The heroes who arrive too late

As international rescue teams pour into Kathmandu to assist locals with the retrieval of the injured from rubble, they are unlikely to find many more survivors. While there’s always a chance a small number of live victims might be trapped in ‘voids’ up to a week after an earthquake, many experts in the field of emergency management have come to question the effectiveness and value-for-money of foreign rescue teams.

Every year, governments of high-income nations spend hundred-of-millions of dollars on humanitarian response to catastrophes in developing nations, with very little to show for the investment. International Urban Search and Rescue (USAR) teams cost more than $2 million USD annually to maintain and comprise of around 70 members and 20 tones of equipment. Their skill and dedication is exceptional. The only problem is that most USAR teams arrive on the scene of disasters more than 24 hours after the event, too late to make an impact on mortality.

In major trauma, the window for possible survival is so narrow it’s commonly referred to as the golden hour. Uncontrolled bleeding and occluded airways are the two biggest killers, and they kill quickly. My first experience of this in a disaster setting came after the 2004 Asian Tsunami when I happened to be holidaying on the Thai island of Koh Lanta and found myself among a small group of medics treating the injured in a small hospital. Patients who could be saved were saved in the first hour after the wave struck. A day later, I watched as rescue teams from a dozen nations arrived on the scene. Sadly, by this time, there were only bodies to recover.

Mounting evidence from numerous catastrophes, including the recent Japanese Tsunami (2011) and the earthquakes in Gujarat (2001) and Pakistan (2005) show this reactive style of international disaster response produces minimal results. After the Iran earthquake of 2003, 40 rescue teams from around the world participated, and only a handful of people were saved. After the Padang, Indonesia earthquake in 2009, 21 USAR teams consisting of 688 personnel and 67 rescue dogs found no survivors at all. The biggest problem in every case has been response time. Even the Australian USAR teams who reached Christchurch as quickly as 12 hours after the quake in 2011 did not find anyone alive in the rubble. After the Haiti earthquake, it was calculated that the costs of dispatching international urban search and rescue teams equated to around $1 million USD per life saved. Considering the aim of disaster response is to achieve ‘the greatest good for the greatest number’, this amounts to a serious waste of aid money.

For the same amount spent on saving one life, hundreds-of-thousands of local first responders could be trained, locals whom we know are on the scene immediately after an event. Yet very few aid-giving governments or NGOs invest in this kind of capacity building. Jobs for paramedic or rescue specialists in the humanitarian sector are virtually non-existent. This is surprising considering 5.8 million people die each year as a result of injuries (more deaths than tuberculosis, malaria and HIV/AIDS combined) and that 80% of the world remains without a coordinated pre-hospital emergency medical service. Indeed, according to the World Health Organisation (WHO), trauma is set to become the leading cause of death worldwide within the next decade.

Resource-poor nations most vulnerable to environmental catastrophes like the one in Nepal are also those who suffer the highest levels of trauma on a daily basis. In these locations, disaster preparedness needs to include training and equipping laypeople for emergency response. In the absence of high-tech ambulance systems we must also build on existing informal resources by better coordinating local taxi drivers, trucks, rickshaws and even donkey-carts for the transport of patients to hospital. 

Triage of disaster response funding will ensure our aid does the greatest good for the greatest number. Flying in experts after an earthquake like the one in Nepal has little benefit when it comes to life-threatening injuries. Local people not only have the greater will, but they are more than capable. They are familiar with the lay of the land, with cultural sensitivities and with language. Most importantly they own the ‘golden hour’, making them the only ones in any position to save lives when minutes count.

First printed in the Sydney Morning Herald, 1/5/15

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