Earthquakes and pediatric nephrology: are we prepared?

Abstract

Sirs, With the recent Haiti earthquake causing significant morbidity and mortality [1], it is now time to look back and analyse our readiness for disaster management. Contrary to our expectations and understanding, earthquakes are common natural disasters from a global point of view. As updated on the home page of the US Geological Survey Earthquake Hazards Program (http://earthquake. usgs.gov/), earthquakes with a magnitude 4.0 or greater occur every day all over the world [2]. Because the number of casualties in a large earthquake is much higher than in other natural disasters, crush syndrome has been recognized to be the most frequent cause of acute kidney injury (AKI) after an earthquake. Kidney failure has been identified by the Centers for Disease Control and Prevention as one of the most urgent public health concerns in Haiti following the 7.0-magnitude earthquake on 12 January 2010 [3]. Historically, recognition and better understanding of acute renal failure was obtained following crush injuries in patients in wartime London in 1940 [4]. The main problems handled by pediatric nephrologists are prevention of AKI (by fluid management), management of AKI (due to sepsis, crush injury and infections), management of hyperkalemia, and renal replacement therapy. Proper and timely transportation of the victims with AKI and those with end stage renal disease (ESRD) to the centre with availability of renal replacement therapy is also required. The logistics of medical supply availability is also an issue [5]. In the face of an imminent emergency situation, dialysis facilities, the AKI and the ESRD community, and emergency response organizations need to execute carefully designed plans, with a well-designed timeline for disaster preparation and response [6]. The experience of the Haitian earthquake identified that the organization of effort was not up to par. Use of the Pediatric Nephrology List Serve by Andrew Aronson allowed for global communication outside of Haiti, but did not allow for communication within Haiti. Having “eyes on site” was important to access the needs of the pediatric population. Constant communication with Dr. Emilo Mena Castro in Santo Domingo in the Dominican Republic allowed for close coverage of care. Utilization of Dr. Castro as a pediatric port of call for the identification of the needs of children with AKI and for distribution of equipment for treatment of AKI was important. Intra-island and intra-Haitian communication was lacking, making it difficult to identify who was in need and where they were located. Further, the lack of available equipment for creatinine or potassium analysis also contributed to care delivery difficulty. It was learned that many pediatric nephrologists throughout the world were willing and ready to help in any way. Local communication and intra-country communication is important to assess and deliver care when needed. S. K. Sethi (*) Division of Pediatric Nephrology, Department of Pediatrics, PGIMER and associated RML Hospital, New Delhi, India 110001 e-mail: sidsdoc@gmail.com