Elsevier

The Lancet

Volume 379, Issue 9831, 2–8 June 2012, Pages 2109-2115
The Lancet

Review
The initial health-system response to the earthquake in Christchurch, New Zealand, in February, 2011

https://doi.org/10.1016/S0140-6736(12)60313-4Get rights and content

Summary

At 1251 h on Feb 22, 2011, an earthquake struck Christchurch, New Zealand, causing widespread destruction. The only regional acute hospital was compromised but was able to continue to provide care, supported by other hospitals and primary care facilities in the city. 6659 people were injured and 182 died in the initial 24 h. The massive peak ground accelerations, the time of the day, and the collapse of major buildings contributed to injuries, but the proximity of the hospital to the central business district, which was the most affected, and the provision of good medical care based on careful preparation helped reduce mortality and the burden of injury. Lessons learned from the health response to this earthquake include the need for emergency departments to prepare for: patients arriving by unusual means without prehospital care, manual registration and tracking of patients, patient reluctance to come into hospital buildings, complete loss of electrical power, management of the many willing helpers, alternative communication methods, control of the media, and teamwork with clear leadership. Additionally, atypical providers of acute injury care need to be integrated into response plans.

Introduction

Christchurch City (figure) has an urban population of about 400 000. On Tuesday Feb 22, 2011, at 1251 h local time, a 6·3 magnitude earthquake struck Christchurch. Its epicentre was 5 km deep, and 10 km southeast of the city centre (figure).1 Peak ground accelerations were among the highest recorded from this type of earthquake.1, 2, 3 Destruction and liquefaction were widespread.1 The central business district was extensively damaged, with two multistorey buildings collapsing, many others partly collapsing, and large amounts of rubble falling into the streets. A combination of high peak ground accelerations, the time of day, and the collapse of buildings resulted in injury and loss of life (table 1).

This report is presented in three major sections. The first section describes Christchurch Hospital's preparedness for a mass casualty event. The second section describes the challenges faced, health-care response, and injury burden within the first 24 h after the earthquake. The final discussion section reviews the response and injury burden in the context of responses to international earthquakes of similar magnitude in urban areas of high-income countries and outlines the lessons learned.

Section snippets

Health system

New Zealand has a publically funded health system with injury care funded by the Accident Compensation Corporation. Access to hospital care is free, and access to primary care is subsidised. A private health system operates in parallel. Panel 1 provides details of how the Accident Compensation Corporation scheme operates and how we collected injury data.

Christchurch has seven hospitals (figure). The Christchurch Hospital campus is on the western edge of the central business district (figure).

Challenges

During the earthquake the hospital was subjected to severe shaking. Staff could not stand unaided, trolleys were shunted across rooms, items fell from shelves and benches, and ceiling panels fell in many areas. Broken water conduits began flooding parts of the hospital, in particular the blood bank, and alarms sounded continuously. Power was lost immediately. Within seconds, six diesel-fuelled generators activated to provide power to electrical outlets designated as essential services. However,

Discussion

The health response to the Christchurch earthquake was unique because the city has only one hospital with an emergency department (which was compromised by earthquake damage). The hospital activated its well developed and practised internal and external incident plans and other non-acute hospitals and primary care facilities responded.

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