The Earthquake and the Long-Term Crush Syndrome as a Problem of Health Care Management and Medical Strategy

In December 1988, an earthquake with a magnitude of 6.9 on the Richter scale killed more than 25,000 people in Armenia. In the aftermath, the occurrence of nearly 600 cases of acute renal failure created a second catastrophe, subsequently called a “renal disaster.” At least 225 victims required dialysis, but despite the availability of more than 36 tons of dialysis supplies, 100 dialysis machines, and volunteer personnel from many countries, the response was ineffective, because no organized international support structure with appropriate training and deployment strategies was available at that time. The poorly organized relief effort with its influx of rescuers and material only worsened the chaos, creating a secondary disaster and interfering with global rescue activities. In this article, we describe management and medical strategies for preventing renal problems related to such disasters