A Comparative Study of Emergency Medical Response in Hanshin-Awaji and Taiwan Earthquake: Lessons Learned from Rapid Medical Response in Taiwan Earthquake
We report the changes that have occurred in the system for emergency medical responses after the Hanshin-Awaji Earthquake, and what we have learned from the emergency medical response following the Taiwan earthquake. In the Hanshin-Awaji earthquake, 5 years ago, we learned many lessons and are going to construct a new system of disaster medical response in Japan. What we learned about the excellent activities of emergency medical response were practiced in Taiwan following the earthquake of last September. Because the damages to the local governmental offices were limited, the unification of incident command was practiced, and many patients with severe injuries were transported out of disaster regions. Large quantities of medical equipment were transported into the disaster regions by the army. Many medical teams from non-disaster areas also were dispatched rapidly, for Taiwanese have good sense of self-defense for preventing disaster.
We should make greater effort to construct a good system for the emergency medical response for the future disasters in Japan. It should include the rapid dispatch system for search and rescue teams with medical teams, a system for transporting the severely injured patients to the non-disaster areas through the core hospitals in disaster areas using helicopters, and the coordination of multiple agencies.
Keywords: earthquake; emergency medical responses; Hanshin-Awaji earthquake; Taiwan
E-mail: ishii@med.kobe-u.ac.jp
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Urban Prehospital Emergency Medical Transportation in Taipei following the Taiwan Earthquake
Patrick Chow-In Ko, MD; Matthew Huei-Ming Ma, MD, PhD; Fuh-Yuan Shih, MD; Fang-Yue Lin, MD, PhD
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
The Taiwan earthquake measuring 7.3 on the Richter scale, struck at 01:47 hours on 21 September 1999, and resulted in the deaths of >2,000 people. Taipei, the capital city of Taiwan and 200 kilometers from the epicenter, sustained collapse of only one building (12-story) like a pile of stacked pancakes, but it resulted in the highest death toll among all collapsed structures in the quake.
To characterize the management of urban, prehospital EMS transportation during a disaster, we surveyed the distribution of the patients by receiving hospitals and by the severity of the injured patients taken from this collapsed building. Seventy-six victims were dead upon extrication. All 138 patients who were extricated alive were distributed between seven surrounding general hospitals within a 15-minute distance for transportation. Among these, 74% (102/l38) of patients were transported by EMS ambulance and 87% (89/l02) were sent to the two most nearby hospitals within 5 minutes distance regardless their severity of injury. They arrived within 3 hours after the quake and resulted in overcrowded conditions in the two Emergency Departments. A diagram of the relation between the surrounding hospital distance, the number, and injury severity by distribution of the patients will be presented.
Transportation management of this confined space disaster in urban area was overlooked. Though the distribution of general hospitals is compact in this prosperous city, the incident command system should carefully manage the dispersal of patients transported by ambulance in a manner to avoid overcrowding problems in the surrounding Emergency Departments.
Keywords: confined-space medicine; distribution; earthquake; emergency department; emergency medical transportation; hospitals; prehospital; urban
E-mail: timentin@ms8.hinet.net or timentin@hotmail.com
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JDR Medical Team's Relief Activities following the Earthquake Disaster inTaiwan
Yuichi Koido;1 Hisayoshi Kondo;1 Akemi Tada;2 Tomoko Miyazaki;3 Eiko Shimada;4 Yoshie Kezuka;5 Tutomu Yamazaki;6 Keiji Nakata;6 Kimio Miura;7 Katsutoshi Fushimi;7 Kouji Fujiya7
1) Nippon Medical School; 2) Toyonaka Watanabe Hospital; 3) JMTDR Registered Nurse; 4) Kitazato University; 5) Saiseikai Utsunomiya Hospital; 6) JMTDR Registered Coordinator; 7) Japan International Cooperation Agency, JAPAN
On 21 September 1999, a great earthquake occurred in Taiwan. A Japan Disaster Relief Team (JDR) was dispatched to Taiwan and treated casualties. It arrived at the scene on 22 September, 48 hours after the quake. The JDR convened at the Disaster Countermeasure Headquarters of Nantou Prefecture, received disaster information, and arranged our activities with them. The JDR was capable of starting its activities on the first day, but it took 3 days until final site for its activites was selected. During these 3 days, the site was moved 3 times in order to get the best site.
At this time, the general condition of almost all of the casualties was rather stable. There were no patients who needed an urgent transfer. The JDR treated a total of 1,041 patients during its 11 days of operation. During the first half of the operation, the main treatments were surgical; during the second half, the main treatments were for medical conditions like respiratory infection, chronic diseases, and mental disease.
Recently, while JDR has been dispatched to disaster affected countries soon after the event has occurred, the number of times in which the activity site was not decided during the first day is increasing. Considering that selection of site for operations has a great influence on success of the relief activities, this presentation will propose some guidelines on selection of the site.
Keywords: coordination; disaster; earthquake;guidelines; Japan Disaster Relief Team (JDR); medical; operations; relief; site selection
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Assessment of Emergency Medical Relief Services following the Taiwan Earthquake
Matthew Huei-Ming Ma, MD, PhD; Edbert Hsu, MD; Michael K.F. Choo; Fuh-Yuan Shih, MD; Fang-Yue Lin, MD, PhD
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
Introduction: The Taiwan earthquake on 21 September 1999 measured 7.3 on the Richter scale and resulted in 2,405 deaths and 11,306 persons injured.
Objectives: To determine whether emergency medical assistance teams (EMATs) were key to assisting critically injured patients through assessment of the number and level of hospitals responding, timeliness of response, and acuity of patients.
Methods: A structured questionnaire was sent to the hospitals that dispatched EMATs in the first 72 hours following the quake. In-depth interviews were conducted with team leaders.
Results: 30 team leaders were interviewed. 10% of the EMATs began providing care within 6 hours (hrs) of the earthquake, 24% within l2 hrs, 38% within l8 hrs, 48% within 24 hrs; 52% responded within 24 hrs. The majority of the patient encounters were level III and level IV, with fewer than 20% of teams seeing >10 level-I patients and fewer than 40% seeing >10 level-II patients.
Conclusions: The degree of emergency medical assistance was impressive, but largely uncoordinated. Most EMATs arrived at the disaster >6 hours after the quake, and did not take care of critically injured patients. A central mechanism that better integrates medical assistance is needed to ensure future disaster EMATs will be deployed in a timely and organized fashion.
Keywords: assistance; deployment; earthquake; emergency medical assistance team (EMATs); hospitals; responses; survey; Taiwan
E-mail: mattma@ha.mc.ntu.edu.tw
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Taiwan 921 Earthquake: A Pictorial Review
Henry K. Cheng
Emergency Department, Mackay Memorial Hospital, Taipei, Taiwan ROC
921 is the date that Taiwan suffered from a major earthquake for the first time since the last century. It resulted in multiple casualities and injuries. We had not been well-prepared in the past, and we have learned from this experience and will be prepared for future such events.
We will relate this unfortunate event using a pictorial review of the disaster from alive to dead, and from human casualities to environmental destruction. We will relate the difficulties encountered in rescue attempts and will share our experiences. We thank those international rescue teams who arrived in Taiwan, who gave their greatest efforts to help us to search for surviving victims and who shared their experiences with us.
Keywords: assistance; disaster; casualities; damage; earthquake; international; rescue; search; teams
E-mail: henryckh@email.com
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Lessons Learned from the Great Hanshin-Awaji Disaster
Yoshio Murayama, MD; Hirofumi Kosuga, MD
Department of Surgery, Akashi National Hospital, JAPAN
On 17 January 1995, a tremendous earthquake occurred just below the southern part of Hyogo Prefecture, Japan. The citizens of the stricken area, having enjoyed a safe and peaceful life for a long time, were caught off guard. Consequently, more than 6,000 people were killed and more than 50,000 people were injured. More than 310,000 people temporarily were left homeless.
Many lessons have been learned from this earthquake disaster. This earthquake made 1995 a turning point in disaster preparedness in Japan. Many people, organizations, national governmental agencies, and local governments have begun to consider preparedness and mitigation for future disasters.
Keywords: disaster; earthquake; Kobe; lessons; response
E-mail: murayama@ma.neweb.ne.jp
Global Assessment of Earthquake Countermeasures after the Great Hanshin-Awaji Earthquake
Takashi Ukai, MD;1 Shuichi Kozawa, MD;2 Kazuhiko Maekawa;3 Ernesto A. Pretto4
1) Director, Prefectural Nishinomiya Hospital; 2) Health and Welfare Department, Hyogo Prefecture Government; 3) Department of Emergency Medicine, Tokyo University 4) Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania USA; Hyogo Prefectural Nishinomiya Hospital, Hyogo, JAPAN
As a commemorative work of the five year anniversary of the Great Hanshin-Awaji earthquake, Hyogo Prefecture Government planned and executed a project called "Global Assessment of Earthquake Countermeasures". International and domestic experts were assigned to each of 20 items of problems related to the disaster. These experts visited Kobe for several days in 1999, discussed issues with the persons concerned, and collected data and evidences of the earthquake and the countermeasures used after the disaster.
On the theme "medical response", there apparently were many problems: search and rescue did not work well; ambulance services system failed; hospitals were damaged and overwhelmed; etc. Taking these precious lessons learned into account, several countermeasure projects were instituted during the last five years. In spite of the limited time and assistant manpower, the assigned experts analyzed and evaluated the progress of the countermeasure projects, identified areas of improvement, and noted the problems that still existed in the affected health/medical community. Details of the assessment of disaster countermeasures after the Great Hanshin-Awaji earthquake will be discussed in accordance with their report.
Keywords: assessment; countermeasures; community vulnerability to disasters; disaster; health; medical; vulnerability
E-mail: ukai-t@mxr.mesh.ne.jp
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Recent Natural Hazards in North Coast of Venezuela
1) Venezuelan Society of Structural Engineers, (AVIE); 2) Institute of Civil Protection and Environment, (IPCA); 3) Consultant, Institute of Civil Protection and Environment, (IPCA) Caracas, VENEZUELA
On 29 July 1967, a 6.5 magnitude earthquake occurred in the Caribbean Sea, north of Venezuela. The focal depth was estimated to be 15 kilometers and was centered about 50 kilometers northwest of Caracas where four modern high-rise buildings collapsed. In Caraballeda City, adjacent to the shore of the Caribbean Sea, approximately 16 kilometers due north of Caracas, the top four floors of an 11-story building collapsed on top of the lower seven floors, which remained standing. Many multi-storied buildings and several hundred single-family dwellings were seriously damaged in areas near the Caribbean and in the Caracas Valley.
It has been reported that the Sebastian Fault, which is located about 10 kilometers north of Venezuelan coast, is the origin of the large earthquakes that have affected Caracas and the Caribbean shore urban areas.
In mid December 1999, extremely heavy rain caused muddy debris slides and massive landslides, killing more than 35,000 persons and leaving 200,000 homeless. The rains washed-out whole neighborhoods and small villages that lie between the Venezuela's coastal mountains, the Caribbean Sea, and the Caracas valley. Urban areas like Caraballeda, Los Corales, Macuto, Carmen de Uria, and La Gilaira in the Caribbean shoreline were heavily destroyed.
The City of Caracas also was affected by slurry flows and slumps caused by ground saturation especially in areas where the mountains were known to be exceptionally landslide prone.
These natural events can be referred to as compound disasters, which occur when nature geological hazards are influenced greatly by acts of man: deforestation; modification of slopes; growing demands for land in a hazardous area; public education; and lack of awareness of hazards.
The main objectives of this paper are to:
1) Incorporate knowledge about natural processes in the affected areas herein studied, portraying all of the available information in a form that can be used by planners and decision-makers; and
2) Study the impact of disasters upon a population including direct effects and generally human responses to the disasters.
Keywords: earthquake; hazards; landslides; mudslides; natural; rain; Venezuela
E-mail: jlalonso@cantv.net
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The Changing Role of the Auxiliary Medical Services in Hong Kong (HKSAR)
Poon Wai Kwong
Auxiliary Medical Services in Hong Kong (HKSAR), HONG KONG
As a supervisor of one of the voluntary medical services providers, the training of volunteer members on the handling of emergency situations as well as the basic first-aid skills are part of my duties. Recently, we have shifted our focus to the emergency disaster assistance (EDA) role. The scope of emergency disaster responses is becoming broader. The role of HKSAR is similar to that of the army medical services in the UK. We provide more supportive services during emergency situations and stand-by services in crowded situations.
In April 1999, the role of the Service changed and our members are training formally to become the EDA within three years time. It is based on the Canadian EMA experience modified to our situation and members. The reasons for the changes in our role include: 1) The importance and focus of prehospital stabilization internationally; 2) The increasing numbers of the disaster-like accidents and multi-casualty incidents (MCIs); 3) The increasing expectations of general public for AMS; 4) The generalization of the first aid knowledge for the public; and 5) coordination with the other related bodies in response to the disaster. Greater focus is expected on regular training and drilling so as to: 1) maintain the morale and to sustained the confidence in their abilities for providing EMA services; 2) familiarize them with the new function role and protocols; and 3) apply the international standards during the disaster.
A disaster is present when resources are outweighed by the event; however, when we try to be prepared for everything and be ready for everything, then we will not be surprised by anything.
Keywords: assistance; disaster; education; emergency medical services; Hong Kong; roles; training
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Volcanoes and their Potentially Devastating Effects: Case Studies from the Pacific Ring-of-Fire
Geological Survey of Canada, Pacific Division, Vancouver, British Columbia, CANADA
The Pacific Ocean is ringed by a chain of volcanoes potentially capable of devastating eruptions. Every year, there are numerous eruptions world-wide, but the bulk of these are within the Pacific Ring-of-Fire. For instance, during a period of two months in late 1999, there were 22 reported eruptions; of these, only two were outside the Pacific Ring-of-Fire. This same land area also is home to nearly two billion people!
With increased globalization of economies and closer socio-economic ties between countries, disasters can threaten not just a single country, but can impact an entire region. Effects may ripple affects through the global economy. Volcanic disasters can be particularly devastating because their impact can be more far reaching than are those of other natural disasters such as earthquakes or storms.
The time leading up to an eruption is an extremely difficult time for the local inhabitants. The science of volcanology has progressed significantly during the last 25 years; many of these gains have been made through the study of the 18 May 1980 and subsequent eruptions of Mt. St. Helens. Volcanologists now are much better able to provide predictions and forecasts for volcanic events; however, it still is an inexact science. This inexactitude is translated into uncertainty, for the people living close to a volcano. Volcanologists can state with some certainty that a volcano will erupt, but the precise time and magnitude of the eruption remain largely unknown. The initial prediction of an eruption can lead to mass evacuations of wide areas surrounding a volcano. If an eruption does not occur almost immediately, the political ramifications of these evacuations can become very high. The volcano may appear to lay people not to be particularly dangerous, and after a few days, the pressure to lift the evacuation notice can become extremely large. The consequences, however, could be very grave. Officials in these areas face a very difficult task of weighing the scientific evidence against political pressure. Over the past year, there have been several areas in which mass evacuations have been ordered: Mexico (Colima and Popocatépetl), Ecuador (Guagua Pichincha and Tungurahua), Philippines (Mt. Mayon), and Japan (Mt. Usu). None of these volcanoes have resulted in a large eruption; however, the evacuations have lasted for months and, in some cases, several years. The longer the activity continues, the greater the effects are on the local population, and the greater the possibility for a more significant regional socio-economic impact, even in the absence of a major eruption.
Following a large eruption, vast regions around the volcano can be made inhospitable for months to years or even decades. Almost a decade later, large areas around the Pinatubo volcano in the Philippines remain inhospitable due to flooding and mudflows. Thousands of people have been displaced permanently. Ash clouds can travel thousands of kilometers, creating acid rain and global climatic effects. We have been lucky in the past 100 years in that there have been no major eruptions to cause more than minor climatic disturbances.
This presentation will focus on the types of impacts caused by volcanic eruptions and how people have coped with the effects using examples from around the Pacific Ring-of-Fire.
Keywords: climate; displacement; eruption; effects, socio-economic; evacuation; Pacific Ring-of-Fire; volcanoes
E-mail: chickson@nrcan.gc.ca
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MSF Activities in Pacific Rim Relief Efforts
Dr. Michael Schull
Canadian Chapter of Doctors without Borders and Clinical Epidemiology Unit and Emergency Department, Sunnybrook and Women's College, Health Sciences Centre, CANADA
This presentation will review the recent activities of the non-governmental medical relief organization Medecins Sans Frontiéres (Doctors Without Borders (MSF)) in the Pacific Rim. MSF was present in at least 11 Pacific Rim countries, carrying out a range of projects from interventions in complex emergencies to the support of local infrastructure in combating public health disasters such as HIV/AIDS. MSF's activities also have included local and international advocacy campaigns, such as the campaign to make essential medicines more affordable and available to those who need them most. Finally, the specific case of East Timor will be examined in greater detail, since it illustrates the difficulties inherent in situations when NGOs and the military must operate side-by-side in the field. Such situations inherently are complex, but they also can threaten the impartiality and neutrality of humanitarian organizations. This can reduce the capacity of an NGO to act freely, and may even endanger its personnel.
Keywords: complex emergencies; cooperation; East Timor; infrastructure; Medicins sans Frontiéres; medications; military; non-governmental organizations (NGOs); public health
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Mount Usu Volcanic Eruption in 2000 and Transportation of Severely Injured Patients by Helicopter
Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine, Sapporo, JAPAN
Japan is famous for volcanoes and earthquakes. Mount Usu in Hokkaido erupted for the second time early Friday, 01 April 2000 after lying dormant for 23 years. The activity was accompanied by temblors with the biggest, a magnitude 4.8 earthquake on the open-ended Richter scale, striking at 03:12 hours. Abuta town was almost deserted as about 10,000 people, out of a total population of 10,200, evacuated the town to nearby municipalities after the eruption. The volcanic fumes rose as high as 3,200 meters, dumping volcanic ash and rocks over a wide area on the downwind side of the explosion. Experts remain wary of Usu's future. On 01 May, observations of the Hokkaido volcano indicated that the eruptions are smaller and occurring less frequently, leading some to predict no major explosions will occur in the near future.
More than 260 citizens from the near towns participated in a disaster preparation-training course in October 1995. Drills and meetings are held routinely by the city or town district. The three municipalities signed an agreement in 1997, promising to assist one another in the event of a volcanic disaster.
Based on the experience in the Mount Unzen-Fugen peak eruption in 1991, from which 43 persons died, we now are planning the transportation by helicopter and airplane when many severely burned victims or patients with severe multiple trauma occur. Until now, no injuries or deaths have been reported. We will report the details of this Mount Usu's volcanic eruption.
Keywords: disaster; earthquake; eruption; evacuation; exercises; Japan; volcano
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The Early Medical Management of Critically Injured Accident Victims in Tokaimura, 30 September 1999
T. Kinugasa;1 K. Maekawa;2 Y. Sasaki;3 G. Suzuki;4 S. Taneka;5 S. Asano2
1) Mitsubishi Kobe Hospital; 2) The University Hospitals of Tokyo; 3) The National Institute of Radiological Sciences; 4) Radiation Effects Research Foundation; 5) The Kyonrin University Hospital, JAPAN
Generally speaking, in this radiation accident, people who needed medical attention were grouped into the following:
1) Three highly-irradiated workers who required treatment for acute radiation syndrome;
2) About 100 persons, mostly workers, with documented low-dose exposure who needed medical follow-up included those who were within the facility at the time of the incident and those who were engaged in the concerted efforts to terminate the continuing event; and
3) Residents who lived near the uranium conversion facility. No significant radiation exposure was documented among them, but explanation of health hazards and psychological attention by professionals were needed.
The following observations that occurred at five points after the accident include:
1) The accident scene at the uranium conversion facility.
2) Transportation of three patients;
3) The initial treatment and triage at the local national hospital;
4) The National Institute of Radiological Sciences (NIRS); and
5) The University Hospitals where acute and long-term treatment was carried out for patients with acute radiation syndrome.
In addition, some new clinical observations were made:
1) Hypoxia can occur soon after the exposure in these three patients;
2) Prolonged massive wound exudate from the injured skin seen in the most severely exposed patients; and
3) Massive watery diarrhea occurred after 4 weeks and then GI bleeding after 7 weeks were observed in one patient.
Keywords: accident; hypoxia; radiation; radiation syndrome; skin; triage; treatment; uranium
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The Medical Response and Problems in 1999 Taiwan Earthquake
Dr. Jih-Chang Chen
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