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Enhancing Triage and Management in Earthquake-Related Injuries: The SAFE-QUAKE Scoring System for Predicting Dialysis Requirements
- Sarper Yılmaz, Remzi Cetinkaya, Mehmet Ozel, Ali Cankut Tatliparmak, Rohat Ak
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 04 October 2023, pp. 716-724
- Print publication:
- December 2023
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Objectives:
Identifying early predictors of dialysis requirements in earthquake-related injuries is crucial for optimal resource allocation and timely intervention. This study aimed to develop a predictive scoring system, named SAFE-QUAKE (Seismic Assessment of Kidney Function to Rule Out Dialysis Requirement), to identify patients at high risk of developing acute kidney injury (AKI) and requiring dialysis.
Methods:A retrospective analysis was conducted on a cohort of 205 patients presenting with earthquake-related injuries. Patients were divided into two groups based on their need for dialysis: the no dialysis group (n = 170) and the dialysis group (n = 35). Demographic, clinical, and laboratory data were collected and compared between the two groups to identify significant predictors of dialysis requirements. The parameters that would form the score were determined by conducting an importance analysis using artificial neural networks (ANNs) to identify parameters that exhibited statistically significant differences in univariate analysis.
Results:The dialysis group had a significantly longer median duration of being trapped under debris (48 hours) compared to the no dialysis group (eight hours). Blood gas and laboratory analyses revealed significant differences in pH levels, lactate values, creatinine levels, lactate dehydrogenase (LDH) levels, and aspartate transaminase (AST)-to-alanine transaminase (ALT) ratio between the two groups. Based on these findings, the SAFE-QUAKE rule-out scoring system was developed, incorporating entrapment duration (<45 hours), pH levels (>7.31), creatinine levels (<2mg/dL), LDH levels (<1600mg/dL), and the AST-to-ALT ratio (<2.4) as key predictors of dialysis requirements. This score included 139 patients, and among them, only one patient required dialysis, resulting in a negative predictive value of 99.29%.
Conclusions:The SAFE-QUAKE scoring system demonstrated a high negative predictive value of 99.29% in ruling out the need for dialysis among earthquake-related injury cases. This scoring system offers a practical approach for health care providers to identify patients at high risk of developing AKI and requiring dialysis in earthquake-affected regions.
The Impact of a Large-Scale Power Outage on Hemodialysis Center Operations
- Mahshid Abir, Sophia Jan, Lindsay Jubelt, Raina M. Merchant, Nicole Lurie
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 6 / December 2013
- Published online by Cambridge University Press:
- 22 August 2013, pp. 543-546
- Print publication:
- December 2013
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Introduction
On June 29, 2012, mid-Atlantic storms resulted in a large-scale power outage affecting up to three million people across multiple (US) states. Hemodialysis centers are dependent on electricity to provide dialysis care to end-stage renal disease patients. The objective of this study was to determine how the power outage impacted operations in a sample of hemodialysis centers in the impacted regions.
MethodsThe sample consisted of all hemodialysis centers located in the District of Columbia and a total of five counties with the largest power losses in West Virginia, Virginia, and Maryland. A semi-structured interview guide was developed, and the charge nurse or supervisor in each facility was interviewed. The survey questions addressed whether their centers lost power, if so, for how long, where their patients received dialysis, whether their centers had backup generators, and if so, whether they had any problems operating them, and whether their center received patients from other centers if they had power.
ResultsCalls were placed to 90 dialysis centers in the sampled areas and a 90% response rate was achieved. Overall, hemodialysis operations at approximately 30% (n = 24) of the centers queried were impacted by the power outage. Of the 36 centers that lost power, 31% (n = 11) referred their patients to other dialysis centers, 22% (n = 8) accommodated their patients during a later shift or on a different day; the rest of the centers either experienced brief power outages that did not affect operations or experienced a power outage on days that the center is usually closed. Some centers in the study cohort reported receiving patients from other centers for dialysis 33% (n = 27). Thirty-two percent (n = 26) of the centers queried had backup generators on site. Eleven percent (n = 4) of the centers experiencing power outages reported that backup generators were brought in by their parent companies.
ConclusionsComprehensive emergency planning for dialysis centers should include provisions for having backup generators on site, having plans in place for the timely delivery of a generator during a power outage, or having predesignated backup dialysis centers for patients to receive dialysis during emergencies. Most dialysis centers surveyed in this study were able to sustain continuity of care by implementing such pre-existing emergency plans.
. ,Abir M ,Jan S ,Jubelt L ,Merchant R .Lurie N The Impact of a Large-Scale Power Outage on Hemodialysis Center Operations . Prehosp Disaster Med.2013 ;28 (6 ):1 -4
Chronic Diseases and Natural Hazards: Impact of Disasters on Diabetic, Renal, and Cardiac Patients
- Andrew C. Miller, Bonnie Arquilla
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- Journal:
- Prehospital and Disaster Medicine / Volume 23 / Issue 2 / April 2008
- Published online by Cambridge University Press:
- 28 June 2012, pp. 185-194
- Print publication:
- April 2008
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Background:
Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response phase of disasters. Chronic disease exacerbations (CDE) account for one of the largest patient populations during disasters, and patients are at increased risk for adverse outcomes.
Objective:The objective of this study was to assess the burden of chronic renal failure, diabetes, and cardiovascular disease during disasters due to natural hazards, identify impediments to care, and propose solutions to improve the disaster preparation and management of CDE.
Methods:A thorough search of the PubMed, Ovid, and Medline databases was performed. Dr. Miller's personal international experiences treating CDE after disasters due to natural hazards, such as the 2005 Kashmir earthquake, are included.
Discussion:Chronic disease exacerbations comprise a sizable disease burden during disasters related to natural hazards. Surveys estimate that 25–40% of those living in the regions affected by hurricanes Katrina and Rita lived with at least one chronic disease. Chronic illness accounted for 33% of visits, peaking 10 days after hurricane landfall. The international nephrology community has responded to dialysis needs by forming a well-organized and effective organization called the Renal Disaster Relief Task Force (RDRTF). The response to the needs of diabetic and cardiac patients has been less vigorous.
Patients must be familiar with emergency diet and renal fluid restriction plans, possible modification of dialysis schedules and methods, and rescue treatments such as the administration of kayexalate. Facilities may consider investing in water-independent extracorporeal dialysis techniques as a rescue treatment. In addition to patient databases and medical alert identification, diabetics should maintain an emergency medical kit. Diabetic patients must be taught and practice the carbohydrate counting technique. In addition to improved planning, responding agencies and organizations must bring adequate supplies and medications to care for diabetic, cardiac, and renal patients during relief efforts.
Conclusions:By recognizing and addressing impediments to the care of chronic disease exacerbations after natural disasters, the quality, delivery, and effectiveness of the care provided to diabetic patients during relief efforts can be improved.