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Post-Earthquake Injuries Treated at a Field Hospital --- Haiti, 2010



Post-Earthquake Injuries Treated at a Field Hospital --- Haiti, 2010
Weekly
January 7, 2011 / 59(51);1673-1677


On January 12, 2010, a 7.0-magnitude earthquake struck Haiti, resulting in an estimated 222,570 deaths and 300,000 persons with injuries. The University of Miami Global Institute/Project Medishare (UMGI/PM) established the first field hospital in Port-au-Prince, Haiti, after the earthquake (1). To characterize injuries and surgical procedures performed by UMGI/PM and assess specialized medical, surgical, and rehabilitation needs, UMGI/PM and CDC conducted a retrospective medical record review of all available inpatient records for the period January 13--May 28, 2010. This report describes the results of that review, which indicated that, during the study period (when a total of 1,369 admissions occurred), injury-related diagnoses were recorded for 581 (42%) admitted patients, of whom 346 (60%) required a surgical procedure. The most common injury diagnoses were fractures/dislocations, wound infections, and head, face, and brain injuries. The most common injury-related surgical procedures were wound debridement/skin grafting, treatment for orthopedic trauma, and surgical amputation. Among patient records with documented injury-related mechanisms, 162 (28%) indicated earthquake-related injuries. Earthquake preparedness planning for densely populated areas in resource-limited settings such as Haiti should account for injury-related medical, surgical, and rehabilitation needs that must be met immediately after the event and during the recovery phase, when altered physical and social environments can contribute to a continued elevated need for inpatient management of injuries.

The UMGI/PM field hospital was established on January 13, 2010. During the first 9 days, the hospital functioned in the United Nations compound in two storage tents capable of holding up to 250 patients. Initially, the facility had approximately 12 volunteer staff members and no critical-care units or organized operating rooms. After 9 days, the hospital moved to a four-tent facility on the grounds of the Port-au-Prince airport, approximately 3.7 miles (6.0 km) from the city center; 17 critical-care beds and three fully organized operating rooms were added. The hospital was staffed by 220 volunteers from the United States and Canada serving rotations of 5--7 days. All supplies were donated directly or bought with privately donated funds, and transported from Miami to Haiti via weekly charter flights. Medical records were established and maintained by the volunteer clinical staff, but few records were kept during January 13--22. A retrospective medical record review and data abstraction of all available field hospital inpatient records from the period January 13--May 28 was conducted at the UMGI/PM headquarters in Miami, Florida. May 28 was the last date for which records were available for abstraction before the field hospital closed and transitioned to a permanent facility.

In June 2010, UMGI/PM and CDC staff members abstracted data from paper-based medical records into an electronic database with the following variables included for analysis: sex; age; dates of injury, admission, and discharge; type and mechanism of injury; all diagnoses (including those not injury-related); surgical procedures; and patient disposition. Dates of injury, admission, and discharge were used to assess changes in injury patterns over time and to calculate length of stay. For 75 patient records in which date of discharge was not recorded, the date of last entry in the medical record was used as a proxy for discharge. Assessing readmissions or calculating injury severity using anatomical scoring systems was not possible because of incomplete documentation. Injury diagnoses were grouped using categories of a modified mass casualty surveillance instrument.* Earthquake-related injuries were defined as diagnoses for which the medical record 1) documented the date of injury as January 12, 2010, 2) recorded in the medical history that the injury was related to the earthquake, or 3) described a mechanism reasonably consistent with an earthquake-caused injury.† Injury cases were defined as injuries in patients with any of the following diagnoses: fracture; post-traumatic wound infection (both primary and postsurgical infections); head, face, or brain injury; burn; crush; or other injury. All injury diagnoses for which the medical record did not suggest earthquake-related injury or specify mechanism were defined as "injury other." A patient could have more than one diagnosis or surgical procedure. Patient disposition variables included discharge to a residential setting (e.g., home, tent, or internally displaced persons camp), discharge to another medical facility (including a rehabilitation facility), or death.

From January 13 to May 28, 2010, a total of 581 patients with medical records available were admitted to the field hospital with an injury diagnosis; of these, 162 (28%) had earthquake-related injuries (Table). Among all injured patients, 333 (57%) were male, and median age was 24 years (range: 1 day--96 years). Patients aged 15--24 years accounted for 22% of patients, more than any other 10-year age group. Median length of stay for patients with earthquake-related injuries and patients with other injuries was 13 days (range: 1--87 days) and 6 days (range: 1--83 days), respectively. The majority of earthquake-related injured patients sought care during the first 4 weeks of the response, after which an increase in the proportion of patients with "injury other" was observed (Figure).

The most common injury-related diagnoses were fractures/dislocations, wound infections, and head, face, and brain injuries. The most common surgical procedures were wound debridement/skin grafting, treatment for orthopedic trauma, and surgical amputation. Among patients with earthquake-related injuries, the most common mechanisms recorded were cut/pierce/struck by an object and crush (Table). Approximately three fourths of injured patients were eventually discharged to a residential setting, 12% were transferred to other medical or rehabilitation facilities, and 3% died (Table). During the study period, 788 inpatients had only non--injury-related diagnoses, of which the most common included infectious diseases followed by cardiac/respiratory conditions.

Reported by
G Hotz, PhD, E Ginzburg, MD, G Wurm, MD, V DeGennaro, MD, D Andrews, MD, Miller School of Medicine, Univ of Miami, Florida. S Basavaraju, MD, V Coronado, MD, L Xu, MD, T Dulski, MPH, Div of Injury Response, National Center for Injury Prevention and Control; D Moffett, PhD, J Tappero, MD, Health Systems Reconstruction Office, Center for Global Health; M Selent, DVM, EIS Officer, CDC.



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Post-Earthquake Injuries Treated at a Field Hospital --- Haiti, 2010

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