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Eur J Psychotraumatol ; 15(1): 2330302, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38573118


Background: Various coping strategies have been shown to alleviate the negative effects of trauma, yet the significance of prosocial behaviour in this realm has been notably underexplored. The present study explored the hypothesis that engaging in prosocial behaviour mitigates the impacts of trauma by promoting a sense of competence and relatedness, post-traumatic growth (PTG), and reconstruction of meaning.Methods: Three consecutive studies were conducted with college students to compare differences in consequence of prosocial behaviours between a trauma group and a control group. Study 1 (N = 96) used self-reported experiences of traumatic vs non-traumatic events; Study 2 (N = 43) used exposure vs. no exposure to video of an earthquake; Study 3 (N = 20) used a randomized controlled trial (RCT) of a prosocial-themed intervention vs. no intervention. Outcomes in all studies were assessed by self-report questionnaires.Results: Trauma damaged participants' sense of competence and meaningfulness. Prosocial behaviour relieved the impact of trauma on meaning, specifically manifested in the individuals' sense of meaningfulness and their search for meaning. Group interventions with a prosocial theme (based on effect size results) reduced post-traumatic stress disorder (PTSD) and enhanced PTG in victims. The promoting effect on PTG persisted a month later, and its enhancing effect on meaning manifested with a delay.Conclusion: Prosocial behaviour can potentially serve as a beneficial strategy for individuals coping with trauma because it helps enhance meaning and promotes PTG in victims. This conclusion is supported by laboratory experiments and a tentative small-scale intervention study, which provide an innovative perspective for future trauma interventions.

Prosocial behaviour can potentially serve as a beneficial strategy for individuals coping with trauma.Prosocial behaviour relieved the impact of trauma on meaning.Prosocial-themed intervention reduced PTSD and enhanced PTG in victims (based on effect size results).

Terremotos , Crescimento Psicológico Pós-Traumático , Humanos , Altruísmo , Dor
BMC Public Health ; 24(1): 945, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38566072


BACKGROUND: Identifying healthcare services and also strengthening the healthcare systems to effectively deliver them in the aftermath of large-scale disasters like the 2023 Turkey-Syria earthquakes, especially for vulnerable groups cannot be emphasized enough. This study aimed at identifying the interventions undertaken or proposed for addressing the health needs or challenges of vulnerable groups immediately after the occurrence of the 2023 Turkey-Syria earthquakes, as well as for prioritizing their healthcare service delivery in the post-Turkey-Syria earthquake. METHODS: In this scoping review compiled with the five steps of the Arksey and O'Malley framework, five databases, including PubMed, Science Direct, Web of Science, OVID, and Google Scholar, were searched for studies published between March and April 2023 in line with the eligibility criteria. Interventions for enhancing post-earthquake healthcare services (PEHS) were grouped into seven (7) categories, adopted from previous guidelines and studies. Each one was assigned a default score of a value equal to one (1), which, in the end, was summed up. RESULTS: Of the 115 total records initially screened, 29 articles were eligible for review. Different interventions they reported either undertaken or proposed to address the healthcare needs and challenges, especially faced by the most vulnerable groups in the aftermath of the Turkey-Syria earthquakes, were categorized into 7 PEHS. They were ranked with their scores as follows: humanitarian health relief (25); medical care (17); mental health and psychosocial support (10); health promotion, education, and awareness (9); disease surveillance and prevention (7); disability rehabilitation (7); and sexual and reproductive health (5). CONCLUSION: Since there are no proper guidelines or recommendations about the specific or most significant PEHS to prioritize for vulnerable groups after the occurrence of large-scale earthquakes, this scoping review provides some insights that can help inform healthcare service delivery and prioritization for vulnerable groups in the post-2023 Turkey-Syria earthquakes and other similar disasters.

Desastres , Terremotos , Humanos , Turquia , Síria , Atenção à Saúde
PLoS One ; 19(4): e0301255, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38574077


Natural disasters, like pandemics and earthquakes, are some of the main causes of distress and casualties. Governmental crisis management processes are crucial when dealing with these types of problems. Social media platforms are among the main sources of information regarding current events and public opinion. So, they have been used extensively to aid disaster detection and prevention efforts. Therefore, there is always a need for better automatic systems that can detect and classify disaster data of social media. In this work, we propose enhanced Arabic disaster data classification models. The suggested models utilize domain adaptation to provide state-of-the-art accuracy. We used a standard dataset of Arabic disaster data collected from Twitter for testing the proposed models. Experimental results show that the provided models significantly outperform the previous state-of-the-art results.

Planejamento em Desastres , Desastres , Terremotos , Desastres Naturais , Mídias Sociais , Humanos , Opinião Pública
Disaster Med Public Health Prep ; 18: e54, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38561982


OBJECTIVE: Natural disasters such as earthquakes can have a significant impact on cancer treatment and care. The objective of the study was to evaluate the psychological effect of the earthquake on survivor cancer patients compared to regular cancer patients. METHODS: Cancer patients who were evacuated from earthquake sites and referred for the continuation of their treatment, as well as regular resident patients were included in the study. The resident cancer patients were compared with the study population as a control group. DASS-21 forms were filled based on patients' declarations. RESULTS: Forty-six patients were earthquake survivors and 55 were resident cancer patients. Stress scores were significantly higher in earthquake survivors (P = 0.021). In contrast, there was no difference in stratified groups due to DASS-21 categorization in stress scores while depression and anxiety subgroups had significant differences (P = 0.012; P < 0.001). Also, women significantly had a worse outcome in the depression and anxiety categories (P = 0.028; P = 0.021) while no difference was observed in men. CONCLUSION: Recent earthquakes in Turkey had psychological negative effects on oncology patients. The increased stress, depression, and anxiety levels were observed in earthquake survivors who were evacuated from the disaster zone and compared to the control group.

Desastres , Terremotos , Neoplasias , Transtornos de Estresse Pós-Traumáticos , Masculino , Humanos , Feminino , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia , Neoplasias/complicações
Disaster Med Public Health Prep ; 18: e53, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38561993


OBJECTIVE: This research was conducted in order to assess the 1-week aid needs determined by the health professional who voluntarily served in the WhatsApp communication network during the earthquakes in Kahramanmaras, Turkey. METHODS: This descriptive retrospective epidemiological study focuses on the 1-week messaging activities of the WhatsApp group created by volunteers after the earthquake in Turkey. During the 7-day period included in the research, a total of 5813 messages were sent. 3472 of these messages were not included in the research for various reasons, and a total of 2341 messages were used for the research. RESULTS: In all 7 days, it was seen that most of the messages were sent via text message and that voice messages were very few. When the distribution of the needs demanded by the earthquake victims for 7 days was examined, it was seen that there was a significant increase in the needs on the fourth day after the earthquake, and that the highest increase was the need for tents. CONCLUSION: While the demands for rescue services increased in the first 2 days, it was determined that the demands for water especially, dry food, and tents increased from the third day onwards. It is suggested that a professional online infrastructure system should be created to enable the transfer of instant scene and need information that can be activated in such disasters.

Desastres , Terremotos , Humanos , Estudos Retrospectivos , Turquia , Voluntários
BMC Public Health ; 24(1): 937, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38561730


BACKGROUND: An earthquake with a magnitude of 7.7 occurred in Pazarcik District of Turkey at 04.17 on February 6, 2023 and another earthquake of 7.6 occurred at 13.24 on the same day. This is the second largest earthquake to have occurred in Turkey. The aim of this study is to investigate the earthquake-related level of knowledge, attitudes and behaviours, general health and psychological status of survivors who were affected by the 2023 Kahramanmaras Earthquake and who were living in Nurdagi District of Gaziantep after the earthquake. METHODS: Data of 2317 individuals older than 18 years of age who were living in earthquake neighbourhoods, tents and containers in Nurdagi District of Gaziantep were examined. Variables were evaluated to find out the demographic characteristics and general health status of earthquake victims. General Health Questionnaire (GHQ-12) was used to find out psychological states of earthquake victims. RESULTS: The rate of injuries was 14.2% and leg and foot injuries were the most common with 44.2%. The relationship between injury status; and age, marital status, and being trapped under debris was revealed (p < 0.05). Mean GHQ-12 score of the survivors was 3.81 ± 2.81 and 51.9% experienced psychological distress. In the evaluation with logistic regression, it was found that female gender, being injured in the earthquake, loss of first degree and second degree relatives (with a higher rate in loss of first degree relative), having a severely damaged -to be demolished house and having a completely destroyed house were correlated with higher level of psychological distress (p < 0.05). CONCLUSION: General characteristics, injury prevalence and affecting factors of earthquake survivors were evaluated in the present study. Psychological distress was found in victims. For this reason, providing protective and assistive services to fight the destructive effects of earthquake is vital. Accordingly, increasing the awareness of people residing in earthquake zones regarding earthquakes is exceptionally important.

Desastres , Terremotos , Transtornos de Estresse Pós-Traumáticos , Humanos , Feminino , Inquéritos e Questionários , Nível de Saúde , Sobreviventes/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
Disaster Med Public Health Prep ; 18: e57, 2024 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-38591261


The catastrophic earthquakes that struck Southern Turkey in 2023 highlighted the pressing need for effective disaster management strategies. The unprecedented scale of the crisis tested the robustness of traditional healthcare responses and highlighted the potential of e-health solutions. Despite the deployment of Emergency Medical Teams, initial responders - primarily survivors of the earthquakes - faced an enormous challenge due to their lack of training in mass-casualty situations. An e-health platform was introduced to support these first responders, offering tools for drug calculations, case management guidelines, and a deep learning model for pediatric X-ray analysis. This commentary presents an analysis of the platform's use and contributes to the growing discourse on integrating digital health technologies in disaster response and management.

Planejamento em Desastres , Terremotos , Incidentes com Feridos em Massa , Telemedicina , Criança , Humanos , Triagem , Turquia
Ideggyogy Sz ; 77(3-4): 97-102, 2024 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-38591928


Background and purpose:

        Natural disasters, such as earthquakes, frequently result in mood disorders among affected individuals. It is established that neuropathic pain arising from traumatic neuropathies is also linked to mood disorders. This study investigates the influence of neuropathic pain on the development of mood disorders in earthquake survivors with peripheral nerve injuries, following the earthquake centered in Kahramanmaras on February 6, 2023. Additionally, we aim to assess the electro­physiological aspects of neuropathic injuries in these survivors.

. Methods:

The study comprised 46 earth-quake survivors with electrophysiologically confirmed peripheral nerve injuries, with 39 trauma-free survivors serving as the control group. Neuropathic pain, anxiety and depression were assessed using the Douleur Neuropathique 4 (DN4) questionnaire and the Hospital Anxiety and Depression Scale (HADS).

. Results:

Our findings revealed that the ulnar and peroneal nerves were the most commonly injured structures. Among the survivors with peripheral nerve injury, 31 out of 46 (67%) were found to experience neuropathic pain. Furthermore, plexopathy and multiple extremity injuries were associated with more severe neuropathic pain. However, there was no significant difference in anxiety and depression scores between the two groups and neuropathic pain was found to have no independent effect.

. Conclusion:

The study indicates that the intensity of neuropathic pain varies based on the localization and distribution of peripheral nerve injuries. However, the presence of peripheral nerve damage or neuropathic pain was not directly associated with HADS scores, suggesting that mood disorders following disasters may have multifactorial causes beyond physical trauma.


Terremotos , Neuralgia , Traumatismos dos Nervos Periféricos , Humanos , Traumatismos dos Nervos Periféricos/complicações , Transtornos do Humor/etiologia , Transtornos do Humor/complicações , Neuralgia/epidemiologia , Neuralgia/etiologia , Sobreviventes
Sci Rep ; 14(1): 5928, 2024 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-38467706


The physical and psychological effects of earthquakes on individuals with their experience dimension are important. This study aimed to examine the relationship between earthquake risk perception, religious orientation, and spiritual well-being among individuals with and without earthquake experience. The data collection instruments included a socio-demographic information questionnaire, earthquake risk perception scale, religious orientation scale, and three-factor spiritual well-being scale. Statistical evaluations were performed using independent samples t test, one-way ANOVA test, Mann-Whitney U test, Kruskal-Wallis test (Levene), Pearson correlation, and multiple linear regression analyses. About 59.9% of the participants had experienced an earthquake. Individuals with earthquake experience scored 33.04 ± 7.80 on the earthquake risk perception scale, 100.65 ± 20.80 on the religious orientation scale, and 119.66 ± 18.87 on the three-factor spiritual well-being scale. Those without earthquake experience scored 31.57 ± 7.74, 96.70 ± 18.46, and 114.09 ± 18.04 on the respective scales. The average scores on the earthquake risk perception scale were found to be statistically significant with respect to gender, while the average scores on the religious orientation scale and the three-factor spiritual well-being scale were found to be statistically significant with respect to both gender and substance use. The regression analysis revealed that religious orientation and three-factor spiritual well-being significantly predicted 13.5% of the variance in earthquake risk perception. Studies to increase individuals' risk perception are important in minimizing the destructive effects of earthquakes in countries in the earthquake zone.

Terremotos , Humanos , Estudos Transversais , Análise de Variância , Análise de Regressão , Inquéritos e Questionários
Turk Neurosurg ; 34(2): 325-330, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38497186


AIM: To identify the patterns and types of neuorosurgical injuries sustained by victims of the double earthquakes affected ten cities with a population of 15 million in southern and central Türkiye. MATERIAL AND METHODS: In this descriptive observational study, we retrospectively analyzed the medical records of a university hospital located in one of the ten cities affected by the earthquake. RESULTS: A total of 1,612 patients with earthquake-related injuries were admitted during the study period, of which 139 (8.6%) had neurosurgical injuries. The mean age of the patients was 42.4 ± 21.1 years (median, 42 years), and 53.2% of them were female. Of the 139 patients with neurosurgical injuries, 41 (29.5%) had craniocerebral injuries, 95 (68.3%) had spinal injuries, and three (2.2%) had both craniocerebral and spinal injuries. A total of 31 surgeries were performed (22.3%) (five [3.6%] for craniocerebral injuries and 26 [18.7 %] for spinal injuries). Ninety-eight patients (70.5%) had concomitant systemic traumas. The overall mortality rate was 5.75%, with crush syndrome (n=4, 50%), being the leading cause of death, followed by neurosurgical pathologies (n=3, 37.5%) and pneumonia with septic shock (n=1, 12.5%). CONCLUSION: Neurosurgical injury is an important cause of post-earthquake mortality and morbidity. To ensure efficient medical rescue and judicious resource allocation, it is essential to recognize the characteristics of earthquake-related neurosurgical injuries. This study provides valuable information regarding the incidence, characteristics, and outcomes of neurosurgical injuries in earthquake-affected patients. Our findings highlight the need for prompt diagnosis and management of such injuries, particularly in those with concomitant systemic trauma.

Traumatismos Craniocerebrais , Terremotos , Traumatismos da Coluna Vertebral , Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Masculino , Turquia/epidemiologia , Estudos Retrospectivos , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/cirurgia , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/cirurgia
Disaster Med Public Health Prep ; 18: e45, 2024 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-38466322


OBJECTIVE: The Kahramanmaras earthquakes struck the north-eastern part of Türkiye and Syria on February 6, 2023. It is well known that timely coordination and provision of emergency medical care in the field is particularly important to save lives after earthquakes. This study aimed to identify the challenges faced by medical responders on the ground. METHODS: This exploratory-descriptive qualitative study was conducted in Hatay, the province most affected by the earthquakes. Data were collected through in-depth semi-structured interviews and field observations, and then analyzed using thematic analysis approach. RESULTS: The study was carried out with 15 first responders from the medical profession. The study revealed 9 themes of challenges faced by medical responders: providing safety and security, human resources management, meeting personal needs, recording data, communication, patient transport, burial procedures, psychological acumen, and logistical problems. Some problems were resolved after 72 h and some continued until day 7. CONCLUSIONS: Inadequate organization of volunteer health workers, communication breakdowns, and logistical problems are some of the main challenges. To address these issues, satellite phones and radio systems can be promoted, as well as disaster-resilient logistical planning and better coordination of volunteers.

Planejamento em Desastres , Desastres , Terremotos , Humanos , Turquia , Pessoal Técnico de Saúde
J Microorg Control ; 29(1): 45-48, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38508762


Fungal contamination in the indoor air of prefabricated temporary houses at the site of the Great East Japan Earthquake revealed extremely high levels compared to those found in conventional residences. We experimentally investigated fungal growth levels on different interior materials to support fungal overgrowth in prefabricated temporary houses. Three species each of allergenic fungi and invasive fungi observed in temporary housing were selected for inoculation tests with various interior materials. The experiments with fungal inoculation were conducted in conformance with standards for industrial products described in the Japanese" JIS Z 2911:2018 Methods of test for fungus resistance" with small modifications. After incubation, visual and stereomicroscopic assessments were performed to determine fungal growth levels. The viability of the fungi varied according to the interior material type. Our findings demonstrate the importance of antifungal measures in indoor environments and the need for additional research on the growth levels of fungal species on various interior materials.

Terremotos , Japão , Habitação
Ulus Travma Acil Cerrahi Derg ; 30(3): 174-184, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38506381


BACKGROUND: Crush Syndrome is a major cause of morbidity and mortality following large-scale catastrophic earthquakes. Since there are no randomized controlled studies on Crush Syndrome, knowledge on this subject is limited to expert experience. The primary objective is to analyze the epidemiological and demographic characteristics, clinical outcomes, and mortality factors of earthquake victims after the Pazarcik and Elbistan earthquakes on February 6, 2023. METHODS: This cross-sectional and observational retrospective study evaluated 610 earthquake victims who presented to our center between February 6 and April 30, 2023. Among these patients, 128 with Crush Syndrome were included in the study. Patient information was gathered from hospital records during their stay and from national registries upon referral. The primary outcome was to identify risk factors for mortality. Demographic and laboratory data were analyzed by acute kidney injury (AKI) stages; mortality-affecting factors were identified through regression analysis. RESULTS: Of the 128 Crush Syndrome patients (100 adults, 28 children), 64 were female. The AKI rate was 32.8%. Among patients with AKI, the frequency of hemodialysis requirement was 69%, and the mortality rate was 14.2%. The overall mortality rate for patients with Crush Syndrome was 4.6%, compared to 3.9% (19/482) in earthquake victims without Crush Syndrome (p=0.705). Notably, low systolic blood pressure at admission was the only factor significantly affecting mortality in Crush Syndrome patients (Hazard Ratio [HR]: 1.088, p=0.021, 95% Confidence Interval [CI]). CONCLUSION: Our study highlights low systolic blood pressure upon admission as a significant risk factor for increased mortality in Crush Syndrome patients. This finding may contribute to the literature by emphasizing the importance of monitoring blood pressure under rubble and administering more aggressive fluid therapy to patients with low systolic blood pressure.

Injúria Renal Aguda , Síndrome de Esmagamento , Terremotos , Adulto , Criança , Humanos , Feminino , Masculino , Síndrome de Esmagamento/epidemiologia , Síndrome de Esmagamento/etiologia , Estudos Retrospectivos , Estudos Transversais , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia
Ulus Travma Acil Cerrahi Derg ; 30(3): 185-191, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38506387


BACKGROUND: Earthquakes are natural disasters that can often cause severe injuries and traumatic situations. These injuries can include crush injuries, fractures, tissue damage, and blood circulation problems. Hyperbaric oxygen therapy (HBOT) has recently become a frequently used treatment modality for individuals suffering from severe injuries. HBOT is a form of treatment that involves administering pure oxygen to the patient under high pressure. This treatment aims to promote tissue healing by increasing cellular oxygenation. It is thought to have a positive effect on factors such as accelerating tissue healing, reducing inflammation, and controlling infection in severe post-earthquake injuries, particularly crush injuries. This study aimed to retrospectively evaluate the clinical effects, contributions to the healing process, and potential advantages of HBOT in 35 patients with severe injuries after the Kahramanmaras earthquake that occurred on 06.02.2023 and to contribute to the development of emergency intervention strategies. METHODS: This study was carried out after ethics committee approval. In the study, the data of patients with a MESS Score between 7-14 who were admitted as earthquake victims and treated in the HBOT Unit due to severe earthquake-related injuries were obtained from records and retrospectively analyzed. Demographic information, general distribution of patient data, mean values, number of HBOT sessions, and functional outcomes were recorded. RESULTS: The gender distribution of the 35 patients who received HBOT was 31.4% male and 68.6% female. 45.7% of patients were aged 18 years or younger, and 54.3% were aged 19 years or older. The most common injuries in the treated patients were observed in the lower extremities. After HBOT, sensory recovery (54.3%) and functional recovery (51.4%) were achieved in the majority of patients. The minor amputation rate was 20.0% and the major amputation rate was 11.4% after HBOT. CONCLUSION: This study evaluated the possible effects of HBOT on patients with severe earthquake injuries in Türkiye, and the results showed that HBOT may have a beneficial effect on critical factors such as sensory recovery, functional recovery, and amputation rates in this particular group of patients, and that this benefit may be more pronounced in those who started treatment early.

Lesões por Esmagamento , Terremotos , Oxigenoterapia Hiperbárica , Humanos , Masculino , Feminino , Oxigenoterapia Hiperbárica/efeitos adversos , Oxigenoterapia Hiperbárica/métodos , Estudos Retrospectivos , Cicatrização
Ulus Travma Acil Cerrahi Derg ; 30(3): 167-173, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38506390


BACKGROUND: The February 6, 2023, Kahramanmaras earthquake caused significant destruction across our country. More than 50,000 people lost their lives, thousands were injured, and health facilities were damaged. Victims were transferred to hospitals in other provinces for treatment. This study evaluates the anesthesia approach applied to the injured who were transferred to our tertiary hospital. METHODS: We retrospectively reviewed the data of patients who underwent surgery between February 6 and February 20, 2023. The study included earthquake victims who underwent emergency trauma surgery, aged 10 years and above. We recorded the date of admission to the hospital, demographic information, type of surgery, surgical site, anesthesia technique, preference for peripheral block, laboratory values, dialysis and intensive care needs, and survival rates. Data analysis was performed using the IBM® Statistical Package for the Social Sciences (SPSS®) Version 26.0. RESULTS: A total of 375 cases were included in the study. Of these, 323 patients underwent surgery for extremity injuries, and 35 for vertebral injuries. Among the extremity injuries, 61.6% were to the lower extremities, and 17.1% to the upper extremities. Debridement was performed on 147 patients, fasciotomy on 49 patients, and amputation on 33 patients. General anesthesia was applied to 352 patients, spinal anesthesia to 19 patients, and sedoanalgesia to four patients. Peripheral nerve block was performed on 33 patients. Dialysis treatment was administered to 105 patients. Twenty-six patients were lost during the treatment process. There were no intraoperative patient deaths. CONCLUSION: The predominance of extremity injuries among earthquake victims increases the inclination towards regional anesthesia. Incorporating Plan A blocks into basic anesthesia skills could enhance the preference for regional anesthesia in disaster situations. Furthermore, transferring the injured to advanced centers may reduce morbidity.

Anestésicos , Desastres , Terremotos , Humanos , Estudos Retrospectivos , Hospitais Urbanos