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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.

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Sichuan earthquake 2008

Sichuan Earthquake 2008

Personal Experience and Afterthoughts

Dr. Poon Tak Lun



Geology
Geology

  • Plate tectonics:

    • India plate converging towards Eurasian plate

    • Uplifting of Tibetan plateau

    • Crushing against Sichuan basin




Complex geology
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
Historical events

  • Since 1973, one major earthquake every 5 years


The tremor and the fault
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



The expedition
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
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
Our Medical Team

  • One A&E doctor

  • 2 surgeons

  • 1 orthopaedic surgeon

  • 1 nurse

  • 1 liaison officer


Preparation of the mission
Preparation of the mission

  • Estimation

  • Nature

  • Duration

  • Service required materials

  • Staffing

  • Briefing

  • Transport

  • Personal requirements


Preparation according to nature of the mission
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
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
Duration of mission

  • At the time of briefing, this was unknown

  • We prepared for one week of work


Personal preparation
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 preparation1
Personal preparation

  • Travel documents

  • Professional license

  • Insurance

  • Arrangement of normal job and work and appointments etc


Psychological preparation
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
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
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
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
Changing scene

  • First day: many survivors rescued

  • Difficult transfer to hospital

  • Slightly more serious injuries

  • 4 ° C at night


Second day
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
Third day

  • Risks of flood

  • Rescue personnel were evacuated

  • Fewer and fewer survivors

  • Fewer and fewer escaping villagers


Fourth day
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Timing

  • Future 2 to 4 weeks


Future of help
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
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



Personal preparation of mission
Personal preparation of mission

  • Self assessment

  • Suitability

  • Capability

  • Preparedness always


Self assessment of suitability and capability
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




Risk assessment we may have to take risks
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
Taking risks

  • Be careful even when taking risks

  • When you are certain that you are prepared

  • Timely action


Flexibility
Flexibility

  • Environmental situations changing or not as what you have prepared

  • Limited resources


The mission1
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
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



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