Original research BMJ Glob Health: first published as 10.1136/bmjgh-2020-002398 on 16 December 2020. Downloaded from Search without rescue? Evaluating the international search and rescue response to earthquake disasters 1 2,3 Anna Rom , Ilan Kelman To cite: Rom A, Kelman I. ABSTRACT Key questions Search without rescue? Earthquakes around the world are unnecessarily lethal Evaluating the international and destructive, adversely affecting the health and well- search and rescue response What is already known? being of affected populations. Most immediate deaths and to earthquake disasters. ► The most common cause of earthquake- related injuries are caused by building collapse, making search BMJ Global Health casualties is building collapse, making early search and rescue (SAR) an early priority. In this review, we 2020;5:e002398. doi:10.1136/ and rescue a priority. bmjgh-2020-002398 assess the SAR response to earthquake disasters. First, ► There is often a lot of media and public interest in we review the evidence for the majority of individuals international search and rescue operations following being rescued locally, often by relatives and neighbours. Handling editor Eduardo earthquake disasters. Gómez We then summarise evidence for successful live rescues ► The majority of search and rescue is carried out lo- by international SAR (ISAR) teams, along with the costs, ► Additional material is cally in the immediate aftermath of earthquakes. published online only. To view ethics and other considerations of deployment. Finally, we please visit the journal online propose an alternative approach to postdisaster ISAR, with What are the new findings? (http:// dx. doi. org/ 10. 1136/ the goal of reducing overall morbidity and mortality. ► International search and rescue teams arrive too late bmjgh- 2020- 002398). to make a significant contribution to lives saved. ► International search and rescue is expensive in com- parison to training and preparing locals. Received 18 February 2020 Revised 13 September 2020 What do the new findings imply? INTRODUCTION Accepted 11 November 2020 ► Investing in equipping and training local teams in In the last 20 years, earthquakes have affected high risk, vulnerable earthquake- prone areas may 125 million people, leading to around 750 save more lives. 1 2 000 deaths. The threat from earthquakes ► Further research is needed to evaluate how best to disproportionately affects poorer countries, deliver such training and who best to receive it. http://gh.bmj.com/ where lack of building standards and ineffec- tive response infrastructure often coexist.3 The most common cause of earthquake- The results were chaotic, with different 4–6 related casualties is building collapse. teams arguing over how to perform rescues, Search and rescue (SAR) is therefore an time wasted repeatedly searching the same immediate priority. SAR is defined as the loca- buildings and overall poor coordination.10 on September 29, 2021 by guest. Protected copyright. tion and extraction of trapped individuals, Following a repeat of these issues after the either informally by relatives and neighbours 1988 earthquake in Armenia,9 11 attempts or formally by professional local or intentional were made to harmonise international efforts, © Author(s) (or their teams. As some countries lack professional resulting in the 1991 formation of the Inter- employer(s)) 2020. Re- use teams, or adequate capacity, international permitted under CC BY-NC. No national Search and Rescue Advisory Group commercial re- use. See rights SAR (ISAR) teams frequently respond. (INSARAG), a global network of countries and permissions. Published by Prior to 1985, earthquake ISAR teams did and organisations dealing with SAR related BMJ. not formally exist, with ad hoc response from issues, operating under the UN’s umbrella.12 1 7 UCL Institute for Global Health, international specialists to some events. Its main aim, and one of its key successes, London, UK After the 1985 earthquake in Mexico City, 2UCL Institute for Global Health has been establishing regularly reviewed, and UCL Institute for Risk and the combination of collapse of multiple rein- minimum international standards and guide- 13 Disaster Reduction, London, UK forced concrete buildings, and the advent of lines for SAR. In 2002, a UN resolution 3University of Agder, 24-hour news beaming pictures of the devas- was adopted endorsing INSARAG and estab- Kristiansand, Norway tation around the world, led to several SAR lishing international consensus on the need 14 Correspondence to teams, usually only operating domestically in for ISAR teams in postdisaster response. Prof Ilan Kelman; their home counties, deploying internation- Since 2005, INSARAG has developed a 8 9 ilan_ kelman@ hotmail. com ally. classification system, INSARAG External Rom A, Kelman I. BMJ Global Health 2020;5:e002398. doi:10.1136/bmjgh-2020-002398 1 BMJ Global Health BMJ Glob Health: first published as 10.1136/bmjgh-2020-002398 on 16 December 2020. Downloaded from Classification (IEC), designating teams as ‘medium’ or Patient and public involvement ‘heavy’ such that their capabilities can be established It was not appropriate or possible to involve patients or before deployment.15 the public in this type of study. Earthquakes have a significant impact on global health and development. While richer countries tend to expe- Evidence for local rescue rience higher costs due to damage to infrastructure of Table 1 presents a review of 13 studies covering assess- higher financial value, poorer countries have so far typi- 16 ment of local SAR response for specific earthquakes. cally had higher mortality. Poverty affects the ability to These studies conclude that extrication of trapped indi- recover; for example, an earning family member’s death, viduals was performed by relatives, neighbours and local destruction of property or livelihood interruption pushes inhabitants in 60%–100% of cases described. people further into poverty and sets back overall devel- 17 There are limitations to these data, such as its retro- opment by years. This widens socioeconomic and other spective collection, sometimes with significant delays23 24; inequities, delaying progress in reducing health inequal- 18 use of hospital records which are noted to be incom- ities in affected populations. plete,25 and will also fail to capture data from people The populations threatened by earthquake disas- who may be injured or die but never make it to hospital; ters are increasing, largely due to population growth anecdotal evidence where no systematic approach has and infrastructure development without seismic safety 26 2 19 been described for who was selected to take part ; and measures. Rapid construction of often multistorey a lack of data from more recent events. These studies buildings result in higher building density and occu- do not provide figures for the actual number of people pancy,20 increasing potential earthquake disaster 21 trapped or rescued, or taking part in rescue operations. impacts. The reasons why some buildings are more Despite these limitations, the reproducibility of findings likely to collapse than others are complex, but ultimately in different events, along with expert consensus from are often due to inadequate building standards or lack field experience articulated in the citations, supports of enforcement of them, due to a failure to invest in the conclusion of most postearthquake rescues being standards and enforcement, alongside officials and the conducted by local people. building industry ignoring any standards and protocols for financial gain.22 This inherent corruption further sets back overall development and proliferates the ongoing ISAR live rescues need for ISAR. Table 2 summarises ISAR contributions to lives saved ISAR effectiveness has not been previously system- in 14 earthquake disasters for 1985–2015. The highest atically reviewed, so this paper assesses ISAR response number of live rescues by ISAR teams was 144 in Turkey, with Haiti second at 134 (range 132–136; see figure 1). to earthquake disasters and its contribution to saving 27 28 lives, by reviewing literature and other evidence from Two post- Haiti agency reviews, also reported these as past earthquake ISAR response, using the number of the highest figures. people extricated from rubble alive as a direct measure When taking into account the estimated death toll http://gh.bmj.com/ of success. We also explore the evidence for local rescue for each event, only Pakistan has a lower value for ‘live after earthquakes, usually by relatives and neighbours, rescues as a percentage of deaths’ than Haiti (aside from and costs involved in international response. Finally, we two events with no live rescues); however, the Turkey propose alternatives to postearthquake ISAR, focusing earthquake still has the highest figure for both ‘live on pre- disaster risk reduction (DRR) and local capacity rescues’ and ‘live rescues as a percentage of deaths’. All building. earthquakes reviewed have an ISAR ‘live rescues as a on September 29, 2021 by guest. Protected copyright. percentage of deaths’ under 0.85% (see figure 2). The lowest number of rescues occurred in Indonesia 2009 and Japan 2011, with no live rescues noted.29 30 For METHODS the Japan earthquake, most deaths were reportedly a Data for this review were identified by searches of Web result of the subsequent tsunami, rather than earthquake- of Science, Scopus, Embase, Geobase, Georef and associated building collapse, which was said to