Accepted Manuscript Typhoon Haiyan - Any Role for Neurosurgery in Natural Disasters? Debadutta Dash, MD Vyas Viswanathan, BS Sepideh Amin-Hanjani, MD PII:

S1878-8750(14)00290-3

DOI:

10.1016/j.wneu.2014.03.040

Reference:

WNEU 2328

To appear in:

World Neurosurgery

Please cite this article as: Dash D, Viswanathan V, Amin-Hanjani S, Typhoon Haiyan - Any Role for Neurosurgery in Natural Disasters?, World Neurosurgery (2014), doi: 10.1016/j.wneu.2014.03.040. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Typhoon Haiyan - Any Role for Neurosurgery in Natural Disasters? Debadutta Dash MD, Vyas Viswanathan BS, Sepideh Amin-Hanjani MD

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Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA

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Corresponding Author: Sepideh Amin-Hanjani MD Department of Neurosurgery University of Illinois at Chicago Chicago, IL, USA [email protected]

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In late 2013, Typhoon Haiyan consumed Southeast Asia in a fury of violent rain and 190 mph winds. The record-breaking storm claimed over 5,200 lives and survivors continue to search for thousands of missing family members and friends. Catastrophic damage from the storm, primarily in the Leyte and Samar provinces (Figure 1), injured over 18,000 people and left over 4 million without their homes. Those who survived are often without food, water, means of communication, transportation, and basic medical care. The local government, structurally weakened by the storm and unable to handle the tremendous burden, has relied upon international aid from the World Health Organization (WHO) and various other humanitarian organizations to lead the much needed medical relief efforts. Despite the influx of international aid, survivors still face the potential for substandard medical care due to delays, excessive patient loads, and limited resources in the affected regions.

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The natural disaster occurred too recently for any formal epidemiological data to be available. According to reports from ground zero, however, the primary medical issues being treated include diarrhea, pneumonia, and infected wounds (11, 12). Poor sanitation and a weakened infrastructure preventing the transport and storage of antibiotics and vaccinations (3) has made infections a mortal problem. Given this, does Neurosurgery have any role in the early management period? A high incidence of spine and head injuries following earthquakes has been well described in the literature (1, 8, 5). However, there is a dearth of literature on neurotrauma resulting from tropical storms and typhoons. Looking at past epidemiological data, morbidity and mortality after hurricanes are related to drowning, electrocution from downed power lines, and mechanical injuries from flying debris (7, 9). Although head injuries are common, (9, 6) patients seen in the hospital often have lacerations or minor traumas that do not require surgical intervention (9, 10). However, neurosurgeons can still play a meaningful role in defining the proper medical response in such settings. Neurosurgical expertise is valuable to creating a tailored emergency response; for example, protocols for first responders such as those for simple but effective first-line strategies in neurotrauma management, such as spinal immobilization, airway protection, and priority triage of surgical head injuries.

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Especially notable to hurricanes is the widespread destruction of a region’s infrastructure, which may severely compound already existing problems in access to medical care. In the immediate aftermath, priorities are rescue, triage and transport. Neurosurgeons typically play no significant role in those activities, but can provide logistical support and man-power to re-establish neurosurgical services at medical centers receiving injured victims. Typhoons and tropical storms are not typically associated with cranial and spine injuries, but there is certainly a subset of the population that will require neurosurgical care. This may include patients who sustain traumatic mechanical injuries or even new non-disaster related cases requiring time-sensitive neurosurgical intervention. Management of such cases may be difficult, if not impossible, in the acute post-disaster setting in the absence of basic necessities such as electricity and running water; however, once logistical issues are addressed and basic infrastructure is functional, neurosurgeons on hand can facilitate appropriate, qualified care of neurosurgical disease.

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Current literature is deficient in robust data to better characterize the mechanisms of injury and management protocols related specifically to neurosurgical care in different types of mass casualty/ natural disaster settings. Such studies will be required to optimize neurosurgical management, particularly in resource poor regions in which expatriate neurosurgical care is likely to be critical in providing effective management. The future of emergent disaster-related neurosurgical care will invariably require mobile solutions to attempt shorter times to the operating room for emergency procedures. Attempts at such solutions have been made in other arenas of trauma care and surgical services (2, 4); however with the complexities of modern operating room equipment, the need for advanced imaging and complicated post-operative care, the difficulty is significantly higher in neurosurgery than other surgical specialties. Despite these difficulties, significant advancements have been made, especially in mobile imaging with modalities such as portable CT. It remains to be seen how technology and staffing will evolve in the upcoming decades to support such mobile environments.

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In the meantime, the storm has subsided in the Philippines, leaving a devastating scar on the South Pacific islands. Now, the focus is shifting from emergency relief to stabilization and rehabilitation. Our thoughts and sympathies are with those suffering tragic losses and injuries in the wake of the deadly typhoon.

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Figure 1 – Map of the Philippines showing the path of Super Typhoon Haiyan and population affected. From Lancet 382:1691-2, 2013. References

1. Bartels SA, VanRooyen MJ: Medical complications associated with earthquakes. Lancet 379:748-57, 2013. 2. Baxt WG, Moody P: The impact of a rotorcraft aeromedical emergency care service on trauma mortality. J Am Med Assoc 249:3047-51, 1983. 3. Chiu Y: Typhoon Haiyan: Philippines faces long road to recovery. Lancet 382:1691-2, 2013.

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4. Cunningham P, Rutledge R, Baker CC, Clancy TV: A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene. J Trauma 43:940-946, 1997.

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5. Gosney JE, Reinhardt JD, Von Groote PM, Rathore FA, Melvin JL: Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce settings: implications for disaster research. Spinal Cord 51:603–9, 2013. 6. Hendrickson LA, Vogt RL, Goebert D, Pon E: Morbidity on Kauai before and after Hurricane Iniki. Prev Med 26:711–6, 1997.

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7. Paul BK: Human injuries caused by Bangladesh’s cyclone sidr: an empirical study. Nat Hazards 54:483–95, 2009.

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8. Rathore FA, Farooq F, Muzammil S, New PW, Ahmad N, Haig AJ: Spinal Cord Injury Management and Rehabilitation: Highlights and Shortcomings From the 2005 Earthquake in Pakistan. Arch Phys Med Rehabil 89:579–85, 2008. 9. Rotheray KR, Aitken P, Goggins WB, Rainer TH, Graham CA: Epidemiology of injuries due to tropical cyclones in Hong Kong: a retrospective observational study. Injury 43:2055–9, 2012. 10. Shultz JM, Russell J, Espinel Z: Epidemiology of Tropical Cyclones: The Dynamics of Disaster, Disease, and Development. Epidemiol Rev 27:21–35, 2005. 11. Win TL: Philippines quake survivors face super-Typhoon Haiyan. Reuters 2013. Available at: http://www.trust.org/item/20131106153803-ae31t. Accessed 11/20/2013.

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12. World Health Organization. WPRO | Typhoon Haiyan (Yolanda): World Health Organization, 2013. Available at: http://www.wpro.who.int/philippines/typhoon_haiyan/en/. Accessed Nov 30, 2013.

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Typhoon Haiyan: any role for neurosurgery in natural disasters?

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