*Preliminary report of the action in Turkey of the International Society of Nephrology Renal Disaster Relief Task Force*

Norbert Lameire

Renal Division, University Hospital, Gent, Belgium

Correspondence and offprint requests to: Prof. N. Lameire, Renal Division, U2 Gent, 185 de Pintelaan, B-9000 Gent, Belgium.

This is a first and very preliminary report on the activities of the European Task Force for Renal Disaster Relief of the ISN Commission of ARF in Turkey.

A massive earthquake in north-western Turkey, the densely populated industrial heartland of the country, occurred at 3.02 am on Tuesday August 17, 1999. Although this was feared, the European Task Force has been preparing for many years for such an event.

Our military partners, together with our other sister organizations, Médeçins sans Frontières (MSF) and Baxter Europe had several times suggested that a `paper exercise', a so-called `Kriegsspiel' would be useful to test the theoretical planning that was developed over recent years. All of a sudden this `Kriegsspiel' was replaced by harsh reality.

As soon as our scouting nephrologist, R. Vanholder, arrived in Istanbul with the first team of MSF in the evening of August 17, it was clear that besides thousands of deaths many crush syndromes, complicated by rhabdomyolysis and ARF, could be expected. On the second day a second nephrologist, B. Van Vlem, and five Flemish dialysis nurses from ORPADT left with a second team of MSF for Istanbul. In the meantime, R. Vanholder was assisting the local Turkish nephrologists to organize dialysis in the major University Hospitals (Marmara, Cerrahpaça, and Çapa) in Istanbul. Our nephrologists were also instrumental in instructing several medical teams of MSF and other rescue workers in the early administration of fluid therapy for prevention of ARF. How well they succeeded in this will only be known in the future.

In Gent, the first shipment of dialysis concentrate, HD and PD catheters, membranes and other equipment was organized with the help of the local University Hospital pharmacy, MSF, the Belgian Air Force, and the European and Belgian divisions of Fresenius and Baxter. After a few days, and thanks to the incredible efforts of the Turkish nephrologists and dialysis nurses and with the great help of Dr Ersoy from Antalya, it was possible to collect more and more correct information on the number of dialysed ARF patients, not only in Istanbul but other cities like Ankara, Bursa, and Eskiçehir.

On Friday August 27, 1999 the Task Force appointed, after consultation with Prof. Erek, President of the Turkish Society of Nephrology, a distinguished Turkish colleague, Prof. Sever from the Çapa University Hospital, as local ISN/Renal Disaster Task Force representative. As of that date approximately 395 patients were on dialysis for post-traumatic ARF in the whole disaster area, 14 patients had recovered renal function and 42 had died. It was agreed that as far as was possible an accurate registering of the number of patients and their follow-up should be attempted in a combined effort of the ISN and the Turkish Society of Nephrology.

At the end of the first week, a second team of Swedish dialysis nurses arrived in Istanbul working together with two other young Belgian nephrologists, Heidi Hoeben and Wim Van Biesen. In view of the extreme efforts of the Turkish nurses who worked long hours day and night, it became apparent that a third and fourth team were needed in both Istanbul and Bursa to give them some rest. A team of five German nurses and one German nephrologist, Dr Schindler from Berlin, travelled to Istanbul while another team of Flemish, French and English nurses went to help in Bursa.

As of August 31, 363 ARF patients were on dialysis, 29 patients had recovered and 48 patients had died. It is estimated that between 20 and 25% of these patients underwent a fasciotomy for compartimental syndrome.

It was planned that a completely French team of five to seven nurses, together with a French nephrologist, Dr D. Erbilgin, would replace the Task Force team in Bursa by September 3, 1999.

Although it is still too early to make an evaluation of this action of the European ISN Task Force, already some lessons can be learned. First, the long and sometimes frustrating preparation and planning for such actions has resulted in a prompt reaction, and hopefully in the saving of many lives. Second, without the help of our partners such as MSF, the dialysis industry, several keymen of the Task Force in many European countries, and the European and Flemish Renal Nurses Association, this fast intervention would not have been possible. Third, as many of our nurses and doctors reported to me, the unbelievable courage, dedication and effort of the whole Turkish medical and nephrological community made it possible that our teams could work in an atmosphere of understanding and mutual trust, which has led to a friendship which will last for many years to come.

We will hopefully be able to communicate later a more detailed scientific report of this action. Finally, our sincere thanks for the help given by all our partners and not least by two of the secretaries of the Gent Renal Division, Chantal Bergen and Ingrid Verslycken, who have worked many extra hours over the last 2 weeks in August 1999.