International notes Earthquake Disaster -Luzon, Philippines

At 4:30 p.m. on July 16, 1990, an earthquake measuring 7.7 on the Richter scale
struck northern and central Luzon Island in the Philippines, resulting in substantial
morbidity and mortality and widespread damage. Among the areas severely
affected were the mountain city of Baguio; the coastal areas in La Union; Dagupan
city in Pangasinan; and the central plain area--primarily Cabanatuan city in Nueva
Ecija and mountainous Nueva Viscaya. Buildings in Baguio and Cabanatuan
suffered extensive structural failure, and buildings in the coastal areas in La Union
and in Dagupan suffered foundation failure or the effects of liquefaction*. This
report summarizes preliminary data gathered by Philippine Field Epidemiology
Training Program (FETP) teams on the damage, deaths, and injuries sustained in
the four areas. Baguio
The city of Baguio (1989 population: 154,000) covers 49 square kilometers (30
square miles) in the Cordillera mountains. Baguio is a major tourist destination and
the principal trade and educational center in the Cordillera region. Twenty-eight
buildings and 132 residences in the city were damaged or destroyed. Three hotels
were totally destroyed. Two schools were severely damaged, trapping students and
faculty members. A factory building collapsed and burned with workers trapped
inside.
For the first 48 hours after the earthquake, the city was isolated from the rest of the
country. Electric, water, and communication lines were destroyed. The city was
inaccessible by land because of landslides and inaccessible by air, except to
helicopters, because of damage at the airport. Food and fuel were scarce. Because
hospital buildings were damaged, patients were relocated under tents set up in open
spaces in front of hospitals. Damage to homes and the occurrence of many
aftershocks caused most residents to set up camps in open spaces in the city. Three
days after the earthquake, a main road leading to the city was cleared to enable
delivery of supplies.
During the first 48 hours, rescue teams consisted of local volunteers, mainly miners
and cadets from a military school in the city, who worked with their hands and with
picks and shovels. Foreign rescue teams with sophisticated equipment and dogs
trained for rescue were able to reach the area after 48 hours.
The FETP team estimated that 1084 earthquake-related casualties occurred: 695
injured survivors and 389 fatalities (case-fatality rate: 36%). The estimated injury
rate was 703 per 100,000 population; the estimated death rate was 252 per
100,000.

The FETP team conducted a case-control study to identify risk factors for
earthquake-related injuries. The study included 150 cases (surviving and deceased
casualties) and 305 controls.** Casualties ranged in age from 3 months to 70 years
(mean: 25 years); 51% were male. Eighty-four (56%) casualties were at home
when the earthquake struck; 19 (13%), in school; 11 (7%), in a street; and 36
(24%), in other places. The majority (74%) of casualties were inside a building
during the earthquake.
The 150 casualties sustained a total of 235 injuries (average: 1.6 injuries per
person). The three most common injuries were contusion (35%), fracture (14%),
and laceration (12%). The most common causes of injury were being hit by falling
objects (37%), being crushed or pinned by heavy objects (29%), and falling (7%).
Based on preliminary analysis, cases and controls were similar in age and sex
distribution. Similar proportions of cases and controls were inside (74% and 80%,
respectively) and outside (26% and 20%, respectively) buildings during the
earthquake. For persons who were inside a building, risk factors included building
height, type of building material, and the floor level the person was on. Persons
inside buildings with seven or more floors were 35 times more likely to be injured
(odds ratio (OR)=34.7; 95% confidence interval (CI)=8.1-306.9). Persons inside
buildings constructed of concrete or mixed materials were three times more likely
to sustain injuries (OR=3.4; 95% CI=1.1-13.5) than were those inside wooden
buildings. Persons at middle levels of multistory buildings were twice as likely to
be injured as those at the top or bottom levels (OR=2.3; 95% CI=1.3-4.2).
Cabanatuan
Cabanatuan (population: 176,053) is a major city in the central plain of Luzon. The
city has many concrete buildings, mostly three stories high. The highest structure, a
six-floor school, was the only building in Cabanatuan that collapsed during the
earthquake. A total of 363 casualties (including 274 (75%) persons, primarily
students, trapped in the collapsed school) were reported in Cabanatuan; 154 (42%)
died. The death and injury rates were 87 and 206 per 100,000 population,
respectively. Dagupan
Dagupan (population: 112,850) is a commercial city located along the coast of
Lingayen Gulf. Approximately 150 concrete buildings were located in the
commercial hub; most of these were less than five stories high. Approximately 90
(60%) buildings in the city were damaged, and approximately 20 collapsed. Some
structures sustained damage because liquefaction caused buildings to sink as much
as 1 meter (39 inches). Because the earthquake caused a decrease in the elevation
of the city, several areas were flooded.
Of 64 casualties, 47 survived and 17 died. The injury and death rates were 57 and
15 per 100,000 population, respectively. Most injuries were sustained during

stampedes at a university building and a theater. Fourteen (82%) of the deaths

occurred among women. La Union
In La Union, a coastal province located in the northwestern part of Luzon, five
municipalities (combined population: 132,208) were affected: Agoo, Aringay,
Caba, Santo Tomas, and Tubao. Principal occupations are farming and fishing. The
houses are constructed of wood, concrete, or light materials; most buildings are
concrete and are less than four stories high. A total of 2387 families were
dislocated when two coastal barangays (i.e., a large neighborhood or barrio) sank.
Many buildings collapsed or were otherwise severely damaged. Of 493 casualties,
32 died. The injury and death rates were 349 and 24 per 100,000 population,
respectively. Patterns of Damage
The earthquake caused different patterns of damage in different parts of Luzon
Island. The mountain resort of Baguio was most severely affected, probably
because it had the highest population density and many tall concrete buildings,
which were more susceptible to seismic damage. Because all routes of
communication, roads, and airport access were severed for several days, relief
efforts were also the most difficult there. Relief efforts were further hampered by
daily drenching, cold rains. Because Baguio is home to a large mining company
and a military academy, experienced miners and other disciplined volunteers
played a crucial role in early rescue efforts. Rescue teams arriving from Manila and
elsewhere in Luzon were able to decrease mortality from major injuries. Surgeons,
anesthesiologists, and specialized equipment and supplies were brought to the area,
and victims were promptly treated. Patients requiring specialized care (e.g.,
hemodialysis) not available in the disaster area were airlifted to tertiary hospitals in
metropolitan Manila. Outside of Baguio, destruction tended to be more diffuse.
Damage was caused by landslides in the mountains and settling in coastal areas.
Relief efforts in these areas were prompt and successful, partly because the areas
remained accessible. Reported by: MC Roces, MD, NI Pastor, MD, IL Gopez, MD,
MCL Quizon, MD, RU Rayray, MD, RR Gavino, MD, ES Salva, MD, MB
Brizuela, MD, FC Diza, MD, EV Falcon, MD, JM Lopez, MD, MEG Miranda,
DVM, RA Sadang, MD, NS Zacarias, MD, MM Dayrit, MD, Field Epidemiology
Training Program, Philippines. Div of Environmental Hazards and Health Effects,
Center for Environmental Health and Injury Control; Global Epidemic Intelligence
Svc, Div of Field Svcs, Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: As in previous earthquake disasters, the most important relief work
in the Philippines was done by survivors during the first 48 hours after the shock
(1,2). Because earthquake relief efforts may be hampered by a lack of accurate data
(3,4), the Department of Health (DOH) deployed teams of FETP epidemiologists
within 24 hours to each site to provide accurate estimates of casualties, damage,
and needs.

Because Baguio was accessible only by air, setting priorities for relief shipments
was vital. Daily reports were provided for local disaster coordinators and to
headquarters in Manila. Information gathering was possible but was constrained by
the lack of telephones, power, and transportation and by general confusion.
On July 19, 3 days after the earthquake, the priority of relief efforts shifted from
treatment of injuries to public health concerns. For example, numerous broken
pipes completely disrupted water systems, limiting the availability of potable
water, and refugees who camped in open areas had no adequate toilet facilities.
Early efforts at providing potable water by giving refugees chlorine granules were
unsuccessful. Most potable water was distributed from fire engines, and DOH
sanitarians chlorinated the water before it was distributed. Surveys of refugee areas
showed few latrines; these had to be dug by the DOH.
Although national disaster plans had worked well in typhoons and floods, their
effectiveness was undermined by the unprecedented demands caused by the
earthquake. High-level government officials, such as cabinet secretaries and
agency heads, were quickly assigned to manage emergency relief in different areas.
Important factors contributing to the risk for death after the collapse of buildings
include entrapment, the severity of injuries, length of time victims can survive
without medical attention, and time to rescue and medical treatment (5-7).
Earthquake drills are important, particularly in relation to appropriate occupant
behavior at the time of an earthquake (8). Deaths and injuries caused by stampedes
in schools underlined the need for earthquake drills.
A widespread public expectation was that epidemics of communicable diseases
would follow the earthquake. However, sentinel surveillance sites established in
each of the earthquake areas did not detect increases in diarrhea, measles, or other
diseases, confirming experiences after previous earthquakes (9). This information
was released to the press frequently and helped to quell rumors, a major concern in
the second and third weeks following the earthquake. In addition, reliable
epidemiologic data permitted relief managers to avoid displacing important relief
goods with unnecessary medicines (sorting and storing large quantities of
inappropriate medicines has been a problem after other recent earthquakes (10)).
Many nations contributed effectively to the successful relief effort. The most useful
international relief was low-technology assistance, such as tents, blankets, and
food. Teams equipped with high-technology equipment to detect survivors arrived
after most of the survivors had already been extricated. A team from Singapore
remained for several weeks to provide a range of services, including medical care
and cooking; these services were particularly useful. In addition, in response to a
request from the Philippine FETP, the government of Mexico provided information
based on its experience with the recent earthquake in Mexico; this information
aided the Philippines in its public health response.

Future international relief efforts should focus more on problems that arise in the
days after earthquakes. In Baguio, these needs were
1. engineers to establish whether buildings are habitable and to help reestablish
water and communication lines, 2) volunteers to help remove corpses from
the wreckage, 3) psychologists and psychiatrists to attend to the
psychological problems of helplessness, depression, and anger in survivors
and rescuers, and 4) tents and food.
References
1. Noji ER. The 1988 earthquake in Soviet Armenia: implications for
earthquake preparedness. Disasters 1989;13:255-62.
2. de Bruycker M, Greco D, Annino I, et al. The 1980 earthquake in southern Italy:
rescue of trapped victims and mortality. Bull WHO 1983;61:1021-5.
3. Lechat MF. Disasters and public health. Bull WHO 1979;57:11-7. 4. Foege WH.
Public health aspects of disaster management. In: Last JM, ed. Public health and
preventive medicine. 12th ed. Norwalk, Connecticut: Appleton-Century-Crofts,
1986:1879-84.
5. Noji EK, Kelen GD, Armenian HK, Oganessian A, Jones NP, Silvertson KT. The
1988 earthquake in Soviet Armenia: a case study. Ann Emerg Med 1990;19:891-7.
6. Glass RI, Urrutia JJ, Sibony S, et al. Earthquake injuries related to housing in a
Guatemalan village. Science 1977;197:638-43.
7. Noji EK, Armenian HK, Oganessian AP. Case control study of injuries due to
earthquake in Soviet Armenia. Ann Emerg Med 1990;19:449.
8. de Bruycker M, Greco D, Lechat MF. The 1980 earthquake in Southern Italy:
morbidity and mortality. Int J Epidemiol 1985;14:113-7.
9. Anonymous. The risk of disease outbreaks after natural disasters. WHO
Chronicle 1979;33:214-6. 10. Autier P, Ferir M-C, Hairapetien A, et al. Drug
supply in the aftermath of the 1988 Armenian earthquake. Lancet 1990;335:138890. *A change in the soil from a firm material into a viscous semiliquid material
that resembles quicksand.
**A case was any casualty (injured or dead) resulting directly from the earthquake
or aftershocks. For injured persons, information was obtained from the patients,
when possible, or from other survivors; for infants and young children, from their
parents or guardians; and for decedents, from survivors or from rescuers. Controls
were noninjured family members or noninjured persons in refugee centers.

Disclaimer

All MMWR HTML documents published before January 1993 are

electronic conversions from ASCII text into HTML. This conversion may have resulted in
character translation or format errors in the HTML version. Users should not rely on this
HTML document, but are referred to the original MMWR paper copy for the official text,
figures, and tables. An original paper copy of this issue can be obtained from the
Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC
20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

Source:
http://www.cdc.gov/mmwr/preview/mmwrhtml/00001734.htm
accessed on 20 September 2016