Investigating Lushan Earthquake Victims’ Individual Behavior Response and Rescue Organization

Abstract

Research concerning the impact of earthquake victims’ individual behavior and its association with earthquake-related injuries is lacking. This study examined this relationship along with effectiveness of earthquake rescue measures. The six most severely destroyed townships during the Lushan earthquake were examined; 28 villages and three earthquake victims’ settlement camp areas were selected as research areas. Inclusion criteria comprised living in Lushan county for a longtime, living in Lushan county during the 2013 Lushan earthquake, and having one’s home destroyed. Earthquake victims with an intellectual disability or communication problems were excluded. The earthquake victims (N (number) = 5165, male = 2396) completed a questionnaire (response rate: 94.7%). Among them, 209 were injured (5.61%). Teachers (p < 0.0001, OR (odds ratios) = 3.33) and medical staff (p = 0.001, OR = 4.35) were more vulnerable to the earthquake than were farmers. Individual behavior was directly related to injuries, such as the first reaction after earthquake and fear. There is an obvious connection between earthquake-related injury and individual behavior characteristics. It is strongly suggested that victims receive mental health support from medical practitioners and the government to minimize negative effects. The initial reaction after an earthquake also played a vital role in victims’ trauma; therefore, earthquake-related experience and education may prevent injuries. Self-aid and mutual help played key roles in emergency, medical rescue efforts.

Full text

International Journal of
Environmental Research
and Public Health
Article
Investigating Lushan Earthquake Victims’ Individual
Behavior Response and Rescue Organization
Peng Kang †, Yipeng Lv †, Qiangyu Deng †, Yuan Liu, Yi Zhang, Xu Liu and Lulu Zhang * ID
Department of Military Health Service Management, College of Military Health Service Management,
Second Military Medical University, Shanghai 200433, China; kpkp315@163.com (P.K.); epengl@163.com (Y.L.);
smmudqy@163.com (Q.D.); yawnlau@126.com (Y.L.); 18602160005@126.com (Y.Z.); aqualau@126.com (X.L.)
*Correspondence: zllrmit@163.com; Tel./Fax: +86-021-8187-1436
† The first three authors contributed equally to this paper.
Received: 15 October 2017; Accepted: 22 November 2017; Published: 11 December 2017
Abstract:
Research concerning the impact of earthquake victims’ individual behavior and its
association with earthquake-related injuries is lacking. This study examined this relationship along
with effectiveness of earthquake rescue measures. The six most severely destroyed townships
during the Lushan earthquake were examined; 28 villages and three earthquake victims’ settlement
camp areas were selected as research areas. Inclusion criteria comprised living in Lushan county
for a longtime, living in Lushan county during the 2013 Lushan earthquake, and having
one’s home destroyed. Earthquake victims with an intellectual disability or communication
problems were excluded. The earthquake victims (N (number) = 5165, male = 2396) completed
a questionnaire (response rate: 94.7%). Among them, 209 were injured (5.61%). Teachers (
p< 0.0001
,
OR (odds ratios) = 3.33)
and medical staff (p= 0.001, OR = 4.35) were more vulnerable to the
earthquake than were farmers. Individual behavior was directly related to injuries, such as the first
reaction after earthquake and fear. There is an obvious connection between earthquake-related injury
and individual behavior characteristics. It is strongly suggested that victims receive mental health
support from medical practitioners and the government to minimize negative effects. The initial
reaction after an earthquake also played a vital role in victims’ trauma; therefore, earthquake-related
experience and education may prevent injuries. Self-aid and mutual help played key roles in
emergency, medical rescue efforts.
Keywords: earthquake victims; individual behavior; injury; rescue efforts
1. Introduction
Natural disasters, especially earthquakes, cause vast destruction, often resulting in massive
casualties and economic loss. Researchers pay great attention to injuries and rescue efforts after
earthquakes [
1
–
4
]; however, most scholars have focused on analyzing the earthquake trauma structure
and its influencing factors, including the objective mechanisms after buildings collapse and the
structure and timing of disaster relief deployment [
5
,
6
]. Consequently, the data collected by medical
institutions are the main source of research data. However, hospitals in earthquake areas, especially
first-level medical institutions, are in a chaotic state after an earthquake [
1
,
4
], which leads to data
collection errors and omissions. To obtain data about earthquake trauma, many researchers can
only conduct simple, cross-sectional, and epidemiological investigations to determine the objective
influencing factors of earthquake trauma [
7
–
9
]. As for earthquake victims, the subjective influencing
factors of trauma and individual behavioral response have also been largely ignored.
In past research, post-earthquake injury evaluation and rescue management were more popular
topics than proactive plans aimed at protecting individuals [
10
–
12
]. However, as we know, pre-disaster
Int. J. Environ. Res. Public Health 2017,14, 1556; doi:10.3390/ijerph14121556 www.mdpi.com/journal/ijerph

Int. J. Environ. Res. Public Health 2017,14, 1556 2 of 10
management is always much better and efficient than post-disaster rescue for saving both people’s
lives and property. Thus, identifying the link between individual response and injury and intervening
before the disaster can help to reduce the injury or even prevent deaths.
In particular, after an earthquake, people tend to be anxious, frightened and overwhelmed [
13
–
15
].
Such types of behavioral responses may make them more vulnerable to injury. However, current
research concerning victims’ behavior is based on hospital interviews or case reports. There is no
systemic research with a large sample concentrating on earthquake victims’ individual behavior.
Precise and timely deployment of rescue forces to the most severely affected areas is commonly
addressed; however, the impact of individual behavior on emergency rescue has been neglected,
especially self- and mutual-aid efforts directly after the earthquake. Furthermore, people who live
in rural counties in China are not educated regarding well-being, especially how to help themselves
and others after an earthquake [
11
,
16
]. To what extent self-aid and mutual rescue efforts in rural
disaster-affected areas can influence the effect of emergency medical rescue is worth studying.
Consequently, determining the relationships among individual behaviors, like the relationships
among victims’ emotions after earthquake, first reaction during the earthquake, earthquake-related
experience, self- and mutual-aid, and their injury are the main purpose of our research. We also tried
to give some policy suggestions based on our results to the rescue organization after earthquake.
This research focuses on the areas in western China most affected by earthquakes. Specifically,
we investigated the aftermath of the Lushan earthquake. The six most severe earthquake-affected
townships including 26 villages were surveyed with an on-site investigation and a large amount of
injury- and rescue-related first-hand data were collected. We attempted to elucidate the relationships
among personal characteristics, injury and rescue effectiveness.
2. Methods
2.1. Study Design
The area most severely affected by earthquake was Lushan county. The six most destroyed
townships were selected, including Taiping, Shuangshi, Luyang, Baosheng, Longmen and Qingren.
Twenty-eight villages and 3 earthquake victims’ settlement camp areas were selected as the research
areas. As family members shared similar experiences as they stayed together at home, we preferred to
investigate individuals from different families to get a holistic view of the earthquake and the related
injury, which is more efficient. Two-step sampling was used in the research to avoid sampling bias.
We used random sampling method both in the first step (choosing the families) and the second step
(choosing the specific family member). With the help of Lushan county’s government, we conducted
random sampling through the census registration system. We randomly chose 5452 families, which
accounted for 33% of all families in Lushan county. Then, the family member whose birthday was
closest to the investigation day was chosen as the participant. If the selected participant did not wish
to participate for some reason, the individual with the second closest birthday participated, and so
on. This sampling method was used until we found a participant from each family. Inclusion criteria
comprised living in Lushan county for a long time, living in Lushan county during the 2013 Lushan
earthquake, and having one’s home destroyed. Earthquake victims with an intellectual disability or
communication problems were excluded.
2.2. Data Collection
Three months after the Lushan earthquake in July 2013, our research group arrived at Lushan,
Sichuan Province to conduct this research. Since researchers and native residents spoke different
dialects, nine graduate students from local universities who had bachelors’ degrees in social science
completed a three-day training course so that they would be able to administer the questionnaires
competently. The training included the research purpose, explaining consent, instrument design,
and communication skills. All students passed the test and conducted the investigation independently.

Int. J. Environ. Res. Public Health 2017,14, 1556 3 of 10
After participants provided written consent to participate, they completed the questionnaire
individually. Researchers explained any confusing questions or recorded the answers if participants
could not read. In total, 5165 participants completed the questionnaire (response rate: 94.7%). Ethical
approval was granted by the Ethics Committee of Second Military Medical University. The consent
procedure was also approved by this committee.
2.3. Instruments
The questionnaire used in this study was designed based on the “earthquake survivor
questionnaire,” created at the University of Cambridge, the UK, and Islamia College, Pakistan.
This questionnaire assesses information about earthquake injury and influencing factors during
and after an earthquake. Based on the geographic and cultural characteristics of western China,
some questionnaire items were amended and combined with earthquake emergency medical rescue
information such as timely medical treatment, medical evacuation, and rescue efficiency and effect.
After consulting experts in the emergency rescue field several times, the final edition of the “Lushan
earthquake victims” questionnaire was created. Although the questionnaire comprised six aspects,
only three were included in this research: (1) demographic information such as name, sex, education,
occupation, marriage, and so on; (2) personal behavioral characteristics such as experience with the
2008 Wenchuan earthquake, earthquake injury, earthquake evacuation training, fear level, first reaction,
whether they were trapped, and their family members’ situation; and (3) victims’ injury and treatment
including injury time, on-site medical treatment, first evacuation experience, and so on.
2.4. Data Analysis
All data were analyzed via SAS version 9.0 (SAS Institute Inc., Cary, NC, USA). We first calculated
the descriptive statistics (frequencies, percentages, means and standard deviations) to show the
basic information of the participants in the investigation.
χ2
analysis was used in analysis of all
multi-category variables. The statistical method of an M:N pair design multivariate logistic regression
was used in the multivariate analysis to determine the key factors influencing earthquake injuries.
When matched with geographic location (the earthquake-affected area), the analysis can exclude
the bias of influence of people’s traits in various geographic locations. Odds ratios (OR) and 95%
confidence intervals (CI) were used to evaluate the risk of variables. The criterion for statistical
significance was set at p= 0.05.
2.5. Ethical Statement
All subjects gave their informed consent before they participated in the study. The study was
conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics
Committee of Second Military Medical University and the ethical approval code was 2014LL015.
3. Results
Participants’ demographic details in terms of their injuries are shown in Table 1. Individuals
older than 65 years were significantly more likely to be injured. Teachers and medical staff were more
vulnerable to the earthquake than were farmers.

Int. J. Environ. Res. Public Health 2017,14, 1556 4 of 10
Table 1.
The demographic factors of Lushan earthquake victims after matching with geographic
location factors.
Without Injury (4875) Injured (290) Odds Ratios (OR)
Number (N) % N % OR 95% CI p
Age *
15–35 1101 22.58 84 28.97 1.00
35–65 3377 69.27 153 52.76 0.86 0.61 1.22 0.396
>65 397 8.14 53 18.28 2.01 1.27 3.18 0.003
Sex
Male 2396 49.15 137 47.24 1.00
Female 2479 50.85 153 52.76 1.01 0.79 1.30 0.914
Education
Above high school 813 16.68 77 26.55 1.00
Junior high school 2518 51.65 131 45.17 1.01 0.70 1.44 0.972
Below primary school 1544 31.67 82 28.28 0.67 0.45 1.01 0.055
Occupation *
Farmer 4083 83.75 202 69.66 1.00
Teacher 73 1.50 20 6.90 3.33 1.81 6.13 0.000
Government officer 48 0.98 1 0.34 0.42 0.06 3.14 0.398
Worker 218 4.47 13 4.48 1.01 0.55 1.88 0.966
Medical staff 32 0.66 10 3.45 4.35 1.88 10.08 0.001
Student 242 4.96 24 8.28 1.75 0.99 3.09 0.056
Business man 106 2.17 7 2.41 1.32 0.58 3.04 0.510
Others 73 1.50 13 4.48 1.85 0.94 3.67 0.077
Marital Status *
Single 764 15.67 67 23.10 1.00
Married 4111 84.33 223 76.90 0.90 0.63 1.28 0.549
Newton-Raphson ridge method was used for parameter optimization and evaluation. The model is matched with
geographic factors, the township location. The fitness of the model was evaluated by likelihood ratio test. * p< 0.05.
Details about participants’ individual characteristics are shown in Table 2. Earthquake-related
mental health education was lacking among the victims: only 36.73% of them received pre- and
post-earthquake mental health counseling or training. Most victims were terrified during the
earthquake. There were wide variations regarding victims’ first reactions after the earthquake occurred.
The odds of being injured increased when victims’ fear reached the two highest levels. People were
most likely to be injured if their first reaction was to stand up or run out when trapped. Figure 1shows
the time at which victims got injured. Of them, 81% were injured during the earthquake, which has
an important relationship with their first reaction. The injury risk rate increased for those who did
not experience the 2008 Wenchuan earthquake, indicating that a prior experience of earthquake may
protect victims. However, previous injury increased the percentage of those who were injured in the
Lushan earthquake by 66%. Furthermore, previously receiving earthquake evacuation training may
significantly decrease the risk rate for injury. However, there was no significant difference between
injured victims who received mental health education and those who did not.
Based on the findings of this research, self- and mutual-aid played a critical role. Figure 2shows
how trapped victims were rescued, suggesting that knowing how to help oneself and others is key to
saving lives. Furthermore, based on our investigation of rescue information, 85.26% of trapped victims
were saved within 30 min while 95% of victims were saved in less than 2 h (Figure 3). Moreover,
78.03% of victims participated in the rescue action immediately after they were saved. Figure 4shows
the result of emergency medical care for the victims in the site. Half of them did not receive emergency
medical care on site from the professional medical personnel because the local medical institutions
were destroyed. Victims had to rely on themselves for obtaining medical care.

Int. J. Environ. Res. Public Health 2017,14, 1556 5 of 10
Table 2. Personal behavioral characteristics with injury situation.
All Not Injured Injured OR
N (%) N (%) N (%) OR 95% CI p
Before the earthquake
Suffered from the Wenchuan earthquake or not *
Yes 4877 (94.42) 4621 (94.79) 256 (88.28) 1.00
No 288 (5.58) 254 (5.21) 34 (11.72) 2.11 1.41 3.17 0.000
Got injured during the earthquake or not *
Yes 195 (3.78) 167 (3.43) 28 (9.66) 1.00
No 4970 (96.22) 4708 (96.57) 262 (90.34) 0.34 0.22 0.53
<0.0001
Received earthquake evacuation training before the earthquake
happened or not *
Yes 3153 (61.05) 3015 (61.85) 138 (47.59) 1.00
No 2012 (38.95) 1860 (38.15) 152 (52.41) 1.62 1.21 2.16 0.001
During the earthquake
Fear level a(increase from 1 to 5) *
1 414 (8.02) 399 (8.18) 15 (5.17) 1.00
2 332 (6.43) 322 (6.61) 10 (3.45) 0.80 0.35 1.84 0.601
3 598 (11.58) 579 (11.88) 19 (6.55) 0.87 0.43 1.76 0.703
4 900 (17.42) 851 (17.46) 49 (16.9) 1.65 0.90 3.03 0.105
5 2639 (51.09) 2454 (50.34) 185 (63.79) 1.93 1.11 3.35 0.020
Forget 282 (5.46) 270 (5.54) 12 (4.14) 1.16 0.52 2.57 0.715
First reaction during the earthquake *
Maintain in the same place 1048 (20.29) 1001 (20.53) 47 (16.21) 1.00
Sit down 123 (2.38) 116 (2.38) 7 (2.41) 1.14 0.50 2.63 0.752
Stand up 367 (7.11) 336 (6.89) 31 (10.69) 1.96 1.21 3.17 0.006
Hidden under the desk or furniture
418 (8.09) 394 (8.08)) 24 (8.28) 1.23 0.73 2.06 0.439
Run out but trapped 329 (6.37) 267 (5.48) 62 (21.38) 4.19 2.76 6.36
<0.0001
Run out of the building 2694 (52.16) 2576 (52.84) 118 (40.69) 0.95 0.66 1.35 0.754
Others 186 (3.60) 185 (3.79) 1 (0.34) 0.11 0.02 0.82 0.031
After earthquake
Trapped after the earthquake or not *
Yes 2073 (40.14 1869 (38.34) 204 (70.34) 2.50 1.87 3.34
<0.0001
No 3092 (59.86) 3006 (61.66) 86 (29.66) 1.00
Family members got trapped or not *
Yes 540 (10.45) 390 (8.00) 150 (51.72) 13.62 10.12 18.31
<0.0001
No 4625 (89.55) 4485 (92.00) 140 (48.28) 1.00
* The model is matched with geographic factors, the township location. The fitness of the model evaluated by
likelihood ratio test. * p< 0.05.
a
Fear ranges from levels 1 to 5. Level 1 means not feeling terrified at all while Level
5 means feeling extremely terrified.
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Table2.Personalbehavioralcharacteristicswithinjurysituation.
 All NotInjured Injured OR
 N(%) N(%) N(%) OR 95%CIp
Beforetheearthquake
SufferedfromtheWenchuanearthquakeornot*
Yes4877(94.42)4621(94.79)256(88.28)1.00  
No288(5.58)254(5.21)34(11.72)2.111.413.170.000
Gotinjuredduringtheearthquakeornot*
Yes195(3.78)167(3.43)28(9.66)1.00  
No4970(96.22)4708(96.57)262(90.34)0.340.220.53<0.0001
Receivedearthquakeevacuationtrainingbeforethe
earthquakehappenedornot*
Yes3153(61.05)3015(61.85)138(47.59)1.00  
No2012(38.95)1860(38.15)152(52.41)1.621.212.160.001
Duringtheearthquake
Fearlevela(increasefrom1to5)*
1414(8.02)399(8.18)15(5.17)1.00  
2332(6.43)322(6.61)10(3.45)0.800.351.840.601
3598(11.58)579(11.88)19(6.55)0.870.431.760.703
4900(17.42)851(17.46)49(16.9)1.650.903.030.105
52639(51.09)2454(50.34)185(63.79)1.931.113.350.020
Forget282(5.46)270(5.54)12(4.14)1.160.522.570.715
Firstreactionduringtheearthquake*  
Maintaininthesameplace1048(20.29)1001(20.53)47(16.21)1.00  
Sitdown123(2.38)116(2.38)7(2.41)1.140.502.630.752
Standup367(7.11)336(6.89)31(10.69)1.961.213.170.006
Hiddenunderthedeskorfurniture418(8.09)394(8.08))24(8.28)1.230.732.060.439
Runoutbuttrapped 329(6.37)267(5.48)62(21.38)4.192.766.36<0.0001
Runoutofthebuilding 2694(52.16)2576(52.84)118(40.69)0.950.661.350.754
Others186(3.60)185(3.79)1(0.34)0.110.020.820.031
Afterearthquake
Trappedaftertheearthquakeornot*  
Yes2073(40.141869(38.34)204(70.34)2.50 1.873.34<0.0001
No3092(59.86)3006(61.66)86(29.66)1.00   
Familymembersgottrappedornot*
Yes540(10.45)390(8.00)150(51.72)13.6210.1218.31<0.0001
No4625(89.55)4485(92.00)140(48.28)1.00   
*Themodelismatchedwithgeographicfactors,thetownshiplocation.Thefitnessofthemodel
evaluatedbylikelihoodratiotest.*p<0.05.aFearrangesfromlevels1to5.Level1meansnotfeeling
terrifiedatallwhileLevel5meansfeelingextremelyterrified.

Figure1.Thetimeatwhichvictimsgotinjured.
81%
11%
4%
4%
0% Duringthemain
shock
Duringthe
aftershock
After
earthquake
Duringthe
rescue
Others
Figure 1. The time at which victims got injured.

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Basedonthefindingsofthisresearch,self‐andmutual‐aidplayedacriticalrole.Figure2shows
howtrappedvictimswererescued,suggestingthatknowinghowtohelponeselfandothersiskeyto
savinglives.Furthermore,basedonourinvestigationofrescueinformation,85.26%oftrapped
victimsweresavedwithin30minwhile95%ofvictimsweresavedinlessthan2h(Figure3).
Moreover,78.03%ofvictimsparticipatedintherescueactionimmediatelyaftertheyweresaved.
Figure4showstheresultofemergencymedicalcareforthevictimsinthesite.Halfofthemdidnot
receiveemergencymedicalcareonsitefromtheprofessionalmedicalpersonnelbecausethelocal
medicalinstitutionsweredestroyed.Victimshadtorelyonthemselvesforobtainingmedicalcare.

Figure2.Waysofgettingoutofthecollapsedbuilding.

Figure3.Timetakentogetoutofthecollapsedbuilding(hours).
82%
6%
10%
1% 1%
Self‐aid
Fromvictims
fromthesame
building
Fromfamily
members
From
professional
rescueteam
Others
85%
7%
2% 1% 1% 1% 3%
0.5h
1h
2h
2‐6h
6‐12h
morethan12h
notsure
Figure 2. Ways of getting out of the collapsed building.
Int.J.Environ.Res.PublicHealth2017,14,1556 6of10

Basedonthefindingsofthisresearch,self‐andmutual‐aidplayedacriticalrole.Figure2shows
howtrappedvictimswererescued,suggestingthatknowinghowtohelponeselfandothersiskeyto
savinglives.Furthermore,basedonourinvestigationofrescueinformation,85.26%oftrapped
victimsweresavedwithin30minwhile95%ofvictimsweresavedinlessthan2h(Figure3).
Moreover,78.03%ofvictimsparticipatedintherescueactionimmediatelyaftertheyweresaved.
Figure4showstheresultofemergencymedicalcareforthevictimsinthesite.Halfofthemdidnot
receiveemergencymedicalcareonsitefromtheprofessionalmedicalpersonnelbecausethelocal
medicalinstitutionsweredestroyed.Victimshadtorelyonthemselvesforobtainingmedicalcare.

Figure2.Waysofgettingoutofthecollapsedbuilding.

Figure3.Timetakentogetoutofthecollapsedbuilding(hours).
82%
6%
10%
1% 1%
Self‐aid
Fromvictims
fromthesame
building
Fromfamily
members
From
professional
rescueteam
Others
85%
7%
2% 1% 1% 1% 3%
0.5h
1h
2h
2‐6h
6‐12h
morethan12h
notsure
Figure 3. Time taken to get out of the collapsed building (hours).
Int.J.Environ.Res.PublicHealth2017,14,1556 7of10


Figure4.Sourceofmedicalcareinthesite.
Amongallinterviewedvictims,290wereinjuredduringtheearthquake,whichaccountsfor
10.45%ofthefamiliesinthedisasterarea.Thepercentageoffamiliesthatlostamembertodeathby
theearthquakewas1.99%.Importantly,33.98%ofthefamiliesascribedtheirrelatives’deathtotheir
severeinjurywhilemorethanhalfofthemblameditonrescuedelayduetoatrafficjamoralackof
medicalresources.Figures3and4displayinformationaboutthetimingofvictims’injuriesandwho
theyreceivedcarefrom,respectively.
4.Discussion
Onlytwodemographicfactorsintheresearchshowanassociationwithinjury.Itiseasytoaccept
thefactthatolderpeopleseemmorelikelytobeinjuredduringanearthquake.Itisinterestingthat
teachersandmedicalstaffaremorelikelytobeinjured.Basedonnewsreportsafterearthquakes,it
canbeobservedthatboththesegroupsaremorelikelytohelptheothers.Theteachersarealways
responsiblefortheirstudents’safetyandthemedicalstaffaremorelikelytostayintheseverely
destroyedareastryingtohelpothers,whichgreatlyincreasestheirpossibilityfor injury.
Ourresultsrevealedthatthereisanobviousconnectionbetweenearthquake‐relatedinjuryand
individualbehavioralcharacteristics.Intheresearch,thiskindofrelationshipismainlyreflectedin
fouraspects:therelationshipsamongvictims’emotionsafterearthquake,firstreactionduringthe
earthquake,earthquake‐relatedexperience,self‐andmutual‐aid,andtheirinjury.
Intheemotionpart,mostvictimsfeltextremelyterrifiedduringtheearthquake,whichaddedto
theriskofinjury.Extremefearmaynegativelyaffectpeople’scognitionandjudgmentduringan
earthquake.Furtherresearchshowedthatthesevictimsarealsomoresusceptibletoposttraumatic
stressdisorder,whichleadstoaninferiorqualityoflife[14,17,18].Consequently,victimsrequire
mentalhealthsupporttominimizethesenegativeeffects.Here,bymentalhealthsupport,werefer
toallthemethodstohelpearthquakevictimsindealingwiththeirmentalproblemsincluding
depressionorseverementalproblemstogetrelieffromandcurefortheirmentalproblems.
Professionalmentalhealthsupportforthevictimswhoexperiencedanearthquakeforthefirsttime
canhelpthemtodevelopahealthieremotionalfunctioningandtostartanewlifeinsteadofbeing
trappedinthestateofsadness;forthevictimswhohadpreviouslysufferedanearthquake,mental
healthcanhelpthemtogetridofitsterriblememoryanddevelopabetterreactiontofacethe
earthquakeandtheirloss.
Thefirstreactionafteranearthquakeplaysavitalroleinvictims’experienceoftrauma.As
shownintheresults,mostofthevictimsgotinjuredduringthemainearthquake.Standingup
immediatelyorrunningaroundwithoutadestinationwillincreasetheriskrateforinjury.Itis
commonlyacceptedthatvictimsshouldhideundersolidmaterialtoavoidbeinghitbyfallingobjects
(e.g.,hidingunderadeskorsolidfurnitureandprotectingone’sheadandneck).Peopleshouldnot
runarounduntiltheyaresurethattheearthquakehasstopped,andthebuildingissafe.Research
28%
16%
5%
51%
Relativesand
neighbors
Emergency
medicalrescue
team
Volunteersfrom
othercities
Withoutreceiving
medicalcareinthe
site
Figure 4. Source of medical care in the site.

Int. J. Environ. Res. Public Health 2017,14, 1556 7 of 10
Among all interviewed victims, 290 were injured during the earthquake, which accounts for
10.45% of the families in the disaster area. The percentage of families that lost a member to death by
the earthquake was 1.99%. Importantly, 33.98% of the families ascribed their relatives’ death to their
severe injury while more than half of them blamed it on rescue delay due to a traffic jam or a lack of
medical resources. Figures 3and 4display information about the timing of victims’ injuries and who
they received care from, respectively.
4. Discussion
Only two demographic factors in the research show an association with injury. It is easy to accept
the fact that older people seem more likely to be injured during an earthquake. It is interesting that
teachers and medical staff are more likely to be injured. Based on news reports after earthquakes,
it can be observed that both these groups are more likely to help the others. The teachers are always
responsible for their students’ safety and the medical staff are more likely to stay in the severely
destroyed areas trying to help others, which greatly increases their possibility for injury.
Our results revealed that there is an obvious connection between earthquake-related injury and
individual behavioral characteristics. In the research, this kind of relationship is mainly reflected in
four aspects: the relationships among victims’ emotions after earthquake, first reaction during the
earthquake, earthquake-related experience, self- and mutual-aid, and their injury.
In the emotion part, most victims felt extremely terrified during the earthquake, which added
to the risk of injury. Extreme fear may negatively affect people’s cognition and judgment during an
earthquake. Further research showed that these victims are also more susceptible to post traumatic
stress disorder, which leads to an inferior quality of life [
14
,
17
,
18
]. Consequently, victims require
mental health support to minimize these negative effects. Here, by mental health support, we refer to
all the methods to help earthquake victims in dealing with their mental problems including depression
or severe mental problems to get relief from and cure for their mental problems. Professional mental
health support for the victims who experienced an earthquake for the first time can help them to
develop a healthier emotional functioning and to start a new life instead of being trapped in the state
of sadness; for the victims who had previously suffered an earthquake, mental health can help them to
get rid of its terrible memory and develop a better reaction to face the earthquake and their loss.
The first reaction after an earthquake plays a vital role in victims’ experience of trauma. As shown
in the results, most of the victims got injured during the main earthquake. Standing up immediately or
running around without a destination will increase the risk rate for injury. It is commonly accepted
that victims should hide under solid material to avoid being hit by falling objects (e.g., hiding under
a desk or solid furniture and protecting one’s head and neck). People should not run around until
they are sure that the earthquake has stopped, and the building is safe. Research about the California
earthquake in 1979 revealed that 50% of the victims got hurt by hitting desks or doors when running
out of the house in a panic. Mahue-Giangreco [
19
] found that some victims valued their property
too much, which led to their injuries. We suggest that people should seek to protect themselves
and their families instead of their property. Research about an Armenian earthquake found that
successfully running out of an effected area is a protective factor for victims—that people should
exit buildings with a plan during an earthquake [
2
]. The results revealed that individuals’ behavior
will be greatly influenced by the earthquake’s intensity, their surroundings, and their evacuation
training, which are all associated with the risk of injury. To protect victims and decrease the injury
rate, educating individuals about earthquake rescue and evacuation exercises is of vital importance.
This will hopefully both reduce victims’ extreme fear and prevent injury by fire or falling objects
when panicking.
We also revealed that surviving a previous earthquake can protect victims from getting hurt.
However, injury during the previous earthquake increased the injury rate in the current earthquake.
Perhaps after the previous earthquake, victims were more willing to practice earthquake rescue
training and drills, which may prevent future injuries. Victims who are injured again may be able

Int. J. Environ. Res. Public Health 2017,14, 1556 8 of 10
to escape due to a physical disability or being “too afraid to move,” based on the psychological
effects of experiencing another earthquake. Consequently, victims injured in previous earthquakes
should receive mental health support directly after the earthquake. However, our results suggest that
effective planning including earthquake evacuation knowledge and psychological counseling can save
lives more efficiently. For example, in the Northridge, California earthquake, one of the most severe
earthquakes to ever strike North America, 2 in 12 families had prepared themselves with some type of
emergency evacuation plan and food. The same was true in Turkey, where families even fixed their
overhead heavy material based on the experience of the previous earthquake where many things fell
down. The government of earthquake-prone areas should conduct emergency evacuation exercises
periodically, which is the most efficient way to protect people from disasters.
Being trapped was one of the key influencing factors for injury severity. Self- and mutual-aid
plays an important role in the early time of rescue after earthquake. Being outside at the time of the
earthquake or having escaped from the collapsing structure was crucial for survival. Many buildings
were badly damaged after the Lushan earthquake. Almost half of the victims were trapped in the
earthquake and most of them were buried under the ruins. Fortunately, 94% of the victims managed to
be rescued in less than two hours. This could not have happened without the victims’ self-aid and
mutual help in a timely fashion. In the research, 82% of victims got out of the ruin by themselves while
only 1% got help from the professional rescue team. Additionally, 79% of them received medical first
aid either by themselves or from their neighbors and relatives. Such a big percentage can really change
the injury outcome and their loss. In the earthquakes in southern Italy and Mexico City, 80–90% of
the victims assisted in post-earthquake rescue. In the Armenian earthquake, 89% of the survivors
were rescued within 24 h [
20
]. Of the 130,000 persons who were injured, 14,000 were hospitalized.
The self- and mutual-aid rate was much lower in the Armenian earthquake. Consequently, its death
rate was higher than in the other earthquakes. The death and injury ratio was 0.19:1, while it was 0.01
in the Lushan earthquake found in this research. Such differences indicate how timely and efficient
on-site medical care is critical to save victims’ lives. Self-aid training is rare for the people in the rural
areas of west China. Basic medical training for the people living in earthquake-prone areas is strongly
suggested to help them cope with such disasters more appropriately, which is the most cost-efficient
way to save lives after terrible disasters.
According to the result, a low percentage of victims, especially the severely injured or trapped
ones, were rescued by the professional rescue team due to the delay in the rescue work. For these
two kinds of victims, to save time is to save their lives and only the professional rescue team including
the medical personnel can save them. Previous research has shown that deaths were 100 times higher
and injury rates were more than five times higher among trapped than non-trapped victims [
7
,
20
].
However, it is often difficult for rescue forces to reach the earthquake area, especially directly after
the earthquake when the traffic system is compromised. Consequently, most of the relief work was
conducted within a few days by unprepared local people who concentrated on rescuing people sharing
the same dwelling. The first 72 h after an earthquake are commonly recognized as the “gold time”
for emergency rescue to save lives [
21
,
22
]. Consequently, rescue organizations and deployment of
rescue teams is the key element in the earthquake emergency rescue. The number of helpers, their
location, and deployment time should be organized according to the injury map in the earthquake
area, which may reduce the casualty rate. Only in this way can we improve the efficiency and effect of
the professional rescue team after the earthquake when there is a shortage of medical resources.
5. Conclusions
This research focuses on the relationship between the impact of earthquake victims’ individual
behavior response and earthquake-related injuries, while also considering the effectiveness of
earthquake rescue measures. All data were collected through interviews with the earthquake
victims. We used a questionnaire to get first-hand information about earthquake victims’ individual
actions right after the earthquake. This study makes a significant contribution to the literature

Int. J. Environ. Res. Public Health 2017,14, 1556 9 of 10
because research about this issue is severely lacking and there is an obvious connection between
earthquake-related injury and individual behavioral characteristics. It is strongly suggested that
victims obtain mental health support from medical practitioners and the government to minimize its
negative effects. The initial reaction after an earthquake also played a vital role in victims’ trauma;
therefore, earthquake-related experience and education may prevent injuries. Self-aid and mutual help
played key roles in emergency, medical rescue efforts.
Acknowledgments:
This work was supported by the youth project of the National Natural Science Foundation
of China (71603271), Major Program of National Natural Science Foundation of China (91224005), the major
project of the National Natural Science Foundation of China (71233008), the National Natural Science Foundation
of China (71774167; 71573270), and the Joint Research Project in major disease at the Shanghai Health Service
(2013ZYJB0006).
Author Contributions:
Peng Kang, Yipeng Lv and Qiangyu Deng contributed equally to this work. Peng Kang
and Yipeng Lv conceived the idea and designed the study. Peng Kang, Yipeng Lv, Qiangyu Deng, Yuan Liu,
Yi Zhang, Xu Liu and Lulu Zhang collected the data. Peng Kang and Yipeng Lv drafted the manuscript. All authors
critically revised the manuscript for important intellectual content. All authors have read and approved the final
version of the manuscript.
Conflicts of Interest: The authors declare no conflict of interest.
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2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access
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