Iranian 2012 earthquake: the importance of Focused Assessment with Sonography for Trauma (FAST) in assessing a huge mass of injured people

Abstract

The 2012 Iranian earthquakes took place in the cities of Ahar and Varzqan in East Azerbaijan province, on August 11, 2012, at 16:53 Tehran time. The twin earthquakes struck northwest Iran on magnitude scales of 6.4 and 6.3 Richter. The two earthquakes were separated by 11 min [1]. The earthquakes were strong enough to destroy 70-90 % of 100 villages, with 20 villages disappearing completely [2]. These twin earthquakes were disastrous events with significant medical and psychosocial consequences.At the night of the event, Imam Reza Hospital, the main referral hospital and trauma center in East Azerbaijan province, was responsible for admission and medical care of injured people [2,3]. According to Ghabili et al. [2], about 1,000 patients were transferred to hospitals in Tabriz, the capital city of East Azerbaijan province. General surgery residents and attending physicians were responsible for triage and providing trauma care for transferred injured people [3][4][5]. In addition, emergency medicine residents and attending physicians and residents of neurosurgery, orthopedics, and radiology were at the hospital participating in providing trauma care.General surgery residents and attending physicians did triage of patients on the basis of being in need of emergent care or not being in need of emergent care [3]. The patients who were in need of emergent care were admitted to the emergency department to be under direct observation [3,4]. All injured patients, even patients who were not in need of emergent care, were supposed to have a blunt abdominal trauma to some extent. The initial evaluation of injured people with respect to their abdominal trauma consisted of a physical examination and a Focused Assessment with Sonography for Trauma (FAST) [4]. First, FAST was done by emergency physicians and general surgery residents, and then, it was repeated by radiology residents. In the cases of a positive FAST and stable vital signs, an abdominal IV contrast computed tomography (CT) scan was conducted. In the cases of unstable vital signs, diagnostic peritoneal lavage (DPL) was done. In the cases with both negative physical examination and negative FAST, interval follow-up visits were planned.Two CT devices were available at the hospital for the management of injured people. Although both FAST and CT were available for the trauma team, decisions were made based on hemodynamic status and physical examination rather than radiologic findings. However, nonoperative management of blunt solid organ injuries of the abdomen is of potential clinical interest and necessitates availability of CT [6].About 350 FAST examinations were conducted, and about 330 of them were repeated by radiology residents. FAST sonographies were done over a time period of about 5-10 min. About 50 individuals had positive FAST

RETRACTED ARTICLE: A Comparative Analysis of Diagnostic Accuracy of Focused Assessment With Sonography for Trauma Performed by Emergency Medicine and Radiology Residents

“…Both RRs- and ERs-performed FASTs had about 60% sensitivity and 99% specificity in comparison to the final outcome based on the findings of abdominal CT scans and clinical follow-up ( 21 ). Kakaei et al evaluated the role of FAST in assessing injured people in Iran 2012 earthquake and reported that sensitivity of FAST did not change when it was performed by RRs, but its specificity increased (compared to EM and surgery residents) ( 22 ).…”

Accuracy of Focused Assessment with Sonography for Trauma (FAST) in Disaster Settings: A Meta-Analysis and Systematic Review

“…Kakaei et al examined the use of FAST in the 2012 Iranian earthquake. 26 Emergency physicians and surgery residents performed FAST, and nearly all of these ultrasounds were repeated by radiology residents and then subsequently were followed by CT results, clinical course, DPL, and surgical findings. These studies were all performed in the hospital.…”

Radiology in the Christchurch earthquake of 22 February 2011: Challenges, interim processes and clinical priorities

“…During periods of high patient influx, FAST was used to assess and triage patients after Hurricane Katrina, 9/11 in New York, Lebanon War in 2006 and Iran earthquake in 2010 …”