title: Survival and cost analysis of fatalities of the Kobe earthquake in Japan.
abstract: OBJECTIVE
  The authors investigated the dying patterns, and cause and preventability of deaths in a major earthquake disaster, and estimated the cost needed to enhance emergency medical services (EMS) response to prevent "unnecessary" deaths.
  
  
  METHODS
  The authors reviewed autopsy data in the Hanshin-Awaji (Kobe) earthquake of 1995. A survival analysis was performed to determine the time course and pattern of dying of these deaths. A cost analysis to estimate acceptable cost for EMS to reduce fatalities was also performed. Potentially salvageable life-years based on expected life-years among fatalities were calculated and used to simulate an acceptable cost for an enhanced EMS disaster response.
  
  
  RESULTS
  The authors analyzed 5,411 fatalities. More than 80% of these patients died within three hours. There were statistically significant differences in survival/dying patterns among causes of death. Thirteen percent of victims experienced a protracted death, which could have been prevented with earlier medical or surgical intervention. The monetary cost of these lost lives was estimated at approximately 600 million US dollars.
  
  
  CONCLUSIONS
  Survival analysis revealed a significant population of potentially salvageable patients if more timely and appropriate medical intervention had been available immediately after the earthquake. Based on our cost analysis, and assuming a 1% annual probability of an earthquake and a 30% enhanced lifesaving capability of the EMS effort, approximately $ million dollars annually could be a reasonable expenditure to achieve the goal of reducing preventable deaths in disasters.
authors.affiliation: School of Health Information Sciences, University of Texas Health Science Center-Houston, Houston, Texas 77030, USA. noriaki.aoki@uth.tmc.edu
authors.forename: Noriaki
authors.initials: N
authors.lastname: Aoki
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Nishimura
authors.forename: Ernesto A
authors.initials: EA
authors.lastname: Pretto
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Sugimoto
authors.forename: J Robert
authors.initials: JR
authors.lastname: Beck
authors.forename: Tsuguya
authors.initials: T
authors.lastname: Fukui
mesh_terms: D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004189:Disaster Planning / Q000191:economics* / Q000379:methods; D004190:Disasters / Q000191:economics / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000191:economics* / Q000379:methods; D006801:Humans; D007564:Japan / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality*