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.