Clean and Clear on Khao Lak Beach

A flag hangs limply on its bamboo pole. "Clean and Clear" are printed on it. A search and rescue team planted the flag on this Asian beach six months earlier, and the area looks not much different than it did then.

The "clean and clear" designation is in name only- occasional bodies are still being found. Col. Khemmarin Hassiri of the Thai Tsunami Victim Identification Center in Takua Pa believes there are hundreds still missing. ¹

The beachside is bulldozed and wide open. The remains of resorts are in view. Thousands of foreign tourists were vacationing here when the tsunami came and swept them and everything else away.

Memorials to victims can be seen around the area. One picture tacked to a palm tree remembers a child named Saga Kalm. The picture on another tree is of a Sophia Stuermer. Loved ones of tsunami victims set up the beachside memorials. They represent a call to action for the international community to work to improve emergency medical services here and throughout Asia.

Organizations such as the Association of Southeast Asian Nations (ASEAN), the World Health Organization (WHO) and the United Nations Educational, Scientific and Cultural Organization (UNESCO) are leading the way for improvement. ^2-4 One of the goals is to "reduce avoidable mortality [during disasters]." ³ To do this, the locals here need a better EMS and disaster-response system.

The need is urgent, especially with another tsunami feared imminent. ^4,5 This call for action means applying lessons learned from the 2004 disaster. In this article, we will review the tsunami's destruction, the EMS response and how to act on the lessons learned.

THE TSUNAMI
When the 9.0-magnitude earthquake occurred last December in the Indian Ocean, it generated a huge tsunami that struck surrounding countries, killing more than 200,000 people and injuring hundreds of thousands more.

Wave heights varied. In parts of northern Sumatra, they approached 80-90 feet. ^6,7 In Khao Lak (Takua Pa, Phangnga,Thailand), they were up to 35. ⁸ The enormity of those waves is evident when you see a Royal Thai Navy vessel carried more than a mile inland. Resorts and small structures near the beach were simply washed out to sea. Other resorts crumpled. Another 80 miles south in Phuket, the waves weren't as high, yet 279 people were killed and close to 3,000 injured.

Vacationing American health professional Mark Oberle, MD, was in Phuket when the tsunami struck. "In the first two hours," he says, "if you couldn't get up to the second floor, you would not survive, because of the still-incoming waves." ⁹

The injured thousands who managed to escape the initial onslaught faced new problems. First responders could not reach the scene. Fallen trees, debris, ships, vehicles and bodies blocked the road. Oberle taught a crash course on bleeding control to a group of volunteers in his hotel lobby. ⁹

In Khao Lak, one stretch of Highway 4 was covered in five feet of mud and debris. Many walking wounded were able to make their way to the hospital, but trauma victims were not. Telecommunications were severely damaged, crippling needs-assessment efforts and leaving local EMS on their own.

I belong to the Emergency Medical Reserve (EMR) team of Raksakon Hospital in Sakornakon. When our team leader, Dr. Kittisarapong, tried to find out if our team was needed, he could not make contact because of the damaged telecommunications network. With communications down, EMS turned to the media to receive information necessary to make response decisions.

According to Dr. Tunakorn Pongwant of Vachira Hospital, "Even though [Patong Beach, Phuket] is only 20 minutes away, it took three hours before victims started to arrive at the hospital." Czech fashion model Petra Nemcova received a pelvic fracture and clung to a tree for nearly eight hours before being rescued. ¹⁰ Others died who would have lived if rescuers had arrived sooner. ¹¹ As IBM's Worldwide Crisis Response Team Manager, Brent Woolworth, summed it up, "If you can't call for help, you can't get help." ¹²