Abstracts

commanders are provided. Future methods for automating the rapid collection of victim tracking information by command- and-control centres are proposed.

93 INTERNATIONAL DISASTER RELIEF - LESSONS LEARNED IN ARMENIA Aghububiun, RV, University of Massachusetts Medical Centre. Worcester, Massachusetts, USA

Major natural disasters can result in death or injury to hundreds of thousands of individuals. When such an incident occurs medical care and emergency response systems are usually overwhelmed. While leadership attempts to find manpower and supplies from outside the region, survivors near the epicenter must initiate rescue efforts and provide fmt aid to the injured. Rapid re-establishment of emergency health care and communications with sources of assistance can decrease morbidity and mortality among victims. During the response to the 1988 earthquake in Armenia personnel from around the world participated in many aspects of the disaster medical response and learned many lessons.

Some of the experiences pointed out deficiencies in planning for international disaster assistance. Following the earthquake information about the numbers of victims requiring extrication and urgent medical care was difficult to obtain. Selection of equipment. medical supplies and personnel for shipment to the impact zone f&m outside the Soviet Union was in some cases inappropriate. Unnecessary equipment and personnel became a burden to the effort. Problems in the transportation, storage and delivery of relief supplies to the most in need were encountered. Some international relief organizations operating within Armenia did not coordinate their activity. Plans for a coofdinated international response to major natural disasters should be developed by a multinational group of Disaster Medicine specialists.

94 THE MULTIPLE SHOOTING AT THE UNIYERSITY OF MONTREAL: AN ANALYSIS OF THE MEDICAL DISASTER RESPONSE Gasfonguay, J, Mosdossy, G. McGill University, Montreal, Quebec, Canada

Gn December 6. 1989. a lone gunman opened fire within the Bngmeering School of the University of Montreal, Quebec. He caused 27 casualties, 14 dead and 13 wounded. The disaster response was detailed, analyzed and critiqued.

The rescuers started to arrive 9 minutes after 911 was alerted. At 10 minutes the police established a perimeter and command post while EMS implemented an independent command post. At 23 minutes the building was entered by police and EMS. Search for victims was accomplished from minute 26 to minute 41 with triage and stabilization at immediate sites of injnry. Three of thirken victims had been evacuated at minute 21 upon spontaneous egress from the building. The 10 remaining victims were transported between minutes 49 to 87 to three university hospitals. Two hemodynamically unstable patients necessitated immediate lifesaving surgical intervention. Five victims were hemodynamically stable but required treatment of significant head, chest and major vessel injuries with ICU or delayed

operative care. Six patients received care for stable soft tissue extremity injuries.

Some difficulties were identified. Each service had a separate command post. On-site communications were hampemd by building construction and equipment availability. No triage or staging areas were explicitly defined. No outside perimeter was established. Rescuer safety was unconfirmed. Media control was not achieved. Information to receiving hospitals was patchy and inaccurate. Coordination of injured to available resources was not established. In one of three hospitals, resources were overwhelmed prior to the event. One of the hospitals was ill prepsred for a disaster response and relied on chance staff availability for a well-controlled response. In spite of the above mentioned shortcomings, victims were adequately triaged and treated according to injury severity. It is suggested that the event was not a full scale disaster but contained enough vital components that a mini disaster model for EMS respome is being developed for futnre use.

95 DIAL “19’: KEY POINTS OF FRENCH EXPERIENCE Bertrand, C, Desfemmes. C, Abbeys, JM, Hrouda. P, Huguenard, P, University Paris XlI, SAMU 94. Crete& France

After many years of functioning as a hospital-based speciality the value of SAMU was recognized by a law (1986). The law institutes a single unique dialing number “15”. Special phone numbers exist in France:

17: Police. 18: Fire Brigade 15: Medical Emergency

At the dispatching centre a specialized doctor is on duty 24 Hrs a day. He chooses the most efficient way to handle the emergency; choice of the teams, of the mobile means guided by radio, and the appropriate measures in Emergency Room to prepare to receive the patient

The choice of methods is based on a prior screening of cases. Absolute emergencies are handled by a SMUR (Medical Mobile Unit) (20% of the calls). Relative emergencies are handled by general practitioners. Serious secondary emergencies are handled by emergency physicians. Screening of cases is based on a pretherapeutic space time which means admissible delay time between the reception of the calls and the administration of the initial care on the scene.

The vehicles of the SMUR are ambulances equipped with full material, supported by a permanent medically equipped helicopter based at the hospital.

Cardiac and neurologic emergencies are first on the list, followed by trauma

% MOTOR VEHICLE DAMAGE DOCUMENTATION: FAILURE OF EMS RUN REPORTS COMPARED TO PHOTOGRAPHS USING A VEHICLE DAMAGE SCORE Hunt, RC. Brown RL, Cline, KA, Krohmer, JR, McCabe, JB, Department of Emergency Medicine, East Carolina University School of Medicine, Greenville, North Carolina, USA

The amouut of motor vehicle damage correlates with Injury Severity Scores. and vehicle damage assessment has been suggested as a nonphysiologic triage tooL The purpose of this study was to determine whether EMS nm reports adequately