A Terrible Choice

US search and rescue teams from Virginia, California, and Florida arrived in an earthquake-devastated Haiti this week. News reports showed many major buildings in Port Au Prince were destroyed - killing thousands (some say more) and trapping hundreds, maybe thousand of people alive in the rubble. For those trapped, time is of the essence, within days many will die of dehydration or from their untreated injuries.

So how do emergency rescue team select what buildings to go to first? With so many people in need, this is a terrible choice.

To learn about this, I did some searching this morning and found "NFPA 1670, Standard on Operations and Training for Technical Search and Rescue Incidents," "UNDAC 2006 H. Urban Search and Rescue" and finally, from the UNITED NATION OFFICE FOR THE COORDINATION OF HUMANITARIAN AFFAIRS Field Coordination Support Section (INSARAG Secretariat), the INSARAG GUIDELINES AND METHODOLOGY, or more simply, the INSARAG Guidelines.

In the Guidelines it tells us

WORK-SITE TRIAGE is the process of prioritising work-sites in order to save as many lives as possible. In some cases the order of priority is obvious from the number of people missing in each building. When the order of priority is not obvious a systematic procedure of categorizing work-sites based on an estimation of voids, an evaluation of stability and available information on missing persons can be applied to facilitate the decision-making process.

That's pretty straightforward. Go to the buildings where you can save as many lives as possible. It then gives guidance on prioritization and the factors to consider.

F11.4 Operations
1. A work-site triage is based on the following five steps:
1) ZONE: Determine the zone that the triage should cover. Mobility of the assessment team performing the triage is a determining factor;
2) COLLAPSE: Identify as potential work-sites all totally and partially collapsed structures within the designated zone;
3) INFORMATION: Collect information from locals that may eliminate potential work-sites or affect the work-site triage in some way, such as available information on missing persons, structural information (use, layout, size, material, construction type, etc.) and prior search and rescue attempts.
4) CATEGORIZE: Determine the category of each potential work-site. Triage Categories and Triage Factors are listed below
5) PRIORITIZE: Based on the missing-persons information, triage category and access to priority voids determine the order of priority for the work-sites.

2. Many other factors may eventually affect the final order of priority, such as:
2.1. Lack of necessary transport or access to site;
2.2. Lack of specialised equipment to mitigate hazards;
2.3. Security and cultural factors;
2.4. Age of victims (for example a school vs. an old people’s home);
2.5. Priorities set by LEMA;
2.6. Aftershocks.

It gives the triage categories with the highest priority going to live victims where the collapsed building are not in extreme instability. I get that. Rescue people, leave the bodies for later. But my question is still -"How do rescue teams prioritize among the living victims?" Everything in the literature seems to indicate that resuce team should go to where the number of trapped victims is highest. Rescue the most living people.

So quantity, number of lives, is one priority.

Item 2.4 above, in case you missed it, gives another priority: Young people should be rescued before old people. (Wow...only in a UN document)
Item 2.5 above, tells us to look for the priorities set by the local emergency management authority. I'm not sure how much help that is here, becuase I read several reports stating that local authorities disappeared (or just as likely, were dead).

Watching a rescue on Thursday, live on CNN, showed the reality of where international rescuers go first. The collapsed UN building.

This shows us the reality of the priority of rescue.
Number of lives (save more)
Age of living victims (save younger)
United Nations employees (save government workers)

As I said, a terrible choice.