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Journal of Postgraduate Medicine, Vol. 52, No. 4, October-December, 2006, pp. 331 News and Views When disaster strikes..Our experience at KEM Hospital, tertiary referral center in Mumbai (Bombay) after the serial bomb blasts Deshpande AA Department of Surgery, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai - 400012 Code Number: jp06117 6.55 pm 11/07/2006.. A routine working day for the surgery registrar on call; attending to the emergency admissions. Suddenly, one patient, with his arm blown away, lands in the Emergency Surgical Ward (ESW). Even before he is examined, five others arrive with somewhat similar presentations and then the flow continues. Each one has come from a different location Matunga.Mahim..Khar- all western suburbs of the city. Within a span of 45 minutes, around 50 patients entered the Casualty department. Twenty one dead bodies were brought in. Of the 76 patients who came in with injuries related to the bomb blast, 54 were admitted to the hospital with severe injuries. The disaster management program in action Within 5-10 minutes of the arrival of the victims, two lecturers from the department of surgery undertook triage of victims and the institutional Disaster Management Program (DMP) was activated. As per the international accepted norms on disaster management, the waiting area outside casualty was quickly converted into a makeshift patient examination area from where stable patients were directly transferred to two general wards. These were managed by three resident doctors posted in each of these wards. Other patients including the ones who were critically ill were managed in the ESW. Resident doctors and faculty members of various other specialties like orthopedics, anesthesiology, otorhinolaryngology, plastic surgery and pediatric surgery joined their colleagues from the General Surgery department in management of these patients. They were supported by interns and medical students, nurses, lab technicians and support staff. The Dean, Dr Nilima Kshirsagar visited the ESW several times during the night giving every bit of support. The other senior administrative staff ensured that adequate material and manpower were available in the wards. This helped in providing simultaneous multi-specialty evaluation and treatment, which most patients needed. The Radiology department carried out 327 investigations over 8 hours, which included plain radiographs, CT scans and ultrasound examinations. Eighteen major surgical interventions were carried out; sixteen of these were completed within 18 hours of the event. One hundred and seventy-five units of blood and blood products were transfused; over 90% of these were carried out during the same night. Head injury, chest trauma (pneumothorax and hemothorax), fractures, tympanic membrane perforations, tinnitus, giddiness and varying degrees of hearing loss were the common injuries encountered. Patients requiring exclusive specialty care (orthopedic, cardiovascular or respiratory medicine) were transferred to the respective wards. This helped ease the burden on ESW. There was no mortality within 24 hours subsequently two out of the 54 patients admitted to the hospital expired. Social support A number of dignitaries including the honorable President Shri APJ Abdul Kalam and the honorable Prime Minister Dr. Manmohan Singh visited the institution and spoke to the grieving victims and relatives. Officials of the Municipal Corporation and Railways also offered valuable assistance. The spirit of Mumbai was evident in the 1000-odd volunteers who turned up to help the patients, care-providers and hospital. The blood bank received 1165 blood donors over 8-10 hours and finally had to stop accepting blood donations. Restaurants in the nearby areas worked through the night ensuring a steady flow of food and beverages for all the workers and pharmaceutical companies supplied drugs free of cost. A job well done Preparedness for disasters is a dynamic process. It is necessary to have a well documented DMP in place, and also to have regular drills to test the hospital′s DMP. A proper DMP in place, its timely implementation, coordinated treatment carried out by the senior faculty members from different specialties, helped us achieve the goals of disaster management: quick triaging, preventing mortality and limiting morbidity. Copyright 2006 - Journal of Postgraduate Medicine |
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