To enable discussion of the health effects of large-scale earthquakes, we searched PubMed, CINAHL, and Embase for reports from 1990 to 2010. The search terms were “earthquake” and “disaster” in combination with “injury”, “disease”, and “illness”. We selected articles with abstracts that described acute medical conditions (<3 months after the earthquake). In view of the large number of reports describing case reports and small case series, we limited inclusion to articles describing 50 or more
ReviewMedical complications associated with earthquakes
Introduction
Earthquakes are some of the most catastrophic natural disasters to affect mankind. The structural damage resulting from severe earthquakes causes many deaths and traumatic injuries in a short period without advanced warning.1 More than a million earthquakes occur worldwide every year, which equates to roughly two earthquakes per minute.2 In the past decade alone, disasters have caused more than 780 000 deaths, with earthquakes accounting for nearly 60% of all disaster-related mortality (table 1).4 In addition to these deaths, earthquakes have directly affected another 2 billion people in this period.2 The threat of earthquakes will probably increase because of global urbanisation and the vulnerability of large urban centres. Many of the most populous cities in the world are on fault lines, and thus millions of people are exposed to earthquakes (figure 1, table 2).4
The epidemiology of mortality and injury means that earthquakes can be differentiated from other natural hazards, such as hurricanes and flood emergencies. Floods and hurricanes typically cause many deaths due to drowning but few serious medical or surgical injuries. As such, these other disasters do not usually overload the existing curative medical system. By comparison, earthquakes not only cause many deaths initially, but also many severe injuries requiring complex surgical and resuscitative medical care. By destroying medical facilities, roads, and bridges, in addition to interrupting medical supply chains, earthquakes devastate the local curative medical capacity and create a large, unmet need for complex surgical and medical care.
The morbidity and mortality caused by an individual earthquake is dependent on magnitude, epicentre's proximity to large urban centres, degree of earthquake preparedness, and extent to which mitigation measures have been implemented.2 Massive earthquakes can result in casualty rates ranging from 1% to 8% of the at-risk population.7 The reported ratios of death to injury vary, but across many studies seem to be about 1:3.8
Fatalities that result from catastrophic injuries at the time of the earthquake are immediate deaths.9 Severe trauma of the brain or spinal cord is a common cause of such injuries and these patients are generally not saveable. Other earthquake victims perish quickly within the first several hours after the event, and past experience has suggested that mortality could be reduced greatly if prompt treatment is provided.10 These individuals have injuries such as subdural haematomas, liver or spleen lacerations, and pelvic fractures. Finally, a third peak of deaths occurs days to weeks after the earthquake and is attributable to sepsis, multisystem organ failure, and disseminated intravascular coagulation.11 These patients die more slowly from injury complications and have the greatest savable potential.9, 11
Injured victims usually seek emergency medical care in the first 3–5 days after an earthquake.2 Thus, the greatest demand for health-care providers comes within the first week. Although primary-care complaints do increase in frequency beyond the first week, care of acutely injured victims might continue to predominate for several weeks, especially when there are large numbers of casualties or when the health-care infrastructure has been destroyed. The arrival of health-care responders, medical equipment, and supplies after this initial period is still important because it helps to reinstate the prehospital-care system, to treat delayed complications, to manage less acute injuries, and to resume management of chronic illnesses and endemic diseases.
Understanding of the medical effects of earthquakes, especially in large urban centres, necessitates awareness of the regional seismic risk, structural vulnerability, local response capacity, and resilience of the curative medical services. A multidisciplinary approach is needed to create a mechanism for prevention, search and rescue, and medical response. In this Review, we discuss the acute medical complications of earthquake-related injuries to major organ systems. Chronic disorders, such as diabetes, heart disease, and asthma, might worsen after earthquakes. These exacerbations could be secondary to earthquake-related trauma, disruption of the health-care system, or an interruption in the patients' ability to self-manage because of earthquake-induced loss of medications, medical equipment, or medical supplies. Although important, discussion of these pre-existing medical conditions and the exacerbations related to earthquakes is not considered in this Review.
Section snippets
Renal system
Crush injury is a form of traumatic rhabdomyolysis that occurs after long lasting continuous pressure on a muscle group has caused extensive necrosis of that muscle,12 with or without associated neurological disturbances. After a major earthquake, entrapment under collapsed structures and debris accounts for most crush injuries. Crush injuries are usually associated with creatine kinase concentrations of more than 1000 U/L.13 Crush syndrome is defined as a crush injury with systemic
Special considerations
Many developing countries, where high proportions of the populations are young people, are located in earthquake-prone regions. Children are often at higher risk of injury and death during earthquakes than are adults.2 In fact, paediatric patients might be preponderant after major earthquakes: in Haiti, 53% of patients were younger than 20 years and 25% were younger than 5 years;108 in India, 25% of patients were aged less than 17 years;109 and in California, 43% of all patients were children.
Search strategy and selection criteria
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