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).
Author Year N of study population |
Geographic region |
Inclusion/ exclusion criteria |
Study
population |
Injury features | Cause: %(n of
cases) |
---|---|---|---|---|---|
Burns et al. 2010 N=19 (SCI) Estimated Deaths= 250,000- 300,000 Estimated Injuries= 300,000 Estimated SCI survivors= 150 |
Haiti | Patients with SCI at the Haiti Hospital Appeal as a result of the earthquake (magnitude 7.0) on January 12, 2010 in Haiti |
Not Provided | Cervical= 1 (5.2%) (C6 motor complete) Asia A or B =13 (68.4%) – Majority low thoracic or lumbar spine injuries – High thoracic injuries uncommon |
Earthquake 12.7% (n=19) |
Karamouzian et al. 2010 N= 130 (SCI) Estimated Injured= 30,000 |
Bam, Iran |
2005-2006 Registered participants at the Kerman Welfare Organization |
Surveyed sample (remaining n=103) Male= 40.8% Female= 59.2% Mean age= 31.5±10.2 years |
Cervical= 2 (1.9%) Thoracic= 8 (7.8%) Thoracolumbar= 93 (90.3%) |
Earthquake: 0.43% (n=130) |
Chen et al. 2009 N=78 Estimated injured= >300,000 |
Sichuan, China |
Treatment for spinal injuries in Chengdu hospital following May 12, 2008 earthquake (magnitude 8.0). |
Males=51% Mean age=42(7- 84) years Women=38 (49%) No Mortality |
Cervical=13 (11%) Thoracic=48 (40%) Lumbar=58 (49%) Single level injuries=55 (71%) Multiple level injuries=23 (29%) Neurological disability=53.8% |
Earthquake: 0.03% (n=78) |
Dong et al. 2009 N=198(SCI) Estimated injuries 374,643 |
Sichuan, China |
Patients admitted to hospital in Sichuan region with spinal injuries from earthquake (magnitude 8.0) on May 12 2008. Exclusion Criteria: Patients injured by earthquake-related MVCs. |
Not provided | Lumbar injuries = 55.3% Thoracic injuries = 31.1% Neurologic deficit in 65 patients: Frankel Levels: A=14 (7%) B=8 (4%) C=24 (12%) D=19 (10%) |
Earthquake: 0.05% (n=198) |
Raissi et al. 2007 N=54 Estimated injured= 23,000 |
Bam, Iran |
SCI patients listed with Social Welfare Organization in Bam area and were injured in the December 6, 2003 earthquake (magnitude 6.8) in Bam, Iran |
Patients surveyed n=54 Male=46% Mean age=31.9±9.6 years |
General injury level*: Between T10 and T12=37 L2 and below=14 Incomplete=3 *(complete neurological level exam not possible) Pain syndromes=52 (96%) |
Earthquake: 0.23% (n=54) |
Rathore et al. 2007 N=187 Estimated injured= 126,000 |
Northern Pakistan |
Patients with SCI from the earthquake (magnitude7.6) on October 8, 2005 in Rawalpindi. |
Surveyed sample (n=187) Males=43% Mean age=28.3±12.4 years |
Complete paraplegia= 43% (n=81) Incomplete paraplegia= 46% (n=86) Incomplete tetraplegia= 5% (n=9) No neurological deficit= 6% (n=11) |
Earthquake: 0.15% (n=187) |
Tauqir et al. 2006 N=194 Estimated injured= 100,000 |
Northern Pakistan |
Admission to 4 hospitals in Rawalpindi and Islamabad with SCI due to earthquake on October 8, 2005 (magnitude7.6). |
Surveyed Sample (n=122) Males=26% 16-39 years =77% (n=151) |
Cervical=5 (3%) Thoracic=48 (25%) Lumbar=120 (62%) Thoracolumbar=18 (9%) Cervicothoracic=1 Lumbrosacral=1 Cord contusion=1 |
Earthquake: 0.19% (n=194) |
Tahmasebi et al. 2005 N=210 N=6 (SCI) Estimated injured= 30,000 |
Bam, Iran |
Patients admitted to hospitals in Tehran with musculoskeletal injuries following earthquake on December 26, 2003 (magnitude 6.8). |
Surveyed sample (n=210) Male=42.4% Mean age=30.2 (7-70) years. |
Not provided | Earthquake: 0.02% (n=6) |
Chang et al. 2000 N=5000 Estimated injuries= 420,000 |
Tangshan , China |
Individuals who sustained SCIs in the Tangshan earthquake (magnitude 7.8) on July 28, 1976. |
Sampled surveyed (n=105) Males= 31.4% Average age=46 (38-62) years. |
T12/L1= 86.5% (n=64) | Earthquake: 1.2% (n=5000) |
Tanaka et al. 1999 N= 29 (SCI) Estimated Injured= 41,000 |
Hanshin region, Japan |
Survey of 53% of all hospital beds in Hanshin area in first 15 days following the January 17, 1995 earthquake (magnitude 7.2). Exclusion criteria: Patients who were dead upon arrival to hospital. |
Patients surveyed n=6107 Males=44% Total mortality=527 (9%) Mortality among SCI=1 (3%)al |
Spinal cord injuries=29 Spinal fractures (n=414): Cervical=18 (4%) Thoracic=145 (35%) Lumbar=251 (61%) |
Earthquake: 0.07% (n=29) |
Maruo and Matumoto 1996 N=6 (SCI) Estimated injured= 34,900 |
Hanshin region, Japan |
Interviews of patients suffering from spinal or truck injuries following the January 17, 1995 Hanshin earthquake (magnitude 7.2). |
Patients surveyed n=230 Males=29.6% Average age=62.9% |
Frankel levels (n=6) A=3 D=3 Most common levels of vertebral fracture (n=140) T12=49 (29%) L1=49 (29%) L2=25 (15%) L3=11 (6.5%) |
Earthquake: 0.02% (n=6) |
Burke et al. 1993 N=42 (SCI) Estimated injured= 150,000 |
Yerevan, Armenia |
Patients admitted to newly established SCI unit following Armenian earthquake on December 7, 1988. |
No information given. |
All patients with paraplegia. Minor paralysis=35.7% (n=15) Severe paralysis=64.3% (n=27) Confined to a wheelchair=16.3% (n=7) Mortality=5% (n=2) |
Earth-quake: 0.03% (n=42) |