The challenges facing medical professionals after the Nepal earthquake

WATCH ABOVE: Thousands have died in Nepal and many more are suffering after a devastating earthquake. Dr. Samir Gupta discusses the challenges facing medical professionals in a disaster zone.

What are the medical consequences of the Nepal earthquake?

As we watch the heartbreaking images of bodies being pulled from destroyed homes in Nepal, one of the main concerns that I have is that the worst is yet to come.

Although each environment is different, scientific studies of the health consequences of various earthquakes around the world can give us a glimpse of what to expect and how we might save the most lives. An extensive review on this topic by Dr Susan A. Bartels and Michael J. VanRooyen was published in the Lancet in 2012, and provides some guidance. There appear to be three typical waves of injuries and deaths after an earthquake.

The first is the immediate deaths, usually from massive brain or spinal cord trauma from being hit by debris, and in this case also due to avalanches. Next, a number of people die within a few hours of the quake, usually from loss of blood from various injuries or from being trapped under debris and being unable to breathe, or running out of air. Finally, there’s a third peak that happens days to weeks after the disaster, and that’s the one that we have the best chance to address with international humanitarian aid efforts. These are people who develop complications such as sepsis from infected wounds, dehydration, crush syndrome – which is when muscles break down after people have been trapped under debris for long periods, and cause the kidneys to fail – and also hypothermia.

Hypothermia is a particular concern in Nepal because not only have people lost their homes, but because of the frequency and severity of aftershocks, people are afraid to go indoors, and families are living out in the open where it is cold and wet (especially at night).

We know that there have been almost 5,000 deaths in this earthquake, and a 1996 study by D. Alexander in Disasters suggests that on average, there are about three injuries for every earthquake death. Accordingly, there are probably around 15,000 injured people needing help in Nepal right now. While the majority of people have minor cuts and bruises caused by falling debris, about 20 to 25 per cent of the injuries are likely to be fractures, many of which will require surgery. The issue here is that the earthquake has not only destroyed medical facilities, but also roads and bridges, interrupting medical supply chains and making it harder to transport patients requiring surgery.

The other issue is that a number of non-injury related health problems seem to flare after earthquakes. For example, in 2006, R.A. Kloner reported in Progress in Cardiovascular Diseases that heart attacks were up 35 per cent in the week after the 1994 earthquake in California. Similarly, in 1998, K. Kario and T. Ohashi reported in the Journal of the American Geriatrics Society that strokes nearly doubled after the 1995 Japan earthquake. This is believed to be related to high stress levels, as well as the fact that people tend to stop taking their medications in these situations. For the same reasons, we see flares in mental health problems and respiratory illnesses. The latter are also triggered by the large amount of dust released from collapsing buildings.

Finally, there are public health concerns, and the largest of these is infections. When many people are crowded into shelters, the spread of infectious diseases is accelerated, particularly respiratory and water-borne illnesses. The major threat in Nepal would be contamination of the water supply. If untreated sewage finds its way into the water supply, this is a recipe for widespread diarrhea illnesses such as cholera.