Unveiling the Natural History of Category 4 Tropical Cyclones: The Puerto Rico Trauma Hospital Experience after Hurricane Maria

Abstract

Objectives: The hazardous environmental conditions hurricanes create might increase injury incidence almost 7 times. Therefore, a cohort study was performed at the Puerto Rico Trauma Hospital to compare morbidity and mortality patterns of patients after Hurricane Maria with a control period. Methods: Admissions from September 20, 2017, through January 20, 2018, constituted the post-Maria period (473 patients); the corresponding months of the previous year comprised the pre-Maria period (439 patients). Comparisons were done using Pearson’s chi-square or Mann-Whitney U-tests, as appropriate. A logistic regression was performed to assess the association between mortality and the study period. Results: Postlandfall admissions among patients aged 40-64 y increased by 6.6%, while among subjects between ages 18 and 39 y dropped by 7.0% (P = 0.03). Falls, gunshots, and burns were the injury mechanisms that varied the most across the exposure period. The median Injury Severity Score (13 vs 12; P = 0.05) and the frequency of Glasgow Coma Scale scores ≤8 (17.1% vs 10.9%; P = 0.03) were higher among poststorm patients. Moreover, a 2-fold (odds ratio = 1.93; 95% CI: 1.07-3.47) increase in mortality was observed after Maria, when adjusting for covariates. Conclusions: Following a hurricane, trauma centers might expect an older population, with more severe injuries and a 2-fold increased mortality risk.

The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico

“…The median age of injured patients increased from 40 to 49. Compared to our findings, studies in the past have shown that during periods of natural disasters and forced isolation (e.g., hurricanes, earthquakes, lockdowns), the population who presents to the hospital seeking care tends to be older (Comelli et al 2020;Ramos-Meléndez et al 2020).…”

“…Along with assaults, falls were the predominant mechanism during the first month of the lockdown. According to the literature, it is among the top mechanisms that increase in frequency in the aftermath of a natural disaster (Ramos-Meléndez et al 2020). While this is not a natural disaster per se, it led to house confinement usually seen during and after natural disasters.…”

Powerless in the Virgin Islands: Emergency Department and Wound Care Clinic Utilization Following the 2017 Hurricanes Irma and Maria on St. Thomas, U.S. Virgin Islands

“…Significantly, more visits after the storms were among patients with a primary diagnosis of injuries to the head, wrist and hand, ankle and foot, knee and lower leg, abdomen/lower back/spine/pelvis, neck, thorax, and elbow/forearm (Figure 1). This finding is consistent with prior studies, 17,20,24,[26][27][28][29][30] and is possibly because residents devoted considerable time attending to their damaged homes between storms and engaged in recovery activities known to produce injuries and health conditions in the aftermath of the hurricanes. 17,28,48…”

“…Substantial evidence shows the effects of power outages on healthcare delivery, home healthcare services, the public health infrastructure, and adverse health outcomes. [8][9][10][11][12][13] The effects of hurricanes on the increased utilization of EDs in New York, [14][15][16][17][18][19] New Jersey, [20][21][22] and Texas 23 ; across 9 U.S. states, 24 among Caribbean islands, [25][26][27][28][29][30] and the impact of a category 5 tropical cyclone on disaster related wounds, 31 have been recently investigated. The hurricane studies attributed the increased ED visits to disrupted access to care for a range of chronic diseases and conditions, including cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease (including ventilator dependence), renal disease, dementia, and mental disorders; disaster-related conditions (such as hypothermia or environmental exposures); carbon monoxide-related accidents; and a lack of prescription refills.…”

Perspectives on the Health Effects of Hurricanes: A Review and Challenges

“…The elderly population is more vulnerable to hurricanes’ direct and indirect impacts, as evident from an increase in the number of patients in the age group 40–64 following Hurricane Maria in Puerto Rico [ 39 ]. Following Hurricane Sandy, the proportion of visits for dialysis, respiratory issues, social and syncope visits was significantly higher for geriatric patients as compared to younger patients [ 40 ].…”