2020 Ege Denizi - Ýzmir depremi sonrasý acil servis yönetimi

AMAÇ: 30 Ekim 2020’de meydana gelen depremin yýkýcý özellikleri ile hem hastane öncesi hem de pandemi yoðunluðu yaþayan hastane ve acil servis organizasyonu hakkýnda bildirim yaparak afet yönetimi konusunda güncel bir kaynak saðlamak için bu çalýþma yapýldý.
GEREÇ VE YÖNTEM: Bu çalýþma çok merkezli, kesitsel geriye dönük olarak 2020 Ege Denizi - Ýzmir depreminden etkilenen olgular üzerinde ger-çekleþti. Deprem bölgesinde yer alan iki hastane ile ambulans servisi verileri deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilme kriterlerine uygun 313 (%60.4’ü kadýn) hasta alýndý. En küçüðü altý aylýk bebek, en büyüðü 91 yaþýnda olmak üzere çalýþmaya katýlanlarýn yaþ ortalamasý 38.0±21.0 olarak saptandý. Depremden etkilenenlerin %41.5’inin ilk üç saat içinde acil servislere geldiði ve ilk saatlerde en fazla sarý triyaj kodlu hastalarýn olduðu saptandý. Göçük altýndan kurtarýlan hastalar deðerlendirildiðinde %35.2’si sað olarak taburcu edildi. Göçük altýndan 24 saat sonra sað kurtarýlarak taburcu edilen toplam dört hasta (üçü 48 saatten fazla olmak üzere- en uzun göçük altýnda kalma süresi 91 saat) vardý. Acil servislere geldiðinde sað olan hastalarýn 32’sinde (%15.9) rabdomiyoliz olduðu, dört (%1.9) hastaya akut böbrek yetersizliðine baðlý acil serviste hemodiyaliz yapýldýðý, sekiz (%3.8) hastaya fasyotomi ve amputasyon gibi diðer acil operasyonlara alýndýðý saptandý. Olay yerinde, hastane öncesi ve hastane sonrasý toplam 122 hastanýn öldüðü 191 hastanýn da hastanelerden taburcu edildiði saptandý. Acil servisten 139 hasta taburcu olduðu, 15 hastanýn yoðun bakým yatýþý, 41 hastaya servis yatýþý verildiði 112 hastanýn ilk deðerlendirme sonrasý doðrudan morglara alýndýðý saptandý. Ýzmir depreminde 500’den fazla bina aðýr hasar aldý ancak ölümlerin çoðunluðu birbirine çok yakýn lokalizasyonda olan çok katlý dokuz binanýn yýkýlmasý sonrasý olduðu saptandý.
TARTIÞMA: Deprem gibi yýkýcý bir felaketin ardýndan yaþanýlan ilk saatler, hem arama-kurtarma hem de acil týp sistemi için çok önemlidir. Acil servis-ler deprem gibi afet durumlarý için doðru kayýt, doðru veri giriþi, doðru triyaj, yeterli kaynak, yeterli ekip, yeterli ekipman sayýsý ile yeterli tedavi alanlarý konusunda hazýr olmalý, afet konusunda yeterli eðitim verilmeli, uygulanabilir afet yardým planlarý hazýrlanmalý ve düzenli tatbikatlar yapýlmalýdýr.

Emergency department management after the 2020 Aegean Sea - Izmir earthquake

BACKGROUND: This article aims to provide an up-to-date resource on disaster management by reporting about the destructive fea-tures of the earthquake that occurred on October 30, 2020, and about the hospital and emergency service organization during a pandemic.
METHODS: This study was carried out with a multicentered, cross-sectional retrospective design on the victims of the 2020 Aegean Sea - Izmir earthquake. Local ethics committee approval was obtained. The data obtained by obtaining permission from two hospitals and ambulance services (transport data) located in the region where earthquake-related destruction was most prominent were evalu-ated. Patient data including demographic data, time of arrival to the emergency department, duration of stay under the debris, triage codes (green: not urgent, slightly injured; yellow: may be delayed, injured; red: critically injured; and black: dead), type of injuries, dura-tion of stay in the emergency department, crush syndrome, rhabdomyolysis, need for invasive procedures (e.g., surgery and dialysis), intensive care admission, hospital admission, and discharge were evaluated.
RESULTS: In total, 313 patients (60.4% females) were included in the study according to the inclusion criteria. The mean age of the participants was 38.0±21.0 years, with the youngest being a 6-month-old baby and the oldest a 91-year-old individual. Approximately 41.5% of the earthquake victims presented to the emergency department within the first 3 h of the earthquake, and patients with yellow triage code were the most common in the 1st h. Further, 35.2% of the patients who were rescued from under the debris were discharged alive. Four patients were discharged alive after being rescued from under the debris 24 h following the earthquake, of whom three were rescued after >48 h (longest duration, 91 h). Further, 32 (15.9%) patients who survived upon presentation to the emergency department had rhabdomyolysis, 4 (1.9%) underwent hemodialysis in the emergency department due to acute renal failure, and 8 (3.8%) underwent other emergency operations such as fasciotomy and amputation. In total, 122 patients died and 191 patients were discharged from the hospitals. Furthermore, 139 patients were discharged from the emergency department, 15 were admitted to the intensive care unit, 41 were hospitalized in the relevant clinics, and 112 were directly transferred to the morgue following preliminary evaluation.
CONCLUSION: Emergency services should be ready in terms of accurate registration, correct data entry, correct triage assignment, sufficient resources, adequate team, sufficient equipment, and adequate treatment areas for disasters such as earthquakes. Further, ade-quate disaster trainings should be provided, feasible disaster relief plans should be prepared, and regular exercises should be conducted.