Paul Benedek

Intensive care in a field hospital in an urban disaster area: lessons from the August 1999 earthquake in Turkey.

ObjectiveTo describe our experience with the implementation of intensive care in the setting of a field hospital, deployed to the site of a major urban disaster. DesignDescription of our experience during mission to Turkey; conclusions regarding implementation of intensive care at disaster sites. SettingMilitary Field Hospital at Adapazari in Turkey. PatientsCivilian patients admitted for care at the field hospital. InterventionsNone. Measurements and Main ResultsOn August 17, 1999 a major earthquake occurred in western Turkey, causing approximately 16,000 fatalities and leaving >44,000 injured. Approximately 66,000 buildings were severely damaged or destroyed. A medical unit of the Israeli Defense Forces Medical Corps, consisting of 23 physicians, 13 nurses, nine paramedics, 13 medics, laboratory and roentgen technicians, pharmacists, and associated support personnel, were sent to Adapazari in Turkey. The field hospital treated approximately 1,200 patients over a period of 2 wks, 70 surgical operations were performed, 20 babies were delivered, and a variety of medical, surgical, orthopedic, and pediatric/neonatal care was provided. The 12-bed intensive care unit operated by the unit, was staffed by three physicians and eight nursing/paramedic personnel. Patient mix was: a total of 63 patients, among them five with major trauma, 20 with acute cardiac disease, 15 patients with various acute medical conditions, and 11 surgical and postoperative patients. Three patients were intubated and mechanically ventilated (one cardiogenic pulmonary edema and two major trauma). The intensive care unit provided the following functions to the field hospital: care of the critically ill and injured, preparation for and implementation of transportation of such patients, pre- and postoperative care for major surgical procedures, expertise, and equipment for the care of very ill patients throughout the field hospital. ConclusionsIn suitable circumstances, an intensive care capability should be an integral part of medical expeditions to major disasters.

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.

No Need to Tax the Sick: Clinical Guidelines for Rofecoxib as an Alternative Effective Method to the Copayment Policy in the Advent of Increasing Pharmaceutical Expenditures

BACKGROUND Over the last few years, major health care systems have been trying to control increasing pharmaceutical expenditures by a variety of methods, such as the controversial copayment policy, as essential health expenditures were being jeopardized. OBJECTIVE To analyze the regulatory intervention of preauthorization on a rofecoxib model in the medical corps of the Israeli Defense Forces (IDF) in terms of indications for prescription, consumption, and cost. INTERVENTIONS Guidelines established by the medical services branch based on current literature and communication with diverse specialists and hospitals were implemented by a general practitioner who checked each rofecoxib prescription that was written for IDF personnel by a specialist. The intervention was initiated in November 2000 and continued until August 2001 and after the study. DESIGN The study was divided into two parts. The first part was a retrospective monthly, preintervention analysis of computerized medical records of IDF personnel (N = 247) for whom rofecoxib was prescribed. The second was a prospective monthly, postintervention analysis of filled-out guideline forms (N = 250) of approved rofecoxib prescriptions. PARTICIPANTS Patients, were IDF personnel, age 18 to 45, treated in military and civilian outpatient clinics for whom rofecoxib was prescribed. SETTING The study took place at the Medical Service Branch of the IDF between August 2000 and August 2001. RESULTS We demonstrated a significant decrease in average monthly consumption (43.0%) and estimated monthly expenditures (40.84%) of rofecoxib, as well as significant shifts (p < 0.001) in indications for whom rofecoxib was approved. These shifts (from pre- to postintervention) include the following: others/nonspecified (80 to 12%), known peptic disorder (7 to 32%), peptic complaints (4 to 22%), and rheumatic (8 to 19%). CONCLUSION This type of intervention can be cost-effective, can provide quality care, and may be a viable alternative to the controversial and problematic copayment policy.

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.