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Background: Critical analysis of shortcomings of emergency medical management of earthquake casualties will provide an invaluable insight to improve outcomes for future events. Using a critical analysis methodology to evaluate the quality of emergency medical management after Bam earthquake, we suggest a practical strategic approach to decrease morbidity and mortality after such events., Methods: We designed a questioner to register the basic demographic data and the key biologic parameters of all rescued victims arriving in hospitals. Based on that questioner a data bank was created and used for different analyses. In addition, published official reports and on the scene observations of our nephrologist colleagues were other sources of our data., Results: Bam earthquake was publicly announced more than six hours after its occurrence. The earliest time when local and international rescue teams arrived at the scene was 12 hours after the disaster. Fifty-four percent of hospital inpatients had been admitted on the second or third day after the earthquake. The mean time of being under the rubble was 4.8+/-4.9 hours. The mean time between extrication and initiation of intravenous fluid infusion was 18.9 hours (min: 10 minutes, max: 96 hours)., Conclusion: Problems encountered in the aftermath of the Bam earthquake were related to the lack of prepared action plan and data management system. Here, we present a specifically designed earthquake chart. By following the chart, rescue paramedic personnel and emergency medical teams will be able to recognize high-risk victims, in order to provide timely medical management.