{"id":681,"date":"2024-05-02T08:30:00","date_gmt":"2024-05-02T05:30:00","guid":{"rendered":"https:\/\/tatd.org.tr\/afet\/?p=681"},"modified":"2024-05-01T20:33:35","modified_gmt":"2024-05-01T17:33:35","slug":"ikinci-basamak-saglik-kuruluslarinda-afet-yonetiminin-zorluklari","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/afet\/afet-yazi-dizisi\/ikinci-basamak-saglik-kuruluslarinda-afet-yonetiminin-zorluklari\/","title":{"rendered":"\u0130kinci Basamak Sa\u011fl\u0131k Kurulu\u015flar\u0131nda Afet Y\u00f6netiminin Zorluklar\u0131"},"content":{"rendered":"\n<p><strong>K\u0131saltmalar:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>AFAD:<\/strong> Afet ve Acil Durum Y\u00f6netimi Ba\u015fkanl\u0131\u011f\u0131<\/li>\n\n\n\n<li><strong>ASH:<\/strong> Acil Sa\u011fl\u0131k Hizmetleri<\/li>\n\n\n\n<li><strong>ASM:<\/strong> Aile sa\u011fl\u0131\u011f\u0131 merkezi<\/li>\n\n\n\n<li><strong>CABG:<\/strong> Koroner arter by-pass greft<\/li>\n\n\n\n<li><strong>CK:<\/strong> kreatin kinaz<\/li>\n\n\n\n<li><strong>DS\u00d6:<\/strong> D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc<\/li>\n\n\n\n<li><strong>FAST:<\/strong> Travma i\u00e7in Odaklanm\u0131\u015f De\u011ferlendirme Sonografisi (Focused Assesment Sonography for Trauma)<\/li>\n\n\n\n<li><strong>GSM:<\/strong> Global System for Mobile Communications<\/li>\n\n\n\n<li><strong>HAP:<\/strong> Hastane Afet ve Acil Durum Plan\u0131<\/li>\n\n\n\n<li><strong>ISMEP:<\/strong> \u0130stanbul Sismik Riskin Azalt\u0131lmas\u0131 ve Acil Durum Haz\u0131rl\u0131k Projesi<\/li>\n\n\n\n<li><strong>KBB:<\/strong> Kulak Burun Bo\u011faz<\/li>\n\n\n\n<li><strong>KBRN-e:<\/strong> Kimyasal, biyolojik, radyolojik ve n\u00fckleer sald\u0131r\u0131lar ve patlamalar<\/li>\n\n\n\n<li><strong>SGK:<\/strong> Sosyal G\u00fcvenlik Kurumu<\/li>\n\n\n\n<li><strong>SALT:<\/strong> S\u0131ralama, De\u011ferlendirme, Hayat Kurtarma, M\u00fcdahaleler, Tedavi ve Nakil (Sort, Assess, Lifesaving, Interventions, Treatment and Transportation)<\/li>\n\n\n\n<li><strong>START:<\/strong> Basit triyaj h\u0131zl\u0131 y\u00f6netim (Simple Triage and Rapid Treatment)<\/li>\n\n\n\n<li><strong>TAMP:<\/strong> T\u00fcrkiye Afet M\u00fcdahale Plan\u0131<\/li>\n\n\n\n<li><strong>TSM:<\/strong> Toplum sa\u011fl\u0131\u011f\u0131 merkezi<\/li>\n\n\n\n<li><strong>UMKE:<\/strong> Ulusal T\u0131bbi Kurtarma Ekipleri<\/li>\n\n\n\n<li><strong>USG:<\/strong> Ultrasonografi<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Giri\u015f<\/strong><\/h2>\n\n\n\n<p>Afet t\u0131bb\u0131n\u0131n as\u0131l hedefi, afetlerin toplum sa\u011fl\u0131\u011f\u0131na verdi\u011fi zarar\u0131 en aza indirgemek, hatta m\u00fcmk\u00fcnse tamamen \u00f6nlemektir[1]. Bu kapsamda, afetler s\u0131ras\u0131nda sa\u011fl\u0131k sistemlerinin etkin bir \u015fekilde yaral\u0131lara m\u00fcdahale etmesini sa\u011flamak, sa\u011fl\u0131k ko\u015fullar\u0131n\u0131 afet \u00f6ncesi seviyelere geri d\u00f6nd\u00fcrebilmek ve sa\u011fl\u0131k hizmetlerini korumak veya yeniden in\u015fa etmek \u00f6nceliklidir.<\/p>\n\n\n\n<p>Afet t\u0131bb\u0131 konusunda bilimsel \u00e7al\u0131\u015fmalar yakla\u015f\u0131k 50 y\u0131l \u00f6nce ba\u015flam\u0131\u015ft\u0131r[2]. Uluslararas\u0131 Afet T\u0131bb\u0131 Derne\u011fi ve D\u00fcnya Afet ve Acil T\u0131p Derne\u011fi (WADEM) hastane \u00f6ncesi ve acil sa\u011fl\u0131k hizmetleri, halk sa\u011fl\u0131\u011f\u0131 ve benzeri konularda k\u00fcresel \u00e7al\u0131\u015fmalar geli\u015ftirmek amac\u0131yla daha sonra meslek birlikleri olarak 2 Ekim 1976\u2019da kurulmu\u015ftur.[3]. WADEM, t\u0131p, hem\u015firelik, acil durum y\u00f6netimi, akademi, askeriye, veterinerlik, psikoloji ve sosyoloji alanlar\u0131nda 55 farkl\u0131 \u00fclkeden resmi veya sivil toplum \u00fcyesi olan en eski afet t\u0131bb\u0131 organizasyonudur[4].<\/p>\n\n\n\n<p>Afet t\u0131bb\u0131 sadece bir deprem i\u00e7in de\u011fil bir\u00e7ok insan eliyle ve do\u011fal kaynakl\u0131 ortaya \u00e7\u0131kan bir\u00e7ok afeti inceler. Bu nedenle, multidisipliner bir hiyerar\u015fiye sahiptir ve arama kurtarma ekipleri, acil sa\u011fl\u0131k hizmetleri, acil t\u0131p, afet y\u00f6netimi ve halk sa\u011fl\u0131\u011f\u0131 gibi bir\u00e7ok t\u0131bb\u0131 halkan\u0131n dinamik y\u00f6netimini gerektirir (<strong>\u015eekil 1<\/strong>). Bu kavramlar\u0131 daha da somutla\u015ft\u0131rmak i\u00e7in yaz\u0131m\u0131z \u00f6zelinde \u00f6zellikle sismik bir olay sonras\u0131 ortaya \u00e7\u0131kan ve bir\u00e7ok yap\u0131ya zarar vererek i\u00e7erisindeki insanlar\u0131n yaralanmas\u0131 ve \u00f6lmesi ba\u015fta olmak \u00fczre bir\u00e7ok etkiye sahip olan deprem \u00fczerinden ilerleyece\u011fiz.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img fetchpriority=\"high\" decoding=\"async\" width=\"865\" height=\"487\" src=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/05\/7963e2236d85cdabb6016d0d95ad7a6d.png\" alt=\"\" class=\"wp-image-683\" srcset=\"https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/05\/7963e2236d85cdabb6016d0d95ad7a6d.png 865w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/05\/7963e2236d85cdabb6016d0d95ad7a6d-300x169.png 300w, https:\/\/tatd.org.tr\/afet\/wp-content\/uploads\/sites\/31\/2024\/05\/7963e2236d85cdabb6016d0d95ad7a6d-768x432.png 768w\" sizes=\"(max-width: 865px) 100vw, 865px\" \/><\/figure>\n\n\n\n<p><strong>\u015eekil 1.<\/strong>Afet t\u0131bb\u0131n\u0131n temel komponentleri ve da\u011f\u0131l\u0131m\u0131<\/p>\n\n\n\n<p>Afet halkalar\u0131 incelendi\u011finde afetlere g\u00fc\u00e7l\u00fc ve tam cevap verebilmenin anahtar\u0131 afetlere haz\u0131rl\u0131k a\u015famas\u0131d\u0131r[5]. \u00dclkemizde 1999 Marmara depreminin ard\u0131ndan afet risklerinin azalt\u0131lmas\u0131 amac\u0131yla \u0130stanbul Sismik Riskin Azalt\u0131lmas\u0131 ve Acil Durum Haz\u0131rl\u0131k Projesi (\u0130SMEP) ba\u015flat\u0131lm\u0131\u015ft\u0131r[6]. Afet t\u0131bb\u0131 alan\u0131nda \u0130SMEP&#8217;te 48 hastane binas\u0131 ile 59 poliklinik ve sa\u011fl\u0131k merkezi binas\u0131 depreme kar\u015f\u0131 g\u00fc\u00e7lendirilmi\u015f, \u0130stanbul&#8217;un en b\u00fcy\u00fck hastanelerinden \u00fc\u00e7\u00fc tamamen y\u0131k\u0131l\u0131p sismik izolat\u00f6r teknolojisiyle yeniden in\u015fa edilmi\u015ftir. Bu proje kapsam\u0131nda ek olarak Ulusal T\u0131bbi Kurtarma Ekipleri (UMKE) i\u00e7in a\u015f\u0131, kan \u00fcr\u00fcnleri ta\u015f\u0131ma arac\u0131, \u00e7e\u015fitli t\u0131bbi ilk m\u00fcdahale ekipmanlar\u0131, forkliftler, mobil jenerat\u00f6r, \u0131\u015f\u0131k kuleleri, so\u011fuk hava depolar\u0131, mobil ileti\u015fim arac\u0131, analog radyo b\u00f6lgesel vericileri ve merkez \u00fcniteleri gibi bir\u00e7ok yat\u0131r\u0131m yap\u0131lm\u0131\u015ft\u0131r. \u0130yi bir haz\u0131rl\u0131k,<\/p>\n\n\n\n<p>Afet sonras\u0131 erken bir cevap i\u00e7in kritik \u00f6neme sahiptir. D\u00fcnya genelinde ya\u015fanan do\u011fal afet verilerine bakarsak Ermenistan&#8217;da deprem sonras\u0131 verilere g\u00f6re ilk 3 saatte yaral\u0131lar\u0131n y\u00fczde 90&#8217;\u0131, ilk 6 saatte ise y\u00fczde 50&#8217;si kurtar\u0131lm\u0131\u015f. Depremden sonraki ilk 72 saat, kurtarma \u00e7al\u0131\u015fmalar\u0131n\u0131n alt\u0131n saatleri olarak nitelendirilir[7].<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Sa\u011fl\u0131k hizmeti basamaklar\u0131<\/strong><\/h2>\n\n\n\n<p>Geli\u015fmi\u015f \u00fclkelerde geni\u015f kapsaml\u0131 sa\u011fl\u0131k sistemi i\u00e7inde, sa\u011fl\u0131k bak\u0131m\u0131 uygulamalar\u0131n\u0131n \u00e7e\u015fitli d\u00fczeyleri veya alanlar\u0131 vard\u0131r. Genellikle, kademeli bran\u015fla\u015fm\u0131\u015f ve donan\u0131m\u0131 yeterli kademelerini temsil eden, genellikle artan bak\u0131m maliyetleriyle birlikte, \u00fc\u00e7 veya bazen d\u00f6rd\u00fcnc\u00fc basamak sa\u011fl\u0131k hizmetinden olu\u015fan piramit \u015feklinde bir yap\u0131 olarak tan\u0131mlan\u0131rlar[8]. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), temel birinci basamak sa\u011fl\u0131k hizmetinin sa\u011flanmas\u0131n\u0131, kapsay\u0131c\u0131 bir birinci basamak sa\u011fl\u0131k hizmeti stratejisinin ayr\u0131lmaz bir bile\u015feni olarak nitelendirmekte ve birinci basamak sa\u011fl\u0131k hizmeti yakla\u015f\u0131m\u0131n\u0131n a\u015fa\u011f\u0131daki \u00fc\u00e7 bile\u015feni i\u00e7ermesi gerekti\u011fini \u00f6nermektedir:<\/p>\n\n\n\n<p>Bunlar:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>\u0130nsanlar\u0131n ya\u015famlar\u0131 boyunca sa\u011fl\u0131k ihtiya\u00e7lar\u0131n\u0131n kar\u015f\u0131lanmas\u0131;<\/li>\n\n\n\n<li>\u00c7ok sekt\u00f6rl\u00fc politika ve eylem arac\u0131l\u0131\u011f\u0131yla sa\u011fl\u0131\u011f\u0131n daha geni\u015f belirleyicilerinin ele al\u0131nmas\u0131<\/li>\n\n\n\n<li>Bireyleri, aileleri ve topluluklar\u0131 kendi sa\u011fl\u0131klar\u0131n\u0131n sorumlulu\u011funu \u00fcstlenmeleri i\u00e7in g\u00fc\u00e7lendirmek.&nbsp;<\/li>\n<\/ol>\n\n\n\n<p>Birinci basamak sa\u011fl\u0131k hizmetleri, ki\u015finin ya\u015fam\u0131 boyunca fiziksel, zihinsel ve sosyal refah\u0131 da dahil olmak \u00fczere sa\u011fl\u0131k ihtiya\u00e7lar\u0131n\u0131n \u00e7o\u011funu kar\u015f\u0131layan, hastal\u0131k merkezli olmaktan ziyade insan merkezli bir hizmettir[9]. Birinci basamak sa\u011fl\u0131k hizmeti genellikle hastalar\u0131n t\u0131bbi endi\u015feleri veya ihtiya\u00e7lar\u0131 oldu\u011funda ald\u0131klar\u0131 ilk bak\u0131m d\u00fczeyidir ve sa\u011fl\u0131\u011f\u0131n geli\u015ftirilmesi, hastal\u0131klar\u0131n \u00f6nlenmesi, tedavi, rehabilitasyon ve palyatif bak\u0131m\u0131 i\u00e7eren bir b\u00fct\u00fcn-toplum yakla\u015f\u0131m\u0131n\u0131 benimser. Birinci basamak sa\u011fl\u0131k hizmetinde ki\u015finin sa\u011fl\u0131k hizmeti sa\u011flay\u0131c\u0131s\u0131 ayn\u0131d\u0131r (aile hekimleri gibi, ancak sistemde geriatri uzmanlar\u0131, pediatristler de birincil sa\u011fl\u0131k hizmetini uygun hasta gruplar\u0131nda devam ettirmektedir.) Yeni bir semptom\/hastal\u0131k varl\u0131\u011f\u0131nda, so\u011fuk alg\u0131nl\u0131\u011f\u0131, grip veya ba\u015fka bir enfeksiyon durumunda, akut travmaya ba\u011fl\u0131 k\u0131r\u0131k dahil yaralanmalarda ve di\u011fer basamaklara sevk durumunda hastalar\u0131n \u00f6ncelikli ba\u015fvurdu\u011fu sa\u011fl\u0131k hizmeti basama\u011f\u0131d\u0131r.<\/p>\n\n\n\n<p>\u0130kinci basamak sa\u011fl\u0131k hizmeti; birinci basamaktan hastay\u0131 spesifik uzmanl\u0131k dal\u0131na sevki ile ba\u015flar. Bu durum koroner arter hastal\u0131klar\u0131 ile kardiyolo\u011fa sevki, kronik metabolik hastal\u0131klar i\u00e7in endokrinoloji, kronik b\u00f6brek yetmezli\u011fi ile nefrolojiye sevki gibi durumlar\u0131 gerektirir. Birinci ve ikinci basamaktaki hekimler de hasta i\u00e7in yine ileti\u015fim halinde kalmaktad\u0131r.<\/p>\n\n\n\n<p>\u00dc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k hizmeti de yine ikinci basamaktan daha \u00f6zelle\u015fmi\u015f bran\u015f uzmanlar\u0131na hastan\u0131n y\u00f6nlendirilmesi\/sevki ile ba\u015flar.&nbsp; Organ nakilleri, koroner arter by-pass greft (CABG) veya estetik ameliyatlar gibi \u00f6zelle\u015fmi\u015f cerrahi bran\u015flar, beyin cerrahi i\u00e7in \u00fc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k merkezlerine sevki ger\u00e7ekle\u015ftirilerek sa\u011fl\u0131k hizmeti s\u00fcrd\u00fcr\u00fclmektedir.<\/p>\n\n\n\n<p>D\u00f6rd\u00fcnc\u00fc basamak sa\u011fl\u0131k hizmetleri ise daha \u00f6zelle\u015fmi\u015f bran\u015flar\u0131 bar\u0131nd\u0131rmakta ancak \u00e7ok \u00f6zellikli durumlarda gerekmektedir. \u00dc\u00e7\u00fcnc\u00fc basama\u011f\u0131n bir uzant\u0131s\u0131 olarak kabul edilir. Bu nedenle de her hastanede ya da t\u0131p merkezinde bulunmamaktad\u0131r.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>T\u00fcrkiye&#8217;de&nbsp;sa\u011fl\u0131k hizmetleri<\/strong>&nbsp;<\/h2>\n\n\n\n<p>Kamu ve \u00f6zel sa\u011fl\u0131k hizmetlerinin her ikisinin de devam\u0131 ve birlikteli\u011fi ile olu\u015fmaktad\u0131r. \u0130lgili mevzuatlar\u0131ndaki tan\u0131mlara uygun olarak birinci, ikinci ve \u00fc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k kurulu\u015flar\u0131 mevcuttur. \u0130lk iki basamak hastalar\u0131n ayaktan veya yatakl\u0131 te\u015fhis ve tedavilerinin yap\u0131ld\u0131\u011f\u0131 sa\u011fl\u0131k kurulu\u015flar\u0131d\u0131r.<\/p>\n\n\n\n<p>T\u00fcrkiye, Genel Sa\u011fl\u0131k Sigortas\u0131&nbsp;sistemi kapsam\u0131nda&nbsp;evrensel sa\u011fl\u0131k hizmetlerine&nbsp;sahiptir. Bu sistem kapsam\u0131nda,&nbsp;Sosyal G\u00fcvenlik Kurumu&#8217;na&nbsp;(SGK) kay\u0131tl\u0131 t\u00fcm vatanda\u015flar, SGK ile s\u00f6zle\u015fmeli hastanelerde muayene, tetkik hakk\u0131 ve tedavi alabilmektedir. \u00dclkemizde; birinci, ikinci ve \u00fc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k hizmetleri mevcuttur.<\/p>\n\n\n\n<p><strong>Birinci basamak sa\u011fl\u0131k hizmet sunucular\u0131 \u015funlard\u0131r:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>B\u00fcnyesinde birinci basamak sa\u011fl\u0131k kurulu\u015fu bulunan il\u00e7e sa\u011fl\u0131k m\u00fcd\u00fcrl\u00fc\u011f\u00fc.&nbsp;<\/li>\n\n\n\n<li>Toplum sa\u011fl\u0131\u011f\u0131 merkezi (TSM).<\/li>\n\n\n\n<li>Aile sa\u011fl\u0131\u011f\u0131 merkezi (ASM).<\/li>\n\n\n\n<li>Halk sa\u011fl\u0131\u011f\u0131 laboratuvar\u0131 (L1ve L2).&nbsp;<\/li>\n\n\n\n<li>Kurum tabipli\u011fi.<\/li>\n\n\n\n<li>112 Acil sa\u011fl\u0131k hizmeti<\/li>\n\n\n\n<li>Evde bak\u0131m hizmetleri<\/li>\n\n\n\n<li>\u0130\u015fyeri sa\u011fl\u0131k ve g\u00fcvenlik hizmeti sunulan birimler.<\/li>\n\n\n\n<li>Belediyelere ait poliklinikler.<\/li>\n\n\n\n<li>\u00d6zel poliklinikler.<\/li>\n\n\n\n<li>A\u011f\u0131z ve di\u015f sa\u011fl\u0131\u011f\u0131 hizmeti veren \u00f6zel sa\u011fl\u0131k kurulu\u015flar\u0131.<\/li>\n\n\n\n<li>\u00dcniversiteler b\u00fcnyesindeki mediko-sosyal birimler.<\/li>\n\n\n\n<li>T\u00fcrk Silahl\u0131 Kuvvetlerinin birinci basamak sa\u011fl\u0131k \u00fcniteleri.<\/li>\n\n\n\n<li>18\/12\/1953 tarihli ve 6197 say\u0131l\u0131 Eczac\u0131lar ve Eczaneler Hakk\u0131nda Kanun kapsam\u0131nda serbest faaliyet g\u00f6steren eczaneler.<\/li>\n\n\n\n<li>Muayenehaneler<\/li>\n<\/ul>\n\n\n\n<ol class=\"wp-block-list\" style=\"list-style-type:upper-alpha\">\n<li><\/li>\n<\/ol>\n\n\n\n<p><strong>\u0130kinci basamak sa\u011fl\u0131k hizmet sunucular\u0131 \u015funlard\u0131r:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>E\u011fitim ve ara\u015ft\u0131rma hastanesi olmayan devlet hastaneleri ve dal hastaneleri ile bu hastanelere ba\u011fl\u0131 semt poliklinikleri.<\/li>\n\n\n\n<li>Entegre il\u00e7e hastanesi.<\/li>\n\n\n\n<li>Bakanl\u0131\u011fa ba\u011fl\u0131 a\u011f\u0131z ve di\u015f sa\u011fl\u0131\u011f\u0131 merkezleri<\/li>\n\n\n\n<li>Kamu kurumlar\u0131na ait olup bakanl\u0131k\u00e7a ruhsatland\u0131r\u0131lm\u0131\u015f olan hastaneler, t\u0131p merkezleri ve dal merkezleri.<\/li>\n\n\n\n<li>\u00d6zel hastaneler.<\/li>\n\n\n\n<li>\u00d6zel t\u0131p merkezleri ve dal merkezleri.<\/li>\n\n\n\n<li>Diyaliz merkezleri, \u00fcremeye yard\u0131mc\u0131 tedavi merkezleri, hiperbarik oksijen tedavi merkezleri, t\u0131bbi laboratuvarlar gibi m\u00fcstakil olarak ruhsatland\u0131r\u0131lan tan\u0131 ve tedavi merkezleri.&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n\n\n\n<li>\u0130kinci basamak sa\u011fl\u0131k hizmet sunucular\u0131na ait faaliyet izin belgelerine; ilgili birim taraf\u0131ndan a\u00e7\u0131l\u0131\u015f onay\u0131 al\u0131nm\u0131\u015f, alkol ve madde ba\u011f\u0131ml\u0131l\u0131\u011f\u0131 tedavi ve e\u011fitim merkezi, \u00e7ocuk ergen madde ba\u011f\u0131ml\u0131l\u0131\u011f\u0131 tedavi merkezi, diyaliz merkezi, gebe okulu, geleneksel ve tamamlay\u0131c\u0131 t\u0131p uygulama birimi, obezite merkezi, toplum ruh sa\u011fl\u0131\u011f\u0131 merkezi, \u00fcremeye yard\u0131mc\u0131 tedavi merkezi, semt poliklinikleri, ek hizmet binalar\u0131 ve benzeri birimler ba\u011fl\u0131 birim olarak eklenir.<\/li>\n<\/ul>\n\n\n\n<p>\u00dc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k hizmet sunucular\u0131 ileri tetkik ve tedavi gerektiren hastal\u0131klar i\u00e7in y\u00fcksek teknoloji i\u00e7eren ve\/veya e\u011fitim ve ara\u015ft\u0131rma hizmetlerinin verilebilece\u011fi altyap\u0131ya sahip \u00fcst d\u00fczey sa\u011fl\u0131k hizmet sunucular\u0131d\u0131r.&nbsp; \u00dc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k hizmet sunucular\u0131, kurum harici veya il d\u0131\u015f\u0131ndan \u00fc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k hizmeti ihtiyac\u0131 i\u00e7in sevkle gelen hastalar\u0131n kabul\u00fcn\u00fc yapar ve sa\u011fl\u0131k hizmeti ihtiya\u00e7lar\u0131n\u0131 kar\u015f\u0131lar.&nbsp; \u00dc\u00e7\u00fcnc\u00fc basamak sa\u011fl\u0131k hizmet sunucular\u0131na ait faaliyet izin belgelerine; ilgili mevzuat\u0131 ve bakanl\u0131k planlama ilkeleri \u00e7er\u00e7evesinde a\u00e7\u0131l\u0131\u015f onay\u0131 al\u0131nm\u0131\u015f, ba\u011f\u0131ml\u0131l\u0131k ar\u0131nd\u0131rma merkezi, ba\u011f\u0131ml\u0131l\u0131k rehabilitasyon merkezi, \u00e7ocuk izlem merkezi, toplum ruh sa\u011fl\u0131\u011f\u0131 merkezi, diyaliz merkezi, gebe okulu, obezite merkezi, \u00fcremeye yard\u0131mc\u0131 tedavi merkezi, semt poliklinikleri, ek hizmet binalar\u0131 ve benzeri birimler de ilgili mevzuat \u00e7er\u00e7evesinde ba\u011fl\u0131 birim olarak eklenebilir[10].<\/p>\n\n\n\n<p>06 \u015eubat 2023 tarihinde, T\u00fcrkiye saatiyle 04:17&#8217;de ve ayn\u0131 g\u00fcn i\u00e7erisinde 13:24&#8217;te, merkez \u00fcss\u00fc Pazarc\u0131k (Kahramanmara\u015f) ve Elbistan (Kahramanmara\u015f) olan, s\u0131ras\u0131yla 7.7 ve 7.6 b\u00fcy\u00fckl\u00fc\u011f\u00fcnde iki deprem meydana gelmi\u015ftir[11]. <strong>T\u00fcrkiye Afet M\u00fcdahale Plan\u0131&#8217;na (TAMP)<\/strong>&nbsp;g\u00f6re T\u00fcrkiye\u2019de ya\u015fanmas\u0131 olas\u0131<strong>&nbsp;afetlerde arama-kurtarma \u00e7al\u0131\u015fmalar\u0131ndan<\/strong>&nbsp;ve&nbsp;<strong>koordinasyonundan&nbsp;<\/strong>sorumlu kurum olan&nbsp;<strong>AFAD\u2019\u0131n verilerine g\u00f6re <\/strong>11 \u015fehirde (Hatay, Kahramanmara\u015f, Ad\u0131yaman, Gaziantep, Malatya, \u015eanl\u0131urfa, El\u00e2z\u0131\u011f, Kilis, Osmaniye, Adana, Diyarbak\u0131r) a\u011f\u0131r y\u0131k\u0131m ve can kayb\u0131 ile sonu\u00e7lanan bu depremde \u201cresmi\u201d verilere g\u00f6re 53.537 ki\u015fi hayat\u0131n\u0131 kaybetmi\u015ftir.<\/p>\n\n\n\n<p>Hastane Afet ve Acil Durum Plan\u0131 (HAP) 20 Mart 2015 tarihli ve 29301 say\u0131l\u0131 Resm\u00ee Gazete\u2019de yay\u0131nlanarak y\u00fcr\u00fcrl\u00fc\u011fe girmi\u015ftir. Ard\u0131ndan, HAP Haz\u0131rlama K\u0131lavuzu\u2019nun Aral\u0131k 2015 tarihinde yay\u0131nlanmas\u0131yla \u00f6nemli bir eksik tamamlanm\u0131\u015ft\u0131r. S\u00fcre\u00e7 i\u00e7erisinde geri d\u00f6n\u00fc\u015fler ve d\u00fcnyadaki g\u00fcncel geli\u015fmeler de\u011ferlendirilerek HAP K\u0131lavuzu\u2019nun g\u00fcncellenerek yay\u0131nlanmas\u0131 uygun bulunmu\u015ftur. Devam\u0131nda yeni HAP Uygulama Y\u00f6netmeli\u011fi 18 Mart 2020 tarih 31072 say\u0131l\u0131 Resm\u00ee Gazete\u2019de yay\u0131nlanm\u0131\u015ft\u0131r. Daha \u00f6nceki k\u0131lavuz ise y\u00fcr\u00fcrl\u00fckten kald\u0131r\u0131lm\u0131\u015ft\u0131r. S\u00f6z konusu y\u00f6netmelikte HAP\u2019lar\u0131n amac\u0131 \u201c<strong><em>\u00fclke genelindeki t\u00fcm hastanelerin, afetlere y\u00f6nelik risklere y\u00f6nelik tedbir almalar\u0131n\u0131, yurt i\u00e7inde meydana gelen afet ve acil durumlarda sunulacak sa\u011fl\u0131k hizmetleri konusunda gerekli haz\u0131rl\u0131klar\u0131 \u00f6nceden yapmalar\u0131n\u0131 ve ilk 72 saat boyunca hastane d\u0131\u015f\u0131ndan hi\u00e7bir yard\u0131m almadan da kendi kendine yeterli olmalar\u0131n\u0131 sa\u011flayabilmek<\/em><\/strong>\u201d olarak ifade edilmektedir[12].<\/p>\n\n\n\n<p>Afet durumunda ilk yap\u0131lmas\u0131 gereken afetin b\u00fcy\u00fckl\u00fc\u011f\u00fc ve \u00f6zelli\u011fine g\u00f6re hastane afet plan\u0131 aktivasyonudur[13]. Fiziki alanlar haz\u0131rlan\u0131rken \u015fu sorular\u0131n yan\u0131tlanmas\u0131 organizasyonu belirleyip kolayla\u015ft\u0131rmak ad\u0131na b\u00fcy\u00fck \u00f6nem ta\u015f\u0131r[14]:<\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"1\">\n<li>Afet durumunu olu\u015fturan olay\u0131n boyutu ve niteli\u011fi nedir?<\/li>\n\n\n\n<li>Olay merkezinin hastaneye uzakl\u0131\u011f\u0131 ve hastaneyi fiziksel ve i\u015flevsel olarak etkileme riski nedir, etkilenmi\u015f ise hasta bak\u0131m\u0131n\u0131 ne boyutta etkilemi\u015ftir?<\/li>\n\n\n\n<li>&nbsp;Acil serviste mevcut hizmeti engelleyecek fiziki veya i\u015flevsel hasar var m\u0131d\u0131r?<\/li>\n\n\n\n<li>Olaydan etkilenen n\u00fcfus ve ba\u015fvurabilecek yaral\u0131 say\u0131s\u0131 ka\u00e7t\u0131r?<\/li>\n\n\n\n<li>Kontamine yaral\u0131 ba\u015fvurma olas\u0131l\u0131\u011f\u0131 var m\u0131d\u0131r? (Dekontaminasyon? Kimyasal, biyolojik, radyolojik ve n\u00fckleer sald\u0131r\u0131lar ve patlamalar [KBRN-e]?)<\/li>\n\n\n\n<li>Hastanenin yatakl\u0131 servislerinde, yo\u011fun bak\u0131mlarda bo\u015f yatak say\u0131s\u0131 nedir? Mevcut yatan hastalardan ka\u00e7\u0131 birka\u00e7 saat i\u00e7inde taburcu edilebilir?<\/li>\n\n\n\n<li>Mevcut yatak kapasitesinin \u00fcst\u00fcne kabul edilebilecek yaral\u0131 say\u0131s\u0131 ka\u00e7t\u0131r?<\/li>\n\n\n\n<li>\u00c7al\u0131\u015fabilecek ameliyathane ve elektif olup ertelenebilecek ameliyat say\u0131s\u0131 ka\u00e7t\u0131r?<\/li>\n\n\n\n<li>Aktif \u00e7al\u0131\u015fan personel say\u0131s\u0131 (\u00f6zellikle cerrahi birimlerde) ve takviye gelecek personel say\u0131s\u0131 ka\u00e7t\u0131r?<\/li>\n\n\n\n<li>Kan bankas\u0131, radyoloji, laboratuvar gibi destek birimlerinde kapasite art\u0131\u015f\u0131 i\u00e7in rutin i\u015flemlerin ertelenmesi ve hizmetlerin afet durumuna y\u00f6neltilmesi gerekecek midir?<\/li>\n\n\n\n<li>G\u00fcvenlik, beslenme ve transport hizmetleri i\u00e7in personel say\u0131s\u0131 yeterli mi, ek personele ihtiya\u00e7 var m\u0131d\u0131r?<\/li>\n<\/ol>\n\n\n\n<p>Afet durumunda triyaj\u0131n ana ilkesi \u201c<strong><em><u>en fazla say\u0131da yaral\u0131 i\u00e7in en b\u00fcy\u00fck fayday\u0131<\/u><\/em><\/strong>\u201d sa\u011flamakt\u0131r. START (Simple Triage and Rapid Treatment) ve SALT (Sort, Assess, Lifesaving, Interventions, Treatment and Transportation) afet durumunda en fazla kullan\u0131lan ve kullan\u0131lmas\u0131 \u00f6nerilen 4 basamakl\u0131 triyaj sistemleridir[15,16]. K\u0131rm\u0131z\u0131, Sar\u0131, Ye\u015fil ve Siyah olarak kulland\u0131\u011f\u0131m\u0131z olay yerindeki triyajda \u201csiyah\u201d sa\u011fl\u0131k kurumuna g\u00f6t\u00fcr\u00fclmeyecek ve olay yerinde m\u00fcdahale edilmeyecek \u00f6l\u00fc ya da kurtar\u0131lma imk\u00e2n\u0131 olmayan hastalar i\u00e7indir. \u201cK\u0131rm\u0131z\u0131\u201d en \u00f6ncelikli hastaneye g\u00f6t\u00fcr\u00fclmesi ve m\u00fcdahale edilmesi gereken hastalar i\u00e7in olup \u201csar\u0131\u201d kodlu hastalar bekleyebilecek hastalar\u0131 tan\u0131mlar. \u201cYe\u015fil\u201d renk hastalar i\u00e7in ambulans kullan\u0131lmaks\u0131z\u0131n kendi imkanlar\u0131yla sa\u011fl\u0131k kurumuna ba\u015fvurabilecek hastalar\u0131 tan\u0131mlar. Acil servisteki d\u00fczende k\u0131rm\u0131z\u0131 ve sar\u0131 alanlar\u0131n d\u00fczenlemesi yap\u0131l\u0131rken \u00f6zellikle afet durumunda ye\u015fil alanlar\u0131n acil servis fiziki yap\u0131lanmas\u0131 i\u00e7inde olmamas\u0131 tercih edilmelidir. Ye\u015fil alanlar i\u00e7in uygun ve kabul edilebilir se\u00e7im hastane bah\u00e7elerinde belirli bir alan\u0131n buna ayr\u0131lmas\u0131d\u0131r.<\/p>\n\n\n\n<p>Ya\u015fanan afet sonras\u0131 g\u00f6revlendirme \u00e7\u0131kmaks\u0131z\u0131n yard\u0131m ama\u00e7l\u0131 acil servise gelen sa\u011fl\u0131k personellerinin d\u00fczenlenmesi ve organizasyonu olduk\u00e7a \u00f6nemlidir. Acil serviste ne yapmas\u0131 gerekti\u011fini bilmeden kaotik kalabal\u0131\u011f\u0131 olu\u015fturan ve her i\u015fin her hasta bak\u0131m\u0131n\u0131n yar\u0131da kalmas\u0131na neden olacak karma\u015falar ya\u015fanabilir. Do\u011fal afetten etkilenimin ne kadar s\u00fcrece\u011fi bilinmiyor ise ba\u015fta olu\u015fan fazla say\u0131daki g\u00f6n\u00fcll\u00fc sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131n\u0131n uzun s\u00fcrede devaml\u0131l\u0131\u011f\u0131n\u0131 sa\u011flamak gerekir. Kimlerin hangi alanda ka\u00e7ar saat \u00e7al\u0131\u015facaklar\u0131 belirlenmelidir.<\/p>\n\n\n\n<p>\u015eanl\u0131urfa\u2019da deprem gecesi ne yaz\u0131k ki n\u00f6bet\u00e7iydim. Deprem sonras\u0131 ilk be\u015f on dakika yak\u0131nlar\u0131m\u0131za ula\u015fmaya \u00e7al\u0131\u015f\u0131p sedyeleri acil servis \u00f6n\u00fcne al\u0131p triyaja ge\u00e7tik. \u0130kinci basamak olan \u015eanl\u0131urfa Bal\u0131kl\u0131g\u00f6l Devlet Hastanesi\u2019nde hastanemizin y\u0131k\u0131lmamas\u0131 ve \u00e7al\u0131\u015fanlar\u0131m\u0131z\u0131n yaralanmamas\u0131, deprem nedenli can kayb\u0131 olmamas\u0131 gibi avantajlar\u0131m\u0131z vard\u0131 ve bunlarla \u00f6v\u00fcn\u00fcyor muyuz buna da pek emin de\u011filim a\u00e7\u0131k\u00e7as\u0131. Acil serviste \u00f6nce doktorlu etkin triyaj ile hastalar\u0131n alanlar\u0131n\u0131 ay\u0131rd\u0131ktan sonra mevcut n\u00f6bet\u00e7i olan ve destek ama\u00e7l\u0131 acil servise gelen eski hekimlerimiz dahil geni\u015f bir ekip ile \u00e7al\u0131\u015fmaya ba\u015flad\u0131k. Ortopedi, beyin cerrahi, genel cerrahi, anestezi, radyoloji, dahiliye ve KBB bran\u015f uzmanlar\u0131m\u0131z\u0131n hastaneye: h\u0131zla gelmesi \u00fczerine ilk m\u00fcdahaleler ve yat\u0131\u015flar, ameliyatlar h\u0131zla ger\u00e7ekle\u015ftirildi. Fazla say\u0131da doktor hem\u015fire sa\u011fl\u0131k personelinin olu\u015fturdu\u011fu kaosu ya\u015famad\u0131k, \u00e7\u00fcnk\u00fc her gelen hekim bize \u201cne yapabilirim?\u201d sorusunu sordu. Radyoloji hekimimiz geldikten sonra tomografideki di\u011fer acil uzman\u0131m\u0131zdan g\u00f6revi devral\u0131p bilgisayarl\u0131 tomografiye ge\u00e7ip o an \u00e7ekilen b\u00fct\u00fcn tomografilerin patolojik bulgular\u0131n\u0131 hasta dosyalar\u0131na yazmaya ba\u015flad\u0131. K\u0131rm\u0131z\u0131 alanda kritik CRUSH yaralanmal\u0131 ve res\u00fcsitasyon gereken hastalara bak\u0131l\u0131p sar\u0131 alanda maj\u00f6r yaralanmas\u0131 olmayan g\u00f6r\u00fcnt\u00fcleme tetkiki i\u00e7in hastalar kabul edildi. Ye\u015fil alanlar kapat\u0131ld\u0131. Cerrahi bran\u015flar acil operasyonlara hastalar\u0131 ile \u00e7\u0131karken radyoloji uzman\u0131 ile bilgisayarl\u0131 tomografide acil s\u00f6zel g\u00f6r\u00fcnt\u00fcleme raporlamalar\u0131 yap\u0131ld\u0131 ve bu da asl\u0131nda s\u00fcreci olduk\u00e7a h\u0131zland\u0131rd\u0131. \u0130lk \u00fc\u00e7 g\u00fcn il i\u00e7indeki deprem ma\u011fdurlar\u0131n\u0131n de\u011ferlendirmesi yap\u0131ld\u0131ktan sonra yak\u0131n ve \u00e7evre illerden ald\u0131\u011f\u0131m\u0131z sevkler ile deprem s\u00fcrecini devam ettirdik. <\/p>\n\n\n\n<p>Operasyon ya da yat\u0131\u015f endikasyonu bulunmayan hastalar\u0131 CRUSH sendromu ve rabdomiyoliz takibi a\u00e7\u0131s\u0131ndan y\u00fcksek kreatin kinaz (CK) d\u00fczeyleri mevcut hastalar ise (Evet, CK dahil b\u00fct\u00fcn tetkik ve g\u00f6r\u00fcnt\u00fcleme sistemlerimiz altyap\u0131 sorunu olmaks\u0131z\u0131n \u00e7al\u0131\u015ft\u0131) dahiliye taraf\u0131ndan yat\u0131\u015f\u0131 yap\u0131l\u0131p akut b\u00f6brek hasar\u0131 geli\u015fmeden tedavi ile taburculuklar\u0131 yap\u0131ld\u0131. \u0130kinci g\u00fcn\u00fcn bitiminde art\u0131k ye\u015fil alan ihtiyac\u0131n\u0131n artmas\u0131 nedenli tekrar ye\u015fil alan\u0131 a\u00e7t\u0131k. <\/p>\n\n\n\n<p>Depremi takip eden g\u00fcnlerde ise; anksiyete bozuklu\u011fu, havan\u0131n so\u011fuk olmas\u0131 ve buna ba\u011fl\u0131 yanl\u0131\u015f \u0131s\u0131nma y\u00f6ntemi teknikleri nedenli karbonmonoksit zehirlenmeleri, solunum yolu ve gastrointestinal enfeksiyonlar ile panik bozukluklar- ba\u015f d\u00f6nmeleri, acil servise ba\u015fvurular\u0131n maj\u00f6r sebepleri oldu. Bu hastalar\u0131 depremden direkt olarak de\u011fil dolayl\u0131 etkilenim olarak de\u011ferlendirdik. \u015eubat ay\u0131 k\u0131\u015f mevsimi nedenli \u00e7ad\u0131rda ya da minib\u00fcs gibi b\u00fcy\u00fck ara\u00e7larda bar\u0131nan \u00f6zellikle s\u0131\u011f\u0131nmac\u0131lar\u0131n d\u0131\u015far\u0131da ate\u015f yakmas\u0131 ve k\u00f6z halinde bar\u0131nma alanlar\u0131na \u0131s\u0131nma i\u00e7in getirmesi nedenli her n\u00f6bet geceleri en az 30-40 hastam\u0131z karbonmonoksit zehirlenmesi nedenli tetkik ve tedavilerini ald\u0131. En yak\u0131n il olmas\u0131 nedenli Ad\u0131yaman\u2019dan bolca sevk al\u0131n\u0131p Ad\u0131yaman\u2019da enkazdan \u00e7\u0131kar\u0131l\u0131p yak\u0131n il\u00e7e olan \u015eanl\u0131urfa\/Bozova Devlet Hastanesine ba\u015fvuran hastalar da g\u00f6r\u00fcnt\u00fcleme ve ileri tetkik tedavi ama\u00e7l\u0131 sevklerini kabul ettik. <\/p>\n\n\n\n<p>Deprem s\u00fcreci boyunca genel cerrahi beyin cerrahi ve ortopedinin bu kadar \u00e7ok vaka almas\u0131na ra\u011fmen hastanemizin ikinci basamak olmas\u0131 nedenli kompartman sendromlu fasyotomili ya da \u00f6zellikli bran\u015f ve \u00fc\u00e7\u00fcnc\u00fc basamak hastane gereksinimi olan vakalar\u0131n kabul\u00fc ve sevki ile ilgili normalde oldu\u011fundan \u00e7ok daha fazla sorun ya\u015fad\u0131k ancak elimizden geldi\u011fince tolere etmeye \u00e7al\u0131\u015ft\u0131k. Depremin merkezi olan illerde; hastanelerin y\u0131k\u0131l\u0131p sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n hayatlar\u0131n\u0131 kaybetti\u011fi bir durumda olsayd\u0131k biz de bu kadar ba\u015far\u0131l\u0131 olamayabilirdik.<\/p>\n\n\n\n<p>Bu yaz\u0131n\u0131n sonu i\u00e7in deprem b\u00f6lgesinin merkezinde Ad\u0131yaman Kahta Devlet Hastanesi Acil T\u0131p Uzman\u0131 Dr. Ay\u015feg\u00fcl \u0130\u015flek Y\u00fcksel ile depremde ya\u015fad\u0131klar\u0131n\u0131 konu\u015ftuk. Y\u0131k\u0131m\u0131n boyutu artt\u0131k\u00e7a \u00f6neriler ve k\u0131lavuzlar yetersiz kal\u0131yor, biz hastanemizde triyaj doktor da\u011f\u0131l\u0131m\u0131 ve bran\u015flarla i\u015f birli\u011fi ile kapasiteyi a\u015fmadan d\u00f6ng\u00fcy\u00fc h\u0131zl\u0131ca s\u00fcrd\u00fcrerek \u015eanl\u0131urfa\u2019da depremi y\u00f6netebildik. Ancak sistemler \u00e7al\u0131\u015f\u0131yor, internet gitmemi\u015f, altyap\u0131lar bozulmam\u0131\u015f ve binam\u0131z da a\u011f\u0131r hasar almam\u0131\u015fken bu bizi hi\u00e7 zorlamadan hasta bakmaya odaklanmam\u0131z\u0131 sa\u011flad\u0131. De\u011ferli katk\u0131lar\u0131 i\u00e7in Dr. Ay\u015feg\u00fcl \u0130\u015flek\u2019e te\u015fekk\u00fcrlerimi iletiyorum, dilerim bir daha b\u00f6yle bir afet ya\u015fanmaz. Dilerim zarar g\u00f6rmeden i\u015fimizi yapmaya devam edebiliriz. \u0130yi okumalar dilerim.:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><em>Depremin boyutu hastanenizde nas\u0131ld\u0131? Hastanenin fiziki yap\u0131s\u0131 ve i\u015fleyi\u015fin aksamas\u0131na yol a\u00e7acak personel yaralanmalar\u0131 ve can kayb\u0131n\u0131z oldu mu?<\/em><\/strong><\/li>\n<\/ul>\n\n\n\n<p>Ad\u0131yaman devlet hastanesi \u00f6n\u00fcnde kilometrelerce kuyruk vard\u0131. Biz saat 09:30 gibi Kahta\u2019ya vard\u0131k. Kahta da on bina bile y\u0131k\u0131lmam\u0131\u015ft\u0131. Hastane hafif hasarl\u0131 idi. Polikliniklerde fiziki hasar mevcuttu ancak acil serviste hasar yoktu. Alt yap\u0131 yoktu. \u0130nternet olmad\u0131\u011f\u0131 i\u00e7in hastaneye giri\u015f a\u00e7\u0131lam\u0131yordu. Telefonlar \u00e7ekmiyordu. 112 ye g\u00f6t\u00fcr\u00fcn buradan \u00e7\u0131kar\u0131n diyorduk, Ad\u0131yaman merkeze de\u011fil en yak\u0131n \u015eanl\u0131urfa olur il\u00e7esi Siverek olur en yak\u0131n yere g\u00f6t\u00fcrmeye \u00e7al\u0131\u015f\u0131yordu maj\u00f6r yaralanmal\u0131 depremzedeleri. \u015eanl\u0131urfa ya da Antep bize zorluk \u00e7\u0131karmad\u0131 durumun fark\u0131ndayd\u0131lar. \u00d6\u011flen 13:15\u2019te de ikinci depreme hastanede&nbsp;yakaland\u0131k. Hi\u00e7bir altyap\u0131 olmad\u0131\u011f\u0131 ve telefonlar \u00e7ekmedi\u011fi i\u00e7in \u00fc\u00e7 tane \u00e7ocu\u011fumu b\u0131rakt\u0131\u011f\u0131m kom\u015fuma dahil ula\u015famad\u0131m. Hastanemiz y\u0131k\u0131lmam\u0131\u015ft\u0131 ancak Ad\u0131yaman merkezde a\u011f\u0131r y\u0131k\u0131m ve doktor personel kayb\u0131 da mevcuttu. Merkezde hastane otopark\u0131nda s\u0131ral\u0131 \u00f6l\u00fcler yat\u0131yordu.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><em>Kay\u0131tlar\u0131 nas\u0131l tuttunuz? G\u00f6r\u00fcnt\u00fclemeleri nas\u0131l yapt\u0131n\u0131z? Tetkikleri yapma imk\u00e2n\u0131n\u0131z oldu mu? Kons\u00fcltasyon ve sevkleri nas\u0131l yapt\u0131n\u0131z?<\/em><\/strong><\/li>\n<\/ul>\n\n\n\n<p>\u0130nternet, telefon, Global System for Mobile Communications (GSM) operat\u00f6rleri, her \u015fey gitmi\u015fti. Haberle\u015fmenin dahi m\u00fcmk\u00fcn olmad\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcn\u00fcn. Ortopedisti aray\u0131p hastay\u0131 anlatamad\u0131\u011f\u0131n\u0131z\u0131 g\u00f6r\u00fcnt\u00fcs\u00fcn\u00fc yollayamad\u0131\u011f\u0131n\u0131z\u0131 d\u00fc\u015f\u00fcn\u00fcn. Telefonlar \u00e7ekmedi\u011fi i\u00e7in 112\u2019yi de arayam\u0131yorduk sevk a\u00e7mak i\u00e7in. Gelen ambulanslara sevk i\u00e7in hasta vermeye ba\u015flad\u0131k bu kez. Yak\u0131n neresi varsa, \u015eanl\u0131urfa\u2019ya g\u00f6t\u00fcr\u00fcyorlard\u0131 \u00e7o\u011funlukla. Kar\u015f\u0131 hastanelerden de hi\u00e7bir sorun \u00e7\u0131kmad\u0131. \u00c7\u00fcnk\u00fc herkes neler ya\u015fad\u0131\u011f\u0131m\u0131z\u0131 a\u015fa\u011f\u0131 yukar\u0131 tahmin ediyordu. Kimli\u011fi olmayan tan\u0131nacak halde olmayan insanlar \u00f6l\u00fc ya da yaral\u0131 getiriliyordu ve kay\u0131tlar\u0131n\u0131 ba\u015fvurduklar\u0131 g\u00fcn ve saat olarak vermeye ba\u015flad\u0131k. 6 \u015eubat saat 14:30\u2019da gelen hasta 061430 diye numaraland\u0131r\u0131l\u0131yordu. A4 ka\u011f\u0131d\u0131na kay\u0131tlar\u0131 tutup foto\u011fraflar\u0131n\u0131 telefonumuza \u00e7ekiyor ve ba\u015fhekime yolluyorduk. Kay\u0131tlar\u0131 bu \u015fekilde tuttuk. E\u015fim radyoloji uzman\u0131yd\u0131 ve hastalarla beraber bilgisayarl\u0131 tomografiye (BT) gidip g\u00f6r\u00fcnt\u00fcy\u00fc o anda \u00e7ekip yorumunu k\u00e2\u011f\u0131da yaz\u0131p tekrar hastayla g\u00f6nderiyordu. Sadece hemogram, kan gaz\u0131 ve kan grubu \u00e7al\u0131\u015fabiliyorduk ve o da sisteme kayd\u0131 olmaks\u0131z\u0131n direkt cihazdan ald\u0131\u011f\u0131m\u0131z sonuca bakabiliyorduk*. \u0130ki tane ultrasonografi (USG) k\u0131rm\u0131z\u0131 alana \u00e7ektik, gelen kritik hastalar\u0131n Focused Assesment Sonography for Trauma (FAST) USG bak\u0131s\u0131n\u0131 mutlaka yap\u0131yorduk. Ortopedi uzman\u0131m\u0131z acilden \u00e7\u0131kmam\u0131\u015ft\u0131. B\u00fct\u00fcn uzmanlar canla ba\u015fla \u00e7al\u0131\u015ft\u0131k Kahta\u2019da.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><em>Triyaj\u0131 nas\u0131l yapt\u0131n\u0131z?<\/em><\/strong><\/li>\n<\/ul>\n\n\n\n<p>Etkin triyaj\u0131n olay yerinde yap\u0131lmas\u0131 \u00e7ok m\u00fcmk\u00fcn olmad\u0131 tabii ki. Ambulans yaral\u0131lar\u0131 getirdi\u011finden daha fazla enkaz alt\u0131ndan \u00f6l\u00fc \u00e7\u0131kan insan\u0131 da getiriyordu ve insanlar bir \u00f6l\u00fcm belgesi alabilmek i\u00e7in getiriyordu acile \u00f6lm\u00fc\u015f yak\u0131nlar\u0131n\u0131. Ex torbas\u0131n\u0131 dahi bulamay\u0131p siyah b\u00fcy\u00fck po\u015fetlerle sar\u0131lan insanlar vard\u0131. Ye\u015fil alan\u0131 kapat\u0131p ventilat\u00f6re ba\u011fl\u0131 hastalar\u0131 da oraya almaya ba\u015flad\u0131k. Hafif yaral\u0131lara 5. g\u00fcnden sonra bakabilme imk\u00e2n\u0131m\u0131z oldu.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><em>Res\u00fcsitasyon alan\u0131n\u0131z yeterli miydi? \u0130la\u00e7 ve malzeme eksi\u011finiz oldu mu?<\/em><\/strong><\/li>\n<\/ul>\n\n\n\n<p>Ayr\u0131 bir res\u00fcsitasyon alan\u0131m yok ne yaz\u0131k ki 4 yatakl\u0131 k\u0131rm\u0131z\u0131 alan\u0131m var sadece, ama elbette yeterli olmad\u0131. 3 tane defibrilat\u00f6r\u00fcm var ancak ne yaz\u0131k ki o da yeterli de\u011fildi. Sadece res\u00fcsitasyon alan\u0131 de\u011fil elbette, morgun kapasitesi de yeterli de\u011fildi. \u0130la\u00e7lar\u0131m\u0131z yeterliydi ancak atelimiz yeterli de\u011fildi.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><em>Ne zaman rutine d\u00f6nebildiniz? Siz bununla nas\u0131l ba\u015f ettiniz?<\/em><\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"has-text-align-left\">Mart ay\u0131ndan itibaren rutin d\u00fczenine d\u00f6nmeye ba\u015flay\u0131p alt\u0131 ayda da tamamen rutine d\u00f6n\u00fcld\u00fc. Acilci oldu\u011fumuz i\u00e7in san\u0131r\u0131m \u00f6l\u00fcmle ya\u015fam aras\u0131nday\u0131z s\u00fcrekli, o kadar da a\u011f\u0131r etkilenmedim gibi geliyor ancak elbette profesyonel yard\u0131m ald\u0131k. Ortalama alt\u0131 ay\u0131 buldu toparlanmam\u0131z. Bundan sonra b\u00f6yle bir afet bug\u00fcn bir ba\u015fka yerde olsa, hepimiz ko\u015farak gidece\u011fiz biliyorum. Dilerim bir daha b\u00f6yle bir afet ya\u015fanmaz.<\/p>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<p><strong>Kaynaklar:<\/strong><\/p>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<p class=\"has-small-font-size\">[1] H. KOCAK, K. KINIK, C. CALISKAN, K. ACIKSARI, The Science of Disaster Medicine: From Response to Risk Reduction, Medeni Med J 36 (2021) 333\u2013342. https:\/\/doi.org\/10.4274\/MMJ.galenos.2021.50375.<\/p>\n\n\n\n<p class=\"has-small-font-size\">[2] E.K. NOJI, Advances in disaster medicine, European Journal of Emergency Medicine\u202f: Official Journal of the European Society for Emergency Medicine 9 (2002) 185\u201391. https:\/\/doi.org\/10.1097\/00063110-200206000-00019.<\/p>\n\n\n\n<p class=\"has-small-font-size\">[3] Keim: Managing health in disasters &#8211; Google Akademik, (n.d.). https:\/\/scholar.google.com\/scholar_lookup?journal=Lancet.&amp;title=Managing+health+in+disasters&amp;author=M+Keim&amp;volume=362&amp;publication_year=2003&amp;pages=2029&amp; (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[4] Association Overview, WADEM (n.d.). https:\/\/wadem.org\/about\/association-overview\/ (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[5] Disaster Phases, Center for Disaster Philanthropy (n.d.). https:\/\/disasterphilanthropy.org\/resources\/disaster-phases\/ (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[6] \u0130smep, (n.d.). https:\/\/istanbul.afad.gov.tr\/ismep (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[7] E.K. Noji, G.D. Kelen, H.K. Armenian, A. Oganessian, N.P. Jones, K.T. Sivertson, The 1988 earthquake in Soviet Armenia: a case study, Ann Emerg Med 19 (1990) 891\u2013897. https:\/\/doi.org\/10.1016\/s0196-0644(05)81563-x.<\/p>\n\n\n\n<p class=\"has-small-font-size\">[8] Medicine | Definition, Fields, Research, &amp; Facts | Britannica, (n.d.). https:\/\/www.britannica.com\/science\/medicine (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[9] Primary health care, (n.d.). https:\/\/www.who.int\/health-topics\/primary-health-care (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[10]10 \u015eubat 2022 PER\u015eEMBE, (n.d.). https:\/\/www.resmigazete.gov.tr\/eskiler\/2022\/02\/20220210-1.htm (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[11] S. Y\u0131lmaz, O. Karakayali, S. Yilmaz, M. \u00c7etin, S.E. Eroglu, O. Dikme, A. \u00d6zhasenekler, M. Orak, \u00d6. Yava\u015fi, F.K. Akarca, M.G. Eneyli, B. Erbil, H. Ako\u011flu, Emergency Medicine Association of Turkey Disaster Committee Summary of Field Observations of February 6th Kahramanmara\u015f Earthquakes, Prehospital and Disaster Medicine 38 (2023) 415\u2013418. https:\/\/doi.org\/10.1017\/S1049023X23000523.<\/p>\n\n\n\n<p class=\"has-small-font-size\">[12] Hastane Afet ve Acil Durum Plan\u0131 (HAP) Haz\u0131rlama K\u0131lavuzu, (n.d.). https:\/\/www.saglik.gov.tr\/TR,1789\/hastane-afet-ve-acil-durum-plani-hap-hazirlama-kilavuzu.html (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[13] Emergency Preparedness\u2014Planning and Management &#8211; PMC, (n.d.). https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7152024\/ (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[14] Afet Y\u00f6netimi ve T\u0131bbi Uygulamalar Serkan Emre Ero\u011flu, https:\/\/www.kitapbankasi.com\/ (n.d.). https:\/\/www.kitapbankasi.com\/afet-yonetimi-ve-tibbi-uygulamalar (accessed April 30, 2024).<\/p>\n\n\n\n<p class=\"has-small-font-size\">[15] M.C. Bhalla, J. Frey, C. Rider, M. Nord, M. Hegerhorst, Simple Triage Algorithm and Rapid Treatment and Sort, Assess, Lifesaving, Interventions, Treatment, and Transportation mass casualty triage methods for sensitivity, specificity, and predictive values, Am J Emerg Med 33 (2015) 1687\u20131691. https:\/\/doi.org\/10.1016\/j.ajem.2015.08.021.<\/p>\n\n\n\n<p class=\"has-small-font-size\">[16] P. Halpern, S.A. Goldberg, J.G. Keng, K.L. Koenig, Principles of Emergency Department facility design for optimal management of mass-casualty incidents, Prehosp Disaster Med 27 (2012) 204\u2013212. https:\/\/doi.org\/10.1017\/S1049023X12000623.<\/p>\n<\/div>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>K\u0131saltmalar: Giri\u015f Afet t\u0131bb\u0131n\u0131n as\u0131l hedefi, afetlerin toplum sa\u011fl\u0131\u011f\u0131na verdi\u011fi zarar\u0131 en aza indirgemek, hatta m\u00fcmk\u00fcnse tamamen \u00f6nlemektir[1]. 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