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, 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

Methods Identification 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 depuis le séisme Nombre total de patients déja déchargé? Nombre total de patients ce jour Raison d'admission la plus courante en ce moment?

Rapid Assessent Tool Fracture - Membre Inf Fracture - Membre Sup Fracture - Pelvis Fracture - colonne vertebrale Fracture - complexe Amputation - Membre Inf Amputation - Membre Sup traumatisme médullaire traumatisme cranial brûlure Blessure aux yeux

Rapid Assessent Tool Distribution d'aides de marche? Y a t'il un stock? Besoin d'un stock? Comment fonctionne les distrib? Chirurgiens Infirmiers Physios Ergos Travailleur social Ressources additionnelles nécessaires? 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

Medi share Data 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 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