Patients rescued from rubble after the 2023 Kahramanmaraş earthquake

Background: This study examines the conditions and laboratory results of patients who were rescued from the rubble and brought to the emergency department following the earthquake centered in Kahramanmaraş on 06 February 2023. The aim is to serve as a resource for healthcare professionals in future disasters, helping to enhance preparedness and reduce loss of life. Methods: This study was designed as a retrospective descriptive study. Demographic data, clinical conditions, and laboratory results of patients rescued from the rubble were retrieved from the hospital’s automation system. Statistical analyses were performed using SPSS Windows version 23.0. A total of 92 patients rescued alive from the rubble were included in the study. Results: The mean duration of entrapment beneath the rubble was 3.5 ± 2.19 days. The most significant complications observed were crush syndrome in 35.9% of patients, the need for dialysis in 17.4%and emergency blood transfusion in 7.6%. Of the patients monitored in the study, 26.1% died, 23.9% required intensive care admission, 50% were treated as inpatients and 23.9% were discharged on the same day. Conclusions: Our findings suggest that proper management of patients rescued from rubble, with particular attention to the risk of crush syndrome and acute kidney failure, is crucial for improving outcomes.

Earthquake; Emergency medicine; Rubble; Kahramanmaraş

[1] Özkaya U, Yalçın MB. Differentiation of compartment syndrome and crush syndrome in earthquake injured patients: fasciotomy to whom and when? Journal of the Turkish Society of Orthopaedics and Traumatology. 2022; 21: 312–315.

[2] Sever MS, Vanholder R; the RDRTF of ISN Work Group on Recommendations for the Management of Crush Victims in Mass Disasters. Recommendations for the management of crush victims in mass disasters. Nephrology Dialysis Transplantation. 2012; 27: i1–i67.

[3] Disel NR, Taskin O, Daglioglu G, Tor B, Secinti S, Devecioglu GF, et al. Factors affecting the mortality of February earthquakes victims in Türkiye. American Journal of Emergency Medicine. 2024; 77: 115–120.

[4] Özkan KÖ. Management of intensive care patients in earthquake; crush syndrome and thorax trauma. Turkish Neurosurgery Journal. 2023; 33: 148–152.

[5] Engin O. Crush syndrome and acute kidney injury. Turkish Neurosurgery Journal. 2023; 33: 153–158.

[6] Ağın Gözükızıl C, Tezcan S. Disasters in Türkiye in the centenary of the republic: 06 February 2023 Kahramanmaras earthquakes. Kent Akademisi. 2023; 16: 97–114.

[7] Sever MS, Erek E, Vanholder R, Özener C, Yavuz M, Kayacan SM, et al. Lessons learned from the Marmara disaster: time period under the rubble. Critical Care Medicine. 2002; 30: 2443–2449.

[8] Macintyre AG, Barbera JA, Smith ER. Surviving collapsed structure entrapment after earthquakes: a “time-to-rescue” analysis. Prehospital and Disaster Medicine. 2006; 21: 4–17.

[9] Inaba M, Naito H, Hisamura M, Harada K, Nakao A. Multidisciplinary approach to a 93-year-old survivor with crush syndrome: a 124-h rescue operation after the 2024 Noto Peninsula earthquake. Acute Medicine & Surgery. 2024; 11: e967.

[10] Usuda D, Shimozawa S, Takami H, Kako Y, Sakamoto T, Shimazaki J, et al. Crush syndrome: a review for prehospital providers and emergency clinicians. Journal of Translational Medicine. 2023; 21: 584.

[11] Bartal C, Zeller L, Miskin I, Sebbag G, Karp E, Grossman A, et al. Crush syndrome: saving more lives in disasters: lessons learned from the early-response phase in Haiti. Archives Of Internal Medicine. 2011; 171: 694–696.

[12] Bulut M, Fedakar R, Akkose S, Akgoz S, Ozguc H, Tokyay R. Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake. Emergency Medicine Journal. 2005; 22: 494–498.

[13] Ramírez-Guerrero G, Reis T, Marcello M, de Cal M, Ronco C. Crush syndrome-related acute kidney injury in earthquake victims, time to consider new therapeutical options? The International Journal of Artificial Organs. 2024; 47: 3–7.

[14] Long B, Liang SY, Gottlieb M. Crush injury and syndrome: a review for emergency clinicians. American Journal of Emergency Medicine. 2023; 69: 180–187.

[15] Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010; 14: 28–32.

[16] Gasecka A, Zimodro JM, Appelman Y. Sex differences in antiplatelet therapy: state-of-the art. Platelets. 2023; 34: 2176173.

[17] Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. The New England Journal of Medicine. 2009; 361: 62–72.

[18] Neugarten J, Acharya A, Silbiger SR. Effect of gender on the progression of nondiabetic renal disease: a meta-analysis. Journal of the American Society of Nephrology. 2000; 11: 319–329.

[19] Oda J, Tanaka H, Yoshioka T, Iwai A, Yamamura H, Ishikawa K, et al. Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. Journal of Trauma and Acute Care Surgery. 1997; 42: 470–475; discussion 475–476.

[20] Koyuncu S, Sipahioglu H, Bol O, İlik HKZ, Dilci A, Elmaağaç M, et al. The evaluation of different treatment approaches in patients with earthquake-related crush syndrome. Cureus. 2023; 15: e47194.