International Cooperation:International Cooperation: Role of the ISN Commission Role of the ISN Commission on Acute Renal Failure and on Acute Renal Failure and History of Disaster Relief History of Disaster Relief

Task ForceTask Force

San Francisco Hilton San Francisco Hilton October 12, 2001October 12, 2001

Kim Solez, M.D.Kim Solez, M.D.

San San FranciscoFrancisco

A fitting setting!A fitting setting! A fitting setting!A fitting setting!

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San Francisco Bay Area San Francisco Bay Area Earthquake TimelinesEarthquake Timelines

San Francisco Bay Area San Francisco Bay Area Earthquake TimelinesEarthquake Timelines

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Earthquakes can kill Earthquakes can kill more people in a few days more people in a few days than die in the coursethan die in the courseof some major wars. of some major wars.

Earthquakes can kill Earthquakes can kill more people in a few days more people in a few days than die in the coursethan die in the courseof some major wars. of some major wars.

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255,000 deaths Tangshan , China,1976. 255,000 deaths Tangshan , China,1976. 830,000 deaths Shensi, China,1556.830,000 deaths Shensi, China,1556.

Revolutionary War - 4,435 deaths. Revolutionary War - 4,435 deaths. Civil War (both sides) - 498,332 deaths. Civil War (both sides) - 498,332 deaths. World War I - 116,708 deaths. World War I - 116,708 deaths. World War II - 407,316 deaths. World War II - 407,316 deaths. Korea - 25,604 deaths. Korea - 25,604 deaths. Vietnam - 58,168 deaths.Vietnam - 58,168 deaths.WTC Bombing - 6,000 deaths.WTC Bombing - 6,000 deaths.

255,000 deaths Tangshan , China,1976. 255,000 deaths Tangshan , China,1976. 830,000 deaths Shensi, China,1556.830,000 deaths Shensi, China,1556.

Revolutionary War - 4,435 deaths. Revolutionary War - 4,435 deaths. Civil War (both sides) - 498,332 deaths. Civil War (both sides) - 498,332 deaths. World War I - 116,708 deaths. World War I - 116,708 deaths. World War II - 407,316 deaths. World War II - 407,316 deaths. Korea - 25,604 deaths. Korea - 25,604 deaths. Vietnam - 58,168 deaths.Vietnam - 58,168 deaths.WTC Bombing - 6,000 deaths.WTC Bombing - 6,000 deaths.

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In developing countriesIn developing countries many many

earthquake deaths earthquake deaths are due to crush injuryare due to crush injury

induced induced acute renal failure.acute renal failure.

In developing countriesIn developing countries many many

earthquake deaths earthquake deaths are due to crush injuryare due to crush injury

induced induced acute renal failure.acute renal failure.

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The Birth of the The Birth of the ISN Commission on ISN Commission on Acute Renal Failure Acute Renal Failure

Disaster Relief Task ForceDisaster Relief Task Force

The Birth of the The Birth of the ISN Commission on ISN Commission on Acute Renal Failure Acute Renal Failure

Disaster Relief Task ForceDisaster Relief Task Force

On Dec. 7, 1988 a powerful On Dec. 7, 1988 a powerful earthquake measuring 6.9 on earthquake measuring 6.9 on the Richter scale heavily the Richter scale heavily damaged key residential damaged key residential areas of Soviet Armenia, areas of Soviet Armenia, killing 40,000 and leaving up killing 40,000 and leaving up to 400,000 homeless.to 400,000 homeless.

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Response to Armenian Earthquake - Response to Armenian Earthquake - Good Intentions, but Chaos!Good Intentions, but Chaos!

No effective dialysis until day 8 following No effective dialysis until day 8 following disaster. many of the 40,000 died of renal failure.disaster. many of the 40,000 died of renal failure.

Tremendous influx of people and unsorted Tremendous influx of people and unsorted material produced a “second disaster”.material produced a “second disaster”.

This massive failure of worldwide humanitarian This massive failure of worldwide humanitarian efforts provided a strong stimulus for efforts to efforts provided a strong stimulus for efforts to improve future relief missions in this setting.improve future relief missions in this setting.

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Key Time PointsKey Time Points

Dec. 7, 1988 - Armenian earthquake, massive Dec. 7, 1988 - Armenian earthquake, massive failure of humanitarian efforts to treat ARFfailure of humanitarian efforts to treat ARF

Dec. 9, 1988 - Meeting on “Acute Renal Failure Dec. 9, 1988 - Meeting on “Acute Renal Failure Society” at ASN, debates earthquake relief.Society” at ASN, debates earthquake relief.

Nov. 1989 - Formation of ISN Commission on ARF Nov. 1989 - Formation of ISN Commission on ARF and Disaster Relief Task Force directed by Kim and Disaster Relief Task Force directed by Kim Solez. European and North American Branch.Solez. European and North American Branch.

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ISN Disaster Relief Task ForceISN Disaster Relief Task Force

Rapid deployment of dialysis equipment and Rapid deployment of dialysis equipment and personnel following natural disasters that result personnel following natural disasters that result in large numbers of cases of acute renal failure.in large numbers of cases of acute renal failure.

Advance team.Advance team.

Key persons in each country with contact Key persons in each country with contact information. Government and NGO aid agency information. Government and NGO aid agency contacts. Fax network, USGS, the Internet.contacts. Fax network, USGS, the Internet.

Organizational partners MSF, Baxter, Belgian Air Organizational partners MSF, Baxter, Belgian Air Force, European Union.Force, European Union.

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Key Time Points (cont.)Key Time Points (cont.)

1990 - Meetings at Metropole Hotel (1990 - Meetings at Metropole Hotel (Salon Marie Salon Marie Curie)Curie) in Brussels, Iran earthquake. in Brussels, Iran earthquake.

1991 - Baxter commitment to fund DRTF. Banff 1991 - Baxter commitment to fund DRTF. Banff Meeting.Meeting.

1992 - Arrangement with MSF, Belgian Air Force, Baxter 1992 - Arrangement with MSF, Belgian Air Force, Baxter Europe, and European Union negotiated by Norbert Europe, and European Union negotiated by Norbert Lameire.Lameire.

Sept. 1993 - Kidney International paper published.Sept. 1993 - Kidney International paper published.

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Key Time Points (cont.)Key Time Points (cont.)

1996 - Latin American Disaster Relief Task force 1996 - Latin American Disaster Relief Task force meeting. Macedonia meeting on Renal Aspects of meeting. Macedonia meeting on Renal Aspects of Disaster Relief.Disaster Relief.

1997 - 1997 - Norbert Lameire succeeds Kim Solez as chair Norbert Lameire succeeds Kim Solez as chair of ISN Commission on ARF.of ISN Commission on ARF.

Aug. 16, 1999 - Massive earthquake in Turkey, DRTF Aug. 16, 1999 - Massive earthquake in Turkey, DRTF deployed early prevented many cases of ARF. deployed early prevented many cases of ARF. Mortality among the 400+ dialyzed patients only 17% Mortality among the 400+ dialyzed patients only 17% compared with the usual 50%.compared with the usual 50%.

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Key Time Points (cont.)Key Time Points (cont.)

April 13, 2000 - Norbert Lameire awarded April 13, 2000 - Norbert Lameire awarded prestigious International Medal by US National prestigious International Medal by US National Kidney Foundation.Kidney Foundation.

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Vision for the FutureVision for the Future

Need more successes like Turkey.Need more successes like Turkey.

Preparation essential.Preparation essential.

Quakes are coming closer and closer to Istanbul, Quakes are coming closer and closer to Istanbul, a megacity of 8 million people.a megacity of 8 million people.

An earthquake in this or another megacity would An earthquake in this or another megacity would create a catastrophy of unimagined proportions!create a catastrophy of unimagined proportions!

Need to find a support structure for North and Need to find a support structure for North and South America and Asia, as the Task Force at South America and Asia, as the Task Force at present is fully functional only in Europe.present is fully functional only in Europe.

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Suggested Reading: Probability of Suggested Reading: Probability of Istanbul Quake, KI papersIstanbul Quake, KI papers

Sever MS, Erek E, Vanholder R, ... Lameire N. et al. Marmara Sever MS, Erek E, Vanholder R, ... Lameire N. et al. Marmara Earthquake Study Group. The Marmara earthquake: Earthquake Study Group. The Marmara earthquake: epidemiological analysis of the victims with nephrological epidemiological analysis of the victims with nephrological problems. Kidney Int 60:1114-23, 2001 problems. Kidney Int 60:1114-23, 2001

Parsons T, Toda S, Stein RS, Barka A, Dieterich JH. Heightened Parsons T, Toda S, Stein RS, Barka A, Dieterich JH. Heightened odds of large earthquakes near Istanbul: An interaction-based odds of large earthquakes near Istanbul: An interaction-based probability probability calculation. Science. 2000 Apr 28;288(5466):661-5.calculation. Science. 2000 Apr 28;288(5466):661-5.

Solez K, ... Eknoyan G, Eliahou H, ... Lameire N, et al. Solez K, ... Eknoyan G, Eliahou H, ... Lameire N, et al. International dialysis aid in earthquakes and other disasters. International dialysis aid in earthquakes and other disasters. Kidney Int. 44:479-83, 1993.Kidney Int. 44:479-83, 1993.

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