Mistakes and complications of wound treatment in children affected by earthquakes

The article presents the experience of organizational and therapeutic work as part of a mobile specialized pediatric surgical team during the period of liquidation of the medical consequences of devastating earthquakes. An analysis of the treatment of children with open bone fractures and soft tissue injuries at all stages of medical evacuation was carried out, the main causes of complications and adverse outcomes were diagnosed and identified. Special attention is paid to therapeutic, tactical and surgical errors, incorrectly performed operations and primary surgical treatment of wounds, which were carried out at the stage of inpatient treatment in children before the arrival of mobile specialized pediatric surgical team. In all cases, the errors presented were the direct causes of severe purulent-septic complications. The guideline of surgical treatment of complications and the features of management of this patient population are substantiated. The experience of treating children with complicated course of soft tissue injuries and open fractures indicates the need for complex, multi-stage operations under general anesthesia in most of the victims. A rational scheme of medical, organizational and advisory work in the general system of medical and sanitary provision for children in emergency situations, developed and consistently applied by mobile specialized pediatric surgical team specialists in practice, is presented, namely, the interaction of the hospital (the main hospital for the concentration and treatment of the children’s contingent) based with other medical institutions and hospitals where injured people were admitted and treated after the earthquake. children.

1. The largest earthquakes of the XXI century. (in Russ.) https://tass.ru/info/16986795?ysclid=m6t8gg0sf0669368508 / Ссылка активна на 11.01.2025

2. Boyce W.H., Saravanan S.A., Wolfson N. Traumatic Injuries During Earthquakes. In: Orthopedics in Disasters. Editors Wolfson N., Lerner A., Roshal L. Berlin.: Springer, 2016; pp. 109–121. DOI: 10.1007/978–3–662–48950–5_10

3. Gutiérrez E., Taucer F., De Groeve T., Al-Khudhairy D. H., Zaldivar J. M. Analysis of worldwide earthquake mortality using multivariate demographic and seismic data. Am J Epidemiol 2005; 161(12): 1151–1158. DOI: 10.1093/aje/kwi149

4. National Geophysical Data Center. World Data Service (2024) — with major processing by Our World in Data. “Deaths from earthquakes — NOAA/NCEI” [dataset]. National Geophysical Data Center. World Data Service, “Global Significant Earthquake Database” [original data]. https://ourworldindata.org/grapher/earthquake-deaths / Ссылка активна на 11.01.2025

5. Leor J., Poole W.K., Kloner R.A. Sudden cardiac death triggered by an earthquake. The New Engl J Med 1996; 334(7): 413–419. DOI: 10.1056/NEJM199602153340701

6. Roshal L.M. An Overview: Pediatric Trauma During Natural and Man-Made Disasters. In: Orthopedics in Disasters. Editors Wolfson N., Lerner A., Roshal L. Berlin.: Springer, 2016; pp. 439–443. DOI: 10.1007/978–3–662–48950–5_35

7. Rozinov V.M., Derzhavin V.M., Keshishyan R.A., Malakhov O.A. et al. Organization of work of teams of specialized surgical care for children in the conditions of man-made disasters and natural disasters. Voenno-medicinskij zhurnal 1990; 7. (in Russ.)

8. Roshal L.M., Keshishian R., Mitish V.A., Karaseva O. Crush Syndrome in Children. In: Orthopedics in Disasters. Editors Wolfson N., Lerner A., Roshal L. Berlin.: Springer, 2016. DOI: 10.1007/978–3–662–48950–5_39

9. Keshishian R., Puzhitsky L., Basargin D., Nikishov S., Ratin D., Roshal L.M. Medical Care for Children with Skeletal Injuries After Earthquakes. In: Orthopedics in Disasters. Editors Wolfson N., Lerner A., Roshal L. Berlin.: Springer, 2016. DOI: 10.1007/978–3–662–48950–5_38

10. Djalali A., Khankeh H., Öhlén G., Castrén M., Kurland L. Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study. Scand J Trauma Resusc Emerg Med 2011;19: 30. DOI: 10.1186/1757–7241–19–30

11. Kondo H., Koido Y., Morino K., Homma M., Otomo Y., Yamamoto Y., Henmi H. Establishing Disaster Medical Assistance Teams in Japan. Prehosp Disaster Med 2009; 24 (6): 556–564. DOI: 10.1017/s1049023x00007512

12. Liang N.J., Shih Y.T., Shih F.Y., Wu H.M., Wang H.J., Shi S.F., et al. Disaster epidemiology and medical response in the Chi-Chi earthquake in Taiwan. Ann Emerg Med 2001; 38 (5): 549–555. DOI: 10.1067/mem.2001.118999

13. Saghafinia M., Araghizade H., Nafissi N., Asadollahi R. Treatment management in disaster: A review of the Bam earthquake experience. Prehospital Disast Med 2007; 22 (6): 517–521. DOI: 10.1017/s1049023x00005355

14. Ceferino L., Mitrani-Reiser J., Kiremidjian A., Deierlein G., Bambarén C. Effective plans for hospital system response to earthquake emergencies. Nat Commun 2020; 11(1): 4325. DOI: 10.1038/s41467–020–18072-w

15. Teryaev V.G., Potapov V.I., Intern L.L., Bayramov Sh.A. Organization of emergency medical care for earthquake victims. Medicinskij alfavit 2018; 2(18): 51–54. (in Russ.)

16. Abu-Zidan F.M., Idris K., Cevik A.A. Prehospital management of earthquake crush injuries: A collective review. Turk J Emerg Med 2023; 23(4): 199–210. DOI: 10.4103/tjem.tjem_201_23

17. Bar-On E. Medical care following earthquakes: Clinical, organizational, and logistic challenges. Acta Orthop Traumatol Turc 2023; 57(6): 296–300. DOI: 10.5152/j.aott.2023.23184

18. Zhang T.-Ch. Zhongguo dang dai er ke za zhi = Chinese J Contemporary Pediatr 2013; 15(6): 416–418.

19. Bar-On E., Lebel E., Blumberg N., Sagi R., Kreiss Y.; Israel Defense Forces Medical Corps, Petah Tikva, Israel. Pediatric Orthopedic Injuries Following an Earthquake: Experience in an Acute-Phase Field Hospital. J Trauma Nurs 2015; 22(4): 223–228. DOI: 10.1097/JTN.0000000000000143

20. Turanlı E.E., Özkaya P.Y., Koç G., Ersayoğlu İ., Karapınar B. Characteristics of Pediatric Intensive Care Patients Following the 2020 İzmir Earthquake. J Pediatr Res 2023; 10(4): 259–263. DOI: 10.4274/jpr.galenos.2023.70845

21. Jacquet G.A., Hansoti B., Vu A., Bayram J.D. Earthquake-related injuries in the pediatric population: a systematic review. PLoS Curr 2013;5:ecurrents.dis.6d3efb-a2712560727c0a551f4febac16. DOI: 10.1371/currents.dis.6d3efba2712560727c0a551f4febac16..

22. Yilmaz S., Akkoc G., Tuncay S.A., Parlak B., Isik A.D., Erdemli P.C., et al. Pediatric wound infections following 2023 Kahramanmaras earthquakes: case series. Wounds 2024; 36(7): 221–226. DOI: 10.25270/wnds/23158

23. Eryilmaz-Eren E., Yalcin S., Ozan F., Saatci E., Suzuk-Yildiz S., Ture Z., et al. An outbreak analysis of wound infection due to Acinetobacter baumannii in earthquake-trauma patients. Am J Infect Control 2024; 52(5): 599–604. DOI: 10.1016/j.ajic.2023.12.005

24. Kantawala B., Shariff S., Barakat M., Wellington J., Nazir A., et al. Medical care after the 2023 earthquake in Türkiye. Int J Surg: Global Health 2023; 6(4): e0163 DOI: 10.1097/GH9.0000000000000163

25. Yeşil E., Tezol Ö., Gokay N., Sürmeli Döven S., Mısırlıoğlu M., Akça M., et al. Analysis of wound infections among pediatric patients following the 2023 Türkiye-Syria earthquakes. Pediatr Surg Int 2024; 40(1): 198. DOI: 10.1007/s00383–024–05755–4

26. Joint Evaluation of Their Responses to the Yogyakarta Earthquake. Independent Evaluation by Pauline Wilson and Donal Reilly with support from Ryan Russell, Malaika Wright, Astri Arini, Desideria Cempaka, Eri Diastami, Listya Narulita, Maria Angela Anindita, YB Johan Dwi Bowo Santosa, Yos Handani, and Yustina Tri Wahyuningsih. Report CARE, Catholic Relief Services, Save the Children and World Vision Indonesia. July 2007. https://www.crs.org/sites/default/files/tools-research/joint-evaluation-response-yogyakarta-earthquake.pdf / Ссылка активна на 10.03.2025

27. Erdogan H., Oto A., Yerci G., Kocer G., Menekse B., Akturk B., et al. An earthquake reality: Fasciotomy wounds and treatments. Eur Res J 2024; 10(6): 1–8. DOI: 10.18621/eurj.1465494

28. Rozinov V.M., Malakhov O.A., Keshishyan R.A., Konovalov A.K. Surgical tactics in the treatment of prolonged compression syndrome in children. In: Medical aspects of the earthquake consequences in Armenia. Yerevan, 1990; pp. 164–165. (in Russ.)