Specifics of rescuing specialized surgical operation for earthquake-stricken in Nepal

There is work analysis of pediatric team (Roshal’s Pediatric Team) while rescuing specialized surgical operation for earthquake-stricken in Nepal 25.04.20015.

Materials and methods. Team of Russian doctors of GBUZ NII NDHiT DZ of Moscow rescued specialized medical operation for earthquake-stricken in Nepal from 30.04.2015 to 18.05.2015. The team consisted of 7 doctors: 2 surgeons, 2 traumatologists, 1 neurosurgeon and 2 anesthesiologists. During that period the team performed: 621 patients’ consultation, among which 184 are children. 59 patients needed complex surgical treatment. 32 of them were adults and 27 children. The age of patient was from 3 to 80 years. Open traumas of soft tissues and bones were complicated with purulent infection at all patients. Close traumas were represented by limb injuries and back bone trauma. The most often cases were lower limb injuries - 39 (49,3 %) patients. Among them the most part was with lower leg injuries – 21 (53,8 %). The second place took upper limbs traumas – 13 (19,7 %) with localization in shoulder area – 6 (46,2%).

Results. 115 operartions were done for 59 patients, 362 bandages and 235 anaesthetic support were done. 52 surgical d-bridements were performed at purulent-necrotic wounds treatment, and 30,7 % needed repeated surgical d-bridement. For local treatment polypharmaceutical ointments based on polyethyleneglycol were used — 69,4 % and iodiphor solutions — 30,6 %. Wounds were ready for final phase of surgical treatment 10-14 days later after surgical d-bridement of purulent-necrotic places, which appeared due to one-time impact of traumatic agent, and 14-18 day later at crush syndrome. For substitution of wound defects and closing of wound surfaces different reparative and plastic operation were used: local tissues plasty of wound (48,1 %), dosed tissue stretching plasty of wound (29,7 %), fasciocutaneous flap with axial type of blood supply (3,7 %), free split autodermotransplantate plasty of wound (18,5 %). In all cases of patient treatment with open soft tissue and bone injuries a positive result was achieved. Only 2 (3,4 %) patients had some marginal flap necrosis, which was neutralized during next bondages. One patient had humid gangrene and sepsis of lower leg and it was decided to perform amputation at the level of upper third part of lower leg.

Conclusions.The use of both methods: active surgical treatment and conveyor belt method of anesthesia providing (on two tables simultaneously) allowed to decrease timelines for recovering and improve treatment quality. Despite some organizational difficulties they could managed with purulent-inflammatory complications, refused from amputations planned by local surgeons and did reparative and plastic operation even in emergency conditions. 

1. Брюсов П. Г. Опыт оказания медицинской помощи пострадавшим при катастрофическом землетрясении 1988 года в Армении. Военный медицинский журнал. 2014; (1): 58-66. [Bryusov P. G. Experience in delivery of health care at injured in disastrous earthquake of 1988 in Armenia. Military medical magazine = Voennyj medicinskij zhurnal 2014; (1): 58-66. (In Russ.)].

2. Eiseman B., Chandler J. G. Sheriff’s Surgeon’s Alert: a Trauma Surgeon Responsibility. J Trauma 2003; 54(1): 156-160.

3. Redmond A. D., Mardel S., Taithe B., Calvot T., Gosney J., Duttine A., Girois S. A Qualitative and Quantitative Study of the Surgical and Rehabilitation Response to the Earthquake in Haiti. 2010. Prehospital and Disaster Medicine. 2011; 26(06): 449—456.

4. Мирзоян А. Э., Швед С. И. Современные представления о принципах организации и объеме хирургической помощи при массовых катастрофах (Обзор литературы). Гений ортопедии. 2001; 2: 61-68. [Mirzoyan A. E., Shved S. I. Modern representations of principal of organization and amount of surgical help in mass disaster (Literature review). Genius of orthopaedy = Genij ortopedii. 2001; 2: 61-68. (In Russ.)].

5. Хрупкин В. И. Организация неотложной специализированной хирургической помощи населению в чрезвычайных ситуациях. Медицина катастроф, скорая и неотложная помощь и экстремальная медицина. 2000; 162-165. [Hrupkin V. I. Organization of urgent specialized surgical help to people in emergency. Disaster medicine, urgent help and extreme medicine = Medicina katastrof, skoraja i neotlozhnaja pomoshh' i jekstremal'naja medicina. 2000; 162-165. In Russ.)].

6. Cushman J. G., Pachter H. L., Beaton H. L. Two New York City Hospitals Surgical Response to the September 11, 2001, Terrorist Attak in New York City. J Trauma 2003; 54:1: 147-155.

7. Ответные меры ВОЗ в случае тяжелых широкомасштабных чрезвычайных ситуаций. Доклад Генерального директора: http://apps.who.int/gb/ebwha/pdf_files/ WHA69/A69_26-ru.pdf [Countermeasures of WHO in case of difficult large-scale emergency situations. Report of the CEO: http://apps.who.int/gb/ebwha/pdf_files/ WHA69/A69_26-ru.pdf].

8. Рошаль Л. М., Митиш В. А., Мединский П. В. Специализированная хирургическая помощь детям с открытыми повреждениями, пострадавшим при землетрясениях. Хирургия. 2014; 1: 59-63. [Roshal L., Mitish V., Medinskiy P., Specialized surgical help to children with open injuries during earthquakes. Surgery = Hirurgija 2014; 1: 59-63. In Russ.)].

9. Mitish V., Roshal L., Medinskiy P., Nalbandyan R. Role of mobile surgical team in treating children with serious injuries after the earthquakes. Difficulties in organizing the mission. Prehospital and Disaster Medicine. 2013; 28:1: 41

10. Кузин М. И., Костючёнок Б. М. Раны и раневая инфекция. 2-е изд. перераб. и доп. М.: Медицина, 1990. 591 с. [Kuzin M. I., Kostyuchenok B. M. Wounds and wound infection. 2nd volune reworked and added – Moscow: Medicine, 1990. P. 591. In Russ.)]