Prehospital management of earthquake casualties buried under rubble.

Earthquakes continue to exact a heavy toll on life, injury, and loss of property. Survival of casualties extricated from under the rubble depends upon early medical interventions by emergency teams on site. The objective of this paper is to review the pertinent literature and to analyze the information as a practical guideline for the medical management of casualties accidentally buried alive. Ashkenazi I, Isakovich B, Kluger Y, Alfici R, Kessel B, Better OS: Prehospital management of earthquake casualties buried under rubble. Prehosp Disast Med 2005;20(2):122–133. Introduction Earthquakes are among the most dangerous and destructive types of natural events. Earthquakes strike suddenly and without warning. Ninety percent of casualties result directly from the collapse of buildings. Secondary events, such as landslides, floods, fires, and tsunamis, account for the remainder (10%) of the casualties. The need for specialization when confronting these calamities has led to the formation of various search and rescue teams worldwide. During the last two decades, there has been an increasing number of publications relating to the experiences accumulated by these teams. The objective of this paper is to summarize the medical experiences of these teams and to offer a practical protocol for the treatment of casualties that have been buried alive for both trained paramedics and other medical personnel responding to similar calamities. Medical personnel working in search and rescue teams usually specialize in areas other than disaster medicine, such as emergency medicine, anesthesia, intensive care, surgery, and trauma medicine. Their professional life only is devoted episodically to disaster medicine. A protocol of treatment should accommodate itself as much as possible to treatment protocols proven in previous trauma scenarios. The Advanced Trauma Life Support (ATLS) protocol was selected as the basis of treatment because it is the standard of trauma management that is taught in many countries.1 Whenever possible, a primary survey and resuscitation should be carried out. Nevertheless, medical personnel should be aware of the unique problems that earthquake casualties present. Most of the seriously wounded casualties are trapped under rubble. Both assessment and treatment are severely constrained by the confined surroundings in which the casualties are found. In all those extricated from under the rubble, crush injury should be suspected until proven otherwise. “Scoop and run” and the “golden hour” are terms that are not applicable in this setting. Nearby hospitals may have been devastated by the event or may be inaccessible. These and other