2023 年土耳其地震中的现场截肢救生：废墟中复杂的医疗和救援程序之外的伦理、社会和法律问题

IF 1.9 4区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Disaster Medicine and Public Health Preparedness Pub Date : 2024-09-18 DOI:10.1017/dmp.2024.110

Martig Franz, Dumont Lionel Bernard, Mumenthaler Mona, Junod Jean-Daniel, Bächtold Urs, Hagon Olivier

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引用次数: 0

摘要

世界卫生组织和国际地震救援咨询小组的指导方针支持将截肢作为地震伤员的救生措施。然而，在高度紧张的情况下执行这些指南可能会使决策变得复杂。本报告介绍了一个在 2023 年土耳其地震中遵照推荐指南实施截肢救生的病例。这名 16 岁的患者在狭窄的走廊中被困了 55 个小时。在其他救援尝试失败后，经过广泛的跨学科讨论，最终决定进行现场截肢手术。考虑到患者神志不清，我们征得了患者家属的同意。周密的计划和使用咪达唑仑和氯胺酮进行的麻醉确保了截肢手术的成功，并将失血量降至最低。会议讨论了救灾过程中遇到的挑战。重点讨论了抗生素给药延迟、缺乏宫颈保护、伦理困境、心理问题和法律影响等问题。持续改进并解决伦理、法律和心理方面的问题对于取得最佳救灾效果至关重要。

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Life-saving Field Amputation During the 2023 Türkiye Earthquake: Ethical, Social, and Legal Implications Beyond the Complex Medical and Rescue Procedures in the Rubble

Amputation as a life-saving measure for earthquake-trapped patients is supported by WHO and INSARAG guidelines. However, implementing these guidelines in highly stressful contexts can complicate decision-making. This report presents a case of life-saving amputation during the 2023 Turkey earthquake, adhering to recommended guidelines. The 16-year-old patient was trapped for 55 hours in a narrow corridor. Extensive interdisciplinary discussions led to the decision for a field amputation after alternative rescue attempts failed. Consent was obtained from the family, given the patient’s delirium. Meticulous planning and anesthesia using midazolam and ketamine ensured successful amputation with minimal blood loss. Challenges encountered during the disaster response were discussed. Delays in administering antibiotics, a lack of cervical protection, ethical dilemmas, psychological concerns, and legal implications were highlighted. Continued improvement and addressing ethical, legal, and psychological aspects are essential for optimal disaster response outcomes.

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来源期刊

Disaster Medicine and Public Health Preparedness PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.40

自引率

7.40%

发文量

258

审稿时长

6-12 weeks

期刊介绍： Disaster Medicine and Public Health Preparedness is the first comprehensive and authoritative journal emphasizing public health preparedness and disaster response for all health care and public health professionals globally. The journal seeks to translate science into practice and integrate medical and public health perspectives. With the events of September 11, the subsequent anthrax attacks, the tsunami in Indonesia, hurricane Katrina, SARS and the H1N1 Influenza Pandemic, all health care and public health professionals must be prepared to respond to emergency situations. In support of these pressing public health needs, Disaster Medicine and Public Health Preparedness is committed to the medical and public health communities who are the stewards of the health and security of citizens worldwide.