A matter of life or limb? A review of traumatic injury patterns and anesthesia techniques for disaster relief after major earthquakes

Andres Missair, Ernesto Pretto, Alexandru Visan, Laila Lobo, Frank Paula, Catalina Castillo-Pedraza, Lebron Cooper, Ralf E Gebhard

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND:: All modalities of anesthetic care, including conscious sedation, general, and regional anesthesia, have been used to manage earthquake survivors who require urgent surgical intervention during the acute phase of medical relief. Consequently, we felt that a review of epidemiologic data from major earthquakes in the context of urgent intraoperative management was warranted to optimize anesthesia disaster preparedness for future medical relief operations. The primary outcome measure of this study was to identify the predominant preoperative injury pattern (anatomic location and pathology) of survivors presenting for surgical care immediately after major earthquakes during the acute phase of medical relief (0-15 days after disaster). The injury pattern is of significant relevance because it closely relates to the anesthetic techniques available for patient management. We discuss our findings in the context of evidence-based strategies for anesthetic management during the acute phase of medical relief after major earthquakes and the associated obstacles of devastated medical infrastructure. METHODS:: To identify reports on acute medical care in the aftermath of natural disasters, a query was conducted using MEDLINE/PubMed, Embase, CINAHL, as well as an online search engine (Google Scholar). The search terms were "disaster" and "earthquake" in combination with "injury," "trauma," "surgery," "anesthesia," and "wounds." Our investigation focused only on studies of acute traumatic injury that specified surgical intervention among survivors in the acute phase of medical relief. RESULTS:: A total of 31 articles reporting on 15 major earthquakes (between 1980 and 2010) and the treatment of more than 33,410 patients met our specific inclusion criteria. The mean incidence of traumatic limb injury per major earthquake was 68.0%. The global incidence of traumatic limb injury was 54.3% (18,144/33,410 patients). The pooled estimate of the proportion of limb injuries was calculated to be 67.95%, with a 95% confidence interval of 62.32% to 73.58%. CONCLUSIONS:: Based on this analysis, early disaster surgical intervention will focus on surviving patients with limb injury. All anesthetic techniques have been safely used for medical relief. While regional anesthesia may be an intuitive choice based on these findings, in the context of collapsed medical infrastructure, provider experience may dictate the available anesthetic techniques for earthquake survivors requiring urgent surgery.

Original languageEnglish
Pages (from-to)934-941
Number of pages8
JournalAnesthesia and Analgesia
Volume117
Issue number4
DOIs
StatePublished - Oct 1 2013

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Earthquakes
Disasters
Extremities
Anesthesia
Wounds and Injuries
Anesthetics
Survivors
Conduction Anesthesia
Outcome Assessment (Health Care)
Conscious Sedation
Search Engine
Incidence
Intraoperative Complications
PubMed
MEDLINE
General Anesthesia
Confidence Intervals
Pathology

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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A matter of life or limb? A review of traumatic injury patterns and anesthesia techniques for disaster relief after major earthquakes. / Missair, Andres; Pretto, Ernesto; Visan, Alexandru; Lobo, Laila; Paula, Frank; Castillo-Pedraza, Catalina; Cooper, Lebron; Gebhard, Ralf E.

In: Anesthesia and Analgesia, Vol. 117, No. 4, 01.10.2013, p. 934-941.

Research output: Contribution to journalArticle

Missair, Andres ; Pretto, Ernesto ; Visan, Alexandru ; Lobo, Laila ; Paula, Frank ; Castillo-Pedraza, Catalina ; Cooper, Lebron ; Gebhard, Ralf E. / A matter of life or limb? A review of traumatic injury patterns and anesthesia techniques for disaster relief after major earthquakes. In: Anesthesia and Analgesia. 2013 ; Vol. 117, No. 4. pp. 934-941.
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AU - Lobo, Laila

AU - Paula, Frank

AU - Castillo-Pedraza, Catalina

AU - Cooper, Lebron

AU - Gebhard, Ralf E

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N2 - BACKGROUND:: All modalities of anesthetic care, including conscious sedation, general, and regional anesthesia, have been used to manage earthquake survivors who require urgent surgical intervention during the acute phase of medical relief. Consequently, we felt that a review of epidemiologic data from major earthquakes in the context of urgent intraoperative management was warranted to optimize anesthesia disaster preparedness for future medical relief operations. The primary outcome measure of this study was to identify the predominant preoperative injury pattern (anatomic location and pathology) of survivors presenting for surgical care immediately after major earthquakes during the acute phase of medical relief (0-15 days after disaster). The injury pattern is of significant relevance because it closely relates to the anesthetic techniques available for patient management. We discuss our findings in the context of evidence-based strategies for anesthetic management during the acute phase of medical relief after major earthquakes and the associated obstacles of devastated medical infrastructure. METHODS:: To identify reports on acute medical care in the aftermath of natural disasters, a query was conducted using MEDLINE/PubMed, Embase, CINAHL, as well as an online search engine (Google Scholar). The search terms were "disaster" and "earthquake" in combination with "injury," "trauma," "surgery," "anesthesia," and "wounds." Our investigation focused only on studies of acute traumatic injury that specified surgical intervention among survivors in the acute phase of medical relief. RESULTS:: A total of 31 articles reporting on 15 major earthquakes (between 1980 and 2010) and the treatment of more than 33,410 patients met our specific inclusion criteria. The mean incidence of traumatic limb injury per major earthquake was 68.0%. The global incidence of traumatic limb injury was 54.3% (18,144/33,410 patients). The pooled estimate of the proportion of limb injuries was calculated to be 67.95%, with a 95% confidence interval of 62.32% to 73.58%. CONCLUSIONS:: Based on this analysis, early disaster surgical intervention will focus on surviving patients with limb injury. All anesthetic techniques have been safely used for medical relief. While regional anesthesia may be an intuitive choice based on these findings, in the context of collapsed medical infrastructure, provider experience may dictate the available anesthetic techniques for earthquake survivors requiring urgent surgery.

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