Learning lessons from the 2011 Van Earthquake to enhance healthcare surge capacity in Turkey

Historically, Turkey has adopted a reactive approach to natural hazards which resulted in significant losses. However, following the 1999 Kocaeli Earthquake, a more proactive approach has been adopted. This study aims to explore the way this new approach operates on the ground. A multi-national and multi-disciplinary team conducted a field investigation following the 2011 Van Earthquake to identify lessons to inform healthcare emergency planning in Turkey and elsewhere. The team interviewed selected stakeholders including, healthcare emergency responders, search and rescue services, ambulance services, and health authority representatives, in addition to conducting a focus group. Data were analysed according to an open coding process and SWOT analysis. The findings suggest that the approach succeeded in developing a single vision by consolidating official efforts in a more structured way, mobilising many governmental and non-governmental organisations, securing significant amounts of resources including physical and human, and increasing the resilience and flexibility of infrastructure to expand its capacity. However, more attention is required to the development of stronger management procedures and acquisition of further resources

Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review.

BACKGROUND: Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. METHODS: We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. RESULTS: Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. CONCLUSION: This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field

Disaster management of chronic dialysis patients

The chronically ill are often the hardest hit by disruptions in the healthcare system--they may be highly dependent on medications or treatments that suddenly become unavailable, they are more physically fragile than the rest of the population, and for socioeconomic reasons they may be more limited in their ability to prepare or react. Medical professionals involved in disaster response should be prepared to care for individuals suffering from the complications of chronic illness, and they must have some idea of how to do so with limited resources. Dialysis-dependent, end-stage renal disease patients are at especially high risk following disasters. Infrastructure damage may make dialysis impossible for days, and few physicians have experience or training in the nondialytic management of end-stage renal disease. Nondialytic management strategies include dietary restrictions, aggressive attempts at potassium removal via resins and cathartics, and adaptations of acute treatment strategies. Appropriate planning and stockpiling of medications such as Kayexalate are critical to minimizing morbidity and mortality