Sichuan Earthquake 2008

Personal Experience and Afterthoughts

Dr. Poon Tak Lun

Location

Geology

• Plate tectonics:– India plate

converging towards Eurasian plate

– Uplifting of Tibetan plateau

– Crushing against Sichuan basin

• Longmenshan fault

• Thrust fault

Classification of faults

Complex geology

• Difference of 6000m altitude within 60 km

• Convergent plates moving at 50mm/yr

• Expected to have further major earthquakes in the future years

Historical events

• Since 1973, one major earthquake every 5 years

7.8 1 June 1786

7.0 10 June 1786

7.5 1816

7.5 1850

7.5 1933

6.0 1935

6.75 1955

7.5 1955

7.5 1955

7.9 1973

6.2 1975

7.2 1976

6.9 1981

6.0 1982

6.7 1982

6.0 2001

8.0 12 May 2008

The Tremor and the Fault

• Magnitude: 8.0

• Longmenshan Fault: a displacement of 9 meters along a fault 240 km long and 20 km deep

• Hard terrain, shallow centre, dense population, weak buildings

• Nearly 8000 aftershocks

• Many major ones were very destructive

The Expedition

• 12 May 2008 1428 hours: earthquake

• 13 May 2008 1400: notification and confirmation of team member availability

• 14 May 2008 1930: expected time of departure

The Mission

• Local Red Cross emergency medical team at Beichuan county entrance

• Taking care of escaping victims

• First aid, simple medical care, simple surgical care

• Escort to hospital

• Already exhausted after first 2 days

• Desperately needing relief personnel

Our Medical Team

• One A&E doctor

• 2 surgeons

• 1 orthopaedic surgeon

• 1 nurse

• 1 liaison officer

Preparation of the mission

• Estimation • Nature• Duration• Service required materials• Staffing• Briefing• Transport• Personal requirements

Preparation according to Nature of the mission

• Simple medical and surgical care

• Simple drugs

• Plenty of simple wound dressing sets and antiseptic fluids, surgical gloves, surgical masks (proved to be the most useful)

• Packaging within 1 hour

• Food and water

Staffing

• Formation of team

• Medical profession and specialty required for job

• At least someone must be well experienced and able to work independently

Duration of mission

• At the time of briefing, this was unknown

• We prepared for one week of work

Personal preparation

• Simple personal belongings: travel light

• Appropriate clothing and equipment

• Personal protection: according to expected situation of work

• Personal working equipments: stethoscope, headlights etc

• Certain level of risk taking

• Simple food and drink

Personal preparation

• Travel documents

• Professional license

• Insurance

• Arrangement of normal job and work and appointments etc

Psychological preparation

• What do you expect to see?

• What is your limit of tolerance?

• With experience you will become seasoned and able to lead your comrades along difficult missions

• Responsibility for oneself and team members

• Goal: to accomplish mission and return

Expectations before arrival

• Difficult travel: true, no confirmation of flights, long hours of road traffic, burst tire, final strip on foot, carrying all materials on shoulders

• Heavy casualties: true, but in a way not very heavy workload, a lot of victims were dead

• Sad scenes: true, and very true

• Arrival: last km on foot• No electricity• No mobile phone network• No hot water, difficult supply of hot meal• No bathing or toileting provisions• Sleeping on chairs in thunderstorm and

aftershocks• Started working immediately

15 – 19 May 2008

• Around 400 cases• Mainly superficial wounds from minor

lacerations, some of them infected• Dressing and suturing• Several fractures: humeral neck, distal radius

and hip, all old people• One CPR, unfortunately failed• Minor diarrhoea• Dehydration and heatstroke in rescue personnel• Escaping villagers would board buses to

Mianyang temporary shelter

Official rescue work

• Command centre at Beichuan Highschool

• Daily marching in of troops of rescuers and soldiers from Hunan, Liaoning, Beijing, Hainan etc

• Bulldozers, cranes and other equipments

• Army rescue medical centre: 2 tents, 5 beds, but not enough dressing sets or antiseptic fluids

Changing scene

• First day: many survivors rescued

• Difficult transfer to hospital

• Slightly more serious injuries

• 4 ° C at night

Second day

• Main road passable

• Ambulances going down to rubbles

• Escaping villages, dehydrated, hungry, minor wounds all over

• People going back to look for relatives and valuables

• Team was told to stay

Third day

• Risks of flood

• Rescue personnel were evacuated

• Fewer and fewer survivors

• Fewer and fewer escaping villagers

Fourth day• Thunderstorms and aftershock• All civilians evacuated• Few survivors expected, if at all• Main entrance blocked to all unofficial

personnel and volunteers• Our mission terminated at 165 hours after the

first shock• Rescue operations: also coming to a reluctant

halt

Difficulties and Dangers • Persistent rain, including thunderstorm• Aftershocks• Quake lakes and risks of floods• Over-saturated roads and vehicles• Scale of damage• No sanitation• Garbage and flies everywhere• Physical dangers: landslides, road blocks• Personal supplies or relief did not come

Work during the present few weeks

• Caring for displaced victims: shelter, food, clean water, sanitation, schooling

• Caring for the injured and sick: medical and surgical care in hospital, outpatient clinics

Statistics as of today

• Death toll: > 69,000

• Missing: 20,000

• Injured: 360,000

• Diverted to many provinces now

How should we evaluate our mission?

• Caring for 400 minor injuries out of 360,000?

• Have we altered the outcome?

Have we altered the outcome?

• Sichuan Red Cross personnel desperately in need of relief when we arrived

• Victims with minor injuries were basically ignored: had we not been there

• Symbol of warmth and care from Hong Kong

• We should have been there one day earlier

Our efforts will be felt in the future

• The scale is large

• The nation is capable

• But Hong Kong is part of the nation

• Chengdu could be doing well

• But how about Mianyang, Mianzhu and all affected places at county level?

• How about Guiyang? Gansu?

Our efforts in the future

• Social rehabilitation

• Rebuilding of hospitals

• Mainly at county level, where the local resources are not adequate

Next phase of help

• Rehabilitation

• Rebuilding and refurbishing of hospitals

• Environmental health and sanitation

• Social rehabilitation

• When the towns are re-inhabited, everything will start from zero

Our expertise

• Medical and health aspects

• Amputees, spinal cord injuries and related rehabilitation

• Assessment (?7500 amputees, 800 paralysis)

• Psychological rehabilitation

• Primary health care

• Physicians, paediatricians, O&G

How shall we start?

• Mandate• Timing• Manpower recruitment• Major working parties: coordination• Identifying a hard hit county to station

resources from Hong Kong?

The Future: at least a decade of work

• Medical and health aspects

• Education

• Rebuilding towns and villages, re-inhabiting them

• New communes

• New and better

constructed houses

Participating parties

• Hong Kong Government• The HA• Hong Kong Red Cross• Hong Kong Rehab Society• HKMA• HKAM, universities, other professional

charity bodies• Coordination by Chinese Government

Planned work

• Mobile medical teams for primary health care, based at county level hospitals

• County level hospitals

• Rehabilitation of amputees and spinal cord injuries in special rehabilitation centres

• Health related work: sanitation, disease prevention

• Non-health related work

Timing

• Future 2 to 4 weeks

Future of help

• Rehabilitation will continue for several years

• Mobile medical units may continue until local doctors fully taking over (1 to 2 years) (depending on infrastructure)

• Long term preparedness

Role and capacity of the Hong Kong Medical Profession

• Are we going to incorporate national disaster emergency aid into functions of the HA?

• Tax-payers’ money or donation money?• Criteria of help?• Vetting?• Role of individual doctors: joining the HA

preparedness team or other charity bodies as volunteers?

• Mandate from the Ministry of Health

• Medical care

• Medical ERUs– Medical equipment and drugs– Storage warehouses

• Enrollment of doctors into scheme

• Special training

• Cooperation with major parties

General advice to would be volunteers

Personal preparation of mission

• Self assessment

• Suitability

• Capability

• Preparedness always

Self assessment ofsuitability and capability

• Uphold your principles at all times

• Teamwork: always a member of the team

• Able to work independently

• Tolerance of long working hours

• Surviving without luxurious items

• Tolerance of adverse conditions

• Able to take care of one’s own safety and health

• Professional and non-professional skills and licenses

• Sound and logical mind always

• Vaccination

• Language abilities

• Preparedness

• Look for personal glamour elsewhere

• Look for thrill elsewhere

• Here: it is all (hard) work, our aim is to improve the present situation of those who need us

Risk assessment: we may have to take risks

• Logical assessment: (situation, yourself, reaction with time)– what needs to be done?– how you can do it?– What are the odds of success?– What are the odds of danger to yourself?– Are you doing it yourself or in a team?– Is there a more experienced member?– How long the operation will take?– Necessary personal protection and equipment

Taking risks

• Be careful even when taking risks

• When you are certain that you are prepared

Timely action

Flexibility

• Environmental situations changing or not as what you have prepared

• Limited resources

The mission

• When you are called, understand your task

• Understand your capability

• Understand your limitations

• Briefing and discussions

• Continuous monitoring and assessment

For the more experienced

• Role of team leader or section leader

• Responsibility rather than power

• Accountability

• Interpersonal and communication skills

• Note the limitations or unwanted behaviors of your members and intervene appropriately

Thank you for your attention