Giora Martonovits

An earthquake disaster in Turkey: an overview of the experience of the Israeli Defence Forces Field Hospital in Adapazari

On 17 August 1999 at 3:04 a.m., an earthquake of 7.4 magnitude (Richter scale) struck the Marmara region in Turkey. The city of Adapazari suffered 2,680 fatalities with approximately 5,300 injured. The Israeli Defence Forces (IDF) field hospital arrived at Adapazari, on day four after the quake. The team consisted of 102 personnel. The field hospital acted as a secondary referral centre. A total of 1,205 patients were treated in the field hospital between day four and day 14 of the earthquake. The frequency distribution of the medical problems seen in the field hospital was 32 per cent internal medicine, 13 per cent general surgery including plastic, 21 per cent orthopaedic surgery, 23 per cent paediatric disease, 10 per cent obstetrics and gynaecology and 1 per cent major psychiatric disorders. A mean number of 35 patients per day were hospitalised in the field hospital for between 24 hours to one week. The rapid establishment of the field hospital enabled the local medical facilities to buy time in order to organise and restore surgical and hospitalisation abilities in this disastrous situation.

Treating traumatic bleeding in a combat setting: possible role of recombinant activated factor VII.

Bleeding is clearly a major cause of morbidity and death after trauma. When bleeding is attributable to transection of major vessels, surgical repair is appropriate. Posttraumatic microvascular bleeding attributable to coagulopathy secondary to metabolic derangements, hypothermia, and depletion or dysfunction of cellular and protein components requires a different approach. Although transfusion of blood products may be necessary to replace the blood loss, it does not always correct the problem of microvascular bleeding. The type of injury, mode of care, and treatment objectives differ significantly for combat-wounded soldiers versus civilian trauma patients. Although hemorrhage is responsible for 50% of combat deaths, published information about coagulation monitoring among combat patients is very limited. These articles summarize the appropriate monitoring of hemostasis among combat trauma patients, review the unique nature of combat casualties and the medical system used to treat them, and discuss information available from civilian studies. Because the development of coagulopathy is relatively infrequent in the young, otherwise healthy, military population, the routine screening measures currently used are adequate to guide initial blood product administration. However, as new intravenous hemostatic agents are used for these patients, better laboratory measures will be required. Although hemorrhage is the leading cause of death for combat casualties, catastrophic hemorrhage is rarely a prehospital combat medical management problem because, when it occurs, it tends to cause death before medical care can be provided. In civilian environments, most seriously injured victims can be reached and transported by emergency medical services personnel within minutes; in combat, it often takes hours simply to transport casualties off the battlefield. In combat situations, even if the transport distances are small, the hazardous nature of the forward combat areas frequently prevents medical personnel from quickly reaching the wounded. Furthermore, whereas civilian blunt trauma victims may have a golden hour, casualties with penetrating battlefield trauma often have only a platinum 5 minutes. Because of the challenges of treating hemorrhage during combat, it is important for military medical personnel to understand their options for treating hemorrhage quickly and efficiently. These articles discuss the causes of posttraumatic microvascular bleeding and the potential treatment options for controlling catastrophic hemorrhage in combat areas.

A multidisciplinary field hospital as a substitute for medical hospital care in the aftermath of an earthquake: the experience of the Israeli Defense Forces Field Hospital in Duzce, Turkey, 1999.

The damage created by an earthquake can overwhelm local health services, and damage to clinics and hospitals can render them useless. After an earthquake, even undamaged medical facilities cannot be used for a period of time if there is a risk of aftershocks and collapse. In such a situation, there may be calls for international health teams--but what constitutes the optimal medical aid a few days after the event? Does a military field hospital fill the gap in the local healthcare system? On 12 November 1999, a 7.2 magnitude earthquake struck Duzce, Turkey. All of the medical activities of the responding Israeli Defense Forces (IDF) mission team field hospital in Duzce, Turkey were recorded and evaluated. A total of 2,230 patient contacts occurred at the field hospital during the nine days it operated. Most of the patients who presented (90%) had non-traumatic medical, pediatric, or gynecological problems unrelated to the earthquake. The IDF hospital offered medical care provided by specialists, hospitalization, and surgical abilities, which Duzces hospitals could not offer until two weeks after the earthquake. These results strengthen the importance of a multidisciplinary, versatile, field hospital as an aid to an earthquake-affected population during the first few weeks after an earthquake.

Recommendations for nursing requirements at a field hospital, based on the Israel Defense Forces field hospital at the earthquake disaster in Turkey—August 1999

On the 17th of August 1999, an earthquake of 7.4 magnitude on the Richter Scale struck the Marmara region in Turkey causing a massive casualties event with an estimated 2,680 deaths and 5,300 injuries just at the city of Adapazari alone. A field hospital was set up by the Israel Defense Forces at Adapazari in order to provide temporary medical services until regular medical forces recovered. The aim of the paper is to overview the requirements of the nursing staff at a field hospital based on our experience and analysis of the nursing activity at the field hospital at Adapazari. The methods implemented include interviewing all nurses and many of the doctors who took part in the field hospital as well as a review of medical literature about disasters. We found an inverted nurse:phycisian ratio of 1:1.77, as opposed to a 2.5-3:1 ratio in regular civilian hospitals. The nurses in our field hospital had to work longer and more intensive shifts than in a regular hospital. They had to overcome language barriers and cultural differences, and faced difficult hygiene conditions. Our overview analysis of results brought up several recommendations. Firstly, although it is not possible to predictthe number and types of casualties, it is necessary to provide an adequate number of nurses (1-1.5:1 nurse:physician ratio). Furthermore, the nurses should be specialized and rotated as needed. Secondly, the language and cultural barriers should not be undermined despite the abundance of translators. Finally, the hygiene status in a field hospital requires management by nurses with active participation of all members.

Israel: a comparison of army personnel satisfaction rates in different primary healthcare settings.

&NA; The Israeli medical corps has recently been examining different primary healthcare settings for home‐front career army personnel. This study compares the satisfaction rates of this unique population in different primary healthcare settings. Previously validated patient‐satisfaction surveys were conducted 4 months apart in 10 large primary care clinics that treat home‐front army career personnel. Satisfaction was highest in a civilian hospital‐based primary care clinic. The specialized military career personnel clinics produced less satisfaction than the hospital setting, according to the survey; however, the differences were not statistically significant. Patient satisfaction was significantly lower in the classic military‐based general practices. The hospital setting of civilian primary care created higher satisfaction in aspects of accessibility, availability, and interpersonal relationships. However, the patients perception of quality of care was lower than in the other settings.

Anxiety and Fears of Pregnant Women: Evaluation of Incidence during the Earthquake in Turkey, 1999

Introduction: Pregnancy is the time in our life representing more than any other period the continuation of life and expectations for a brighter future. Any threat to the well‐being of the individual, loss of life in the family or significant property damage may affect the physical and emotional well‐being. An earthquake disaster is a rare and unique life‐threatening state of major emotional stress; however, the emotional and behavioural effects of this unique scenario have not yet been described in the medical literature. Objective: To study some of the effects of an earthquake disaster experience on pregnant womens behaviour and emotions during and after the earthquake. Patients and Methods: We conducted a survey, using a questionnaire prepared by Israeli and Turkish physicians during the IDF field hospital stay in Adapazari in August 1999. The questionnaire focused on some behavioural and emotional aspects that were experienced by these women during and after the earthquake. The questionnaire was fill...

Recommendations for pediatric nursing requirements at a field hospital based on the Israel defense forces' experiences following the 1999 Turkish earthquake disaster

Abstract In August 1999 an earthquake struck the Marmara region in Turkey causing massive casualties. A field hospital was set up by the Israel Defense Forces at Adapazari to provide temporary medical services until regular medical services could resume. The pediatric nurses in the field hospital had to work longer and more intensive shifts than in a regular hospital and overcome language barriers and cultural differences whilst also being faced with difficult hygienic conditions. The aim of this paper is to provide an overview of the requirements for pediatric nursing staff at a field hospital based on our experience and analysis of the pediatric nursing activity at the field hospital at Adapazari. The pediatric nursing staff and many of the doctors who took part in the field hospital were interviewed. Our analysis of the interviews allowed us to provide several recommendations: firstly, although it is not possible to predict the number and types of casualties it is recommended that an adequate number of pediatric nurses be provided; they should be specialised and rotated as needed. Secondly, despite the abundance of translators, the language and cultural barriers should not be underestimated. Moreover, even in cultures where this is not done, breastfeeding should be encouraged because running water and other feeding alternatives may not be available. Thirdly, providing social support is critical because these services may be destroyed in earthquake disasters. Finally, preventive measures are required to overcome poor hygiene and cold weather.