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Injury. 2015 Jan;46(1):156-61. doi: 10.1016/j.injury.2014.08.029. Epub 2014 Aug 19.

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

Author information

1
Aga Khan University-Johns Hopkins University Outcomes Research Collaboration, Karachi, Pakistan. Electronic address: adl_ajz@yahoo.com.
2
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
3
Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins School of Medicine, Baltimore, MD, USA.
4
Aga Khan University-Johns Hopkins University Outcomes Research Collaboration, Karachi, Pakistan.

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.

KEYWORDS:

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

PMID:
25225172
DOI:
10.1016/j.injury.2014.08.029
[Indexed for MEDLINE]

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