Dirk Danschutter - Academia.edu (original) (raw)
Papers by Dirk Danschutter
Intensive Care Medicine, 1996
Introduction One of the authors (LJS), as part of doctoral studies, has developed nurse-based pro... more Introduction One of the authors (LJS), as part of doctoral studies, has developed nurse-based prospective audit of nosocomial infection in Adult Intensive Care. We wished to apply this method to a Multidisciplinary Regional PICU to determine the incidence of nosocomial infection on such a unit. Method Patient risk assessment: On admission-document risk factors (e.g. diabetes or steroid therapy), placement of invasive devices and major surgical procedures. 4 categories of infection were looked for: ventilator associated pneumonia, urinary tract infection, IV device related infection, and surgical wound infections. Daily Assessment: 1: Assess status of each invasive device and surgical wound. 2. Using algorithm, decide on infection status of each site. For each site infection status is evaluated by 4 parameters: a. Clinical signs and symptoms (graded according to increasing severity). b.Positive bacteriology. c. Antibiotic prescription. d. Written medical diagnosis. Infection at that site is present if 2 or more of a, b and c or if d are positive. Results 69 patients were admitted in a 3 month period from June 1995. Documentation was complete on 39 (56%). 5 patients (12%) acquired ventilator associated pneumonia and 2 patients (5%) developed intravenous device related septicaemia. The were no urinary tract or wound infections. Conclusion We have developed a bedside method of prospectively monitoring nosocomial infection rates in a PICU. Use of this tool not only allows us to measure the effect of infection control interventions, but also increases staff awareness and encourages effective care planning.
Pediatric Research, 2010
Aims: To look at the association between level of social deprivation and incidence of penetrating... more Aims: To look at the association between level of social deprivation and incidence of penetrating trauma in children in London.
Prehospital and Disaster Medicine, 2011
IntroductionDuring disaster relief, personnel's safety is very important. Mental well-being i... more IntroductionDuring disaster relief, personnel's safety is very important. Mental well-being is a part of this safety issue. There is however a lack of objective mental well being monitoring tools, usable on scene, during disaster relief. This study covers the use of validated tools towards detection of psychological distress and monitoring of mental well being of disaster relief workers, during the Belgian First Aid and Support Team deployment after the Haiti earthquake in 2010.MethodologyThe study was conducted using a demographic questionnaire combined with validated measuring instruments: Belbin Team Role, Compassion Fatigue and Satisfaction Self-Test for Helpers, DMAT PsySTART, K6 + Self Report. A baseline measurement was performed before departure on mission, and measurements were repeated at day 1 and day 7 of the mission, at the end of mission, and 7 days, 30 days and 90 days post mission.ConclusionsThe study proved the ability to monitor mental well being and detect psyc...
European journal of emergency medicine : official journal of the European Society for Emergency Medicine, Jan 22, 2016
Disaster medicine research generally lacks control groups. This study aims to describe categories... more Disaster medicine research generally lacks control groups. This study aims to describe categories of diagnoses encountered by the Belgian First Aid and Support Team after the 2010 Haiti earthquake and extract earthquake-related changes from comparison with comparable baseline data. The hypothesis is that besides earthquake-related trauma, medical problems emerge soon, questioning an appropriate composition of Foreign Medical Teams and Interagency Emergency Health Kits. Using a descriptive cohort study design, diagnoses of patients presenting to the Belgian field hospital were prospectively registered during 4 weeks after the earthquake and compared with those recorded similarly by Médecins Sans Frontières in the same area and time span in previous and later years. Of 7000 triaged postearthquake patients, 3500 were admitted, of whom 2795 were included and analysed. In the fortnight after the earthquake, 90% suffered from injury. In the following fortnight, medical diseases emerged, p...
Critical Care Nursing Clinics of North America, 2005
PEDIATRICS, 2007
BACKGROUND. Five children with catheter-related deep venous thrombosis were encountered in our PI... more BACKGROUND. Five children with catheter-related deep venous thrombosis were encountered in our PICU. Three types of polyvinyl chloride tubing for the administration of intravenous solutions were in use (Terumo, Codan, and Perfusend). All were di-(2-ethylhexyl)phthalate plasticized. We suspected problems with the Codan tubing. METHODS. Different types of tubing at different time intervals in vitro were investigated. Tubing segments were assessed on structural alterations by surface electron microscopy. High-performance liquid chromatography-diode array detection and liquid chromatography-mass spectrometry-diode array detection were performed to identify and to quantify di-(2-ethylhexyl)phthalate. The hospital's minimal clinical data set (coded with the International Classification of Diseases, Ninth Revision, Clinical Modification) was investigated on catheter-related deep venous thrombosis between 2000 and 2004. RESULTS. Surface electron microscopy demonstrated that the Codan tu...
Annales de dermatologie et de vénéréologie, 1998
Pediatric Critical Care Medicine, 2004
Background: Ketorolac is a potent nonsteroidal analgesic agent to treat postoperative pain. It pr... more Background: Ketorolac is a potent nonsteroidal analgesic agent to treat postoperative pain. It produces excellent analgesia without the sedating side-effects of opioid analgesics. Routine use of ketorolac after cardiac bypass surgery is limited by concerns of bleeding complications. The purpose of this study was to evaluate the risk of bleeding complications of ketorolac to treat pain after congenital heart surgery in infants and children. Design: Prospective randomized clinical trial was conducted in the cardiac ICU of a pediatric tertiary care hospital. Infants and children who underwent congenital heart surgery requiring cardiopulmonary bypass were randomized to one of two arms in the trial. Postoperative pain control was performed with ketorolac and opioid analgesics in one arm of the study and opioid analgesics alone in the other arm. The main outcome evaluated was bleeding complications measured by chest-tube drainage and wound and gastrointestinal bleeding. Results: 70 infants and children were randomized to the two treatment arms. The median age was 10 months (range, 2.5-174 months). In the ketorolac arm, the median chest-tube drainage was 13.3 (range, 4-22) cc/kg/day, no patient had significant wound bleeding and one (0.03%) patient had gastrointestinal bleeding. In the control arm the median chest-tube drainage was 16.5 (range, 3-24) cc/kg/day, one (0.03%) patient had wound bleeding and no patient had gastrointestinal bleeding. There was no statistically significant difference in the outcomes of the two groups. Conclusion: Ketorolac does not significantly increase the risk of bleeding complications after congenital heart surgery in infants and children.
Nurse Education Today, 2011
The aim was to identify a set of competences for the Flemish academic Master of Nursing and Obste... more The aim was to identify a set of competences for the Flemish academic Master of Nursing and Obstetrics degree that answer perceived needs in health care. The competency model was to demonstrate a degree of consensus among key nurses. The study was conducted in all Flemish hospitals registered to have 400 beds or more. Head nurses of surgery, geriatrics and intensive care units were eligible to participate, as well as one nurse from administration per hospital. A two round Delphi process allowed participants to comment on items identified in an analysis of existing international competency profiles of master level nurses and adapted to the Flemish context. Competences agreed to by 90% of the respondents were considered to have consensus. Fifteen out of 19 eligible hospitals were recruited in the study, 45 nurses participated in the Delphi panel. Consensus was reached on 31 competences that can be assigned to 5 nurse's roles: nursing expert, innovator, researcher, educator and manager. The resulting competency profile is in accordance with published profiles for similar programs. The reported study demonstrates a practical method to develop a consensus competency model for an academic master program based on the input of key individuals in mainstream nursing.
International Journal of Cardiology, 2010
We report the case of an 8 year old boy presenting with episodes of decreased consciousness. As t... more We report the case of an 8 year old boy presenting with episodes of decreased consciousness. As the boy's father died of a sudden cardiac death (SCD) at the age of 31 years, among other causes a Brugada syndrome (BS) was suspected. The boy was further examined at the UZ Brussels Heart Rhythm Management Center. The intravenous administration of ajmaline confirmed a BS without ventricular arrhythmias. Syncope in children can be an imminent sign of BS. BS is a life threatening condition that can deteriorate into SCD. The boy presented with episodes of lowered consciousness, transpiration and paleness. Readmission for further investigation was required. Clinical observation and continuous registered EEG during sleep showed multiple epileptical incidents. Hence the child was diagnosed with new onset epilepsy. For initiation of antiepileptic therapy, the patient was admitted at the pediatric intensive care unit (PICU). Close clinical observation and cardiovascular monitoring with continuous 12-lead ECG registration were performed during orally administered sodium valproic acid. During this anticonvulsive treatment in a child with documented BS no significant alterations in ECG-findings were observed. In this particular patient sodium valproic acid treatment can be estimated as a safe anticonvulsive therapy.
Intensive Care Medicine, 1996
The mortality due to meningoccocal sepsis is high in spite of important progress in emergency and... more The mortality due to meningoccocal sepsis is high in spite of important progress in emergency and intensive care medicine. During the last decade multiple scoring-systems have been developed in order to establish a therapeutic approach and to evaluate the final outcome of a meningococcal infection. Different clinical and biological data (shock, ecchymosis, peripheral WBC and platelet count, coagulopathy, acidosis, meningism, etc) are taken into consideration and the importance given to these data depends on the scoring-system used. A review of the different scoring-systems is given and a clinical case is presented. We report the case of a 4 year old male, who was transfered to our ICU 12 hours after onset of temperature and skin rash. The parents described a fast deterioration of his condition. The boy presented wide spread ecchymosis, high temperature, no signs of meningism, circulatory insufficiency and shock, coagulopathy and low peripheral WBC and platelet count. Disseminated intravascular coagulopathy developed promptly. The Glasgow Meningococcal Septicemia Prognostic Score (GMSS) was used and the obtained score reached the highest level (15115). This corresponds to a 100% mortality. The patient required mechanical ventilation for 5 days. At admission he received human albumine, fresh frozen plasma, dexamethason, dopamine, dobutamine and a continuous infusion of adrenaline. Antibiotical treatment consisted of ceftriaxone. The evolution was favorable and the infant fully recovered. Retrospectively the GMSS was compared to other meningococcal scoring scales which gave the same mortality (100%). We conclude that the scoring-systems are important to evaluate the seriousness and to assess the therapeutic approach, but they should be used cautiously even when 100% mortality is predicted by several risk evaluations scoring-systems.
AACN Advanced Critical Care, 2010
Pathophysiology The Virchow triad of venous stasis, injury to the vessel wall, and a hypercoagula... more Pathophysiology The Virchow triad of venous stasis, injury to the vessel wall, and a hypercoagulable state is considered to be the chief mechanism for venous thrombosis development. The development of venous thrombosis occurs when coagulation is triggered in areas of decreased blood flow or areas where particles and xenobiotics are infused, or when the infused emulsion characteristics become altered because of physicochemical interactions. Thrombosis is set off by several interacting pathways (coagulation and complement pathways) often consisting of enzymes that intensify the effect of an early trigger event. A similar series of events result in fibrinolysis, and even though thrombus development and thrombolysis are constant actions, with increased stasis, procoagulant factors, or injury to the endothelium, the pathologic development of an obstructive thrombus may occur. Deep vein thrombosis of the lower extremity usually commences in the deep veins around the valve cusps or at venous branch points such as in calf or femoral veins. Venodilation can disturb the endothelial cell barrier and uncover the subendothelium. Platelets attach to the subendothelial surface (extrinsic pathway), activating neutrophils and platelets. A similar activation via the contact system (intrinsic pathway) can follow the insidious infusion of xenobiotics and particles. The coagulation and interacting complement pathway release procoagulant and inflammatory mediators (such as selectins), leading to an active inflammatory response in the vessel wall and the development of a thrombus. Most calf vein thrombi resolve spontaneously without therapy. Approximately 20% spread proximally. The process of adherence of a venous thrombus does not begin until 5 to 10 days after thrombus development. Until this process has been fully established, the nonadherent thrombus may propagate and/or embolize.
Connect: The World of Critical Care Nursing, 2006
• October 8th, 2005 saw a devastating earthquake with a magnitude of 7.6 on the Richter scale, wh... more • October 8th, 2005 saw a devastating earthquake with a magnitude of 7.6 on the Richter scale, which hit the Pakistani North Western Frontier Province (NWFP) and the pre-Himalayan Pakistan and Indian controlled provinces of Kashmir. • About 4 million people were affected, with an estimated 3.2 million left homeless. More than 100,000 people have died. • Pakistan made a request for relief to the international community and Belgium, among many other countries, offered to send a medical Phase I team. This team was B-FAST (Belgian First Aid & Support Team), which is constituted of mainly civilian medical doctors and nurses. • In addition a mobile (tent) hospital, International Dispensary Association kits, food, water and blankets were transported to Muzzafarabad, the epicentre of the devastating earthquake. • The United Nations Headquarters dedicated the trapped border town Chakothi, lying at the Line of Control with India to the team. However Chakothi could not be reached because the road had been destroyed and covered with rocks. Instead B-FAST joined a Pakistani military base in Tandali valley at the border of the Jehlum River. • More than 2,000 badly injured (27% younger than twelve years old) could be treated. About 5% of the patients in a critical condition could be stabilized and transferred to the international back-up hospitals (French, Turkish, and Russian) at Muzzafarabad or the University Medical Center of Islamabad.
Intensive Care Medicine, 1996
Introduction One of the authors (LJS), as part of doctoral studies, has developed nurse-based pro... more Introduction One of the authors (LJS), as part of doctoral studies, has developed nurse-based prospective audit of nosocomial infection in Adult Intensive Care. We wished to apply this method to a Multidisciplinary Regional PICU to determine the incidence of nosocomial infection on such a unit. Method Patient risk assessment: On admission-document risk factors (e.g. diabetes or steroid therapy), placement of invasive devices and major surgical procedures. 4 categories of infection were looked for: ventilator associated pneumonia, urinary tract infection, IV device related infection, and surgical wound infections. Daily Assessment: 1: Assess status of each invasive device and surgical wound. 2. Using algorithm, decide on infection status of each site. For each site infection status is evaluated by 4 parameters: a. Clinical signs and symptoms (graded according to increasing severity). b.Positive bacteriology. c. Antibiotic prescription. d. Written medical diagnosis. Infection at that site is present if 2 or more of a, b and c or if d are positive. Results 69 patients were admitted in a 3 month period from June 1995. Documentation was complete on 39 (56%). 5 patients (12%) acquired ventilator associated pneumonia and 2 patients (5%) developed intravenous device related septicaemia. The were no urinary tract or wound infections. Conclusion We have developed a bedside method of prospectively monitoring nosocomial infection rates in a PICU. Use of this tool not only allows us to measure the effect of infection control interventions, but also increases staff awareness and encourages effective care planning.
Pediatric Research, 2010
Aims: To look at the association between level of social deprivation and incidence of penetrating... more Aims: To look at the association between level of social deprivation and incidence of penetrating trauma in children in London.
Prehospital and Disaster Medicine, 2011
IntroductionDuring disaster relief, personnel's safety is very important. Mental well-being i... more IntroductionDuring disaster relief, personnel's safety is very important. Mental well-being is a part of this safety issue. There is however a lack of objective mental well being monitoring tools, usable on scene, during disaster relief. This study covers the use of validated tools towards detection of psychological distress and monitoring of mental well being of disaster relief workers, during the Belgian First Aid and Support Team deployment after the Haiti earthquake in 2010.MethodologyThe study was conducted using a demographic questionnaire combined with validated measuring instruments: Belbin Team Role, Compassion Fatigue and Satisfaction Self-Test for Helpers, DMAT PsySTART, K6 + Self Report. A baseline measurement was performed before departure on mission, and measurements were repeated at day 1 and day 7 of the mission, at the end of mission, and 7 days, 30 days and 90 days post mission.ConclusionsThe study proved the ability to monitor mental well being and detect psyc...
European journal of emergency medicine : official journal of the European Society for Emergency Medicine, Jan 22, 2016
Disaster medicine research generally lacks control groups. This study aims to describe categories... more Disaster medicine research generally lacks control groups. This study aims to describe categories of diagnoses encountered by the Belgian First Aid and Support Team after the 2010 Haiti earthquake and extract earthquake-related changes from comparison with comparable baseline data. The hypothesis is that besides earthquake-related trauma, medical problems emerge soon, questioning an appropriate composition of Foreign Medical Teams and Interagency Emergency Health Kits. Using a descriptive cohort study design, diagnoses of patients presenting to the Belgian field hospital were prospectively registered during 4 weeks after the earthquake and compared with those recorded similarly by Médecins Sans Frontières in the same area and time span in previous and later years. Of 7000 triaged postearthquake patients, 3500 were admitted, of whom 2795 were included and analysed. In the fortnight after the earthquake, 90% suffered from injury. In the following fortnight, medical diseases emerged, p...
Critical Care Nursing Clinics of North America, 2005
PEDIATRICS, 2007
BACKGROUND. Five children with catheter-related deep venous thrombosis were encountered in our PI... more BACKGROUND. Five children with catheter-related deep venous thrombosis were encountered in our PICU. Three types of polyvinyl chloride tubing for the administration of intravenous solutions were in use (Terumo, Codan, and Perfusend). All were di-(2-ethylhexyl)phthalate plasticized. We suspected problems with the Codan tubing. METHODS. Different types of tubing at different time intervals in vitro were investigated. Tubing segments were assessed on structural alterations by surface electron microscopy. High-performance liquid chromatography-diode array detection and liquid chromatography-mass spectrometry-diode array detection were performed to identify and to quantify di-(2-ethylhexyl)phthalate. The hospital's minimal clinical data set (coded with the International Classification of Diseases, Ninth Revision, Clinical Modification) was investigated on catheter-related deep venous thrombosis between 2000 and 2004. RESULTS. Surface electron microscopy demonstrated that the Codan tu...
Annales de dermatologie et de vénéréologie, 1998
Pediatric Critical Care Medicine, 2004
Background: Ketorolac is a potent nonsteroidal analgesic agent to treat postoperative pain. It pr... more Background: Ketorolac is a potent nonsteroidal analgesic agent to treat postoperative pain. It produces excellent analgesia without the sedating side-effects of opioid analgesics. Routine use of ketorolac after cardiac bypass surgery is limited by concerns of bleeding complications. The purpose of this study was to evaluate the risk of bleeding complications of ketorolac to treat pain after congenital heart surgery in infants and children. Design: Prospective randomized clinical trial was conducted in the cardiac ICU of a pediatric tertiary care hospital. Infants and children who underwent congenital heart surgery requiring cardiopulmonary bypass were randomized to one of two arms in the trial. Postoperative pain control was performed with ketorolac and opioid analgesics in one arm of the study and opioid analgesics alone in the other arm. The main outcome evaluated was bleeding complications measured by chest-tube drainage and wound and gastrointestinal bleeding. Results: 70 infants and children were randomized to the two treatment arms. The median age was 10 months (range, 2.5-174 months). In the ketorolac arm, the median chest-tube drainage was 13.3 (range, 4-22) cc/kg/day, no patient had significant wound bleeding and one (0.03%) patient had gastrointestinal bleeding. In the control arm the median chest-tube drainage was 16.5 (range, 3-24) cc/kg/day, one (0.03%) patient had wound bleeding and no patient had gastrointestinal bleeding. There was no statistically significant difference in the outcomes of the two groups. Conclusion: Ketorolac does not significantly increase the risk of bleeding complications after congenital heart surgery in infants and children.
Nurse Education Today, 2011
The aim was to identify a set of competences for the Flemish academic Master of Nursing and Obste... more The aim was to identify a set of competences for the Flemish academic Master of Nursing and Obstetrics degree that answer perceived needs in health care. The competency model was to demonstrate a degree of consensus among key nurses. The study was conducted in all Flemish hospitals registered to have 400 beds or more. Head nurses of surgery, geriatrics and intensive care units were eligible to participate, as well as one nurse from administration per hospital. A two round Delphi process allowed participants to comment on items identified in an analysis of existing international competency profiles of master level nurses and adapted to the Flemish context. Competences agreed to by 90% of the respondents were considered to have consensus. Fifteen out of 19 eligible hospitals were recruited in the study, 45 nurses participated in the Delphi panel. Consensus was reached on 31 competences that can be assigned to 5 nurse's roles: nursing expert, innovator, researcher, educator and manager. The resulting competency profile is in accordance with published profiles for similar programs. The reported study demonstrates a practical method to develop a consensus competency model for an academic master program based on the input of key individuals in mainstream nursing.
International Journal of Cardiology, 2010
We report the case of an 8 year old boy presenting with episodes of decreased consciousness. As t... more We report the case of an 8 year old boy presenting with episodes of decreased consciousness. As the boy's father died of a sudden cardiac death (SCD) at the age of 31 years, among other causes a Brugada syndrome (BS) was suspected. The boy was further examined at the UZ Brussels Heart Rhythm Management Center. The intravenous administration of ajmaline confirmed a BS without ventricular arrhythmias. Syncope in children can be an imminent sign of BS. BS is a life threatening condition that can deteriorate into SCD. The boy presented with episodes of lowered consciousness, transpiration and paleness. Readmission for further investigation was required. Clinical observation and continuous registered EEG during sleep showed multiple epileptical incidents. Hence the child was diagnosed with new onset epilepsy. For initiation of antiepileptic therapy, the patient was admitted at the pediatric intensive care unit (PICU). Close clinical observation and cardiovascular monitoring with continuous 12-lead ECG registration were performed during orally administered sodium valproic acid. During this anticonvulsive treatment in a child with documented BS no significant alterations in ECG-findings were observed. In this particular patient sodium valproic acid treatment can be estimated as a safe anticonvulsive therapy.
Intensive Care Medicine, 1996
The mortality due to meningoccocal sepsis is high in spite of important progress in emergency and... more The mortality due to meningoccocal sepsis is high in spite of important progress in emergency and intensive care medicine. During the last decade multiple scoring-systems have been developed in order to establish a therapeutic approach and to evaluate the final outcome of a meningococcal infection. Different clinical and biological data (shock, ecchymosis, peripheral WBC and platelet count, coagulopathy, acidosis, meningism, etc) are taken into consideration and the importance given to these data depends on the scoring-system used. A review of the different scoring-systems is given and a clinical case is presented. We report the case of a 4 year old male, who was transfered to our ICU 12 hours after onset of temperature and skin rash. The parents described a fast deterioration of his condition. The boy presented wide spread ecchymosis, high temperature, no signs of meningism, circulatory insufficiency and shock, coagulopathy and low peripheral WBC and platelet count. Disseminated intravascular coagulopathy developed promptly. The Glasgow Meningococcal Septicemia Prognostic Score (GMSS) was used and the obtained score reached the highest level (15115). This corresponds to a 100% mortality. The patient required mechanical ventilation for 5 days. At admission he received human albumine, fresh frozen plasma, dexamethason, dopamine, dobutamine and a continuous infusion of adrenaline. Antibiotical treatment consisted of ceftriaxone. The evolution was favorable and the infant fully recovered. Retrospectively the GMSS was compared to other meningococcal scoring scales which gave the same mortality (100%). We conclude that the scoring-systems are important to evaluate the seriousness and to assess the therapeutic approach, but they should be used cautiously even when 100% mortality is predicted by several risk evaluations scoring-systems.
AACN Advanced Critical Care, 2010
Pathophysiology The Virchow triad of venous stasis, injury to the vessel wall, and a hypercoagula... more Pathophysiology The Virchow triad of venous stasis, injury to the vessel wall, and a hypercoagulable state is considered to be the chief mechanism for venous thrombosis development. The development of venous thrombosis occurs when coagulation is triggered in areas of decreased blood flow or areas where particles and xenobiotics are infused, or when the infused emulsion characteristics become altered because of physicochemical interactions. Thrombosis is set off by several interacting pathways (coagulation and complement pathways) often consisting of enzymes that intensify the effect of an early trigger event. A similar series of events result in fibrinolysis, and even though thrombus development and thrombolysis are constant actions, with increased stasis, procoagulant factors, or injury to the endothelium, the pathologic development of an obstructive thrombus may occur. Deep vein thrombosis of the lower extremity usually commences in the deep veins around the valve cusps or at venous branch points such as in calf or femoral veins. Venodilation can disturb the endothelial cell barrier and uncover the subendothelium. Platelets attach to the subendothelial surface (extrinsic pathway), activating neutrophils and platelets. A similar activation via the contact system (intrinsic pathway) can follow the insidious infusion of xenobiotics and particles. The coagulation and interacting complement pathway release procoagulant and inflammatory mediators (such as selectins), leading to an active inflammatory response in the vessel wall and the development of a thrombus. Most calf vein thrombi resolve spontaneously without therapy. Approximately 20% spread proximally. The process of adherence of a venous thrombus does not begin until 5 to 10 days after thrombus development. Until this process has been fully established, the nonadherent thrombus may propagate and/or embolize.
Connect: The World of Critical Care Nursing, 2006
• October 8th, 2005 saw a devastating earthquake with a magnitude of 7.6 on the Richter scale, wh... more • October 8th, 2005 saw a devastating earthquake with a magnitude of 7.6 on the Richter scale, which hit the Pakistani North Western Frontier Province (NWFP) and the pre-Himalayan Pakistan and Indian controlled provinces of Kashmir. • About 4 million people were affected, with an estimated 3.2 million left homeless. More than 100,000 people have died. • Pakistan made a request for relief to the international community and Belgium, among many other countries, offered to send a medical Phase I team. This team was B-FAST (Belgian First Aid & Support Team), which is constituted of mainly civilian medical doctors and nurses. • In addition a mobile (tent) hospital, International Dispensary Association kits, food, water and blankets were transported to Muzzafarabad, the epicentre of the devastating earthquake. • The United Nations Headquarters dedicated the trapped border town Chakothi, lying at the Line of Control with India to the team. However Chakothi could not be reached because the road had been destroyed and covered with rocks. Instead B-FAST joined a Pakistani military base in Tandali valley at the border of the Jehlum River. • More than 2,000 badly injured (27% younger than twelve years old) could be treated. About 5% of the patients in a critical condition could be stabilized and transferred to the international back-up hospitals (French, Turkish, and Russian) at Muzzafarabad or the University Medical Center of Islamabad.