Disaster reanimatology potentials : A structural interview study in Armenia : I. Methodology and preliminary results

ABSTRACT

In general, preparations for disasters which results in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgey, and prolonged life support (PLS intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks.Preliminary results permit the following generalizations 1)a significant nomber of victims died slowly as the result of iinjuries such as external hemorrhage, head injury with coma,shock, or crush sundrome; 2) early search and rescue was perfomed primarily by uninjured covictims using hand tools; 3) many livespotentially could have been saved by the use of LSFA and ATLS started during extrication of crushed victims. 4) medical teams from neighboring EMS systems started to arrive at the site at 2-3 hours and therefore, ATLS could have been provided in time to save lives and limbs; 5) some amputations had to be perfomed in the field to enable extrication; 6) the usefulness of other resuscitative surgery in the fieldneeds to be clarified; 7) evacuations were rapid; 8) air evacuation proved essential; 9) hospital intensive care was well organized; and 10)international medical aid, which arrived after 48 hours, was too late top impact on resuscitation. definitive analysis of data in the near future will lead to recommendations for local, regional, and National Disaster Medical Systems (NDMS).(AU)