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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
slide6
Longmenshan fault
  • Thrust fault
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
slide15
Nearly 8000 aftershocks
  • Many major ones were very destructive
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
slide35
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?
slide62
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
slide66
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
slide67
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
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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