Tropical cyclone Fani-perspective from the trauma and emergency department of an affected tertiary hospital

Purpose:To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department(TED)of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster.Methods:A retrospective study was conducted in the TED in the affected zone.Data of all victims affected by the cyclone Fani on May 3,2019 were obtained from disaster records and medical case sheets.All patients except death on admission were included.Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score(RTS)and injury severity score(ISS).Trauma injury severity score(TRISS)was also calculated.Results:Of 75 patients,74 were included and the other one was brought dead and thus excluded.The age,median±interquartile range(IQ),was 41.0(27.7-53.0)years.The male to female ratio was 2:1.Most of the wounded were transported by the police control room vans on day 1:first 10 h,50.0%;10-24 h,20.3%.The median±IQ range of RTS,ISS and TRISS were 20(14-28),7.84(7.841-7.841),and 97.4(91.6-98.9),respectively.Simple external injury was the dominant injury type.Polytrauma(ISS>15)was seen in 67%cases and spine injury in 14%cases(7%cervical and 7%thoracolumbar).Injury causes included sharp flying objects(broken pieces of glasses and asbestos)in 31%cases,followed by fall of trees in 20.3%.Twenty-four patients were discharged after primary treatment,30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center.There was no in-house mortality.Challenges were related to electricity failure,mobile network breakdown,infrastructure collapse,and delay in expertise repair from outside due to airport/railway closure.Conclusion:In cyclonic storm like Fani,sharp flying objects,fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions.Polytrauma was seen in the majority of patients though external injury was the commonest.The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.

Pattern of injuries due to wild animal attack among patients presenting to the emergency department:A retrospective observational study

Purpose:The human-wildlife conflicts(HWCs)causing nuisances and injuries are becoming a growing public health concern over recent years worldwide.We aimed to study the demographic profile,mode of injury,pattern of injury,and outcome of wild animal attack victims presented to the emergency department.Methods:This retrospective cross-sectional study was conducted in the emergency department of a tertiary-care hospital in Eastern India.Data were retrieved from the medical records from May 2017 to May 2021.Patients of all ages and genders attacked by wild animals and secondary injuries were included in this study.Patients with incomplete data,injuries due to the attack of stray and domestic animals and trauma due to other causes were excluded.Demographic profile,mode of injury,the pattern of injury,injury severity score(ISS),radiological pattern,and outcome were recorded.Statistical analysis with R(version 3.6.1.)was conducted.Results:A total of 411 wild animal attack victims were studied,of which 374(90.9%)were snakebite injuries and 37(9.1%)were wild mammalian(WM)attack injuries.The mean age of WM attack victims was 46 years,and the male-to-female ratio was 4:1.Elephant attack injury(40.5%)was the most common WM attack injury reported.Most WM attacks(43.2%)occurred between 4:00 a.m.to 8:00 a.m.The median ISS was 18.5(13-28),where 54.2%of patients had polytrauma(ISS>15).Elephant attack was associated with a higher ISS,but the difference was not significant compared to other animal types(p=0.2).Blunt trauma was common pattern of injury in the elephant attack injury cases.Lacerations and soft tissue injuries were common patterns in other animal attacks.Among snakebites,neurotoxic was the most common type(55.4%),and lower extremity was the most common site involved.Conclusion:The young male population is the major victim of HWCs;and elephant is the most common animal involved.There is a need to design scientifically sound preventive strategies for HWCs and to strengthen the preparedness in health establishments to manage victims effectively.