Renal Disaster Relief Task Force

General Information

The ISN’s Renal Disaster Relief Task Force (RDRTF) provides essential medical care to people in the wake of natural disasters. The Task Force consists of a worldwide network of experts in the management of patients with acute renal failure. It was created after the severe earthquake in Armenia in 1988 to provide future renal aid in action wherever needed around the globe.  The Task Force works in close collaboration with the Medecins sans Frontiéres.

Sumatra-Padang earthquake, September 30, 2009

A severe earthquake struck Western Sumatra, Indonesia, on September 30, 2009, shortly after an eartquake and tsunami in the Samoa Islands. It was followed by another severe afterquake some hours later. Padang city (900.000 inhabitants) was especially affected,  officials refering to "thousands of people trapped under the rubble".

Three experts from the ISN-RDRTF left Europe for Sumatra on October 1st, 2009, to evaluate what support may be needed for people injured in the earthquake. They were part of a broader team of Médecins sans Frontières (MSF). The intervention of the ISN/RDRTF in Sumatra ended Thursday, October 8. The number of victims with acute renal failure was low, due to the high mortality in Padang.

Our rescue team concentrated on relocating the chronic dialysis unit of the Padang hospital.  As the building where dialysis usually took place was declared unsafe, dialysis took place outside, under a tent, at extremely high temperatures. Our team helped to move the dialysis unit to a safe building, taking care to install the water treatment system and pipes in a safe and reliable way. They were helped in this action by the local team, which was lead by Dr S. Azmi, nephrologist. Four dialysis machines were shipped to Sumatra to be installed in this unit. Training on how to handle the machines was taken care of by the local provider.

We wish to thank all who participated in this action, as well as those who have been standby.
Ray Vanholder, Coordinator ISN/RDRTF

First report of the ISN Renal Disaster Relief Task Force, October 1, 2009
Second report of the ISN Renal Disaster Relief Task Force, October 7, 2009

Reports on l'Aquila, Italy earthquake of April 6, 2009

In the aftermath of the earthquake in l'Aquila, Italy, on Monday April 6, the ISN Renal Disaster Relief Task Force (RDRTF) is in continuous contact with several Italian physicians. The number of victims with crush syndrome seems to be limited and they were together with chronic dialysis patients redistributed to other hospitals in the surrounding area. From the information obtained, it appears that the Italian means are sufficient to cope with the problems without external support. The RDRTF sent also recommendations on the practical approach of crush to the local physicians. These recommendations are still at a preliminary stage, as the drafting is still going on. Nevertheless, they should offer ample practical information, e.g. on how to deal with victims who are rescued from under the rubble. From images in the press, it appears as if at least some of these victims were extricated with no infusion positioned before their rescue. This underscores also the need to publish and disseminate the RDRTF recommendations in the nearby future, once they have been finalize.

Reports on the Sichuan- Chengdu, China earthquake of May 12, 2008

Final Report: Status on May 23

  • The number of AKI in Chengdu finally stabilized around 130 without further substantial influx any more from the First and second line.
  • The material purchased by Médecins Sans Frontières (MSF) was distributed by our assessors the last few days.
  • Other material was made available by the Hong Kong Society of Nephrology.
  • Our assesors left Chengdu Thursday afternoon May 22 at 17.45 local time (12.45 Brussels time) to reach Brussels in the late afternoon of Fiday May 23.

This brings to an end the renal aspect of this mission of the ISN/Renal Disaster Relief Task Force and MSF.

 Report 4: Status on May 20

  • Activities have the last two days essentially focused on teaching 
    and screening of hospitals outside Chengdu.
  • The influx of AKI seems to stabilize although occasionally cases of
    crush are detected in outside hospitals, which are then immediately 
    transported to Chengdu.
  • Pamphlets have been distributed highlighting the characteristics of
    crush and also how AKI can be prevented.
  • The same messages have also been broadcasted via radio and TV.
  • The preliminary draft of crush recommendations (M. Sever) Istanbul
    were translated in Chinese to be distributed among health workers.
  • P. Li (Hong Kong) returned home after a fruitful mission. We thank
    him for the kind cooperation.
  • Dialysis material was provided by Médecins Sans Frontières on one
    hand and by the Hong Kong Society of Nephrology on the other.
  • The nephrological situation seems well under control. No additional
    rescue teams are necessary.
  • Our two assessors will start their return home Thursday night or at
    the latest Friday morning.
  • We thank everybody who cooperated in this action, especially all
    Chinese and Hong Kong colleagues and nurses, Médecins Sans Frontières, 
    the International Society of  Nephrology, and all who contributed 
    either in China or here on the home front.
  • I would like to suggest that, once things have calmed down a bit,  
    the next step to take for our Chinese colleagues is to work on advance 
    planning, so that action plans are ready for future disasters.

Report 3: Status on May 18

  • Our assessors, A Van der Tol and Stefaan Claus reached Chengdu by 17.30 local time on Friday May 16.  
  • They were joined by Philip Li, nephrologist from Hong Kong.
  • Visit to the main hospitals in Chengdu started on Saturday, May 17.  
  • Reception by Chinese nephrologists was cordial and cooperation efficient. Teaching activities were planned. The situation in Chengdu was well under control, with enough nephrologists (also flowing in from elsewhere in China) and approximately 120 dialyzed AKI patients. Fruitful contacts with Fu Ping and Wang Li. Questionnaire distributed.
  • There was not much influx of new AKI patients
  •  Needs were essentially material (dialyzers, tubings ?). Material to be bought on a 50/50 bases (MSF/RDRTF and Hong Kong Society of Nephrology).
  • Chinese doctors kindly translated crush recommendations (preliminary version, Sever et al) provided by the RDRTF into Chinese.
  • Team probably to be joined on Monday May 19,  by a nurse from Hong Kong: Sandy Hui Yun Ho.
  • This morning, restriction on travelling outside Chengdu was relaxed by Chinese authorities. Visit to one external hospital today (70 km from Chengdu). Some obvious cases of crush (red-brown urine; swollen limbs). Transfer to Chengdu arranged, where there are better therapeutic possibilities.
  • Further screening of other external hospitals in the region warranted (Monday).

Report 2: Status on May 16  (correction of May 15 - see hyphen 6): 

  • The Belgian members (Arjan van der Tol, nehrologist, and Stefaan Claus, renal nurse) of our assessment team received their visa for China this morning. They are member of a team of Médecins Sans Frontières.
  • They left Brussels this afternoon at 17.15 for Munich and from there to Bejing and Chengdu, to arrive in Chengdu  tomorrow afternoon (16/5/8), 17.25 local time.
  • We insisted several times vis à vis our Chinese colleagues on the potential help and advice they could get from this  team, in view of their ample experience with previous mass disasters.
  • Philip Li (nephrologist from Hong Kong) will join the assessment team on his own force. He will leave Hong Kong tomorrow around 10.00 and arrive in Chengdu around 13.00.
  • A second nephrological member from Hong Kong will also join the team, probably a nursing officer. Andrew Wong (president of the Hong Kong Society of Nephrology) takes care of the selection.
  • We are aware of 14 AKI patients at the hospital of Wang Li, our nephrologist contact person in Chengdu.  We do not know how many of them require dialysis. The influx of wounded has increased lately.  According to certain sources, some 500 traumatized patients have been admitted to another large hospital in Sichuan than Wang Li's hospital, among which there certainly still should be more crush patients (information from Philip Li). 
  • The death toll has risen to > 50,000. This, the density of the population, and the type of the buildings makes us expect a large number of AKI patients, if rescue and transportation possibilities are sufficient.
  • There are reportedly 65,000 wounded of whom 10% (6,500) heavily wounded. This fits perfectly with the statistics displayed by Ron et al in Arch Intern Med 1984. If we further extrapolate the Ron data, there should be 7/10 heavily wounded with crush, i.e. 4550!
  • This would be a renal disaster of unprecedented dimensions.
  • If these figures are correct, and if most patients do not die before they can reach the hospitals, a tremendous load of AKI can be expected, and further help will be needed. We again wish to emphasize that possibilities to offer this help in a swift way would be very welcome.

Report 1: Status on May 13

  • The number of deaths is constantly increasing.
  • In view of the structure of the buildings and the numbers of wounded and deaths, the number of AKI might be high.
  • It was difficult to find contact persons. Many of the provided email addresses bounced back. Via Dr Philip Li, HongKong, we finally got the coordinates of Dr Wang Li, who is nephrologist in Chengdu.
  • Dr Wang Li is on her way back home after the ERA-EDTA congress in Stockholm. So, we could not come in direct contact with her yet, but sent several e-mails, and they did not bounce back.
  • MSF is ready to compose a scouting team. From Belgian nephrological side this would include Dr A van der Tol (Nephrologist) and Mr Stefaan Claus (renal nurse).
  • The scouting team should also contain a member from HongKong, prefarably a nurse, or a nephrologist with technical skills. A HongKong member would have several interesting advantages: no need for visa, knowledge of language and culture, living nearby. Travel and transport should be organized via MSF HongKong.

Activities

The Task Force has recently offered crucial assistance in the aftermath of the below disasters:  

2007- August: Earthquake in Peru
In an immediate response to the dreadful Peru quake the RDRTF sent a volunteer, S. Claus, to join the MSF assessment team for a one week intervention. 

2006- July: Israelo-Lebanese War
The RDRTF teamed up once more with MSF colleagues to bring aid, supplies and relief to Lebanon within just three days of the initial alert.

2006- May: Earthquake in Indonesia
Following the devastating earthquake that hit Indonesia on May 26, 2006, Task Force members  underwent a 10 day intervention which consisted of the extensive screening of more than 1,000 hospitalized victims, as well as providing education on the identification and treatment of crush syndrome and acute renal failure.

2005- October: Earthquake in Pakistan
In collaboration with colleagues from Médecins Sans Frontières (MSF), Task Force members were on the ground in Islamabad within days of the quake. The mission marked over two weeks of ISN intervention and relief work.

2003- December: Earthquake in Iran
After the earthquake in Bam, 140 patients needed dialysis and were
evacuated, first to the nearby city of Kerman and if necessary further
away by air-bridge.

2003 - May: Earthquake in Algeria

1999 - August: Marmara Earthquake
After this major earthquake, close to 500 patients needed dialysis. Six
Doctors and more than 30 nurses were active over an entire month to help
their Turkish colleagues. Furthermore, material help was offered by
providing 5 hemodialysis machines and several thousands of dialysers.

 

Committee Membership (January 2008 - January 2011)

Chair/Coordinator: Raymond Vanholder (Belgium)
General e-mail address : [email protected] 

Coordination center :
Secretary Mrs. Chantal Bergen, Nephrology Section

0K12A, University Hospital Ghent
De Pintelaan 185,  BE- 9000 Gent, Belgium.
Tel  +32 9 332 4522      Fax    +32 9 332 4599 

Cusumano

Ana MariaMD
EscuderoElizabethMD
HarrisDavid MD PhD
Hooi lai Seong MD PhD
Hurtado Abdias MD PhD
JhaVivekanand MD PhD
LameireNorbert MD PhD
Li PhilipMD PhD
LombardiRaulMD
LuyckxValerieMD
Mehta Ravindra MD PhD
PrasantoHeruMD PhD
SeverMehmet SukruMD PhD
Van der Tol Arjan MD
Van VlemBruno MD
VanholderRaymondMD PhD Chairman ISN/RDRTF
Younes Ibrahim  Md PhD
YuLuisMD PhD

 

VOLUNTEERS

Nephrologists and intensivists who are interested to enroll as volunteer for the RDRTF should contact the coordination centre through [email protected].  Below you will find a task description for volunteers.

Task Description for Volunteers (pdf, 169.7 KB)

EDUCATION MATERIAL

The following education material is available:

Logistic Coordination in Renal Disasters (pdf, 2.9 MB)

Crush Syndrome Following Disasters (pdf, 5.6 MB)

RDRTF Crush Patients Clinical Follow-up Chart (doc, 177 KB)

RDRTF Crush Patients Questionnaire (doc, 227 KB)

RDRTF Crush Patients Flow Statistics (doc, 173 KB)

RDRTF LITERATURE PUBLICATIONS

Brown D: Rescue Can Bring Quake Victims New Danger – Some Are Freed From Rubble Only to Suffer the Ravages of 'Crush Syndrome'. Washington Post; Saturday, May 17, 2008; Page A08

Erek E, Sever MS, Serdengecti K et al.: An overview of morbidity and mortality in patients with acute renal failure due to crush syndrome: the Marmara earthquake experience. Nephrol Dial Transplant 17:33-40, 2002

Hatamizadeh P, Najafi I, Vanholder R et al.: Epidemiologic aspects of the Bam earthquake in Iran: the nephrologic perspective. Am J Kidney Dis 47:428-438, 2006 Lameire N, Mehta R, Vanholder R, Sever M: The organization and interventions of the ISN Renal Disaster Relief Task Force. Adv Ren Replace Ther 10:93-99, 2003

Najafi I, Van BW, Sharifi A et al.: Early detection of patients at high risk for acute kidney injury during disasters: development of a scoring system based on the Bam earthquake experience. J Nephrol 21:776-782, 2008

Sever MS, Erek E, Vanholder R et al.: Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake. Nephrol Dial Transplant 17:1942-1949, 2002

Sever MS, Erek E, Vanholder R, Lameire N: Effect of gender on various parameters of crush syndrome victims of the Marmara earthquake. J Nephrol 17:399-404, 2004

Sever MS, Erek E, Vanholder R et al.: Features of chronic hemodialysis practice after the Marmara earthquake. J Am Soc Nephrol 15:1071-1076, 2004

Sever MS, Erek E, Vanholder R et al.: Lessons learned from the Marmara disaster: Time period under the rubble. Crit Care Med 30:2443-2449, 2002

Sever MS, Erek E, Vanholder R et al.: Lessons learned from the catastrophic Marmara earthquake: factors influencing the final outcome of renal victims. Clin Nephrol 61:413-421, 2004

Sever MS, Vanholder R, Lameire N: Management of crush-related injuries after disasters. N Engl J Med 354:1052-1063, 2006

Sever MS, Erek E, Vanholder R et al.: Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake. Kidney Int 62:2264-2271, 2002

Sever MS, Erek E, Vanholder R et al.: Serum potassium in the crush syndrome victims of the Marmara disaster. Clin Nephrol 59:326-333, 2003

Sever MS, Erek E, Vanholder R et al.: The Marmara earthquake: epidemiological analysis of the victims with nephrological problems. Kidney Int 60:1114-1123, 2001

Sever MS, Erek E, Vanholder R et al.: The Marmara earthquake: admission laboratory features of patients with nephrological problems. Nephrol Dial Transplant 17:1025-1031, 2002

Sever MS, Erek E, Vanholder R et al.: Treatment modalities and outcome of the renal victims of the Marmara earthquake. Nephron 92:64-71, 2002

Van der TA, Hussain A, Sever MS et al.: Impact of local circumstances on outcome of renal casualties in major disasters. Nephrol Dial Transplant, 2008

Vanholder R, Sever MS, Erek E, Lameire N: Acute renal failure related to the crush syndrome: towards an era of seismo-nephrology? Nephrol Dial Transplant 15:1517-1521, 2000

Vanholder R, van der TA, De SM et al.: Earthquakes and crush syndrome casualties: lessons learned from the Kashmir disaster. Kidney Int 71:17-23, 2007

Vanholder R, Sever MS, De SM et al.: Intervention of the Renal Disaster Relief Task Force in the 1999 Marmara, Turkey earthquake. Kidney Int 59:783-791, 2001

Vanholder R, Sever MS, Erek E, Lameire N: Rhabdomyolysis. J Am Soc Nephrol 11:1553-1561, 2000

Vanholder R, Van BW, Lameire N, Sever MS: The role of the International Society of Nephrology/Renal Disaster Relief Task Force in the rescue of renal disaster victims. Contrib Nephrol 156:325-332, 2007

Vanholder R, Van BW, Hoste E et al.: The role of the Renal Disaster Relief Task Force in the prevention and treatment of Crush syndrome in mass disasters. Acta Clin Belg Suppl405-407, 2007

Vanholder R, Sever MS, Lameire N: The role of the Renal Disaster Relief Task Force. Nat Clin Pract Nephrol 4:347, 2008

Zoraster R, Vanholder R, Sever MS: Disaster management of chronic dialysis patients. Am J Disaster Med 2:96-106, 2007

LINKS

Médecins Sans Frontières: http://www.msf.org/

ORPADT (Dutch website): http://www.orpadt.be/index.php

AFIDTN: http://www.afidtn.com

 

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