Earthquakes. Earthquakes induce a high level of mortality due to crush injuries from falling objects. The greatest risk of injury from an earthquake is either indoors or in close proximity to buildings and other structures. The risk of injury in open areas such as fields or in the countryside is very low. Furthermore, injury severity is inversely related to the distance from the epicentre of the earthquake. Injuries and deaths are generally increased with the magnitude of the earthquake, increased ground motion, and structural damage. If an earthquake occurs at night, there is a greater incidence of trauma to the pelvis, thorax, and spine. This is because most victims are lying down in bed at the time of the disaster. These injuries commonly lead to severe damage to internal organs coinciding with severe internal bleeding. If the earthquake occurs during the daytime, it is more common to See: Injuries of the extremities with comorbid lacerations, severe external bleeding, and crush injuries including rhabdomyolysis and compartment syndrome. Additionally, since most victims are standing or sitting down, most injuries during a diurnal earthquake occur to the skull and the collarbone because of falling debris. Victims that have been trapped in fallen rubble for hours or possibly days run the risk of having infected wounds and/or gangrene. Common trauma procedures that need to be urgently addressed include amputations, vascular stabilisation, faciotomies, orthopedic stabilisation, and debridement and/or dressing of severe open wounds. It is important to note that patients who suffer from crush injuries also run a high risk of developing hypovolemic shock, hyperkalemia, renal failure, and have a greater chance of having a fatal cardiac arrhythmia or myocardial infarct. While most of the trauma in an earthquake is a direct result of falling debris or collapsing structures, fire is another major concern within the first 'golden' 24 hours after the disaster. Depending on the size and extent of the fires, burn injuries, as well as respiratory problems due to smoke inhalation can quickly become a major strain on the medical system after an earthquake.