Massive earthquakes often cause structures to collapse, trapping victims under dense rubble for long periods of time. Commonly, this spurs resource intensive, dangerous, and frustrating attempts to find and extricate live victims. The search and rescue phase usually is maintained for many days beyond the last “save,” potentially diverting critical attention and resources away from the pressing needs of non-trapped survivors and the devastated community. This recurring phenomenon is driven by the often-unanswered question “Can anyone still be alive under there?” The maximum survival time in entrapment is an important issue for responders, yet little formal research has been conducted on this issue. Knowing the maximum survival time in entrapment helps responders: (1) decide whether or not they should continue to assign limited resources to search and rescue activities; (2) assess the safety risks versus the benefits; (3) determine when search and rescue activities no longer are indicated; and (4) time and pace the important transition to community recovery efforts.

The time period of 1985–2004 was selected for investigation. Medline and Lexis-Nexis databases were searched for earthquake events that occurred within this timeframe. Medical literature articles providing time-torescue data for victims of earthquakes were identified. Lexis-Nexis reports were scanned to select those with time-to-rescue data for victims of earthquakes. Reports from both databases were examined for information that might contribute to prolonged survival of entrapped individuals.

A total of 34 different earthquake events met study criteria. Fortyeight medical articles containing time-to-rescue data were identified. Of these, the longest time to rescue was “13–19 days” post-event (secondhand data and the author is not specific). The second longest time to rescue in the medical articles was 8.7 days (209 hours). Twenty-five medical articles report multiple rescues that occurred after two days (48 hours). Media reports describe rescues occurring beyond Day 2 in 18 of 34 earthquakes. Of these, the longest reliably reported survival is 14 days after impact, with the next closest having survived 13 days. The average maximum times reported from these 18 earthquakes was 6.8 days (median = 5.75 days). The event with the most media reports of distinct rescue events was the 1999 Marmara, Turkey earthquake (43 victims). Times range from 0.5 days (12 hours) to 6.2 days (146 hours) for this event. Both databases provide little formal data to develop detailed insight into factors affecting survivability during entrapment.

A thorough search of the English-language medical literature and media accounts provides a provocative picture of numerous survivors beyond 48 hours of entrapment under rubble, with a few successfully enduring entrapment of 13–14 days. These data are not necessarily applicable to non-earthquake collapsed-structure events. For incident managers and their medical advisors, the study findings and discussion may be useful for postimpact decision-making and in establishing and/or revising incident priorities as the response evolves.

Proper management of mass-casualty incidents (MCIs) relies on triage as a critical component of the disaster plan.

The objective of this study was to assess the precision of triage in mass-casualty incidents.

The precision of decisions made by two experienced triage officers was examined in two large MCIs. These decisions were compared to the real severity of injury as defined by the Israeli Defence Forces (IDF) classification of severity of injuries and the Injury Severity Score (ISS).

Two experienced trauma physicians triaged a total of 94 casualties into 77 mild, seven moderate, and 10 severe casualties. Based on the IDF criteria, there were 74 mild, five moderate, and 15 severe casualties. Based on ISS scoring, there were 78 mild (ISS <9), five moderate (9 ≤ISS<16), and 11 severe (ISS < 16) casualties. Of 15 severely injured victims defined by the IDF classification of injury severity, the triage officers identified only seven (47%).

Primary triage, even when carried out by experienced trauma physicians, can be unreliable in a MCI.

Standardized, validated training programs for teaching administrative decision-making to healthcare professionals responding to weapons of mass destruction (weapons of mass destruction) incidents have not been available. Therefore, a multidisciplinary team designed, developed, and offered a four-day, functional exercise, competency-based course at a national training center.

This report provides a description of the development and initial evaluation of the course in changing participants' perceptions of their capabilities to respond to weapons of mass destruction events.

Course participants were healthcare professionals, including physicians, nurses, emergency medical services administrators, hospital administrators, and public health officials. Each course included three modified tabletop and/or real-time functional exercises. A total of 441 participants attended one of the eight course offerings between March and August 2003. An intervention group only, pre-post design was used to evaluate change in perceived capabilities related to administrative decision-making for weapons of mass destruction incidents. Paired evaluation data were available on 339 participants (81.9%). Self-ratings for each of 21 capability statements were compared before and after the course. A 19-item total scale score for each participant was calculated from the pre-course and post-course evaluations. Paired t-tests on pre- and postcourse total scores were conducted separately for each course.

There was consistent improvement in self-rated capabilities after course completion for all 21 capability statements. Paired t-tests of pre- and postcourse total scale scores indicated a significant increase in mean ratings for each course (all p <0.001).

The tabletop/real-time-exercise format was effective in increasing healthcare administrators' self-rated capabilities related to weapons of mass destruction disaster management and response. Integrating the competencies into training interventions designed for a specific target audience and deploying them into an interactive learning environment allowed the competency-based training objectives to be accomplished.

Local health departments are among the first agencies to respond to disasters or other mass emergencies. However, they often lack the ability to handle large-scale events. Plans including locally developed and deployed tools may enhance local response. Simplified cluster sampling methods can be useful in assessing community needs after a sudden-onset, short duration event.

Using an adaptation of the methodology used by the World Health Organization Expanded Programme on Immunization (EPI), a Microsoft Access-based application for two-stage cluster sampling of residential addresses in Louisville/Jefferson County Metro, Kentucky was developed. The sampling frame was derived from geographically referenced data on residential addresses and political districts available through the Louisville/Jefferson County Information Consortium (LOJIC). The program randomly selected 30 clusters, defined as election precincts, from within the area of interest, and then, randomly selected 10 residential addresses from each cluster.

The program, called the Rapid Assessment Tools Package (RATP), was tested in terms of accuracy and precision using data on a dichotomous characteristic of residential addresses available from the local tax assessor database. A series of 30 samples were produced and analyzed with respect to their precision and accuracy in estimating the prevalence of the study attribute. Point estimates with 95% confidence intervals were calculated by determining the proportion of the study attribute values in each of the samples and compared with the population proportion. To estimate the design effect, corresponding simple random samples of 300 addresses were taken after each of the 30 cluster samples.

The sample proportion fell within ±10 absolute percentage points of the true proportion in 80% of the samples. In 93.3% of the samples, the point estimate fell within ±12.5%, and 96.7% fell within ±15%. All of the point estimates fell within ±20% of the true proportion. Estimates of the design effect ranged from 0.926 to 1.436 (mean = 1.157, median = 1.170) for the 30 samples.

Although prospective evaluation of its performance in field trials or a real emergency is required to confirm its utility, this study suggests that the Rapid Assessment Tools Package, a locally designed and deployed tool, may provide populationbased estimates of community needs or the extent of event-related consequences that are precise enough to serve as the basis for the initial post-event decisions regarding relief efforts.

Although the need for on-site physicians at mass gatherings has been investigated in developed countries, it has not been studied in a developing country, where resources are limited, paramedical services are unavailable, and transportation and other facilities are inadequate.

The presence of on-site physicians would result in the effective management and prehospital care of casualties at mass gatherings or major sporting events in a developing country.

A retrospective review of the planning procedures and medical records of the 19th Nigerian University games was conducted. Data from demographic profiles of visitors presenting to the on-site, secondary, and tertiary medical centers and the treatments used were extracted from log-books and processed and interpreted.

The Games hosted 6,000 accredited athletes and officials, and an estimated 80,000 spectators. Medical coverage was provided by 54 doctors and other healthcare staff at on-site, secondary, and tertiary medical centers. No trained paramedics were available. A total of 494 visits were made to the medical centers (medical usage rate of 2.1/1,000, patient presentation rate of 0.08). Forty-six percent of the visitors were evaluated by a physician on-site. Ninety percent of the visits were managed on-site, while 5% and 3% were referred to secondary and tertiary medical centers, respectively.

The presence of on-site physicians at a major sporting event resulted in the majority of injuries and complaints being effectively treated on-scene. This reduced the number of hospital referrals and saved time and money for treatment.