Christchurch Hospital Emergency Department and the February 22 earthquake

A review by Professor Michael Ardagh and colleagues from the University of Otago, Christchurch and the Canterbury District Health Board, shows emergency health services coped well with the major earthquake in Christchurch on February 22 last year, despite being placed under enormous pressure.

The review has just been published in the top international medical journal The Lancet, graphically describing the impact of the 6.3 earthquake on the Emergency Department (ED) at Christchurch Hospital and the huge patient demand.

It details how the ED staff and health professionals and doctors from across the Canterbury health system managed the unprecedented emergency, treating hundreds of patients who flooded into the department and other Canterbury medical centres and hospitals following the quake and for hours afterwards.

This is despite many services such as power, water and communications at the hospital being interrupted because of the intensity of the shaking, and triage space to diagnose and organise patients being overloaded. For instance the total number of orthopaedic patients admitted was 107 over five days, with 65 on the first day alone.

“The main reasons why we managed to cope with this kind of influx were that we did have a plan, a mass casualty incident response framework and a major external incident plan,” says Professor Ardagh. “That said, the Department also did very well because staff innovated, improvised and took the initiative in dealing with the multiple and extremely urgent and unusual demands of the moment.”

Because of the large numbers of patients, with serious to relatively minor injuries being brought to ED by members of the public, without pre-hospital care, staged triage had to be developed outside ED in the ambulance bay as well as inside.

Some, with minor injuries, went directly home after initial care in the ambulance bay, meaning they had no record of the care provided.

Ardagh reports that as in other earthquakes overseas there were problems in tracking patients, partly caused by two ID numbers, which have since been changed to one.

However, the well established leadership relationships within Christchurch Hospital, between hospitals and primary care in the city, and health professional groups resulted in good teamwork. Previous incidents, and the quake in September 2010 also provided a solid platform for response.

Professor Ardagh says the injuries in Christchurch ED were consistent with those described in other earthquakes, with a large proportion being soft tissue, bony limb and crush injuries. The controlled transfer of some patients to other centres allowed all patients to access treatment to prevent potentially fatal renal failure from crush injuries.

The main lessons arising from the February 22 event according to this review are:

• The importance of rehearsed response plans and a hierarchy of strong leadership
• The need for excellent back-up electricity and communication systems
• Large numbers of patients will present without pre-hospital care, and some will be reluctant to enter the hospital for fear of collapse
• Registration and tracking of patients will be difficult
• Management of volunteer health professionals is essential
• Other hospitals and primary care centres should be integrated into any plan tocope with masses of injured people
• Media interest needing to be managed