TÜSAD Issues Important Warnings

Important Warnings from TÜSAD The Turkish Respiratory Society TÜSAD has issued a warning that the safety of teams working in the field and healthcare workers must be ensured following the earthquake that occurred on 6 February and affected 10 provinces. In a statement made by Assoc. Prof. Dr. Ayşe Coşkun Beyan, emphasizing the importance of this for teams and healthcare workers to assist more people, it was stated that "protective equipment should be provided to search and rescue teams, affected healthcare workers should not be forced to work, and assigned personnel should not be made to work long hours." Following the earthquake centered in Kahramanmaraş and affecting 10 provinces, search and rescue and debris removal operations continue uninterrupted on one hand, while work on basic needs such as health, food and shelter continues on the other. Noting that teams working in this environment are operating under unsafe conditions, the Turkish Respiratory Research Society (TÜSAD) Professional and Environmental Respiratory Diseases-Occupational Health Working Group has reminded that attention should be paid to the working conditions of assigned teams in order to help more people. In a statement made by Working Group Chair Assoc. Prof. Dr. Ayşe Coşkun Beyan, the following important warnings regarding the safety of teams working in the rubble and the conditions of healthcare workers working in the region were included:

Protective Equipment Must Be Provided

• Search and rescue team workers who will intervene in demolition and debris work must use at least FFP 2 dust masks, safety glasses or protective goggles and face shields. Protective goggles must meet the requirements of ANSI Standard Z87.1. When splash protection is designed, protective goggles should be "D3" and D4 for dust protection. Especially for CO and CO2, ordinary masks are not sufficient; for gases and vapours, a suitable reusable respiratory device with cartridges depending on the specific contaminant is required. • Search and rescue team workers must use gloves and shoes. For gloves with EN 388, cut and puncture resistance of at least 2 and gloves with C rating should be used. For shoes, 20345 S or 20346 P series should be preferred. To prevent nails, etc. penetrating or puncturing the sole, they should be hardened, with an intermediate sole marking of 3 mm for small nails PS, and 4.5 mm for large nails PL. Water impermeability marking is WPA. It should contain the LG marking suitable for climbing ladders. • Search and rescue team workers should not be allowed to work long hours.

Long Hours Must Not Be Permitted

Reminding that it should not be forgotten that healthcare workers are also earthquake victims, Beyan shared the following regarding the conditions of these teams called to duty while their homes remain in ruins: • Healthcare workers have experienced the earthquake, and their loved ones are either under rubble or have lost their lives. Under no circumstances should healthcare workers working in the earthquake-affected area (including doctors, nurses and auxiliary health personnel) be forced to report for duty. Such an approach will create psychosocial risks that healthcare workers cannot bear, leading to unwanted serious consequences. Many colleagues in the western regions are ready to substitute for healthcare workers. The Ministry of Health should conduct urgent work on this matter and make assignments accordingly. Support can be sought from specialist associations on this matter. • Healthcare workers in 10 provinces, even if willing, should not be allowed to work and should be removed on mandatory administrative leave for at least several days. Self-assessment ability is reduced in the acute phase of trauma. • Healthcare workers should not be allowed to work long hours. Fatigue, sleep deprivation and high psychosocial risk will lead to burnout in workers and deterioration of biopsychosocial health. Healthcare workers with chronic diseases may experience severe episodes. In the long term, untreatable health problems will emerge and performance loss will occur. • Personal protective equipment must be provided to healthcare workers. Healthcare workers should wear masks, gloves, glasses and aprons. • Immunization of healthcare workers, especially tetanus, must be ensured urgently.

• Alternative solutions such as telemedicine and models that will rapidly deliver services to the field should be encouraged. Support Should Be Sought from Public Health Experts

The TÜSAD Professional and Environmental Respiratory Diseases-Occupational Health Working Group listed the following matters that should be particularly noted in the field: • Relief supplies that may deteriorate must be checked before distribution to the field. Products past their expiry date should not be used. • The field must be coordinated very rapidly. Public Health experts' knowledge and experience should be utilized on this matter. • Problems related to bodies will begin to occur in the coming period. Starving animals may attempt to consume these bodies. This is one of the priority issues in terms of both biological and psychosocial risk. For this reason, feeding the animals is important. Feeding the animals will also prevent starving animals from attacking people.