Earthquakes and their Effect Earthquakes and their Effect on Medical Careon Medical Care

Rachael L. Meyer

May 4, 2009

EAS 193: Introduction to Earthquakes

Dr. Robert Herrmann

Summary

• Introduction• Why is This Such an Important Issue?• Problems Faced While Trying to Provide Medical Care After

an Earthquake• Organizations Focused on Providing Medical Care • American Red Cross International Services • Médecins Sans Frontières (MSF) • The World Health Organizations (WHO)• International Medical Corps (IMC)• 2008: Sichuan Earthquake• Case Study of Zhang Jiazhi• Recommendations• Conclusion

Introduction

• In January 1995, the Great Hanshin earthquake occurred in Japan resulting in the greatest number of deaths and injuries in Japan since World War II.

• After the earthquake, researchers handed out questionnaires to those affected by the earthquake. The surveys were used to assess the current state the hospital and evaluate their capability to release information and provide emergency care after a disaster has occurred.

• “The survey results show that information about the ability to admit new patients and the availability of medical supplies is necessary immediately after such a disaster. These results will be useful for planning countermeasures against this kind of disaster” (1999).

• The results of this survey do not just apply to the opinions of the people in Japan, but express the needs for people throughout the world who are at risk for becoming victims of an earthquake.

• Earthquakes occur suddenly and can cause massive destruction, numerous casualties, high number of fatalities.

Figure 2: Collapsed highway

Figure 1: Destruction after the earthquake

Problems Faced While Trying to Provide Medical Care After an Earthquake

• Mudslides• Landslides• Falling debris• People trapped under collapsed buildings• Collapsed roads• Major or minor injuries• Hospital admissions becoming quickly overwhelmed and overcrowded preventing

treatment to be provide to all in need• Hospital or treatment centers and equipment being destroyed or damaged during the

earthquake• Maintaining sanitary conditions and hygienic practices • Lack of essential medical equipment• Lack of food and clean water for survivors• Limited access to or no electricity• Communication with areas affected by an earthquake can be minimal to non-existent• Post-traumatic psychological treatment for survivors• Follow-up care for the injured survivors of earthquakes, who may have been forced to

relocate as a result of the earthquake

1. Preparedness and availability of medical facilities, services, personnel and equipment

2. Immediate fatalities and injured caused by the disaster3. Deterioration of health conditions following the disaster4. Destruction or damage to medical and health centers

and services5. Response capability of the health services and the

capability for post-disaster recovery.

The Effects of Natural Disasters on Health Can be Considered from Five Aspects

Organizations Focused on Providing Medical Care After an Earthquake

1. American Red Cross International Services

2. Médecins Sans Frontières (MSF)

3. The World Health Organizations (WHO)

4. International Medical Corps

American Red Cross International Services

• Helps communities prepare for natural disasters

• Responds to areas affected by a natural disaster

• Uses the International Red Cross and Red Crescent Movement—the world’s largest humanitarian network comprised of more than 97 million volunteers

• Follows 7 principles: humanity, impartiality, neutrality, independence, voluntary service, unity, and universality

Médecins Sans Frontières (MSF)

• Began in 1971, by a group of French doctors to help famine victims of the civil war of Nigeria.

• Is the world’s leading independent organization for medical humanitarian aid

• MSF are currently working in over 60 countries

• Provide relief after a natural disaster has occurred including: running emergency feeding programs, organize mass vaccination programs, programs to train local medical staff, install sanitation facilities

• Was awarded the Nobel Peace Prize in 1999

The World Health Organization (WHO)

• In 1945, diplomats met to form the Untied Nations and acknowledge a need to set up a global health organization

• On April 7, 1948, WHO’s Constitution was written and put into practice

• Coordinating authority for health within the United Nations System

• WHO is responsible for providing leadership on global health matters, determining the research agenda, articulating evidence-based policy options, providing technical support to countries, and monitoring and assessing health trends.

International Medical Corps (IMC)

• Began in Afghanistan in 1984• Is a global humanitarian non-profit

organization focused on immediate, emergency relief

• One of the world’s fastest and most effective response agencies

• Services IMC provides include: mass immunizations, give out basic necessities (food, water, baby formula), supply medicines, medical equipment to local hospital facilities, create ‘cash for work’ programs to restore disaster communities to self-reliance

IMC Emergency Response

Team

The Great Sichuan Earthquake

• Occurred on May 12, 2008 in the Sichuan province of China• Declared the ninetenth deadliest earthquakes of all time• Was measured at a 7.9-8.0 magnitude• The main tremor was recorded as lasting about three minutes• According to the China Earthquake Administration (CEA), the

earthquake occurred along the Longmenshan fault along the Indo-Australian and Eurasian Plate

• The earthquake was also felt in Hong Kong, Macau, Taiwan, Vietnam, Thailand, Mongolia, Bangladesh, Nepal, India, Pakistan, and Russian

• For months afterwards strong aftershocks continued to hit the area, resulting in further damage

The Great Sichuan Earthquake (cont.)

• The earthquake occurred in an area that had been neglected by China’s economic rise– Many of the victims had no insurance

– Thousands of children died due to substandard construction of their school building

• The earthquake occurred just three months before the 2008 Summer Olympics.

• Was one of the costliest natural disaster in Chinese history• “On 6 November 2008, the central government announced that it

will spend 1 trillion yuan (about $146.5 billion) over the next three years to rebuild areas ravaged by the earthquake.”

• Formation of “Quake lakes”

The Great Sichuan Earthquake (cont.)

• Efforts were hindered by heavy rain and landslides• Rescue Efforts

– Less than 2 hours after the earthquake, Premier Wen Jiabao, an expert in geomechanics flew to oversee the rescue work

– China’s Health Ministry sent ten emergency medical teams to the area

– China’s Chengdu Military Area Command dispatched 50,000 troops and armed police to help with the rescue work

– National Disaster Relief Commission declared a ‘Level II emergency contingency plan’ which is the most serious level\

– Red Cross Society of China– Special Operation Troops were later parachuted into

inaccessible areas with emergency relief supplies

Figure 1: Map showing the epicenter

of the earthquakeFigure 2: One of the many medical centers filled with injured citizens seeking treatment.

Figure 3: Medical teams searching for survivors.

Case Study of Zhang Jiazhi

• After 11 year old Zhang crawled out of his destroyed middle school, his parents began a 20 hour ordeal to get medical care for their son, whose arms had been severely crushed.

• At the closest hospital to his village Zhang was turned away because of overcrowding. His parents then rushed their son to the city's main square, which had become a main triage center. However, doctors were overwhelmed there as well.

• Jiazhi and his parents were eventually crammed into an ambulance with nine other people, making it to Deyang City People's Hospital.

• After waiting for several hours, Jiazhi was taken to an operating room. • Jiazhi wasn’t the only patient taken to surgery. Doctors performed

surgery on 7 other patients who were lying side-by-side. • Sadly, the doctors couldn't save either of his arms. His father

explained that, "after two hours, they said the nerves and blood vessels die and there's no way to get it back to normal“

Recommendations

• Continue providing education programs about earthquakes which emphasize safety during an earthquake.

• Encourage people to aid earthquake victims through financial contributions, medical supplies, personal items (clothing, hygiene items), non-perishable food, blankets, etc.

• Increase the funding for each of these emergency relief programs.

• Require that every country maintain a natural disaster relief team capable of going “on duty” immediately after a disaster occurs.

Figure 1: Students donating money to victims of the Sichuan earthquake

• The immediate response required after an earthquake suggests that a larger number of rescue personnel, surgeons, and intensive care specialists who are experienced in life supporting methods and resuscitation should be sent out to disaster scenes.

• Also, special teams responsible for disposing of the large number of dead victims after an earthquake is a disheartening, but important task to consider.

• Hospitals be built to be tremor resistant; especially those built in high risk zones likely to experience an earthquake.

Recommendations (cont.)

Conclusion

“In envisaging emergency relief, it is crucial to recall that in sudden-impact disasters,

particularly earthquakes, health and medical needs are immediate, but short-lived. There is no margin for trial and error and mistakes or

delays cannot be rectified. This makes knowledge and experience in scientific disaster

medicine all the more indispensable.”

Works Cited

• 2008 Sichuan earthquake. From Wikipedia: The Free Encyclopedia. Retrieved April 30, 2009, from http://en.wikipedia.org/wiki/2008_Sichuan_earthquake

• Ang, A. (2008). Long wait for medical care after China quake. Retrieved April 30, 2009, from http://www.boston.com/news/world/asia/articles/2008/05/10/15/

long_wait_for_medical_care_after_china_quake/

• Bolt, B. (2006). Earthquakes: 2006 Centennial update. New York: W.H. Freeman and Company• Global disaster response. (2009). From International Medical Corps. Retrieved April 30, 2009,

from http://www.imcworldwide.org/section/programs/global_disaster_response• Gunn, S. (1995). Health effects of earthquakes. Retrieved April 30, 2009, from

http://www.emeraldinsight.com/Insight/ViewContentServlet?Filename=Published/EmeraldFullTextArticle/Articles/0730040501.html

• International services. (2009). From American Red Cross. Retrieved April 30, 2009, from http://www.redcross.org/portal/site/en/menuitem.86f46a12f382290517a8f210b80f78a0/?vgnextoid=127d44e75215b110VgnVCM10000089f0870aRCRD&vgnextfmt=default

• Miyamot, M, Sako, M. Kimura, M., Kanno, T., Inoue, M,. Takeda, H., Takahashi, T., et. al.(1999). Case report: Great earthquakes and medical information systems, with special reference to telecommunications. Journal of the American Medical Informatics Association. Retrieved April 30, 2009, from http://www.jamia.org/cgi/content/abstract/6/3/252

• One month after the sichuan earthquake. (2008). From Doctors Without Borders. Retrieved April 30, 2009, from http://msf.org.au/from-the-field/field-news/article/one-month-after-the-sichuan-earthquake.html

• World health organization. (2009). Retrieved April 30, 2009, from http://www.who.int/about/en/• Yunlong, S. (2008). Sichuan earthquake death toll reaches 12,012. Retrieved April 30, 2009,

from http://www.news.xinhuanet.com/english/2008-05/3/content_8162542.htm