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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 15260USA
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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

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