Afet Yönetiminde ve Afete Bağlı Yaralanmalarda Fizyoterapistlerin Rol ve Görevleri

Abstract

Afetlerin Türkiye’de görülme sıklığının artması ile birlikte, yaşanan büyük can kayıplarının yanı sıra, ciddi yaralanmalar sonucu rehabilitasyona ihtiyaç duyan birey sayısında büyük artış meydana gelmiştir. Afetlerle başa çıkmanın en etkili yolu, toplumu afetten korumak, koruma gerçekleşmediği zaman ise toplumun hazırlığını artırarak ve rehabilitasyon alanında yeterli bilgi donanımı ile üst düzeyde afet yanıtının verilmesini sağlamaktır. Afet yönetiminin bütün aşamalarında fizyoterapistlere önemli görevler düşmektedir. Afet öncesinde eğitimlerle toplumun afete karşı hazırlıklı hale getirilmesi, müdahale ve iyileşme aşamalarında ise erken tedavi ve rehabilitasyon hizmetlerinin verilmesiyle afetin olumsuz etkileri en aza indirilebilir. Afetlerden sonra, kırıklar, periferik sinir, spinal kord, travmatik beyin yaralanmaları, yanıklar, solunum problemleri ve amputasyonlar gibi kas-iskelet, nöro-musküler ve kardiyo-pulmoner sistem kaynaklı problemler meydana gelir. Fizyoterapistler sahip oldukları bilgi ve kapasiteyle bu problemlerin değerlendirilmesi, triyajı ve tedavisinde kilit rol oynarlar. Fizyoterapistlerin diğer rol ve görevleri ilk yardım, yardımcı ekipmanın sağlanması, tıbbi komplikasyonların yönetimi, ikincil yaralanmaların önlenmesi, afetzedelerin, bakım verenlerin ve diğer sağlık personellerinin eğitimidir. Afet yönetim programlarına eğitimli ve deneyimli fizyoterapistlerin dahil olduğu kapsamlı rehabilitasyon müdahalelerinin entegre edilmesi, afetzedelerin fonksiyonel durumlarının ve yaşam kalitelerinin en üst düzeye çıkarılmasına olanak sağlar. Afet yönetimi ve organizasyonlarında fizyoterapi mesleğinin rol ve sorumlulukları ile uygulama alanları konusunda sağlık personelinin, ilgili kamu kurumlarının, sivil toplum kuruluşlarının ve fizyoterapistlerin farkındalıklarının artırılması önemlidir. Fizyoterapistlerin ekip çalışması içerisindeki etkin rolü, sağlık ve sosyal politikalar üretmede ve çözüm önerileri konusunda büyük yararlar sağlayacaktır.

Keywords

• Afetler
• yönetim
• fizyoterapistler
• rehabilitasyon
• konservatif tedavi.

The Role and Duties of Physiotherapists in Disaster Management and Disaster- Related Injuries

Abstract

With the increasing frequency of disasters in Turkey, there has been a significant rise in the number of individuals requiring rehabilitation due to severe injuries, as well as high loss of life. The most effective approach to dealing with disasters is to protect society from them, and when protection fails, it is crucial to enhance society's preparedness and provide a well-equipped disaster response that includes comprehensive knowledge in the field of rehabilitation. Physiotherapists play vital roles in all stages of disaster management. The adverse effects of disasters can be minimized by preparing society through pre-disaster training and by delivering early treatment and rehabilitation services during the response and recovery phases. Post-disaster, various problems related to the musculoskeletal, neuro-muscular, and cardio-pulmonary systems arise, such as fractures, peripheral nerve damage, spinal cord injuries, traumatic brain injuries, burns, respiratory issues, and amputations. Physiotherapists, leveraging their expertise and capacity, assume a key role in assessing, triaging, and treating these problems. Additionally, physiotherapists have responsibilities such as providing first aid, supplying assistive and essential equipment, managing medical complications, preventing secondary injuries, and training victims, caregivers, and other healthcare professionals. By integrating comprehensive rehabilitation interventions led by trained and experienced physiotherapists into disaster management programs, the functional status and quality of life of victims can be maximized. It is important to increase the awareness of health personnel, relevant public institutions, non-governmental organizations, and physiotherapists about the roles and responsibilities of the physiotherapy profession in disaster management and organizations and its application areas. The active role of physiotherapists in teamwork will provide great benefits in producing health and social policies and in solution proposals.

Keywords

• Disasters
• management
• physiotherapists
• rehabilitation
• conservative treatment.

References

1. Erden Z. Afetlerde fizyoterapi ve rehabilitasyon yaklaşımları. Ergoterapi ve Rehabilitasyon Dergisi. 2013;1(2):78-82.
2. Bahadır H, Uçku R. Uluslararası acil durum veri tabanına göre Türkiye Cumhuriyeti tarihindeki afetler. Doğal Afetler ve Çevre Dergisi. 2018;4(1):28-33.
3. Khan F, Amatya B, Gosney J, Rathore FA, Burkle JFM. Medical rehabilitation in natural disasters: a review. Arch Phys Med Rehabil. 2015;96(9):1709-27.
4. Mousavi G, Ardalan A, Khankeh H, Kamali M, Ostadtaghizadeh A. Physical rehabilitation services in disasters and emergencies: a systematic review. Iran J Public Health. 2019;48(5):808-15.
5. Kızıloğlu FM, Okuroğlu M, Örüng İ. Kırsal yerleşimler ve doğal afetler. JAFAG. 2006;23(2):53-8.
6. World Confederation for Physical Therapy. WCPT Report: The role of physical therapists in disaster management. [homepage on the internet]. London, UK: WCPT; March 2016. [Accessed on: 2023 February 20]. Available from: https://world.physio/sites/default/ files/2020-06/Disaster-Management-Report-201603.pdf.
7. Harrison RM. Preliminary investigation into the role of physiotherapists in disaster response. Prehosp Disaster Med. 2007;22(5):462-65.
8. Erden Z. Afetlerde fizyoterapi ve rehabilitasyon. In: Altıntaş KH, editor. HAMER Acil ve afet durumlarında sağlık yönetimi. Ankara: Hacettepe Üniversitesi Yayınları; 2013. p. 275-83.

9. Trivedi N, Rathod P. Physiotherapy in disaster management: physiotherapist view. Natl J Integr Res Med. 2017;8(4):32-4.
10. Klappa S, Audette J, Do S. The roles, barriers and experiences of rehabilitation therapists in disaster relief: post-earthquake Haiti 2010. Disabil Rehabil. 2014;36(4):330-8.
11. Gosney JJE. Physical medicine and rehabilitation: critical role in disaster response. Disaster Med Public Health Prep. 2010;4(2):110-2.
12. Lathia C, Skelton P, Clift Z (Eds). Early rehabilitation in conflicts and disasters. [homepage on the internet]. 1st Edition, January 2020. [Accessed on: 2023 March 4]. Available from: https://www. hi.org/sn_uploads/document/36199-Humanity--Inclusion-Clinical- Handbook-web_1.pdf.
13. Landry MD, O'Connell C, Tardif G, Burns A. Post-earthquake Haiti: the critical role for rehabilitation services following a humanitarian crisis. Disabil Rehabil. 2010;32(19):1616-18.
14. Li-Tsang CWP, He CQ, Lo AGW, Ding SJ, Deng X, Yang YH, et al. Rehabilitation needs of the survivors of the 2013 Ya'an earthquake in China. J Rehabil Med. 2015;47(7):586-92.
15. Yoshida T, Tada K, Uemura K, Yonenobu K. Peripheral nerve palsies in victims of the Hanshin-Awaji earthquake. Clin Orthop Relat Res. 1999;(362):208-17.
16. Ahrari MN, Zangiabadi N, Asadi A. Prevalence and distribution of peripheral nerve injuries in victims of Bam earthquake. Electromyogr Clin Neurophysiol. 2006;46(1):59-62.
17. He CQ, Zhang LH, Liu XF, Tang PF. A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan, China. Neural Regen Res. 2015;10(2):252-9.
18. Mallick M, Aurakzai JK, Bile KM, Ahmed N. Large-scale physical disabilities and their management in the aftermath of the 2005 earthquake in Pakistan. East Mediterr Health J. 2010;16(8):98-105.
19. Amatya B, Vasudevan V, Zhang N, Chopra S, Astrakhantseva I, Khan F. Minimum technical standards and recommendations for traumatic brain injury rehabilitation teams in sudden-onset disasters. J Int Soc Phys Rehabil Med. 2018;1(2):72-94.
20. Bhatti SH, Ahmed I, Qureshi NA, Akram M, Khan J. Head trauma due to earthquake October, 2005 - experience of 300 cases at the combined military hospital Rawalpindi. J Coll Physicians Surg Pak. 2008;18(1):22-6.
21. Uz I, Çetin M, Songur Kodik M, Guvenc E, Karbek Akarca F, Ersel M. Emergency department management after the 2020 Aegean Sea - İzmir earthquake. Ulus Travma Acil Cerrahi Derg. 2022;28:361-8.
22. Redmond AD, Mardel S, Taithe B, Calvot T, Gosney J, Duttine A, et al. A Qualitative and quantitative study of the surgical and rehabilitation response to the earthquake in Haiti, January 2010. Prehosp Disaster Med. 2011;26(6):449-56.
23. Kurultak İ. Deprem yaralanmalı erişkin hastada ezilme (Crush) sendromu. TOTBİD. 2022;21:294-303.
24. Dağlar B. Deprem yaralanmalı hastada kompartman sendromu. TOTBİD. 2022;21:283-8.
25. Sahebi A, Nejati-Zarnaqi B, Vasei N, Jahangiri K. Deep Vein Thrombosis after earthquake: a systematic review and meta-analysis. Disaster Med Public Health Prep. 2023 Feb;17:e304.
26. Sakuma M, Nakamura M, Hanzawa K, Kobayashi T, Kuroiwa M, Nakanishi N, et al. Acute pulmonary embolism after an earthquake in Japan. Semin Thromb Hemost. 2006;32(8):856-60.
27. Kouadio IK, Aljunid S, Kamigaki T, Hammad K, Oshitani H. Infectious diseases following natural disasters: prevention and control measures. Expert Rev Anti Infect Ther. 2012;10(1):95-104.
28. Özdoğan S, Hocaoğlu A, Cağlayan B, Imamoğlu OU, Aydin D. Thorax and Lung injuries arising from the two earthquakes in Turkey in 1999. Chest. 2001;120(4):1163-6.
29. Palmer G. Complex regional pain syndrome. Aust Prescr. 2015;38(3):82-6.
30. Zhang X, Reinhardt JD, Gosney JE, Li J. The NHV rehabilitation services program improves long-term physical functioning in survivors of the 2008 Sichuan earthquake: a longitudinal quasi experiment. PLoS One. 2013;8(1):e53995.
31. Ni J, Reinhardt JD, Zhang X, Xiao M, Li L, Jin H, et al. Dysfunction and post-traumatic stress disorder in fracture victims 50 months after the Sichuan earthquake. PLoS One. 2013;8(10):e77535.
32. Li Y, Reinhardt JD, Gosney JE, Zhang X, Hu X, Chen S, et al. Evaluation of functional outcomes of physical rehabilitation and medical complications in spinal cord injury victims of the Sichuan earthquake. J Rehabil Med. 2012;44(7):534-40.
33. Hu X, Zhang X, Gosney JE, Reinhardt JD, Chen S, Jin H, et al. Analysis of functional status, quality of life and community integration in earthquake survivors with spinal cord injury at hospital discharge and one-year follow-up in the community. J Rehabil Med. 2012;44(3):200-5.
34. Lee SY, Amatya B, Judson R, Truesdale M, Reinhardt JD, Uddin T, et al. Applicability of traumatic brain injury rehabilitation interventions in natural disaster settings. Brain Inj. 2019;33(10):1293-8.