Disaster Reanimatology Potentials: A Structured Interview Study in Armenia. III. Results, Conclusions, and Recommendations

Abstract

National medical responses to catastrophic disasters have failed to incorporate a resuscitation component.Purpose:This study sought to determine the lifesaving potentials of modern resuscitation medicine as applied to a catastrophic disaster situation. Previous articles reported the preliminary results (I), and methodology (II) of a structured, retrospective interview study of the 1988 earthquake in Armenia. The present article (III) reports and discusses the definitive findings, formulates conclusions, and puts forth recommendations for future responses to catastrophic disasters anywhere in the world.Results:Observations include: 1) The lack of adequate construction materials and procedures in the Armenian region contributed significantly to injury and loss of life; 2) The uninjured, lay population together with medical teams including physicians in Armenia were capable of rapid response (within two hours); 3) Due to a lack of Advanced Trauma Life Support (ATLS) training for medical teams and of basic first-aid training of the lay public, and scarcity of supplies and equipment for extrication of casualties, they were unable to do much at the scene. As a result, an undetermined number of severely injured earthquake victims in Armenia died slowly without the benefit of appropriate and feasible resuscitation attempts.Recommendations:1) Widespread adoption of seismic-resistant building codes for regions of high seismic risk; 2) The lay public living in these regions should be trained in life-supporting first-aid (LSFA) and basic rescue techniques; 3) Community-wide emergency medical services (EMS) systems should be developed world-wide (tai-lored to the emergency needs of each region) with ATLS capability for field resuscitation; 4) Such systems be prepared to extend coverage to mass casualties; 5) National disaster medical system (NDMS) plans should provide integration of existing trauma-EMS systems into regional systems linked with advanced (heavy) rescue (public works, fire, police); and 6) New techniques and devices for victim extrication should be developed to enable rapid extrication of earthquake casualties within 24 hours.

Disaster epidemiology and medical response in the Chi-Chi earthquake in Taiwan

“…Trauma was the most common cause of death. Pretto et al 8 suggested that deaths might have been prevented if the victims had received medical attention in the first 6 hours after the earthquake. Safar, 24 studying the 1980 earthquake in Italy, concluded that 25% to 50% of victims who were injured and died slowly could have been saved if lifesaving first aid had been rendered immediately.…”

“…7 Although studies related to earthquakes are abundant, few of them have focused on the analysis of emergency care needs to reduce mortality and morbidity. For example, Pretto et al 8 reported that deaths might have been prevented if victims had received appropriate medical attention in the first 6 hours after the Armenia earthquake. Schultz et al 9 indicated that response time is critical in the administration of emergency medical care and that special field hospitals established 1 week or more after the earthquake would be too late to prevent early mortality.…”

Effective Plans for Hospital System Response to Earthquake Emergencies

“…We considered that patients arrive to the closest hospital during a period of 4 days after the earthquake in accordance to the evidence from previous earthquakes. 39,61 Thus, in the flow model the demand-supply variable b i (t)…”

The disaster response performance of hospitals in Taiwan: evaluation and classification

“…Because these individuals are often at the highest risk, human and economic resources should be allocated to enhance their survival and promote their well being during a catastrophe. Pretto et al (1992Pretto et al ( , 1994 demonstrated that there were many victims whose deaths might have been prevented if they had received medical attention in the first 6 h after the tremor. Safar (1986) showed that about 25-50% of the patients could have been saved if emergency care had been rendered at once.…”