Pediatric surgical emergencies in the setting of a natural disaster: Experiences from the 2001 earthquake in Gujarat, India

Background/Purpose: On January 26, 2001, a 7.9 Richter earthquake struck the Indian state of Gujarat. Over the next 6 days, the International Red Cross set up a mobile hospital in the city of Bhuj, near the epicenter. The authors describe all surgeries on children treated there during the first 4 weeks of operation. The evolution of presenting injuries is noted, the types of surgery required are classified and an effective disaster relief team composition and strategy are proposed. Methods: Total casualties were estimated at 30,000, with 250,000 people injured. Of 1,142 inpatients treated at NorFinn hospital during the first 4 weeks, approximately 300 (25%) were less than or equal to17 years old. Of these, the authors report on the 62 who underwent surgery. Demographic data collected includes (where possible) age, date of presentation, injury, and surgery performed. Injuries are classified as orthopedic, soft tissue, burns, or miscellaneous. Injuries are grouped in 4 weekly time periods beginning February 1 when the hospital opened. Results: Children's ages were evenly distributed. Children required surgery less often than adults. Of children needing surgery, 42% needed orthopedic attention, 42% had soft tissue trauma, 10% had burns, and 6% had miscellaneous injuries. During the hospital's first week, operations were predominantly orthopedic. During the second week, orthopedic and soft tissue injuries occurred at similar frequency. In weeks 3 and 4, soft tissue and burn surgeries were prevalent. Conclusions: More than 25% of patients requiring hospitalization were children, of whom greater than 20% needed surgery. The operations fell into 4 categories: orthopedic, soft tissue injuries, burns, and miscellaneous. There was an immediate need for orthopedic and general surgery skills followed by a delayed need for plastic surgery skills.