On July 19,1989, at 1515h, United Airlines flight 232 with 297 passengers and crew on board, experienced disintegration of the number 2 engine (in the tail section) while at 40-thousand feet above Alta, Iowa (Map 1). The DC-10, en route from Denver to Chicago, was diverted to Sioux City, Iowa's Gateway Airport. The disabled jet made a crash landing on an unused runway, burst apart, and caught fire upon impact. Due to the advanced warning of the potential crash, local crash-fire-rescue (CFR) units from the Air National Guard stationed at Gateway Airport, local and regional paramedic and fire units, an advanced life-support EMS helicopter service, and the two Sioux City hospitals were on alert and ready. Firefighters and Air National Guard personnel fought the fire and EMS personnel performed triage, provided emergency care in the field, and transported victims from the crash scene to local health care facilities in Sioux City. Injured victims in critical condition were transported first followed by those with lesser injuries. All were being treated within one hour and 45 minutes of the event. Of the 297 passengers and crew, 59 were admitted to local hospitals in critical condition, and 124 were treated for less severe injuries and later released.

Resuscitology is the science of reanimation from apparent death or from unconsciousness. Prior to the last quarter of this century, resuscitation was steeped in myth, supported only by anecdote, and founded on unphysiologic principles. The development of new, scientifically based, modern concepts and practice of cardiopulmonary resuscitation (CPR) injected great hope into improving the chances for survival and quality of life for cardiac patients.

Recent reports indicate that there are nearly 70,000 “successful” cardiac resuscitations annually. However, it is estimated that only 10% are able to resume their former lifestyles. It is anticipated that with the expansion of prehospital emergency medical services, this proportion will increase. These facts have stimulated intense research aimed at elucidating the pathophysiology of cellular death with the goal of protecting the brain during cardiac arrest.

An earthquake with the destructive magnitude of 6.9 on the Richter scale struck Armenia on Wednesday, 7 December 1988 at 1142 local time. It devastated an area 80 km in diameter in the northern part of the Armenian Soviet Socialist Republic (SSR), encompassed the towns of Leninakan, Spitak, Stepanovan, and Kirovakan, and killed some 25,000 persons (Table 1). Almost 15,000 persons were rescued alive. The load placed on medical facilities and transport capabilities was profound. Many Armenian nurses and physicians died during the earthquake and most of the hospitals and clinics within the disaster area were destroyed (Tables 1,2). More than 31,000 persons required some form of medical assistance in hospitals. Some 12,000 (38%) were conveyed by some form of ambulance. Of these, 82% were received by hospitals within the Armenian SSR and 22% still were hospitalized at the beginning of the newyear. Only 13% of those who received care at a hospital died in the hospital. More than 100-thousand victims had to be transported from the scene.