Iranian 2012 earthquake: the importance of Focused Assessment with Sonography for Trauma (FAST) in assessing a huge mass of injured people

Abstract

The 2012 Iranian earthquakes took place in the cities of Ahar and Varzqan in East Azerbaijan province, on August 11, 2012, at 16:53 Tehran time. The twin earthquakes struck northwest Iran on magnitude scales of 6.4 and 6.3 Richter. The two earthquakes were separated by 11 min [1]. The earthquakes were strong enough to destroy 70–90 % of 100 villages, with 20 villages disappearing completely [2]. These twin earthquakes were disastrous events with significant medical and psychosocial consequences. At the night of the event, Imam Reza Hospital, the main referral hospital and trauma center in East Azerbaijan province, was responsible for admission and medical care of injured people [2, 3]. According to Ghabili et al. [2], about 1,000 patients were transferred to hospitals in Tabriz, the capital city of East Azerbaijan province. General surgery residents and attending physicians were responsible for triage and providing trauma care for transferred injured people [3–5]. In addition, emergency medicine residents and attending physicians and residents of neurosurgery, orthopedics, and radiology were at the hospital participating in providing trauma care. General surgery residents and attending physicians did triage of patients on the basis of being in need of emergent care or not being in need of emergent care [3]. The patients who were in need of emergent care were admitted to the emergency department to be under direct observation [3, 4]. All injured patients, even patients who were not in need of emergent care, were supposed to have a blunt abdominal trauma to some extent. The initial evaluation of injured people with respect to their abdominal trauma consisted of a physical examination and a Focused Assessment with Sonography for Trauma (FAST) [4]. First, FAST was done by emergency physicians and general surgery residents, and then, it was repeated by radiology residents. In the cases of a positive FAST and stable vital signs, an abdominal IV contrast computed tomography (CT) scan was conducted. In the cases of unstable vital signs, diagnostic peritoneal lavage (DPL) was done. In the cases with both negative physical examination and negative FAST, interval follow-up visits were planned. Two CT devices were available at the hospital for the management of injured people. Although both FAST and CTwere available for the trauma team, decisions were made based on hemodynamic status and physical examination rather than radiologic findings. However, nonoperative management of blunt solid organ injuries of the abdomen is of potential clinical interest and necessitates availability of CT [6]. About 350 FAST examinations were conducted, and about 330 of them were repeated by radiology residents. FAST sonographies were done over a time period of about 5–10 min. About 50 individuals had positive FAST F. Kakaei : S. Zarrintan (*) Department of General Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Golgasht St., Tabriz 51664, Iran e-mail: s.zarrintan@yahoo.com