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An Analysis of Prehospital Mortality in an Earthquake

  • Ernesto A. Pretto (a1), Derek C. Angus (a1), Joel I. Abrams (a2), Bern Shen (a3), Richard Bissell (a4), Victor M. Ruiz Castro (a5), Roberto Sawyers (a6), Yukihiro Watoh (a1), Norma Ceciliano (a1), Edmund Ricci (a7) and other members of the Disaster Reanimatology Study Group...



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.


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.


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.


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.


Corresponding author

Principal Investigator, Disaster Reanimatology Study Group (DRSG), International Resuscitation Research Center, 3434 Fifth Ave., Pittsburgh, PA 15260 USA


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1. Safar, P: Resuscitation potentials in mass disasters. Prehospital and Disaster Medicine 1986;2:3447.
2. Lechat, MF: Disasters and public health. Bull WHO 1979;57:1117.
3. Binder, S, Sanderson, LM: The role of the epidemiologist in natural disasters. Ann Emerg Med 1987;16:10811084.
4. Gregg, MB (ed): The Public Health Consequences of Disaster. Atlanta, Centers for Disease Control, 1989.
5. deBruyker, M, Greco, D, Annino, I, et al. : The 1980 earthquake in southern Italy: Morbidity and mortality. Int J Epidemiol 1985;14:113117.
6. DeVille de Goyet, C, Del Cid, E, Romero, E, et al. : Earthquake in Guatemala: Epidemiologic evaluation of the relief effort. Pan Am Health Org Bull 1976;10:95109.
7. DeVille de Goyet, C, Jeannee, E: Epidemiological data on morbidity and mortality following the Guatemala earthquake. IRCS Med Sciences: Social and Med 1976;4:212.
8. DeVille de Goyet, C, Zeballos, JL: Communicable diseases and epi demiological surveillance after sudden natural disasters. In Baskett, P, Weller, R (eds): Medicine Jar Disasters. London, Wright, 1988;252269.
9. Seaman, J, Leivesley, C, Hogg, C (eds): Epidemiology of Natural Disasters. Basel & New York: Karger, 1984.
10. Baker, CW, Chapman, (eds): Man and Society in Disaster, New York: Basic Books Inc., 1962.
11. Baker, Fj: The management of mass casualty disasters. Topics in Emerg Med 1979;1:149.
12. Barton, AH: Social organization under stress: A sociological review of disaster studies, disaster study No. 17, publication No. 1032, Disaster Research Group, National Academy of Sciences—National Research Council, Washington, DC, 1963.
13. Barton, A: Communities in Disaster: A Sociological Analysis of Collective Stress Situations. Garden City: Doubleday and Co., 1969.
14. Drabek, TE: Human System Responses to Disaster: An Inventory of Sociological Findings. New York: Spinger-Verlag, 1986.
15. Quarantelli, EL: Some basic themes in sociological studies of disasters. In: Quarantelli, EL (ed): Disasters: Theory and Research. Beverly Hills, Calif: Sage Publications, 1978.
16. Quarantelli, EL: Inventory of Disaster Field Studies in the Social and Behavioral Sciences 1919–1979, Disaster Research Center, University of Delaware, Newark, 1982.
17. Chandler, AM: Building damage in Mexico City earthquake. Nature 1986:320:497501.
18. Krimgold, F: Collapsed buildings: Search-and-rescue challenges. Emergency Medical Services 1987;16:3435.
19. Tiedman, H: Casualties as a Function of Building Quality and Earth quake Intensity. Proceedings of the International Workshop on Earthquake Injury Epidemiology: Implications for Mitigation and Response. Baltimore: Johns Hopkins University, 1989;420434.
20. Solnes, J (ed): Engineering Seismology and Earthquake Engineering. Leiden, Noordhoff, 1974.
21. Safar, P, Ramos, V, Mosquera, J, et al. : Anecdotes on resuscitation potentials following the earthquake of 1970 in Peru. Prehospital and Disaster Medicine 1987;3:124.
22. Safar, P, Kirimli, N, Agnes, A, Magalini, S: Anecdotes on resuscitation potentials following the earthquake of 1980 in Italy. Proceedings of the Fourth World Congress on Emergency and Disaster Medicine (abstract). Brighton, UK, June 1985.
23. Safar, P, Pretto, E, Bircher, N: Disaster resuscitology including the management of severe trauma. In: Baskett, P, Weller, R (eds): Medicine for Disasters. London: Wright-Butterworth, 1988, pp 3686.
24. Glass, RI, Urrutia, JJ, Sibornys, S, et al. : Earthquake injuries related to housing in a Guatemalan village. Science 1977;197:638643.
25. Noji, EK, Kelen, GD, Armenian, HK, et al. : The 1988 earthquake in Soviet Armenia: A case study. Ann Emerg Med 1990;19:7581.
26. Pollander, GS, Rund, DA: Analysis of medical needs in disasters caused by earthquake: The need for a uniform reporting scheme. Disasters 1989;13:365369.
27. American College of Surgeons Committee on Trauma. Collicott, PE (ed): Advanced Trauma Life Support Course for Physicians. Chicago: American College of Surgeons, 1984.
28. Cowley, RA, Dunham, CM (eds): Shock Trauma/Critical Care Manual. Initial Assessment and Management. Baltimore: University Park Press, 1982.
29. Restall, J, Knight, J: Analgesia and anesthesia in the field. In: Baskett, P, Weller, R (eds), Medicine for Disasters. London: Wright-Butter worth, 1986, pp 87101.
30. Williams, ML, Hammond, PY: Engineering challenges for minimizing casualties from earthquakes. Prehospital and Disaster Medicine 1985;1:427.
31. Kvetan, V (ed): Disaster Management. Crit Care Clin 1991;7:257448.
32. Frey, R: The Club of Mainz for improved worldwide emergency and critical care medicine systems and disaster preparedness. Crit Care Med 1978:6:389.
33. Klain, M, Ricci, E, Safar, P, et al. : Disaster reanimatology potentials: A structured interview study in Armenia I. Methodology and preliminary results. Prehospital and Disaster Medicine 1989:4:135152.
34. Ricci, E, Pretto, E, Safar, P, et al. : Disaster reanimatology potentials: A structured interview study in Armenia II. Method for evaluation of medical response to major disasters. Prehospital and Disaster Medicine 1991;6:159166.
35. Pretto, E, Ricci, E, Safar, P, et al. : Disaster reanimatolgy potentials: A structured interview study in Armenia III. Final results, conclusions and recommendations. Prehospital and Disaster Medicine 1992:7:327338.
36. Pretto, E, Angus, D, Abrams, J, et al. : The incidence of protracted death after the April 22, 1991, earthquake in Limón Province, Costa Rica. Proceedings of the 2nd Asian-Pacific Conference on Disaster Medicine, Tokyo, Japan, 1992.
37. Ricci, E, Pretto, E: Assessment of prehospital and hospital response in disaster. Crit Care Clin 1991:7:471484.
38. Bissell, R, Pretto, E, Angus, D, et al. : Post-preparedness response in Costa Rica. Prehospital and Disaster Medicine, 1994;9:96106.
39. Allan, AN: Preventable pre-hospital deaths: A review. J Br Assoc Immed Care 1991;14:1720.
40. Zhi-Yong, S: Medical support in the Tangshan earthquake. A review of the management of mass casualties and certain major injuries. J Trauma 1987;10:11301135.
41. Allister, C: Cardiac arrest after crush injury (a case report). Br Med J 1983;287:531532.
42. Villazon-Sahagun, A: Mexico City earthquake. Medical response. Prehospilal and Disaster Medicine 1986;2:1520.
43. Better, OS, Stein, JH: Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med 1990:322:835–829.
44. Kai, T, Pretto, E, Safar, P, Capone, A: Development of a crush injury research model in the rat. Proceedings of the Second International Urban Emergency Medicine Symposium, October 27–29, 1993, Beijing, China.
45. Angus, D, Pretto, E, Abrams, J, et al. : Recommendations for life-supporting first-aid training of the lay public for disaster preparedness. Prehospital and Disaster Medicine 1993;8:157160.
46. Abrams, J, Pretto, E, Angus, D, et al. : Guidelines for rescue training of the lay public. Prehospital and Disaster Medicine 1993;8;151156.
47. Auf Der Heide, E: Disaster Response: Principles of Preparation and Coordination. St. Louis, Mosby-Year Book, 1989.
48. Haynes, BE, Freeman, C, Rubin, JL, et al. : Medical response to catastrophic events: California's planning and the Loma Prieta earth quake. Ann Emerg Med 1992;21:368374.
49. Pretto, E, Safar, P: National medical response to mass disasters in the United States: Are we prepared? JAMA 1991;266:12591266.



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