(Chest. 2001;120:1163-1166.)
© 2001
American College of Chest Physicians
Thorax and Lung Injuries Arising From the Two Earthquakes in Turkey in 1999*
Sevda Özdo
an, MD;
Arzu Hocaolu, MD;
Benan Çalayan, MD;
Oya Uncu Imamolu, MD and
Dilek Aydin, MD
*
From the Department of Chest Diseases and Tuberculosis (Drs. Özdoan, Hocaolu, Çalayan, and Aydin) and the Department of General Surgery (Dr. Imamolu), Kartal Education and Research Hospital, 
stanbul, Turkey.
Correspondence to: Sevda Özdoan, MD, TüccarKatibi sok 50, yil Apt 8/16, 81070 Suadiye, stanbul, Turkey; e-mail: sozdogan{at}superonline.com
 |
Abstract
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Study objective: To make a descriptive analysis of the
frequency and the type of thorax and lung injuries among the casualties
of the two devastating earthquakes that occurred in Turkey in 1999.
Design: Records of the hospitalized patients injured
in the earthquakes were examined retrospectively.
Results: Among the total of 356 hospitalized patients, 21
(9.7%) in the Izmit earthquake and 6 (7.6%) in the Duzce earthquake
had thorax and lung injuries. Pneumothorax and rib fractures were the
two most frequent pathologies and accounted for 50% and 33.3% of the
injuries, respectively.
Conclusion: Approximately 10%
of the casualties of a great earthquake may be expected to have thorax
and lung injuries, and traumatic chest diseases should be considered in
planning the medical response strategies.
Key Words: earthquake • injury • thorax
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Introduction
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Turkey
was hit by two devastating earthquakes on August 17 (Izmit region;
magnitude, 7.4 on the Richter scale) and December 12 (Duzce region;
magnitude, 7.2 on the Richter scale) in 1999.1
Officially,
15,000 people were killed and > 30,000 people were injured, but
estimates were about twofold to threefold higher.2
A great
number of the casualties were treated in Kartal Education and Research
Hospital due to its nearby location.
Among the total of 356 hospitalized patients, 9.7% of the Izmit
earthquake casualties and 7.6% of the Duzce earthquake casualties had
thorax and lung injuries. A retrospective descriptive analysis of the
frequency and type of thorax and lung injuries has been performed, and
the results were compared with those from previous earthquake disasters
that have been reported.
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Materials and Methods
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Two hundred sixty-one trauma patients were hospitalized between
August 17 and 31, 1999, following the Izmit earthquake. Of those
patients, 215 (82.38%) had records that could be accessed. Twenty-one
of the 215 patients (9.77%) had thorax and/or lung injuries, and these
records were examined in detail. Chest radiographs, physical
examinations, and, in some cases, CT scans of the thorax were used in
diagnosing the thorax and lung injuries.
Ninety-five trauma patients were hospitalized between December 12 and
20, 1999, due to the Duzce earthquake. Seventy-eight records for these
95 patients (82.11%) were available, and 6 patients (7.6%) were found
to have thorax and lung injuries.
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Results
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There were 21 patients with thorax and lung injuries after the
Izmit earthquake (9.77% of the total; women, 8 patients [38.1%];
men, 13 [61.9%]). The mean age was 35.6 years (age range, 6 months
to 79 years). The distribution of the thorax injuries is summarized in
Table 1
.
Pneumothorax was the most frequent pathology (52.4%). One patient had
a bilateral pneumothorax, and another one had a pneumohemothorax.
Four patients (19%) had hemothoraces, of which two were accompanied by
rib fractures and one by a pneumothorax (Fig 1
). Tube thoracostomy was performed on arrival at the hospital in 10
patients. Among the seven patients (33.3%) with rib fractures, five
had multiple rib fractures (Fig 2
).
Four patients (19%) with severe trauma developed crush syndrome and
ARDS (Fig 3
). The duration of the entrapment under the rubble was as long as 9
h for one patient. The time until rescue was not recorded in the other
three patients, but we can infer from the date of hospitalization that
it was < 24 h.
Three patients had pneumonia. Two of them had minor injuries and were
admitted to the hospital because of the pneumonia that had developed
within 3 days after the earthquake. The third patient was a child with
head trauma who developed a case of hospital-acquired pneumonia on the
sixth day of the hospitalization. One patient had a pulmonary embolism
in the follow-up period.
Three patients (ARDS, two patients; pneumothorax and intra-abdominal
bleeding, one patient) died. Other complications encountered were
sepsis in two patients, acute renal insufficiency in four patients, GI
bleeding in one patient, and pelvic infection in one patient.
The types of injuries that accompanied the thorax and lung injuries
were as follows: extremity injury (bone fracture), eight patients; head
trauma with subarachnoid hemorrhage, four patients; abdominal trauma,
one patient; vertebral injury, one patient; and pelvis injury, one
patient. Edema and contusion in several areas were seen in four
patients.
There were six patients (7.6% of the total) with thorax and lung
injuries after the Duzce earthquake. Of those patient, five were men
(83.3%) and one was a woman (16.6%). The mean age was 51.3 years (age
range, 35 to 70 years) The distribution of the thorax injuries is
summarized in Table 2
.
Pneumothorax was again the most common pathology (50%)
after the Duzce earthquake. Two pneumothorax patients had also suffered
rib fractures. The rib fractures in those patients were multiple, and
one of them had a hemothorax while the other had subcutaneous
emphysema. A tube thoracostomy was performed on arrival in four
patients.
A pulmonary consultation was requested for two patients with dyspnea.
Both had lower extremity bone fractures, and in one of them the chest
radiograph revealed minor changes that were attributed to a pulmonary
contusion. The second patient was consulted on in the emergency
department on his arrival. He had moderate bronchospasm attributed to
the severe inhalation of dust (ie, bronchial
hyperreactivity), although he had no history of asthma. These patients
were classified as the dyspnea group in Table 2
.
The accompanying injuries of the patients in Duzce earthquake were
lower extremity bone fractures in three patients and pelvis injury in
one patient. None of the patients experienced crush syndrome or ARDS
after the Duzce earthquake, and none of them died.
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Discussion
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Earthquakes are natural disasters in which a large number of
people die in a very short period of time. Besides this, a great number
of people are injured when medical facilities also are destroyed or are
in great chaos. Problems pertaining to medical assistance during
previous major earthquakes have been reported in the medical
literature.3
4
An earthquake in Mexico in September 1985
with a magnitude of 9 on the Richter scale caused 14,000 deaths and
$4.5 billion lost according to the official numbers. Thirteen hospitals
in the region were severely damaged or totally destroyed, costing
numerous medical staff and doctors their lives.5
Unfortunately, current community disaster plans in Turkey rely on
hospitals for immediate medical care. The revision of such plans and
the development of specialized medical and rescue teams that would be
available immediately at the local level are essential because there
may be considerable physical damage to the hospitals or to the roads
that connect the hospitals to the disaster region, or the number of
people requiring hospitalization may exceed the number of hospital beds
that would be available. As part of an effective strategy, local
health-care staff can be trained to have skills in emergency medicine
and can perform essential life-saving procedures, including the
insertion of chest tubes in the field, with adequate resources.
However, these health-care staff will not be able to rescue
victims who are trapped in collapsed structures. Training programs
should be implemented for local residents. Local teams with specialists
in search techniques, structural engineering, heavy rescue, and
emergency medicine should be formed. All these programs can be formed
only by a very structured organization that requires ample funding.
Therefore, in developing or low-income countries small pilot projects
in high-risk areas should be considered as an initial step. Since the
likelihood of survival for entrapped victims rapidly declines after the
first 24 to 48 h, the priority should be given to seismic safety
in building design. A well-planned medical response is also important,
but it constitutes just one component of the mortality-reducing
strategy in the aftermath of earthquakes.3
The earthquake in Turkey in 1999 resulted in a great number of deaths
and injured people in a region where many medical facilities were put
out of use by the earthquake. In our study, 9.2% of the casualties of
both the Izmit and Duzce earthquakes had thorax and lung injuries.
Pneumothorax was the most frequent pathology observed (50% of
patients), and rib fracture was the second most frequent (33.3% of
patients). Crush syndrome developed in four patients (19%) who had
severe trauma. This condition is characterized by acute renal failure
of rapid onset. A prolonged physical pressure on the muscles and
partial or total loss of blood to the compressed parts lead to the
release of harmful toxins that cause renal failure as well as damage to
the lungs and heart.
In the Kobe, Japan, earthquake (magnitude, 7.2 on the Richter
scale), 12.9% of the patients seen in Kobe University Hospital had
thorax injuries. The most common types of injuries in these patients
were superficial lacerations and contusions (46.0%) followed by the
fracture of ribs or the clavicle (34.9%).6
The total
number of thorax injuries in the Kobe earthquake is slightly higher
than our total number of patients, but the patients hospitalized as
well as the patients examined in the outpatient basis were included in
the analysis of the Kobe University Hospital. Only the hospitalized
patients are included in our study, because it is a retrospective
analysis and the probability of unrecorded outpatients is high on the
day of the disaster. The frequency of rib fractures was similar in both
earthquakes (around 34%), but pneumothorax was a much more frequent
finding in the earthquakes in Turkey (50%) than in the Kobe earthquake
(3.2%). In Turkey, most casualties were heavily entrapped
survivors of totally collapsed buildings. In the Kobe earthquake,
only 12.6% patients were hospitalized and only 9.5% were rescued
from collapsed buildings.6
Most of the injuries were
caused by pieces of flying glass or by falling objects.
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Conclusion
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Among the survivors of a great earthquake, approximately 10% may
be expected to have thorax and/or lung injuries. The most frequent type
of injury probably depends on the way one is exposed to the trauma,
but, in general, pneumothoraces and rib fractures are the most frequent
types of injuries among the heavily entrapped survivors of totally
collapsed buildings.
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Acknowledgements
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The authors thank Haluk Özsaraç
MD, Hanife Yildirim, Özlem Öncel, and Aysun Kanat
for their help in collecting the data from the hospital records.
Received for publication September 5, 2000.
Accepted for publication April 11, 2001.
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References
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Yoshimura, N, Nakayama, S, Nakagiri, K, et al (1996) Profile of chest injuries arising from the 1995 southern Hyogo Prefecture earthquake. Chest 110,759-761[Abstract/Free Full Text]
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Abstract
Introduction
