Different medical needs between hurricane and earthquake victims

Abstract

Study objectives: Because of recent world events, disaster planning has become more important. To better understand patient needs and thereby improve resource allocation for deployments, it is important to examine past disaster responses. Previous studies found important differences between flood and hurricane victims and noted similarities between victims of 2 hurricanes. However, there are few if any other data or research in this area. Our study question is, Do the victims of hurricanes have different medical needs than the victims of earthquakes?Methods: We performed a retrospective cohort review of patient encounter forms. All patients treated by the New Mexico Disaster Medical Assistance Team (NMDMAT) after Hurricanes Andrew and Iniki (Florida, August 1991, and Hawaii, September 1991, respectively) and the Northridge, CA (January 1994), earthquake were included. The parameters we examined were age, medical history, chief complaint, diagnosis, treatment rendered, and disposition of the patient. We analyzed age using Student's t test and all other variables using χ2 test. We considered differences significant at a P value less than .05. Results are reported as hurricanes versus earthquake, odds ratio (OR), 95% confidence interval (CI).Results: NMDMAT treated 1,056 patients after the hurricanes and 621 after the earthquake. Patients presenting after the hurricanes were older (mean 33.3 years versus 22.3 years, difference 11.0±1.97 years, P<.0001). Female patients were treated less often after the hurricanes (46.7% versus 58.0%, OR 0.62, 95% CI 0.51 to 0.77). Patients after the hurricanes reported negative medical histories less often (38.9% versus 67.5%, OR 0.31, 95% CI 0.25 to 0.38). We found several differences in chief complaints between the 2 types of disasters. They were wounds (24.5% versus 5.3%, OR 5.79, 95% CI 3.95 to 8.72), musculoskeletal pain (12.7% versus 8.7%, OR 1.53, 95% CI 1.08 to 2.17), medication refill (11.4% versus 3.1%, OR 4.06, 95% CI 2.46 to 7.05), upper respiratory symptoms (URIs) (12.2% versus 42.9%, OR 0.19, 95% CI 0.14 to 0.24), abdominal complaints (4.9% versus 9.7%, OR 0.48, 95% CI 0.32 to 0.72), and stress (0.9% versus 6.3%, OR 0.14, 95% CI 0.06 to 0.29). The diagnoses also differed with respect to wounds (19.3% versus 4.6%, OR 4.97, 95% CI 3.37 to 7.56) and URIs (3.1% versus 15.8%, OR 0.17, 95% CI 0.11 to 0.2). Treatments rendered were reflective of the chief complaints and diagnoses: wound care (17.5% versus 4.7%, OR 4.24, 95% CI 2.86 to 6.47), tetanus (17.1% versus 3.8%, OR 5.17, 95% CI 3.36 to 8.25), medications refilled (5.6% versus 1.7%, OR 3.47, 95% CI 1.81 to 7.31), antibiotics (16.4% versus 23.0%, OR 0.65, 95% CI 0.51 to 0.83), and pain relievers (10.1% versus 27.1%, OR 0.30, 95% CI 0.23 to 0.39). The victims of the hurricanes had a higher acuity according to triage category, with a lower proportion triaged as green (79.9% versus 91.0%, OR 0.39, 95% CI 0.25 to 0.61). There was no difference in patients sent to a hospital (5.9% versus 5.2%, OR 1.15, 95% CI 0.73 to 1.84).Conclusion: Several differences were found including chief complaint, diagnoses given, treatment rendered, and level of acuity. The older patients treated by NMDMAT after the hurricanes resulted in more patients with medical histories and therefore more medication refills. More URIs were treated after the earthquake, likely caused by more dust produced during an earthquake than a hurricane, leading to throat, eye, and lung irritation mimicking URI symptoms. Stress-related complaints were more common after the earthquake, likely because of the suddenness of the event, leaving the population less emotionally prepared to deal with the disaster. In conclusion, this unique study demonstrates some interesting points: first, and not surprisingly, that hurricane and earthquake victims have different medical needs; and second, these results taken in the context of previously published studies indicate that different disasters will likely result in different medical needs among the victims, but these needs may be predictable according to the disaster type (ie, flood, hurricane, or earthquake).