Plan Ahead
2010; Lippincott Williams & Wilkins; Volume: 110; Issue: 3 Linguagem: Inglês
10.1213/ane.0b013e3181cccbc1
ISSN1526-7598
Autores Resumo“Forewarned, forearmed; to be prepared is half the victory.” —Miguel de Cervantes More than half the world's population lives in earthquake-prone areas. Alaska's magnitude 9.2 shaker of 1964 remains the second largest quake in recorded history. Even those who dwell on stable continental plates and well away from subduction zones are not immune from temblors: some of the largest earthquakes in the continental United States were 4 large quakes from the New Madrid Seismic Zone in southeastern Missouri in 1811 and 1812. And the hundreds of thousands of deaths from the 2010 earthquake in Haiti and the 2004 Indian Ocean tsunami are still fresh in our memories. For almost 4000 years, China has been famous for its earthquakes. The earliest documented quake comes from China, in 1831 bc from the Shandong province. The most complete historical records also come from China, starting in 780 bc during the Zhou Dynasty in China. It is likely that more people have died from earthquakes in China than from earthquakes anywhere else in the world. On May 12, 2008, the ground in China's Sichuan province heaved and trembled for 2 minutes. Anyone who has experienced the terror of a mere 10-second earthquake can appreciate the destruction, both physical and psychological, of a hundred seconds of violent shaking. Yet, this is nothing compared to the human suffering that followed, as described in the article by Chen and coworkers.1 In the minutes and hours after a major quake, immediate rescue and medical assistance are the highest priorities. There are about 800,000 doctors in the United States, or about 1 doctor for 375 people. With 3 million nurses, it's roughly 1 nurse for every 100 people. With proper geographical distribution, this should be enough. But of course doctors and nurses will not be optimally dispersed after an earthquake. Perhaps more importantly, they will not have the clinical support necessary to aid the injured: hospitals, surgical supplies, anesthesia assistance, and pharmacological stores. Chen and coworkers vividly recount the difficulties of moving doctors and medical supplies into disaster zones when roads and transportation systems are damaged. So why not take the opposite approach, at least initially? Why not organize and use the medical material already in place? Hospitals are not the only sources of medical supplies; schools, universities, commercial drug stores, military bases, large companies, manufacturing sites, neighborhood clinics, etc., all maintain medical provisions. It makes sense for the state and local communities to identify such stores and prearrange distribution from nontraditional caches of medical supplies in the event of a catastrophe. Most people will survive an earthquake in relatively good physical shape, only to find a less pressing but no less threatening prospect facing them: thirst, hunger, exposure to the elements, and disease. As in most earthquakes, many deaths are not immediate, but rather come from the lack of proper health care and vital resources. This is where an oft-overlooked threat lies. Chen and coworkers list a number of lessons learned from the Sichuan earthquake. Perhaps the most important, synthesized from their article, is this: Most people will not have ready access to vital resources. With transportation and communications in disarray, many and perhaps most earthquake victims will be on their own for days, maybe weeks: no electricity, no running water, no gas, no shopping, no Internet, no hospital, and no pharmacy. The best advice to people is to be prepared to live outdoors for 2 weeks. Think tents, sleeping bags, flashlights, dried/canned food, small stove, pots and pans, medicine, hats, gloves, etc. Water, especially potable water, is by far the most important resource after an earthquake. Water is required for drinking, food preparation, wound dressing, and personal hygiene. This also means having pots and fuel for boiling contaminated water. By caching emergency supplies of water, both on an individual and state level, and installing proven and regularly tested communications, transportation and triage systems, the effects of earthquakes and other widely distributed natural disasters can be minimized. A growing world population means there are more people in harm's way. The 1857 magnitude 7.9 Ft. Tejon earthquake in California killed only 2 people. Today, it would be many times this number. In 1994, 72 people died in the 6.7 magnitude Northridge (California) earthquake. The same magnitude quake in Bam, Iran, in 2003 killed more than 26,000 because most structures were unreinforced mud dwellings that collapsed. The difference was building codes. California has construction requirements that explicitly address earthquakes. Building codes save lives. However, both in the third world and in some old and poor parts of the United States, such codes are either ignored or not enforced. Earthquakes are most-sudden and unpredictable natural events that cause human suffering on a regional scale, but they are not the only ones. Hurricanes, blizzards, and volcanic eruptions spread devastation over large areas, although there are usually a few days' warning for these. Here again, preparedness is the key. And as with earthquakes, clean water is probably the most crucial to good health over periods of days and weeks. Although the states and federal government have plans and resources for mitigating disasters, at some level they also recognize the futility in protecting every citizen. Indeed, California's firefighters have begun quietly telling people not to depend on them to save their lives and homes in wildfires. By shifting the burden of protection to the individual homeowners, California is telling its people, “We'll do the best we can, but it may very well be you who saves your house and your life, not us. Plan ahead!” This is good advice, and it applies most directly to earthquakes. Earthquakes come with no warning. People and the medical community in seismic zones must be ready at all times. Additional information about earthquake preparedness can be found in Table 1.Table 1: Web Sites for More Information About Earthquake PreparednessForewarned is forearmed. Plan ahead!
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