Abstract
Earthquake areas in Yushu County, Qinghai.
According to the Xinhua News Agency, in the Yushu County quake more than 2220 people were confirmed dead, 70 are missing, and 12,135 were injured, of which 1434 were severely injured. Homes, schools, monasteries, and health facilities have all collapsed or are on the verge of collapse.
The Yushu earthquake was one of the highest earthquakes in the world; the quake areas are at a mean altitude of 4000 m (elevation from 3750 m to some villages sitting above 4878 m). As head of a Qinghai medical rescue team, I and my team were promptly rushed to the stricken area. Emergency teams have been pouring into the quake area in the meantime. Some 35 civilian and military medical rescue teams with 3346 medical workers have been working in Yushu since the quake. Because the quake areas are at a high altitude and local medical facilities were badly damaged in the quake, on April 17 more than 1300 seriously injuried were airlifted to hospitals at the lower neighboring cities of Xining (2261 m), Golmud (2808 m), and Lanzhou (1517 m). In these hospitals, surgeons and nurses performed 544 emergency surgical operations.
Unexpectedly, within 24 h some 100,000 rescuers (half of them soldiers) who were lowlanders were rapidly transported by air (the Yushu–Batang airport, at 3980 m, is 20 km from the quake epicenter) from the lowlands of China to Yushu, and immediately after their arrival they worked around the clock to save the lives of people buried under the debris of collapsed houses. However, as quake relief workers rushed to the quake-hit area, they were often stranded by heavy snow, hail, and sandstorms. Overnight temperatures fall to −12°C to −15°C at Jeigu County even in spring. Freezing weather, high altitude, and cold have made the rescue efforts difficult.
A high incidence of acute altitude illness occurred in the unacclimatized rescuers. About 80% of these, who were from sea level or lowlands, developed acute mountain sickness (AMS). For example, in the Guangdong rescue team from Guangzhou city at sea level, nearly all 300 rescuers suffered from AMS and had to be evacuated to low altitude. During the rescue operation, one reporter was confirmed dead owing to serious high altitude pulmonary edema (HAPE), and another rescuer died from high altitude cerebral edema (HACE). A 42-year-old electrician working to restore a local power supply died suddenly in the field without prodromal symptoms after strenuous physical exertion. He had dug for survivors with hands and shovel, and it is speculated that his sudden cardiac death was owing to coronary artery disease. In addition, one rescuer died in a road accident, and another died in a strong aftershock. To “rescue the rescuers” was a main task of the Qinghai and Tibetan rescue teams.
Among approximately 20,000 rescuers, a total of 146 cases of HAPE were identified in the quake area, which, calculated roughly, was an incidence of HAPE of 0.73%. Initially, helicopters were not used in the Yushu earthquake rescue owing to inclement weather and windstorm. In such remote areas away from medical resources, where descent was not feasible because of the terrain, patients with HAPE were treated promptly by bed rest, supplemental oxygen, or a portable hyperbaric chamber (pressure bag) (Zafren et al., 1996; Luks et al., 2010) as a first therapy step before evacuation. In addition, dexamethasone was routinely used in all 146 cases, and 82 patients were treated with nifedipine (Oelz et al., 1989). Sildenafil was used in 36 patients after transfer to Xining hospital. All patients with severe AMS, HAPE, and HACE were gradually transferred to Xining. After admission to the hospital, treatment focused on oxygen administration, the use of pulmonary vasodilators, dexamethasone, and diuretics. All symptoms improved and arterial oxygen desaturation was relieved. All patients have recovered completely.
These conditions reminded me of a similar circumstance during the armed conflict on the India–China border in 1962, when thousands of Indian soldiers were flown to the airstrip at Leh (3500 m) in Ladakh, and many cases of HAPE were seen (Menon, 1965; Singh et al., 1965). However, Yushu–Batang airport is at an altitude of 3980 m and thus is higher than Leh. So rapid ascent without adequate acclimatization en route, altitude hypoxia, extreme physical exertion, and dehydration often precipitated HAPE (Bagnoud et al., 1991; Singh et al., 1965).
It should be emphasized that during the Yushu earthquake local Tibetans performed heavy exertion that demonstrated their better altitude hypoxic adaptation. After the earthquake, thousands of Tibetan monks were active in the search for and rescue of quake victims in the rubble and were successful in retrieving buried, yet still alive, victims; they also retrieved dead bodies and performed the subsequent traditional Tibetan sky burial or mass cremation. Among Tibetan natives, none suffered altitude illness.
As the search was finished and rescue teams left, work shifted to the long task of reconstruction of what has been destroyed. Medical teams continue to work in the Yushu quake area because some 30,000 workers are now here for rebuilding where the quake was centered. Thus the treatment and prevention of altitude illness are still critical tasks for us. Also, medical workers are needed to prevent water pollution, marmot plagues, and outbreaks of respiratory and intestinal disease that may possibly occur. Psychological problems will become frequent in the first 3 months after the earthquake, and psychological specialists will help quake survivors to cope with their fear and trauma.
Mountain Rescue in the Yushu Earthquake: Have Lessons Been Learned?
Unlike at lowlands, in Yushu, the rescue teams were facing a number of logistical challenges. First, Yushu's high elevation, mountainous terrain, and bad weather made it difficult for rescue vehicles to reach the disaster zone and to rapidly transfer the injured to low altitudes; this is particularly important for air rescue, especially when using helicopters for mountain rescue (Bagnoud et al., 1991). Second, in this particular emergency circumstance, when rescue teams must ascend rapidly to and perform physical work at altitudes above 4000 m, consideration can be given to the concurrent use of acetazolamide and dexamethasone for the prevention of AMS (Luks et al., 2010). Finally, rescuers with preexisting conditions, such as hypertension or coronary artery disease, are at extraordinary risk during a mountain rescue operation and should obviously be advised against going to high altitude.
Footnotes
Acknowledgments
The available data relating to some figures in this letter are from the Congress on Yushu Earthquake Medical Emergency held in Xining, which was organized by the Chinese Medical Association for High Altitude Medicine and conducted on June 3–4, 2010.