International Cooperation: Role of the ISN Commission on Acute Renal Failure and History of Disaster Relief Task Force San Francisco Hilton October 12, 2001 Kim Solez, M.D.

San Francisco San Francisco A fitting setting! A fitting setting!

Slide 3

Slide 4 San Francisco Bay Area Earthquake Timelines

Slide 5 Earthquakes can kill more people in a few days than die in the course of some major wars. Earthquakes can kill more people in a few days than die in the course of some major wars.

Slide 6 255,000 deaths Tangshan, China, ,000 deaths Shensi, China,1556. Revolutionary War - 4,435 deaths. Civil War (both sides) - 498,332 deaths. World War I - 116,708 deaths. World War II - 407,316 deaths. Korea - 25,604 deaths. Vietnam - 58,168 deaths. WTC Bombing - 6,000 deaths. 255,000 deaths Tangshan, China, ,000 deaths Shensi, China,1556. Revolutionary War - 4,435 deaths. Civil War (both sides) - 498,332 deaths. World War I - 116,708 deaths. World War II - 407,316 deaths. Korea - 25,604 deaths. Vietnam - 58,168 deaths. WTC Bombing - 6,000 deaths.

Slide 7 In developing countries many many earthquake deaths are due to crush injury induced acute renal failure. In developing countries many many earthquake deaths are due to crush injury induced acute renal failure.

Slide 8 The Birth of the ISN Commission on Acute Renal Failure Disaster Relief Task Force The Birth of the ISN Commission on Acute Renal Failure Disaster Relief Task Force

On Dec. 7, 1988 a powerful earthquake measuring 6.9 on the Richter scale heavily damaged key residential areas of Soviet Armenia, killing 40,000 and leaving up to 400,000 homeless.

Slide 11 Response to Armenian Earthquake - Good Intentions, but Chaos! No effective dialysis until day 8 following disaster. many of the 40,000 died of renal failure. No effective dialysis until day 8 following disaster. many of the 40,000 died of renal failure. Tremendous influx of people and unsorted material produced a “second disaster”. Tremendous influx of people and unsorted material produced a “second disaster”. This massive failure of worldwide humanitarian efforts provided a strong stimulus for efforts to improve future relief missions in this setting. This massive failure of worldwide humanitarian efforts provided a strong stimulus for efforts to improve future relief missions in this setting.

Slide 12 Key Time Points Dec. 7, Armenian earthquake, massive failure of humanitarian efforts to treat ARF Dec. 7, Armenian earthquake, massive failure of humanitarian efforts to treat ARF Dec. 9, Meeting on “Acute Renal Failure Society” at ASN, debates earthquake relief. Dec. 9, Meeting on “Acute Renal Failure Society” at ASN, debates earthquake relief. Nov Formation of ISN Commission on ARF and Disaster Relief Task Force directed by Kim Solez. European and North American Branch. Nov Formation of ISN Commission on ARF and Disaster Relief Task Force directed by Kim Solez. European and North American Branch.

Slide 13 ISN Disaster Relief Task Force Rapid deployment of dialysis equipment and personnel following natural disasters that result in large numbers of cases of acute renal failure. Rapid deployment of dialysis equipment and personnel following natural disasters that result in large numbers of cases of acute renal failure. Advance team. Advance team. Key persons in each country with contact information. Government and NGO aid agency contacts. Fax network, USGS, the Internet. Key persons in each country with contact information. Government and NGO aid agency contacts. Fax network, USGS, the Internet. Organizational partners MSF, Baxter, Belgian Air Force, European Union. Organizational partners MSF, Baxter, Belgian Air Force, European Union.

Slide 14

Slide 15 Key Time Points (cont.) Meetings at Metropole Hotel (Salon Marie Curie) in Brussels, Iran earthquake Meetings at Metropole Hotel (Salon Marie Curie) in Brussels, Iran earthquake Baxter commitment to fund DRTF. Banff Meeting Baxter commitment to fund DRTF. Banff Meeting Arrangement with MSF, Belgian Air Force, Baxter Europe, and European Union negotiated by Norbert Lameire Arrangement with MSF, Belgian Air Force, Baxter Europe, and European Union negotiated by Norbert Lameire. Sept Kidney International paper published. Sept Kidney International paper published.

Slide 16 Key Time Points (cont.) Latin American Disaster Relief Task force meeting. Macedonia meeting on Renal Aspects of Disaster Relief Latin American Disaster Relief Task force meeting. Macedonia meeting on Renal Aspects of Disaster Relief Norbert Lameire succeeds Kim Solez as chair of ISN Commission on ARF Norbert Lameire succeeds Kim Solez as chair of ISN Commission on ARF. Aug. 16, Massive earthquake in Turkey, DRTF deployed early prevented many cases of ARF. Mortality among the 400+ dialyzed patients only 17% compared with the usual 50%. Aug. 16, Massive earthquake in Turkey, DRTF deployed early prevented many cases of ARF. Mortality among the 400+ dialyzed patients only 17% compared with the usual 50%.

Slide 17 Key Time Points (cont.) April 13, Norbert Lameire awarded prestigious International Medal by US National Kidney Foundation. April 13, Norbert Lameire awarded prestigious International Medal by US National Kidney Foundation.

Slide 18 Vision for the Future Need more successes like Turkey. Need more successes like Turkey. Preparation essential. Preparation essential. Quakes are coming closer and closer to Istanbul, a megacity of 8 million people. Quakes are coming closer and closer to Istanbul, a megacity of 8 million people. An earthquake in this or another megacity would create a catastrophy of unimagined proportions! An earthquake in this or another megacity would create a catastrophy of unimagined proportions! Need to find a support structure for North and South America and Asia, as the Task Force at present is fully functional only in Europe. Need to find a support structure for North and South America and Asia, as the Task Force at present is fully functional only in Europe.

Slide 19 Suggested Reading: Probability of Istanbul Quake, KI papers Sever MS, Erek E, Vanholder R,... Lameire N. et al. Marmara Earthquake Study Group. The Marmara earthquake: epidemiological analysis of the victims with nephrological problems. Kidney Int 60: , 2001 Sever MS, Erek E, Vanholder R,... Lameire N. et al. Marmara Earthquake Study Group. The Marmara earthquake: epidemiological analysis of the victims with nephrological problems. Kidney Int 60: , 2001 Parsons T, Toda S, Stein RS, Barka A, Dieterich JH. Heightened odds of large earthquakes near Istanbul: An interaction-based probability calculation. Science Apr 28;288(5466): Parsons T, Toda S, Stein RS, Barka A, Dieterich JH. Heightened odds of large earthquakes near Istanbul: An interaction-based probability calculation. Science Apr 28;288(5466): Solez K,... Eknoyan G, Eliahou H,... Lameire N, et al. International dialysis aid in earthquakes and other disasters. Kidney Int. 44:479-83, Solez K,... Eknoyan G, Eliahou H,... Lameire N, et al. International dialysis aid in earthquakes and other disasters. Kidney Int. 44:479-83, 1993.

Slide 20