EARTHQUAKE KNOWLEDGE UPDATE

EARTHQUAKE KNOWLEDGE UPDATEkapak

FIRST AID AND TRIAGE

Buğra Kundakçı1 Melih Bağır2

1Çukurova University, Faculty of Medicine, Department of Orthopedics and Traumatology, Adana, Türkiye
2Çukurova University, Faculty of Medicine, Department of Orthopedics and Traumatology, Adana, Türkiye

Kundakçı B, Bağır M. First Aid and Triage. In: Kalenderer Ö, Servet E, editors. Earthquake Knowledge Update. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.25-33.

ABSTRACT

Natural disasters, especially earthquakes, create a serious burden on health systems with their sudden and devastating effects. Orthopedic trauma accounts for approximately 90% of injuries in such mass disasters, and systematic triage, rapid response and optimal utilization of resources are vital for effective disaster management. This chapter presents the basic principles of post-earthquake orthopaedic trauma management based on clinical experience and literature.

The sudden increase in patient load in disasters necessitates the correct application of the triage system due to limited resources. Triage ensures the most efficient use of resources by classifying patients according to risk to life, danger of limb loss, and urgency of treatment. Especially in unpredictable disasters such as earthquakes, there is a peak in hospital admissions in the first 24-72 hours, and in this process, it is of great importance to distinguish between simple injuries and critical cases.

The most common mechanism of injury in earthquakes is crush injuries due to building collapse. In such traumas, systemic complications such as rhabdomyolysis, compartment syndrome, and acute renal failure may develop in tissues exposed to prolonged compression. In the management of crush syndrome, fluid resuscitation and necessary surgical interventions in the first 6 hours “golden period” are of vital importance. Fasciotomy should only be considered in the early period. Amputation should be considered, especially in cases where limb perfusion is impaired and the risk to life is high.

In the management of orthopedic injuries, emergencies such as open fractures and compartment syndrome are the priority. External fixators are one of the most appropriate methods for fracture stabilization in disaster conditions because they can be applied quickly and effectively with minimal resource use. Definitive surgical procedures should be postponed until the patient is stable and resources are sufficient.

In the post-disaster period, team coordination and a multidisciplinary approach form the basis of a successful treatment process. Orthopedists should work in collaboration with emergency physicians, general surgeons and nephrologists to ensure that patients recover with minimal damage. In addition, regular patient follow-up and efficient use of resources help to minimize the long-term effects of the disaster.

In conclusion, orthopedic trauma management in mass disasters such as earthquakes is shaped by rapid decision making, correct triage and effective surgical interventions. In this process, clinical experience and knowledge of the literature play a critical role in increasing survival rates. It is recommended that hospitals update their disaster protocols and continue trainings to prepare for future disasters.

Keywords: Earthquake; Triage; Crush syndrome; Fasciotomy; Amputation; External fixator; Damage control orthopedics; Disaster management

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