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close this bookCorporal Damage as Related to Building Structure and Design: The Need for an International Survey (Centre for Research on the Epidemiology of Disasters, 1989, 16 p.)
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View the document2. MITIGATION VS RESPONSE
View the document5. RESEARCH
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View the documentBIBLIOGRAPHY


At the moment, rescue is most often unplanned. The population is generally ill-prepared, yet ready to help. It is only recently that the potential of the local community for self help has been fully realized by health managers, with its implication for preparedness of the population and training of personnel. The concept is not yet fully accepted. Too often too large a reliance is still placed on external help.

Three sets of observation points to the central role that the disaster stricken community can play in search and rescue.

(1) Social scientists have been much more eager than health managers in studying the reaction of disaster-struck populations. Observations suggest that the response of the local community is quite effective, if not always efficient. In Japan, it was observed that within half an hour after an earthquake (Niigata, 1964), 75 percent of the non-affected survivors were engaged in some kind of rescue activity. In another more recent earthquake, Southern Italy, 1980, the proportion of survivors who remembered participating to rescue was lower, around 20 percent (3,4).

In earthquake prone areas, this capacity for search and rescue should be improved by adequate preparedness and training.

(2) Studies on the survival of trapped victims according to the delay in rescue show that immediate rescue is what counts. It has led to the concept of the “Golden twenty-four hours”. In the Tangshan, China, 1976 earthquake, the proportion of trapped people who survived declined from 99 percent within half and hour to 81 percent for those extricated later but before 24 hours after the impact, and 37 percent for those extricated on the second day (Fig. 1). Similar figures were observed in the Campania-Irpinia earthquake, Italy, 1980 where a retrospective survey of some 3.600 survivors in the 7 worst affected villages (overall casualty rate 19.7 percent) has shown that the proportion of people extricated alive among all extricated was respectively 88 percent for the first day, 35 percent for the second day, and 9 percent on the two following days. Of all the trapped victims extricated alive, 94 percent were rescued within the first 24 hours (3,4).

For all trapped victims which were extricated, dead or alive, 471 in total, 25 percent were extricated within half an hour, 44 percent within 3 hours, and 56 percent within 12 hours (Fig. 2). Within two days, 80 percent of all the trapped people were extricated. The time within which 50 percent of the victims had been extricated, dead or alive, (Time Lib50), was 8 hours.

Such studies however have severe limitations. The observations nay be partly due to a selection bias, since the less affected victims screaming for help or easily located are likely to be extricated first.

In addition, in Italy, 95 percent of the trapped survivors later evacuated to a medical center, were extricated with local means such as shovel, spikes, or bare hands. While it does not mean that more people could not have been saved would adequate equipment be available, this observation shows at least that the local population can play a determinant role in rescue. (10)

This was confirmed by comparing death rates, ratios of injured to death, and delays for extrication in single and multiple households. People living in single households had a death rate 2,4 times higher than those living in households with one or more members of the household present. When trapped, their death rate was approximately 1.5 times higher. Injured to death ratio was 2.6 for single households victims vs 1.8 people in multiple households. Proportion of people trapped who were extricated, dead or alive, within 24 hours was 46 percent only in simple households as compared to 61 percent in multiple households (Table 1).

Whatever the limitations of these studies, they indicate that the local community is quite effective in search and rescue, which as an essential component of disaster preparedness should be part and parcel of primary health care.

(3) External rescue teams, with an arrival delay on the spot of 2 to 4 days if not more, come generally too late to have a significant impact on the saving of life. While they may achieve isolated brilliant results well publicized by the media, their impact population wise needs to be properly evaluated. It is likely to be minimal and should be properly evaluated. This is not to say that external aid is not needed, far from it, since one life saved is worth every effort. It just does mean that investments are likely to be more productive in terms of the total number of lives saved when the local population is properly educated in search and rescue. That technologically advanced equipment can achieve what the local population is not able to perform with the local tools concerns only a small fraction of the victims surviving long enough to benefit from it.