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Never ending trouble of humanity. When The Earthquake Hits How We Can Survive In Poor Constructed Buildings? Suggestions Concerning Reduction of Mortality.

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Presentation on theme: "Never ending trouble of humanity. When The Earthquake Hits How We Can Survive In Poor Constructed Buildings? Suggestions Concerning Reduction of Mortality."— Presentation transcript:

1 Never ending trouble of humanity

2 When The Earthquake Hits How We Can Survive In Poor Constructed Buildings? Suggestions Concerning Reduction of Mortality and Morbidity M.Ferudun ÇELIKMEN¹, Kurtulus ACIKSARI², Sezgin SARIKAYA¹, Derya ABUSKA 3, Pınar TURA¹, Ali KANDEMİR¹, Halil DOGAN 4, Mustafa YAZICIOGLU 4, D. Niyazi OZUCELIK 5. ¹ İstanbul Yeditepe University, Faculty of Medicine, Emergency Medicine Department, İstanbul 2 İstanbul Bilim University, Faculty of Medicine, Emergency Medicine Department, İstanbul 3 Emergency and Disaster Medical Services, Health Directorate of İstanbul, İstanbul 4 Bakirkoy Dr. Sadi Konuk Research and Training Hospital, Emergency Medicine Department, Istanbul 5 İstanbul University Faculty of Health Sciences, İstanbul ²

3 Introduction Main survival factors in the post-disaster period are prevention from injuries as well as detecting the location of the survivors and the rescued. The reality of the situation of persons who lost their lives in such traps, the severely injured, and the ones who survived must be analyzed. Main survival factors in the post-disaster period are prevention from injuries as well as detecting the location of the survivors and the rescued. The reality of the situation of persons who lost their lives in such traps, the severely injured, and the ones who survived must be analyzed. Rational prevention methods against possible crush injuries due to collapsing buildings have been considered in the light of the field and simulation experience we gained and suggestions have been presented to reduce mortality and morbidity. Our work has been conducted with the aid of medicine based on proof, appropriate observation as well as sampling and experimental methods. Rational prevention methods against possible crush injuries due to collapsing buildings have been considered in the light of the field and simulation experience we gained and suggestions have been presented to reduce mortality and morbidity. Our work has been conducted with the aid of medicine based on proof, appropriate observation as well as sampling and experimental methods.

4 Aim Action plans of developed countries with higher building standards, which construct buildings that would not collapse in case of earthquakes and similar disasters, have been adopted one to one by underdeveloped and developing countries without questioning against what and why these should be applied. Action plans of developed countries with higher building standards, which construct buildings that would not collapse in case of earthquakes and similar disasters, have been adopted one to one by underdeveloped and developing countries without questioning against what and why these should be applied. A global approach concerning worst case scenario led by earthquakes has been proposed taking into consideration the different models of behavior in different countries and societies to increase the chance of survival to a maximum and to reduce injuries to a minimum level. Due to unlimited possibilities of travelling nowadays, it is not possible to estimate the place, the country or the circumstances under which a person could experience a disaster. A global approach concerning worst case scenario led by earthquakes has been proposed taking into consideration the different models of behavior in different countries and societies to increase the chance of survival to a maximum and to reduce injuries to a minimum level. Due to unlimited possibilities of travelling nowadays, it is not possible to estimate the place, the country or the circumstances under which a person could experience a disaster.

5 Materials and Methods 1 Moreover the situation and location of the rescued persons and the survivors during and after the disaster have been analysed by search and rescue teams in the between years in Turkey and other countries of the world dealing with mass disasters led by earthquakes which result in crush injuries Moreover the situation and location of the rescued persons and the survivors during and after the disaster have been analysed by search and rescue teams in the between years in Turkey and other countries of the world dealing with mass disasters led by earthquakes which result in crush injuries On site

6 Earthquakes in the previous years in Turkey and other countries, where we personally joined the post-disaster search and rescue operations, their magnitudes and figures of casualties are shown Date Date Time TimeLocationMagnitu.Mortality Morbidity Rescued :18 19:18 Erzincan Erzincan R:6.8 R: :57 17:57 Dinar Dinar R:6.1 R: :02 03:02 Marmara Marmara R:7.4 R: :56 14:56 Athens Athens R:5.9 R: :47 17:47 Taiwan Taiwan R:7.6 R: :48 18:48 Düzce Düzce R:7.2 R: TOTAL TOTAL

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9 One of their approaches was to involve schools. Teachers in selected cities were encouraged to conduct air raid drills where they would suddenly yell, "Drop!" and students were expected to kneel down under their desks with their hands clutched around their heads and necks. Some schools even distributed metal "dog tags," like those worn by World War II soldiers, so that the bodies of students could be identified after an attack. One of their approaches was to involve schools. Teachers in selected cities were encouraged to conduct air raid drills where they would suddenly yell, "Drop!" and students were expected to kneel down under their desks with their hands clutched around their heads and necks. Some schools even distributed metal "dog tags," like those worn by World War II soldiers, so that the bodies of students could be identified after an attack.

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11 The advice to "duck and cover" holds well in many situations where structural destabilization or debris may be expected, such as during an earthquake or tornado. At a sufficient distance from a nuclear explosion, the blast wave would produce similar results and ducking and covering would perhaps prove.earthquake tornadonuclear explosion blast wave

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13 Ducking and covering would also reduce exposure to the gamma rays. Since they are mostly emitted in a straight line, people on the ground will have more chance to have obstacles such as building foundations, cars, etc. between them and the source of radiation. The technique offers a small protection against fallout—people standing up could receive a large, possibly lethal, dose of radiation, while people protected will receive less of it. Ducking and covering would also reduce exposure to the gamma rays. Since they are mostly emitted in a straight line, people on the ground will have more chance to have obstacles such as building foundations, cars, etc. between them and the source of radiation. The technique offers a small protection against fallout—people standing up could receive a large, possibly lethal, dose of radiation, while people protected will receive less of it. fallout

14 Duck and Cover!..

15 Drop, Cover and Hold On!.. It is after all, a first response countermeasure only. In much the same way that 'Drop, Cover and Hold On' is during an earthquake, with the advice having little utility once the earthquake has passed, and possibly other looming dangers like a tsunami may be approaching. It is after all, a first response countermeasure only. In much the same way that 'Drop, Cover and Hold On' is during an earthquake, with the advice having little utility once the earthquake has passed, and possibly other looming dangers like a tsunami may be approaching.tsunami

16 This victim who died perhaps could have still been alive if he had taken the fetus position in the same gap with a sufficient height. This victim perhaps could have still been alive if he had taken the fetus position in the same gap with a sufficient height.

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18 Floor and ceiling even get close allow some space to survive if you get proper position..

19 Materials and Methods 2 Simulation

20 Simulation As the rubble was removed and approaching tunnels were established, the assessment of the damage on the dummies showed that the ones placed (horizontally) prone,supine position or kneeling were completely crushed. Only 2 of the dummies reduced in size by folding the extremities (imitated fetal posture) and placed in a horizontal side position between beds full of books underneath and desks in cage construction showed crush injuries on leg pieces after being hurled; others did not show any damage. As the rubble was removed and approaching tunnels were established, the assessment of the damage on the dummies showed that the ones placed (horizontally) prone,supine position or kneeling were completely crushed. Only 2 of the dummies reduced in size by folding the extremities (imitated fetal posture) and placed in a horizontal side position between beds full of books underneath and desks in cage construction showed crush injuries on leg pieces after being hurled; others did not show any damage.

21 Discussion Main aim of the prevention from crush injuries must be minimising the risk of injuries while maximizing the chance of survival. This can be achieved by reducing injury targets as much as possible. Main aim of the prevention from crush injuries must be minimising the risk of injuries while maximizing the chance of survival. This can be achieved by reducing injury targets as much as possible. The main factor decreasing the rate of mortality and morbidity in massive disasters such as earthquakes is clearly the construction of robust buildings on safe ground. However the last chance in every situation should be exploited by doing the proper action within seconds. The main factor decreasing the rate of mortality and morbidity in massive disasters such as earthquakes is clearly the construction of robust buildings on safe ground. However the last chance in every situation should be exploited by doing the proper action within seconds.

22 lying down in the fetus position next to the relatively safety places Lying down in the fetus position next to the relatively safety places Households,furnitures that can be crushed but not completely destroyed Lying down on the ground beside the cars also increase survival chance

23 Fetus position..Minimise targeting.. You need only one bottle of water and cellphone! (usually both should be with you even in the night time…)

24 Results Individual emergency action plans of developed countries with much higher urbanisation and building standards which construct buildings that would not collapse in case of earthquakes and similar disasters comprise more the cases caused by smashing objects rather than collapsing buildings. These plans are adopted one to one by countries with lower standards. Individual emergency action plans of developed countries with much higher urbanisation and building standards which construct buildings that would not collapse in case of earthquakes and similar disasters comprise more the cases caused by smashing objects rather than collapsing buildings. These plans are adopted one to one by countries with lower standards.

25 Results Action plans concerning disasters such as earthquakes recommended by relevant authorities of developed countries such as USA and Japan comprise more an approach to the protection of individuals from smashing objects during an earthquake such as going under a table, rather than the prevention from crush injuries. Action plans concerning disasters such as earthquakes recommended by relevant authorities of developed countries such as USA and Japan comprise more an approach to the protection of individuals from smashing objects during an earthquake such as going under a table, rather than the prevention from crush injuries. It is bitter reality that an earthquake of the same magnitude and duration causing nearly no casualties in developed countries can lead to thousands of deaths and physical disabilities due to crush injuries in underdeveloped countries. It is bitter reality that an earthquake of the same magnitude and duration causing nearly no casualties in developed countries can lead to thousands of deaths and physical disabilities due to crush injuries in underdeveloped countries.

26 Suggestions 1 Minimizing target as much as possible by staying in the fetus position in possible gaps formed by horizontal layers, between vertical elements of the building, next to furniture that can be crushed but not completely destroyed is a fact observed by many rescued or surviving persons. Dummies that were made compact show the least damage. Minimizing target as much as possible by staying in the fetus position in possible gaps formed by horizontal layers, between vertical elements of the building, next to furniture that can be crushed but not completely destroyed is a fact observed by many rescued or surviving persons. Dummies that were made compact show the least damage.

27 Suggestions 2 Being under rubble combined with winter conditions while waiting to be rescued can lead to hypothermia which can also be lethal. Being under rubble combined with winter conditions while waiting to be rescued can lead to hypothermia which can also be lethal. The best prevention against hypothermia is again minimizing the body surface as much as possible and taking the fetus position. The best prevention against hypothermia is again minimizing the body surface as much as possible and taking the fetus position. This position just like the recovery position will help to avoid lethal situations such as asphyxia secondary to the aspiration which can occur due to the loss of consciousness in case of lying for a long period of time. This position just like the recovery position will help to avoid lethal situations such as asphyxia secondary to the aspiration which can occur due to the loss of consciousness in case of lying for a long period of time.

28 Suggestions 3 The best method of staying alive with the basal metabolic rate is to be in a permanent state of sleeping. Many mammals manage to sleep in the fetus position for months during the winter without supplying any nutrition or liquid to their body (hibernation). The best method of staying alive with the basal metabolic rate is to be in a permanent state of sleeping. Many mammals manage to sleep in the fetus position for months during the winter without supplying any nutrition or liquid to their body (hibernation). In case of collapsing buildings the first fatal blow will be on the head and neck region if the ‘drop, cover and hold on’ kneeling position is taken. In case of collapsing buildings the first fatal blow will be on the head and neck region if the ‘drop, cover and hold on’ kneeling position is taken.

29 Suggestions 4 A survival gap for the fetal posture must be at least hip height, i.e. an average height of 40 cm would be sufficient. The height required for the ‘drop, cover and hold on’ position is minimum twice as much.This height of approximately 1m is even more than the thickness of carrier elements such as columns and beams which help to form survival gaps between horizontal layers in case of ‘pancake’. A survival gap for the fetal posture must be at least hip height, i.e. an average height of 40 cm would be sufficient. The height required for the ‘drop, cover and hold on’ position is minimum twice as much.This height of approximately 1m is even more than the thickness of carrier elements such as columns and beams which help to form survival gaps between horizontal layers in case of ‘pancake’.

30 Suggestions 5 Staying in kneeling position for a long time makes it impossible to stay alive exposing the lower extremities to pressure as well as due to the congestion in thoracic and splanchnic areas whereas in the fetus position, just as in the recovery position, the functions of cardiac and respiratory system can be preserved for a longer time. Staying in kneeling position for a long time makes it impossible to stay alive exposing the lower extremities to pressure as well as due to the congestion in thoracic and splanchnic areas whereas in the fetus position, just as in the recovery position, the functions of cardiac and respiratory system can be preserved for a longer time.

31 Suggestions 6 Early access of the rescued with crush injuries to dialysis is the most significant medical approach concerning mortality and morbidity. Another very important survival factor before the dialysis is maintaining the function of kidneys while waiting for rescue. It is quite obvious that the protection of at least one kidney can be achieved in the embryonic position between horizontal elements of less than 40 – 50 cm height compared to a face down or up horizontal position. Early access of the rescued with crush injuries to dialysis is the most significant medical approach concerning mortality and morbidity. Another very important survival factor before the dialysis is maintaining the function of kidneys while waiting for rescue. It is quite obvious that the protection of at least one kidney can be achieved in the embryonic position between horizontal elements of less than 40 – 50 cm height compared to a face down or up horizontal position.

32 Suggestions 7 Staying in the compact fetus side position with knees pulled towards the abdomen, the rubble can be pushed by hands and feet to expand the necessary survival gap. Staying in the compact fetus side position with knees pulled towards the abdomen, the rubble can be pushed by hands and feet to expand the necessary survival gap. It is obvious that for persons living in high rise buildings objects such as tables, chairs with small surfaces and contact with the floor are not stable and change position easily in earthquakes with high magnitudes. Looking for protection under such objects is not much different than expecting shelter from an umbrella during a severe storm. It is obvious that for persons living in high rise buildings objects such as tables, chairs with small surfaces and contact with the floor are not stable and change position easily in earthquakes with high magnitudes. Looking for protection under such objects is not much different than expecting shelter from an umbrella during a severe storm.

33 Suggestions 8 The priority in search and rescue operations in case of ‘pancake’ buildings is to look for survivors in bulging areas. In 284 cases survivors rescued by our SAR teams in search and rescue operations in Turkey and other countries until now (personal participation in 138 cases with SAR activities) we can see persons who survived due to fetus or similar positions rescued from these confined spaces. The priority in search and rescue operations in case of ‘pancake’ buildings is to look for survivors in bulging areas. In 284 cases survivors rescued by our SAR teams in search and rescue operations in Turkey and other countries until now (personal participation in 138 cases with SAR activities) we can see persons who survived due to fetus or similar positions rescued from these confined spaces.

34 Suggestions 9 Asphyxia is one of the mortality reasons for those under rubble.In the horizontal side position it is possible to protect the mouth and the nose from rubble by using the underarms and hands and in this way to expand the respiratory area. Asphyxia is one of the mortality reasons for those under rubble.In the horizontal side position it is possible to protect the mouth and the nose from rubble by using the underarms and hands and in this way to expand the respiratory area.

35 Suggestions 10 It is of great importance to protect the upper and lower extremities in case of long lasting rescue operations to lift the rubble and get the survivors out.To prevent a crush syndrome the ıv lines must be establish as soon as the rescuers find the survivors using cheap, potassium-free, easily accessible fluids such as saline solutions to stabilize the positive liquid balance. It is of great importance to protect the upper and lower extremities in case of long lasting rescue operations to lift the rubble and get the survivors out.To prevent a crush syndrome the ıv lines must be establish as soon as the rescuers find the survivors using cheap, potassium-free, easily accessible fluids such as saline solutions to stabilize the positive liquid balance. The fetus position with its compact state increases the chance of protecting extremities. The fetus position with its compact state increases the chance of protecting extremities.

36 Developing and undeveloped countries main eartquake problem is totally collapsed buildings secondary to the poor construction and mis choosen landscape for erecting buildings!

37 Dozens of myths Dozens of myths

38 If indoors If indoors DROP to the ground; take COVER by getting under a sturdy table or other piece of furniture; and HOLD ON until the shaking stops. If there isn’t a table or desk near you, cover your face and head with your arms and crouch in an inside corner of the building. DROP to the ground; take COVER by getting under a sturdy table or other piece of furniture; and HOLD ON until the shaking stops. If there isn’t a table or desk near you, cover your face and head with your arms and crouch in an inside corner of the building. Stay away from glass, windows, outside doors and walls, and anything that could fall, such as lighting fixtures or furniture. Stay away from glass, windows, outside doors and walls, and anything that could fall, such as lighting fixtures or furniture. Stay in bed if you are there when the earthquake strikes. Hold on and protect your head with a pillow, unless you are under a heavy light fixture that could fall. In that case, move to the nearest safe place!!!? Stay in bed if you are there when the earthquake strikes. Hold on and protect your head with a pillow, unless you are under a heavy light fixture that could fall. In that case, move to the nearest safe place!!!?

39 Stay in bed if you are there when the earthquake strikes. Hold on and protect your head with a pillow, unless you are under a heavy light fixture that could fall !!!!!…

40 Stay in bed!!…… Hold on and protect your head with a pillow!!.

41 Earhquake packs!! Earhquake packs!! Another mit..Time elapsing for survive.. Another mit..Time elapsing for survive.. Originally coming from subway culture of London bombing and adopted during cold war! Originally coming from subway culture of London bombing and adopted during cold war! There is enough food etc if you can survive,even in the poorist country! There is enough food etc if you can survive,even in the poorist country!

42 Shelter paranoia!! Consider These Products when Preparing for an Earthquake Deluxe Emergency Backpack Kit (4 Person) Price: $ $ Deluxe Emergency Bucket Kit (4 Person) Price: $ $ Emergency Preparedness Fanny Pack Kit (3 Day) Price: $36.99 $27.99 Long Term Storage Emergency Food Servings (1 Month) Price: $ $ Base Camp 2-Way Radio with Emergency Crank Power Price: $ $99.99

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44 There is nothing comparable with the saving lives


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