On 12 January 2010 Port-au-Prince, Haiti was struck by a 7.0 Mw earthquake that devastated the city and destroyed much of the Haiti University and Educational Hospital. In the following weeks, a tent hospital was erected at the site and hundreds of patients were seen daily by expatriate healthcare volunteers. The high volumes of patients, disorganized hospital grounds, and high levels of stress among patients led to issues of crowd control.

To improve security a new triage system was designed and implemented based on current emergency medicine models. This design addressed patient flow, triage, environmental conditions, and differentiation of emergency services. The results of this system were a streamlined triage system as well as improved safety.

During the chaos following the Haiti earthquake, a triage design was implemented at the HUEH that lead to improved Emergency Department patient flow and hospital safety.

Triage is an important aspect of the management of mass-casualty incidents (MCIs). This study evaluates triage after the Turkish Airlines aircraft crash near Amsterdam in 2009. What were the results of triage? What were the injuries of priority 3, and of “walking” casualties? Did the mechanism of trauma have a factor in this mass-casualty triage? How does this affect spinal immobilization rate during transport?

A retrospective analysis of investigational reports, ambulance forms, and medical charts of survivors of the crash was performed. Outcomes included triage classification, type of injury, Abbreviated Injury Scale (AIS) score, Injury Severity Scale (ISS) score, need for emergency intervention according to the “Baxt criteria”, and spinal immobilization during transport.

There was minimal documentation of prehospital triage. According to the in-hospital triage, 28% of patients were priority 1, 10% had an ISS score ≥ 16, and 3% met the Baxt criteria for emergency intervention. Forty percent were priority 3, 72% had an ISS score ≤ 8, and 63% were discharged from the emergency department. Approximately 83% were over-triaged, and the critical mortality rate was 0%. Nine percent of priority 3 casualties. and 17% of “walking” casualties had serious injuries. Twenty-five percent of all casualties were transported with spinal immobilization; 22% of patients with diagnosed spinal injury were not transported with spinal immobilization.

After the Turkish Airlines crash, documentation of triage was minimal. According to the Baxt criteria, there was a great amount of over-triage. Possible injuries sustained by plane crash survivors that seem minimally harmed (P3) must not be underestimated. Considering spinal immobilization, Not insufficient consideration given the high-energy trauma mechanism.

At this time, no triage method is considered better than another in comparison to the outcome of the casualties. It is important and useful to identify a triage method that can be used for both adults and children at the same time. It should consider the anatomical and physiological differences between adults, children, and infants.

To revise and adapt the current triage system in use in the Piemonte Emergency Medical Services for the first triage in a validated method that is effective for adults, children, and babies in order to unify and simplify the triage system.

In accordance with pediatricians, the “Triage Sieve” procedure and parameters were revised into a single method.

Setting the height of the casualty was considered to be both quick and easy. In this revised method, all the casualties are classified with the sieve methods, but some changes have been introduced. Casualties with a stature < 59 cm are classified as infants, and are therefore priority T1 (red) in every case. Casualties > 60 cm but < 120 cm in stature are classified as children. Children with a respiratory rate < 15 or > 40 breaths per minute and a heart rate < 80 or > 160 beats per minute are classified as T1.

Children will probably be over-triaged in this method, but the authors do not consider that a substantial problem. This first triage system is simple and effective. But, it has not yet been tested effectively during an actual mass-casualty incident or disaster.

The derailment accident occurred on 25 April 2005. 562 passengers were injured and 107 people died. Based on our periodic training in mass disaster triage, we accepted 113 wounded victims regardless of the severity of their condition. Initially, Simple Triage and Rapid Treatment was supposed to be performed by an emergency physician as a triage officer but START is not the most effective method for this case because patients of different severity levels were admitted to our hospital. Therefore, we performed triage by inspection and palpation based on our experience and intuition. Patient's facial color, breathing patterns, and trauma were processed for inspection. Furthermore, palpation was carried on without counting pulse and we diagnosed victims based upon strength of pulse and sensation of cold. From inspirational and sensuous diagnosis, the severity was determined. Comparing START with experiential and intuitive triage, differences between level of consciousness, the severity of trauma, and vital sign were examined. In addition, which components were necessary for primary survey was also reviewed.

Severe or moderate, which were evaluated from ISS, vital sign, and Revised Trauma Score: RTS, Probability of survival: PS, were classified and then agreement rate, sensitivity, and specificity between START (S model) and triage (D model) were assessed. For START, data was extracted from clinical records.

Agreement rate between the S model and the D model was 76.9%. Moreover, at the percentage of questions answered, the S model showed 84.2% and the D model showed 68.4%. Thus the experiment showed significant difference. 5 over triage cases appeared when the D model was operated. RTS, vital sign, and PS did not show great differences.

It could be difficult and insufficient to use START when a mass disaster occurs, however experiential and intuitive triage is also effective as START.

The Sichuan earthquake on 12 May 2008 with a magnitude of 8.0 killed > 87,000 people. The response of the Hong Kong Red Cross (HKRC) included a basic healthcare team to a small rural town called Yanmen three weeks after the earthquake. The objective of this study was to review HKRC's medical records to identify the disease pattern in the Chinese rural setting post earthquake.

A cross-sectional, record-based study of all patients treated by the HKRC basic healthcare team from 01 June to 19 June 2008. This retrospective study studied the medical records collected during the clinical consultations, and descriptive analysis was performed for the demographic and clinical information. Blood pressure measurement was classified according to the JNC-7 classification, and the age- and gender-specific prevalence of hypertension was sought.

A total of 2,034 cases were seen during the 19-day period with daily attendance ranging from 73 to 153 cases. Musculoskeletal, respiratory, and gastrointestinal problems were the top three categories and accounted for 30.4, 17.4, and 12.7% respectively. Trauma accounted for 5.4% of the cases attended, and 26.0% of the injuries were related to the earthquake. A total of 38.7% of the consultations were for medical problems that existed before the earthquake. A total of 43.4% patients with blood pressure measurements were above the recognized cutoff for hypertension.

Due to the impact and time phase post disaster, trauma, and injuries directly resulting from the earthquake did not contribute to a large number of cases. However, the management of chronic illness was an important issue, especially with the excessive prevalence of high blood pressure found in this study. Further studies to investigate the relationship between chronic diseases including hypertension and post-earthquake conditions are needed.

In 2009 in Delhi, 7,516 road traffic crash victims were admitted to hospitals as unknown or unattended.

The aim of this study was to assess the morbidity and mortality of unknown or unattended patients and problems they faced relative to the provision of nursing care.

This is a retrospective analysis from February 2010 to August 2010 wherein all unknown or unattended patients with head injuries (Glasgow Coma Scale (GCS) score = 1–15) admitted to the neurosurgery department were included. The duration of hospital stay, admission GCS, and outcome were assessed and an attempt also was made to analyze the problems faced by nursing personnel.

The total number of patients enrolled was 38. Of these, 22 were unknown, and 16 were unattended. The average hospital stay of unknown and unattended victims was 35 (1–151), and 21 (7–120) days, respectively. The mean GCS score of unknown patients upon admission was 9 (3–15), and during discharge, 8 (3–15). The mean GCS scores of unattended patients during admission and discharge was 12 (13–15) and 14 (3–15). respectively. Of the 22 unknown patients, 24% were identified during their stay, 33% were transferred to rehabilitation homes, and 43% died without being identified. Of the 16 unattended patients, 25% went home, 63% were transferred to rehabilitation homes, and 12% expired. The most common problems faced during nursing care were contractures (8%) and pressure sores (11%), due mainly to their long hospital stays.

Patients remaining unknown/unattended is a unique problem as far as developing countries are concerned. Managing these patients is difficult, as they occupy hospital beds for a longer duration, and require more nursing care, and have higher mortality and morbidity. It remains surprising that in spite of advancements in the field of mass communication, almost 76% of the unknown patients remain unidentified.

Lessons learned from medical humanitarian mission during Somalia civilian war 1992–1994. Moroccan experience L. Safi. Chirurgical Intensive Unit Mohammed V Military Hospital Hay Riad Rabat Morocco Introduction Natural disasters and civilian war in Africa demonstrate a similar critical need for national preparedness. As one of a team of military physician who went on a medical mission, I would like to share glimpses of our experience and reflect our thought about humanitarian mission.

To report our experience during medical humanitarian mission.

During Somalia civilian war Morocco deployed level 2 hospital to provide medical and social aid to soma liens during united Nations interventions UNISOM. The specific mission was to provide immediate relief to the affected population of Mogadishu, to minimize loss of life, and to mitigate human suffering. A team of 21 physicians specialists and 40 nurses were deployed in an university campus to provided medical assistance.

Data were collected from interviews, observations, field notes, memos, and retrospective study of medical statistique.

80% of all patients we examined have infection disease in all fields: dermatology, ophthalmology, ORL, pneumology etc 90% of childs have denutrition Only the emergency surgery was involved.

In doing so, the medical team learned many important lessons, including five of particular value to planners of similar relief operations in the future. A successful medical humanitarian mission will depend on accurate and relevant medical intelligence and socio-geographical mapping in advance of deployment.