Research

One year ago not business as usual: Wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia

Marc Maegele^1,2 , Sven Gregor³ , Nedim Yuecel¹ , Christian Simanski¹ , Thomas Paffrath¹ , Dieter Rixen¹ , Markus M Heiss³ , Claudia Rudroff³ , Stefan Saad³ , Walter Perbix⁴ , Frank Wappler⁵ , Andreas Harzheim⁶ , Rosemarie Schwarz⁷ and Bertil Bouillon¹

¹Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany

²Intensive Care Unit of the Department of Traumatology and Orthopedic Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany

³Department of Visceral Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany

⁴Department of Plastic and Reconstructive Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany

⁵Department of Anaesthesiology, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany

⁶Department of Radiology, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany

⁷Department of Microbiology, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany

author email corresponding author email

Critical Care 2006, 10:R50doi:10.1186/cc4868

Published:	29 March 2006

Abstract

Introduction

Following the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients.

Methods

This study is an observational report on complex wound management, infection and psychoemotional control associated with the 2004 Tsunami disaster. The setting was an adult intensive care unit (ICU) of a level I trauma center and subjects included severely injured tsunami victims repatriated from the disaster area (19 to 68 years old; 10 females and 7 males with unknown co-morbidities).

Results

Multiple large flap lacerations (2 × 3 to 60 × 60 cm) at various body sites were characteristic. Lower extremities were mostly affected (88%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included aggressive debridement together with vacuum-assisted closure in the interim between initial wound surgery and secondary closure. All patients received empiric anti-infective therapy using quinolones and clindamycin, later adapted to incoming results from microbiology and resistance patterns. This approach was effective in all but one patient who died due to severe fungal sepsis. All patients displayed severe signs of post-traumatic stress response.

Conclusion

Individuals evacuated to our facility sustained traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated severe post-traumatic stress response. For optimum treatment and care a multidisciplinary approach is mandatory.