in which local health actors must act in the first days after an earthquake [12].…”

Section: Discussionmentioning

confidence: 99%

“…Understanding the profile of admitted earthquake victims is crucial to gain insight not only on health consequences of earthquakes, but also to understand what type of resources are mostly needed, in order to better prepare for such events. Literature on earthquake victims in low resource settings is mostly from foreign field teams who only arrive some days after the disaster, failing to picture the victims who reach the local health services in the first days after the earthquake [12, 13]. Since Nepal is a highly earthquake-prone country, understanding the immediate post-earthquake reality in local hospitals is extremely important to improve preparedness and response for the future.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and demographic profile of admitted victims in a tertiary hospital after the 2015 earthquake in Nepal

et al. 2019

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Background In 2015, an earthquake killing 9,000 and injuring 22,000 people hit Nepal. The Tribhuvan University Teaching Hospital (TUTH), a reference tertiary hospital, was operational immediately after the earthquake. We studied the profile of earthquake victims admitted in TUTH and assessed what factors could influence hospital length of stay. Methods An earthquake victim dataset was created based on patient records, with information on sex, age, date of admission and discharge, diagnosis, and surgical intervention. We performed an initial descriptive overview of the earthquake victims followed by a time-to-event analysis to compare length of hospital stay in different groups, using log rank test and cox regression to calculate Hazard Ratios. Results There were in total 501 admitted victims, with the peak of admissions occurring on the fifth day after the earthquake. About 89% had injury as main diagnosis, mostly in lower limbs, and 66% of all injuries were fractures. Nearly 69% of all patients underwent surgery. The median length of hospital stay was 10 days. Lower limb and trunk injuries had longer hospital stays than injuries in the head and neck (HR = 0.68, p = 0.009, and HR = 0.62 p = 0.005, respectively). Plastic surgeries had longer hospital stays than orthopaedic surgeries (HR = 0.57 p = 0.006). Having a crush injury and undergoing an amputation also increased time to discharge (HR = 0.57, p = 0.013, and HR = 0.65 p = 0.045 respectively). Conclusions Hospital stay was particularly long in this sample in comparison to other studies on earthquake victims, indirectly indicating the high burden TUTH had to bear to treat these patients. To strengthen resilience, tertiary hospitals should have preparedness plans to cope with a large influx of injured patients after a large-scale disaster, in particular for the initial days when there is limited external aid.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and demographic profile of admitted victims in a tertiary hospital after the 2015 earthquake in Nepal

et al. 2019

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“…All titles and abstracts were screened and only 11 articles met the inclusion criteria. [10][11][12][13][14][15][16][17][18][19][20] The Google search returned over 300,000 hits for each word combination entered, and the first 200 hits for each search were examined; data were extracted from 20 sources (mainly official EMT webpages with limited information). More data were obtained from key web sites, especially from the web Humanitarian Response, including 10 WHO-MoHP coordination meeting…”

Section: Methodsmentioning

confidence: 99%

“…Several papers have presented I-EMT individual experiences of deployment after the Nepal earthquake. [10][11][12][13][14][15][16][17][18][19][20] Additionally, a report by the Nepal Health Research Council (NHRC; Kathmandu, Nepal) reviews the effectiveness of I-EMTs' deployment following the earthquake. 8 Building on the information already available, the aim of this study was to describe the characteristics, timing, and activities performed by I-EMTs deployed to Nepal after the 2015 earthquake, and to assess their adherence to WHO-EMT registration and minimum standards.…”

Section: Introductionmentioning

confidence: 99%

International Emergency Medical Teams in the Aftermath of the 2015 Nepal Earthquake

Camacho

Karki

Subedi³

et al. 2019

Prehosp. Disaster med.

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Introduction:International Emergency Medical Teams’ (I-EMTs) response to disasters has been characterized by a late arrival, an over-focus on trauma care, and a lack of coordination and accountability mechanisms. Analysis of I-EMT performance in past and upcoming disasters is deemed necessary to improve future response.Objective:This study aimed to describe the characteristics, timing, and activities of I-EMTs deployed to the 2015 Nepal earthquake, and to assess their registration and adherence to the World Health Organization Emergency Medical Teams’ (WHO-EMT; Geneva, Switzerland) minimum standards compared to past disasters.Methods:An online literature search was performed and key web sites related to I-EMT deployments were purposively examined. The methodology used is reported following the STARLITE principles. All articles and documents in English containing information about characteristics, timing, and activities of I-EMTs during Nepal 2015 were included in the study. Data were retrieved from selected sources to compile the results following a systematic approach. The findings were validated by the Nepalese focal point for the coordination of I-EMTs after the earthquake.Results:Overall, 137 I-EMTs deployed from 36 countries. They were classified as Type I (65%), Type II (15%), Type III (1%), and specialized cells (19%). Although national teams remained the first responders, two regional I-EMTs arrived within the first 24 hours post-earthquake. According to daily reporting, the activities performed by I-EMTs included 28,372 out-patient consultations (comprising 6,073 trauma cases); 1,499 in-patient admissions; and 440 major surgeries. The activities reported by I-EMTs during their deployment were significantly lower than the capacities they offered at arrival. Over 80% of I-EMTs registered through WHO or national registration mechanisms, but daily reporting of activities by I-EMTs was low. The adherence of I-EMTs to WHO-EMT standards could not be assessed due to lack of data.Conclusion:The I-EMT response to the Nepal earthquake was quicker than in previous disasters, and registration and follow-up of I-EMTs was better. Still, there is need to improve I-EMT coordination, reporting, and quality assurance while strengthening national EMT capacity.Amat Camacho N, Karki K, Subedi S, von Schreeb J. International Emergency Medical Teams in the aftermath of the 2015 Nepal earthquake. Prehosp Disaster Med. 2019;34(3):260–264.

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“…The deployed anaesthesiologist, who usually practises in a high-technology operating room (OR), should adapt the anaesthetic plan to the austere environment 1 2. It has been suggested that regional anaesthesia (RA) is particularly suitable in this environment 1 4–6. Among regional techniques, spinal anaesthesia (SA) remains predominantly used in humanitarian settings 7 8.…”

Section: Introductionmentioning

confidence: 99%

Thoracic spinal anaesthesia for abdominal surgery in a humanitarian military field hospital: a prospective observational study

et al. 2022

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BackgroundProviding safe and effective anaesthesia in the context of humanitarian medicine is always a challenging situation. Spinal anaesthesia, and in particular its thoracic approach, represents a promising technique for such a limited-resource environment. This prospective observational study investigated the feasibility of thoracic spinal anaesthesia (TSA) for abdominal surgery in a field-deployed military hospital.Materials and methodsWe included adults scheduled for elective open cholecystectomy in a field hospital. Patients received TSA at the T9–T10 level. The primary outcomes were the feasibility of surgery under TSA and the haemodynamic/respiratory stability of this anaesthetic technique. The secondary outcomes included patient satisfaction and surgeon comfort regarding the anaesthesia technique and postoperative events (nausea and vomiting, urinary retention, postdural puncture headache).ResultsSurgery was performed successfully in 61 patients under TSA (90% female, 53±13 years old). Intraoperative pain scores were low, with a median Numeric Rating Scale score of 0 (IQR 0–2). Surgeon and patient satisfaction scores were excellent. The haemodynamic and respiratory parameters remained stable throughout the surgery. The incidence of postoperative events was low (nausea/vomiting=8%). None of our patients presented with postdural puncture headache or urinary retention.ConclusionTSA could be an effective anaesthetic technique for abdominal surgery in the context of a field hospital or austere environment.

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Role of regional anaesthesia in disaster medicine

Cited by 50 publications

References 8 publications

Clinical and demographic profile of admitted victims in a tertiary hospital after the 2015 earthquake in Nepal

Clinical and demographic profile of admitted victims in a tertiary hospital after the 2015 earthquake in Nepal

International Emergency Medical Teams in the Aftermath of the 2015 Nepal Earthquake

Thoracic spinal anaesthesia for abdominal surgery in a humanitarian military field hospital: a prospective observational study

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