To be truly effective, earthquake hazard reduction measures must be based on a realistic appraisal of occupants' capabilities and actions during earthquakes. Studies suggest that many overly general beliefs about appropriate response can endanger rather than protect building occupants. We need to analyze occupant actions with respect to hazards posed by the seismic performance of specific building types. This paper will review the findings of recent U.S. studies, discuss the applicability of research from abroad, and summarize requirements for continued progress in this vital research area.

In the Imperial County, California, earthquake of 15th October 1979, the Imperial County Services Building was seriously damaged — and has subsequently been demolished. At the time of the earthquake there were approximately 123 occupants in the six‐storey reinforced concrete building which housed a number of county service departments. This paper investigates occupant behavior in a building subjected to an earthquake, and describes, in detail, what people do during and immediately subsequent to the shock.

Current earthquake casualty reduction measures are examined and recommendations made for needed changes. Key new approaches are outlined and a new framework for understanding casualty reduction measures presented. The framework considers both issues of demand for medical services and supply within primary, secondary and tertiary prevention aspects of each. It is used to assess current measures against recent empirical data and to suggest changes that incorporate new data and methods. Issues include the management of emergency medical services, messages for individual protective actions and assumptions about the nature of injuries. Research has tended to consider primarily the demand side of earthquake injury prevention, focusing on the injured rather than the uninjured. Case series investigations have tended to be descriptive rather than analytical and be undertaken from a clinical rather than an epidemiological perspective, documenting medical aspects of earthquake injuries. Linking these injuries to the risk factors associated with them has not been as systematically studied. Proposed here is an approach for casualty reduction research to fill knowledge gaps. It includes steps to integrate future casualty data and assessment efforts into casualty modeling and into ongoing earthquake policy formation.

The Santa Cruz County 9-1-1 emergency response system was taxed severely with over 1,000 calls during the first seven hours following the Loma Prieta earthquake. It remained functional and responsive, making 229 ambulance runs in the 72-hour period following the earthquake. Initially, the demand was very high compared to normal, but decreased to slightly greater than normal levels during the second day. A fewer than normal number of advanced life support transports were required, and the number of vehicular accident cases were fewer than normal following the earthquake. The 9-1-1 center adopted an abbreviated procedure and only attempted to determine if the call was a medical emergency and the location for dispatch. During the initial emergency period, there were an unusually low proportion of transports and an unusually high number of cases in which the patient was not located. The medical system in Santa Cruz County was able to accommodate the injury load: the health care system was extensive; its three community hospitals were not damaged severely; and there was light demand.Based on this experience, a revised 9-1-1 emergency medical services (EMS) procedure is recommended for disaster periods: 1) the dispatcher inquires whether the patient can be transported by other means; 2) the caller is asked to explain the need for an ambulance in order to assign a priority to the request; and 3) the caller is asked to cancel the call if there no longer is a need. This procedure is expected to improve disaster management of limited ambulance resources during and following a disaster, while maintaining rapid call processing.

The San Salvador earthquake caused a relatively large number of casualties. Perhaps one-third of the fatalities occurred in engineered structures. Structural collapse, nonstructural elements, occupant actions, fire, and soil failure all played a role in earthquake injuries. The collapse of several multistory buildings necessitated heavy rescue operations by local authorities, foreign experts, and volunteers. This experience revealed the need for better coordination of such efforts in future disasters. Earthquake damage significantly disrupted local health services, causing evacuation of all major hospitals. Health care continues in temporary facilities. Future health service decentralization is a possible positive outcome.