The south Manchester Accident Rescue Team and the earthquake in Iran, June 1990.
Authors: A D Redmond, S Watson, P Nightingale
Journal: BMJ (1991)

BMJ 1991;302:1521-3 On the night of 20 June 1990 an earthquake struck the northwestern provinces of Iran. The huge scale of the disaster was apparent immediately?it was thought to be at least similar to that of Armenia in December 1988. The South Manchester Accident Rescue Team (SMART) was included as part of the aid package offered by the disaster unit of the Overseas Develop? ment Administration on behalf of the United Kingdom. The dispatch of the team and its equipment was delayed when the Red Cross in Geneva stated that foreign medical aid was not required. Clarification was sought by the disaster unit from the British interests section of the Swedish Embassy in Tehran. The response to a telex from the Fontmell Group on Disaster Relief to the head of the United Nations Disaster Relief Organisation (UNDRO), however, was confirmation that the ministry of foreign affairs in Tehran was ready to receive the team. We made our own travel arrangements, and the account was settled by the Overseas Development Administration. Although we had been ready to go 12 hours after the earthquake, we left for Tehran on Tuesday 26 June. The pooled experience of the team already encom? passed the Bradford fire, the Air India disaster, the Manchester Airport fire, the gas explosion at Chelubynsk in the Soviet Union, the Armenian earth? quake, and the Lockerbie air disaster.13 To meet its local responsibilities the team has identified suitable doctors and nurses and trained them in disaster management. Members are well known to each other, and the social cohesiveness of the group is essential to its success. The team selected for Iran included four women, three of whom were nurses. They wore Islamic dress throughout the stay, starting when we boarded the Iran Air flight in London. The medical specialties represented were accident and emergency medicine, general surgery, plastic and reconstructive surgery, anaesthetics, and intensive care. The experiences of Armenia and Chelubynsk have enabled the team to identify the essential equipment for this work and the quantities required and the whereabouts of the equipment within the South Manchester Health Authority. Requisition numbers have been listed and circulated to relevant departments. One phone call to the duty stores manager activates the mobilisation of our equipment. A similar process secures the personal medical kits and drugs from the pharmacy department. Such a system ensures that our equipment and supplies are part of district supplies and therefore constantly turned over. Products will not expire on the shelf between trips, nor will resources be wasted by lying unused. This is important: there is no budget for this work. If another country asks for help and the foreign office agrees then the cost is refunded in full, but there is no money   for preparation, which must be funded from within existing resources. The same applies to preparing for disasters at home. SMART is a registered charity. We assume the host country has nothing, not even basic dressings, and that international medical aid will not make it to the front line in time?and not at all unless accompanied all the way by doctors who can use it. It was policy at that time for SMART to send a 10 person team to work five days continuously on site, excluding rest and travel, with equipment for treating up to 100 patients. The team is self sufficient in food, water, surgical equipment, dressings, and drugs. The travel to the scene is tiring and the work is stressful. After five days on scene exhaustion, both mental and physical, will be established. This will reduce the effectiveness of the team and increase the risk to the patients who they have come to treat. It is extremely difficult to turn your back on large scale suffering and a strict rule to disengage after five days must be accepted by the team before leaving Britain. After appropriate rest the team is fit to return to its NHS work. A series of