Disaster nephrology: Medical perspective

Disaster medicine is an extension of emergency medicine involving mass casualties and use of the best available techniques in search and rescue. To achieve the best results extensive, predisaster preparedness is mandatory. Earthquakes have caused the loss of more than 1 million lives in the 20th century. Evidence-based medicine confirms that these deaths were mostly preventable based on experience in developed countries. The key to success is implementing building codes and structural reinforcement. In earthquakes as well as in collapse of buildings in bomb blasts, loss of life is either because of the direct effect of trauma or to the metabolic consequences of rhabdomyolysis and complications of its management. Hyperkalemia and infection are the commonest causes of death in victims who survive the direct effect of trauma. Acute renal failure, a grave complication of rhabdomyolysis, is mostly preventable by timely rehydration and bicarbonate therapy. Mannitol therapy can be very efficient in reducing the severity of muscle damage and its sequelae. Fasciotomy can be limb saving if it is done in the early hours, although a firm guideline is still lacking. Although each country is responsible for improving the structure of buildings and organizing an efficient disaster response, national and international organizations in developed countries should give high priority to communicating with developing countries to encourage their preparedness. (C) 2003 by the National Kidney Foundation, Inc.