An Analysis of Prehospital Mortality in an Earthquake

Abstract

Introduction:Anecdotal observations about prehospital emergency medical care in major natural and human-made disasters, such as earthquakes, have suggested that some injured victims survive the initial impact, but eventually die because of a delay in the application of life-saving medical therapy.Methods:A multidisciplinary, retrospective structured interview methodology to investigate injury risk factors, and causes and circumstances of prehospital death after major disasters was developed. In this study, a team of United States researchers and Costa Rican health officials conducted a survey of lay survivors and health care professionals who participated in the emergency medical response to the earthquake in Costa Rica on 22 April 1991.Results:Fifty-four deaths occurred prior to hospitatization (crude death rate = 0.4/1,000 population). Seventeen percent of these deaths (9/54) were of casualties who survived the initial impact but died at the scene or during transport. Twenty-two percent (2/9) were judged preventable if earlier emergency medical care had been available. Most injuries and deaths occurred in victims who were inside wooden buildings (p <.O1) as opposed to other building types or were pinned by rubble from building collapse. Autopsies performed on a sample of victims showed crush injury to be the predominant cause of death.Conclusions:A substantial proportion of earthquake mortality in Costa Rica was protracted. Crush injury was the principal mechanism of injury and cause of death. The rapid institution of enhanced prehospital emergency medical services may be associated with a significant life- saving potential in these events.

Terremotos, salud y sociedad: lecciones aprendidas

“…Las muertes tardías ocurren en días y pueden deberse a deshidratación, hipotermia, hipertermia, síndrome de aplastamiento, infección de heridas o sepsis posoperatoria. 15,16 Como sucede en otros desastres naturales, la mayoría de las personas que requieren asistencia médica luego de terremotos tiene lesiones menores causadas por la caída de materiales como piezas de mampostería, revestimientos y vigas. 17 En este contexto, se comparten las experiencias operativas de los modelos de asistencia que fueron implementados, para los contornos de la Ciudad de México, Morelos, el Estado de México y el Istmo de Tehuantepec, en Oaxaca.…”

Integrating epidemiological and engineering approaches in the assessment of human casualties in earthquakes

“…These criteria used to screen all abstracts included. Eight studies met these criteria and were included in this section (Noji et al 1993;Pretto et al 1994;Tanaka et al 1998;Fawcett and Oliveira 2000;Liang et al 2001;Bissell et al 2004;Jiang et al 2012;Wen et al 2012 studies were included in this section for the purpose of establishing a theoretical framework for the association between medical preparedness and response and the number of casualties in earthquake events (Schultz et al 1996;Peek-Asa et al 1998;Ashkenazi et al 2005;Ramirez and Peek-Asa 2005;Macintyre et al 2006;Bayard 2010;Bartal et al 2011;Haojun et al 2011;Archer et al 2011). Although these studies did not quantitatively measure the association between medical preparedness and response and earthquake casualties, they contributed through establishing the need for evidence-based and theoretically driven modeling.…”

“…In addition, providing medical aid in a disaster-affected area also entails working under extreme conditions, such as reduced workforce, limited medical supplies and resources compared to the increased demands for medical care (Archer et al 2011;Jiang et al 2012), and requires particular knowledge and preparedness for this scenario. Nonetheless, hospitals are considered the principal providers of immediate medical care after catastrophic events, and the general assumption is that a wellprepared hospital and medical staff could reduce mortality after a serious earthquake (Schultz et al 1996;Pretto et al 1994). Only one study directly assessed health sector preparedness levels and the association with earthquake-induced mortality.…”

“…The findings revealed that 'low prepared' regions had five times more fatalities per 100 injuries compared to 'medium prepared' regions and that 'high prepared' regions had 30 times fewer fatalities compared to 'medium prepared' regions (Bissell et al 2004). Other studies found that the mortality rate for severely injured victims was 15-25 % and was usually higher in frontline hospitals and that these rates may decline to 9-3 % or even lower, if proper medical care is not delayed (Pretto et al 1994;Tanaka et al 1998;Fawcett and Oliveira 2000;Jiang et al 2012;Wen et al 2012). Some studies reported findings that relate to this subject indirectly.…”

Crush injury and rhabdomyolysis

“…Over 600 patients developed renal failure and required dialysis [110]. There was a paucity of patients with major trauma to the head, chest, or abdomen seen in hospitals after the earthquake, suggesting that these injuries lead to asphyxiation and are generally fatal when they occur in the setting of a disaster that generates significant crush injuries [15,17]. It became clear early on that the local medical resources were going to be insufficient to care for the large number of injured patients, and dialysis teams from several countries were flown to the area.…”