Dr. Susan A. Bartels and Dr. Michael J Van Rooyen's review published Online First in The Lancet details the devastating health effects of earthquakes and the challenges posed by these natural disasters.
The authors, Dr. Susan A Bartels at the Department of Emergency Medicine and Beth Israel Deaconess Medical Center Boston and Harvard Humanitarian Initiative in Boston, MA and Dr. Michael J Van Rooyen, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, and Harvard Humanitarian Initiative, Boston, MA, USA state:
"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.
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. Many patients surviving blunt and penetrating trauma and crush injuries have subsequent complications that lead to additional morbidity and mortality."
Earthquakes have caused over 780,000 deaths in the past decade alone, accounting for nearly 60% of all disaster-related mortality, and in 2004, the tsunami crisis claimed over 200,000 lives. Millions of people are exposed to earthquakes because many of the most inhabited cities in the world are built on fault lines, like Los Angeles, New York, Tokyo, Delhi and Shanghai.
Massive earthquakes have the ability to cause casualty rates that ranges from 1% to 8% amongst the endangered population, creating a large, unmet need for complex surgical and medical care as medical facilities, roads, and bridges are destroyed and medical chain supplies are interrupted.
Although reports of death and injury ratios vary, many studies estimate it to be approximately 1:3, with many victims dying immediately.
After the initial death toll, the second mortality peak occurs a few hours after the quake, when those with serious injuries, such as liver or spleen lacerations, pelvic fractures, and sub-dural haematomas succumb to their injuries.
The third peak follows within days to weeks following a quake, as people with sepsis and multi-organ failure die of their injuries. Those suffering from chronic diseases, such as diabetes and heart conditions are also subjected to a higher death risk as crucial medicines and care is being cut off.
About 2% to 15% of the population can suffer crush injuries from heavy loads crushing their bodies. This can result in kidney problems and failure, and in severe cases even amputation. Patients, including those whose electrolyte levels appear to be normal should undergo aggressive fluid resuscitation.
It is important that these fluids do not contain potassium or calcium, as crush victims already have high levels of these minerals and administering more will raise the risk of death.
About half of the crush victims will develop kidney failure and half of these will need dialysis. The death toll for people with kidney failure in earthquake setting ranges from 14% to 18%.
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