INJURY PATTERNS AND PROJECTED REHABILITATION NEEDS AS A RESULT OF THE

JANUARY 12, 2010 EARTHQUAKE IN HAITI

Colleen O’Connell, MD FRCPC, Aleema Shivji, BSc PT, Thomas Calvot, MKDE

Handicap International, Haiti and France

4:53pm Jan 12, 2010

7.0 magnitude earthquake occurred in Haiti

• Epicentre (Léogâne) 25km west of Port au Prince (population approximate 3 million)

Immediate Aftermath

Early estimates of communities 30-90% destroyed,

Thousands of injured make way to hospitals, clinics

Hospitals in affected areas destroyed, damaged, staff injuries/deaths

Makeshift care sites, field hospitals and more distant centres accept injured

• Telecommunications and electricity down

• Hospitals overwhelmed, supplies depleted

Study Objective

• Provide a rapid assessment of the patterns and incidence of injuries to aid in planning the urgent and emergent rehabilitation needs and guide the development of longer term interventions

MethodsIdentification and direct visits of Field and permanent hospitals

Methods

• Collection of available data from the Governmental representatives, International NGOs, national NGOs, and Emergency coordination units (Clusters, etc.)

• Direct assessment of approximately 600 persons with injuries at both hospital and community level

• Interviews with doctors, administration staff, paramedical teams, physical rehabilitation teams

• Cross-reference for comparison with previous disasters

Rapid Assessment Tool

Rapid Assessent Tool

Nombre total de patients admis depuisle séismeNombre total de patients déjadéchargé?Nombre total de patients ce jourRaison d'admission la plus courante ence moment?

Rapid Assessent Tool

Fracture - Membre InfFracture - Membre SupFracture - PelvisFracture - colonne vertebraleFracture - complexeAmputation - Membre InfAmputation - Membre Suptraumatisme médullairetraumatisme cranialbrûlureBlessure aux yeux

Rapid Assessent Tool

Distribution d'aides de marche? Y a t'ilun stock? Besoin d'un stock? Commentfonctionne les distrib?

ChirurgiensInfirmiersPhysiosErgosTravailleur socialRessources additionnellesnécessaires?En ont t'il déjà déployé

Individual Data Collection

Assessment Teams

Targeted Injuries – Mobility/Impairment

• Single, multiple or complex fractures• Polytrauma• Vertebral fractures• Spinal Cord Injuries• Amputations• Traumatic Brain Injuries• Burns

MedishareData collection

from 17 hospitals from 15-29th of January

Patient Data Collection

• 600 patient examined• 282 Hospital-based

Gender and Age Distribution

Patterns of Injury

Fractures

Amputations• 35% of Hospital based

high aquity admissions • Previous earthquakes

2.5-5%

Spinal Cord Injury

• No in-country surgical capacity

• No immediate stable transport

• Early deaths tetraplegics

• 17 patients identified days 8-11 outdoors in tents/tarps

• Extrapolated to potential 100 survivors

Discussion and Outcomes

• Extrapolations determined 1500-2000 persons with amputations, 100 potential SCI survivors, and 7500 risk permanent impairment/complications

• Determined need for 8-9 sites for Prosthetics• Determined need for urgent surgical access and

dedicated SCI rehab sites• Mobilization and rapid training of local staff and

implementation community access sites

Urgent and Emergent

• Mobility aid distribution• Community access site with

hygiene/wound kits• Establish of coordination system for

referrals• Development of acute and longer term

rehabilitiation plan

Conclusion

• Rapid identification of injury patterns and available resources, led by experts in rehabilitation, is an effective method to inform and direct urgent and emergent care needs.

Conclusion

• The Haiti earthquake resulted in a high incidence of injuries causing potential or actual permanent impairment, which will require significant increase in the countries capacity to deliver short and long term rehabilitation services.

Results

Follow-Up

• 8 P&O Centres established – over 600 patients fit; estimated over half of persons newly amputated have been evaluated for limbs

SCI

• 3 “centres” for SCI rehabilitation and 2 centres for SCI surgery; no deaths in last 2 months and first discharges have occurred

• Currently 45 patients in rehab centres