Death in earthquake: Experts say it’s not just the tremor

Photo: Jerome Cristobal

MANILA, Philippines – Earthquakes – which can lead to earth shaking, soil liquefaction, landslides, fissures, avalanches, fires, tsunamis, and other devastation – killed 750,000 people globally from 1998 to 2017, According to the World Health Organization.

The World Health Organization described earthquakes, which can strike suddenly and without warning, as “a violent and sudden shaking of the Earth, caused by movement between tectonic plates along a fault line in the Earth’s crust.”

The World Health Organization said that deaths from earthquakes in the past decade accounted for nearly 60 percent of all disaster-related deaths worldwide.

Graphic: Christina Eloisa Buckleigh

While the extent of devastation and damage caused by an earthquake depends on factors such as size, intensity, duration, and much more, the data showed that apart from deaths, the natural disaster affected 125 million people worldwide between 1998 and 2017.

This means that affected individuals are “injured, homeless, displaced or evacuated during the emergency phase of the disaster”.

Ten of the most powerful earthquakes to hit the Philippines in recent years – their magnitudes ranged from 6.1 to 7.8 – killed more than 11,000 people – the deadliest being the 1976 Moro Bay earthquake and tsunami that killed 8,000 people.

Read: List: Deadly earthquakes in the Philippines

However, studies have shown that ground vibrations during earthquakes are rarely the direct cause of death or injury. Most earthquake-related deaths and injuries result from collapsing walls, flying glass, and falling objects due to ground shaking.

Some studies have also found that certain medical conditions and the risk of disease outbreaks after an earthquake can increase the number of deaths or injuries.

Distinguish between earthquake-related deaths

Reports of earthquake-related death and injury rates vary. However, several studies have previously indicated that the ratio is approximately 1:3, with many victims dying on the spot.

Several studies – based on medical records following various earthquakes around the world – have found that most deaths in earthquakes were due to damage to buildings, including structural collapse of buildings and infrastructure and falling debris from damaged buildings.

Researchers Sodia Bartholdson and Johan von Schreeb write in a study titled “Natural Damage Disasters and Injuries: What Does a Surgeon Need to Know?”

The injuries caused by damage to infrastructure – caused by earthquakes – that ultimately lead to death are crush injuries and other injuries.

Graphic: Christina Eloisa Buckleigh

Encyclopedia Britannica defines a crush injury as “any of the effects of body stress, which results from collapse of buildings, mine disasters, earthquakes, and caverns.”

Following findings from various studies on earthquake-related deaths, Encyclopedia Britannica also reported that crush victims – especially those with serious chest and abdominal injuries – usually die before help arrives.

“Limb injuries may not immediately appear serious, although underlying symptoms often appear.”

Similarly, crush victims experience disseminated intravascular coagulation, sepsis, adult respiratory distress syndrome, and death.

Bartholdson and Schreib also found that the start time affects the number of dead.

“Earthquakes cause damage to infrastructure, damage to health facilities, and disrupt transportation. This can cause injuries and deaths, but also restrict rescue efforts and increase the vulnerability of the affected population,” the researchers said.

Meanwhile, among the most common causes of earthquake-related deaths – including instant deaths – are severe trauma with head injury, suffocation or hypoxia, and shock.

During the 1999 earthquake in Taiwan, 30 percent of people died from head injuries.

Causes of earthquake injuries

According to Burke and co-researchers, the “vast majority” of health problems related to earthquakes recorded globally are injuries – specifically, “injuries to soft tissue and bone resulting from falls and collisions with non-skeletal items (such as furniture, decorations, and light bulbs).”

They pointed out that the majority of these injuries are considered minor and do not require hospitalization.

In the study “Earthquake-related injuries among survivors: a systematic review and quantitative synthesis of the literature,” researchers provided additional data on how common these earthquake-related injuries are.

The study analyzed 74 research articles on earthquake-related injuries from China as well as from other countries published over the past 50 years.

“In this analysis, fractures, soft tissues, and crush injuries were the three most common and most common types of injury. The extremities and head/neck were the most common and sites of injury mentioned,” the researchers said.

Of the total earthquake-related injuries they collected from 74 research articles, fractures were the most common, accounting for 48.47 percent.

Other earthquake-induced injuries also noted: “ranging from mild cuts and bruises to more serious conditions such as severe fractures, internal organ damage, crush syndrome and burns.”

Bartholdson and Schraib note that burn injuries during earthquakes are relatively rare. However, it is common when earthquakes occur in rural areas of low- and middle-income countries, “where basic cooking and heating methods are used”.

“Earthquakes that occur during common cooking times may also increase the incidence of scalding,” they added.

Graphic: Christina Eloisa Buckleigh

After the 7.0 magnitude earthquake that struck Haiti on January 12, 2010, the US Centers for Disease Control and Prevention (CDC) published a report of post-earthquake injuries treated at a field hospital.

The earthquake killed 222,570 people and injured 300,000, based on records from January 13 to May 28. A total of 1,369 individuals were accepted into the University of Miami Global Institute/Medishare Project (UMGI/PM).

Of the total admitted, 581 or 42 percent had injury-related diagnoses, of whom 346 or 60 percent required a surgical procedure. However, only 162-28 percent were identified as earthquake-related injuries.

“Earthquake-related injuries were defined as diagnoses for which the medical record was 1) the date of injury on January 12, 2010, 2) recorded in the medical record that the injury was associated with the earthquake, or 3) a reasonable mechanism described consistent with an earthquake-caused injury” The report explained.

The data showed that the most common diagnoses for those injured by earthquake were fractures or dislocations and wound infection or abscess – accounting for 88 cases (54.3 percent) and 60 cases (37 percent), respectively.

The injuries were severe, too. 41 cases accounted for 25.3 percent.

The CDC report confirmed that a patient may have more than one diagnosis.

The report also recorded the various mechanisms of injury (Ministry of Interior) or the manner in which the bodily injury occurred.

Among the earthquake-related injury patients, the majority of injuries had an unknown injury mechanism. Meanwhile, most patients experienced cuts, punctures, or blows to their skin or organs.

Many patients with earthquake injuries had to have one or more surgeries. Most of them underwent skin grafting, incisions, drainage, plastic surgery, and debridement.

Late deaths and health risks

Earthquake-related losses, based on one study, are divided into two types: direct and indirect.

“Injuries that occur during an earthquake, such as a fall, are direct effects of the physical force of an earthquake. One study indicated that injury caused by structural collapse can be either direct or indirect.

“If it happens during an earthquake, it is direct; if it occurs 24 hours later, it is usually considered indirect.”

In July 1990, when a massive 7.7 magnitude earthquake hit the island of Luzon, much of Luzon was affected – the city of Baguio suffered the most devastating effects.

As the shaking continued for a full minute, the collapsed buildings caused damage and deaths. Meanwhile, the stampede caused by people fleeing multi-storey buildings caused injuries and deaths.

Apart from the direct injuries that were recorded as a result of this earthquake, there were also reports and accounts of indirect injuries where some victims died as a result of complications due to collapse or failure of collapsing infrastructure.

“At Christian College, a six-story building completely collapsed, trapping nearly 250 students and teachers inside,” recalls Tara Lukasek, editor of the International Code Council (ICC).

“Heroic rescue efforts saved many, but some of the victims who did not die in the avalanche were later found dead due to dehydration because they were not pulled out in time,” she added.

Petra Ratu of Medical News Today also reported that earthquake victims with severe injuries such as lacerations of the liver or spleen, pelvic fractures and subdural hematomas die of their injuries a few hours after the earthquake.

Rato explained that these deaths are among the second peaks of deaths – or deaths recorded after the initial number of deaths.

A third peak occurs within days to weeks after an earthquake, as people with sepsis and multiple organ failure die from their injuries.

“Those with chronic conditions, such as diabetes and heart disease, are also at greater risk of death as essential medication and care are cut off,” Rato said.

About 2 to 15 percent of the population can suffer crushing injuries from heavy loads crushing their bodies as a result of earthquakes. About half of these victims, according to previous research, may develop kidney failure, and half of those will need dialysis.

The data showed that the death toll among people with kidney failure in earthquake conditions ranged between 14 and 18 percent.

Studies have indicated that earthquakes can also cause environmental pollution that can affect the health of many people.

One study cited the 1994 Northridge earthquake in the United States, where active surveillance in Ventura County documented increased cases of coccidioidomycosis, an infectious disease known as “valley fever.”

Valley fever is a respiratory disease transmitted by inhalation of airborne fungal spores.

A 1997 Washington Post report stated that “dust clouds, created by aftershocks and landslides after the 1994 Northridge earthquake, led to an outbreak of an unusual lung infection that killed three people.”

The infection had no symptoms, but some victims developed fatigue, coughing, night sweats, and fever.

“Other health emergencies, such as overcrowding in makeshift shelters, can lead to epidemic outbreaks of infectious diseases as people are displaced from their homes after the initial response to the earthquake subsides,” Rato said.

Aside from indirect injuries and epidemic outbreaks, earthquakes can also cause PTSD and mental health problems.

A 2006 study by Hayriye Ertem Fehid, Behiye Alyanak, and Aysel Eksi—which monitored victims of the 1999 Turkey earthquake—found that 17 percent of those who survived had suicidal thoughts after the disaster.

The researchers stated that “the current study indicates that injury to self or loved ones, damage to home or property, or loss of family members as a result of the earthquake enhances suicidal tendencies.”

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