title: Orthopedic Activity in Field Hospitals Following Earthquakes in Nepal and Haiti : Variability in Injuries Encountered and Collaboration with Local Available Resources Drive Optimal Response.
abstract: Field hospitals have been deployed by the Israel Defense Forces (IDF) Medical Corps in numerous disaster events. Two recent deployments were following earthquakes in Haiti in 2010 and in Nepal in 2015. Despite arrival in similar timetables, the mode of operation was different-independently in Haiti and in collaboration with a local hospital in Nepal. The pathology encountered in the two hospitals and the resultant treatment requirements were significantly different between the two events. The purpose of this study was to analyze these differences and their implications for preparation and planning of future deployments.
  
  
  
  Data were obtained from IDF records and analyzed using SPSS™ software.
  
  
  
  1686 patients were treated in Nepal versus 1111 in Haiti. The caseload in Nepal included significantly less earthquake-related injuries (26 vs. 66 %) with 28 % of them sustaining fractures versus 47 % in Haiti. Femoral fractures accounted for 7.9 % of fractures in Nepal versus 26.4 % in Haiti with foot fractures accounting for 23.8 and 6.4 %, respectively. The rate of open fracture was similar at 29.4 % in Nepal and 27.5 % in Haiti. 18.1 % of injured patients in Nepal underwent surgery, and 32.9 % of which was skeletal compared to 32 % surgical cases (58.8 % skeletal) in Haiti. 74.2 % of patients in Nepal and 34.3 % in Haiti were treated for pathology unrelated to the earthquake.
  
  
  
  The reasons for the variability in activities between the two hospitals include the magnitude of the disaster, the functionality of the local medical system which was relatively preserved in Nepal and destroyed in Haiti and the mode of operation which was independent in Haiti and collaborative with a functioning local hospital in Nepal. Emergency medical teams (EMTs) may encounter variable caseloads despite similar disaster scenarios. Advance knowledge of the magnitude of the disaster, the functionality of the local medical system, and the collaborative possibilities will help in planning and preparing EMTs to function optimally and appropriately. However, as this information will often be unavailable, EMTs should be capable to adapt to unexpected conditions.
authors.affiliation: Schneider Children's Medical Center, Petah Tikva, Israel. belhanan@gmail.com.|Israel Defense Forces Medical Corps, Jerusalem, Israel. belhanan@gmail.com.|Sackler Medical School, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. belhanan@gmail.com.
authors.forename: Elhanan
authors.initials: E
authors.lastname: Bar-On
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.|Sackler Medical School, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.|Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Nehemia
authors.initials: N
authors.lastname: Blumberg
authors.affiliation: Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Kathmandu, Nepal.
authors.forename: Amit
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Gam
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.|Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Amos
authors.initials: A
authors.lastname: Peyser
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.|Barzilai Medical Center, Ashkelon, Israel.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Lee
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.|Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Shree Krishna
authors.initials: SK
authors.lastname: Kashichawa
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.|Barzilai Medical Center, Ashkelon, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Morose
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.|Dov Klein Medical Center, Tel Aviv, Israel.
authors.forename: Ophir
authors.initials: O
authors.lastname: Schein
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.|Rambam Healthcare Campus, Haifa, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Lehavi
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.|Sheba Medical Center, Tel Hashomer, Israel.|The Department of Military Medicine, The Hebrew University, Jerusalem, Israel.
authors.forename: Yitshak
authors.initials: Y
authors.lastname: Kreiss
authors.affiliation: Israel Defense Forces Medical Corps, Jerusalem, Israel.|The Department of Military Medicine, The Hebrew University, Jerusalem, Israel.
authors.forename: Tarif
authors.initials: T
authors.lastname: Bader
mesh_terms: D003299:Cooperative Behavior; D004190:Disasters; D055866:Earthquakes; D005260:Female; D006205:Haiti; D006295:Health Resources; D006761:Hospitals; D006801:Humans; D008297:Male; D009390:Nepal; D019637:Orthopedic Procedures; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult