Content uploaded by Murat Kalemoglu
Author content
All content in this area was uploaded by Murat Kalemoglu on Sep 01, 2015
Content may be subject to copyright.
Original Article
If I get trapped under debris after an earthquake, what should I do while
waiting for help?
Eryilmaz M1, Yigitler C2, Durusu M3, Balkan A4, Kalemoglu M5
Gulhane Military Medicine Academy, 1Department of Emergency Medicine, Ankara, Turkey
Balikesir Military Hospital, 2Department of General Surgery, Balikesir, Turkey
Diyarbakir Military Hospital, 3Department of General Surgery, Diyarbakir, Turkey
Gulhane Military Medicine Academy, 4Department of Chest Disease, Ankara, Turkey
Gulhane Military Medicine Academy, Haydarpasa Training Hospital, 5Department of Emergency Medicine,
Istanbul, Turkey
Abstract: Many studies have been carried out on the
issues of mass injuries and protection measures,
which have entered into the agenda of our country
after 1999 Great Marmara Earthquake. Many scien-
tific studies have increased constantly after the
earthquake regarding with especially on mitigation
measures and health care services. Most of the stud-
ies are carried on in regards to pre- and post-
disaster period. The issue of what should the people
do when they are trapped under concrete blocks? is
ignored in our country where the earthquakes are
considered with the most common potentially disas-
ter. In this study, some opinions are presented which
have been improved through compiling the remarks
shared within various national and international e-
mail groups related to the field.
Key words: Earthquake, concrete blocks.
____________________________________________
Earthquakes, which happen in Turkey, have the
disaster potentials with massive destructions and
life losses occur the most frequently [1]. Mitigation
activities and structural measures implemented in
the developed countries having high risk of earth-
quake potential, which assume the most effective
role among preventive activities. Contemporary
preparations to be attained after long-term eco-
nomic, cultural, mental and organizational plan-
ning and practices will lay the foundation for the
success of that population in terms of its local re-
sponse [2]. It is seen that the whole focus related to
national and international response is the principles
of search, rescue and evacuation. On the other
hand, phase of struggling for life which is the real
start point of the spectrum is the first step with an
utmost significance. It is not frequent that we see
some resources and warnings related to individual
action plan of the person who is struggling for life.
Starting point should be individual action plans for
short-term improvement of the societies aware-
ness on disaster prevention. Actually, individuals
not having an action plan should not have the right
to question institutional, national and global re-
sponse in ethical terms. It is evaluated that extra-
ordinary situations in which personal experiences
are not shared, lessons learned are not elaborated
and post-incidental investigation is not performed
cannot help mankind get strong in case of a new
threat [3].
Individual action plans occupy an important place
for protection from natural disasters. However,
these plans are mostly the methods depending on
scientific evidence and they aim at teaching
behaviors necessary for the individual to save
himself or to recover from the situation with little
damage when the incidence occurred. It is foreseen
that in a type of disaster such as earthquake,
individual plans cannot be prepared according to
very comprehensive scenarios and it wont be
possible to develop a certain plan with scientific
evidences for each scenario. In this study, a group
of researchers whose main field of interest is
disaster were asked through a questionnaire about
their accumulation of medical knowledge and
thoughts based on their acquired experiences
regarding a scenario encountered frequently in the
recent earthquakes. It was aimed to collect and
present the answers and comments according to
Balkan Military Medical Review
11, 61-67 (2008) BALKAN
Military Medical
REVIEW
Correspondence o: M. Eryilma, MD, e-mail: drmehmeteryilma@yahoo.com
their characteristics.
Materials and methods
Within this study that was prepared after the occur-
rence of a series of earthquakes in October 2005 in
the offshore area of Sigacik Bay (Seferihisar/Izmir
-TURKEY) with the magnitudes of 5.7, 5.9 and 5.4
and of the following hundreds of aftershocks, five
questions were asked to some e-groups on the
internet which their names are trauma, emer-
gency management, travma, afettr, aciltip,
Aciltip-Turkiye, say-umke and an-
karaaciller. After collecting the answers and the
experience shared among different persons, such
study has been produced [4].
The questions for the present study, which were
sent in October 20, 2005 to the relevant e-mail
groups via internet, are as follows:
1. If I get stuck under concrete blocks after
an earthquake, what should I do while
waiting for help?
2. How should my flow of thought be?
3. To which extent, should I try to make my
voice heard?
4. How much should I spend my energy?
5. How should I control my respiration rate?
Answers to these questions were grouped among
themselves according to feelings and recommenda-
tions in general, emotional and behavioral skills
recommended in case of being trapped under con-
crete blocks after an earthquake were determined.
Results
Out of 8 communication groups to which the ques-
tions were addressed, 17 members responded.
General approach and judgments on the situation
It is not very easy but interesting to answer the
questions asked in mail groups. Unfortunately,
replies may be quite changeable. It is very difficult
to be able to give a certain answer and make a
profound statement. Answer of the question, in fact
lies u nder empathy. Also, it may be tried to stan-
dardize the answers according to priorities under
debris with an aim to prevent the reasons of death.
Informing the behavior under the debris is not the
same and as effective as the real life comparing to
the emergent situation, since this probably wont
be taken into consideration as an information or
real behavior by most of the people. Making ordi-
nary the notion of being trapped under debris may
also create some controversial feelings within the
society. It may lead the society to a wrong percep-
tion that All of us will be trapped under debris in
an earthquake. Therefore, the transferred informa-
tion will certainly be helpful for those approaching
to issue calmly and with a wish to get specific
information. It is aimed that light search and rescue
teams organized within the neighborhood provide
assistance so that they can help those trapped under
debris especially until heavy search and rescue
teams and equipment reach to the scene.
Those who have experienced the conditions of
debris in advance know the meaning of claustro-
phobia very well. It is not similar to operate a per-
son in the hospital who has been removed from the
debris. Operating someone is a routine job you do
everyday if you compare this condition with trap-
ping under debris. You take care about only with
the things happened before you and the mechanic
effects of trauma if known (mostly unknown).
Professionally, you do your daily work. Only after
you remove an injured body from the debris, you
will be depressed and stressful by the nature of this
catastrophe. After a major earthquake, you know
that there are a large number of such people and
with this sense, it shouldnt be forgotten that most
of the members of rescue teams will mentally par-
ticipate among the unknown victims of the
earthquake and they might be subject to post trau-
matic stress disorder if they are not experienced
and prepared for this situation.
We all need a road map in terms of what to do in a
situation which is directly related to type of the
debris, the type of the injury and what type of a
load leaning on our body. It is required to create a
solution to this problem.
Understanding the situation, empathy
You may try it yourself. Get yourself trapped in a
dark, narrow, cold place which you cannot move
even your head and even your rib cage also moves
with difficulty. Tell your spouse to place the big
objects in your house over your body one by one,
and spill sand and debris from the construction
with time intervals.
You may even imagine that you have a severe pain
in somewhere inside your body. If you want to feel
the climate effects, spend the whole night outside
the balcony. Also, add smelling of the dead bodies
and moaning of your neighbors or your family
62 Balkan Military Medical Review
Vol. 11, No. 2, April 2008
members within the scenario. Focusing on a long
time period, imagine that you need to survive from
here for many days without food or water. You
will feel an awful pain wherever you have a bruise.
Recommendations
Controlling Flow of Thought
The situation may get worsen as time passes by.
Your thought slows down and you may not be able
to think of anything logically. You may lose your
time perception after a while. Try hard to survive!
Resist patiently. One of the common features of
the survivors in extra-ordinary situations and plane
crashes and of the mountaineers got lost is that
they think problem-oriented. After the disaster the
person should describe the problem properly and
think of surviving himself and his family from this
situation is the key to the success. Also, the feature
characterizing the unsuccessful ones is that they
think about where they did a mistake and get panic.
Negative energy which reveals in this second con-
dition makes it difficult for the people to continue
to struggle for life. Since there wont be any way-
out or escape in case of being trapped under debris,
the person should only focus on surviving and try
to control his breathing and energy consumption as
much as he could. The aim and focus should be
managing to survive for a time as long as possible
until the professional help reaches, which is not
certain for that moment when to come.
Being calm
We should ask ourselves What would I do? The
answer of "I guess you should be calm at first" is
quite logical. But logic comes out if you are bleed-
ing, hungry, thirsty, or hopeless or maybe if you
are lying with someone silently. It is not so easy.
Although state of "being calm" could be a thing
learnt to some extent in advance, the main issue is
the ability of regulating your flow of thought ac-
cording to the situation. You may be under the
influence of a large variety of feelings; anger,
hopelessness, sadness. But, you should absolutely
be calm. Trying to be calm and using our living
energy economically is of great importance under a
condition if we dont know the exact time to be
find out by rescuers. First of all you should be
calm and not shout for that reason. Being calm will
help you to control your respiration and energy and
use them cautiously until you will be rescued.
Being calm, think of what you can do. Someone
who is claustrophobic may have to struggle harder
to manage to be calm. You may regulate the respi-
ration by taking a deep breath from the nose count-
ing to two and giving out through mouth counting
to four.
Motivation
Firstly, you should appreciate yourself lucky since
your condition allows you to think. Think that
Life is beautiful; I will be rescued from here safe
and healthy. Consider the happy events in your
life as if you are watching a film and try to feel
positive energies once more. Relieve yourself say-
ing I am strong and I will overcome this, too.
Try not to sleep and to keep your mind alert. Pray-
ing is good while waiting for being rescued. It
helps you control your thoughts. At this time, think
of someone you love and remember how nice it
will be to see them again. Always tell yourself you
will be saved.
Keeping air way open and controlling respiration
Airway obstruction and respiratory problems are
the most important and fatal problems that you will
face immediately after tremor and also those from
which you will be easily protected if you are con-
scious. Your mouth and face may be covered with
dust-dirt. Breathing gets quite difficult. Making
your voice heard may not be easy. You may feel as
if you were choked. You might not move. It is
reasonable to keep your mouth closed first against
dust-sand particles, which might come from up-
side, make nasal respiration and turn your head on
one side. If you can move, turning to your side and
keeping your body at recovery position will be the
safest direction considering that you will lose your
consciousness in long-term. Under such circum-
stances, it is appropriate to protect yourself from
the dust particles in the air through a part of a dress
or t-shirt. If you are covered with dust and dirt you
may try to clear your mouth and nose and stretc h
your t-shirt or undershirt across your mouth like a
mas k. If you are tr apped; you shou ld close your
mouth with a handkerchief, rag or scarf. As re-
quired by your individual action plan which you
developed for earthquakes, these materials should
absolutely be available in your pocket. Dust may
have entered into your mouth or nose. Therefore,
you should pay attention not to let dust penetrate
into your trachea while inhaling. Your body will
need air; you should try to control your respiration.
It is necessary to inhale and exhale as slowly as
Eryilma et al.: Trapping under debris after an earthquake and waiting for help 63
possible. Try to control your breathing. You should
try to take slow and non-deep breathes. Until
someone finds your location, you should use your
breathe in a controlled manner. Dust is very sig-
nificant for the people trapped under debris. Im-
mobility and bruise will lead you to breathe more
frequently. Because loss of water and energy will
occur in the bruised region with the leakage of
fluid into the tissue, moreover required concentra-
tion of oxygen may become inadequate due to
presence of dust in the atmosphere.
Measures for injury
You should concentrate on a single point and
check out if you have any injury. Control your
surrounding. Make small findings. Check your feet
and hands. Never move yourself or anything you
dont know what it is until the dark room is light-
ened. Examine throughout your body and try to
find the most comfortable position under those
circumstances. If you know meditation, you may
try to slow down your pulse. Do not spend too
much energy. If you have a fracture or dislocation,
dont change your position unless required. Check
particularly whether you have a bleeding. If any,
try to stop it. To support blood circulation, move
your feet and hands slowly. If you are injured, you
should identify the site of injury and control it.
Unnoticed trauma cases though having a life-
threatening bleeding are reported frequently.
Therefore, care should be exerted for such cases. If
you have much pain because of a fracture or other
traumas, you may try to do auto-hypnosis. Also,
you may give the command of release to your en-
dorphins if you have received a special training
thereon. You can be sure that our body listens to
our mind much better.
Checking the environment and availabilities
Control yourself after the tremor. Try to stay under
something you believe that protecting you from
crushing in a following shake. After that, it is re-
quired to define the problem clearly and focus on
it. Are you injured? On which floor are you? How
many floors are there after yours? Who can reach
to you? Which ways can you try? Whats the time
now? Who might be in the building other than
you? Who might be alive? On which part of the
building may they be sitting at this time? Where
might be the other members of the family? Are
they alive? Can they reach to you? How might
have the building collapsed? What are the other
potential dangers? How the oxygen status in the
room is, is there any current of air? If yes, what
kind of a route it is following? Is there any possi-
bility of water, electricity, gas leakage? Is there
any water resource around you; if yes, how long
does it suffice? What do you have to be protected
from cold? How many days may it take for the
professional rescue teams to locate you?
Medication and supplies
If you have developed an action plan in advance
and if you can reach to the bag you prepared for
that purpose under debris, you should try to get the
bottle of water and dressing materials. If available,
you should swallow natural tablets containing
oregano oil which are sold out of the country, one
tablet for each set of a few hours you spent under
debris. It will be helpful for the protection of abra-
sions, cuts, bruises, scratch resulted from the
trauma you were exposed to. Under such circum-
stances, you should try to protect your injured skin
with olive oil or oregano oil until you are removed
from the debris. If adequately available, you
should take olive oil tablets. One oregano tablet
and a rag to close your mouth will be the best pro-
tective equipment for you under debris. American
and other international resources recommend that
the people should have oregano and olive oil tab-
lets in their bags prepared within their action plans.
Basic trainings on disaster awareness advise that
the person should place a certain amount of food,
water, a whistle and a flashlight at some points at
the house. These things will help person to survive
longer only if they are closely available to him or
to his bed. Under debris, you should check out if
there are any useful materials around you.
Call for help
After recovering from the first panic, you should
try to be calm and use the oxygen sufficiently
breathing as slow as possible. When you hear a
voice if you are able to tap somewhere, you should
give out regular taps. If they call you saying is
there anybody there? you should try to make your
voice heard or to make a voice by tapping or rub-
bing something if you can move. It is not true to
spend your energy by shouting. If you hear they
have started to work on the concrete blocks under
which you are lying, stay silent instead of shouting
during all that noise and wait for the teams stop-
ping to control the debris. Since they wont reach
you in a time less than a few hours, not trying to
64 Balkan Military Medical Review
Vol. 11, No. 2, April 2008
make your voice hear d inst antly after you get
trapped will be the best thing to do. Shouting
means spending your energy if there isnt anybody
outside. Equipment of search and rescue teams is
very educated and talented. If there are living peo-
ple in the building, they will probably find you.
There is no need to try for shouting. Another and
very significant call for help is making rhythmic
sounds. Instead of using your voice, you may try to
tap in a rhythmic way on a rock or another object.
You should find the lightest object that will give
out the highest sound. Whistle is another important
tool to call for help. If you have a whistle with you,
it will help you make your voice heard easily to the
people outside. When you hear a voice after listen-
ing to the outside carefully, it will be more reason-
able to blow the whistle at time intervals instead of
shouting. There should always be a whistle in the
bags or key rings to be used in emergency.
In Morse alphabet, three short, three long and three
short taps means SOS. Someone who hears and
knows its meaning will understand it is a human-
made rhythm.
Of course, it is something you can do on the first
days if you still have energy. What will you do
when your energy is over or when you are so in-
jured that you cant even give out any voice or if
you are under 2-3 floors of a collapsed building?
The most important thing here is not to be over-
come by hopelessness. It is very crucial in the first
hours that your only hope will be your neighbors
or your surviving friends that will come to look for
you. If you shout and call for help continually, you
will be tired and after a while you will lose your
energy and wont be able to give out voice. There-
fore, if someone comes and calls you outside, do
not rush. Wait for ceasing of the voices coming
outside and give your voice out within silence.
Your general approach should be making yourself
heard through tapping something instead of shout-
ing. If available around you, you may convey your
sound further by tapping the water and heating
system pipes. If you endure for a few days, some-
one will definitely come to search for you. In this
situation, you will need to make your voice reach
to the rescuer. Tell your location and position
properly to search and rescue team if you can see
around. However, during the days waiting to be
rescued, most of the injured will have a conscious
trouble. There have been some injured people try-
ing to express themselves by only rubbing a stone
to the wall rhythmically and tried to be rescued
from the debris by this way.
What can be done for self-sustaining?
After you recover from the initial hesitant mo-
ments, you may imagine that you are watching
again the funny films that you have watched be-
fore. You may express positive things to yourself.
You may realize your daily favorite hobbies from
each of its step in your mind as if you are really
living it. You may think of the meal times and
visualize yourself as if you are having each meal
without skipping any of them. If you stay without
water for a long time, drinking your urine may
provide you additional time. It may take a long
time to locate and reach you. For this reason, ex-
tension of waiting time under debris may come to
you much more difficult to endure. Whatever it
may cost, do not los e your patience and desire t o
live. Looking at the people survived from debris
after days, their shared feature is that they were
trapped in an area with water. Accordingly, bath-
room and kitchen are more advantageous places. If
you have communication media with you such as
radio or mobile phone; operate them at some inter-
vals and try to get information from outside. The
answer of which exit route is the most appropriate
is directly related to your trapped place or not. Do
not forget that the most dangerous places in earth-
quakes are especially the upper floors.
After a while, water will become the most impor-
tant need for you. Another important problem is
heating. If there is room for moving, you should
try to be away from wet clothes and find some-
thing dry. A person trapped under the debris of a
collapsed shopping mall in Japan and who cant be
rescued for a long time managed to survive
through making the fabric which he found around
absorbed the water used for settling the dust during
search and rescue work.
During and after rescue
Another important issue to be remembered is that
you cant survive without reaching the search and
rescue teams. You should maintain that psychol-
ogy pertaining to crisis time until you are taken to
a hospital or an emergency center of a clinic to
reach for the medical support. You may need sup-
port for recovering of your body back to normal
conditions and after this support you may become
capable of only the things necessary for your vital
functions. It is of great importance that we should
know the possibility of posttraumatic stress disor-
der syndromes.
Eryilma et al.: Trapping under debris after an earthquake and waiting for help 65
Additional information and recommendations
We hope that no one will experience the above-
mentioned situations and nobody will face these
one day. We hope because, it seems that the alter-
natives of surviving or losing our lives after a dis-
aster are under our control, taking our existing
building structures into account. First, in our daily
life, we should never forget that we are living in a
country of earthquakes. If the conditions are feasi-
ble, it should urge us to try to mitigate both struc-
tural and non-structural risks of the buildings such
as our houses and offices where we spend most of
our time for to minimize post-disaster risks. Train-
ings provided by District Directorates of Civil
Defense and Disaster Preparedness Training Unit
of Bogazici University Earthquake Research Insti-
tute will help us to enhance our awareness and
improve ourselves regarding with earthquakes by
getting an access via internet through these condi-
tions. Cooperating with any of the groups, who
work in the relevant field in your neighborhood,
carries huge importance in terms of learning the
existing risks.
In one of these trainings, behavior of a victim at an
old age is given as an example: this old man has
stated after the disaster when search and rescue
team started to work, there was noise so he shouted
under debris; but he kept silence when the team
was listening to hear his voice since he thought
everybody went. However, listening phase in
which the outside sounds were decreased to mini-
mum is a guiding and vital information regarding
the people under debris.
As a human-being, we have some individual, so-
cial and institutional responsibilities. It is not nec-
essary to be trapped under debris to understand the
importance of taking our own measures. For this, it
is enough to know even a bleeding that might de-
velop in our foot or hand after an extraordinary
situation will lead to fatal results that we may not
be able to reach to a doctor. Considering human
resources are very limited and they are difficult for
you to reach in such a time. Knowing that stealing
the living right of a person who really necessitates
a doctor, creates awareness on individual responsi-
bility to take these measures. Thats why it is very
significant to fix the non-structural objects in the
places such as house, office and school where we
spend most of our time.
In some search and rescue works, still you can see
many people over the debris. Unfortunately, not
learning from old experiences will lead the injured
person under debris to swallow a serious amount of
dust, also a block of concrete might move and kill
him and it also endangers the life of search and
rescue team.
Another question is that what can I do not to be
trapped under debris, which this issue requires
longer discussion. By examining the Disaster
Preparedness Training Programme provided by
Bogazici University Kandilli Observatory and
Earthquake Research Institute and their web page
[5], you will see the sections of Disaster Prepar-
edness Plan for Families, Basic Disaster Aware-
ness, Mitigation of Non-Structural Risks, Commu-
nity Volunteers of Disaster, Structural Awareness
on Earthquake and the relevant trainings. You can
also reach to a section for children.
This study should be supported and promoted.
Furthermore, every person can receive a basic-
level distance training which covers the necessary
things to be learnt on this issue.
Conclusions
Efforts of the societies not to turn extra ordinary
situations into disasters are their indicators for
civilization. Civilized countries, in the light of the
lessons, which they have learnt from their experi-
ences, will be able to attain the optimal results in
overcoming problems through using analytic and
sharing method.
Studies performed up to now were mostly focused
on the action plans for those who will respond to
disaster victims. However, there is also a need for
the resources which will ensure the people living
together with disaster potentials to develop their
own action plans in case that they are trapped
under concr ete blocks. Emergency health care
services provided in each stage of a disaster
process from under-debris to the first response,
from search and rescue to evacuation of the
injured, should be elaborated with all their aspects
and the events experienced should shed light upon
the events to be experienced.
66 Balkan Military Medical Review
Vol. 11, No. 2, April 2008
References
1. Eryilmaz M. Afetin Potansiyelleri.Eds.: Eryilmaz
M, Dizer U. Afet Tibbi Kitabi: Unsal yayinlari,
Ankara, 2005, pp. 29-60.
2. Eryilmaz M. Afetin Tanimi.Eds.: Eryilmaz M,
Dizer U. Afet Tibbi Kitabi: Unsal yayinlari,
Ankara, 2005, pp. 7-22.
3. Eryilmaz M. Afetin Dinamigi.Eds.: Eryilmaz M,
Dizer U. Afet Tibbi Kitabi: Unsal.yayinlari,
Ankara, 2005, pp.61-76.
4. www.travma.org.tr/secilmis_Mesajlar.asp Access
Date January 25, 2006.
5. www.iahep.org/ev/ Access Date December 27,
2005.
Eryilma et al.: Trapping under debris after an earthquake and waiting for help 67