Global Spotlights Heartfelt tremors: empowering communities to mitigate the impacts of earthquakes and other natural disasters Tuğba Kemaloğlu Öz 1 * and Zainab Atiyah Dakhil 2 1 Department of Cardiology, Liv Hospital Ulus, Meclis mah Çağatay sok no: 2 Sancaktepe İstanbul Turkey 34785; and 2 Department of Cardiology, Ibn Al-Bitar Cardiac Centre, AlSalhiya, Baghdad, Iraq, 10002 * Corresponding author. Tel: +905062650437, Email: tugbakemalogluoz@gmail.com © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com ‘Remember: When disaster strikes, the time to prepare has passed.’ Steven Cyros On 6 February 2023, Turkey and Syria were hit by two catastrophic earthquakes followed by thousands of aftershocks. These events tra- gically affected around 9.1 million people in Turkey and 8.8 million people in Syria, causing 50,000 and 5900 deaths, respectively. More than 3 million people in Turkey and around half a million in Syria were displaced. 1 As a cardiology community, we need to know what we can do to prepare our healthcare system and our patients to mitigate future crises. Earthquakes, like many natural disasters, are associated with negative health impacts. Earthquake survivors have a signifcant increase in major adverse cardiovascular events like myocardial infarction (MI), stroke, heart failure (HF), and arrhythmia as well as increased atherosclerotic risk factors. 2 Multiple mechanisms contribute to these events, without taking into consideration the impact of earthquakes on cardiovascular care and services because of infrastructure damage. 2 To mitigate the effect of natural disasters on healthcare during and after the event, it is crucial to adapt a disaster risk management plan, with preparedness being an important component. 3 As part of being prepared, all facilities should be assessed for risk regarding their current infrastructure, 4 capacity, and essential cardiac services, especially in areas that are vulnerable to natural disasters like earthquakes. After facility assessment, cardiac wards, and catheterization units should be maintained, expanded, and/or remodelled so they can face future challenges. Adequate funding and disaster/emergency budgets are mandatory for risk management planning. Proper authorization schemes can prevent delays in emergency patient management since telephone and internet communications are usually damaged follow- ing earthquakes. Natural disasters highlight the importance of establishing electronic health records (EHR) in different national healthcare systems. It is vital to be able to access patients medical details after the disaster, so their prescription can be maintained, and patients can be managed properly. This aspect should be a priority in countries without established elec- tronic healthcare systems. In countries where EHR exists, providing pa- tients with paper and/or electronic formats of medical records is also critical 5 as many EHR systems cannot be accessed uniformly and rou- tinely through different regions. This is especially the case where public displacement across cities is undertaken in response to extensive earth- quake damage. Preparedness relates not only to facilities or budgets but also, more importantly to healthcare providers (HCPs). Comprehensive training for all medical and administrative staff involved in medical care should be ensured. Unfortunately, HCPs rarely receive training in disaster risk management. 4 Cardiology fellowship training and the wider curric- ulum should include profcient disaster management training. During the COVID-19 pandemic, many issues were raised regarding the ne- cessity of implementing disaster medicine training during fellowships, 6 and this should be fully embraced now, considering that natural disas- ters are expected to be more frequent in the future. Training is not only needed for HCPs but also for the public. Health education for patients and carers is a critical step to improving patient outcomes during natural disasters. An example is cardiopulmonary re- suscitation (CPR) training for the public. During earthquakes, bystander CPR for witnessed cardiac arrests was signifcantly performed less than before earthquakes which worsened survival and neurological outcomes of post-disaster patients. 7 This highlights the importance of basic life sup- port training for the public to mitigate the challenges during earthquakes (like delays in ambulance arrival or professional cardiac care). It is helpful to educate cardiac patients and their relatives on global disaster guide- lines and protocols. 8,9 A proposed disaster-toolkit (Figure 1) can help car- diac patients during earthquakes and natural disasters. In the post-earthquake period, rapid assessment of damage should be done. Clear communication and coordination among higher European Heart Journal (2023) 44, 4303–4305 https://doi.org/10.1093/eurheartj/ehad497 Downloaded from https://academic.oup.com/eurheartj/article/44/41/4303/7243240 by guest on 17 February 2024