Were there enough physicians in an emergency department in the affected area after a major earthquake? An analysis of the Taiwan Chi-Chi earthquake in 1999

doi:10.1067/mem.2001.119054

Annals of Emergency Medicine

Volume 38, Issue 5, November 2001, Pages 556-561

https://doi.org/10.1067/mem.2001.119054 Get rights and content

Abstract

Study Objective: The purpose of this study was to evaluate physician manpower and mobilization in an urban emergency department receiving patients after a major earthquake. Methods: Patient charts were reviewed. The workload of physicians was assessed semiquantitatively before and after a major earthquake. The physicians' mobilization in the postearthquake emergency response was assessed by using a confidential questionnaire. Results: In the 3 days after the earthquake, 566 patients with earthquake-related illnesses or injuries were sent to the urban ED. Three hundred one (53.2%) patients arrived within the initial 10 hours. In the initial hours, there was no significant difference between the number of patients per physician per hour before and after the earthquake. Workloads of wound treatment and advanced life support procedures were significantly higher after the earthquake compared with before the earthquake, during the first to sixth hour and second to fifth hour, respectively. Sixty-five percent of the hospital's physicians did not assist in either the ED or in any other parts of the hospital in the initial 6 hours after the earthquake. Conclusion: The number of physicians in the ED was insufficient in the initial hours after the earthquake because of the sudden influx of a large number of patients. Future disaster planning must address the issue of physicians' behavior with regard to their priorities immediately after a major earthquake and include greater provision for efficient mobilization of physicians. [Chen W-K, Cheng Y-C, Ng K-C, Hung J-J, Chuang C-M. Were there enough physicians in an emergency department in the affected area after a major earthquake? An analysis of the Taiwan Chi-Chi earthquake in 1999. Ann Emerg Med. November 2001;38:556-561.]

Introduction

In 1999, there were approximately 20 major earthquakes around the world, which killed 22,000 people.¹ In the early morning (1:47 AM ) of September 21, 1999, central Taiwan suffered a major earthquake (magnitude 7.3 on the Richter scale), which resulted in nearly 2,400 deaths and more than 10,000 injuries. It was the largest earthquake in the world during 1999. The epicenter was near Chi-Chi, a small town about 200 km south-southwest of Taipei and about 40 km southeast of Taichung City. Geographically, the Chelungpu fault crosses 3 main areas of central Taiwan: Nantou County, Taichung County, and Taichung City. It runs along the western margin of the Taichung basin and extends in a north-south direction. The location of the Chelungpu fault, its epicenter, and the vital data of the 3 major affected areas of the Taiwan earthquake in 1999 are shown in Figure 1.

Taiwan is an island nation with a high population density and more than 50 fault lines. Among them, at least 10 faults are active, and many faults run close to major urban concentrations. The last major earthquake of a similar magnitude to strike Taiwan occurred in 1935. In the past 5 decades, no hospitals in Taiwan have had to cope with a natural disaster on such a scale nor has there been a need to manage a large number of patients in a very short period of time. This earthquake therefore presented an overwhelming and novel challenge to the Taiwanese emergency services. Some hospitals had developed disaster plans, but these had not been tested at night or at other times with low manpower.

The American College of Emergency Physicians (ACEP) has stated that, “Emergency physicians should assume a primary role in the medical aspects of disaster planning, management, and patient care.” Furthermore, ACEP has stated that, “Improvement of established disaster management methods requires the integration of data from research and experience. Emergency physicians must use their skills in organization, education, and research to incorporate these improvements as new concepts and technology emerge.”²

In this study, we collected data on physician manpower and mobilization after the earthquake to examine any weaknesses in our emergency department's disaster response.

Section snippets

Materials and methods

The patients in this study received medical care at a 1,290-bed university teaching hospital in Taichung City in central Taiwan. It is located only 10 km from the Chelungpu fault and 40 km from the Chi-Chi epicenter. There were 406 physicians (185 attending and 221 resident physicians) on staff at the hospital, of whom 9 were attending physicians in the ED. There were usually 2 attending and 3 resident physicians in the ED before midnight, which was reduced to 1 attending and 2 resident

Results

A total of 566 patients were admitted to the ED during the initial 3 days after the earthquake. Three hundred seventy-five (66.2%) patients arrived on the first day, and 103 and 88 patients arrived on the following 2 days, respectively. On the first day, the woman/man ratio was 1.6:1, and for September 22 and 23, the ratios were 1.4:1 and 1.3:1, respectively. The majority of patients were 15 to 30 years old.

The diagnostic categories and percentages of these patients with earthquake-related

Discussion

In the Loma Prieta earthquake, Thiel et al³ reported that during a massive earthquake with large numbers of casualties, the greatest demand for medical attention occurs during the initial 24- to 48-hour period after the disaster. Henderson et al⁴ has stated that after a natural disaster, a hospital ED can expect to see an increase of 3 to 5 times the number of patients normally seen in the ED. In the experience of Taiwan's earthquake, the number of patients admitted to our ED increased 1.8-fold

Acknowledgements

Author contributions: WKC and YCC conceived and designed the study. YCC, KCN, and JJH supervised the patients' data collection and managed the physicians' questionnaires, including quality control. CMC provided statistical advice on the study design and analyzed the data. WKC drafted the manuscript and all authors contributed substantially to its revision. WKC takes responsibility for the paper as a whole.

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^*: Author contributions are provided at the end of this article.

^**: Address for reprints: Wei-Kung Chen, MD, Department of Emergency Medicine, China Medical College Hospital, No 2, Yuh-Der Road, Taichung 404, Taiwan, ROC;,886-4-2052121, fax 886-4-2036401; E-mail [email protected].

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Original ContributionsWere there enough physicians in an emergency department in the affected area after a major earthquake? An analysis of the Taiwan Chi-Chi earthquake in 1999*,**

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

J Emerg Med

1999 Large earthquake

Disaster medical service

Ann Emerg Med

911 EMS process in the Loma Prieta earthquake

Prehosp Disaster Med

Original Contributions
Were there enough physicians in an emergency department in the affected area after a major earthquake? An analysis of the Taiwan Chi-Chi earthquake in 1999*,**