Treatment of Survivors after the Tsunami

Treatment of Survivors after the Tsunamito the editor: The tsunami that struck the Asian subcontinent and Africa on December 26, 2004, caused the deaths of more than 200,000 people.In Thailand more than 10,000 people were treated in ambulatory health centers.After a tsunami, the effects on people occur in three phases.The injuries that are incompatible with life (e.g., severe cardiovascular events, head injury, and blunt injury) happen in the first minutes; then, over the following hours, complications such as massive hemorrhage, hemopneumothorax, and pulmonary embolism are seen.These are followed, in turn, by the late complications, including infectious diseases that develop over days to weeks. 1 A tsunami directly injures the victims by the mechanism of blunt trauma and penetrating injury to any part of the body. 1 Soil, small pieces of wood, and glass in the contaminated saltwater penetrate the soft tissue of victims at high velocity.Most of those who survived the disaster also had saltwater aspiration.In most of those admitted to health care facilities with cellulitis, progressive fasciitis developed unless there was prompt treatment with appropriate antibiotics and aggressive débridement. 2Other common complications included bony fractures, soft-tissue contusions, hypoxic encephalopathy, and acute stress disorder.The volunteer medical team at Rajavithi Hospital in Bangkok, Thailand, treated 37 patients with serious medical complications.All 37 had aspirated saltwater contaminated with soil and had soft-tissue infections.Aspiration pneumonia (in 17 patients), pneumothorax (in 7), and pneumomediastinum (in 3) were the major respiratory problems.In eight patients the acute respiratory distress syndrome developed, with a progressive course in three, rapid resolution followed by severe pneumonia in three, and rapid resolution followed by mildto-moderate pneumonia in two.Burkholderia pseudomallei is endemic in this region. 3We encountered one human immunodeficiency virus (HIV)-positive patient with a B. pseudomallei lung abscess and one patient with diabetes mellitus in whom acute B. pseudomallei lobar pneumonia developed (Fig. 1).Table 1 summarizes the clinical findings in these two patients, who had melioidosis after the disaster.Both were febrile, with cough, dyspnea, and sputum production, and required respiratory support.Among all the patients, cultures of blood, spu-