Neurosurgical Emergencies of The October 2005 Earthquake In Pakistan At Lady Reading Hospital Peshawar

Mumtaz Ali, Shahid Ayub, Hamzullah Khan, Khalid Mahmood Khan
Department of Neurosurgery,
Postgraduate Medical Institute,
Lady Reading Hospital, Peshawar

Correspondence to:
Dr. Mumtaz Ali
Assistant Professor
Neurosurgery Unit
Lady reading hospital,
Peshawar

INTRODUCTION

Earthquake is a natural disaster mainly affecting the mountainous zone and they strike in different parts of the world. Countries commonly affected are Japan, Iran, Turkey, Indonesia and Pakistan. No zone can be declared earthquake safe. It leads to tremendous amount of economic and human losses within no time. In the last two decades, millions of people have died and innumerable have remained handicapped due to earthquakes. Millions were severely injured on 8th October, 2005 which badly affected the mountainous zone of NWFP and Kashmir. This earthquake was more than 7 on the Richter scale. In Iran, on the 26th December 2003, an earthquake of 6.5 , in Los Angeles on 17 Jan 1994 an earthquake of 6.7, and in Japan in 1995, an earthquake of 7.2 , resulted in great loss of lives and economy. Earthquakes more than 6 on the Richter scale can cause extensive damage to buildings, vehicles and roadways apart from human loss 1. The number of human casualties cannot be estimated in underdeveloped countries clearly. The major injuries are cranial followed by spinal injuries and injuries to the long bones. An estimated report from different earthquake studies shows that about 310,000 people died and millions were left destitute by the tsunami on 26th Dec, 2004 . More than 43,000 died and 30,000 were injured in the city of Bam, Iran on 26th Dec 2003 . About 6500 died and 34,900 were injured in Osaka Japan, on 17th Jan 1995 3. Among the injured peoples the majority were long-bone fractures, chest and spinal fractures and head injuries.

The aim of the present study was to determine the nature and extent of neurosurgical emergencies during the earthquake in Pakistan.

MATERIAL AND METHODS

This study was conducted at the department of Neurosurgery PGMI Lady Reading Hospital Peshawar from the time since the earthquake of October 2005 till December 2005. About 49 patients were shifted from the earthquake zone to the department of neurosurgery Lady Reading hospital Peshawar, which is located about 200 km from the disaster zone. Emergency teams were also sent to the disaster field and a few urgent surgical procedures were performed in the field hospitals after primary trauma care. Our unit began to receive patients on the 2nd day of the disaster. Extra beds were arranged in the casualty department and the elective patients of neurosurgery unit were discharged and new elective admissions were stopped to provide beds for the earthquake victims. All diagnostic and therapeutic facilities including X-rays, CT scan (and MRI when indicated) of brain and spine were provided free of cost by the hospital.

The earthquake victims were thoroughly examined in the casualty department and then were referred to the concerned department for proper management. After management, the patients were referred to different camps in Peshawar where nursing care and rehabilitation services were already arranged.

RESULTS

A total of 49 patients were admitted to the neurosurgery department with an age range of 4 - 60 years; mean age was 18 years. Male: female ratio was 1.5:1 (Figure -1). There were 36 patients with head injuries (73.46%) and 13 patients (26.53%) with spinal injuries (Table-1). Three patients had scalp injuries (8.3%) and 6 patients had depressed skull fractures (16.66%). Twenty four patients had extradural haematoma (27.66%) and closed head injuries (Table-1) with and without skull fractures (66.66%) and associated limb injuries and fracture of humerus in one patient. Eleven cases were operated on and 25 were treated conservatively. Out of the operated cases, debridements and duraplasty was performed in 7 cases. Spinal injury was seen in 13 patients, 9 of them had D12 and L1 fractures and 4 had high spinal injury in the thorax (Table-1). Transpedicular fixation was done in the 9 patients who had D12 and L1 fractures and 4 patients were treated conservatively. These patients were then referred to rehabilitation centers. Out of a total of 49 patients, 2 patients died because of ventriculitis after closed head injury and two patients developed tetanus who had been operated on initially in the field of disaster (Table-2).

Table 1. TYPES OF INJURIES TREATED IN CASES OF EARTH QUAKE VICTIMS IN NEUROSURGERY UNIT, LRH (n=49)

Table 2. MORBIDITY AND MORTALITY ASSOCIATED WITH HEAD/SPINAL INJURY CASES IN EARTHQUAKE DISASTER

DISCUSSION

During the last 20 years natural disasters have claimed more than 3 million lives worldwide. These have affected at least 800 million people and has resulted in property damage which exceeds 500 billion dollars . This is because it often strikes quickly and without any warning thus its effects are unpredictable and potentially severe . Possible factors exacerbating injuries may include inability to move quickly, to avoid falling objects and to vacate buildings and decrease tolerance to injury. Entrapment in buildings and secondary disasters following earthquakes include fire, landslides, accidents and destruction of bridges and roads. These all obstruct the speedy and adequate relief of the victims and increases the death rate 6.

Catastrophes can occur anywhere at any time and the number of victims cannot be foreseen in any way. The earthquake casualties can only be reduced significantly, if it were possible to predict an earthquake.

To deal with the consequences of the earthquake disaster, the approach should be multifaceted. The government, different departments, organizations and the people at large, all should play their role with enthusiasm. The government should organize groups in different departments and NGOs who should have proper training and should be properly equipped to deal with such natural disasters.

The Medical Disaster Response, (MDR-SAVE) methodology is the systematic attempt to use Triage as a tool to maximize patient benefit in the immediate aftermath of catastrophic disaster. Medical Disaster Response projects deal with the scenario in which specially trained, local medical services providers evacuate patients immediately. The SAVE Triage was developed to direct limited resources. The SAVE assesses the solvability of patients with various injuries and describes the relationship between expected benefits and resource consumption.

CONCLUSION

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