The Dragon Strikes: Lessons from the Wenchuan Earthquake

Guo, Chen; Wei, Lai; Liu, Fei; Mao, Qingxiang; Tu, Faping; Wen, Jia; Xiao, H.; Zhang, Jian Cheng; Zhu, Tao; Chen, Bin; Hu, Zhao; Li, Rong Mei; Zhi, Liang; Nie, Hongtao; Hong, Yan; Yang, Bang Xiang; Du, Qiang; Huang, Wen; Jiang, Yao; Kwan, Alan; Song, Li; Wu, Chao Meng; Xiang, Tia; Xu, Hong; Lau, Wayne Bond; Song, Hai Bo; Wen, Chuan Bin; Yao, Zhen Hai; Zhang, Lan; Zeng, Jianrong; Dai, Yue E.; Lopez, Bernard L.; Zheng, Jian; Zhou, Jihong; Christopher, Theodore A.; L., Xin; Yu, Hui; Xu, Li; Qiao, Guo; Song, Zhi; Volinn, Ernest; Kryger, King; Cao, Yu; Ge, Heng; Liu, Hui; Luo, Chao Zhi; Tao, Weike; Zuo, Yun Xia; Liu, Jin

doi:10.1213/ane.0b013e3181cbc62c

Cited by 33 publications

(26 citation statements)

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“…In the emergency response phase to a natural disaster, where resources are often constrained, oligoanalgesia is even more common [11–13]. Standard pain management in disaster settings for severe lower limb injuries includes intramuscular or intravenous injections of narcotic pain medications, with morphine being the recommended agent [14, 15].…”

Section: Introductionmentioning

confidence: 99%

“…Standard pain management in disaster settings for severe lower limb injuries includes intramuscular or intravenous injections of narcotic pain medications, with morphine being the recommended agent [14, 15]. However, narcotic medications may be unavailable in low-income settings, and patients with trauma may have clinical instability making narcotic medications less safe to use; both factors can be barriers to appropriate pain treatment for earthquake victims [11, 16]. Subsequently, insufficient pain management can potentiate both short-term and long-term sequelae, including immunosuppression, thrombotic complications, post-traumatic stress disorders, and chronic pain syndromes, all of which may further increase the morbidity associated with index injuries [12, 17].…”

Section: Introductionmentioning

confidence: 99%

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Regional Anesthesia for Painful Injuries after Disasters (RAPID): study protocol for a randomized controlled trial

Levine

Teicher²,

Aluisio

et al. 2016

Trials

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BackgroundLower extremity trauma during earthquakes accounts for the largest burden of disaster-related injuries. Insufficient pain management is common in resource-limited disaster settings, and regional anesthesia (RA) may reduce pain in injured patients beyond current standards of care. To date, no controlled trials have been conducted to evaluate the use of RA for pain management in a disaster setting.Methods/designThe Regional Anesthesia for Painful Injuries after Disasters (RAPID) study aims to evaluate whether regional anesthesia (RA), either with or without ultrasound (US) guidance, can reduce pain from earthquake-related lower limb injuries in a disaster setting. The proposed study is a blinded, randomized controlled equivalence trial among earthquake victims with serious lower extremity injuries in a resource-limited setting. After obtaining informed consent, study participants will be randomized in a 1:1:1 allocation to either: standard care (parenteral morphine at 0.1 mg/kg); standard care plus a landmark-guided fascia iliaca compartment block (FICB); or standard care plus an US-guided femoral nerve block. General practice humanitarian response providers who have undergone a focused training in RA will perform nerve blocks with 20 ml 0.5 % levobupivacaine. US sham activities will be used in the standard care and FICB arms and a normal saline injection will be given to the control group to blind both participants and nonresearch team providers. The primary outcome measure will be the summed pain intensity difference calculated using a standard 11-point Numerical Rating Scale reported by patients over 24 h of follow-up. Secondary outcome measures will include overall analgesic requirements, adverse events, and participant satisfaction.DiscussionGiven the high burden of lower extremity injuries in the aftermath of earthquakes and the currently limited treatment options, research into adjuvant interventions for pain management of these injuries is necessary. While anecdotal reports on the use of RA for patients injured during earthquakes exist, no controlled studies have been undertaken. If demonstrated to be effective in a disaster setting, RA has the potential to significantly assist in reducing both acute suffering and long-term complications for survivors of earthquake trauma.Trial registrationClinicalTrials.gov (NCT02698228), registered on 16 February 2016.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Regional Anesthesia for Painful Injuries after Disasters (RAPID): study protocol for a randomized controlled trial

Levine

Teicher²,

Aluisio

et al. 2016

Trials

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“…In that earthquake, at least 69,227 people died and 374,640 people were severely injured. The total infrastructure damage has been estimated at upwards of US $150 billion [1]. SCI can have a severe impact on patients and their families because of the physical and psychosocial effects of this injury.…”

Section: Introductionmentioning

confidence: 99%

Bladder management of patients with spinal cord injuries sustained in the 2008 Wenchuan earthquake

Luo

Ding

et al. 2012

The Kaohsiung J of Med Scie

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This study's aim is provide an overview of the patients who suffered spinal cord injury (SCI) after the magnitude 8.0 Wenchuan earthquake, including each patient's demographic and epidemiological characteristics, bladder management status, and quality of life (QOL). We also assessed the relationships between bladder management methods, symptomatic urinary tract infection (SUTI), and QOL. Two years after the 2008 Wenchuan earthquake, a cross‐sectional face‐to‐face survey was conducted on 180 patients with SCI. A self‐administered questionnaire and the WHOQOL‐BREF assessment were used to assess injury‐related information, bladder management methods, and SUTI. Statistical analysis was performed using the Chi‐square test and analysis of variance. A p value <0.05 was considered statistically significant. This study found that a male‐to‐female ratio of approximately 1.2:1, including 98 (54.4%) male patients and 82 (45.6%) female patients. Thoracic‐level injuries were seen in 82 patients (45.56%), 60 (33.33%) patients had lumbar‐level injuries, 18 (8.33%) patients had thoracolumbar‐level injuries, and a small number of patients had cervical‐ or sacral‐level injuries. Sixty‐two patients (34.44%) demonstrated normal voiding, 65 (36.11%) required manually assisted voiding, 29 (16.11%) required catheterization, and 24 (13.33%) used aurine‐collecting apparatus. The prevalence of SUTI was 43.89%. Patients who emptied their bladder via manually assisted voiding, catheterization, or with the use of a urine‐collecting apparatus demonstrated higher rates of SUTI compared with patients who voided normally (p < 0.05); the patients who required catheterization had higher rates of SUTI compared with patients who required manually assisted voiding (p < 0.05). When manually assisted voiding and catheterization were compared with the use a urine‐collecting apparatus, no statistically significant differences were observed in terms of the risk of developing SUTI. The patients in this study demonstrated low scores on the WHOQOL‐BREF physical domain (11.61 ± 3.80), psychological domain (10.11 ± 3.63), social domain (11.46 ± 2.84), and environmental domain (11.86 ± 2.51). The patients who reported normal voiding also demonstrated the best QOL in terms of physical, psychological, and social component scores (p < 0.05). In conclusion, the percentage of women in this study is higher than that reported in other studies on traumatic causes of SCI. Patients who suffered SCI following the Wenchuan earthquake demonstrate poor bladder management status and are unable to take advantage of urodynamic testing that is used to monitor the functional state of the bladder. This study's findings indicate that bladder management methods influence the rate of SUTI and the QOL of patients with SCI. Caring for SCI patients following a disaster requires comprehensive long‐term planning. Bladder management of patients with SCI is essential for improving the QOL of these patients.

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“…23 A report on lessons from the Wenchuan earthquake describes both a response within a hospital to treat arriving earthquake victims, and the experience of a team sent to the epicenter to provide medical care. 24 In addition to the challenges faced by the deployed Chinese response team, such as absence of an emergency generator, water purification system, satellite communication system, and drugs to protect the team from visceral leishmaniasis, there are considerations that we faced in responding to an international natural disaster, such as long-distance transportation challenges, immunization considerations, and security issues. Similar to the Chinese team, we had no preexisting response plan established and have learned from this exercise.…”

Section: Discussionmentioning

confidence: 99%

An Organized, Comprehensive, and Security-Enabled Strategic Response to the Haiti Earthquake

McCunn¹,

Ashburn²,

Floyd³

et al. 2010

Anesthesia &Amp; Analgesia

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An organized strategic response to medical needs after an international natural disaster emergency can be accomplished safely and effectively within 6 to 12 days by an academic anesthesiology department, with medical system support, in a center with no previously established response system. The value and timeliness of this response will be determined with further study. Institutions with limited experience in putting an emergency medical team into the field may be able to quickly do so when such efforts are executed in a systematic manner in coordination with a health care organization that already has support infrastructure at the site of the disaster.

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The Dragon Strikes: Lessons from the Wenchuan Earthquake

Cited by 33 publications

References 1 publication

Regional Anesthesia for Painful Injuries after Disasters (RAPID): study protocol for a randomized controlled trial

Regional Anesthesia for Painful Injuries after Disasters (RAPID): study protocol for a randomized controlled trial

Bladder management of patients with spinal cord injuries sustained in the 2008 Wenchuan earthquake

An Organized, Comprehensive, and Security-Enabled Strategic Response to the Haiti Earthquake

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