Crush syndrome resulting in rhabdomyolysis and acute kidney injury is the second most frequent cause of mortality after direct trauma after major earthquakes. After the Haiti earthquake, efforts were made to set up a functioning dialysis unit and the team encountered many problems related to communication, infrastructure, and logistic hurdles. For example, there was no running water or electricity. After several days, the dialysis unit was up and running. 19 patients with crush syndrome were ultimately referred for hemodialysis and the team ran 64 dialysis sessions. The authors attributed the low number of patients who were dialyzed to the fact that most people who were severely injured died early on.
What can we as nephrologists learn from the Haiti disaster relief efforts? Vanholder et al. for the RDRTF summarized in the Lancet:
1. “need for better interagency communication to provide awareness of services available in the disaster area”
2. “the necessity of early fluid resuscitation”
3. “the value of the iSTAT point-of-care device for early diagnosis.” By measuring the potassium, BUN, creatinine, the medical team was able to identify patients quickly who were in need of renal replacement therapy.
Haiti, considered the poorest nation in the Western Hemisphere, has only four known nephrologists for its nine million people. There was a symposium at the American Society of Nephrology annual meeting last year on disaster relief, which was particularly timely. The role for nephrologists in disaster relief efforts and ways to improve mobilization, logistics, and communication remain ongoing topics for discussion.
Posted by Julie Paik M.D.