In this issue’s cover photograph (reproduced below), Bruno P. Petinaux, MD (left), and Anthony Macintyre, MD (right), evaluate and treat a victim just extricated after more than 2 days trapped in rubble from the 2010 Haiti earthquake. The physicians are members of the Fairfax County (Virginia) Urban Search and Rescue Task Force. The task force is sponsored by the US Agency for International Development/Office of US Foreign Disaster Assistance to respond to international disasters as USA-1.Figure 1

FIGURE 1

The task force is multidisciplinary in nature, including rescue technicians, search personnel and canines, structural engineers, and logisticians. The medical team consists of physicians and paramedics trained and equipped to enter collapsed structures and initiate patient evaluation and treatment during the extrication process. In some cases, the extrication interval can extend over many hours and require patient stabilization, sophisticated pain control, and advanced immobilization and extrication techniques. Medical care in this austere, confined-space environment is complicated by poor access to the patient, difficulties in maneuvering to deliver therapy, and hazards that create risk for the patient and rescuers.Figure 2

FIGURE 2

A question that is frequently raised after earthquakes and other collapsed-structure incidents is how long can individuals survive entombed in rubble? This important question strongly influences many of the management decisions that direct actions and allocate resources. Reports in the literature suggest that lengthy survival is possible but uncertain. Rather than accepting a universal time constant for survival, authors in this issue of the journal promote a decision-support strategy that is incident and situation specific and supported by medical science and response experience.

Cover photo by Lt Mark Stone. Address correspondence and photo reprint requests to Dr Anthony Macintyre, Department of Emergency Medicine, The George Washington University, 2150 Pennsylvania Ave NW, Washington, DC 20037 (e-mail: amacintyre@mfa.gwu.edu).

Get your photograph of a disaster event/response effort considered for the cover of Disaster Medicine and Public Health Preparedness. See the Instructions for Authors at www.dmphp.org for details.