Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake

Abstract

Objectives The aim of this study was to evaluate the benefits of our triage system in acceleration of intervention for the musculoskeletal injuries and clinical follow-ups of trauma patients admitted to our center after the Kahramanmaras earthquake. Patients and methods Between February 6 th , 2023 and February 20 th , 2023, a total of 439 patients (207 males, 232 females; mean age: 37.1±19.1 years; range, 1 to 94 years) with earthquake-related musculoskeletal injuries after the Kahramanmaras earthquake were retrospectively analyzed. Data including age, sex, referral city information, removal time from the rubbles, physical examination findings, clinical photos, fasciotomy and amputation stumps and levels, and X-ray images and computed tomography images of all patients were shared and archived in the WhatsApp (Meta Platforms, Inc.® ATTN/CA, USA) group called ‘Earthquake’ created by orthopedic surgeons. To complete the patient interventions as soon as possible and to ensure order, the patients were distributed with the teams in order through this group by the consultant orthopedic surgeon. The treatments were applied and recorded according to the skin and soft tissue conditions, and fractures of the patients. All treatments were carried out with a multi-disciplinary approach. Results Of the patients, 16.2% were children. Lower limb injuries constituted 59.07% of musculoskeletal injuries. Upper limb, pelvic, and spinal cord injuries were observed in 21.9%, 12.7%, and 6.25%, respectively. Conservative treatment was applied to 183 (41.68%) patients. The most common surgical intervention was debridement (n=136, 53.1%). External fixation was applied in the first stage to 21 (8.2%) patients with open fractures. The mean removal time from the rubbles was 32.1±29.38 h. A total of 118 limb fasciotomy operations were applied to the patients. Fifty limb amputations were performed in 40 patients at the last follow-up due to vascular insufficiency and infection. Conclusion Based on our study results, we believe that a triage system using a good communication and organization strategy is beneficial to prevent treatment delay and possible adverse events in future disasters.

Orthopedic surgery in disaster

“…Injuries of the lower extremities made up 59.07% of musculoskeletal injuries, with other injuries including the upper limb (21.9%), pelvis (12.7%), and spinal cord (6.25%). 4 Following the earthquake, there was a notable shift in presentation patterns at outpatient clinics for orthopedics and traumatology. The number of patients from other areas and trauma-related diagnoses increased, while unnecessary outpatient visits decreased.…”

2023 Kahramanmaraş Depremlerinin İlk Günlerindeki Ortopedik Travmaların Değerlendirilmesi

“…If the demographic characteristics, clinical outcomes, and injuries of presenting victims are known, it may be useful to report these for the purpose of developing policies aimed at preparedness for future earthquakes, response, recovery, and reducing losses caused by natural disasters. An effective disaster assistance program, using a good communication and organization strategy may also be useful in minimizing the damage caused by earthquakes [3,4,[12][13][14][15].…”