Jun Oda

Morbidity and mortality of hospitalized patients after the 1995 Hanshin-Awaji earthquake

The objective of this study was to provide an overview of the morbidity and mortality of hospitalized patients during the Hanshin-Awaji earthquake. Medical records of 6,107 patients admitted to 95 hospitals (48 affected hospitals within the disaster area and 47 back-up hospitals in the surrounding area) during the initial 15 days after the earthquake were analyzed retrospectively. Patient census data, diagnoses, dispositions, and prognoses were considered. A total of 2,718 patients with earthquake-related injuries were admitted to the 95 hospitals included in our survey, including 372 patients with crush syndrome and 2,346 with other injuries. There were 3,389 patients admitted with illnesses. Seventy-five percent of the injured were hospitalized during the first 3 days. In contrast, the number of patients with illnesses continued to increase over the entire 15-day period after the earthquake. The mortality rates were 13.4% (50/372), 5.5% (128/2,346), and 10.3% (349/3,389) associated with crush syndrome, other injuries, and illness, respectively. The overall mortality rate was 8.6% (527/6,107 patients). Morbidity as well as mortality rates increased with age in patients with both injuries and illnesses. In the initial 15-day period, there was an unprecedented number of patients suffering from trauma, and they converged upon the affected hospitals. Subsequently an increased incidence of illness was observed. This survey underscores the need for adequate disaster response in such an urban situation.

Overview of evacuation and transport of patients following the 1995 Hanshin-Awaji earthquake.

We investigated how patients were evacuated and transported from affected hospitals in the disaster area to backup hospitals following the 1995 catastrophic Hanshin-Awaji earthquake. A retrospective review was conducted of medical records of 6107 patients hospitalized during the first 15 days after the earthquake, collected from 48 affected hospitals in the disaster area and 47 backup hospitals in the surrounding area. Of the 6107 patients, a total of 2290 (38%) were transferred to backup hospitals, consisting of 187 patients (50%) with crush syndrome, 702 (26%) with other traumas, and 1401 (41%) with illness. Of those 2290 patients, 1741 (76%) were transferred from affected hospitals to backup hospitals, while 549 patients (24%) were evacuated directly to backup hospitals. The peak in transport came during the first 4 days. The family car was the most frequently used means of transport; ambulance was used in only 26% of cases, and helicopters were used minimally. There was no notable difference in the percentage of intensive care patients and nonintensive care patients transferred to backup hospitals. The mortality rate for patients with trauma and crush syndrome was significantly higher in the affected hospitals. These results suggest that the existing emergency medical service system was not adequate for this urban earthquake. From our vantage point, we are keenly aware of the need for improved communications between hospitals, a well equipped patient transport system, and a well coordinated disaster response mechanism.

Delayed Hemispheric Neuronal Loss in Severely Head-Injured Patients

Recent experimental studies have revealed that traumatic brain injury as well as ischemic brain injury can cause chronic progressive neuronal damage. In the present study, we demonstrate previously unreported delayed cerebral atrophy on computerized tomography (CT) scans in severely head-injured patients. Seventeen severely head-injured patients who required mild hypothermia to control intracranial hypertension after the failure of conventional therapies were retrospectively analyzed. All 17 patients survived more than 1 year. Delayed neuronal loss (DNL) was observed in only eight of the 17 patients. Eight patients with DNL required longer durations of mild hypothermia to control intracranial hypertension than nine patients without DNL. Six of these eight patients with DNL achieved functional recovery despite progressive atrophic changes demonstrated on CT scans. On CT scans, DNL was characterized by (1) the sudden appearance at several months postinjury of a low-density area in the hemisphere ipsilateral to the injury; (2) the preservation of essential cortical structure although related white matter structures showed severe atrophic changes; and (3) no spread of the low-density area to the contiguous territory of the other main cerebral artery. It is concluded that focal primary injury to underlying brain, if severe enough, can result in delayed hemispheric atrophy.

Burn injuries in the 1995 Hanshin-Awaji earthquake.

In the 1995 Hanshin-Awaji earthquake, 504 deaths were listed as fire related, although many of the victims may have been crushed or suffocated before they were burned. Census data related to surviving burn victims, however, were unknown. This study was designed to examine the medical requirements of those burn patients following the earthquake. Medical records of 2718 patients with injuries admitted to 95 hospitals during the 15 days after the earthquake were retrospectively reviewed. Only 44 patients (1.9 per cent) were hospitalized with burns. Scalds with less than 20 per cent total burn surface area (TBSA) were mainly observed; flame burns from earthquake-associated fires were rare. Morbidity rates increased in patients over 40 years old. Associated injuries were observed in 11 cases. These included three soft tissue injuries, one rib, three spine, three pelvis and two extremity fractures, and two cases of crush syndrome. Intensive care was required for only 10 patients, five of whom were transferred to hospitals that were undamaged or outside the earthquake zone. No relationship was noted between the number of burned houses and that of hospitalized burn patients. These results suggest that the number of burn patients requiring medical care was less than might have been expected in view of the total number of fire-related deaths in this urban earthquake.