ISSUES OF RESCUE AND MEDICAL-CARE FOLLOWING THE 1988 ARMENIAN EARTHQUAKE

On-site emergency care and rescue efforts may be critical in preventing disability and other serious consequences of disasters. In this report we compare efforts used in the rescue and emergency medical care of 189 people (case subjects) from Kumairy (Leninakan), Armenia, who were hospitalized with serious injuries following the Armenian earthquake of 7 December 1988, with efforts used in helping 68 people (controls) from Kumairy with mild injuries who were not hospitalized. We used a standardized interview questionnaire to ascertain the circumstances of entrapment, the rescue process used, the injuries the victims sustained, and the medical care they received. Case and control subjects shared similar social and demographic characteristics; however, case subjects waited longer to be rescued and to receive medical care than did control subjects. Of the people who said they were trapped, 66.2% of the case subjects and 41.2% of the control subjects said that they were trapped for >1 hour (odds ratio [OR] = 2.79, 95% confidence interval [CI] : 1.52-5.13) whilst the OR for >6 hours of entrapment was 3.88 (95% CI : 1.69-9.10). Of those requiring medical care, 28.6% of people who were hospitalized waited >1 hour after rescue to receive medical care, compared with only 14.7% of the control subjects (OR = 2.32, 95% CI : 1.05-5.23). In addition to the case-control study, we collected data on general characteristics of the rescue and emergency medical care process. We found that most of the trapped people were rescued by untrained local inhabitants who most often used their hands or simple tools. Only 2.5% of the trapped survivors were rescued by Soviet specialists in urban search and rescue, and fewer than 1% were rescued by specialized foreign rescue groups. Many of the surviving injured victims (43.5%) did not receive their first medical care until they arrived at a hospital. Of the people with serious injuries, 37% walked to hospitals or were transported by private cars, and 24% were transported by plane or helicopter. Of those who received some sort of medical treatment, more than 60% underwent an orthopaedic procedure and 56.7% required only minor procedures. Only 1.6% required surgery. The results of this study highlight, once more, the importance of local disaster preparedness and proper on-site emergency care.