Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-22T11:00:24.970Z Has data issue: false hasContentIssue false
  • English
  • Français

Pakistan Earthquake: Experiences of a Multidisciplinary Surgical Team

Published online by Cambridge University Press:  28 June 2012

Asim Rajpura ,
Ihab Boutros ,
Tahir Khan  and
Sohail Ali Khan
Asim Rajpura*
Affiliation:
Department of Orthopedics, Hope Hospital, Salford, UK
Ihab Boutros
Affiliation:
Department of Orthopedics, Hope Hospital, Salford, UK
Tahir Khan
Affiliation:
Department of Orthopedics, Hope Hospital, Salford, UK
Sohail Ali Khan
Affiliation:
Department of Orthopedics, Hope Hospital, Salford, UK
*
6 Manthorpe Ave., Worsley, Greater Manchester UK, M28 2AZ, E-mail: asimrajpura@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Four weeks after the earthquake in Kashmir, Pakistan, multi-disciplinary surgical teams were organized within the United Kingdom to help treat disaster victims who had been transferred to Rawalpindi. The work of these teams between 05-17 November 2005 is reviewed, and experiences and lessons learned are presented.

Methods:

Two self-sufficient teams consisting of orthopedic, plastic surgical, anesthetic, and theatre staff were deployed consecutively over a two-week period. A trauma unit was set up in a donated ward within a private ophthalmological hospital in Rawalpindi.

Results:

Seventy-eight patients with a mean age of 23 years were treated: more than half (40) were <16 years of age. Fifty-two patients only had lower limb injuries, 18 upper limb injuries, and eight combined lower and upper limb. The most common types of injuries were: (1) tibial fractures (n = 24), with the majority being open grade 3B injuries (n = 22); (2) femoral fractures (n = 11); and (3) forearm fractures (n = 9). Almost half (n = 34) of the fractures were open injuries requiring soft tissue cover.

Over 12 days, 293 operations were performed (average 24.4 per day). A total of 202 examinations under anesthesia, washouts, and debridements were performed. The majority of wounds required multiple washouts prior to definitive procedures. Thirty-four definitive orthopedic procedures (fixations) and 57 definitive plastic procedures were performed. Definitive orthopedic procedures included 15 circular frame fixations of long bones, nine of which required acute shortening and five open reduction and internal fixation of long bones. Definitive plastic procedures included 21 skin grafts, four amputations, 11 revisions of amputations, 20 regional flaps, and one free flap.

Conclusions:

A joint ortho-plastic approach was key to the treatment of the spectrum of injuries encountered. Only four patients required fresh amputations. Twenty patients may have required amputation without the use of ring fixators and soft tissue reconstruction. Having self-sufficient teams along with their own equipment and supplies also was mandatory in order not to put further demand on already scarce resources. However, mobilizing such teams logistically was difficult, and therefore, an organization consisting of willing volunteers for future efforts has been established.

Keywords

earthquakeIlizarovKashmirlimb reconstructionmultidisciplinaryorthopedicPakistanplastic surgery
Type
Case Study
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 4 , August 2010 , pp. 361 - 367
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.US Geological Survey: Northern Pakistan Earthquake of 8 October 2005. Available at http://earthquake.usgs.gov/eqcenter/eqarchives/poster/2005/20051008.php. Accessed 18 May 2008.Google Scholar
2.The International Federation of Red Cross and Red Crescent Societies: Pakistan Earthquake FACTS AND FIGURES SHEET. Available at http://www.ifrc.org/Docs/pubs/disasters/pakistan-earthquake/facts-figures-1006.pdf. Accessed 18 May 2008.Google Scholar
3.Baker, CC, Oppenheimer, L, Stephens, B, et al: Epidemiology of trauma deaths. Am J Surg 1980;140(1):144–150.CrossRefGoogle ScholarPubMed
4.Trunkey, DD: Trauma. Accidental and intentional injuries account for more years of life lost in the US than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am 1983;249(2):28–35.CrossRefGoogle ScholarPubMed
5.Ahmad, MA, Naqui, SZ, Shah, N, et al: The Pakistan earthquake: A British trainee's experience. Injury 2006;37(6):567–569.CrossRefGoogle ScholarPubMed
6.Bozkurt, M, Ocguder, A, Turktas, U, Erdem, M: The evaluation of trauma patients in Turkish Red Crescent field hospital following the Pakistan earthquake in 2005. Injury 2007;38(3):290–297.CrossRefGoogle ScholarPubMed
7.Helminen, M, Saarela, E, Salmela, J: Characterisation of patients treated at the Red Cross field hospital in Kashmir during the first three weeks of operation. Emerg Med J 2006;23(8):654–656.CrossRefGoogle ScholarPubMed
8.Mulvey, JM, Awan, SU, Qadri, AA, Maqsood, MA: Profile of injuries arising from the 2005 Kashmir earthquake: The first 72 h. Injury 2008;39(5):554–560.CrossRefGoogle ScholarPubMed
9.Siddiqi, K: The Pakistan earthquake: A personal experience. Lancet 2006; 367(9515):986.CrossRefGoogle ScholarPubMed
10.Yasin, MA, Malik, SA, Nasreen, G, Safdar, CA: Experience with mass casualties in a subcontinent earthquake. Ulus Travma Acil Cerrahi Derg 2009;15(5):487–492.Google Scholar
11.Laverick, S, Kazmi, S, Ahktar, S, et al: Asian earthquake: Report from the first volunteer British hospital team in Pakistan. Emerg Med J 2007;24(8):543–546.CrossRefGoogle ScholarPubMed