After the dust settles

1. After the dust settles Mike Ardagh, Professor of Emergency Medicine University of Otago, Christchurch

2. After the dust settles – the initial health system response to the February 22, 2011, Christchurch earthquake

3. 12.51, February 22, 2011

4. Nature has no daughter and father has no son Papa rolls beneath me and Rangi’s on the run

5. The night is falling on us and morning might not come "You're just starting," Mother mocks me, "a fight already won."

6. "Loaves or fishes?" Mother teases, "I've only got a few But indeed we have not either, so neither then will do.”

7. “Heart or lungs?" she continues, "you cannot have the two, so it’s breathing or it’s beating. That’s the best I’ll do for you.”

8. “Heart or lungs,” mother promised, but even then she lied That’s bad, that’s bad enough, but worse the bad belied

9. The hearts are full or air and the lungs are blood inside They skip an empty beat and their breath is sanguine sighed

10. “The time has come,” the Walrus says “to talk of many things, of how we might make good of this, until that lady sings.”

11. A call to arms, willing troops, and the stuff that each one brings “Let’s go,” shouts the Carpenter, “my family of kings.”

12. Scrums take shape around them all, binding extra tight They roll, while she is sleeping, further from the light,

13. Shoulders briefly rounded, now holding heads upright, Doubt and dark and danger, just focusing the fight

14. Now Mother, you are waking. Does our spirit give you life? Do you see how we are fighting, with heart and head and knife

15. How Rangi has returned, to settle down his wife? How we chased away that man, the one with cape and scythe

16. So quiet his dark dissection, so quickly his retreat, and the parts of us he carried as he hurried silent feet

17. But our grip on others strengthened, a strength he couldn’t meet He’s gone now, we believe, conceding his defeat

18.  Nature has no daughter. Nature you’re a thief Your hand was cold as ice, your fingers bit like teeth

19. A moment of oblivion, an eternity of grief, but we stand now where you felled us, bolstered by belief.

20. Plan • Telling our own stories (Rhise) • The initial health system response • Some lessons learned

21. Confidentiality • Identifiable pictures of the public have come from public media • Hospital pictures have no identifiable patients, but remain sensitive • Staff are identifiable • The images aren’t for distribution

22. The Christchurch earthquake, 22 February, 2011 Telling our own stories

24. Rhise Is a loose collaboration of researchers and research groups

25. Rhise Specific objectives: • Create a forum for sharing • Encourage funding for EQ research • Construct a database of the total burden of injury and illness

26. 1. Create a forum for sharing Basecamp - a shared website for: • Management and collaboration of projects online • Sharing information between groups

28. 2. Encourage funding for EQ research

29. 3. Construct a database of the total burden of injury and illness

30. Lancet 2012;379:2109-15

31. The Christchurch earthquake, 22 February, 2011 The injuries, our response and some lessons learned

32. Facts and figures

34. 12.51pm, Tuesday Feb 22, 2011 • 6.3 magnitude, 10k SE of CBD, 5k deep • Accelerations up to 2.2G • Among the highest ever recorded • The greatest vertical accelerations on record

35. Christchurch City • Mains power gone • Sewerage broken • Water lost • Transport difficult • Communication limited

36. Christchurch Hospital • Infrastructure damaged • Continuous aftershocks (440 in the first 24 hours) • Running water possibly contaminated • Flooding in places (blood bank) • Communication overloaded • Supplies stretched • Electricity lost repeatedly • Unable to get upstairs

37. Bad eh?

38. Factors associated with injury and death • Peak ground accelerations • Time of day • Type of buildings • multi-storey, concrete, unreinforced masonry Ramirez M, Peek-Asa C. Epidemiology of traumatic injuries from earthquakes. Epidemiol Rev 2005; 27: 47–55.

40. Injuries from 22 February

43. Total Injuries (first 24 hours) 6659 (ACC accepted claims) Pegasus Health 24 Hour Surgery 373 Pre-hospital deaths* 175 Southern Cross Hospital 94 Christchurch Hospital ED 365 disaster packs used 273 patients registered (3 DOA, 1 death in ED) Princess Margaret Hospital 50 Burwood Hospital 15 Admitted to Christchurch Hospital 142 (14 transfers to other cities, 1 death on the ward) St Georges Hospital 9 Admitted to ICU 18 (2 deaths) Other primary care 5578 *182 deaths in first 24 hours. 185 official toll attributed to the earthquake

44. Overall injury burden

45. Other deaths? • True death toll open to interpretation • Elderly evacuated • Elderly in damaged homes • Cardiac deaths • Road trauma from quake damaged roads • ?respiratory deaths

46. Christchurch Hospital response

47. Disaster triage

49. Key roles • ED medical and nurse controllers • Red, yellow, green (and black) medical and nursing leaders • In red area, teams in each resus capable bay with at least one ED doc and nurse • Clerical, Social Work, Radiography and Aids roles

50. Patients • First patient a child unconscious and blue, brought in by a stranger • First briefing from ED registrar who ran in from town “It’s carnage; the city is flattened” • About 100 registered in first two hours • Probably 100 more not registered