An earthquake measuring 6.6 on the Richter scale on 23 December 2003 devastated the city of Bam in southeastern Iran. During the response and recovery phases, considerable shortcomings were discovered. The dire situation in the affected area, a variety of urgently required interventions, and the large number of aid organizations involved brought about difficulties in management, coordination, and communication among authorities and aid organizations. This article highlights flaws in management in the var-ious aspects of this disaster in order to assess what was done, and what should be done to overcome these shortcomings in future disasters.

A retrospective review of the various aspects of management related to the Bam disaster was done via the assessment of files, multi-center studies, governmental data, and available literature from 2003–2008.

A review of the available data relevant to search and rescue (S&R) operations and short-term aid provision revealed flaws in different aspects of disaster management including personnel, the transfer of the injured, availability medical supplies, treatment planning, problems concerning the composition of treatment forces dispatched to the region, distribution of tasks among treatment workers, transferring of equipment, availability of facilities, and lack of coordination among the organizations responsible for the management of the disaster. Most of the aforementioned issues have been addressed.

A comprehensive disaster management plan must not be limited only to the response phase, but rather must include: preparedness, recovery with optimal legislation and budgeting, improvement of healthcare facilities, and organized communication channels between the different governmental departments. This important issue has been addressed, and a disaster management organization under the supervision of the President has been established, developing a national S&R strategy and protocol for unified managerial organization, an alert system, an international disaster command system (under which S&R and emergency medical service teams can be deployed, increasing the efficacy and coordination of the arrival of foreign teams and the con-struction field hospitals), and developing a flowchart to coordinate international agencies and the domestic authorities in charge. Continuous education, training of the general population, conducting periodic exercise drills, and provision for prepared task force mobilization in disaster management all are important aspects of the management of disasters due to natural hazards.

An earthquake measuring 6.6 Richter in 2003 devastated the historic Iranian city of Bam. During the response and recovery phases, considerable shortcomings were experienced. Flaws in the management of the various aspects of this disaster were identified to assess what was done or should be done to overcome these shortcomings during future disasters.

A review of the management of the Bam disaster was performed by assessing files and data from 17 multi-center studies from 2003–2008. This assessment included data that related to the: (1) early warning phase; (2) time under rubble; (3) time to reach the scene and evacuate casualties; (4) assessment of rescue operations; (5) coordination of rescue teams; (6) triage; (7) trauma management; (8) transfer of equipment (resource mobilization); (9) rate of Disseminated Intravascular Coagulopathy (DIC), Acute Respiratory Distress Syndrome (ARDS), and Acute Renal Failure (ARF); (10) medical care provided; (11) efficacy of foreign field hospitals; (12) assistance of military forces; (13) rate of psychological distress among survivors; (14) provision of water, power, telephone, and healthcare services; and (15) social issues (opium abuse in survivors).

Data relevant to search-and-rescue operations and disaster management indicated shortcomings in human resources, patient transfer, availability of equipment and facilities, and trauma treatment. One percent of victims had compartment syndrome and needed a below-the-knee amputation, 11.6% were septic, 7.3% experienced DIC, 9.1% had ARDS, and 38.9% needed fasciotomy. The average time under rubble was 1.9 hours and the time from rescue to receipt of first aid time was 3.5 hours.

Comprehensive disaster management must not be limited to the response phase but must include preparedness, recovery, and prevention, improvement of healthcare facilities, and provision of organized communication channels between organizations for running a command system and instituting coordination among relief workers. Continuous education, training of the general population and task forces involved in disaster management, and conducting periodic exercise drills also are important.

Iran is a country wim an area of 1,648,195 km2 with a population of >8,000,000 people. The devastating earthquake in the Bam District of Kerman Province struck on 26 December 2003 when the population was sleeping, and left a total of 29,878 dead and 22,628 injured. It had a magnitude of 7.4 on tbe Richter scale. The aim of this study was to determine the frequency of physical injuries.

The data of 206 patients were collected from the medical records.

The majority of patients were in the 20–29 year age group. The female/male ratio was 1.51. The overall mortality rate was 2%. Most frequent injuries were lower extremity, pelvic, and spinal fractures respectively. Of the extremity fractures, 4.9% had open fractures, 95.1% had closed, and 19 patients underwent fasiotomy due to compartment syndrome. Of the pelvic fractures, 7.9% were unstable. Of the cases, 32% with vertebral fractures had spinal cord injuries. Other injuries were less frequent and included pneumothorax, hemothorax, abdominal viscous injuries, rib fracture, and head injuries.

The main problems in the victims were orthopedic. Hospitals must prepare to treat these injuries.

In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed >90% of the city. After the assessment and initial treatment of injuries at national and international field hospitals, a considerable number of victims (approximately 12,000) were transferred to tertiary referral hospitals around the country. Objective: This report evaluated the injuries of 854 victims transferred to 12 referral hospitals in Tehran.

The demographic data, injury patterns, injury severity score (ISS), diagnosis, treatment, and outcome data of 854 Bam earthquake victims were assessed.

There were 467 (54.7%) males and 387 (45.3%) females. The mean age of the patients was 29.0 years. Transportation by aircraft was the most common method used for evacuation, which was used to evacuate 555 patients (65%). Fifty-four percent of the victims required initial medical aid at field hospitals before transportation to Tehran. There were 1,322 patients with injuries, of which, fractures of the lower extremities were the most common (331; 25%). Limb fixation was the most commonly performed primary procedure in emergency wards (389 cases, 39.9%). The mean value ±SD for ISS was 6.7 ±5.2. Orthopedic operations were the most frequent surgical procedures performed (195/260 operations, 75%) and the overall mortality rate was 1.6% (n = 14).

Along with the crucial importance of aid provided by national and international field hospitals in disasters, suitable triage of casualties and preparedness of tertiary referral centers in unaffected regions also play an important role in providing medical care to disaster victims. During these situations, the number of victims cannot be predicted accurately, and sufficient medical care, particularly for orthopedic problems, can be provided by referral centers.

In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city.

The purpose of this study was to assess the status of the rescue, evacuation, and transportation of the casualties during the early stages following the earthquake.

A cross-sectional study of 185 casualties who were transferred to and hospitalized in the university hospital during the first week period following the earthquake was conducted. Information regarding different places of settlement after being removed from the rubble, initial medical care, and the means of transportation was obtained by reviewing medical records and interviewing the victims.

The mean value of the duration of times taken for the first rescuers to reach the scene and remove the casualties from the rubble was 1.7 ±2.7 and 0.9 ±1.1 hours, respectively. Sixty-nine (37.7%) of the patients stayed within the area immediately surrounding their home for average times of 8 ±10 hours. The majority of casualties (57.6%) were transferred manually to a first place of settlement; 45.8% were taken to a second place of settlement using blankets. Of the patients studied, 159 (85.9%) did not receive any basic medical care at the first place and intravenous fluid therapy was the most common treatment provided for 24 (13%) patients at the second place of settlement. Patients received medical care at the first place of settlement for a mean time of 16.8 ±13.5 hours after escaping the rubble.

These findings indicate that the emergency medical service system in Bam was destroyed and not able to respond adequately. In order to reduce the negative effects of such disasters in the future, there is an essential need for a comprehensive disaster management plan and improvement of hospital structures, healthcare facilities, and communication between the different governmental departments for better coordination and planning.