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      When the Earth Trembles in the Americas: The Experience of Haiti and Chile 2010

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          The response of the nephrological community to the Haiti and Chile earthquakes which occurred in the first months of 2010 is described. In Haiti, renal support was organized by the Renal Disaster Relief Task Force (RDRTF) of the International Society of Nephrology (ISN) in close collaboration with Médecins Sans Frontières (MSF), and covered both patients with acute kidney injury (AKI) and patients with chronic kidney disease (CKD). The majority of AKI patients (19/27) suffered from crush syndrome and recovered their kidney function. The remaining 8 patients with AKI showed acute-to-chronic renal failure with very low recovery rates. The intervention of the RDRTF-ISN involved 25 volunteers of 9 nationalities, lasted exactly 2 months, and was characterized by major organizational difficulties and problems to create awareness among other rescue teams regarding the availability of dialysis possibilities. Part of the Haitian patients with AKI reached the Dominican Republic (DR) and received their therapy there. The nephrological community in the DR was able to cope with this extra patient load. In both Haiti and the DR, dialysis treatment was able to be prevented in at least 40 patients by screening and adequate fluid administration. Since laboratory facilities were destroyed in Port-au-Prince and were thus lacking during the first weeks of the intervention, the use from the very beginning on of a point-of-care device (i-STAT®) was very efficient for the detection of aberrant kidney function and electrolyte parameters. In Chile, nephrological problems were essentially related to difficulties delivering dialysis treatment to CKD patients, due to the damage to several units. This necessitated the reallocation of patients and the adaptation of their schedules. The problems could be handled by the local nephrologists. These observations illustrate that local and international preparedness might be life-saving if renal problems occur in earthquake circumstances.

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          Most cited references 24

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          Management of crush-related injuries after disasters.

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            Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes.

            This study analyzes the effects of fluid resuscitation in the crush victims of the Bingol earthquake, which occurred in May 2003 in southeastern Turkey. Questionnaires asking about demographic, clinical, laboratory, and therapeutic features of 16 crush victims were filled in retrospectively. Mean duration under the rubble was 10.3 +/- 7 h, and all patients had severe rhabdomyolysis. Fourteen patients were receiving isotonic saline at admission, which was followed by mannitol-alkaline fluid resuscitation. All but two patients were polyuric. Admission serum creatinine level was lower than and higher than 1.5 mg/dl in 11 and 5 patients, respectively. Marked elevations were noted in muscle enzymes in all patients. During the clinical course, hypokalemia was observed in nine patients, all of whom needed energetic potassium chloride replacement. Four (25%) of 16 victims required hemodialysis. Duration between rescue and initiation of fluids was significantly longer in the dialyzed victims as compared with nondialyzed ones (9.3 +/- 1.7 versus 3.7 +/- 3.3 h, P < 0.03). Sixteen fasciotomies were performed in 11 patients (68%), nine of which were complicated by wound infections. All patients survived and were discharged from the hospital with good renal function. Early and vigorous fluid resuscitation followed by mannitol-alkaline diuresis prevents acute renal failure in crush victims, resulting in a more favorable outcome.
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              Implications of hospital evacuation after the Northridge, California, earthquake.

              On January 17, 1994, an earthquake with a moment magnitude (total energy release) of 6.7 occurred in Northridge, California, leading to the evacuation of patients from several hospitals. We examined the reasons for and methods of evacuation and the emergency-management strategies used. The experience in California may have implications for hospital strategies for responding to any major disaster, including an act of terrorism. From September 1995 to September 1996, we surveyed all acute care hospitals in Los Angeles County that reported having evacuated patients after the Northridge earthquake. Physicians, nurses, hospital administrators, and staff on duty at the hospitals during the evacuation responded to a 58-item structured questionnaire. Eight of 91 acute care hospitals (9 percent) were evacuated. Six hospitals evacuated patients within 24 hours (the immediate-evacuation group), four completely and two partially. All six cited nonstructural damage such as water damage and loss of electrical power as a major reason for evacuation. Five hospitals evacuated the most seriously ill patients first, and one hospital evacuated the healthiest patients first. All hospitals used available equipment to transport patients (blankets, backboards, and gurneys) rather than specialized devices. No deaths resulted from evacuation. One hospital evacuated patients after 3 days and another after 14 days because of structural damage, even though initial inspections had shown no damage (the delayed-evacuation group). Both hospitals required demolition. Some hospitals identified destinations for their evacuated patients independently, whereas others sought the assistance of the Los Angeles County Emergency Operations Center; the two strategies were equally effective. After even a moderate earthquake, hospitals are at risk for both immediate nonstructural damage that may force them to evacuate patients and the delayed discovery of structural damage resulting in permanent closure. Evacuation of large numbers of inpatients from multiple hospitals can be accomplished quickly and safely with the use of available resources and personnel. Copyright 2003 Massachusetts Medical Society

                Author and article information

                Nephron Clin Pract
                Nephron Clinical Practice
                S. Karger AG
                February 2011
                30 August 2010
                : 117
                : 3
                : c184-c197
                aNephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium; bRouen University Hospital, and cNephrology Department, Dialysis Unit, Bois Guillaume Hospital, Rouen, France; dNephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium; eDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; fMédecins Sans Frontières, Brussels, Belgium; gDivision of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta., Canada; hNephrology Section, Arzobispo Loayza General Hospital, Cayetano Heredia Peruvian University, Lima, Peru; iDivision of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alta., Canada; jDivision of Nephrology, University of Arkansas for Medical Sciences, Little Rock, Ark., USA; kNephrology Section, Hospital Regional Antonio Musa, Universidad Central del Este, Santo Domingo, Dominican Republic; lDepartment of Internal Medicine and Nephrology, Istanbul School of Medicine, Istanbul, Turkey; mNephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium; nService of Internal Medicine and Nephrology, Department of Internal Medicine, Hospital Militar de Santiago, University of the Andes and Valparaiso, Santiago, Chile
                Author notes
                *Raymond Vanholder, Nephrology Section, University Hospital, De Pintelaan 185, BE–9000 Gent (Belgium), Tel. +32 9332 4525, Fax +32 9332 4599, E-Mail raymond.vanholder@ugent.be
                320200 Nephron Clin Pract 2011;117:c184–c197
                © 2010 S. Karger AG, Basel

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                Page count
                Figures: 6, Tables: 4, References: 31, Pages: 14

                Cardiovascular Medicine, Nephrology

                Crush syndrome, Dialysis, Acute kidney injury


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