{"id":571,"date":"2022-08-17T03:02:14","date_gmt":"2022-08-17T00:02:14","guid":{"rendered":"https:\/\/tatd.org.tr\/afet\/?p=571"},"modified":"2022-08-16T20:50:21","modified_gmt":"2022-08-16T17:50:21","slug":"deprem-insan-ve-degismeyenler","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/afet\/genel\/deprem-insan-ve-degismeyenler\/","title":{"rendered":"Deprem, \u0130nsan ve De\u011fi\u015fmeyenler"},"content":{"rendered":"

\u00c7\u00f6kme Esnas\u0131nda Meydana Gelebilecek Ezilme Yaralanmalar\u0131na Kar\u015f\u0131 Rasyonel Korunma Y\u00f6ntemleri: \u015eehir Efsanelerine Kar\u015f\u0131 Mortalite Ve Morbidite Azalt\u0131c\u0131 \u00d6neriler<\/strong><\/p>\n

Giri\u015f<\/strong><\/p>\n

\u0130nsanlar\u0131n, ya\u015fam alan\u0131 olarak kulland\u0131klar\u0131 binalar deprem, toprak kaymas\u0131, bombalanma ya da \u00e7\u00f6kme sonras\u0131nda, \u00e7al\u0131\u015ft\u0131klar\u0131 madenler\u00a0 g\u00f6\u00e7me sonucu, seyahat etti\u011fi ara\u00e7lar trafik kazalar\u0131nda, spor yapt\u0131\u011f\u0131 karl\u0131 da\u011flar \u00e7\u0131\u011f felaketlerinde saniyeler i\u00e7inde insanlar i\u00e7in \u00f6l\u00fcmc\u00fcl tuzaklara d\u00f6n\u00fc\u015febilmektedir.<\/p>\n

Son 17 y\u0131lda T\u00fcrkiye\u2019de\u00a0ve d\u00fcnyan\u0131n de\u011fi\u015fik \u00fclkelerinde meydana gelen ba\u015fta depremler olmak \u00fczere ezilme yaralanmalar\u0131na yol a\u00e7an, kitlesel bas\u0131 olu\u015fturan felaketlerde, bizzat i\u00e7inde yer al\u0131nan arama-kurtarma ekiplerince kurtar\u0131lan ve kurtulan insanlar\u0131n felaket an\u0131 ve sonras\u0131 \u00a0konumlar\u0131, ya\u015famsal \u00f6nem arzeder. Bu yaz\u0131 dizimizde sahadan ve simulasyon \u00e7al\u0131\u015fmalar\u0131ndan elde edilen deneyimler \u0131\u015f\u0131\u011f\u0131nda herhangi bir nedenle kar\u015f\u0131la\u015f\u0131lacak \u00e7\u00f6kme esnas\u0131nda meydana gelebilecek ezilme yaralanmalar\u0131na kar\u015f\u0131 rasyonel korunma y\u00f6ntemleri aktar\u0131lmaya \u00e7al\u0131\u015f\u0131lm\u0131\u015f ve mortalite & morbidite azalt\u0131c\u0131 \u00f6neriler sunulmu\u015ftur.<\/p>\n

\u00a0<\/strong><\/p>\n

Saha Deneyimleri<\/strong><\/p>\n

Son 15 y\u0131lda arama kurtarma \u00e7al\u0131\u015fmalar\u0131na bizzat kat\u0131ld\u0131\u011f\u0131m\u0131z T\u00fcrkiye ve di\u011fer \u00fclkelerdeki depremler, \u015fiddetleri, resmi rakamlara g\u00f6re \u00f6l\u00fc ve yaral\u0131 say\u0131lar\u0131 Tablo 1\u2019de sunulmu\u015ftur.<\/p>\n

Tablo 1. Bizzat kat\u0131l\u0131nan arama-kurtarma faaliyetlerinde kurtar\u0131lan depremzedelerin say\u0131lar\u0131<\/strong><\/p>\n

TAR\u0130H\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 SAAT\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 YER\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u015e\u0130DDET\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00d6L\u00dc\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 YARALI \u00a0\u00a0\u00a0KURTARILAN<\/p>\n

13 .03.1992,\u00a0 \u00a0\u00a0\u00a019:18 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Erzincan,\u00a0\u00a0 \u00a0\u00a0R:\u00a0 6.8 M, \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0653 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a03.500 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a03<\/p>\n

01 .10.1995,\u00a0 \u00a0\u00a0\u00a017:57\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dinar,\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0 R:\u00a0 6.1 M, \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0101\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0260 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a02<\/p>\n

17 .08.1999, \u00a0\u00a0\u00a0\u00a003:02\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Marmara,\u00a0\u00a0 \u00a0\u00a0R:\u00a0 7.4 M,\u00a0\u00a0\u00a0 17.840 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a043.953 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0118<\/p>\n

07 .09.1999,\u00a0\u00a0 \u00a0\u00a014:56\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Atina,\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0 R: \u00a05.9 M,\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0143\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a02.000\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a02<\/p>\n

21 .09.1999,\u00a0\u00a0 \u00a0\u00a017:47\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Taiwan,\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0R: 7.6 M,\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a02.161 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a08.736 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a01<\/p>\n

12 .11.1999,\u00a0\u00a0 \u00a0\u00a018:58\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D\u00fczce,\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0R: 7.2 M,\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0848 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a04.948 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a012<\/p>\n

TOPLAM\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 21.746\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 63.397\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 138<\/em><\/strong><\/p>\n

 <\/p>\n

Simulasyon Deneyimleri<\/strong>
\n\u0130stanbul da ka\u00e7ak in\u015faat olarak tesbit edilmi\u015f ve \u0130stanbul B\u00fcy\u00fck\u015fehir Belediyesi\u2019nce y\u0131k\u0131m\u0131na karar verilmi\u015f iki \u00e7ok katl\u0131 binada, iki ayr\u0131 zamanda deprem sim\u00fclasyonu yap\u0131lm\u0131\u015ft\u0131r.<\/p>\n

Binalar\u0131n belli b\u00f6l\u00fcmleri okul dersli\u011fi, yatak odas\u0131, \u00e7al\u0131\u015fma odas\u0131 farkl\u0131 insan ya\u015fam alanlar\u0131\u00a0gibi\u00a0b\u00f6l\u00fcmler olarak tefri\u015f edilmi\u015f, buralara de\u011fi\u015fik konumlarda cans\u0131z\u00a0manken yerle\u015ftirilmi\u015ftir. Numaraland\u0131r\u0131lan bu mankenlerin konumlar\u0131 kaydedilerek y\u0131k\u0131m\u0131na karar verilen, biri 3 katl\u0131 di\u011feri 7 katl\u0131 iki binada, 2 farkl\u0131 tarihte, 2 sim\u00fclasyon \u00e7al\u0131\u015fmas\u0131 ger\u00e7ekle\u015ftirilmi\u015ftir. Ezilse bile yok olmayacak ve ortalama kolon \u2013kiri\u015f kal\u0131nl\u0131\u011f\u0131na yak\u0131n\u00a0en az \u00a050-60 cm y\u00fcksekli\u011finde “ya\u015fam bo\u015fluklar\u0131” b\u0131rakacak ev e\u015fyalar\u0131, metal kafes yap\u0131daki s\u0131ralar, binalar\u0131n ev ve okul d\u00fczenekleri korunarak yerle\u015ftirilmi\u015ftir. Al\u00e7\u0131 ve sert k\u0131r\u0131lgan plastik mataryelden yap\u0131lan mankenler 10 adedi masa, sandalye, s\u0131ra alt\u0131na, bantla tutturularak (\u00e7\u00f6melmeyi sim\u00fcle etme gayesi ile) yar\u0131 g\u00f6vde “torso”halinde yerle\u015ftirildi. 10 adedi de, i\u00e7inde s\u0131k\u0131ca kitap istiflenmi\u015f sand\u0131k, alt\u0131na kitap ve nevresim, kuma\u015f s\u0131k\u0131\u015ft\u0131r\u0131lm\u0131\u015f yatak gibi ev e\u015fyalar\u0131n\u0131n yan\u0131na yerle\u015ftirildiler. Ta\u015f\u0131y\u0131c\u0131 sistemleri zay\u0131flat\u0131lan binalarda a\u011f\u0131r i\u015f makinalar\u0131 ile, \u00e7ekme ve darbe y\u00f6ntemi ile farkl\u0131 y\u00f6nlere do\u011fru deprem dalgalar\u0131 etkileri sim\u00fcle\u00a0 edilerek, bina rezonans a sokularak “pancake” y\u0131k\u0131m ger\u00e7ekle\u015ftirildi.<\/p>\n

\"\"<\/p>\n

\u0130stanbul Teknik \u00dcniversitesi(\u0130T\u00dc) Sismoloji Enstit\u00fcs\u00fc\u2019nce sismik \u00f6l\u00e7\u00fcmleri de yap\u0131lan, ta\u015f\u0131y\u0131c\u0131 sistemleri zay\u0131flat\u0131larak en k\u00f6t\u00fc senaryo gere\u011fi, deprem dalgalar\u0131n\u0131n s\u00fcreklili\u011fi ile olu\u015fan \u00a0“rezonans” etkisine benzer sarsmalarla olu\u015fturulan y\u0131k\u0131mla, “pancake” haline getirilen binalardaki mankenlerin\u00a0 hasar durumu tesbit edilmi\u015ftir.<\/p>\n

Sonu\u00e7lar<\/strong><\/p>\n

Saha deneyimleri<\/strong><\/p>\n

Sahada yerinde g\u00f6zlem ile arama-kurtarma (SAR) operasyonlar\u0131nda\u00a0 taraf\u0131m\u0131zdan kurtar\u0131lanlar\u0131n konumlar\u0131, tamam\u0131nda<\/em><\/strong> enkaz alt\u0131nda yan yatar durumla uyumludur. En ge\u00e7 \u00e7\u0131kar\u0131lan\u0131 depremden sonra 5. g\u00fcne tekab\u00fcl eden bu vakalar\u0131n 34 \u00fc alt ekstremite, 2 si kol\u00a0 s\u0131k\u0131\u015fmas\u0131na ba\u011fl\u0131 crush yaralanmalar\u0131ndan etkilenmi\u015f, 1 ine enkaz alt\u0131nda amputasyon gerekmi\u015f, di\u011fer depremzedelerin y\u00fczeyel s\u0131yr\u0131klar d\u0131\u015f\u0131nda t\u0131bbi sorunlar\u0131 olmam\u0131\u015ft\u0131r.<\/p>\n

Simulasyon Deneyimleri<\/strong><\/p>\n

Enkaz alt\u0131nda kalan mankenlerin, moloz kald\u0131r\u0131m\u0131 ve t\u00fcnel a\u00e7\u0131larak hasar oranlar\u0131 incelendi\u011finde, her iki binada da masa ve s\u0131ra gibi e\u015fyalar\u0131n alt\u0131na yerle\u015ftirilen, boylu boyunca uzanm\u0131\u015f ve \u00e7\u00f6melmi\u015f (torso) olanlar\u0131n tamam\u0131n\u0131n ezildi\u011fi g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Bacak ve kollar\u0131 katlanarak, k\u00fc\u00e7\u00fclt\u00fcl\u00fcp yan yat\u0131r\u0131lan mankenlerin sand\u0131k, alt\u0131 kitap dolu yatak\u00a0ve kafes yap\u0131da s\u0131ralar aras\u0131nda olanlar\u0131n\u0131n sadece 2\u2019sinde, savrulma sonras\u0131 bacak par\u00e7alar\u0131nda ezilme oldu\u011fu tesbit edilmi\u015ftir. Di\u011ferlerinde hasar g\u00f6zlenmemi\u015ftir.<\/p>\n

\u00a0<\/strong><\/p>\n

Tart\u0131\u015fma<\/strong><\/p>\n

T\u00fcrkiye Depremleri<\/strong><\/p>\n

\u0130lki<\/a> 17 A\u011fustos 1999 tarihinde saat 03:02 \u2018de, yaz s\u0131ca\u011f\u0131nda 45 saniye s\u00fcren deprem insanlar\u0131 uykuda, geceyar\u0131s\u0131 yataklar\u0131nda yakalam\u0131\u015f, ikincisi 12 Kas\u0131m ak\u015fam \u00fczeri saat 18:58 de olan 30 sn s\u00fcren deprem de ise insanlar i\u015flerinden \u00e7\u0131km\u0131\u015f ya da \u00e7\u0131kmak \u00fczere iken “k\u0131\u015f “ko\u015fullar\u0131nda felakete maruz kalm\u0131\u015flard\u0131r.<\/p>\n

Crush Injury (ezilme yaralanmas\u0131), ba\u015fta depremler olmak \u00fczere trafik kazalar\u0131nda, toprak kaymalar\u0131nda, maden g\u00f6\u00e7\u00fcklerinde, \u00e7\u0131\u011f kazalar\u0131nda, toplumsal olaylarda insan v\u00fccudunun b\u00fct\u00fcn\u00fcn\u00fcn ya da bir b\u00f6l\u00fcm\u00fcn\u00fcn, ekstremitelerin bas\u0131 alt\u0131nda kald\u0131\u011f\u0131 her durumda g\u00f6r\u00fclebilir. Crush\u2019a ba\u011fl\u0131 ezilme yaralanmalar\u0131, \u00f6zellikle uzun s\u00fcre t\u0131bbi yard\u0131m\u0131n ula\u015famad\u0131\u011f\u0131 durumlarda olu\u015fan masif rabdomyoliz nedeniyle mortal seyreden Akut B\u00f6brek Yetmezli\u011fi (ABY)\u2019ne yol a\u00e7abilir.<\/p>\n

Crush sendromu’nda ise, ezilme yaralanmalar\u0131 sonucu ortaya \u00e7\u0131kan rabdomyolizis’e (kas doku hasar\u0131) ba\u011fl\u0131 myoglobin\u00fcri, buna ba\u011fl\u0131\u00a0 geli\u015fen olig\u00fcr\u00fc, an\u00fcr\u00fc, akut tubuler nekroz ve ABY(akut b\u00f6brek yetmezli\u011fi) s\u00f6z konusudur. Zaman\u0131nda diyalize al\u0131namama durumunda \u00f6l\u00fcmle sonu\u00e7lanabilir. Bu \u015fekli\u00a0ilk kez 2. D\u00fcnya Sava\u015f\u0131\u2019nda Londra\u2019n\u0131n bombalanmas\u0131 esnas\u0131nda tan\u0131mlanm\u0131\u015ft\u0131r. Bas\u0131 alt\u0131nda kalan ekstremitelerde olu\u015fan kompartman sendromu nedeniylede morbiditeyi artt\u0131ran b\u00fcy\u00fck fasyotomiler, amp\u00fctasyonlar gerektirebilir. Crush sendromu, bir uzvun dahi bas\u0131 alt\u0131nda kalmas\u0131 ile ger\u00e7ekle\u015febilmektedir.<\/p>\n

Ezilme yaralanmalar\u0131ndan korunmada ana ama\u00e7, olabildi\u011fince hedef\u00a0k\u00fc\u00e7\u00fclterek,\u00a0 ya\u015fama \u015fans\u0131n\u0131 artt\u0131rmak, yaralanma \u015fans\u0131n\u0131 azaltmak olmal\u0131d\u0131r. Deprem gibi b\u00fcy\u00fck felaketlerde mortalite ve morbiditeyi azaltan ana unsurun, o anda, sa\u011flam zemine yap\u0131lm\u0131\u015f sa\u011flam bina da bulunmak oldu\u011fu a\u015fikard\u0131r. Ama saniyeler i\u00e7inde uygulanacak davran\u0131\u015f bi\u00e7imi ile her ortamda son \u015fans do\u011fru kullan\u0131lmal\u0131d\u0131r.<\/em><\/strong><\/p>\n

Mortalite ve Morbidite<\/strong><\/p>\n

\u0130nsan nedenli k\u00f6t\u00fc kentle\u015fme sonucu, bir ka\u00e7 saniyede onbinlerce can kayb\u0131na, y\u00fczbinlerce a\u011f\u0131r yaralanmalara yol a\u00e7abilecek depremlerde, sava\u015flarda, giderek\u00a0artan trafik kazalar\u0131nda, ormans\u0131zla\u015ft\u0131rma sonucu olu\u015fan toprak kaymalar\u0131nda, maden g\u00f6\u00e7\u00fcklerinde, \u00e7\u0131\u011flarda anl\u0131k do\u011fru davran\u0131\u015flar mortalite ve morbiditeyi azaltabilecektir.<\/p>\n

T\u00fcrkiyedeki ve di\u011fer \u00fclkelerdeki alt\u0131 deprem bizzat arama kurtarma ekiplerinde yer alarak incelenmi\u015f, \u00f6rneklenmi\u015ftir. \u0130ki sim\u00fclasyon \u00e7al\u0131\u015fmas\u0131nda 20 cans\u0131z manken farkl\u0131 konumlarda test edilmi\u015ftir. Ba\u015fta depremler olmak \u00fczere crush yaralanmalar\u0131na yol a\u00e7an felaketler, son y\u0131llarda \u00f6zellikle k\u00f6t\u00fc kentle\u015fen, insanlar\u0131n standart d\u0131\u015f\u0131 binalarda oturdu\u011fu geri kalm\u0131\u015f ve geli\u015fmekte olan \u00fclkeler de y\u00fcz binlerce insan\u0131n \u00f6l\u00fcm\u00fcne, sakatlanmas\u0131na yol a\u00e7m\u0131\u015ft\u0131r.<\/p>\n

Tayvan ve Yunanistan da olu\u015fan depremlerde de kat\u0131l\u0131nan arama ve kurtarma \u00e7al\u0131\u015fmalar\u0131nda sa\u011f olarak kurtar\u0131lan kazazedelerin hepsinin ortak y\u00f6n\u00fc uzunca s\u00fcre enkaz alt\u0131nda kalm\u0131\u015f olsalarda bir \u015fekilde ezilmeden, enkaz alt\u0131nda\u00a0“bo\u015fluk”larda “do\u011fru pozisyonda” bulunmalar\u0131 olmu\u015ftur.<\/p>\n

Sim\u00fclasyonla y\u0131k\u0131lan binalarda da mankenlerin yaln\u0131zca kompakt hale getirilen ve \u201cezilse bile yok olmayan\u201d, alt\u0131 “kitap” benzeri cisimlerle tamamen doldurulmu\u015f yatak gibi e\u015fyalar\u0131n yan\u0131nda bulunanlar\u0131 en az hasar g\u00f6ren grubu olu\u015fturmu\u015ftur. Crush yaralanmalar\u0131na kar\u015f\u0131, alt\u0131 daha \u00f6nceden kitap, nevresim benzeri e\u015fyalarla s\u0131k\u0131ca doldurulmu\u015f, devrilebilecek e\u015fyalardan uzakta, ters tarafta, yata\u011f\u0131n yan\u0131na cenin pozisyonunda uzanmak, deprem stim\u00fclasyon \u00e7al\u0131\u015fmas\u0131nda “sa\u011flam” manken deneklerle de yararl\u0131l\u0131\u011f\u0131 kan\u0131tlanm\u0131\u015f bir se\u00e7enektir.<\/p>\n

\u00c7ok daha y\u00fcksek standart da konutlardan olu\u015fan kentlerde ya\u015fan\u0131lan geli\u015fmi\u015f \u00fclkelerde, bina\u00a0 y\u0131k\u0131lmalar\u0131ndan ziyade obje d\u00fc\u015fmelerine kar\u015f\u0131\u00a0 olu\u015fturulan acil durum bireysel eylem planlar\u0131, bina standard\u0131 d\u00fc\u015f\u00fck \u00fclkeler taraf\u0131ndan da aynen kopyalanmaktad\u0131r. Ayn\u0131 \u015fiddetde ve s\u00fcredeki bir depremin, geli\u015fmi\u015f bir \u00fclkede nerdeyse hi\u00e7 can kayb\u0131na yol a\u00e7maz iken, geri kalm\u0131\u015f \u00fclkelerde crush yaralanmalar\u0131ndan \u00f6t\u00fcr\u00fc binlerce insan\u0131n \u00f6l\u00fcm\u00fcne, sakatlanmas\u0131na yol a\u00e7mas\u0131 ac\u0131 bir ger\u00e7ektir.<\/p>\n

 <\/p>\n

Konu ile ilgili \u00f6zellikle ABD, Japonya gibi geli\u015fmi\u015f \u00fclkelerin\u00a0 ilgili kurumlar\u0131n\u0131n, deprem benzeri felaketlere kar\u015f\u0131 \u00f6nerilen eylem plan\u0131, “crush ” yaralanmalar\u0131na kar\u015f\u0131 olmaktan ziyade, sallant\u0131 esnas\u0131nda d\u00fc\u015febilecek cisimlerden korunmak i\u00e7in, masa alt\u0131na girmek gibi yakla\u015f\u0131mlar i\u00e7ermektedir. <\/strong><\/p>\n

Bu yakla\u015f\u0131m zemin ve bina yap\u0131s\u0131 konusunda yeterince g\u00fcvenceli, y\u00fcksek standartlar\u0131 olan insan yerle\u015fimlerinde, \u00f6zetle “y\u0131k\u0131lmayacak “binalarda ge\u00e7erli olabilir. Ama \u00fczerinde tonlarca a\u011f\u0131rl\u0131k bulunan \u00e7ok katl\u0131 binalarda “bina y\u0131k\u0131l\u0131rsa” masa, s\u0131ra gibi zay\u0131f \u015femsiyelerin “crush” yaralanmalar\u0131na kar\u015f\u0131 hayatta kalma \u015fans\u0131n\u0131 artt\u0131rmad\u0131\u011f\u0131, yaralanmalar\u0131 azaltmad\u0131\u011f\u0131, gerek stim\u00fclasyon gereksede arama kurtarma \u00e7al\u0131\u015fmalar\u0131nda sa\u011flam deneklerin ve kurtar\u0131lanlar\u0131n, kurtulanlar\u0131n konumlar\u0131nda g\u00f6zlenmi\u015ftir.<\/p>\n

\u0130lgin\u00e7 bir \u015fekilde yap\u0131 standard\u0131 daha y\u00fcksek olan geli\u015fmi\u015f \u00fclkelerin deprem benzeri felaketlerdeki “y\u0131k\u0131lmayacak binaya” g\u00f6re \u00f6ng\u00f6r\u00fclm\u00fc\u015f eylem planlar\u0131\u00a0 geri kalm\u0131\u015f ve geli\u015fmekte olan \u00fclkelerce neye kar\u015f\u0131 ve ni\u00e7in uygulanmas\u0131 gerekti\u011fi dahi tart\u0131\u015f\u0131lmadan aynen kopyalanmaktad\u0131r<\/em><\/strong>.<\/p>\n

So\u011fuk sava\u015f y\u0131llar\u0131nda n\u00fckleer serpintiye kar\u015f\u0131 ba\u015fta ABD olmak \u00fczere baz\u0131 \u00fclkelerde “duck and cover” yani \u201d\u00e7\u00f6mel-kapan\u201d yakla\u015f\u0131m\u0131 \u00f6nerilmi\u015ftir. \u0130yonizan radyasyonun, \u00f6zellikle penetrasyon yetene\u011fi y\u00fcksek olan \u201cgama\u201d \u0131\u015f\u0131nlar\u0131, camdan rahatl\u0131kla ge\u00e7ebilmektedir. \u0130nsanlar\u0131, yap\u0131 standard\u0131nda 90 cm ile 1 m y\u00fcksekli\u011findeki pencere y\u00fcksekli\u011finin alt\u0131nda, beton koruyuculu\u011fun da tutmak i\u00e7in \u00f6nerilen \u00e7\u00f6mel- kapan duru\u015fu , “drop, cover and hold on” \u201c\u00e7\u00f6k-kapan-tutun\u201dduru\u015fu \u015fekline modifiye olarak, zamanla, ba\u015fta deprem olmak \u00fczere hemen her t\u00fcrl\u00fc\u00a0 y\u0131k\u0131c\u0131 felakette \u00f6nerilir olmu\u015ftur. T\u00fcrkiye\u00a0 (1992 y\u0131l\u0131ndan\u00a0 g\u00fcn\u00fcm\u00fcze de\u011fin), Yunanistan, Tayvan, \u0130ran, Hindistan, Pakistan, \u00c7in, Haiti, Hint Okyanusu depremi ve izleyen tsunami felaketi ve Japonya Sendai de olan, y\u0131k\u0131c\u0131 etkileri ile crush yaralanmalar\u0131na yol a\u00e7an b\u00fcy\u00fck \u00e7apl\u0131 depremler de, gerek bizzat kat\u0131l\u0131nan arama \u2013kurtarma faaliyetlerinde, gerekse yerinde g\u00f6zlem ve incelemelerde, arama-kurtarma ekiplerinin bildirimlerinde bu \u015fekilde “y\u0131k\u0131lan enkazlarda<\/u><\/strong>” crush yaralanmalar\u0131ndan korunmu\u015f, s\u0131ra ve masa alt\u0131ndan \u00e7\u0131kar\u0131lan hi\u00e7 bir vaka bildirimine\u00a0 rastlanmam\u0131\u015ft\u0131r.<\/p>\n

\"\"<\/p>\n

ABD VE JAPONYADA DURUM FARKLI<\/strong><\/p>\n

Ba\u015fta\u00a0ABD\u00a0<\/strong>ve\u00a0Japonya\u00a0<\/strong>olmak \u00fczere \u00f6nceli\u011fin\u00a0<\/strong>beton y\u0131\u011f\u0131nlar\u0131 alt\u0131nda kalmaktan<\/strong>\u00a0\u00e7ok,\u00a0<\/strong>ba\u015f\u0131n\u0131za d\u00fc\u015febilecek e\u015fyalardan sak\u0131nmak<\/strong>\u00a0oldu\u011fu baz\u0131 \u00fclkelerde halen \u00f6nerilen\u00a0\u00e7\u00f6mel-kapan-tutun<\/strong>y\u00f6ntemi, binlerce binan\u0131n moloz y\u0131\u011f\u0131n\u0131na d\u00f6n\u00fc\u015ft\u00fc\u011f\u00fc,\u00a020 bine\u00a0<\/strong>yak\u0131n insan\u0131m\u0131z\u0131 yitirdi\u011fimiz\u00a017 A\u011fustos<\/strong>gibi felaketlerde,\u00a0Deveku\u015fu\u2019nun ba\u015f\u0131n\u0131 kuma g\u00f6mmesi<\/strong>\u00a0gibi,\u00a0<\/strong>\u2018f\u0131rt\u0131nada \u015femsiyeden medet ummak\u2019<\/strong>tan farks\u0131zd\u0131r.<\/p>\n

Fuku\u015fima\u00a0<\/strong>felaketinde\u00a0<\/strong>R9<\/strong>\u2019lar\u0131 bulan depremin direkt etkisinden \u00f6len\u00a0Japonlar\u0131n<\/strong>\u00a0yaln\u0131zca\u00a0onlarca<\/strong>,Tsunamiden\u00a0<\/strong>\u00f6lenlerin\u00a0<\/strong>onbinlerce<\/strong>\u00a0ve\u00a0radyasyonun<\/strong>\u00a0devam eden etkileri ile \u00f6len ve \u00f6leceklerin muhtemelen\u00a0y\u00fcz binleri\u00a0<\/strong>bulaca\u011f\u0131n\u0131 unutmamakta yarar var. Buradan da anla\u015f\u0131laca\u011f\u0131 gibi\u00a0oradaki sorun bizimkinden \u00e7ok farkl\u0131<\/strong>.<\/p>\n

 <\/p>\n

 <\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

G\u00fcn\u00fcm\u00fczde\u00a0en haz\u0131rl\u0131ks\u0131z<\/strong>\u00a0an\u0131n\u0131z olan\u00a0uykuda\u00a0<\/strong>dahi yan\u0131n\u0131zda olmas\u0131 gereken\u00a0<\/strong>iki\u00a0 \u015fey \u015farjdaki bir telefon<\/strong>\u00a0ve zaten \u00e7o\u011fumuzun\u00a0gece a\u011fz\u0131m\u0131z kurudu\u011funda bir yudum su i\u00e7mek<\/strong>\u00a0i\u00e7in bulundurdu\u011fumuzbir \u015fi\u015fe pet sudur<\/strong>\u2026<\/p>\n

\u00c7\u0131kar\u0131mlar ve \u00f6neriler<\/strong><\/p>\n

Deprem benzeri felaketlerde en k\u00f6t\u00fc senaryo olan \u00e7ok b\u00fcy\u00fck, a\u011f\u0131r, yatay levhalar aras\u0131nda crush yaralanmalar\u0131nda korunma, sa\u011f kal\u0131m, \u00e7ok y\u00fcksek bir olas\u0131l\u0131k de\u011fildir<\/em><\/strong>.<\/p>\n

K\u0131r\u0131lan\u00a0 kolon-kiri\u015f gibi ta\u015f\u0131y\u0131c\u0131 elemanlar\u0131n da yard\u0131m\u0131yla yatay plaklar aras\u0131nda olu\u015fan bo\u015fluklarda, ezilse bile yok olmayacak e\u015fyalar\u0131n yan\u0131nda “olabildi\u011fince hedef k\u00fc\u00e7\u00fcltmek”\u00a0 ve \u015fuur kayb\u0131 olsa dahi “uzunca s\u00fcre ya\u015famaya elverir bi\u00e7imde””cenin” pozisyonunu almakla bu \u015fans artt\u0131r\u0131labilir.<\/u><\/strong><\/p>\n

Crush yaralanmalar\u0131na kar\u015f\u0131 korunmada ;<\/p>\n

1.Olabildi\u011fince hedef k\u00fc\u00e7\u00fcltmek, en k\u00f6t\u00fc “pancake” y\u0131k\u0131mlarda” ezilse bile yok olmayan “ev e\u015fyalar\u0131n\u0131n” yan\u0131nda, binalar\u0131n dikey yap\u0131 unsurlar\u0131n\u0131nda, yatay katlar aras\u0131nda olu\u015fturdu\u011fu bo\u015fluklar\u0131n da yard\u0131m\u0131yla\u00a0 yan yatar, cenin<\/strong> pozisyonunda bulunmak, bir\u00e7ok kurtulan ve kurtar\u0131lan depremzede de g\u00f6zlenen bir konumdur. Manken deneklerde de kompakt hale getirilenler bu konumlarda en az hasar\u0131 g\u00f6rm\u00fc\u015ft\u00fcr.<\/p>\n

2.Binalar\u0131n zemin, giri\u015f gibi 10 -15 sn de t\u00fcm bireylerle birlikte\u00a0 terkedilebilecek alt katlar\u0131ndan sars\u0131nt\u0131 hissedilir hissedilmez d\u0131\u015far\u0131ya, g\u00fcvenli mahalle ka\u00e7\u0131\u015f ya\u015fam kurtar\u0131c\u0131d\u0131r. \u00c7ok katl\u0131 binalar\u0131n \u00fcst katlar\u0131nda biryerlere ko\u015fu\u015fturmak, pencerelerden atlamaya \u00e7al\u0131\u015fmak, asans\u00f6r, merdiven gibi g\u00fcvenli olmayan yerlere y\u00f6nelmek \u00f6l\u00fcmc\u00fcl olabilir. Daha \u00f6nceden kararla\u015ft\u0131r\u0131lm\u0131\u015f, ezilse bile yok olmayacak ev e\u015fyalar\u0131n\u0131n yan\u0131nda cenin pozisyonu alarak hedef k\u00fc\u00e7\u00fcltmek ezilme olas\u0131l\u0131\u011f\u0131n\u0131 azaltacakt\u0131r. Bu konum g\u00fcnler s\u00fcrebilecek bir s\u00fcre\u00e7te katabolik fazda \u015fuur kayb\u0131n\u0131nda s\u00f6z konusu oldu\u011fu durumlarda\u00a0 “recovery pozisyon” da imi\u015f gibi, aspirasyon, asfiksi gibi \u00f6l\u00fcmc\u00fcl durumlar\u0131 da engelleyecektir.<\/p>\n

3.Enkaz alt\u0131nda kalmalar, uzunca s\u00fcre kurtar\u0131lmay\u0131 beklerken bazen k\u0131\u015f ko\u015fullar\u0131nda hareketsiz kalma ile de birle\u015fince \u00f6l\u00fcmc\u00fcl olabilecek hipotermiye neden olabilir. Hipotermiden korunman\u0131n da en iyi yolu olabildi\u011fince \u00a0v\u00fccut y\u00fczeyini k\u00fc\u00e7\u00fcltmekle, cenin pozisyonunu almakla\u00a0 m\u00fcmk\u00fcnd\u00fcr.<\/p>\n

4.Bazal metabolizma ile ya\u015fam\u0131 idame ettirmenin en iyi yolu s\u00fcrekli uyku halinde bulunmakla m\u00fcmk\u00fcn olabilecektir. Bir \u00e7ok memeli canl\u0131 aylar s\u00fcren k\u0131\u015f uykusunda(hybernation), hi\u00e7 bir \u015fey yiyip i\u00e7meden “cenin” pozisyonunda yatarak bunu ba\u015farabilmektedir.<\/p>\n

5.”Drop, cover and hold on “pozisyonunda, \u00e7\u00f6melmi\u015f durumda iken \u015fayet crush yaralanmas\u0131na yol a\u00e7abilecek bir bina kollaps\u0131 s\u00f6z konusu olursa, \u00e7\u00f6ken yap\u0131 elemanlar\u0131 bu pozisyonda ilk olarak en fatal darbeyi “ba\u015f ve boyun” b\u00f6l\u00fcm\u00fcnde olu\u015fturacakt\u0131r.<\/p>\n

    \n
  1. Yan yatar “cenin” pozisyonunda iken ya\u015fama \u015fans\u0131n\u0131 artt\u0131ran bo\u015fluk y\u00fcksekli\u011fi i\u00e7in en az “kal\u00e7a” y\u00fcksekli\u011fi kadar olan, ortalama 40-50 cm mesafe yeterli olacakt\u0131r. “Drop, cover and hold on”\u00e7\u00f6mel,kapan,tutun\u201d i\u00e7in gerekli mesafe bunun en az 2 kat\u0131d\u0131r. Bir \u00e7ok “pancake” enkazda 1 metreye yak\u0131n bu kadar mesafe, esas “yatay katmanlar aras\u0131 ya\u015fam bo\u015fluklar\u0131n\u0131” sa\u011flayan dikey ve yatay ta\u015f\u0131y\u0131c\u0131 elamanlar olan “kolon ” ve “kiri\u015flerin” kal\u0131nl\u0131\u011f\u0131ndan daha geni\u015ftir.<\/li>\n<\/ol>\n

    .\"\"<\/p>\n

     <\/p>\n

      \n
    1. \u00c7\u00f6melme pozisyonuda uzunca s\u00fcre durulmas\u0131, gerek alt ekstremite dola\u015f\u0131m\u0131n\u0131n bas\u0131 alt\u0131nda kalmas\u0131 y\u00fcz\u00fcnden gerekse de torasik ve splanknik alana olan konjesyon nedeniyle ya\u015fam\u0131n uzunca s\u00fcre idamesini olanaks\u0131z k\u0131lmaktad\u0131r. Oysaki yan yatar “cenin” konumunda aynen “recovery” pozisyonunda oldu\u011fu gibi gerek kardiak gereksede solunum sistemlerinin i\u015flevselli\u011fi daha uzun s\u00fcre korunabilecektir.<\/li>\n
    2. Crush yaralanmalar\u0131nda, enkaz alt\u0131ndan kurtar\u0131lma sonras\u0131 depremzedelerin erken dialize al\u0131nmas\u0131 mortalite\u00a0 ve morbidite yi etkileyen en \u00f6nemli t\u0131bbi yakla\u015f\u0131mlardand\u0131r. B\u00f6breklerin kurtar\u0131l\u0131ncaya kadar fonksiyon g\u00f6rmesi dializ \u00f6ncesi gene mortalite ve morbiditeyi etkileyen en \u00f6nemli unsurdur. Yan yatar “cenin pozisyonunda, \u00e7\u00f6ken yatay elamanlar aras\u0131nda 40-50 cm den daha dar alanlarda s\u0131k\u0131\u015fma s\u00f6z konusu oldu\u011funda dahi en az\u0131ndan bir b\u00f6bre\u011fin y\u00fcz \u00fcst\u00fc vaya s\u0131rt\u0131 \u00fcst\u00fc yatar duruma g\u00f6re daha korunakl\u0131 olaca\u011f\u0131 a\u015fikard\u0131r.<\/li>\n<\/ol>\n

      9.Binalar\u0131n y\u0131k\u0131lmas\u0131 durumunda “drop,cover and hold on “pozisyonu y\u00fcz \u00fcst\u00fc kapaklanma ile sonu\u00e7lanacak bir final duru\u015fa d\u00f6n\u00fc\u015fecektir ki, burada \u00f6ncelikle ba\u015f ve boyun, dorsal omurga \u00a0olmak \u00fczere, son anda bu gibi ya\u015famsal v\u00fccut b\u00f6l\u00fcmlerini d\u00fc\u015fen objelerden sak\u0131nma \u015fans\u0131 yitirilmi\u015f olmaktad\u0131r. Oysaki yan yatar “cenin” pozisyonunda\u00a0 ba\u015f ve boyun \u00f6nkol ve ellerin korumas\u0131nda, en az y\u00fcksekli\u011fe ihtiya\u00e7 isteyen konumda, son anda dahi refleks olarak bir sak\u0131nma hareketi yapabilecektir.<\/p>\n

        \n
      1. Kompakt hale gelmi\u015f, dizler kar\u0131na do\u011fru \u00e7ekili yan yatar “cenin” konumunda, enkaz alt\u0131nda kal\u0131nd\u0131\u011f\u0131nda enkaz molozlar\u0131 ayakla ve elle itilerek, “ya\u015fam bo\u015flu\u011fu” i\u00e7in gerekli alan ekspanse edilebilir.<\/li>\n
      2. Magnit\u00fcd\u00fc b\u00fcy\u00fck ve uzun s\u00fcren depremleri \u00f6zellikle \u00e7ok katl\u0131 binalarda ya\u015fayanlar, masa, sandalye gibi \u00e7ok k\u00fc\u00e7\u00fck y\u00fczeylerle zemine de\u011fen e\u015fyalar\u0131n stabil olmad\u0131\u011f\u0131n\u0131, \u015fiddetli sars\u0131nt\u0131da kolayl\u0131kla yer de\u011fi\u015ftirdiklerini, \u00e7\u00f6melerek bu t\u00fcr e\u015fyalar\u0131n bacaklar\u0131na tutunman\u0131n, alt\u0131na s\u0131\u011f\u0131nman\u0131n “f\u0131rt\u0131nada \u015femsiyeden medet ummaktan” \u00e7ok fark\u0131 olmad\u0131\u011f\u0131 a\u015fikard\u0131r.<\/li>\n
      3. Depreme yatakta yakalan\u0131ld\u0131\u011f\u0131nda ba\u015fa yast\u0131k \u00f6rt\u00fclmesi, bina y\u0131k\u0131lmazsa tavandan, duvardan d\u00fc\u015febilecek boya par\u00e7alar\u0131na kar\u015f\u0131 koruyucu olabilir. Kollaps ger\u00e7ekle\u015firse, ba\u015fl\u0131ca \u00f6l\u00fcm nedenlerinden olan kafa ve boyna k\u00fcnt travmaya kar\u015f\u0131 yast\u0131\u011f\u0131n koruyucu olamayaca\u011f\u0131 a\u015fikard\u0131r.\"\"<\/li>\n
      4. Unutulmamas\u0131 gereken en \u00f6nemli hususlardan biri de \u00e7o\u011fu aktif tektonik plakalar \u00fczerinde yer alan geri kalm\u0131\u015f ve geli\u015fmekte olan \u00fclkeler de, sa\u011fl\u0131ks\u0131z kentle\u015fmeden \u00f6t\u00fcr\u00fc sa\u011flam olmayan zeminlere in\u015faa edilmi\u015f\u00a0 k\u00f6t\u00fc yap\u0131la\u015fma \u00a0nedeniyle b\u00fcy\u00fck depremlerdeki y\u0131k\u0131ma ba\u011fl\u0131 olarak\u00a0crush yaralanmalar\u0131n\u0131n daha \u00f6n planda olmas\u0131d\u0131r.<\/li>\n
      5. Arama-kurtarma \u00e7al\u0131\u015fmalar\u0131nda, “pancake “olmu\u015f binalarda d\u0131\u015fardan bak\u0131ld\u0131\u011f\u0131nda kabar\u0131k g\u00f6z\u00fcken yerler \u00f6ncelikle canl\u0131 aran\u0131lan\u00a0 yerlerdir. Bizim de kat\u0131ld\u0131\u011f\u0131m\u0131z arama kurtarma \u00e7al\u0131\u015fmalar\u0131nda bug\u00fcne kadar T\u00fcrkiyede ve di\u011fer \u00fclkelerde taraf\u0131m\u0131zdan sa\u011f \u00e7\u0131kar\u0131lan 128 vaka, cenin pozisyonu ya da ona yak\u0131n konumda bu t\u00fcr ya\u015fam \u00fc\u00e7genlerinden kurtar\u0131lanlard\u0131r.<\/li>\n<\/ol>\n

        15.Asfiksi, enkaz alt\u0131nda kalan depremzedelerde ana \u00f6l\u00fcm nedenlerinden biridir. Eller ve \u00f6nkolla korunan a\u011f\u0131z ve burun etraf\u0131nda yan yatar durumda, y\u0131k\u0131nt\u0131 an\u0131nda molozlardan korunma, sonras\u0131nda da gere\u011finde solunum sahas\u0131n\u0131 ekspanse etme olana\u011f\u0131 vard\u0131r. Y\u00fcz \u00fcst\u00fc \u00e7\u00f6melme yada yatakta s\u0131rt \u00fcst\u00fc yatarak yast\u0131kla kafan\u0131n \u00f6rt\u00fclmesi durumunda \u015fayet bina y\u0131k\u0131l\u0131rsa bu \u015fans ortadan kalkacakt\u0131r<\/p>\n

          \n
        1. Kazazedelerin \u00e7\u0131kar\u0131lmas\u0131, \u00fcstteki molozun kald\u0131r\u0131lmas\u0131ndan dolay\u0131\u00a0 uzun s\u00fcrece\u011fi durumlarda alt ve \u00fcst ekstremitenin olabildik\u00e7e korunmas\u0131 hayati \u00f6nem ta\u015f\u0131r. Crush sendromundan korumak i\u00e7in s\u0131k\u0131\u015fm\u0131\u015f kazazedeye ula\u015f\u0131l\u0131r ula\u015f\u0131lmaz damar yolunun s\u00fcratle a\u00e7\u0131lmas\u0131 ve salin solusyonu gibi ucuz, kolay bulunan, potasyumsuz mayilerle pozitif s\u0131v\u0131 balans\u0131n\u0131n sa\u011flanmas\u0131 gerekir. Cenin pozisyonu\u00a0 kompakt duru\u015fu ile ekstremitelerin korunma \u015fans\u0131n\u0131 artt\u0131r\u0131r.<\/li>\n<\/ol>\n

          17.Deprem \u00e7antas\u0131<\/em><\/strong>,binas\u0131 sa\u011flam,kentle\u015fmesi uygun zemin et\u00fcdleri ile ge\u00e7ekle\u015ftirilmi\u015f\u00a0 \u00fclkelerde sel bask\u0131n\u0131,tayfun,hortum,deprem benzeri felaketlerde ,esas sorunun enkaz alt\u0131nda kalmaktan ziyade, \u201cmahsur kalmak\u201d \u015feklinde tan\u0131mlanabilece\u011fi durumlar i\u00e7in uygun olabilir.Yoksa yap\u0131 standard\u0131 d\u00fc\u015f\u00fck,kentle\u015fmesi k\u00f6t\u00fc \u00fclkeler de\u00a0 ,depremin ilk sallant\u0131s\u0131nda i\u00e7eri\u011fi nerede ise \u00e7anta de\u011fil \u201cbavul\u201d gerektiren onca malzemenin pe\u015fine d\u00fc\u015f\u00fcld\u00fc\u011f\u00fcnde \u201chayatta kalabilme \u201ci\u00e7in \u00e7ok az olan zaman\u0131n yitirilmesine neden olacakt\u0131r.En k\u00f6t\u00fc senaryo ile enkaz alt\u0131nda kal\u0131nd\u0131\u011f\u0131nda ,\u00e7antadaki malzemelerle \u201cRobinson Crusoe \u201c hayat\u0131 ya\u015fanamayaca\u011f\u0131 kesindir.Unutulmamal\u0131d\u0131r ki bug\u00fcne\u00a0 kadar en fakir \u00fclkede dahi bir \u015fekilde depremlerin y\u0131k\u0131c\u0131 etkisinden kurtulmay\u0131 ba\u015faran\u00a0 hi\u00e7 kimse, a\u00e7l\u0131ktan \u00f6lmemi\u015ftir.<\/p>\n

          \"\"<\/p>\n

          18.\u00d6zellikle deprem an\u0131nda ,ilk sallant\u0131lar hissedildi\u011finde,\u201dzaman ya\u015famd\u0131r\u201d e\u011fer bina y\u0131k\u0131l\u0131rsa zaten devre d\u0131\u015f\u0131 kalacak\u00a0 olan elektri\u011fi ,gaz\u0131 kesmeye \u00e7al\u0131\u015fmakla, zaman ,bir ba\u015fka deyimle \u201cya\u015fam\u201d yitirilmemelidir.Binalar\u0131n y\u0131k\u0131lmas\u0131 sonucu, bu t\u00fcr ani ak\u0131m bo\u015falmalar\u0131nda en yak\u0131n konumlu gaz,elektrik vs devre kesicilerinin devreye otomatik olarak girmesi \u00e7a\u011fda\u015f kentle\u015fmenin ,yap\u0131 standard\u0131n\u0131n gere\u011fidir.<\/p>\n

          Tart\u0131\u015fma<\/strong><\/p>\n

          Kan\u0131ta dayal\u0131 , yerinde g\u00f6zlem, \u00f6rnekleme ve deneysel metodlarla irdelenen bu \u00e7al\u0131\u015fmada \u00fclkeden \u00fclkeye, toplumdan topluma de\u011fi\u015febilen davran\u0131\u015f modellerinde, deprem ba\u015fta olmak \u00fczere ezilme yaralanmalar\u0131na kar\u015f\u0131 en k\u00f6t\u00fc senaryo g\u00f6z\u00f6n\u00fcnde bulundurularak ya\u015fama \u015fans\u0131n\u0131 en fazla artt\u0131rmaya, yaralanmalar\u0131 en aza indirmeye y\u00f6nelik yakla\u015f\u0131mlr payla\u015f\u0131lmaktd\u0131r. Zira g\u00fcn\u00fcm\u00fcz\u00fcn s\u0131n\u0131r tan\u0131mayan seyahat imkanlar\u0131nda\u00a0 kimin nerede, hangi \u00fclkede, hangi ko\u015fulda, hangi felaketle kar\u015f\u0131la\u015fabilece\u011fini kestirmek m\u00fcmk\u00fcn de\u011fildir.\u00a0 <\/strong><\/p>\n

           <\/p>\n

          \"\"<\/p>\n

          \u00a0<\/em><\/strong><\/p>\n

          Referanslar<\/strong><\/p>\n

          1-Pellegrini VD, Reid JS, Evarts CM. Crush syndrome. In:Rockwood CA, Green DP, Bucholz RW, Heckman JD (eds). Rockwood and Green’s Fractures in Adults, 4th edn. Lippincott-Raven, New York, 1996; 450-1.<\/p>\n

          2- Bywaters EGL. 50 years on: The crush syndrome. BMJ 1990; 301: 1412-15.<\/p>\n

          3-Sever MS, Erek E, Vanholder R, et al. Clinical findings in the renal victims of a catastrophic disaster: in the Marmara earthquake. Nephrol Dial Transplant 2002; 17: 1942-1949.<\/p>\n

          4-Better OS. Rescue and salvage of casualties suffering from the crush syndrome after mass disasters. Military Medicine 1999 164; 366-369.<\/p>\n

          5- Hiraide A, Ohnishi M, Tanaka H, et al. Abdominal and lower extremity crush syndrome. Injury 1997;28:685\u20136.<\/p>\n

          6-Visweswaran P, Guntupalli J. Rhabdomyolysis. Crit. Care Clin. 1999; 15: 415-28.<\/p>\n

          7-Smith J, Greaves I. Crush injury and crush syndrome: a review. J Trauma 2003; 54: S226-S230.<\/p>\n

          8-Erek E, Sever MS, Serdenge\u00e7ti K, et al. An overview of morbidity and mortality in patients with acute renal failure due to crush syndrome: the Marmara earthquake experience. Nephrol Dial Transplant 2002; 17: 33-40.<\/p>\n

          9-Bywaters EGL, Beall D. Crush injuries with impairment of renal function. BMJ 1941; 1: 427-<\/p>\n

          10-Guha Sapir D, Carballo M. Disaster in Turkey: lessons for health preparedness. Lancet 1999;354:1649.<\/p>\n

          11- de Bruycker M, Greco D, Annino I, Stazi MA, de Ruggiero N, Triassi M, de Kettenis YP, Lechat MF. The 1980 earthquake in southern Italy: rescue of trapped victims and mortality. Bull World Health Organ. <\/em>1983;61(6):1021\u20131025<\/p>\n

          12-Noji EK,Kelen GD,Armenian HK,et al.The 1988 earthquake in Soviet Armenia:a case study. Ann Emerg Med 1990;19:891-17<\/p>\n

          13- Angus DC<\/a>, Pretto EA<\/a>, Abrams JI<\/a>, Ceciliano N<\/a>, Watoh Y<\/a>, Kirimli B<\/a>, Certug A<\/a>, Comfort LK<\/a>, Epidemiologic assessment of mortality, building collapse pattern, and medical response after the 1992 earthquake in Turkey. Disaster Reanimatology Study Group (DRSG).Prehosp Disaster Med. 1997 Jul-Sep;12(3):222-31.<\/p>\n

          14- Ellidokuz H<\/a>, Ucku R<\/a>, Aydin UY<\/a>, Ellidokuz E<\/a>. \u00a0\u00a0Risk factors for death and injuries in earthquake: cross-sectional study from Afyon, Turkey. Croat Med J. 2005 Aug;46(4):613-8.<\/p>\n

          15- Pretto EA<\/a>, Angus DC<\/a>, Abrams JI<\/a>, Shen B<\/a>, Bissell R<\/a>, Ruiz Castro VM<\/a>, Sawyers R<\/a>, Watoh Y<\/a>, Ceciliano N<\/a>, Ricci E<\/a>. An analysis of prehospital mortality in an earthquake. Disaster Reanimatology Study Group.Prehosp Disaster Med. 1994 Apr-Jun;9(2):107-17.<\/p>\n

          16- Papadopoulos IN<\/a>, Kanakaris N<\/a>, Triantafillidis A<\/a>, Stefanakos J<\/a>, Kainourgios A<\/a>, Leukidis C<\/a>.\u00a0\u00a0 \u00a0Autopsy findings from 111 deaths in the 1999 Athens earthquake as a basis for auditing the emergency response.Br J Surg. 2004 Dec;91(12):1633-40<\/p>\n

          17- Philippines.Roces MC<\/a>, White ME<\/a>, Dayrit MM<\/a>, Durkin ME<\/a>.\u00a0Risk factors for injuries due to the 1990 earthquake in Luzon,Bull World Health Organ. 1992;70(4):509-14<\/p>\n

          18- Risolo E<\/a>, De Carlo M<\/a>, Micillo A<\/a>, Vetrella M<\/a>. Pediatria Cold injuries in children. Experiences of the earthquake of November 1980 (Napoli). 1982 Mar 31;90(1):45-51<\/p>\n

          19- O Demirkiran, Y Dikmen, T Utku and S Urkmez Crush syndrome patients after the Marmara earthquake Emerg. Med. J. <\/em>2003;20;247-250 doi:10.1136\/emj.20.3.247<\/p>\n

          20- Gholam Reza Raissi, J Earthquakes and Rehabilitation Needs: Experiences From Bam, Iran, Spinal Cord Med. 2007; 30(4): 369\u2013372. PMCID: PMC2031928<\/p>\n

          21- What to Do During an Earthquake: FEMA; http: \/\/www.fema.gov\/hazard\/earthquake\/eq _during. shtm<\/a>; Last Modified: Wednesday, 22-Aug-2007 13:42:40 EDT<\/p>\n","protected":false},"excerpt":{"rendered":"

          \u00c7\u00f6kme Esnas\u0131nda Meydana Gelebilecek Ezilme Yaralanmalar\u0131na Kar\u015f\u0131 Rasyonel Korunma Y\u00f6ntemleri: \u015eehir Efsanelerine Kar\u015f\u0131 Mortalite Ve Morbidite Azalt\u0131c\u0131 \u00d6neriler Giri\u015f \u0130nsanlar\u0131n, ya\u015fam alan\u0131…<\/p>\n","protected":false},"author":1478,"featured_media":580,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10043,1,10013],"tags":[10069,10059,10067],"class_list":["post-571","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-afet-yazi-dizisi","category-genel","category-kutlama-ve-anma","tag-17-agustos","tag-afet","tag-marmara-depremi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts\/571","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/users\/1478"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/comments?post=571"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/posts\/571\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/media\/580"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/media?parent=571"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/categories?post=571"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/afet\/wp-json\/wp\/v2\/tags?post=571"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}