Survival and Cost Analysis of Fatalities of the Kobe Earthquake in Japan

Noriaki Aoki, Akiyoshi Nishimura, Ernesto A. Pretto, Katsuhiko Sugimoto, J. Robert Beck, Tsuguya Fukui

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objectives. 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. 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 $2 million annually could be a reasonable expenditure to achieve the goal of reducing preventable deaths in disasters.

Original languageEnglish (US)
Pages (from-to)217-222
Number of pages6
JournalPrehospital Emergency Care
Issue number2
StatePublished - 2004


  • Cost
  • Disaster preparedness
  • Earthquake
  • Japan
  • Natural disasters

ASJC Scopus subject areas

  • Emergency Medicine


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