Hostname: page-component-77f85d65b8-hzqq2 Total loading time: 0 Render date: 2026-03-28T15:54:35.003Z Has data issue: false hasContentIssue false
  • English
  • Français

The Pathophysiology of Injuries and Deaths Managed in Emergency Departments After Earthquake Disasters: A Narrative Review

Published online by Cambridge University Press:  04 November 2024

Sarper Yilmaz Open the ORCID record for Sarper Yilmaz [Opens in a new window] ,
Ali Cankut Tatliparmak  and
Rohat Ak Open the ORCID record for Rohat Ak [Opens in a new window]
Sarper Yilmaz*
Affiliation:
University of Health Sciences, Department of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
Ali Cankut Tatliparmak
Affiliation:
Uskudar University Faculty of Medicine, Department of Emergency Medicine, Istanbul, Turkey
Rohat Ak
Affiliation:
University of Health Sciences, Department of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
*
Corresponding author: Sarper Yilmaz; Email: sarperyilmaz08@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Earthquakes cause devastating effects, resulting in the deaths of thousands of people each year. Understanding the full range of impacts, including fatalities, and the pathophysiological mechanisms underlying these effects is crucial for mitigating the aftermath of earthquakes. Therefore, this review aims to: delineate the critical golden time periods following earthquakes and identify the most effective responses and resilience factors during these periods; accurately define the terminology for injuries sustained post-earthquake; elucidate the basic pathophysiology of CRUSH injury-induced myopathy, one of the most significant pathologies in post-earthquake patient management; explore the role of nitric oxide (NO) mechanisms in crush injuries, which are believed to be fundamental to the “smiling death phenomenon” and represent the unseen part of the iceberg; and highlight the importance of the 3 main phenomena responsible for mortality—acidosis, coagulopathy, and hypothermia—during disasters. This comprehensive review, based on the latest literature, encompasses search and rescue, pre-hospital processes, emergency department procedures, and subsequent internal and surgical management algorithms.

Keywords

earthquakesmortalitymass casualty incidentsnitric oxidegolden time periodsacidosiscoagulopathyhypothermia

Information

Type
Review Article
Information
Disaster Medicine and Public Health Preparedness , Volume 18 , 2024 , e252
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

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.)

Article purchase

Temporarily unavailable

References

Bartels, SA, VanRooyen, MJ. Medical complications associated with earthquakes. The Lancet. 2012;379(9817):748–757.CrossRefGoogle ScholarPubMed
Shapira, S, Novack, L, Bar-Dayan, Y, et al. An integrated and interdisciplinary model for predicting the risk of injury and death in future earthquakes. PLoS One. 2016;11(3):e0151111CrossRefGoogle ScholarPubMed
Özel, M, Altintaş, M, Tatliparmak, AC, et al. The role of Mangled Extremity Severity Score in amputation triage in a transport health facility with catastrophic earthquake admissions. Injury. 2023:111003CrossRefGoogle Scholar
Yılmaz, S, Cetinkaya, R, Ozel, M, et al. Enhancing triage and management in earthquake-related injuries: the SAFE-QUAKE scoring system for predicting dialysis requirements. Prehosp Disaster Med. 2023:1–9.CrossRefGoogle Scholar
Ozel, M, Tatliparmak, AC, Cetinkaya, R, et al. Earthquake-related isolated blunt thoracic trauma patients: A special population study in the emergency department. Am J Emerg Med. 2024;75:148–153.CrossRefGoogle ScholarPubMed
Yilmaz, S, Tatliparmak, AC, Karakayali, O, et al. February 6th, Kahramanmaraş earthquakes and the disaster management algorithm of adult emergency medicine in Turkey: an experience review. Turk J Emerg Med. 2024;24(2):80.CrossRefGoogle ScholarPubMed
Cetinkaya, R, Ozel, M, Tatliparmak, AC, et al. Comparing doppler ultrasonography and computerized tomography angiography in emergency department evaluation of earthquake-related crush injuries: a case series analysis. Prehosp Disaster Med. 2024;39(2):206–211.CrossRefGoogle ScholarPubMed
Yilmaz, S, Tatliparmak, AC, Ak, R. START-A (Simple Triage, Rapid Treatment and Analgesia) in mass casualty incidents. Wilderness Environ Med. 2024:10806032231222474CrossRefGoogle Scholar
Earthquake Preparedness and Response - Preparedness | Occupational Safety and Health Administration. Accessed July 2024. https://www.osha.gov/earthquakes/preparedness.Google Scholar
Earthquake Safety. Accessed July 2024. https://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-emergencies/earthquake.html.Google Scholar
Article Detail. Accessed July 2024. https://community.fema.gov/ProtectiveActions/s/article/Earthquake-Earthquake-Early-Warning-System-Drop-Cover-and-Hold-On.Google Scholar
Emergency Response, and Community Impact After February 6, 2023 Kahramanmaraş Pazarcık and Elbistan Earthquakes: Reconnaissance Findings and Observations on Affected Region in Türkiye. Bulletin of Earthquake Engineering. Accessed May 2024. https://link.springer.com/article/10.1007/s10518-024-01867-3Google Scholar
Manfredi, V, Nicodemo, G, Masi, A. Estimation of human casualties due to earthquakes: overview and application of literature models with emphasis on occupancy rate. Safety. 2023;9(4):82.CrossRefGoogle Scholar
Celikmen, MF, Yilmaz, S, Tatliparmak, AC, et al. Drop, Cover, and Hold On versus Fetal Position in the Triangle of Life to Survive in an earthquake: a Delphi study. Prehosp Disaster Med. 2023;38(3):287–293.CrossRefGoogle Scholar
Macintyre, AG, Barbera, JA, Smith, ER. Surviving collapsed structure entrapment after earthquakes: a “time-to-rescue” analysis. Prehosp Disaster Med. 2006;21(1):4–17; discussion 18-19.CrossRefGoogle ScholarPubMed
Macintyre, AG, Barbera, JA, Petinaux, BP. Survival interval in earthquake entrapments: research findings reinforced during the 2010 Haiti Earthquake response. Disaster Med Public Health Prep. 2011;5(1):13–22.CrossRefGoogle ScholarPubMed
Abu-Zidan, FM, Idris, K, Cevik, AA. Prehospital management of earthquake crush injuries: a collective review. Turk J Emerg Med. 2023;23(4):199–210.CrossRefGoogle ScholarPubMed
Koca, TT, Topak, D. Rehabilitation approach after earthquake disaster: a brief report from Turkey. J Rehabil Med Clin Commun. 2024;7:34748. doi: 10.2340/jrmcc.v7.34748Google ScholarPubMed
Rajagopalan, S. Crush injuries and the Crush Syndrome. Med J Armed Forces India. 2010;66(4):317–320.CrossRefGoogle ScholarPubMed
Sever, MS. Prevention and Treatment of AKI during Various Disasters. Kidney Dial. 2022;2(1):85–90.CrossRefGoogle Scholar
CRED. Annual Reports. Accessed July 2024. https://www.emdat.be/categories/adsr/Google Scholar
Bazyar, J, Farrokhi, M, Khankeh, H. Triage systems in mass casualty incidents and disasters: a review study with a worldwide approach. Open Access Maced J Med Sci. 2019;7(3):482–494.CrossRefGoogle ScholarPubMed
Yancey, CC, O’Rourke, MC. Emergency department triage. StatPearls. 2024. StatPearls Publishing; 2024.Google Scholar
START Adult Triage Algorithm – CHEMM. Accessed August 2024. https://chemm.hhs.gov/startadult.htm.Google Scholar
Bazyar, J, Farrokhi, M, Salari, A, et al. Accuracy of triage systems in disasters and mass casualty incidents; a systematic review. Arch Acad Emerg Med. 2022;10(1):e32.Google ScholarPubMed
Ebrahimi, M, Heydari, A, Mazlom, R, et al. The reliability of the Australasian Triage Scale: a meta-analysis. World J Emerg Med. 2015;6(2):94–99.CrossRefGoogle ScholarPubMed
Hodge, A, Hugman, A, Varndell, W, et al. A review of the quality assurance processes for the Australasian Triage Scale (ATS) and implications for future practice. Australas Emerg Nurs J. 2013;16(1):21–29.CrossRefGoogle ScholarPubMed
Brouns, SHA, Mignot-Evers, L, Derkx, F, et al. Performance of the Manchester triage system in older emergency department patients: a retrospective cohort study. BMC Emerg Med. 2019;19(1):3.CrossRefGoogle ScholarPubMed
Guide: Mass casualty preparedness and response in emergency units – World | ReliefWeb. Accessed March 2024. https://reliefweb.int/report/world/guide-mass-casualty-preparedness-and-response-emergency-units.Google Scholar
Yilmaz, S, Ozel, M, Tatliparmak, AC, et al. START: the fusion of rapid treatment and triage - a broader perspective for artificial intelligence comparison. Am J Emerg Med. 2024;76:241–242.Google ScholarPubMed
Disaster Triage: START, then SAVE—A New Method of Dynamic Triage for Victims of a Catastrophic Earthquake | Prehospital and Disaster Medicine | Cambridge Core. Accessed July 2024. https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/abs/disaster-triage-start-then-savea-new-method-of-dynamic-triage-for-victims-of-a-catastrophic-earthquake/EC54009D37A0BC3D14A9BBFE6B6C42A8.Google Scholar
Better, OS, Stein, JH. Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med. 1990;322(12):825–829.Google ScholarPubMed
Giannoglou, GD, Chatzizisis, YS, Misirli, G. The syndrome of rhabdomyolysis: pathophysiology and diagnosis. Eur J Intern Med. 2007;18(2):90–100.CrossRefGoogle ScholarPubMed
Rubinstein, I, Abassi, Z, Coleman, R, et al. Involvement of nitric oxide system in experimental muscle crush injury. J Clin Invest. 1998;101(6):1325–1333.CrossRefGoogle ScholarPubMed
Li, W, Qian, J, Liu, X, et al. Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32 cases. Crit Care. 2009;13(6):R178.CrossRefGoogle Scholar
Yılmaz, S, Cetinkaya, R, Ozel, M, et al. Enhancing triage and management in earthquake-related injuries: the SAFE-QUAKE scoring system for predicting dialysis requirements. Prehosp Disaster Med. 2023:1–9.CrossRefGoogle Scholar
Kobzik, L, Reid, MB, Bredt, DS, et al. Nitric oxide in skeletal muscle. Nature. 1994;372(6506):546–548.CrossRefGoogle ScholarPubMed
Burger, M, Schaller, DJ. Metabolic acidosis. StatPearls. StatPearls Publishing; 2023Google Scholar
Stewart, PA. How to understand acid-base: a quantitative acid-base primer for biology and medicine. Accessed July 2023. https://scholar.google.com/scholar_lookup?title=How%20to%20understand%20acid%E2%80%93base%3A%20a%20quantitative%20acid%E2%80%93base%20primer%20for%20biology%20and%20medicine&publication_year=1981&author=Stewart%2CPA.Google Scholar
Schück, O, Matousovic, K. Relation between pH and the strong ion difference (SID) in body fluids. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2005;149(1):69–73.CrossRefGoogle ScholarPubMed
Morgan, TJ. The Stewart Approach – one clinician’s perspective. Clin Biochem Rev. 2009;30(2):41–54.Google ScholarPubMed
Strong ions, weak acids and base excess: a simplified Fencl–Stewart approach to clinical acid–base disorders†. British Journal of Anaesthesia. Accessed July 2023. https://www.bjanaesthesia.org/article/S0007-0912(17)36228-1/fulltext.Google Scholar
Güven, AG. Asid-Baz Bozukluklar›, Asidozun Degerlendirilmesi: Mekanizmalarizmalar, Klinik Yaklasim, Tedavi. J Curr Pediatr. 2007;5(1). Klinik Yaklafl›m, TedaviGoogle Scholar
Gunal, AI, Celiker, H, Dogukan, A, et al. Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes. J Am Soc Nephrol. 2004;15(7):1862–1867.CrossRefGoogle ScholarPubMed
The conscious pig as a large animal model for studies of hemorrhagic hypotension. Accessed July 2023. https://inis.iaea.org/search/search.aspx?orig_q=RN:18046166.Google Scholar
Hemorrhage and hemorrhagic shock in swine: a review. Accessed July 2023. https://apps.dtic.mil/sti/citations/ADA221297.Google Scholar
Mannucci, PM, Tripodi, A. Hemostatic defects in liver and renal dysfunction. Hematology. 2012;2012(1):168–173.CrossRefGoogle ScholarPubMed
van Dijk, PC, Jager, KJ, de Charro, F, et al. Renal replacement therapy in Europe: the results of a collaborative effort by the ERA-EDTA registry and six national or regional registries. Nephrol Dial Transplant. 2001;16(6):1120–1129.CrossRefGoogle ScholarPubMed
Martini, WZ, Pusateri, AE, Uscilowicz, JM, et al. Independent contributions of hypothermia and acidosis to coagulopathy in swine. J Trauma. 2005;58(5):1002–1009; discussion 1009-1010.CrossRefGoogle ScholarPubMed
Rand, MD, Lock, JB, van’t Veer, C, et al. Blood clotting in minimally altered whole blood. Blood. 1996;88(9):3432–3445.CrossRefGoogle ScholarPubMed
Westfall, S, Granados, S. Why freezing temperatures in the quake-struck areas are so dangerous. Washington Post. Published February 12, 2023. Accessed July 16, 2023. https://www.washingtonpost.com/world/2023/02/08/turkey-syria-cold-dangers-freezing-earthquake-hypothermia/.Google Scholar
Brown, DJA, Brugger, H, Boyd, J, et al. Accidental hypothermia. N Engl J Med. 2012;367(20):1930–1938.CrossRefGoogle ScholarPubMed
Danzl, DF, Pozos RS. Accidental hypothermia. N Engl J Med. 1994;331(26):1756–1760.CrossRefGoogle Scholar
Korkmaz, İ, Eren, ŞH, Kukul Güven, FM, et al. Hipotermi değerlendirmesi, tanı ve tedavisi. Akademik Acil Tıp Dergisi. 2009;8(1):9–12.Google Scholar