Epidemiologic Assessment of Mortality, Building Collapse Pattern, and Medical Response after the 1992 Earthquake in Turkey

Abstract

Background:Post-earthquake engineering and epidemiologic assessments are important for the development of injury prevention strategies. This paper describes mortality and its relationship to building collapse patterns and initial medical responses following the 1992 earthquake in Erzincan, Turkey.Methods:The study consisted of: 1) background data collection and review; 2) design and implementation of a field survey; and 3) site inspection of building collapse patterns. The survey included: 1) national (n = 11) and local (n = 17) officials; 2) medical and search and rescue (SAR) workers (n = 38); and 3) a geographically stratified random sample of lay survivors (n = 105). The survey instruments were designed to gather information regarding location, injuries, initial actions and prior training of survivors and responders, and the location, injuries, and management of dead and dying victims. A case-control design was constructed to assess the relationship between mortality, location, and building collapse pattern.Results:There was extensive structural damage throughout the region, especially in the city where mid-rise, unreinforced masonry buildings (MUMBs) incorporating a “soft” first floor design (large store windows for commercial use) and one story adobe structures were most vulnerable to collapse. Of 526 people who died in the city, 87% (n = 456) were indoors at the time of the earthquake. Of these, 92% (n = 418) died in MUMBs. Of 54 witnessed deaths, 55% (n = 28) of victims died slowly, the majority of whom (n = 26) were pinned or trapped (p <0.05). Of 42 MUMB occupants identified through the survey, those who died (n = 25) were more likely to have been occupying the ground floor when compared with survivors (n = 28) (p <0.01). Official medical and search and rescue responders arrived after most deaths had occurred. Prior first-aid or rescue training of lay, uninjured survivors was associated with a higher likelihood of rescuing and resuscitating others (p <0.001).Conclusion:During an earthquake, MUMBs with soft ground floor construction are highly lethal, especially for occupants on the ground floor, suggesting that this building type is inappropriate for areas of seismic risk. The vulnerability of MUMBs appears due to a lack of lateral force resistance as a result of the use of glass store fiont windows and the absence of shear walls. The prevalence of this building type in earthquake-prone regions needs to be investigated further. A large portion of victims dying in an earthquake die slowly at the scene of injury. Prior public first-aid and rescue training programs increase participation in rescue efforts in major earthquakes and may improve survival.

Lethal injuries following building collapse: comparison between autopsy and radiographic findings

“…Discussione I meccanismi, la distribuzione e la tipologia delle lesioni traumatiche a seguito di un crollo di un edifi cio abitativo sono molteplici e complessi e vanno principalmente, ma non esclusivamente, posti in relazione alla causa del crollo [9][10][11][12][13][14][15] [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Autopsy revealed the presence of diffuse intra-alveolar oedema and haemorrhage and areas of acute emphysema in two cases.…”

“…The mechanisms, distribution and type of traumatic lesions sustained following a building collapse are many and complex, and they must be chiefl y, though not exclusively, considered in relation to the cause of the collapse [9][10][11][12][13][14][15]. Assessing the number, type and severity of lesions observed on the cadavers, revealed by direct necroscopic examination and/or radiography and toxicological analysis, is instrumental for establishing the causes of the event, preventing and reducing risks deriving from such accidents and understanding the death of the victims.…”

“…In fact, it is well e alla modalità di morte delle vittime piuttosto che ad un aumentato rischio generico di danno [8][9][10]. Il crollo di un edifi cio può essere dovuto a cause molto diverse tra loro, dagli uragani a cedimenti strutturali imprevedibili [11][12][13][14][15]. Nel caso in oggetto, l'esplosione di una bombola di gas ha rappresentato l'evento scatenante, ma non causa esclusiva della tragedia: i rilievi successivi al disastro hanno, infatti, dimostrato notevoli carenze strutturali ed irregoknown that in the event of a building collapse, regardless of its causes, the technical characteristics of the building and the circumstances of the damage are more closely related to the pattern of injury and to the mechanism of the victims' deaths rather than to a general increase in the risk of injury [8][9][10].…”

Global Concord for the Mitigation of Acute Deaths in Disaster: Injury Prevention and Mitigation Strategies in Earthquakes

“…In our experience, the majority of protracted deaths are found among victims entrapped under light to moderately heavy rubble in partially collapsed wooden or unreinforced masonry structures. 2 This situation produces multiple trauma and on occasion severe crush injuries of chest, abdomen, or extremities.…”

A Fundamental, National, Medical Disaster Management Plan: An Education-Based Model

“…3 During disasters, especially earthquakes, health systems are expected to play an essential role in reducing mortality and injuries, 4,5 and prehospital and hospital care systems are important components of the health system. [6][7][8][9] For appropriate medical response to these disasters, local medical services must have an effective disaster management plan, adequate equipment, and most importantly, trained workers. 10 Iran is a disaster-prone country.…”