Christchurch Hospital. Photo / APN
Christchurch's only hospital emergency department has been praised for its response to the deadly February 22, 2011 earthquake in a global medical journal.
The initial medical response by Christchurch Hospital highlights how careful preparation for such a disaster helped to reduce death rates and the burden of injury, international medical journal, The Lancet has reported today.
The magnitude-6.3 shake killed 182 people in the first 24 hours, injured 6500, wiped out electricity and communication lines, while also damaging the city's only emergency department.
But despite the horrendous working conditions faced by frontline hospital staff and influx of casualties, the emergency health system response was "very effective", a review published online today by The Lancet said.
"The hospital activated well-developed and practised internal and external incident plans and the response of other non-acute hospitals and primary care facilities was critical to ensuring an effective and timely response," said lead author of the study, Michael Ardagh from the University of Otago, Christchurch.
The report said the city was able to draw on experience of previous incidents and practice exercises, including activation of the mass casualty incident plan in response to an earthquake that injured 97 in the Christchurch area in September 2010.
Christchurch Hospital faced many hurdles in the aftermath of the quake the report said.
Its buildings were extensively damaged in the violent shaking, with some areas losing all power because of disturbed sump sludge in the back-up generators' diesel tanks.
Loss of its communication systems meant the emergency department had little information on the scope of the disaster, expected numbers of casualties, and when patients might arrive.
Meanwhile, large numbers of patients arrived on foot, in cars, carried by members of the public, in police vehicles, on doors strapped to the tops of cars, and in the back of small trucks.
Impassable roads and communication difficulties resulted in little pre-hospital triage or treatment for most of those who presented early, the report said.
To overcome these difficulties, the report says: "Radiotelephones and mobile phones were made available to key staff, and medical students were sent to get updates from television broadcasts and report back.
"The open-air ambulance bay was used to provide triage and to treat patients who were unwilling to enter the hospital buildings for fear of collapse."
Other challenges included registering and keeping track of patients.
Professor Ardagh said: "Use of multiple patient identifiers led to inefficiencies in matching imaging and laboratory results with individuals and colleagues.
"The use of unique patient identifiers and dedicated staff for identifying and tracking patient movements will help in future major incidents."
A surge in volunteers without overall organisation emphasised the importance of anticipating and managing the many volunteer medical staff to ensure immediate use of their skills.
The review also highlighted the need for atypical providers of acute injury care to be included in disaster response plans.
Professor Ardagh said: "Robust emergency plans were in place at most facilities but they did not anticipate the need to receive triage, and manage so many undifferentiated injured patients."
The report authors concluded that an integrated approach is needed for future disasters, in which primary care providers, non-acute hospitals, and acute hospitals are "prepared to provide care for masses of injured people."