Survival and cost analysis of fatalities of the kobe earthquake in Japan |
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Authors: | Noriaki Aoki Akiyoshi Nishimura MD Ernesto A. Pretto MD Katsuhiko Sugimoto MD J.Robert Beck MD Tsuguya Fukui MD |
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Affiliation: | from the School of Health Information Sciences (NA), University of Texas Health Science Center-Houston, Houston, Texas; the Center for Health Service, Outcomes Research and Development-Japan, Tokyo, Japan (CHORD-J) (NA); the Department of Legal Medicine (AN), Yokohama City University School of Medicine, Yokohama, Japan; the Department of Anesthesiology and Safar Center for Resuscitation Research (EAP), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; the Department of Emergency and Critical Care Medicine (KS), Showa University School of Medicine, Tokyo, Japan; Fox Chase Cancer Center (JRB), Philadelphia, Pennsylvania; and the Department of General Medicine and Clinical Epidemiology (TF), Kyoto University Hospital, Kyoto, Japan |
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Abstract: | ObjectivesThe authors investigated the dying patterns, and cause and preventability of deaths in a major earthquake disaster, and estimated the cost needed to enhance emergency medical services (EMS) response to prevent “unnecessary” deaths.MethodsThe authors reviewed autopsy data in the Hanshin-Awaji (Kobe) earthquake of 1995. A survival analysis was performed to determine the time course and pattern of dying of these deaths. A cost analysis to estimate acceptable cost for EMS to reduce fatalities was also performed. Potentially salvageable life-years based on expected life-years among fatalities were calculated and used to simulate an acceptable cost for an enhanced EMS disaster response.ResultsThe authors analyzed 5,411 fatalities. More than 80% of these patients died within three hours. There were statistically significant differences in survival/dying patterns among causes of death. Thirteen percent of victims experienced a protracted death, which could have been prevented with earlier medical or surgical intervention. The monetary cost of these lost lives was estimated at approximately $600 million US.ConclusionsSurvival analysis revealed a significant population of potentially salvageable patients if more timely and appropriate medical intervention had been available immediately after the earthquake. Based on our cost analysis, and assuming a 1% annual probability of an earthquake and a 30% enhanced lifesaving capability of the EMS effort, approximately $2 million annually could be a reasonable expenditure to achieve the goal of reducing preventable deaths in disasters. |
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Keywords: | natural disasters cost disaster preparedness earthquake Japan |
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