Türkiye Hastanelerinin Acil Servislerinin Afetlere Hazırlık Durumu ve Gelecek Planlamasına Öneriler: Kahramanmaraş Depremi Örneği

Öz

Giriş: 6 Şubat 2023 Kahramanmaraş Depremi, hastanelerde ciddi yapısal hasarlara yol açarak acil sağlık hizmetlerini büyük ölçüde aksattı. Acil sağlık profesyonelleri üzerindeki aşırı yük, etkin bir afet müdahalesi için Hastane Afet ve Acil Durum Planları (HAP)’ın önemini bir kez daha ortaya koydu. Bu çalışma, deprem sırasında ve sonrasında acil tıp doktorları, hemşireler, paramedikler ve destek personelinin deneyimlerini değerlendirerek hastane hazırlık düzeyi, afet müdahalesinin etkinliği ve altyapı sorunlarına yönelik görüşlerini analiz etmeyi amaçlamaktadır. Yöntemler: Bu tanımlayıcı kesitsel çalışma, Gaziantep, Adıyaman, Kahramanmaraş, Şanlıurfa, Kilis ve Malatya illerinde depremden etkilenen hastanelerin acil servislerinde görev yapan sağlık çalışanlarını kapsamaktadır. Veriler, sosyodemografik özellikler, depreme hastanede yakalanma durumu, HAP farkındalığı, afet müdahalesi uygulamaları ve hastane altyapısına (elektrik, su, hijyen, hasta yönetimi) ilişkin değerlendirmeleri içeren çevrimiçi bir anket ile toplanmıştır. Bulgular: Toplam 189 sağlık çalışanı ankete katılmıştır. %76.2’si hastanelerinin yapısal hasar gördüğünü, ancak %84.7’sinin görev yerinde kaldığını veya geri döndüğünü bildirmiştir. Katılımcıların yalnızca %46’sı HAP’ın uygulandığını belirtirken, %69.3’ü hastanelerinde afet sorumlusunun kim olduğunu bilmediklerini ifade etmiştir. Ayrıca, %56.6’sı hastanelerinin afetlere yetersiz hazırlandığını, %59.8’i düzenli afet eğitimi ve tatbikatlarının yapılmadığını bildirmiştir. %39.7 enerji kesintisi, %50.3 ısıtma sorunları ve %45.5 su kesintisi yaşamıştır. %60.3’ü ise ailelerinin güvenliğiyle ilgili endişelerinin hasta bakımına odaklanmalarını zorlaştırdığını ifade etmiştir. Sonuç: Çalışmada hastane afet hazırlığında önemli eksiklikler belirlenmiştir. HAP protokollerine yönelik farkındalığın düşük olması, eğitim eksiklikleri ve altyapı sorunları, etkili bir afet müdahalesi önündeki temel engellerdir. Hastane dirençliliğini artırmak için afet müdahale planlarının güçlendirilmesi, personel eğitimlerinin artırılması ve kaynak tahsisinin iyileştirilmesi gereklidir. Gelecekte, standartlaştırılmış hastane afet yönetim stratejileri geliştirmek ve uzun vadeli etkilerini değerlendirmek amacıyla daha kapsamlı araştırmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• afet yönetimi
• acil tıp
• hastane afet ve acil durum planı (HAP)
• kahramanmarş depremi

Preparedness of Emergency Departments in Turkish Hospitals for Disasters and Recommendations for Future Planning: The Case of the Kahramanmaraş Earthquake

Öz

Background The Kahramanmaraş Earthquake of February 6, 2023, caused severe structural damage to hospitals and significantly disrupted emergency healthcare services. The overwhelming burden placed on emergency medical professionals highlighted the critical importance of well-prepared Hospital Disaster and Emergency Plans (HAPs) in ensuring an effective disaster response. This study evaluates the experiences of emergency physicians, nurses, paramedics, and support staff in emergency departments (EDs) during and after the earthquake, focusing on their assessments of hospital preparedness, disaster response effectiveness, and infrastructure challenges. Methods This descriptive cross-sectional study surveyed healthcare professionals working in emergency departments across six earthquake-affected regions: Gaziantep, Adıyaman, Kahramanmaraş, Şanlıurfa, Kilis, and Malatya. Data were collected through an online survey assessing sociodemographic characteristics, presence at the hospital during and after the earthquake, perceived adequacy of hospital disaster preparedness, implementation of HAP protocols, and infrastructure conditions (power, water, hygiene, and patient management). Results A total of 189 healthcare professionals participated. 76.2% of hospitals sustained structural damage, yet 84.7% of respondents remained or returned to their workplace. Only 46% reported that HAP was implemented, and 69.3% were unaware of their hospital’s designated disaster chairperson. Additionally, 56.6% believed their hospitals were inadequately prepared for disasters, and 59.8% reported a lack of regular disaster training and drills. Infrastructure challenges were common, with 39.7% experiencing energy outages, 50.3% reporting heating issues, and 45.5% facing water shortages. Concerns for family safety negatively impacted 60.3% of respondents, affecting their ability to focus on patient care. Conclusion Significant gaps in hospital disaster preparedness were identified, including limited awareness of HAP protocols, insufficient training, and infrastructure vulnerabilities. Strengthening disaster response plans, increasing staff training, and improving resource allocation are essential to enhance hospital resilience in future disasters. Further research is needed to develop standardized hospital disaster management strategies and assess their long-term impact.

Anahtar Kelimeler

• disaster management
• emergency medicine
• hospital disaster and emergency plan (HAP)
• kahramanmaraş earthquake

Kaynakça

1. 1. Barten DG, Klokman VW, Cleef S, et al. When disasters strike the emergency department: a case series and narrative review. Int J Emerg Med. 2021;14(1):49. doi:10.1186/s12245-021-00372-7
2. 2. Coppola DP. Introduction to International Disaster Management. Amsterdam: Elsevier; 2006.
3. 3. United Nations Office for Disaster Risk Reduction. Sendai Framework for Disaster Risk Reduction 2015-2030. https://www.undrr.org/publication/sendai-framework-disaster-risk-reduction-2015-2030. Accessed February 5, 2025.
4. 4. World Health Organization. Hospital Emergency Response Checklist. Geneva: World Health Organization; 2011. https://www.who.int. Accessed February 5, 2025.
5. 5. World Health Organization. Strengthening Health-System Emergency Preparedness: Toolkit for Assessing Health-System Capacity for Crisis Management. Geneva: World Health Organization; 2012. https://www.who.int. Accessed February 5, 2025.
6. 6. Emergency Medical Services Authority. Hospital Incident Command System Resources. Rancho Cordova, CA: California Emergency Medical Services Authority. https://emsa.ca.gov/disaster-medical-services-division-hospital-incident-command-system-resources/. Accessed February 4, 2025.
7. 7. Birkland TA. Lessons of disaster: policy change after catastrophic events. J Contingencies Crisis Manag. 2009;17(1):1-9. doi:10.1111/j.1468-5973.2009.00566.x
8. 8. Presidency of the Republic of Türkiye, Strategy and Budget Directorate. 2023 Kahramanmaraş and Hatay Earthquakes Report. Ankara: Strategy and Budget Directorate; 2023. https://www.sbb.gov.tr/wp-content/uploads/2023/03/2023-Kahramanmaras-and-Hatay-Earthquakes-Report.pdf. Accessed February 4, 2025.

9. 9. Motamedi MHK, Saghafinia M, Ebrahimi A, et al. Major earthquakes of the past decade (2000-2010): a comparative review of various aspects of management. Trauma Mon. 2012;17(1):219-229. doi:10.5812/traumamon.5176
10. 10. Dursun R, Görmeli CA, Görmeli G, et al. Disaster plan of hospital and emergency service in the Van earthquake. JAEM. 2012;11:86-92. doi:10.5152/jaem.2012.035
11. 11. Brevard SB, Weintraub SL, Aiken JB, et al. Analysis of disaster response plans and the aftermath of Hurricane Katrina: lessons learned from a level I trauma center. J Trauma. 2008;65(5):1126-1132. doi:10.1097/TA.0b013e318188d6e5
12. 12. Melnychuk E, Sallade TD, Kraus CK. Hospitals as disaster victims: lessons not learned? J Am Coll Emerg Physicians Open. 2022;3(1):e12632. doi:10.1002/emp2.12632
13. 13. Wood KH, Wheelock MD, Shumen JR, et al. Controllability modulates the neural response to predictable but not unpredictable threat in humans. Neuroimage. 2015;119:371-381. doi:10.1016/j.neuroimage.2015.06.086
14. 14. Loke AY, Fung OW. Nurses' competencies in disaster nursing: implications for curriculum development and public health. Int J Environ Res Public Health. 2014;11(3):3289-3303. doi:10.3390/ijerph110303289
15. 15. Koçak HS, Kaplan Serin E. Are nurses ready for a disaster in Turkey? A hospital case. Disaster Med Public Health Prep. 2023;17:e436. doi:10.1017/dmp.2023.100
16. 16. Lakbala P. Hospital workers' disaster management and hospital nonstructural: a study in Bandar Abbas, Iran. Glob J Health Sci. 2015;8(4):221-226. doi:10.5539/gjhs.v8n4p221
17. 17. Chaffee M. Willingness of health care personnel to work in a disaster: an integrative review of the literature. Disaster Med Public Health Prep. 2009;3(1):42-56. doi:10.1097/DMP.0b013e31818e8934
18. 18. Qureshi K, Gershon RR, Sherman MF, et al. Health care workers' ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005;82(3):378-388. doi:10.1093/jurban/jti086
19. 19. US Department of Health and Human Services. Tips for Retaining and Caring for Staff After a Disaster. Washington, DC: US Department of Health and Human Services. https://files.asprtracie.hhs.gov/documents/tips-for-retaining-and-caring-for-staff-after-disaster.pdf. Accessed February 4, 2025.
20. 20. Shapira Y, Marganitt B, Roziner I, et al. Willingness of staff to report to their hospital duties following an unconventional missile attack: a state-wide survey. Isr J Med Sci. 1991;27(11-12):704-711.
21. 21. Lim HW, Li Z, Fang D. Impact of management, leadership, and group integration on the hospital response readiness for earthquakes. Int J Disaster Risk Reduct. 2020;48:101586. doi:10.1016/j.ijdrr.2020.101586
22. 22. Shapira S, Friger M, Bar-Dayan Y, et al. Healthcare workers' willingness to respond following a disaster: a novel statistical approach toward data analysis. BMC Med Educ. 2019;19(1):130. doi:10.1186/s12909-019-1561-7
23. 23. Ochi S, Tsubokura M, Kato S, et al. Hospital staff shortage after the 2011 triple disaster in Fukushima, Japan—an earthquake, tsunamis, and nuclear power plant accident: a case of the Soso district. PLoS One. 2016;11(10):e0164952. doi:10.1371/journal.pone.0164952