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Hope for the Best, Expect the Worst

Ballard, Dustin MD

doi: 10.1097/01.EEM.0000411391.83018.3f
Screened and Examined
Some 182 people died in the Christchurch earthquake in 2011

Some 182 people died in the Christchurch earthquake in 2011



For many of us, “disasters” are unexpected daily travails — a missed connecting flight, a blown hot water heater on the day the in-laws arrive, or, worst of all perhaps, the DVR failing to record Game of Thrones.

Unfortunate events all but trivial compared with true disasters like Hurricane Katrina. Actual disasters are quite common across the world, but experiencing one (thankfully) is rather rare. I recall personal involvement with just one in my lifetime — the 1989 San Francisco (Loma Prieta) earthquake.

Such infrequency makes it easy to become complacent about potential threats lurking in our environment, namely floods, fires, and quakes. This is true even among first responders (like us). After all, it's difficult to maintain focused preparation for an event that may never happen, and if it does, it will likely be with little warning anyway. As Kevin J. Kitka, DO, an emergency physician in Joplin, MO, the site of the region's recent tornado, wrote, “You never know that it will be the most important day of your life until the day is over.”

Most of us have become conditioned to cope with the inherent possibility of natural disaster in the environment around us. Here in the San Francisco Bay Area, we take comfort in strict building codes and governmental readiness on the local and state level. But while complacency is comfortable, it can be dangerous. Consider, for example, what happened last year in Christchurch, New Zealand.

“One minute we were sitting [and] contemplating a gentle walk to the Art Gallery,” writes Dr. Elizabeth Mowat, who was visiting Christchurch from England this past February. “[The] next minute the immense glass front of the hotel was looming precariously toward us then crashing down around us with nowhere to hide!”

Another witness wrote, “I was talking on Skype one minute, and the next the screen went blank and computers were crashing onto the ground all around me. I ran to the doorway, but the floor was shaking so much I couldn't stand, so I just got down into the fetal position and started praying.”

The 6.3 earthquake killed 182 people, and caused major infrastructure damage, leaving areas of the city virtually uninhabitable. It was a minor tremor on the devastation scale compared with what happened in Japan and Haiti but nonetheless crushing to Kiwis, especially because it seemed like they had a handle on earthquake preparedness. Christchurch had, after all, survived a larger quake (7.1) in September 2010 with no causalities, and the city's building codes, EMS response strategy, and public education programs have served as a model for other fault-centric locales.

Take, for example, their long-running quake preparedness TV commercial focused on “Fix. Fasten. Forget.” The ad starred two comic characters who just couldn't seem to figure out proper safety procedures (like fastening the water heater). One shows a Kiwi version of Beavis and Butthead, but the message nonetheless seems to have resonated with more than 90 percent of surveyed residents who recalled it.

Despite all this, why did Christchurch suffer so horribly? Mostly, it was bad luck. The quake struck midday when many people were out and about, it occurred along a rather obscure fault (one not thought to be high risk), and it caused significant ground liquefaction (similar to what happened to the San Francisco marina in 1989). It was thought that any cataclysmic earthquake in Canterbury (the region on the South Island where Christchurch is located) would radiate out from the Great Alpine Fault.

Yet both recent quakes occurred along other faults and in highly populated areas that were not fully prepared. Helen Clark, the former prime minister of New Zealand, acknowledged this not long after the quake. “Clearly the level of building resilience in Christchurch was not up to, in every case, dealing with this shallow and quite severe shock,” she said. “I guess it will be back to the textbooks now to see what further work needs to be done to really ramp up New Zealand's resilience.”

What lessons can we take from the Christchurch experience? In a seismically active region, expect the unexpected, and realize that you may not be as secure as you suppose. “The 182 deaths resulting from this relatively small magnitude event [Christchurch] should heighten public awareness of the need to get ready for the much larger quake that is expected in the Bay Area in coming years,” said Jason Eberhart-Phillips, MD, a public health officer for Marin County.

A few minutes of preparation now will serve us well in an actual disaster. This is good advice not only for our patients but for ourselves. A great place to start is with a simple family disaster plan and disaster supplies. The Red Cross also has an excellent supply checklist ( that includes basics like nonperishable food, flashlights, and diapers for three days. And, as a Christchurch witness stated, “Have plenty of bottled water. When it stops coming out of the tap, it is not nice to consider the consequences.”

Other sensible additions include medications (a week's supply), extra batteries, cash, and a crank radio. Keeping your car's gas tank half-full at all times and having a backup (nonelectrical) charging mechanism for your phone are other practical tips. Day-to-day disasters will still occur, and in times of need, having a backup DVR can make an awful lot of sense.

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Dr. Ballardis an associate emergency physician at Kaiser-Permanente in San Rafael, CA, and the chair of the CREST ED Research Network. His writing credits include co-authorship with Angela Ballard of the award-winning travel narrative A Blistered Kind of Love: One Couple's Trial by Trail (Mountaineers Books, 2003) and authorship of The Bullet's Yaw (IUniverse, 2007). Dr. Ballard writes a biweekly-medical column for the Marin Independent Journal, which he posts on his blog:

© 2012 Lippincott Williams & Wilkins, Inc.