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Disaster Reanimatology Potentials: A Structured Interview Study in Armenia I. Methodology and Preliminary Results

Published online by Cambridge University Press:  28 June 2012

Miroslav Klain ,
Edmund Ricci ,
Peter Safar ,
Victor Semenov ,
Ernesto Pretto ,
Samuel Tisherman ,
Joel Abrams  and
Louise Comfort
Miroslav Klain
Affiliation:
International Resuscitation Research Center (IRRC), Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh
Edmund Ricci
Affiliation:
Graduate School of Public Health, University of Pittsburgh
Peter Safar*
Affiliation:
International Resuscitation Research Center (IRRC), Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh
Victor Semenov
Affiliation:
Institute of Reanimatology of the USSR Academy of Medical Sciences, Moscow, USSR
Ernesto Pretto
Affiliation:
International Resuscitation Research Center (IRRC), Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh
Samuel Tisherman
Affiliation:
International Resuscitation Research Center (IRRC), Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh
Joel Abrams
Affiliation:
School of Engineering, University of Pittsburgh
Louise Comfort
Affiliation:
Graduate School of Public and International Affairs, University of Pittsburgh
*
University of Pittsburgh, 3434 Fifth Avenue, Pittsburgh, PA 15260, USA; 412/624–6735; fax 412/624–0943
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Abstract

In general, preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgery, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks. Preliminary results permit the following generalizations: 1) a significant number of victims died slowly as the result of injuries such as external hemorrhage, head injury with coma, shock, or crush syndrome; 2) early search and rescue was performed primarily by uninjured covictims using hand tools; 3) many lives potentially could have been saved by the use of LSFA and ATLS started during extrication of crushed victims. 4) medical teams from neighboring EMS systems started to arrive at the site at 2-3 hours and therefore, A TLS could have been provided in time to save lives and limbs; 5) some amputations had to be performed in the field to enable extrication; 6) the usefulness of other resuscitative surgery in the field needs to be clarified; 7) evacuations were rapid; 8) air evacuation proved essential; 9) hospital intensive care was well organized; and 10) international medical aid, which arrived after 48 hours, was too late to impact on resuscitation. Definitive analysis of data in the near future will lead to recommendations for local, regional, and National Disaster Medical Systems (NDMS).

Keywords

EarthquakeAdvanced Life SupportEmergency Medical ServicesEvaluationFirst AidHealth Care RescueResuscitation
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 4 , Issue 2 , December 1989 , pp. 135 - 152
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1989

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References

1. De Ville de Goyet, C, Jeannee, E: Epidemiological data on morbidity and mortality following the Guatemala earthquake. IRCS Med Sciences: Soc and Med 1976; 4:212.Google Scholar
2. Comfort, L: The San Salvador Earthquake. In, Coping with Crisis: The Management of Disasters, Riots, and Terrorism. Rosenthal, U, Charles, M, t'Hart, P (eds). Springfield, Charles C. Thomas, 1989.Google Scholar
3. Comfort, L: International disaster assistance in the Mexico City Earthquake. New World: Journal of Latin American Studies 1986; 1:12–43.Google Scholar
4. Romo, CR: The Mexico City earthquake—an international disaster. An overview. Prehosp & Disaster Med 1986; 2:4–8.CrossRefGoogle Scholar
5. Quarantelli, EL (ed): Disasters: Theory and Research. Beverly Hills, Sage, 1978.Google Scholar
6. Alexander, DE: Death and injury in earthquakes. Disasters 1985; 9:57–60.CrossRefGoogle ScholarPubMed
7. Lechat, MF: Disasters and Public Health. Bull. WHO 1979; 57:11–17.Google ScholarPubMed
8. Kerr, RA: How the Armenian quake became a killer. Science 1989; 243:170.CrossRefGoogle ScholarPubMed
9. Lechat, MF: An epidemiologist's view of earthquakes. In, Engineering Seismology and Earthquake Engineering. NATO Advanced Study Institutes Series. Solnes, J (ed). Leiden, Noordhoff, 1974; pp. 285–306.CrossRefGoogle Scholar
10. Manni, C, Magalini, SI (eds): Emergency and disaster medicine. Proceedings of WAEDM Congress, Rome, May 1983. Heidelberg, Springer Verlag, 1985.Google Scholar
11. Whittaker, R, Fareed, D, Green, P, et al: Earthquake disaster in Nicaragua: reflection on the initial management of massive casualties. J Trauma 1974; 14:37–43.CrossRefGoogle ScholarPubMed
12. Glittenberg, J: Socioeconomic and psychological aspects of disasters. Prehosp Disaster Med 1989; 4:21–30.CrossRefGoogle Scholar
13. Safar, P: Resuscitation potentials in mass disasters. In, Proceedings of Mobile ICU Symposium, Mainz, West Germany, Sept. 1973. Frey, R, Nagel, E, Safar, P (eds). Anesthesiology and Resuscitation Vol. 95. Heidelberg, Springer-Verlag, 1976.Google Scholar
14. Safar, P (ed): Disaster Resuscitology. Proceedings of Second World Congress on Emergency and Disaster Medicine, Pittsburgh, PA, USA, May 1981. Prehosp & Disaster Med 1985; 1 (Suppl I):1–436.Google Scholar
15. Safar, P, Bircher, NG: Cardiopulmonary Cerebral Resuscitation. In An Introduction to Resuscitation Medicine. 3rd ed. Stavanger, Laerdal Publ; and London: W.B. Saunders Publ., 1988.Google Scholar
16. American College of Surgeons Committee on Trauma (Collicott, PE, ed.): Advanced Trauma Life Support Course for Physicians 1984. American College of Surgeons, 55 East Erie Street, Chicago, IL, 60611, USA.Google Scholar
17. American Society of Anesthesiologists, Committee on Acute Medicine (Safar, P Chairman): Community-wide emergency medical services. JAMA 1968; 204:595.Google Scholar
18. Shoemaker, WC, Grenvik, A, Thompson, WL, Holbrook, PR (eds): The Society of Critical Care Medicine: Textbook of Critical Care. Philadelphia: WB Saunders, 1984, 2nd ed, 1988.Google Scholar
19. Shires, GT: Care of the trauma patient. New York, McGraw-Hill, 1984.Google Scholar
20. Noji, EK, Sivertson, KT: Injury prevention in natural disasters: A theoretical framework. Disasters 1987; 11:290–296.CrossRefGoogle Scholar
21. Noji, EK: Evaluation of the efficacy of disaster response. UNDRO News, July/August 1987; pp. 11–13.Google Scholar
22. Pesola, G, Bayshtok, V, Kvetan, V: American critical care team at a foreign disaster site: The Armenian experience. Crit Care Med 1989; 17:582–585.CrossRefGoogle Scholar
23. Goldsmith, MF: Armenian earthquake elicits aid from all, strengthens American-Soviet ties. JAMA 1989; 261:341–342.CrossRefGoogle ScholarPubMed
24. Lindley, D: US team returns with insights into Armenian earthquake. Nature 1989; 337:107.CrossRefGoogle ScholarPubMed
25. Safar, P: Resuscitation potentials in mass disasters. Prehosp & Disaster Med 1986; 2:34.CrossRefGoogle Scholar
26. Mahoney, LE, Esch, VH: The U.S. National Medical Disaster System. Prehosp & Disaster Med 1986;2:149–151.CrossRefGoogle Scholar
27. Safar, P, Ramos, V, Mosquera, J, et al: Anecdotes on resuscitation potentials following the earthquake of 1970 in Peru. Prehosp & Disaster Med 1987; 3(1):124.*Google Scholar
28. Safar, P: Resuscitation potentials in earthquakes. An International Panel. Prehosp & Disaster Med 1987; 3(2):77.Google Scholar
29. Safar, P, Kirimli, N, Agnes, A, Magalini, S: Anecdotes on resuscitation potentials following the earthquake of 1980 in Italy. Proceedings of Fourth World Congress on Emergency and Disaster Medicine, June 1985, Brighton, UK (abstract).Google Scholar
30. De Bruycker, M, Greco, D, Annino, I, et al: The 1980 earthquake in southern Italy: rescue of trapped victims and mortality. Bull. WHO 1983; 61:1021–1025.Google ScholarPubMed
31. De Bruycker, M, Greco, D, Lechat, MF: The 1980 earthquake in Southern Italy: morbidity and mortality. Int J Epid 1985; 14:113–117.CrossRefGoogle ScholarPubMed
32. Molfese, A: 1980 earthquake in Basilicata. Prehosp & Disaster Med 1987; 3(1):96–98.Google Scholar
33. Bozza-Marrubini, M: Three major disasters in Italy. Experience of Niguarda Hospital of Milan as “base hospital.” Prehosp & Disaster Med 1985; 1 (Suppl I):414–419.CrossRefGoogle Scholar
34. Villazon-Sahagun, A: Mexico City earthquake: medical response. Prehosp & Disaster Med 1986; 2:15–20.CrossRefGoogle Scholar
35. Tiedemann, H: Earthquake damage in Mexico City. Nature 1987; 329:677.CrossRefGoogle Scholar
36. Hays, WW: The 19 September 1985 Mexico earthquake: technical problems. Prehosp & Disaster Med 1986; 2–4:9–14.CrossRefGoogle Scholar
37. 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
37a. Basken, PJF, Fisher, J (eds) Proceedings of the Fourth World Congress on Emergency and Disaster Medicine, Brighton, UK, 1985. Prehosp of Disaster Med 1986; 2:112–235.Google Scholar
37b. Basket, P, Weller, R (eds): Medicine for Disasters. London, Butterworth, 1988.Google Scholar
38. Ricci, E: A model of evaluation of disaster management. Prehosp & Disaster Med 1985; 1 (Suppl I): 30–32.CrossRefGoogle Scholar
39. Ricci, E, Malloy, C, Safar, P: Impact evaluation of a community-wide resuscitation program. Prehosp & Disaster Medicine, 1985; 1, (Suppl I): 54–57.CrossRefGoogle Scholar
40. Ricci, E, Gunter, M, Silverman, M, Rawson, I (eds): Case studies in community decision making: The emergency medical services experience. University of Pittsburgh, Research monograph prepared for National Center for Health Services Research, 1979.Google Scholar
41. Patton, M: Utilization focused evaluation. Beverly Hills and London, Sage Publ, 1978.Google Scholar
42. Rubinson, L, Neutens, J: Research techniques for the health sciences. New York, Macmillan Publ, Co., 1987.Google Scholar
42a. Wallace, L: Dog rescue teams. Prehosp & Disaster Med 1986; 2:25–26CrossRefGoogle Scholar
43. Champion, HR, Moreau, MM, Gainer, PS: Assessment and triage. In: Medicine for Disasters. Baskett, P and Weller, R (eds). London, Wright-Butterworth Publ., 1988, pp 19–35.Google Scholar
44. Grenvik, A, Powner, DJ, Snyder, JV, et al: Cessation of therapy in terminal illness and brain death. Crit Care Med 1978; 6:284.CrossRefGoogle ScholarPubMed
45. Wanzer, SH, Adelstein, SJ, Cranford, RE, et al: The physician's responsibility toward hopelessly ill patients. New Engl J Med 1984; 310:955–959.CrossRefGoogle ScholarPubMed
46. Star, LD, Abelson, LC, DelGuercio, LRM: Further concepts in mass disaster planning for the eighties. Prehosp & Disaster Med 1985; 1:145–146.Google Scholar
47. Comfort, L: Crisis as opportunity: Designing networks of organizational action in disaster environments. In, The Psychosocial Consequences of Disaster. Lima, B (ed). Chicago, Simon Bolivar Press, 1989.Google Scholar
48. Safar, P (ed) : Military and disaster medicine. Prehosp & Disaster Med 1985; 1:1–85.Google Scholar
49. Bisgard, JC: The role of the military in international military-civilian collaboration for disaster medicine in the USA. Prehosp & Disaster Med 1985; 1:21–22.Google Scholar
50. Burkle, FM Jr, Sanner, PH, Wolcott, BW (eds): Disaster Medicine. New York, Medical Examination Publ., 1984.Google Scholar
51. Alexejev, G: Military-civilian collaboration for disaster medicine in the USSR. Prehosp & Disaster Med 1985; 1:31–32.Google Scholar
52. Pierce, W: Search and rescue. Prehosp & Disaster Med 1986;2:21–24.CrossRefGoogle Scholar
53. Williams, ML, Hammond, PY: Engineering challengesfor minimizing casualties from earthquakes. Prehosp & Disaster Med 1985; 1 (Suppl I):427–xxx.CrossRefGoogle Scholar
54. Safar, P, Pretto, E, Bircher, N: Disaster re-suscitology including management of severe trauma. In, Medicine for Disasters. Baskett, P, Weller, R (eds). London, Wright-Butterworth Publ. 1988; pp. 36–86Google Scholar
55. Frey, R, Nagel, E, Safar, P (eds): Mobile intensive care units. Advanced emergency care delivery systems. Symposium Mainz, Sept. 1973. Anesthesiology and Resuscitation Vol. 95. Heidelberg, Springer-Verlag, 1976.Google Scholar
56. Frey, R, Safar, P (eds) : Proceedings of the First World Congress on Emergency and Disaster Med (Club of Mainz), Mainz, Sept. 1977. (Vol. 1) Types and Events of Disasters; Organization in Various Disaster Situations. (Vol. 2) Resuscitation and Life Support; Relief of Pain and Suffering, Disaster Medicine. Heidelberg, Springer-Verlag, 1980.Google Scholar
57. Gunn, SWA: Earthquakes. In, Medicine for Disasters. Baskett, P, Weller, R (eds). London, Wright-Butterworth Publ. 1988; pp 285–290.Google Scholar
58. Gunn, SWA: The Coordination of governments and the relief agencies. In, Medicine for Disasters. Baskett, P, Weller, R (eds). London, Wright-Butterworth Publ. 1988; pp 145–151.Google Scholar
59. Adler, J: Assessment of disasters in the developing world. In, Medicine for Disasters. Baskett, P, Weller, R (eds). London, Wright-Butterworth Publ., 1988, pp 132–144.Google Scholar
60. Jones, N, Noji, E, Krimgold, F, Smith, G (eds): International workshop on earthquake injury epidemiology for mitigation and response. Johns Hopkins University, Workshop Proceedings july 1989, in press.Google Scholar