Abstract
This paper is based on the experience gained from three recent earthquakes in India. Lature (Maharashtra 1993), Jabalpur (M.P. 1997),and Kutch (Gujarat 2001).
The importance of such studies and lessons learnt from the management of casualties cannot be under stated as we have had at least 6 major earthquakes in various parts of the world in the first two months of the New Millenium.
The uniqueness of an earthquake lies in its unpredictability. There is no warning & no time to take preventive measures. The event is sudden, takes a heavy toll of human life, leaves a huge injured population and very many trapped under the debris of fallen buildings. It also results in great fear psychosis in the injured/uninjured population as well.
Success of relief operations in earthquakes depends on:-
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Preparedness for such eventualities by a clear established protocol of action before hand in earthquake prone areas.
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Establishment of immediate communication links between affected area and controlling authorities.
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Establishing a clear line of command from higher authorities to the rescue teams.
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Immediate Co-ordination between government agencies and Non-Government Organisations flooding the area with man power and relief supplies. An effective control centre should be established for this.
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Immediate mobilization of resources from nearby areas:-
Medical services.
Relief teams for removing debris to rescue trapped people.
Supply of food/water/shelters/Medical supplies.
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Mobilization of Ambulance services/Helicopters for evacuation of injured patients after proper triage.
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Monitoring services to keep updated statistics of injured/trapped /dead, and to constantly advise change of strategies for more effective rescue operations.
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Minimize panic and boost morale of the affected population as well as rescue teams by preventing rumours of fresh quakes from circulating.
Early rescue operations to evecuate trapped people from debris/early evacuation of casualties by trained personnel in properly organised ambulance services help in drastically reducing the death toll.
Proper early management of polytraumatised victims on ATLS principles helps in saving a lot of lives in the first week after the earthquake. Systematic establishment of camps/mobile hospitals especially in remote areas further helps minimize mortality and morbidity in the second phase of relief services after the initial 2–4 days of emergency operations.
Psychotherapy of not only the injured but also the whole population is extremely important to minimize permanent mental scars which may take a lifetime to disappear.
It is important to conclude by stating that relief services require enormous manpower which should have a very high degree of motivation to perform under extreme physically and mentally stressful conditions.
Leadership is required at various levels to provide this motivation & is the key to success.
It must also be constantly kept in mind by medical personnel that the victims do not have only medical problems but far greater socio-economic and psychological problems from death in the family requiring completion of last rites, collapse of their houses & loss of all belongings & fear psychosis of further tremours.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
