Your program discussion this morning about the Mexico City earthquake brings back some recent and actual vivid memories. I was in Mexico City last fall. I went there within two weeks of the earth tremor that hit. I was there in my capacity as the Director in the Office of Foreign Disaster Assistance (OFDA) and AID. Several weeks later, I joined FEMA, the Federal Emergency Management Agency, with its full load of domestic emergencies and various systems and plans to meet those crises. Some of you may ask, well, is there any major difference, basic difference, between coping with a disaster overseas and disasters that occur here in the United States? And, of course, you also, I suspect, would be interested to find out how I connect those disasters with the purpose of this conference, which is how to deal with the mass casualty incidents. Obviously, there are differences in all nations.

I will present a general view of the events that took place in Mexico City on September 19th, 1985.

I will make reference, in the first place, to certain facts related with the subject, then I will describe the general damage to health and to the health services, and finally I will give information about the action taken in the area of epidemiological surveillance.

The information in this work was generated through a committee formed by different health institutions and in which I participated. This organization was responsible for the health services and the epidemiological surveillance during the events of September 1985.

The September 19, 1985, Mexico earthquake reminded scientists and engineers of the importance of considering soil amplification effects in earthquake-resistant design. The Mexico earthquake illustrated the “worst case”—the ground response and the building response occurring at approximately the same period, 2 seconds. This resonance phenomenon was predictable on the basis of similar experiences in past earthquakes. A number of areas in the United States also exhibit significant predictable soil amplification effects. Special steps are needed in these areas to mitigate the potential damage and losses that could occur in future earthquakes.

The earthquake that shook Mexico City could not have chosen a more vulnerable target. The capital city is located in the center of the world's most populated area. Some 18 million people, one fourth of the nation's inhabitants, are jammed into a mere 890 square miles, roughly 1% of the predominantly rural area. It is estimated that nearly one third of all families in Mexico City live huddled together in a single room and the average family has five members.

Besides being a densely populated area, Mexico City was founded on a shaky geological base that makes it specially susceptible to tremors. The first human settlements were made on the soft, humid clay of an old lake bed. The city has been constantly sinking through the years and some buildings are even tilted sideways, therefore having a greater risk in case of earth movements.

I want to first talk about search and rescue as it occurred in Mexico City; secondly, about what we learned in Mexico City; where are we going from there; what are some of the things that are happening and should be happening in major disaster management, especially as it deals with search and rescue.

There are four main phases in search and rescue. Those four phases are: First, you have to locate the victims; second, you have to reach the victims; third, you need to stabilize those victims; and fourth, you need to evacuate them. I'm going to deal primarily with locating the victims because that was my main responsibility, coordinating the search aspect in Mexico City.

This presentation will discuss search dogs in general, their training, and the experience the dog teams had in the Mexico City earthquake. All of the search dogs in Mexico City, those from the U.S. and other countries, are trained similarly and have a similar job to do. What I will do is explain how the dogs are trained and what they can do.

It is my intention to discuss air scenting dogs, their use and training. You have to remember that the dog and the handler are a team and they train together, they live together, and they work together. The discussion will focus only on the dogs' training.

Prediction of natural phenomena which have the potential for causing disasters is an extremely difficult proposition both from a scientific and socio-political perspective. Experience has shown repeatedly our inability to predict events leading to disasters. Geophysical predictions, in order to have maximum utility, must specify the date, time, place and magnitude of physical events. In order to meet the minimum criteria for effectiveness and credibility, predictions must be stated within limits which are useful to the public and can be practically applied. Perhaps the best way to deal with the inevitable conflicts and uncertainties associated with the problem of disaster prediction is to either not make such pronouncements or issue forecasts based on the likelihood or probability of event occurrence. In the latter case it is best to provide simplified thresholds for various threat levels and suggest appropriate actions necessary to avert the impacts of an event.

The term mitigation is often mistaken for litigation, and they are not entirely divorced. What we really mean by mitigation is reducing impact. The activity of early warning and the activities of preparedness planning as well as many other pre-disaster activities certainly have that effect. However, in the engineering, architecture, and planning sense, what we mean by mitigation is the reduction of impact of natural phenomenon primarily on buildings and facilities used by people. For that reason we will be focusing primarily on building related disasters; that is, disasters which effect people through building or constructed facility failures. Those failures are primarily related to the natural hazards of earthquakes, floods, and winds, a somewhat different selection from those which you deal with in terms of emergency medical services.

Mass disasters are events which overwhelm, damage or destroy local Emergency Medical Services (EMS) systems, and therefore need the response of a State or National Disaster Medical System (NDMS). Natural mass disasters include major earthquakes, floods, hurricanes and fires. Manmade mass disasters include major fires, industrial accidents, wars, and nuclear accidents. Mass disasters must be distinguished from “multicasualty incidents” (MCI), such as major transportation accidents, which the local EMS system should be able to handle, if necessary, with the assistance of surrounding (regional) EMS systems. Endemic-epidemic disasters (e.g., droughts, famines, infectious diseases, and refugee problems) are catastrophes which deserve separate considerations, as they require ongoing political-economic solutions.

It has been said that never are two disasters alike. Indeed the effects of floods on health are considerably different from the effects of earthquakes. But even two earthquakes may bring different results depending on a number of circumstances, which basically involve the characteristics of the event itself (e.g., magnitude, depth of the hypocenter, distance from the epicenter, etc.), of the striken population (its “disaster culture,” knowledge of disasters and preparedness, level of immunity against certain diseases, endemicity, etc.) and the physical and sociological environment (e.g., type of housing, high mountains vs. pantanous jungles, etc.). However, we are getting to know more and more about disasters and about populations at risk to be able to anticipate some of the effects the disaster may have on the health of the community, as long as we keep in mind the three factors mentioned above.

The Republic of Colombia is situated in the northern part of South America, with coasts to both the Atlantic and the Pacific Oceans. It has a long history of natural disasters: hurricanes from the Caribbean sea have lashed the eastern seaboard more than once, while the western part of the country belongs to the so called “Pacific Fire Belt.” Being in the zone of contact between the Nazca and the South American Techtonic Plates, where the former gets under the latter, it suffers from volcanic eruptions and earthquakes (Figures 1 and 2). The more recent major earthquakes were those in Tumaco in 1979 and Popayan in 1983. In Tumaco, the combined action of the earth movement (magnitude 7.9 in the Richter scale) and the subsequent Tsunami caused an estimated 500 deaths (Gueri et al). Popayan was almost totally destroyed by an earthquake of 5.3 magnitude in which over 100 people died (Gueri and Alzate).

Underground medical care is required in certain instances where patients sustain life or limb threatening injuries or illness while in the underground environment. This most often occurs during deep mining operations, both coal and non-coal, and during recreational caving activities. Additional situations such as industrial tunneling, underground repositories and storage areas and building collapses, such as might occur in a natural disaster or in terroristic activities might also occasion the need for such care. The U.S. mining industry suffered 102 fatal accidents with 250 total permanent disabilities during 1980. In 1983 there were 70 fatalities and in 1984, 124 miners died because of mining accidents. Analysis of accident reports indicate that 25–50% of these injuries may have been ameliorated by timely delivery of physician and paramedic based care in the underground environment. From 1967–1975, 187 recorded caving accidents resulted in 33 deaths among 311 victims. It is unclear how many of these fatalities or injuries could have been prevented or ameliorated by rapid delivery of physician and paramedic based underground medical care.

In May 1985, a cyclone from the Bay of Bengal struck the coastal islands of Bangladesh. In spite of early detection of atmospheric turbulance and the history of severe cyclones in the area, an estimated 11,000 people lost their lives.

In a natural experiment, cyclone death rates from the two severely affected islands, Urir Char and Sandwip, were analyzed to determine the risk factors of cyclone-associated mortality.

In Urir Char, in which no cyclone shelters existed, the study group lost 40 percent of the family members in contrast to 3.4 percent from Sandwip, where at least eight cyclone shelters existed. Individuals who did not seek shelter were at the highest risk. Barriers in seeking safety were physical as well as behavioral. Easy access to shelters was a significant factor in reducing the risk. Deaths could have been averted through improved timing and method of advance warning.

I would like to talk about the changing forms of warfare, terrorism in particular, and try to relate to you where you may have some involvement with the problem. First of all, let me tell you that terrorism, and I'm not going to seek to define it fully because no one has ever succeeded in doing so, is political extortion. It is the warfare of the weak. The terrorists generally use very low technology weapons, by this I mean, hand grenades, bombs, automatic weapons, pistols; but their logistical support is of the highest magnitude in terms of technology, things such as jet aircraft and instant global satellite communications. The most fundamental observation to make about terrorism is that it's theatre and very highly choreographed. Its purpose is to make large governments, particularly democracies which both enjoy and insist upon human dignity and human rights, look impotent. And we have been made to look impotent in my mind.

There are over 25 active insurgencies in progress worldwide today. Terrorism is often part of these actions. But terrorism is also found worldwide in areas where no active insurgency exists. There has been a sharp rise in terrorist activities in the last five years, and there will continue to be an increase in such activities in the future.

Bombs, in various assortments, are the favorite weapons of terrorists. When guns are utilized, they are often of the military type and produce subsequent high velocity missile injuries which have entirely different characteristics than the normal type of handgun injury encountered in the civilian practice of medicine. The type of wounds produced by bombings include blast injuries, burns, multiple fragment injuries, blunt trauma, and major mutilation to include amputation. High velocity missile injuries produced by the use of various military rifles and submachine guns require treatment by a surgeon knowledgeable in the care of such wounds. Surgical lessons learned by military surgeons dating back to the time of Napoleon's surgeon Larrey are discussed in some detail in the article. Special considerations attending to medical care associated with terrorist activities are highlighted. Such consequences include multi-system trauma to an individual, trauma to large numbers of individuals at one time, massive trauma to individuals, and the difficulty in treating and evacuating victims who are trapped in rubble.

For most civilized people terrorism is hard to imagine. Scenarios are concrete descriptions of events, case studies that help the imagination. Statistics inform, but are abstract. Planners and strategists, be they Colonels, Captains or Chiefs, need good scenarios, and they need to think and talk about them. Those who rely exclusively on statistics, to use a phrase popular in another decade or on another coast, don't get their consciousnesses raised; terrorism remains beyond the imagination.

A National Disaster Medical System (NDMS) has been planned to deal with medical care needs in disasters of great magnitude. NDMS is based on the concepts of the Civilian-Military Contingency Hospital System, in which civilian hospitals voluntarily commit a portion of their beds for military casualties. In the NDMS, the hospital beds will be augmented by medical teams and logistic support to enable the system to serve a large civilian disaster. The system is a cooperative effort of the Department of Health and Human Services, the Department of Defense, the Federal Emergency Management Agency, State and local governments, and the private sector. NDMS will comprise 150 disaster medical response teams to clear and stage civilian casualties, an evacuation system, and 100,000 pre-committed beds in hospitals throughout the Nation. The system will serve national needs in the event of a massive peace-time disaster or an overseas conventional military conflict.

I will discuss the need for a viable pre-hospital contingency plan applicable to mass casualty or disaster mode situations.

It is my experience, during eighteen years in public safety and emergency services, that most organizations are highly competent and responsive to the daily expectations which are placed upon them. As most emergency services managers will tell you, they generally plan for the expected. After all, analysis in such areas as population growth, economic levels, unemployment and criminal trends are the lifeblood of any emergency service agency's personnel, equipment and budgetary allocations. Our level of sophistication today allows us to predict, with some degree of certainty, what demand will be placed on our organizations and how we will meet that demand. The point is this: we in emergency services have been extremely efficient and proficient in addressing the expected needs of the public we serve.

I will present a process by which many of the prehospital providers in this country are trying to organize effective and efficient response plans for major medical incidents which could in fact include a disaster response.

Many people in the emergency medical services community, including myself, have been involved in a planning process for voluntary national EMS standards, the program being coordinated by the American Society of Testing & Materials (ASTM) F30 Emergency Medical Services Standards Committee. I chair a subtask group on Disaster Management. The committee has prepared a document containing elements, suggestions, processes and procedures from MCI/disaster response plans from EMS agencies around the country. These places include the cities of Los Angeles, New York, Chicago, Washington, D.C. area, Phoenix, Arizona and other urban places. The intent of this task group is not to prepare a document as a rigid standard to cover every detail on an individual task response plan. Instead, the intent of our task group is to provide an overview of expectations of what an individual mass casualty plan should include; focusing on such topical areas as Incident Command Management, communications, triage, transportation, logistical support issues, mutual aid and ancillary support services and many other topical areas that agency planners must address in developing their respective operational response plans.

There is a rich mythology surrounding disasters and our response to them, which has built up over decades and hampers a scientific and objective response to the salvage of life and property. That mythology supports rationales for not dealing prospectively with the very real, but unpredictable, quirks of mankind, nature, and technology. Our response to disaster planning is all too often characterized by ignorance, with a fair share of parochialism, misinformation and unrealistic expectations.