Abstract
Every major mass disaster challenges the health care services, especially in the third world. These challenges include the expected situations mainly pertaining to the overload of patients and the stretching of hospital facilities. We report our experiences about several unforseen challenges faced by our hospital in the 2005 earthquake that struck the Kashmir region.
A major earthquake measuring 7.6 on the Richter scale struck the Himalayan region of Kashmir on 8 October 2005. Around 90,000 people died in this disaster. The Government Hospital for Bone and Joint Surgery had to deal with the orthopaedic morbidity generated by the quake. The hospital received 463 patients over a period of five days. The resources of this 150-bed hospital were stretched to the limit and beyond.
The problems were discussed at emergency meetings. The management made use of all the space in the hospital, imported manpower, increased resource allocation, increased working hours in accordance with established guidelines for the management of mass disasters. These measures gave a semblance of order to what was essentially a very difficult and chaotic situation.
Major disasters warrant retrospective studies, so that all levels of emergency medical care can be improved. Based on the data already available, it is possible to reasonably predict the likely requirements for the management of mass disaster victims in tertiary care centres. The challenges include the provision of increased beds, manpower and resources.
During the aftermath of the Kashmir earthquake, the doctors and the medical staff encountered several situations, which had not been covered in the initial emergency briefing. First, because the patients had been buried under rubble they arrived in heavily soiled clothes. Therefore the staff had to sponge wash all the patients and then provide them with clean clothes. The initial management plan had not made allowances for these requirements.
Another important factor was that very few of the patients were accompanied by family members as the patient was often the sole survivor of the earthquake. In third world countries, the family members play an important part in the care of patients in the hospitals. The staff, therefore, had to cope with less assistance than they had expected. In addition, the absence of family members meant that it was often difficult for staff to obtain informed consent for any investigations or procedures that the patient required. The doctors had to use their own discretion, often having to decide to go ahead without receiving the patient's agreement. There were also problems in discharging patients as their homes had been destroyed by the earthquake. Temporary rehabilitation centres were set up to gradually ‘wean’ the patient off the hospital and help them to return to the outside world.
The earthquake was followed by 18 aftershocks. This made working conditions in the operating theatres especially difficult. The natural tendency to run out during the aftershocks, thus abandoning the patients might well die as a result, was overcome by the supreme effort of will by the theatre staff. This was especially commendable as sometimes pieces of plaster fell off the walls during the aftershocks.
Disasters strike in various forms and in various places. However, patient needs are the same. We feel some of the experiences detailed above should be factored in to any disaster management plans at the outset. This is especially important in the third world.