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

Güzelali Özdemir; Taner Karlıdağ; Olgun Bingöl; Baran Sarıkaya; Ceyhun Çağlar; İbrahim Bozkurt; Mehmet Orçun Akkurt; Nurettin Mantı; Batuhan Gencer; Vedat Biçici; Şahin Çepni; Cem Cüneyt Köse; Özgür Doğan; Fatih İnci; Erman Ceyhan; İbrahim Alper Yavuz; Murat Gülçek; Hilmi Alkan; Sualp Turan; Kasım Kılıçaslan; Metin Doğan; Bülent Özkurt; Osman Tecimel; Ahmet Şükrü Solak; Enes Uluyardımcı; Halil İbrahim Özaslan; Merve Bozer; Şahan Güven; Enis Erdem; Nuri Koray Ülgen; Tahsin Aydın; Ali Murat Güllerci; Ömer Halit Keskin

doi:10.52312/jdrs.2023.1102

Güzelali Özdemir¹, Taner Karlıdağ¹, Olgun Bingöl¹, Baran Sarıkaya¹, Ceyhun Çağlar², İbrahim Bozkurt¹, Mehmet Orçun Akkurt¹, Nurettin Mantı¹, Batuhan Gencer¹, Vedat Biçici¹, Şahin Çepni¹, Cem Cüneyt Köse¹, Özgür Doğan¹, Fatih İnci¹, Erman Ceyhan¹, İbrahim Alper Yavuz¹, Murat Gülçek¹, Hilmi Alkan¹, Sualp Turan¹, Kasım Kılıçaslan¹, Metin Doğan², Bülent Özkurt¹, Osman Tecimel², Ahmet Şükrü Solak¹, Enes Uluyardımcı², Halil İbrahim Özaslan², Merve Bozer², Şahan Güven², Enis Erdem², Nuri Koray Ülgen¹, Tahsin Aydın¹, Ali Murat Güllerci¹, Ömer Halit Keskin¹

¹Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Türkiye
²Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Türkiye

Keywords: Amputation, crush, earthquake, fasciotomy, Kahramanmaras earthquake, systematic triage.

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.

Citation: Özdemir G, Karlıdağ T, Bingöl O, Sarıkaya B, Çağlar C, Bozkurt İ, et al. Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake. Jt Dis Relat Surg 2023;34(2):480-487. doi: 10.52312/jdrs.2023.1102.

Ethics Committee Approval

The study protocol was approved by the Ankara Bilkent City Hospital Ethics Committee (date: 08.03.2023, no: E1-23-3333). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/consept, design, supervision, data collection and processing, analysis and interpretation, literature review, writing the article, critical review, references: G.Ö., T.K., O.B., B.S.; Supervision, data collection and processing, analysis and interpretation, literature review, critical review, references: C.Ç., İ.B., M.O.A., N.M., B.G., V.B., Ş.Ç., C.C.K., Ö.D., F.İ., E.C., İ.A.Y., M.G., H.A., S.T., K.K., M.D., B.Ö., O.T., A.Ş.S., E.U., H.İ.Ö., M.B., Ş.G., E.E., N.K.Ü., T.A., A.M.G., Ö.H.K.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Patient Consent for Publication

A written informed consent was obtained from each patient and/or parents or legal guardians of the patient.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.