Publications

INTRODUCTION: Periods of civil unrest pose significant operational and security challenges to those seeking to provide emergency care to patients. For emergency departments (EDs) and their staff, effectively operating in this potentially hostile environment requires careful planning. Understanding the challenges posed during periods of civil unrest is paramount for emergency medicine staff and emergency planners to ensure continuity of care.

OBJECTIVE: To provide ED and hospital staff with an understanding of the challenges faced during periods of civil unrest and to offer recommendations to maintain safety and operational viability.

DISCUSSION: Preplanning before any anticipated civil unrest is essential to a well-coordinated response. During the period of civil unrest, maintaining effective communication between command elements and clinicians in the ED is vital to ensure bidirectional sharing of information. Deviations from normal operating procedures should be expected and relayed to clinicians as quickly as possible. Similarly, staff may need to shelter in place or relocate to a more secure area within the hospital. Civil unrest is highly dynamic, and hospital leadership must follow developments closely to protect staff and facilities.

CONCLUSION: This review provides ED and hospital staff with an understanding of the significant challenges during periods of civil unrest.

On February 6, 2023, a moment magnitude (Mw) of 7.7 earthquake occurred on the East Anatolian Fault Zone at Pazarcık-Kahramanmaraş-Türkiye. Following this earthquake, approximately 9 hours later, another earthquake with a magnitude of Mw = 7.6, whose epicenter was in the Elbistan district of the same city, occurred on the Çardak Fault, which branches from the East Anatolian Fault. These two earthquakes, which occurred at a distance of approximately 90 km from each other, were followed by numerous aftershocks. The earthquakes were effective in an area of approximately 400 km long and 100-200 km wide in the southwest and northeast directions. In this paper, the failures and damages observed in buildings, building foundations, retaining structures, highways, railways, slopes, and tunnels were evaluated for four cities located in these two fault rupture regions. The investigated sites were chosen by considering the characteristics of fault lines, geology, and structural systems. In this way, the observations were associated with the site effects based on the soil properties and distance to the fault of the region.

Indonesia contributed to the 2023 Turkiye earthquake response with a 181-member urban search and rescue team, an emergency medical team, and 140 tons of relief supplies. Multistakeholder international humanitarian assistance improves regional collaboration and human capital development of disaster response professionals. Additionally, humanitarian diplomacy nurtures our global community and aids in reducing disaster risks from impacts of disaster, climate change, and conflict. Indonesia and Turkiye collaborated excellently during the 2004 Aceh tsunami response to ensure marginalized communities had access to essential humanitarian relief. Both Indonesia and Turkiye as well as the United States (US) are vital partners. The three countries comprise close to a tenth of the global population, representing the West, Middle East, and Asia. The Federal Emergency Management Agency of the US, the Turkiye Disaster and Emergency Management Presidency (Afet ve Acil Durum YÖnetimi Başkanlığı), and Indonesia's National Disaster Management Agency (Badan Nasional Penanggulangan Bencana) have been collaborating in knowledge exchange for disaster risk reduction. The humanitarian assistance to the Turkiye earthquake response provided lessons on international emergency response operations and integrated technical and cultural knowledge in emergency management. The experience demonstrated how to leverage education and training to build capabilities. This case is also about forging regional collaboration to support and serve marginalized, at-risk communities.

Foreign volunteer rescue team personnel's health is sometimes disregarded in disaster response activities. To provide insight on this little-discussed subject, this research analyzes the Turkish Earthquake situation in 2023 as a case study. Natural calamities, such as earthquakes, necessitate prompt action by local and international rescue personnel. Foreign volunteers, who confront particular hurdles in unfamiliar areas, are sometimes overlooked. The 2023 Turkish Earthquake mobilized foreign rescue teams to help in search, rescue, and relief efforts. The physically and mentally demanding nature of disaster relief work, along with unfamiliar surroundings and language problems, can have a negative influence on foreign volunteers. Exhaustion, stress, trauma, and exposure to hazardous situations are all challenges. Their lack of knowledge with local healthcare institutions hinders their access to medical care even further. The need of prioritizing the health of foreign volunteer rescue team employees is emphasized in this research. Predeployment health tests, complete self-care training, medical resource availability, and post-deployment mental health programs can all help to reduce health risks. Increased knowledge and focus on these issues can help to ensure the success and long-term viability of disaster response activities. By ensuring the safety of foreign volunteers, international disaster response activities can be made more resilient and efficient. Overall, the health of foreign volunteer rescue team employees is a little-discussed issue that demands more attention, and addressing it is critical for effective disaster response.

This research underscores the critical role of disaster literacy education in enhancing societal preparedness for disasters. Through semistructured interviews with 20 earthquake survivors in Turkey, the study focused on basic disaster skills, particularly pertaining to earthquakes. Predisaster skills encompass home preparations, education, communication, emergency supplies, site selection, risk reduction, earthquake drills, and awareness sharing. Skills during a disaster involve finding safe areas, alternative communication, first aid, assistance, and gathering points. Post-disaster skills include reassurance, aid, first aid, psychosocial support, and effective communication. The study aims to advance disaster literacy education by identifying essential skills across disaster phases, offering recommendations for improved effectiveness. The results provide a crucial foundation for societal preparedness and post-disaster resilience.

On February 6, 2023, at 4:17 AM local time, an earthquake of 7.8 on the Richter scale devastated southeastern Turkey and parts of Syria resulting in over 50,000 deaths. As in past natural disasters, the Israeli government, in coordination with the Israel Defense Forces Home Front Command, organized a medical delegation of 142 personnel. The Israeli medical delegation arrived in Turkey on February 8, 2023, and decided to integrate with an existing hospital in the city of Kahramanmaraş. The hospital had been left with a skeleton staff. From February 9, 2023, through February 14, 2023, the Israeli team helped bring the Necip Fazil City Hospital back to working capacity. Working alongside volunteer Turkish medical professionals, they treated patients in the emergency department (ED) as well as the inpatient wards and intensive care unit of the hospital. A total of 470 patients were examined by the Israeli team in the ED during the 6 days of clinical operation. There was a peak of 152 patients on February 11, 2023. The ED staff treated 17 patients removed from the rubble of the earthquake. Ten patients underwent operations, 48 were hospitalized in the inpatient ward, and 27 in the intensive care unit. However, the biggest accomplishment was helping rehabilitate the ED and overall the hospital so that groups of volunteer Turkish physicians could continue their operation.

This study aimed to explain the coordination problems that were experienced by volunteer healthcare providers in the acute period of disasters, with a special focus on the February 6 Kahramanmaraş Earthquakes. The population comprised of volunteer healthcare providers in the earthquake area participating in the health service in the first 72 hours after the Kahramanmaraş Earthquakes. A phenomenological type of study and criterion sampling method were used, and 12 people participated in the study. Data were collected through semistructured in-depth interviews. The transcripts were evaluated via the content analysis technique, and the process was from codes to categories and from categories to themes. This study observed that the organizational problems during the transfer caused loss of time and motivation. Experiencing disasters provided an advantage in adaptation to the area, whereas the lack of experience, organization, adaptation, and physical needs were obstructive in professional roles and in orientation. Individuals created reactive solutions to problems. There were differences in thought, approach, and behavior in coordination between healthcare providers from different regions. Healthcare providers experienced significant coordination problems in the earthquakes centered in Kahramanmaraş. However, there is a benefit in experience for future disasters.

OBJECTIVES: Millions of children were physically and psychosocially affected at different levels by the Kahramanmaraş earthquake. This study aimed to investigate the medical issues frequently encountered by pediatricians among pediatric earthquake survivors from the earthquake-affected region and to determine the relationship between the earthquake-related courses they took in medical school and pediatrics specialty training and their self-evaluation in managing these issues.

METHODS: After the Kahramanmaraş earthquake, patients were transferred to different cities in Turkey by air as soon as the survivors were stabilized. A link to a structured questionnaire (Google® survey) was sent via e-mail to clinical administrative/educational managers who admitted earthquake survivors to their inpatient wards. These clinical administrative/educational officers were asked to share the survey link with the pediatricians and pediatric residents they worked with. Pediatricians working in the earthquake-affected region (11 provinces) and physicians who were not pediatricians were excluded from the study. The Pearson chi-square test was used to compare the categorical variables. A p-value <0.05 indicated a statistically significant difference.

RESULTS: The number of physicians who completed the questionnaire was 154. The most common situations encountered while managing earthquake victims in intensive care units or inpatient wards were monitoring amputees (23.4 percent), psychological problems (21.6 percent), and hemodialysis (14.4 percent). Among the physicians, almost 10.5 percent who graduated less than 6 years ago, 26.3 percent who graduated 6-14 years ago, and 22.9 percent who graduated ≥15 years ago considered themselves competent in giving bad news. The difference between these groups was statistically significant. A statistically significant difference was observed between physicians' perception of themselves as competent in managing patients with crush syndrome and having taken a course on "Approach to a Child Patient with Crush Syndrome" in medical faculty and specialty training programs.

CONCLUSION: Structuring and disseminating an earthquake-related curriculum, including psychological first aid, in Turkey's medical faculty and pediatrics specialty training programs is extremely important for caring for pediatric earthquake victims.