Intensive care in a field hospital in an urban disaster area: lessons from the August 1999 earthquake in Turkey.

OBJECTIVE

To describe our experience with the implementation of intensive care in the setting of a field hospital, deployed to the site of a major urban disaster.

DESIGN

Description of our experience during mission to Turkey; conclusions regarding implementation of intensive care at disaster sites.

SETTING

Military Field Hospital at Adapazari in Turkey.

PATIENTS

Civilian patients admitted for care at the field hospital.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

On August 17, 1999 a major earthquake occurred in western Turkey, causing approximately 16,000 fatalities and leaving >44,000 injured. Approximately 66,000 buildings were severely damaged or destroyed. A medical unit of the Israeli Defense Forces Medical Corps, consisting of 23 physicians, 13 nurses, nine paramedics, 13 medics, laboratory and roentgen technicians, pharmacists, and associated support personnel, were sent to Adapazari in Turkey. The field hospital treated approximately 1,200 patients over a period of 2 wks, 70 surgical operations were performed, 20 babies were delivered, and a variety of medical, surgical, orthopedic, and pediatric/neonatal care was provided. The 12-bed intensive care unit operated by the unit, was staffed by three physicians and eight nursing/paramedic personnel. Patient mix was: a total of 63 patients, among them five with major trauma, 20 with acute cardiac disease, 15 patients with various acute medical conditions, and 11 surgical and postoperative patients. Three patients were intubated and mechanically ventilated (one cardiogenic pulmonary edema and two major trauma). The intensive care unit provided the following functions to the field hospital: care of the critically ill and injured, preparation for and implementation of transportation of such patients, pre- and postoperative care for major surgical procedures, expertise, and equipment for the care of very ill patients throughout the field hospital.

CONCLUSIONS

In suitable circumstances, an intensive care capability should be an integral part of medical expeditions to major disasters.