Impact of a predefined hospital mass casualty response plan in a limited resource setting with no pre-hospital care system

Adil Aijaz Shah, Abdul Rehman, Raza Hasnain Sayyed, Adil Hussain Haider, Amber Bawa, Syed Nabeel Zafar, [No Value] Zia-Ur-Rehman, Kamran Ali, Hasnain Zafar

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction Pre-hospital triage is an intricate part of any mass casualty response system. However, in settings where no such system exists, it is not known if hospital-based disaster response efforts are beneficial. This study describes in-hospital disaster response management and patient outcomes following a mass casualty event (MCE) involving 200 victims in a lower-middle income country in South Asia. Methods We performed a single-center, retrospective review of bombing victims presenting to a trauma center in the spring of 2013, after a high energy car bomb leveled a residential building. Descriptive analysis was utilized to present demographic variables and physical injuries. Results A disaster plan was devised based on the canons of North-American trauma care; some adaptations to the local environment were incorporated. Relevant medical and surgical specialties were mobilized to the ED awaiting a massive influx of patients. ED waiting room served as the triage area. Operating rooms, ICU and blood bank were alerted. Seventy patients presented to the ED. Most victims (88%) were brought directly without prehospital triage or resuscitation. Four were pronounced dead on arrival. The mean age of victims was 27 (±14) years with a male preponderance (78%). Penetrating shrapnel injury was the most common mechanism of injury (71%). Most had a systolic blood pressure (SBP) >90 with a mean of 120.3 (±14.8). Mean pulse was 90.2 (±21.6) and most patients had full GCS. Extremities were the most common body region involved (64%) with orthopedics service being consulted most frequently. Surgery was performed on 36 patients, including 4 damage control surgeries. All patients survived. Conclusion This overwhelming single mass-casualty incident was met with a swift multidisciplinary response. In countries with no prehospital triage system, implementing a pre-existing disaster plan with pre-defined interdisciplinary responsibilities can streamline in-hospital management of casualties.

Original languageEnglish (US)
Pages (from-to)156-161
Number of pages6
JournalInjury
Volume46
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • Developing country
  • Disaster plan
  • Disaster response
  • Low-middle income country
  • Mass casualty event
  • Resource limited
  • Terrorism
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

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