Multitasking a telemedicine training unit in earthquake disaster response: paraplegic rehabilitation assessment.

The objective of this work was to provide computer and telecommunications skill training for paraplegics using a telemedicine training center in a curriculum that would support connectivity and offer new skills for career applications in the rehabilitation phase and beyond. This was a hospital-based, cross-sectional study. The study was conducted from October 10, 2005 to May 10, 2006 in the hospitals of Rawalpindi Medical College and the Melody Rehabilitation Center, Rawalpindi, Pakistan. These centers provided care for casualties of the October 2005 earthquake in Pakistan. One hundred and ninety four (194) paraplegics were admitted to Rawalpindi Medical College allied hospitals after injuries in the rural mountains near the epicenter. Surveys assessed the education level of the patients, and a sample of 12 patients was enrolled in computer training classes. Of the 194 patients, 144 were female and 50 were male. The majority, 78% (151) were 16-39 years of age. Although only 60% were literate, the overall literacy rate of Pakistan is just 48.7%. Telephone service at home was available after discharge for 40% of patients. Only 8% of patients had basic computer skills. All patients participated in the survey and sought to take the course. All the enrolled patients demonstrated full competency in the skills taught. The social disruption of disaster plus the new challenge of a neurological deficit in paraplegia did not deter a remarkable number of patients from a rural area from engaging in computer and telemedicine training. This study demonstrated the feasibility of educating rural paraplegics in computer skills for telemedicine. The telemedicine training center was used for this task without special equipment or personnel, thereby increasing the utilization of the facility.

Complications in Patients with Spinal Cord Injuries Sustained in an Earthquake in Northern Pakistan

Background: Spinal cord injury (SCI) is devastating trauma suffered by many of the victims of an earthquake that struck Northern Pakistan on October 8, 2005. It rendered approximately 600 patients paraplegic, which is the highest number ever reported in any disaster. This study was conducted to evaluate the risk of complications. Methods: The cross-sectional restrospective study covering a 2-month perido was conducted on 194 patients admitted to the surgical/neurosugical wards of Rawalpindi Medical College and allied hospitals (Holy Family Hospital, Rawalpindi General Hospital, and District Headquarter Hospital) and Melody Relief and Rehabilitation Center, Islamabad. Results: The male-to-male ratio was approximately 1:3 (n=50 [26%] and n=144 [74%], respectivily). The majority (78% [ n=151]) were 16 to 39 years of age; 62% (n=120) had lumbar-injuries, 25% (n=48) had thoracic-level-injuries, 9% (n=18) had thoracolumbar-level injuries, and a few had cervical - or sacral-level-injuries. Forty six percent (n=90) had American Spinal Injury Association type A injuries; 4% (n=8) were graded B, 11% (n=21) were graded C, 95 (n=18) were graded D, and 14% (n=27) were graded E. Twenty percent (n=39) developed pressure ulcers, of which 38% (n=15) had grade, 1, 36% (n=14) had grade 2, 23% (n=29) had grade 3, and 3% (n=1) had grade 4. All patients developed urinary tract infections; 15% (n=30) had bowel complaints; 2% (n=3) developed deep-vein thrombosis (1 died of pulmonary embolism); and 0.05% (n=1) developed wound infection. Conclusion: Awareness of potential complications in patients with paraplegia is essential to care planning in the disaster setting. The priorities include skin, bowel, and bladder care and provision of prophylactic heparin. SCI post-disaster care requires comprehensive long-term planning. (AU)