1. The Christchurch Earthquake

16. The Christchurch earthquake, 22 February, 2011 The injuries, our response and some lessons learnt

17. Plan • Facts and figures • The earthquake • The damage • The injuries • Christchurch Hospital experience • Lessons

18. 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

19. Facts and figures

20. The earthquake

24. 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

25. The damage

26. The City • 80% of city without power • Water and sewerage compromised • Airport closed • Roads blocked • Communication impaired

30. The Hospital • Scattered damage – particularly ceiling panels • Continued aftershocks (440 in 24 hours) • Water supply lost, and possibly contaminated • Flooding in places, including LGF (blood bank) • Electricity off – essential power from 6 generators • Two of the 6 generators fail repeatedly • Elevators out of action • Theatre, ICU and Radiology upstairs

34. The injuries

35. 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.

37. Providers

41. Injuries from 22 February

42. 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

43. Overall injury burden

44. Deaths in hospital in first 24 hours • Three dead on arrival • Multiple injuries/severe crushing • One died in ED • Major chest trauma • Two deaths in ICU • One severe head trauma, one multiple injuries and haemorrhagic shock • One death in ward • Elderly patient with fractured neck of femur and multiple co-morbidities.

45. Deaths after the first 24 hours • Two late deaths in hospital • Both weeks later • Both elderly • Both respiratory failure • One fractured neck of femur, one multiple limb fractures • One late death in the community • ‘Ruptured heart’

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

47. Christchurch Hospital response

48. Disaster triage

50. 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 • Clerical, Social Work, Radiography and Aids roles