Impact of the 2023 Earthquake on Emergency Department Utilization Patterns in the Non-Injured Population: A Comparative Study of 26,869 Patients

Imagine the Emergency Department (ED) as a giant, bustling train station. Usually, it's a place where people hop on and off for all sorts of reasons: a broken leg, a sudden fever, a panic attack, or just a check-up. But what happens when a massive earthquake shakes the ground beneath the tracks? Most people assume the station would just get flooded with injured people, like a sudden, chaotic rush hour. But scientists have wondered: what about everyone else? What happens to the regular commuters who didn't get hurt, but whose lives were turned upside down?

To understand this, we need to look at a few key ideas. First, there's the "direct victim"—the person with a broken bone from falling debris. Then there's the "indirect impact," which is how the disaster changes the behavior of the general population. Maybe people are too scared to leave their homes, maybe their regular doctors' offices are closed, or maybe the stress of the event makes old health problems flare up. This study asks a simple but tricky question: When a disaster hits, does the train station just get crowded with the injured, or does the type of traffic change for everyone else? By separating the injured from the rest of the crowd, researchers can see if the earthquake acts like a filter, changing who shows up and why.

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The Earthquake's Ripple Effect: A Train Station Story

So, what did the researchers actually do? They decided to take a peek behind the curtain at a major hospital in Diyarbakır, Turkey, right after the massive February 6, 2023, Kahramanmaraş earthquake. They looked at a huge pile of data—26,869 visits from 23,302 unique patients. But here's the magic trick: they didn't just look at everyone. They acted like a super-strict bouncer and kicked out 686 people who were directly injured by the earthquake. They wanted to see the "regular" crowd, the people who came in for things like headaches, stomach aches, or heart trouble, but who weren't crushed by falling walls.

They compared two equal time windows: the two weeks before the quake (January 23 to February 5) and the two weeks after (February 6 to February 19). It's like comparing the train station's traffic on a normal Tuesday versus the Tuesday after a massive storm hit the city.

The Big Surprise: Fewer People, But Sicker Ones

The first thing they found was a bit counterintuitive. You might think a disaster means a massive surge of people rushing to the hospital. But for this "non-injured" crowd, the opposite happened. The total number of visits dropped by 17.8%. It's as if the earthquake scared the "worried well" (people with minor, non-urgent issues) into staying home. The station was less crowded, but the people who did show up were different.

The average age of the patients crept up slightly, from 35 to 36 years old. While this was a real statistical difference, the researchers noted it was so tiny it didn't really matter in the real world. The gender mix stayed exactly the same. But the type of problems people brought in? That's where the story gets interesting.

The Shift in Traffic: More Surgery, More Heart Trouble

Even though fewer people showed up, the ones who did were in more serious shape. The researchers found that the "urgency" of the visits went up. More people were tagged as "urgent" (yellow) rather than "non-urgent" (green).

Here is the most dramatic shift: Surgical admissions jumped from 17.2% of all visits to 19.6%. It's as if the earthquake acted like a pressure cooker, forcing hidden or delayed injuries to the surface, or perhaps making minor conditions worse because people couldn't get their regular medicine.

But the real star of the show was the heart. The number of people needing a cardiology (heart specialist) consultation nearly doubled. Before the quake, it was 0.67% of visits; after, it was 1.07%. The researchers calculated that the odds of needing a heart consult went up by a factor of 1.603. This wasn't just a small bump; it was a clear, loud signal. The stress of the earthquake, the sleepless nights, and the physical exertion of the aftermath seemed to be hitting people's hearts hard, even if they weren't physically injured by the shaking ground.

The Vanishing "Frequent Flyers"

Perhaps the most fascinating discovery was about the "repeat visitors." In any hospital, there are people who come in all the time—sometimes for good medical reasons, sometimes because they have nowhere else to turn. These are the "high-frequency users."

Before the earthquake, 1.4% of patients had visited the ED 4 or more times during that two-week period. After the earthquake? That number plummeted to 0.3%. That is an 84.1% drop. It's as if the earthquake wiped the slate clean for these frequent visitors. They didn't just stop coming; they essentially disappeared from the data. The researchers suggest this might be because these people were displaced, couldn't get to the hospital, or their usual patterns of seeking care were completely broken. The hospital went from seeing the same familiar faces over and over to seeing a sea of new, one-time visitors.

What About Accidents and Crime?

You might wonder: "Did the earthquake cause more fights, car crashes, or workplace accidents?" The researchers checked the "forensic" cases (traffic accidents, work accidents, and other legal injuries). The answer? Nothing changed. The rate of these accidents stayed exactly the same before and after the quake. The earthquake didn't seem to make the city more violent or dangerous in terms of accidents; it just changed how people used the hospital for their health.

The Takeaway

So, what's the lesson here? The earthquake didn't just create a pile of injured people; it acted like a giant filter for the whole community. It scared away the minor cases, it made the surgical and heart problems more urgent, and it made the "frequent flyers" vanish.

The study suggests that when planning for future disasters, hospitals shouldn't just expect a massive crowd of injured people. They need to prepare for a different kind of crowd: fewer people overall, but more people with serious heart issues and surgical needs, and a total lack of the usual repeat patients who usually fill the waiting rooms. The earthquake didn't just break buildings; it broke the routine, and the hospital had to adapt to a completely new rhythm.