Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-26T16:59:38.589Z Has data issue: false hasContentIssue false
  • English
  • Français

An Analysis of Prehospital Mortality in an Earthquake

Published online by Cambridge University Press:  28 June 2012

Ernesto A. Pretto ,
Derek C. Angus ,
Joel I. Abrams ,
Bern Shen ,
Richard Bissell ,
Victor M. Ruiz Castro ,
Roberto Sawyers ,
Yukihiro Watoh ,
Norma Ceciliano  and
Edmund Ricci
Ernesto A. Pretto*
Affiliation:
International Resuscitation Research Center (IRRC), and the Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Derek C. Angus
Affiliation:
International Resuscitation Research Center (IRRC), and the Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Joel I. Abrams
Affiliation:
Department of Civil Engineering, University of Pittsburgh, Pittsburgh, Pa.
Bern Shen
Affiliation:
Center for Emergency Medicine, University of Pittsburgh, Pittsburgh, Pa.
Richard Bissell
Affiliation:
Maryland Institute for Emergency Medical Services Systems, University of Maryland, Baltimore, Md.
Victor M. Ruiz Castro
Affiliation:
Comisión Nacional de Emergencia (CNE), Costa Rica
Roberto Sawyers
Affiliation:
Caja de Seguro Social (CCSS), Costa Rica.
Yukihiro Watoh
Affiliation:
International Resuscitation Research Center (IRRC), and the Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Norma Ceciliano
Affiliation:
International Resuscitation Research Center (IRRC), and the Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Edmund Ricci
Affiliation:
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa.
*
Principal Investigator, Disaster Reanimatology Study Group (DRSG), International Resuscitation Research Center, 3434 Fifth Ave., Pittsburgh, PA 15260 USA
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

advanced trauma life supportcrush injurydisasterdisaster epidemiologydisaster medicinedisaster reanimatologydisaster responseearthquakeemergency medical servicesinjury typeslife supporting first-aidpreventable deathsprotracted deathsresuscitationrisk factorssearch and rescuestructured interview
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 9 , Issue 2 , June 1994 , pp. 107 - 117
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Safar, P: Resuscitation potentials in mass disasters. Prehospital and Disaster Medicine 1986;2:34–47.CrossRefGoogle Scholar
2. Lechat, MF: Disasters and public health. Bull WHO 1979;57:11–17.Google ScholarPubMed
3. Binder, S, Sanderson, LM: The role of the epidemiologist in natural disasters. Ann Emerg Med 1987;16:1081–1084.CrossRefGoogle ScholarPubMed
4. Gregg, MB (ed): The Public Health Consequences of Disaster. Atlanta, Centers for Disease Control, 1989.Google Scholar
5. deBruyker, M, Greco, D, Annino, I, et al. : The 1980 earthquake in southern Italy: Morbidity and mortality. Int J Epidemiol 1985;14:113–117.Google Scholar
6. DeVille de Goyet, C, Del Cid, E, Romero, E, et al. : Earthquake in Guatemala: Epidemiologic evaluation of the relief effort. Pan Am Health Org Bull 1976;10:95–109.Google Scholar
7. DeVille de Goyet, C, Jeannee, E: Epidemiological data on morbidity and mortality following the Guatemala earthquake. IRCS Med Sciences: Social and Med 1976;4:212.Google Scholar
8. DeVille de Goyet, C, Zeballos, JL: Communicable diseases and epi demiological surveillance after sudden natural disasters. In Baskett, P, Weller, R (eds): Medicine Jar Disasters. London, Wright, 1988;252–269.Google Scholar
9. Seaman, J, Leivesley, C, Hogg, C (eds): Epidemiology of Natural Disasters. Basel & New York: Karger, 1984.Google Scholar
10. Baker, CW, Chapman, (eds): Man and Society in Disaster, New York: Basic Books Inc., 1962.Google Scholar
11. Baker, Fj: The management of mass casualty disasters. Topics in Emerg Med 1979;1:149.Google ScholarPubMed
12. Barton, AH: Social organization under stress: A sociological review of disaster studies, disaster study No. 17, publication No. 1032, Disaster Research Group, National Academy of Sciences—National Research Council, Washington, DC, 1963.CrossRefGoogle Scholar
13. Barton, A: Communities in Disaster: A Sociological Analysis of Collective Stress Situations. Garden City: Doubleday and Co., 1969.Google Scholar
14. Drabek, TE: Human System Responses to Disaster: An Inventory of Sociological Findings. New York: Spinger-Verlag, 1986.CrossRefGoogle Scholar
15. Quarantelli, EL: Some basic themes in sociological studies of disasters. In: Quarantelli, EL (ed): Disasters: Theory and Research. Beverly Hills, Calif: Sage Publications, 1978.Google Scholar
16. Quarantelli, EL: Inventory of Disaster Field Studies in the Social and Behavioral Sciences 1919–1979, Disaster Research Center, University of Delaware, Newark, 1982.Google Scholar
17. Chandler, AM: Building damage in Mexico City earthquake. Nature 1986:320:497–501.CrossRefGoogle Scholar
18. Krimgold, F: Collapsed buildings: Search-and-rescue challenges. Emergency Medical Services 1987;16:34–35.Google Scholar
19. Tiedman, H: Casualties as a Function of Building Quality and Earth quake Intensity. Proceedings of the International Workshop on Earthquake Injury Epidemiology: Implications for Mitigation and Response. Baltimore: Johns Hopkins University, 1989;420–434.Google Scholar
20. Solnes, J (ed): Engineering Seismology and Earthquake Engineering. Leiden, Noordhoff, 1974.CrossRefGoogle Scholar
21. Safar, P, Ramos, V, Mosquera, J, et al. : Anecdotes on resuscitation potentials following the earthquake of 1970 in Peru. Prehospital and Disaster Medicine 1987;3:124.Google Scholar
22. Safar, P, Kirimli, N, Agnes, A, Magalini, S: Anecdotes on resuscitation potentials following the earthquake of 1980 in Italy. Proceedings of the Fourth World Congress on Emergency and Disaster Medicine (abstract). Brighton, UK, June 1985.Google Scholar
23. Safar, P, Pretto, E, Bircher, N: Disaster resuscitology including the management of severe trauma. In: Baskett, P, Weller, R (eds): Medicine for Disasters. London: Wright-Butterworth, 1988, pp 36–86.Google Scholar
24. Glass, RI, Urrutia, JJ, Sibornys, S, et al. : Earthquake injuries related to housing in a Guatemalan village. Science 1977;197:638–643.CrossRefGoogle Scholar
25. Noji, EK, Kelen, GD, Armenian, HK, et al. : The 1988 earthquake in Soviet Armenia: A case study. Ann Emerg Med 1990;19:75–81.CrossRefGoogle ScholarPubMed
26. Pollander, GS, Rund, DA: Analysis of medical needs in disasters caused by earthquake: The need for a uniform reporting scheme. Disasters 1989;13:365–369.CrossRefGoogle Scholar
27. American College of Surgeons Committee on Trauma. Collicott, PE (ed): Advanced Trauma Life Support Course for Physicians. Chicago: American College of Surgeons, 1984.Google Scholar
28. Cowley, RA, Dunham, CM (eds): Shock Trauma/Critical Care Manual. Initial Assessment and Management. Baltimore: University Park Press, 1982.Google Scholar
29. Restall, J, Knight, J: Analgesia and anesthesia in the field. In: Baskett, P, Weller, R (eds), Medicine for Disasters. London: Wright-Butter worth, 1986, pp 87–101.Google Scholar
30. Williams, ML, Hammond, PY: Engineering challenges for minimizing casualties from earthquakes. Prehospital and Disaster Medicine 1985;1:427.CrossRefGoogle Scholar
31. Kvetan, V (ed): Disaster Management. Crit Care Clin 1991;7:257–448.Google Scholar
32. Frey, R: The Club of Mainz for improved worldwide emergency and critical care medicine systems and disaster preparedness. Crit Care Med 1978:6:389.Google ScholarPubMed
33. Klain, M, Ricci, E, Safar, P, et al. : Disaster reanimatology potentials: A structured interview study in Armenia I. Methodology and preliminary results. Prehospital and Disaster Medicine 1989:4:135–152.CrossRefGoogle Scholar
34. Ricci, E, Pretto, E, Safar, P, et al. : Disaster reanimatology potentials: A structured interview study in Armenia II. Method for evaluation of medical response to major disasters. Prehospital and Disaster Medicine 1991;6:159–166.CrossRefGoogle Scholar
35. Pretto, E, Ricci, E, Safar, P, et al. : Disaster reanimatolgy potentials: A structured interview study in Armenia III. Final results, conclusions and recommendations. Prehospital and Disaster Medicine 1992:7:327–338.CrossRefGoogle Scholar
36. Pretto, E, Angus, D, Abrams, J, et al. : The incidence of protracted death after the April 22, 1991, earthquake in Limón Province, Costa Rica. Proceedings of the 2nd Asian-Pacific Conference on Disaster Medicine, Tokyo, Japan, 1992.Google Scholar
37. Ricci, E, Pretto, E: Assessment of prehospital and hospital response in disaster. Crit Care Clin 1991:7:471–484.CrossRefGoogle ScholarPubMed
38. Bissell, R, Pretto, E, Angus, D, et al. : Post-preparedness response in Costa Rica. Prehospital and Disaster Medicine, 1994;9:96–106.CrossRefGoogle ScholarPubMed
39. Allan, AN: Preventable pre-hospital deaths: A review. J Br Assoc Immed Care 1991;14:17–20.Google Scholar
40. Zhi-Yong, S: Medical support in the Tangshan earthquake. A review of the management of mass casualties and certain major injuries. J Trauma 1987;10:1130–1135.CrossRefGoogle Scholar
41. Allister, C: Cardiac arrest after crush injury (a case report). Br Med J 1983;287:531–532.CrossRefGoogle Scholar
42. Villazon-Sahagun, A: Mexico City earthquake. Medical response. Prehospilal and Disaster Medicine 1986;2:15–20.CrossRefGoogle Scholar
43. Better, OS, Stein, JH: Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med 1990:322:835–829.Google ScholarPubMed
44. Kai, T, Pretto, E, Safar, P, Capone, A: Development of a crush injury research model in the rat. Proceedings of the Second International Urban Emergency Medicine Symposium, October 27–29, 1993, Beijing, China.Google Scholar
45. Angus, D, Pretto, E, Abrams, J, et al. : Recommendations for life-supporting first-aid training of the lay public for disaster preparedness. Prehospital and Disaster Medicine 1993;8:157–160.CrossRefGoogle ScholarPubMed
46. Abrams, J, Pretto, E, Angus, D, et al. : Guidelines for rescue training of the lay public. Prehospital and Disaster Medicine 1993;8;151–156.CrossRefGoogle ScholarPubMed
47. Auf Der Heide, E: Disaster Response: Principles of Preparation and Coordination. St. Louis, Mosby-Year Book, 1989.Google Scholar
48. Haynes, BE, Freeman, C, Rubin, JL, et al. : Medical response to catastrophic events: California's planning and the Loma Prieta earth quake. Ann Emerg Med 1992;21:368–374.CrossRefGoogle Scholar
49. Pretto, E, Safar, P: National medical response to mass disasters in the United States: Are we prepared? JAMA 1991;266:1259–1266.CrossRefGoogle ScholarPubMed