The difficulty of nuclear emergency prevention measures during natural disasters: Ongoing challenges in Japan.

It is crucial to anticipate nuclear emergency scenarios and implement effective measures. Japan's climate and topography make it vulnerable to natural disasters; thus, it is necessary to address compounding and cascading disaster scenarios involving the simultaneous occurrence of natural and nuclear disasters. On January 1, 2024, an earthquake hit the Noto region of Ishikawa Prefecture, resulting in damage to the area around the Shika Nuclear Power Plant, located 90 km from the epicenter. This earthquake revealed that, in the event of a complex disaster, residents living within 30 kilometers of the Shika Nuclear Power Plant may be completely unprepared for a nuclear disaster. In the event of a complex disaster, it is crucial to implement appropriate countermeasures while balancing responses to both nuclear and natural disasters and optimizing radiation disaster prevention measures.

The relationship between media exposure and mental health in children following Kahramanmaras earthquakes in Turkey.

PURPOSE: We aimed to explore the relationship between media exposure to the Kahramanmaras earthquakes and its impact on children's mental health difficulties. METHODS: This cross-sectional study was conducted with 409 parents between March and July 2023. Parents were invited to participate in an online survey through social media platforms. The data was collected using the 'Descriptive Characteristics Form', the 'Media Exposure Form Related to the Earthquake', and the 'Strengths and Difficulties Questionnaire'. RESULTS: The results indicated that exposure to images of earthquake-related events on the first day after the earthquake (p < 0.001), people rescued alive from the rubble on television (p < 0.001), earthquake victims staying on the streets/in tents on television (p = 0.006), and earthquake-related events while alone on the Internet (p = 0.02) were significantly associated with the impact of children's mental difficulties. Furthermore, exposure to images of people pulled deceased from the rubble (p < 0.001), exposure to images of demolished houses on the Internet (p = 0.007), and exposure to images of destroyed roads on the Internet (p = 0.01) were found to significantly predict the impact of children's mental difficulties (r2 = 0.29; p < 0.001). CONCLUSIONS: This study has shown that children who are exposed to screen media may experience difficulties in coping mentally, leading to emotional and behavioral problems. PRACTICE IMPLICATIONS: Children who have experienced natural disasters may be exposed to distressing images on screen, which can lead to difficulties and stress. To reduce the risk of mental health problems related to disasters, nurses may suggest that victims limit their exposure to television footage.

The relationship between earthquake-induced post-traumatic stress disorder and breastfeeding attitude and behavior.

BACKGROUND: This study aimed to investigate the prevalence and severity of post-traumatic stress disorder (PTSD) and analyze the relationship between PTSD and breastfeeding attitudes and behaviors among breastfeeding mothers and women with children aged 0-24 months, all of whom had experienced the earthquake. METHODS: In this cross-sectional survey, a face-to-face questionnaire was administered to 173 earthquake survivors in Adiyaman, Turkey, during June and July 2023. The PTSD Checklist-Civilian scale was used to assess the presence of PTSD, while the Breastfeeding Attitudes of the Evaluation Scale (BAES) was employed to evaluate breastfeeding behaviors in mothers. RESULTS: Significantly higher PTSD scores (47.6 ± 17.4) were found among women staying in tents, while lower scores (37.0 ± 16.4) were observed in those who continued breastfeeding. 78.6% of women reported decreased breast milk because of the earthquake. Mothers with reduced milk supply had higher PTSD scores (46.1 ± 17.3). Breastfeeding training was associated with higher BAES scores (106.8 ± 56.8) and lower PTSD scores (32.5 ± 11.0). A significant negative correlation was observed between the PTSD score and BAES (r = -0.742; p < 0.001). CONCLUSIONS: The study demonstrated that breastfeeding may protect mothers against PTSD in the aftermath of earthquakes, emphasizing the importance of breastfeeding education. The higher frequency and severity of PTSD observed among earthquake survivor mothers residing in tents underscores the importance of promptly transitioning to permanent housing after the earthquake.

Burnout levels and correlates among healthcare providers in Syria following the 2023 Turkish-Syrian earthquakes: A cross-sectional study.

Background and Aims: This article examines the prevalence of burnout among healthcare providers in the aftermath of the recent earthquakes in Syria and Turkey and explores the associated risk factors. Methods: This cross-sectional study included 270 healthcare providers in three Syrian cities damaged by earthquakes. Participants were asked to fill out a validated questionnaire on the fifth day of emergency response using the Geldard Occupational Burnout questionnaire. Results: The mean score for the Geldard Occupational Burnout Questionnaire was 129.79, with 81.4% indicating moderate burnout risk and only 3% indicating high risk. Gender was not significantly associated with burnout, but there was a significant difference in burnout scores between city groups, with Latakia scoring significantly lower than Aleppo. Conclusion: This study highlights the prevalence of burnout among healthcare providers in the aftermath of an earthquake in Syria, with the majority having a moderate risk of burnout. Gender was not significantly associated with burnout risk. Further research is needed to develop effective interventions and address study limitations. The study emphasizes the importance of prioritizing healthcare providers' mental health to ensure high-quality care after natural disasters.

One disaster two traumas: Being under rubble and burn injuries in the 2023 Maras, Turkey earthquakes.

INTRODUCTION: On February 6, 2023, two separate destructive earthquakes with magnitudes of 7.7 and 7.5 occurred in Kahramanmaras, Türkiye. More than 50,000 people lost their lives, and over 100,000 were reported injured. In this study, patients referred to hospitals with burn diagnosis and management of burn wounds following the disaster were evaluated. MATERIAL AND METHODS: Information on burn injury admissions related to the earthquake was collected from all burn facilities in the country within 15 days after the earthquake. The patients' demographics, being under rubble, rescue times, burn causes, grafting procedures, and deaths were recorded. RESULTS: Following the earthquake, burn victims were transferred to the 13 Burn Treatment Centers located in 10 provinces. A total of 191 patients were burned. Among the burn patients, 101 (52.9%) were rescued from the rubble 2-60 h after the earthquake. Eight patients who were hospitalized at the burn centers died. Scalding and flame burns were the most common etiologies. Burned total body surface area, concomitant crush injury, hospitalization, and mortality was higher among the patients trapped under rubble (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Victims who stayed longer time under the rubble required significantly more grafting procedures (p < 0.001). CONCLUSION: In a literature review, it was observed that there are a limited number of publications reporting earthquake-related burns. In the February, 6 Türkiye earthquake, flame burns were seen due to small fires that occurred in collapsed buildings during the earthquake. And also contact burns and hot liquid burns were seen in earthquake victims trapped under rubble. Bursting hot water pipes, overturned stoves, contact with hot central heating radiators, and heated construction irons caused scalding and contact burns. It is believed that prolonged entrapment may cause delays in burn treatment or lead to deeper burns due to prolonged contact with the burning agent, increasing hospitalization rates. This earthquake once again drew attention to burn injuries that could occur during and after earthquakes, including those that may occur under rubble.

2023 catastrophic Turkey earthquake: clinical outcomes of pediatric patients rescued under the rubble.

OBJECTIVES: Children are the most vulnerable population affected by the earthquake. We aimed to examine the characteristics, morbidity, mortality, and the factors affecting these pediatric earthquake victims to guide the follow-up of pediatric patients who were rescued under the rubble in possible future disasters. METHODS: This is a retrospective observational study. The files of pediatric earthquake victims aged 0-18 years who were admitted to Adana City Training and Research Hospital between 6 February-30 April 2023 were analyzed. 318 patients were included in the study. RESULTS: Of all patients 48.7% (n = 155) were female and 51.3% (n = 163) were male. The mean age of the patients was 114.8 months. 65.4% (n = 208) of the patients were discharged from our hospital, eighteen patients (5.7%) died. Information on the hour when the patients were rescued under the rubble could be reached in 117 (36.8%) patients. The mean rescue time of these patients was 50.5 hours. 62 (53%) victims were rescued in the first 24 hours after the earthquake. There were 111 patients (34.9%) with fractures. There were 118 patients (37.1%) who underwent fasciotomy surgery. The total number of patients with amputation was 48 (15.1%). There were 36 patients (11.3%) with one limb amputated, 12 patients (%3.7) with more than one limb amputation. Internal organ injury was present in 30.5% (n = 97) of the patients. Of these patients, 85.6% (n = 83) had single organ trauma and 14.4% (n = 14) had multiple organ trauma. There were 58 patients (18.2%) with acute renal failure in follow-up. The mean rescue time for patients with amputation was 83.65 ± 62.9 hours, and for patients without amputation was 36.44 ± 50.6 hours. This difference was statistically significant (p = 0.001). No statistically significant difference was found when the ages of the patients were compared to fasciotomy, amputation, and fracture status. CONCLUSION: While evaluating earthquake-induced trauma, pediatric patients should be approached carefully.

Metaphorical perceptions of surgical nurses regarding care for earthquake victims.

BACKGROUND: The physical, psychological, and social effects of the earthquake affect a person's functionality directly. It challenges individuals because it is often traumatizing, intense fear is experienced, and it is unpredictable, uncontrollable, and destructive. Nurses are one of the professional groups that have important duties in social disasters, and they are constantly exposed to the details of the traumatic situation, sometimes physically and sometimes by listening. To understand the severity of the trauma caused by this exposure, it is important to understand the emotions and thoughts that nurses feel while caring for earthquake victims. AIMS: This study was planned to reveal the perceptions of nurses, who were themselves earthquake victims, regarding caring for earthquake victims through metaphors. METHODS: This study was conducted as a phenomenological study with a qualitative research approach, in a province affected by the earthquake, with 85 surgical clinic nurses who were also earthquake victims and cared for earthquake victims. RESULTS: The metaphors produced were examined together with their reasons and grouped under 3 categories (positive, negative, both positive and negative). CONCLUSIONS: As a result, when the metaphors used by earthquake victims are evaluated, the effects of nurses being earthquake victims themselves can be seen in the metaphors. It is revealed through metaphors that nurses' earthquake-related traumas are triggered while caring for earthquake victims.

The feasibility of a psychological first aid intervention as a supportive tactic for feelings of psychological distress and mental health recovery outcomes among earthquake survivors in Northern Syria.

AIM: This study aimed to investigate the feasibility of implementing a psychological first aid intervention for psychological distress, resilience capacity, quality and meaning of life among survivors affected by earthquake adversity in Northern Syria. METHODS: A quasi-experimental, pre-posttest, two-group research design was utilized. A convenience sample of 95 survivors (46 in the study group and 49 in the control group) was recruited for the psychological First Aid intervention at a 1:1 ratio. The psychological first aid intervention was delivered in 10 sessions, twice weekly, followed by 3-month follow-up. RESULTS: A statistically significant improvement in the mean scores of resilience capacity, quality and meaning of life among survivors, along with a significant reduction in psychological distress, was registered among the study group compared with the control group. CONCLUSION: Our work verified the suitability of implementing psychological first aid following the catastrophic temblors which struck Northern Syria. Given that the psychological first aid intervention is grounded in psychological safety, cognitive reframing, mobilization of social support and installation of hope, the feasibility of its path following public health emergency, traumatic events or even a personal crisis can be favourable.

Examining primary healthcare services following earthquake shocks in Turkiye: A critical analysis of the initial 3 months and the vital role of humanitarian policy transfer for rapid response.

The purpose of this article is to discuss the importance of policy transfer by humanitarian NGOs to post-disaster regions and the effectiveness of mobile Primary Health Care (PHC) services immediately after disasters. This study also focused on analysing the first 3 months aftermath of the earthquake and assessed the changes in the access and needs of vulnerable groups in emergency response creation and systematic interventions after disasters. In disasters that require urgent response such as earthquakes, the importance of the existing NGOs (Such as MdM) capacity in the countries has emerged in terms of rapid response and experience sharing. During the field work, it is observed that MdM Mobile Medical Units (MMU) teams had played a key role in terms of tracking PHC needs, functioning as early warning system for epidemics, and prevention of communicable diseases in the EQ effected areas. In this aspect, the changes in diagnoses in the first trimester is examined using the comparative analysis methods. This study used a cross-sectional mixed-method approach in terms of objective evaluation. The results from a quantitative needs assessment were complemented by qualitative data. Herein, the data were collected in two stages: First, primary data was collected through the field activities of MMU, and second field-based assessments was conducted with health professionals who have been working in the MMU teams since the first moments of the earthquake.

Association between evacuation and becoming overweight after the Great East Japan Earthquake: a 7-year follow-up of the Fukushima Health Management Survey.

OBJECTIVES: Disaster evacuation increases the risk of becoming overweight or obese owing to lifestyle changes and psychosocial factors. This study evaluated the effect of evacuation on becoming overweight during a 7-year follow-up among residents of Fukushima Prefecture during the Great East Japan Earthquake. STUDY DESIGN: This was a prospective cohort study. METHODS: We analysed data collected from 18,977 non-overweight Japanese participants who completed the 'Comprehensive Health Checkup Program' and 'Mental Health and Lifestyle Survey', as part of the Fukushima Health Management Survey, between July 2011 and November 2012. An evacuation was defined as the moving out of residents of municipalities designated as an evacuation zone by the government or having a self-reported experience of moving into shelters or temporary housing. Follow-up examinations were conducted in March 2018 to identify patients who became overweight. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using a Cox proportional hazards regression model. RESULTS: Among 15,875 participants (6091 men and 9784 women; mean age 63.0 ± 11.1 years) who received follow-up examination (mean follow-up, 4.29 years), 2042 (856 men and 1186 women) became overweight. Age-, baseline body mass index-, lifestyle-, and psychosocial status-adjusted HRs (95% CIs) for becoming overweight after evacuation were 1.44 (1.24-1.66) for men and 1.66 (1.47-1.89) for women. CONCLUSION: Evacuation was associated with the risk of becoming overweight 7 years after the disaster. Thus, maintaining physical activity, healthy diet, and sleep quality and removing barriers to healthy behaviour caused by disasters, including anxiety concerning radiation, may prevent this health risk among evacuees.

Relationship Between Posttraumatic Stress Disorder, Death Anxiety, and Insomnia in Adults After the Earthquake.

This study aimed to determine the relationship between posttraumatic stress disorder, death anxiety, and insomnia in adults after the earthquake. This study, designed in a relational-cross-sectional-descriptive model, was conducted with 624 adult individuals living in a province affected by the earthquake that occurred in Turkey on February 6, 2023. The study data were collected using a personal information form, Posttraumatic Stress Disorder Checklist, Turkish Death Anxiety Scale, and Bergen Insomnia Scale. The analysis of the study data was performed by using SPSS 25.0, AMOS 24.0, and G*Power 3.1 Statistical package software. A significant positive correlation was found between posttraumatic stress disorder and Insomnia and Death Anxiety (p < .05). There was a significant positive correlation between Death Anxiety and Insomnia (p < .05). It was determined that Death Anxiety has a mediating role in the impact of posttraumatic stress disorder on insomnia (95% Confidence Interval: 0.572/1.407) (p < .05). It was determined that the model created in line with the hypotheses was compatible and the model fit indices were within the desired limits, with x2/df = 1.795, RMSEA = 0.03, CFI = 0.95, GFI = 0.946, AGFI = 0.93, IFI = 0.95. It was determined that posttraumatic stress disorder increased death anxiety and insomnia after the earthquake. Conducting longitudinal studies on the post-earthquake period is recommended.

Masqueraders Around Disaster: Clinical Features of Scrub Typhus in Fukushima, Japan.

Background: Scrub typhus (ST) is endemic in Fukushima, with the largest number of cases reported in Japan from 2009 to 2010. Although ST is highly treatable, its atypical clinical presentation impedes diagnosis, causing delays in treatment. Methods: We review the clinical features of ST in adults from 2008 to 2017 at Ohta Nishinouchi General Hospital in Fukushima, Japan. Results: Fifty-five cases (serotype Karp 24, Irie/Kawasaki 21, Hirano/Kuroki 10) of ST were confirmed via serology based on elevated immunoglobulin (Ig)M and IgG and polymerase chain reaction positivity of eschar samples. The mean age was 69 years, and 64% were female. The case fatality rate was 1.8% (1/55). Approximately 70% of cases (38/55) were not diagnosed as ST upon the initial clinic visit. Inappropriate use of antibiotics was identified in 22% of cases (12/55). In terms of atypical clinical features, 1 or more of the manifestations, fever, rash, and eschar, was absent in 31% of cases (17/55). Approximately 11% of cases presented without eschar (6/55; Karp 1, Irie/Kawasaki 1, Hirano/Kuroki 4). Moreover, severe complications were observed with shock and disseminated intravascular coagulation in 7% of cases (4/55), Thus, while 53% of cases presented with the typical triad (29/55), unusual complications and atypical features occurred in 40% (22/55). Conclusions: Diagnosis of ST becomes clinically challenging in the absence of typical features. In Fukushima, an endemic area of ST, an atypical presentation involving multisystem disease is common.

Sex Ratio at Birth after Concurrent Events of Earthquakes and the COVID-19 Pandemic in Croatia.

The sex ratio at birth (ratio of males to females) has been known to be affected by exogenous shocks such as wars, pollution, natural catastrophes, economic crises, and others. Among these stressful events, both earthquakes and the COVID-19 pandemic have been reported to lower the sex ratio at birth. In this article, a rather unusual situation of two episodes of simultaneous events of COVID-19 lockdown and earthquakes approximately nine months apart (March and December of 2020) is investigated to assess whether they were associated with a bias in sex ratio at birth 3-5 months later (in utero loss) and 9 months later (loss at conception) in Croatia. The monthly time series of sex ratio at birth, total number of births, and total number of both male and female births from January 2010 to December 2021 were analyzed. Seasonally adjusted autoregressive moving-average models were used to estimate the functional form of the time series from January 2010 to February 2020. These results were used to predict the future values of the series until December 2021 and to compare them with the actual values. For all series used, there was no indication of deviation from the values predicted by the models, neither for 3-5 months nor for 9 months after the COVID-19 lockdown and earthquake events. The possible mechanisms of the absence of bias, such as the threshold of the stressful events and its localized reach, as well as the statistical methods employed, are discussed.

Gratitude practice helps undergraduates who experienced an earthquake in China find meaning in life.

This study was conducted following a magnitude 6.8 earthquake that occurred in early September 2022, coinciding with the commencement of a positive psychology course for the affected students. A sample of 479 Chinese undergraduates was recruited for an intervention focused on weekly gratitude practice. Data were collected through an online questionnaire package at 3 time points: the first week of the course (Time 1), the fifth week (Time 2), and the ninth week (Time 3), assessing gratitude, learning engagement, and the meaning of life. Findings revealed that gratitude significantly predicted meaning in life through learning engagement over time. This highlights the significant mediating role of learning engagement in the context of earthquakes and provides insights for positive interventions aimed at facilitating personal growth among emerging adults in higher educational settings, particularly those who have experienced traumatic events such as earthquakes.

Investigating a hybrid extreme learning machine coupled with Dingo Optimization Algorithm for modeling liquefaction triggering in sand-silt mixtures.

Liquefaction is a devastating consequence of earthquakes that occurs in loose, saturated soil deposits, resulting in catastrophic ground failure. Accurate prediction of such geotechnical parameter is crucial for mitigating hazards, assessing risks, and advancing geotechnical engineering. This study introduces a novel predictive model that combines Extreme Learning Machine (ELM) with Dingo Optimization Algorithm (DOA) to estimate strain energy-based liquefaction resistance. The hybrid model (ELM-DOA) is compared with the classical ELM, Adaptive Neuro-Fuzzy Inference System with Fuzzy C-Means (ANFIS-FCM model), and Sub-clustering (ANFIS-Sub model). Also, two data pre-processing scenarios are employed, namely traditional linear and non-linear normalization. The results demonstrate that non-linear normalization significantly enhances the prediction performance of all models by approximately 25% compared to linear normalization. Furthermore, the ELM-DOA model achieves the most accurate predictions, exhibiting the lowest root mean square error (484.286 J/m3), mean absolute percentage error (24.900%), mean absolute error (404.416 J/m3), and the highest correlation of determination (0.935). Additionally, a Graphical User Interface (GUI) has been developed, specifically tailored for the ELM-DOA model, to assist engineers and researchers in maximizing the utilization of this predictive model. The GUI provides a user-friendly platform for easy input of data and accessing the model's predictions, enhancing its practical applicability. Overall, the results strongly support the proposed hybrid model with GUI serving as an effective tool for assessing soil liquefaction resistance in geotechnical engineering, aiding in predicting and mitigating liquefaction hazards.

Data-driven modeling using system dynamics simulation to provide relief in earthquake based on different scenarios.

Effective relief reduces damages and protects people during natural disasters, such as earthquakes. This research proposes a data-driven model based on sustainability, taking into account the pre and post-crisis simultaneously. Real data was used to validate the model in various earthquake scenarios. The study addresses questions regarding the amount and allocation of relief goods during earthquakes. This research is carried out in two phases: simulation and modeling. The purpose of the simulation phase is to estimate the number of relief goods in different scenarios. Additionally, in the modeling phase, a data-based multi-objective model is presented, considering sustainability, to minimize the lack of relief goods, the number of untreated wounded, and supply chain costs. Using the dynamic simulation system, and after designing the structure of the earthquake effects on urban infrastructure, the actions and effects of the earthquake on vital arteries are investigated in different scenarios, and scenarios with a higher degree of risk are identified. The results showed that the highest and lowest demands for relief goods were related to the "Mosha-day fault" and "North Tehran-night fault" scenarios, respectively.

REHABILITATION APPROACH AFTER EARTHQUAKE DISASTER: A BRIEF REPORT FROM TURKEY.

Devastating earthquake disasters are experienced all over the world. On February 6, 2023, two major earthquakes with magnitudes of Mw 7.7 and 7.6, respectively, occurred centered in Kahramanmaras, Turkey. It resulted in at least 50,783 deaths and more than 122,000 injuries according to official data. Defining the post-earthquake experiences and earthquake risk assessment well and identifying the deficiencies will guide the coordination, management, and planning of subsequent disasters. In this study, the rehabilitation approaches of earthquake victims with physical injuries in our rehabilitation center are emphasized and the situations that will be encountered in the immediate, intermediate, and long-term periods after the earthquake are summarized.

Aftermath Türkiye's double earthquake: detailed analysis of fracture characteristics and acute management from a level I trauma center.

BACKGROUND: This research investigated surgical interventions for the treatment of extremity and pelvic fractures and aimed to provide an analysis of management challenges under crisis conditions in a Level I Trauma Center after Türkiye's February 6, 2023, earthquakes. METHODS: The study was a retrospective examination of the medical records of 243 fracture cases associated with the earthquakes. The age, gender, time of admission, types of extremity and pelvic fractures, anatomical localizations, and surgical treatment methods for fractures were recorded. The results of these parameters were evaluated in detail, together with the results of other surgical treatments performed in the hospital in the first week after the disaster, such as fasciotomy, amputation, and wound debridement. RESULTS: Most of the 243 (119 males and 124 females) patients with extremity fractures and pelvic fractures receiving surgical treatment were adults (n = 182, 74.9%). The most common lower extremity fractures among all fracture cases were tibial shaft (30.8%) and femoral shaft (20.6%) fractures. A total of 33 patients had surgical procedures for the treatment of two or more significant bone fractures involving either the extremity or the pelvic ring. The analysis showed that the median age of patients who underwent surgery due to extremity and pelvic fractures was 36 years, with a range of 1 to 91 years, which was statistically increased compared to patients who received surgery for other musculoskeletal injuries such as fasciotomy, amputation and debridement (p < 0.001). CONCLUSION: Fractures were one of the most common musculoskeletal injuries in the first days after earthquakes, and the management of fractures differs significantly from soft tissue injuries and amputation surgeries as they require implants, special instruments, and imaging devices. The delivery of healthcare is often critically impaired after a severe earthquake. Shortages of consumables such as orthopedic implants, power drills, fluoroscopy equipment, and the need for additional staff should be addressed immediately after the earthquake, ideally by the end of the first day.

Surgical and critical care management of earthquake musculoskeletal injuries and crush syndrome: A collective review.

Earthquakes are unpredictable natural disasters causing massive injuries. We aim to review the surgical management of earthquake musculoskeletal injuries and the critical care of crush syndrome. We searched the English literature in PubMed without time restriction to select relevant papers. Retrieved articles were critically appraised and summarized. Open wounds should be cleaned, debrided, receive antibiotics, receive tetanus toxoid unless vaccinated in the last 5 years, and re-debrided as needed. The lower limb affected 48.5% (21.9%-81.4%) of body regions/patients. Fractures occurred in 31.1% (11.3%-78%) of body regions/patients. The most common surgery was open reduction and internal fixation done in 21% (0%-76.6%), followed by plaster of Paris in 18.2% (2.3%-48.8%), and external fixation in 6.6% (1%-13%) of operations/patients. Open fractures should be treated with external fixation. Internal fixation should not be done until the wound becomes clean and the fractured bones are properly covered with skin, skin graft, or flap. Fasciotomies were done in 15% (2.8%-27.2%), while amputations were done in 3.7% (0.4%-11.5%) of body regions/patients. Principles of treating crush syndrome include: (1) administering proper intravenous fluids to maintain adequate urine output, (2) monitoring and managing hyperkalemia, and (3) considering renal replacement therapy in case of volume overload, severe hyperkalemia, severe acidemia, or severe uremia. Low-quality studies addressed indications for fasciotomy, amputation, and hyperbaric oxygen therapy. Prospective data collection on future medical management of earthquake injuries should be part of future disaster preparedness. We hope that this review will carry the essential knowledge needed for properly managing earthquake musculoskeletal injuries and crush syndrome in hospitalized patients.