title: Post-preparedness medical disaster response in Costa Rica.
abstract: BACKGROUND
  The 1991 earthquake in the Limón area of Costa Rica presented the opportunity to examine the effectiveness of a decade of disaster preparedness.
  
  
  OBJECTIVE
  Costa Rica's concentrated work in disaster preparedness would result in significantly better management of the disaster response than was evident in earlier disasters in Guatemala and Nicaragua, where disaster preparedness largely was absent.
  
  
  METHODS
  Structured interviews with disaster responders in and outside of government, and with victims and victims' neighbors. Clinical and epidemiologic data were collected through provider agencies and the coroner's office.
  
  
  RESULTS
  Medical aspects of the disaster response were effective and well-managed through a network of clinic-based radio communications. Nonmedical aspects showed confusion resulting from: 1) poor government understanding of the roles and responsibilities of the central disaster coordinating agency; and 2) poor extension of disaster preparedness activities to the rural area that was affected by the earthquake.
  
  
  CONCLUSIONS
  To be effective, disaster preparedness activities need to include all levels of government and rural, as well as urban, populations.
authors.affiliation: University of Maryland, National Study Center for Trauma and EMS 21201-1023, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Bissell
authors.forename: E
authors.initials: E
authors.lastname: Pretto
authors.forename: D C
authors.initials: DC
authors.lastname: Angus
authors.forename: B
authors.initials: B
authors.lastname: Shen
authors.forename: V
authors.initials: V
authors.lastname: Ruíz
authors.forename: N
authors.initials: N
authors.lastname: Ceciliano
authors.forename: R
authors.initials: R
authors.lastname: Sawyers
authors.forename: D
authors.initials: D
authors.lastname: Shurtleff
authors.forename: J
authors.initials: J
authors.lastname: Abrams
mesh_terms: D003364:Costa Rica / Q000453:epidemiology; D004189:Disaster Planning / Q000458:organization & administration*; D004190:Disasters; D006166:Guatemala / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D009527:Nicaragua / Q000453:epidemiology; D011159:Population Surveillance; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology