Family witness resuscitation. Allow or deny? Which is true?
Explore the source record for details and available documents.
Attitude of Health Personnel↗
Biomedical subjects
Gurkan Ersoy
Publications and source records attributed to Gurkan Ersoy.
Impact of the terrorist bombings of the Hong Kong Shanghai Bank Corporation headquarters and the British Consulate on two hospitals in Istanbul, Turkey, in November 2003.
BACKGROUND: The authors sought to estimate the impact of the terrorist bombings of the Hong Kong Shanghai Banking Corporation headquarters and the British consulate in Istanbul, Turkey, on November 20, 2003, on two nearby hospitals, in terms of epidemiologic outcomes, resource utilization, and time course of emergency needs. METHODS: The authors used data from hospital records of injured survivors who used the emergency departments (EDs) at the Taksim Education and Research State Hospital (TERSH) and the American Hospital (AH) in Istanbul on November 20, 2003, to determine the totals and rates of mortality (early, late, and critical), injury, critical injury (Injury Severity Score > 15), ED use, hospitalization, operative care, and in-hospital overtriage and the time intervals of ED arrival. RESULTS: The TERSH received 184 victims in the first hour after the initial blast, of which 88 (48%) were brought by emergency medical services, 171 (93%) had lacerations, 7 (4%) had penetrating eye injuries, 28 (15%) were hospitalized, 18 (10%) received operative care, and 7 (4%) were critically injured. Three deaths occurred in critically injured survivors, including one early death in the operating room and two late deaths on days 5 and 6. The AH received 16 victims, of which 14 (88%) had lacerations, 3 (19%) were hospitalized, 2 (13%) received operative care, and 1 (6%) was critically injured. An additional 4 victims were transferred to the AH from other hospitals, of which 3 were hospitalized and none were critically injured. No early or late deaths occurred. CONCLUSION: Mortality, injury, and hospitalization rates at both hospitals were consistent with previous reports of open-air mass-casualty terrorist bombings. The TERSH experienced an unprecedented demand for ED surge capacity in an open-air bombing.
Blast Injuries↗
Impact of the terrorist bombings of the Neve Shalom and Beth Israel Synagogues on a hospital in Istanbul, Turkey.
OBJECTIVES: The authors sought to estimate the impact of the open-air mass-casualty terrorist bombings of the Neve Shalom and Beth Israel Synagogues in Istanbul, Turkey, on November 15, 2003, on the American Hospital (AH) in terms of resource utilization, epidemiologic outcomes, and time course of emergency needs. METHODS: A retrospective descriptive study using data from hospital records of injured survivors who used the emergency department at AH on November 15, 2003, to determine the number and percentage of injured survivors who were hospitalized, received operative care, had specific injury types, had an Injury Severity Score >/=16, died, and arrived within certain time intervals. RESULTS: AH received 69 (91%) injured survivors from the scene, of which nine (12%) were hospitalized and three (4%) received operative care. Starting four hours after the initial blast, seven (9%) injured survivors were transferred to AH from other hospitals, of which five (7%) were hospitalized and four (5%) received operative care. Of the 49 injured survivors from the scene with documented injuries, 43 (88%) had injuries to the head or face, 42 (86%) had lacerations, five (10%) had fractures, one (2%) had a penetrating eye injury, one (2%) had a serious intracranial injury, and none had primary blast injuries. Four (5%) injured survivors at AH had an Injury Severity Score >/=16, and none died. CONCLUSIONS: Seventy-six injured survivors used the emergency department at AH, including a delayed wave of injured survivors transferred from other hospitals. The majority of injured survivors with documented injuries had non-life-threatening lacerations of the head or face, and relatively few injured survivors were hospitalized or received operative care.
Blast Injuries↗
Chemical injury to the tongue following contact with sodium hydroxide drain cleaner.
Solid sodium hydroxide compounds are used to unclog drains. In Turkey, these agents are easily available and commonly used by housewives. They are sold in weak bags and usually stored within these bags. We present the case of an elderly woman with dementia who developed severe alkaline tongue burn and edema after unintentional short contact with solid sodium hydroxide drain cleaner. Official legislation for safety packing in Turkey will lead to reduction in the incidence of accidental caustic injuries.
Aged↗
Terrorism in Turkey.
Over the past two decades, terrorism has exacted an enormous toll on the Republic of Turkey, a secular democracy with a 99.8% Muslim population. From 1984 to 2000, an estimated 30,000 to 35,000 Turkish citizens were killed by a nearly continuous stream of terrorism-related events. During this period, the Partiya Karekerren Kurdistan (PKK), a Kurdish separatist group (re-named KADEK in 2002), was responsible for the vast majority of terrorism-related events (and casualties), which disproportionately affected the eastern and southeastern regions of Turkey, in which the PKK has focused its activities. Most terrorist attacks over the past two decades have been bombings or shootings that produced < 10 casualties per event. From 1984 to 2003, 15 terrorist attacks produced > or = 30 casualties (eight shootings, five bombings, and two arsons). The maximum number of casualties produced by any of these events was 93 in the Hotel Madimak arson attack by the Turkish Islamic Movement in 1993. This pattern suggests that terrorist attacks in Turkey rarely required more than local systems of emergency medical response, except in rural areas where Emergency Medical Services (EMS) are routinely provided by regional military resources. The last decade has seen the development of several key systems of local emergency response in Turkey, including the establishment of the medical specialty of Emergency Medicine, the establishment of training programs for EMS providers, the spread of a generic, Turkish hospital emergency plan based on the Hospital Emergency Incident Command System, and the spread of advanced training in trauma care modeled after Advanced Trauma Life Support.
Civil Defense↗
Mass-casualty, terrorist bombings: epidemiological outcomes, resource utilization, and time course of emergency needs (Part I).
INTRODUCTION: This article characterizes the epidemiological outcomes, resource utilization, and time course of emergency needs in mass-casualty, terrorist bombings producing 30 or more casualties. METHODS: Eligible bombings were identified using a MEDLINE search of articles published between 1996 and October 2002 and a manual search of published references. Mortality, injury frequency, injury severity, emergency department (ED) utilization, hospital admission, and time interval data were abstracted and relevant rates were determined for each bombing. Median values for the rates and the inter-quartile ranges (IQR) were determined for bombing subgroups associated with: (1) vehicle delivery; (2) terrorist suicide; (3) confined-space setting; (4) open-air setting; (5) structural collapse sequela; and (6) structural fire sequela. RESULTS: Inclusion criteria were met by 44 mass-casualty, terrorist bombings reported in 61 articles. Median values for the immediate mortality rates and IQRs were: vehicle-delivery, 4% (1-25%); terrorist-suicide, 19% (7-44%); confined-space 4% (1-11%); open-air, 1% (0-5%); structural-collapse, 18% (5-26%); structural fire 17% (1-17%); and overall, 3% (1-14%). A biphasic pattern of mortality and unique patterns of injury frequency were noted in all subgroups. Median values for the hospital admission rates and IQRs were: vehicle-delivery, 19% (14-50%); terrorist-suicide, 58% (38-77%); confined-space, 52% (36-71%); open-air, 13% (11-27%); structural-collapse, 41% (23-74%); structural-fire, 34% (25-44%); and overall, 34% (14-53%). The shortest reported time interval from detonation to the arrival of the first patient at an ED was five minutes. The shortest reported time interval from detonation to the arrival of the last patient at an ED was 15 minutes. The longest reported time interval from detonation to extrication of a live victim from a structural collapse was 36 hours. CONCLUSION: Epidemiological outcomes and resource utilization in mass-casualty, terrorist bombings vary with the characteristics of the event.
Emergencies↗
Mass-casualty, terrorist bombings: implications for emergency department and hospital emergency response (Part II).
This article reviews the implications of mass-casualty, terrorist bombings for emergency department (ED) and hospital emergency responses. Several practical issues are considered, including the performance of a preliminary needs assessment, the mobilization of human and material resources, the use of personal protective equipment, the organization and performance of triage, the management of explosion-specific injuries, the organization of patient flow through the ED, and the efficient determination of patient disposition. As long as terrorists use explosions to achieve their goals, mass-casualty, terrorist bombings remain a required focus for hospital emergency planning and preparedness.
Emergency Medical Services↗
Mass-casualty terrorist bombings in Istanbul, Turkey, November 2003: report of the events and the prehospital emergency response.
BACKGROUND: This paper describes the two mass-casualty, terrorist attacks that occurred in Istanbul, Turkey in November 2003, and the resulting pre-hospital emergency response. METHODS: A complex, retrospective, descriptive study was performed, using open source reports, interviews, direct measurements of street distances, and hospital records from the American Hospital (AH) and Taksim Education and Research State Hospital (TERSH) in Istanbul. RESULTS: On 15 November, improvised explosive devices (IEDs) in trucks were detonated outside the Neve Shalom and Beth Israel Synagogues, killing 30 persons and injuring an estimated additional 300. Victims were maldistributed to 16 medical facilities. For example, AH, a private hospital located six km from both synagogues, received 69 injured survivors, of which 86% had secondary blast injuries and 13% were admitted to the hospital. The TERSH, a government hospital located 1 km from both synagogues, received 48 injured survivors. On 20 November, IEDs in trucks were detonated outside the Hong Kong Shanghai Banking Corporation (HSBC) headquarters and the British Consulate (BC), killing 33 and injuring an estimated additional 450. Victims were maldistributed to 16 medical facilities. For example, TERSH, located 18 km from the HSBC site and 2 km from the the BC received 184 injured survivors, of which 93% had secondary blast injuries and 15% were hospitalized. The AH, located 9 km from the HSBC site and 6 km from the BC, received 16 victims. CONCLUSION: The twin suicide truck bombings on 15 and 20 November 2003 were the two largest terrorist attacks in modern Turkish history, collectively killing 63 persons and injuring an estimated 750 others. The vast majority of victims had secondary blast injuries, which did not require hospitalization. Factors associated with the maldistribution of casualties to medical facilities appeared to include the distance from each bombing site, the type of medical facility, and the personal preference of injured survivors.
Ambulances↗