Page 117 - JSOM Winter 2023

Where the key outcome determinant is time to hospital and time There were multiple challenges due to the magnitude of the earth-
to surgical intervention, the rationale for CASEVAC may prevail; quakes, and the size of the affected population and area. The main
but where continuous intervention is needed to assure outcome, challenges were: difficulty in the transportation of teams due to
MEDEVAC becomes essential. Remote, robotic-led interventions damage to highway, airport, and railways; since the earthquake
are being developed. A recent analysis of 1,267 U.S. combat casu- happened at night while people were sleeping, many people were
alties [ref #] showed that only 47% would have needed any med- affected; lack of coordination of national and international teams;
ical intervention in flight and thus “could have been transported triage was difficult because of a large number of casualties, and it
safely by UAV.” The obvious solution therefore becomes intelligent was difficult to the registration of casualties; it took time for the
hybrid use of the available transport systems. Drones offer the po- wounded to be transferred, as hospitals were damaged.
tential for applying greater precision while reducing the demand
for the more sophisticated MEDEVAC platform as well as risk. References
Turkish Presidency Strategy and Budgetary Office. (2023). https://www.
References sbb.gov.tr/wp-content/uploads/2023/03/2023-Kahramanmaras-and-
Maddry JK, Arana AA, Mora AG, et al. Advancing Prehospital Combat Hatay-Earthquakes-Report.pdf
Casualty Evacuation: Patients Amenable to Aeromedical Evacuation Yılmaz S, Karakayali O, Yilmaz S, et al. Emergency Medicine Associ-
via Unmanned Aerial Vehicles. Mil Med. 2021;186(3-4):e366-e372. ation of Turkey Disaster Committee Summary of Field Observations
DOI:10.1093/milmed/usaa438 of February 6th Kahramanmaraş Earthquakes. Prehosp Disaster Med.
2023;38(3):415–418. doi:10.1017/S1049023X23000523
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3-Afet Arastırmaları Dernegi 26 Şubat 2023 Deprem Raporu. www.
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The Türkiye Earthquake Challenges of afet.org.tr
Initial Disaster Management
Dr. Turhan SOFUOGLU, President of Emergency Disaster Whole Blood Transfusion in
Ambulance Physicians Association (AAHD)
Austere Environments – Temperature Effects
urkey is located on the highly seismically active Anatolian Ludvig Emerick, Andrea Riddle, Drew Homan, Emine Foust,
Tfault, where major earthquakes have occurred throughout Andrew Banko, Rakesh Dubey, United States Military Academy,
history. There have been 20 earthquakes with magnitudes greater West Point, NY
than 7 since 1900. On 6 February and 20 February, 3 major
earthquakes occurred in Türkiye. Approximately 15 million peo- n the battlefield, trauma resulting from hemorrhagic shock
ple, and a 110,000km area were affected by these earthquakes. Ostands as the primary cause of preventable fatalities. The cur-
2
On 6 February at 04:17 a 7.8-magnitude earthquake occurred rent solution is the concept of the “Walking Blood Bank,” which is
and 9 hours later a 7.6-magnitude earthquake occurred. On 20 the transfusion of blood from one soldier to another at the point
February, a 6.4-magnitude earthquake happened, causing major of injury. The agent of choice in this process is whole blood [1]. It
destruction and loss of lives and property in 11 provinces, includ- is an all-in-one solution, is more easily transported, and has shown
ing more than 278,000 buildings (>800,000 flats were collapsed/ a higher post-transfusion survival rate than component therapy
seriously damaged and over 450,000 buildings sustained medium [1]. The practice of blood transfusion has developed drastically
or minor damaged) and over 1.5 million homeless people. High- since its initial use in the World War I, but there is still room for
ways, railways, and airports were damaged, and the communi- improvement [1].
cation infrastructure collapsed. Some 112 emergency call centers
and hospitals were damaged. More than 50,000 people died and Time is critical when treating patients with a massive hemor-
100,000 were injured. rhage. Every minute of delay in transfusion protocol initiation in-
creases the odds of mortality by 5% [2]. There have been reports
of complications when utilizing the combat blood transfusion kit
in austere environments. Austere environments are categorized
as low-temperature and low-pressure regions. In collaboration
with the Naval Health Research Center and the Naval Medical
Research Unit, researchers at the United States Military Academy
(USMA) seek to understand the mechanisms that lead to poor
functioning of the transfusion kits in austere environments and
design a new transfusion kit to ensure Soldiers in the field receive
quick and life-saving treatment. As part of the USMA study, this
work specifically focuses on the effects of temperature on blood
flow through the transfusion kit.

Low-temperature environments have a significant impact on hu-
man biological responses, increasing the rate of mortality for those
experiencing combat trauma [3]. Acute exposure to low tempera-
International Search and Rescue Teams started to reach the earth- tures can lead to an increase in oxygen consumption as well as a
quake zone from the first day upon the 4th level alarm call from decreased level of blood oxygen supply throughout the body, thus
the Turkish State. A total of 6,636 search and rescue and medical placing an increased demand on the cardiovascular system [4].
personnel from 45 countries came to support in the first 3 days. Once a severe injury occurs, the low temperatures can aggravate
Later, this number increased to over 10,000 from 74 countries. existing trauma through a decrease in body temperature inducing
The casualties were transported by ground and air ambulances, hypothermia and coagulopathy [3]. This clotting disorder in a hy-
military ships, and helicopters. Besides air and helicopter ambu- pothermic state diminishes the patient’s chances of survival and
lances of the Ministry of Health, military helicopters and ships emphasizes the importance of an efficient transfusion protocol
were also used for this medical evacuation. A total of 327 casual- designed to combat the effects of cold weather [5].
ties were transported by sea routes. Two military ships in Hatay
were converted into hospitals. The Turkish Ministry of Health Several rheological properties of blood are affected by low tem-
National Medical Rescue Teams (UMKE) set up medical response peratures which adversely impact the ability to perform fast, ef-
tents near the debris. Sixteen countries established 34 field hospi- fective transfusions. This study aims to systematically analyze
tals in the earthquake region.
blood flow through the components of the transfusion kit from a

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