Publication: Afet Tıbbı Açısından KBRN Müdahale Sistemi: Suriye’deki Kimyasal Silah Yaralılarının Yönetimi Örneği
Today, as Chemical, Biological, Radiological and Nuclear (CBRN) weapons are generally used to cause terror and havoc, they are also used to bring about mass destruction and breach of the capacity. Since CBRN weapons are easily procurable, they became an untrammeled power supply in the hands of weak states. Despite all international judgments, treaties and pressures preventing production, storage and usage of chemical weapons, uncontrolled usage still has not been averted. Dual-use feature of some chemicals provides convenience in their trading permissions and their passing through customs. Because chemical detections are difficult and early warning systems are not prevalent in border crossings and customs entries, there is an increasing danger. Disregard of the agencies and institutions meant to be responsible from protecting human health and health of other species, jeopardizes the situation more. In terms of disaster medicine, management of injuries with chemical warfare agents and injured peoples require a multi-disciplinary approach, study and coordination. Unfortunately, academic studies regarding standard procedures and algorithms of rescue and health services provided to the injured peoples as from the initial contact, - especially in the case of injuries with chemical weapons- have a very limited availability. On the purpose of removing this uncertainty and remedying the current deficiency; scientists, forensic science experts, health care providers, chemists, engineers, search and rescue experts, firefighters, members of the managerial disciplines, legists, logistics specialists and experts related to the security field urgently need to determine required standard algorithms of prevention and response. The objective of this cross-sectional study is, review of the medical care processes provided to the victims of chemical weapons from 2011 until today; their comparison with the health care processes applied to the victims of chemical weapons in the Iran – Iraq War and World War I and putting forward proposals about these processes. In line with this objective, highlighting the gap in academic studies related to the medical care processes of the victims of chemical weapons and making contribution to the literature are aimed. Not only the cases either injured in attacks by the chemical weapons which has been used as weapons of chemical mass destruction in Syria from 2011; but also the victims who were passed through the border gates in Hatay and Kilis; whose first responses and transports were provided in ambulances of Emergency Health Presidencies of Kilis, Hatay and Gaziantep and also the cases whose medical cares were maintained in the same provinces are investigated. In this study, acute stage medical cares of the cases exposed to the attacks of chemical agents actualized by two different chemical agents (SM and Chlorine Gas) in two different places are examined. 13 blister agent of Sulfur Mustard (SM) cases whose medical cares were provided in Gaziantep Şehitkâmil State Hospital by being passed through Kilis – Oncupinar Bordergate are all male. Their ages vary between 16 and 48 (average age 29.31 ± 9.87 years) and length of their treatment period vary between 8 and 23 days (average 12.91 days). While 12 of these cases were discharged from the hospital with recovery, one of them was died (%7,69) in the intensive care unit in consequence of cardiopulmonary arrest. While 10 of the 23 cases by exposure to the pulmonary agent Chlorine Gas were male (%43,4), 13 of them were female (%56,6). Both lungs were auscultated; coarse crackles and rhonchus (80%), respiratory distress (100%) and infiltration parts in the lungs (60%) were diagnosed. Despite the oxygenotherapy and supportive care, one of the cases were intubated as a consequence of the decrease of the saturation; and was died after the occurrence of (%4,34) acute respiratory distress syndrome (ARDS) in the intensive care unit. As a consequence, medical care of the all cases exposed to chemical weapons is a process, demanding a great importance and notice. It has a vital importance that, all of the medical personnel, -especially doctors- and everyone actively assigned in the field need to be trained about the influences of chemical weapons on health; protection methods; antidotes; personal decontamination ways and decontamination ways of injured people; field case management and medical care processes for hospitals and fields in accordance with the type of agent and also active exercises need to be conducted for these people regularly.
Thesis (Doctoral)--Bezmialem Vakıf University, Disaster Medicine Doctoral Program, Istanbul, 2019
Afet Tıbbı , KBRN , Kimyasal Silah , Tıbbi Bakım , Disaster Medicine , CBRN , Chemical Weapon