Can the emergency department sustain the first strike? Experience from the 2016 earthquake in Tainan

Background: After the main shock of a major earthquake, casualties cluster in a short period and may overwhelm the capacities of health care facilities. An earthquake with a magnitude of 6.4 on the Richter scale struck Tainan City causing 117 fatalities and 513 injuries. Objectives: We conducted a retrospective study to review the medical records of emergency department after the attack of earthquake. The aim of this study was delineating the medical resource requirements after the disaster. Methods: We reviewed the medical records of patients admitted to the emergency department of Chi Mei Medical Center. Each chart indicating that the emergency department visit was earthquake‐related was reviewed. After the earthquake struck, the Chi Mei Medical Center mobilized off‐duty staff through a preset 333 code. Subsequently, routine surgeries and nonurgent admissions were postponed to reserve the maximal capacity for wounded patients. Results: A total of 150 patients were reviewed during the study period. In all, 25 cases (23.8%) required admission, and 9 of them (8.6%) were admitted to the intensive care unit. Patients with earthquake‐related injuries constituted 62.8% of all traumatic patients in the 24‐h aftermath. The requirements for wound sutures, blood component transfusion, numbers of radiographic/computed tomographic scans, and invasive procedures increased dramatically (earthquake‐related/total: 66.0%, 30.0%, 72.1%/57.4%, and 47.7%, respectively). Conclusion: Patients with earthquake‐related injuries arrived at the emergency department soon after the earthquake occurred and substantial emergency department resources were utilized in the 24‐h aftermath. Each hospital should have a preset mobilization signal to call in off‐duty workers to treat casualties resulting from the main shock of an earthquake. Subsequently, hospital‐based mobilization should be initiated to provide comprehensive care to severely injured patients.