Earthquakes and ruins: How does an USAR rescuer operates? – Brief interview to Nicola Bortoli

bortoli_terremotoNicola Bortoli is an Italian USAR rescue professional and his curriculum is rich of many medical
fields skills, such as healthcare, fire fighting and mountain rescue. He is a surgeon with anesthetic and resuscitation qualifications, and he is member of the Italian Red Cross Military Corps. Bortoli has been one of the first rescuers arrived in Amatrice – town of Central Italy hit by the recent earthquake of August 2016.

Now, after a few days from that mission, when many people have been saved – among them, the little Giorgia, symbol of hope for people of those areas – we appreciate to discuss some aspects of rescue during catastrophes and USAR. Nicola explains us these arguments precisely. Advices and considerations made by Dr. Bortoli could be helpful also in case of other catastrophes.

We always need silence during earthquakes in order to localize victims beneath ruins. In this cases, how do rescuers communicate?

Members of our crew are always equipped with two-way radios. There are various radio links in order to guarantee communication flows which allow to speak without screaming. We have to bear in mind, though, that during digging procedures we use noisy instruments, such as pneumatic drills, chainsaws or tools like those. During the first hours, there are many volunteers and rescuers on place, who are not trained in USAR operations. So, when we need silence, we use codified sounds to force the silence and, if these signals cannot be recognize by everyone, we use vocal communication.

When an injured occurs, which protocol and which method do you use for a triage?

Usually, we use a SIEVE/SORT protocol. Among ruins, when the possibilities of rescue are limited to a single injured, we do not make triage. We make a head-to-toe physical examination and we assign a health care code according to the clinical situation of the patient.

Team: in the case of Giorgia, we saw that many different rescue crews involved (Firefighters – Police – Mountain Rescue). How were the crews organized?

There is a specific rescue team in each area. From that moment on, that crew manages the area. In case of need or availability of more rescuers, other operators will be at disposition of the chief who manages the area. Anyway, the integration and cooperation in these scenarios is at best. The very last objective is rescue victims.

unicinofilaWhich technologies had been the most useful during this emergency?

In this scenario, the canine search had been fundamental. On the scenario of the ruins, in particular during the first days, we used simple instruments, such as shovels, pickaxes and portable instruments supplied with battery or with little portable power generators. Plus the common equipment, which have to be compact and portable, we used intraosseous access with satisfaction and, where it was possible, we used foldable stretchers, because the working areas were inaccessible for emergency vehicles.

PTSD: this is a difficult argument to discuss, but many rescuers risk to suffer this disease after an earthquake like this. How can you deal with it? What do you suggest to other rescuers?

In this situation I saw a great number of psychologists and helpful groups. Surely, the presence of specialists is helpful to deal with this situation. Belonging to an attached group like ours and the capacity to discuss suddenly about what happens, helps very much. When the team is tight, its members can easily talk, discuss and confide to each other. I believe it is a successful option:  planning the intervention with operators who shared training and rescue operations. In the end, this behavior repays and guarantees a harmony which is difficult to improvise.

De-briefing: is there some element which you underlined during de-briefing, which could help you to improve the future management of emergency situations?

The official debriefing has to be organized, because we are finishing the first phase of rescue just now. I will make you know if there will be something interesting for the readers.

I hope to write an article about this experience soon.