Medical teams in disaster zones should be prepped to treat children

Emergency medical teams deployed to disaster zones should anticipate a large number of surgical procedures in pediatric patients, particularly those of an orthopedic nature, research suggests.

More than one in three individuals treated by a medical deployment team following the 2010 earthquake in Haiti were children and adolescents, report investigators.

These children were more likely to sustain femoral fractures and were more likely to require surgery than adults in the disaster zone, they say.

"Organizations providing post-earthquake relief are usually geared toward adult populations and will require supplementation of both manpower and equipment specifically suited for treatment of pediatric patients," write Elhanan Bar-on (Schneider Children's Medical Center, Petah Tikva, Israel) and colleagues in the Journal of Trauma and Acute Care Surgery.

The earthquake in Haiti struck on January 12, 2010, killing 222,570 and injuring 300,000 people.

Among the responders, the Israel Defense Forces (IDF) Medical Corps dispatched a field hospital to the disaster zone. The field hospital was operational 89 hours after the earthquake and included four operating theaters.

Within hours of being set up, the hospital was filled to surge capacity. Specifically, the teams treated 1111 patients, of whom 37% were children or adolescents (≤18 years).

Nearly half (47%) of the pediatric patients were treated for fractures sustained during the earthquake, of which 72% were lower-limb fractures. The femur was the most commonly fractured bone in children compared with the tibia in adults.

Overall, 34% of children had a femur fracture versus 23% of adults, a borderline statistically significant difference.

Among the children admitted to the field hospital for traumatic injuries, 44% underwent surgery. By contrast, 29% of adults underwent surgery.

Of the procedures performed on children during the 10-day deployment, 41% were soft-tissue procedures, including debridement, rotation flaps, and skin grafts. Nineteen patients underwent closed reduction of femoral fractures with spica casting and 15 patients had an external fixation of the fracture.

Open fractures tended to be more common in children compared with adults.

Bar-on et al conclude: "Early deployment teams should be adequately staffed with adult and pediatric orthopedists."

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