This compilation covers emergency medical management lessons from the February 6^th Kahramanmaraş earthquakes. The objective is to review relevant literature on emergency services patient management, focusing on Koenig’s 1996 Simple Triage and Rapid Treatment (START) and Secondary Assessment of Victim Endpoint (SAVE) frameworks. Establishing a comprehensive seismic and mass casualty incident (MCI) protocol chain is the goal. The prehospital phase of seismic MCIs treats hypovolemia and gets patients to the nearest hospital. START-A plans to expedite emergency patient triage and pain management. The SAVE algorithm is crucial for the emergency patient secondary assessment. It advises using Glasgow Coma Scale, Mangled Extremity Severity Score, Burn Triage Score, and Safe Quake Score for admission, surgery, transfer, discharge, and outcomes. This compilation emphasizes the importance of using diagnostic tools like bedside blood gas analyzers and ultrasound devices during the assessment process, drawing from 6 February earthquake research. The findings create a solid framework for improving emergency medical response strategies, making them applicable in similar situations.

Thoracic and abdominal computed tomography scans are widely used modalities for trauma patients in emergency department (ED). However, alternative diagnostic and follow-up tools are also needed, due to limitations such as high cost and exces-sive radiation exposure. This study aimed to investigate the utility of repeated extended focused abdominal sonography for trauma (rE-FAST) performed by the emergency physician in patients with stable blunt thoracoabdominal trauma. This was a prospective, single-center diagnostic accuracy study. Patients with blunt thoracoabdominal trauma admitted to the ED were included in the study. The E-FAST was performed on the patients included in the study at the 0th h, the 3rd h, and the 6th h during their follow-up. Then, the diagnostic accuracy metrics of E-FAST and rE-FAST were calculated. The sensitivity and specificity of E-FAST in determining thoracoabdominal pathologies were found to be 75% and 98.7%, respectively. The sensitivity and specificity for specific pathologies were 66.7% and 100% for pneumothorax, 66.7% and 98.8% for hemothorax, and 66.7% and 100% for hemoperitoneum, respectively. The sensitivity and specificity of rE-FAST in determining thoracal and/or abdominal hemorrhage in stable patients were found to be 100% and 98.7%, respectively. E-FAST successfully rules in thoracoabdominal pathologies in patients with blunt trauma, with its high specificity. However, only a rE-FAST might be sensitive enough to exclude traumatic pathologies in these stable patients.

In the 21st century, disasters (particularly earthquakes, which remain the leading cause of death) continue to be among the foremost issues requiring global emergency response. While the impact of advancing technologies on the environmental and human damage caused by earthquakes is still a subject of debate, search and rescue (SAR) teams and emergency departments (ED), specifically emergency physicians (EPs), play a crucial role in the most acute management of the effects of these earthquakes on human life. This study aims to examine the injury dynamics of two catastrophic earthquakes that occurred in Turkey 24 years apart from the perspective of EPs, utilizing archival records from the SAR teams in which EPs served. This study is a cross-sectional investigation analyzing the injury and SAR dynamics of casualties, based on the archives of SAR teams that included 12 EPs, during the 1999 Marmara and 2023 Kahramanmaraş (Maraş) earthquakes (groups). In this study, a total of 160 injured individuals who were rescued alive from the rubble were included, with 26.3% (n = 42) from the Maraş group and 73.8% (n = 118) from the Marmara group. Identification of the injured was achieved in 54.8% (n = 23) of the Maraş group and 88.1% (n = 104) of the Marmara group, with an overall identification rate of 79.4% (n = 127) (p < 0.001). The most common injuries among the injured were lower extremity injuries (53.1%, n = 85) and upper extremity injuries (49.4%, n = 79), with the most frequent scenario being the extraction of two individuals from the same location (33.8%, n=54). The most common interventions provided to the injured were intravenous fluid therapy (63.8%, n =102) and oxygen support (57.5%, n =92). The rate of intubation at the scene was 16.1% (n = 19) in the Marmara group and 4.8% (n = 2) in the Maraş group (p < 0.05). Additionally, cardiopulmonary resuscitation (CPR) was administered at the scene in 13.6% (n = 16) of the Marmara group, compared to 2.4% (n = 1) in the Maraş group (p < 0.05). When examining the challenges encountered during SAR operations, the most frequent issue in the Maraş group was identification, affecting 57.1% of the cases (p < 0.001), whereas the most common issue in the Marmara group was entrapment, occurring in 50.0% of cases (p < 0.001). Lighting difficulties were observed at similar rates in both earthquakes (19.0% in Maraş, 19.5% in Marmara; p = 1.000). Additionally, weather conditions posed a challenge in 11.9% of cases in the Maraş group, whereas this issue was not encountered in the Marmara group (p < 0.001). The 24 years of experience and expertise gained by EPs who served in Türkiye in these operations constitute a valuable global resource. Disseminating this knowledge is crucial not only for managing earthquakes but also for preparing for other catastrophic events that could cause widespread destruction. Harnessing this accumulated experience can significantly enhance knowledge-sharing and the development of more effective preparedness strategies.

Objective Pulmonary embolism (PE) is a vascular disease that is most frequently diagnosed using the radiological imaging technique computed tomography pulmonary angiography (CTPA). In this study, we aimed to demonstrate the diagnostic accuracy of the Hounsfield unit (HU) for PE based on the hypothesis that acute thrombosis causes an increase in HU value on CT. Methods This research was a single-center, retrospective study. Patients presenting to the emergency department diagnosed with PE on CTPA were enrolled as the study group. Patients admitted to the same emergency department who were not diagnosed with PE and had noncontrast CT scans were included as the control group. A receiver operating curve was produced to determine the diagnostic accuracy of HU values in predicting PE. Results The study population (n=74) consisted of a study group (n=46) and a control group (n=28). The sensitivity and specificity of the HU value for predicting PE on thoracic CT were as follows: for the right main pulmonary artery, 61.5% and 96.4% at a value of 54.8 (area under the curve [AUC], 0.690); for the left main pulmonary artery, 65.0% and 96.4% at a value of 55.9 (AUC, 0.736); for the right interlobar artery, 44.4% and 96.4% at a value of 62.7 (AUC, 0.615); and for the left interlobar artery, 60.0% and 92.9% at a value of 56.7 (AUC, 0.736). Conclusion HU may exhibit high diagnostic specificity on CT for thrombi up to the interlobar level. An HU value exceeding 54.8 up to the interlobar level may raise suspicion of the presence of PE.