Natural Disasters
Although natural disasters of significant magnitude are rare, their occurrences can have devastating effects. Natural disasters have the potential to not only lead to mass casualties but also to a sudden high frequency of severely injured persons. Because SCIs are only one type of severe injury that requires specialized and specific care, triage schemes are applied in order to allocate scarce resources to those who are most likely to benefit (Bensen et al. 1996; Jenkins et al. 2008). In such instances, patients with complex trauma might not be given immediate priority because of their smaller probability of survival (Gautschi et al. 2008) or surgical care may not be regarded as an immediate priority because resources are scarce (Sheng 1987). Thus individuals with SCI, in particular those with high lesions who may require surgical spinal stabilization and intensive acute care, may not receive the needed services, especially in regions with a lack of resources like transport facilities.
In low resource countries the health care infrastructure for SCI care and provision of pre-hospital, acute care, and rehabilitation are often inadequate. When faced with the consequences of a natural disaster, the health system becomes exposed with the understaffed and underequipped local medical emergency teams, and the lack of efficient transportation to provide services to remote rural regions. Even in regions with sufficient infrastructures, health services may be overwhelmed if many patients with major trauma need to be admitted at the same time. Regardless of region, most lay persons and first responders providing rescue and medical aid to survivors are not trained to provide adequate care for persons with SCI and do not know how to transport these individuals safely. Secondary lesions may result from well-intended but harmful manipulation.
We identified 12 studies with a focus on SCI resulting from natural disasters (Table 13). These papers cover the earthquakes in Tangshan, China in 1976, Yerevan, Armenia in 1988, Hanshin, Japan in 1995, Bam, Iran in 2003, Kashmir, Pakistan in 2005, Sichuan, China in 2008, and Haiti in 2010. Of note, we did not find any publications reporting on SCI resulting from other types of natural disasters.
The frequency of SCI among all injuries ranged from 0.02% in Japan and Iran (Maruo et al. 1996; Tahmasebi et al. 2005) to a high of 1.2% (n = 5000 SCIs) in China (Chang et al. 2000).
The majority of injuries reported were to the lumbar region of the spine, (Chen et al. 2009; Dong et al. 2009; Tauqir et al. 2006; Chang et al. 2000; Tanaka et al. 1999; Maruo et al. 1996; Karamouzian et al. 2010) however, not all injuries resulted in damage to the spinal cord. The most common mechanism of SCI was being struck by a falling object while sitting or standing (Rathore et al. 2007; Maruo et al. 1996).
