A review published in The Lancet, reveals that careful earthquake preparation helped to lower mortality rates and the burden of injury during the February 22nd earthquake in Christchurch, New Zealand, in 2011. According to the analysis, the emergency health-system response was extremely effective, even though power outages made delivering medical care considerably difficult and communication systems were down.
The earthquake injured over 6,500 people and claimed 182 lives.
Lead author of the study, Michael Ardagh from the University of Otago, Christchurch, New Zealand, said:
"The health response to the Christchurch earthquake was unique because the city had only one hospital with an emergency department (which was compromised by earthquake damage). The hospital activated well developed and practiced internal and external incident plans and the response of other non-acute hospitals and primary care facilities was critical to ensuring an effective and timely response."
The city learned from experiences of earlier incidents and practice exercises. These included the activation of the mass casualty incident plan in response to an earthquake that injured 97 people in the Christchurch area, in September, 2010.
The February 22, 2011 earthquake caused extensive damage to the Christchurch Hospital. In addition, some areas of the hospital were left without electricity, due to disturbed sump sludge in the back-up generators' diesel tanks.
The magnitude of the disaster was not fully known by the emergency department, due to loss of communication systems. Therefore, they were unaware as to how many casualties to expect, and when patients might arrive.
"Large numbers of patients presented in various ways, such as on foot, carried by members of the public, in cars, in police vehicles, on doors strapped to the top of cars, and in the back of small trucks. Impassable roads and communication difficulties resulted in little pre-hospital triage or treatment for most of those who presented early."
As a result, key members of staff were given radiotelephones and mobile phones, in order to overcome these difficulties, and medical students were sent to get updates from television broadcasts and report back. Patients who were unwilling to enter the hospital buildings for fear of collapse were treated outside in the open-air ambulance bay, although registering and keeping track of patients was challenging.
"Use of multiple patient identifiers led to inefficiencies in matching imaging and laboratory results with individuals. The use of unique patient identifiers and dedicated staff for identifying and tracking patient movements will help in future major incidents."
The high number of volunteers without overall organization highlighted how important it is to anticipate and manage the high number of medical staff volunteers so their skills can be efficiently utilized immediately.
Furthermore, the report highlights that disaster response plans need to include atypical providers of acute injury care: "Robust emergency plans were in place at most facilities but they did not anticipate the need to receive triage, and manage so many undifferentiated injured patients." The researchers conclude:
"An integrated approach is needed, in which primary care providers, non-acute hospitals, and acute hospitals are prepared to provide care for masses of injured people."
Written By Grace Rattue