The 2004 tsunami disaster: injury pattern and microbiological aspects

Introduction

On 26 December 2004, a giant earthquake shocked south-east Asia triggering deadly flood waves (tsunami) across the Indian Ocean. More than 300,000 people have been reported dead and millions left destitute. Shortly thereafter, the German government organized airborne home transfer of the most severely injured tourists using 'MedEvac' aircraft (Medical Evacuation). Upon arrival, patients were distributed to various medical centers. One cohort was admitted to the Cologne-Merheim Medical Center (Germany) for further surgical and ICU treatment.

Objective

To describe the unique pattern of injuries and microbiological findings associated with the 2004 Tsunami disaster.

Methods

Seventeen severely injured tsunami victims were screened upon arrival for characteristic injury patterns. In parallel, multilocal microbiological assessment was performed to identify pathogens responsible for high-level wound contamination.

Results

The predominant pattern of injury comprised multiple large-scale soft-tissue wounds (range: 2 × 3–60 × 60 cm²) located at lower (88%) and upper extremities (29%), but also the head (18%). Additional injuries included thoracic trauma with hemopneumothorax and serial rib fractures (41%) and peripheral bone fractures (47%). A major problem associated with wound management was significant contamination. Microbiological assessment identified a variety of common (Pseudomonas 54%, Enterobacteriae 36%, Aeromonas hydrophilia/veronii 27%) but also uncommon isolates with high resistances (multiresistant Acinetobacter and ESBL-positive E. coli 18% each). Upper respiratory tract specimens contained an unusual high rate of multiresistant Acinetobacter species, but also MRSA, A. hydrophilia, Pseudomonas and Candida albicans.

Conclusion

Individuals who survived their initial injuries and who were evacuated to Europe had traumatic injuries to the head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be placed into isolation until their microbial flora is identified as they may introduce new pathogens into an ICU.

Figure 1

(abstract P128)